Barkley Whnp Diagnostic Readiness Test Drt
Complete Practice Exam Questions And Correct
Answers With Rationales| Instant Download
Question 1
A patient at 34 weeks gestation presents with new-onset severe pruritus
of palms and soles without rash. Which laboratory finding would most
specifically confirm the suspected diagnosis and guide immediate
management?
A) Elevated total bile acids with normal alkaline phosphatase
B) Elevated AST/ALT with elevated total bilirubin
C) Elevated serum bile acids >40 µmol/L with prolonged PT
D) Elevated GGT with normal bile acids
Answer: C) Elevated serum bile acids >40 µmol/L with prolonged PT
Explanation: Intrahepatic cholestasis of pregnancy (ICP) is
diagnosed by elevated serum bile acids; levels >40 µmol/L confer
significantly increased risk of stillbirth and meconium, warranting
delivery at 36 weeks. Elevated transaminases alone are nonspecific.
Bile acids >40 µmol/L specifically drive the timing of delivery
decision.
,Question 2
Which mechanism best explains why low-dose aspirin initiated at 12-16
weeks reduces preeclampsia risk more effectively than initiation after 20
weeks?
A) Aspirin inhibits thromboxane A2 synthesis, preventing late placental
thrombosis
B) Aspirin promotes trophoblastic invasion by inhibiting cyclooxygenase-2
in the decidua
C) Aspirin selectively blocks prostacyclin production, reducing
vasoconstriction
D) Aspirin enhances nitric oxide synthase activity in the umbilical arteries
Answer: B) Aspirin promotes trophoblastic invasion by inhibiting
cyclooxygenase-2 in the decidua
Explanation: Early aspirin administration (before 16 weeks) targets
the critical window of trophoblastic invasion and spiral artery
remodeling. By inhibiting COX-2 mediated thromboxane and
inflammatory mediators in the decidua, it facilitates deeper
placentation and reduces the risk of abnormal placentation that
underlies preeclampsia.
Question 3
A 28-year-old G2P1 at 36 weeks presents with blood pressure 160/110,
severe headache, and visual changes. Which is the priority nursing
action?
,A) Administer magnesium sulfate IV
B) Administer labetalol IV
C) Prepare for immediate delivery
D) Both A and B
Answer: D) Both A and B
Explanation: Severe preeclampsia requires immediate treatment
with magnesium sulfate for seizure prophylaxis and
antihypertensives (e.g., labetalol, hydralazine) for severe
hypertension. Delivery is indicated but after maternal stabilization.
Question 4
Which medication is first-line for prevention of preterm labor in a patient
with a history of spontaneous preterm birth?
A) Progesterone supplementation
B) Magnesium sulfate
C) Nifedipine
D) Betamethasone
Answer: A) Progesterone supplementation
Explanation: Progesterone supplementation (17-alpha
hydroxyprogesterone caproate or vaginal progesterone) is
recommended for prevention of recurrent preterm birth in women
with a history of spontaneous preterm delivery.
, Question 5
A 32-year-old G1P0 at 39 weeks presents with spontaneous rupture of
membranes. Which finding is most concerning for chorioamnionitis?
A) Maternal fever of 38.5°C
B) Fetal heart rate of 150 bpm
C) Clear amniotic fluid
D) Mild contractions
Answer: A) Maternal fever of 38.5°C
Explanation: Maternal fever is a cardinal sign of chorioamnionitis,
along with uterine tenderness, foul-smelling amniotic fluid, and fetal
tachycardia.
Question 6
A 24-year-old female presents with vulvar pruritus and a thick, white,
"cottage cheese-like" discharge. Which organism is most likely?
A) Candida albicans
B) Trichomonas vaginalis
C) Gardnerella vaginalis
D) Chlamydia trachomatis
Answer: A) Candida albicans
Explanation: Vulvar pruritus with thick, white, "cottage cheese-like"
discharge is classic for vulvovaginal candidiasis. Trichomonas
presents with frothy, greenish discharge. Bacterial vaginosis
presents with thin, gray discharge and a fishy odor.
Complete Practice Exam Questions And Correct
Answers With Rationales| Instant Download
Question 1
A patient at 34 weeks gestation presents with new-onset severe pruritus
of palms and soles without rash. Which laboratory finding would most
specifically confirm the suspected diagnosis and guide immediate
management?
A) Elevated total bile acids with normal alkaline phosphatase
B) Elevated AST/ALT with elevated total bilirubin
C) Elevated serum bile acids >40 µmol/L with prolonged PT
D) Elevated GGT with normal bile acids
Answer: C) Elevated serum bile acids >40 µmol/L with prolonged PT
Explanation: Intrahepatic cholestasis of pregnancy (ICP) is
diagnosed by elevated serum bile acids; levels >40 µmol/L confer
significantly increased risk of stillbirth and meconium, warranting
delivery at 36 weeks. Elevated transaminases alone are nonspecific.
Bile acids >40 µmol/L specifically drive the timing of delivery
decision.
,Question 2
Which mechanism best explains why low-dose aspirin initiated at 12-16
weeks reduces preeclampsia risk more effectively than initiation after 20
weeks?
A) Aspirin inhibits thromboxane A2 synthesis, preventing late placental
thrombosis
B) Aspirin promotes trophoblastic invasion by inhibiting cyclooxygenase-2
in the decidua
C) Aspirin selectively blocks prostacyclin production, reducing
vasoconstriction
D) Aspirin enhances nitric oxide synthase activity in the umbilical arteries
Answer: B) Aspirin promotes trophoblastic invasion by inhibiting
cyclooxygenase-2 in the decidua
Explanation: Early aspirin administration (before 16 weeks) targets
the critical window of trophoblastic invasion and spiral artery
remodeling. By inhibiting COX-2 mediated thromboxane and
inflammatory mediators in the decidua, it facilitates deeper
placentation and reduces the risk of abnormal placentation that
underlies preeclampsia.
Question 3
A 28-year-old G2P1 at 36 weeks presents with blood pressure 160/110,
severe headache, and visual changes. Which is the priority nursing
action?
,A) Administer magnesium sulfate IV
B) Administer labetalol IV
C) Prepare for immediate delivery
D) Both A and B
Answer: D) Both A and B
Explanation: Severe preeclampsia requires immediate treatment
with magnesium sulfate for seizure prophylaxis and
antihypertensives (e.g., labetalol, hydralazine) for severe
hypertension. Delivery is indicated but after maternal stabilization.
Question 4
Which medication is first-line for prevention of preterm labor in a patient
with a history of spontaneous preterm birth?
A) Progesterone supplementation
B) Magnesium sulfate
C) Nifedipine
D) Betamethasone
Answer: A) Progesterone supplementation
Explanation: Progesterone supplementation (17-alpha
hydroxyprogesterone caproate or vaginal progesterone) is
recommended for prevention of recurrent preterm birth in women
with a history of spontaneous preterm delivery.
, Question 5
A 32-year-old G1P0 at 39 weeks presents with spontaneous rupture of
membranes. Which finding is most concerning for chorioamnionitis?
A) Maternal fever of 38.5°C
B) Fetal heart rate of 150 bpm
C) Clear amniotic fluid
D) Mild contractions
Answer: A) Maternal fever of 38.5°C
Explanation: Maternal fever is a cardinal sign of chorioamnionitis,
along with uterine tenderness, foul-smelling amniotic fluid, and fetal
tachycardia.
Question 6
A 24-year-old female presents with vulvar pruritus and a thick, white,
"cottage cheese-like" discharge. Which organism is most likely?
A) Candida albicans
B) Trichomonas vaginalis
C) Gardnerella vaginalis
D) Chlamydia trachomatis
Answer: A) Candida albicans
Explanation: Vulvar pruritus with thick, white, "cottage cheese-like"
discharge is classic for vulvovaginal candidiasis. Trichomonas
presents with frothy, greenish discharge. Bacterial vaginosis
presents with thin, gray discharge and a fishy odor.
