NM702 Exam Review Questions with Verified
Correct Answers
What symptoms might make a person suspect they are pregnant?
· This includes PRESUMPTIVE data. Subjective; what a woman reports. Could be
pregnancy but could be due to other causes.
o Amenorrhea
o Breast tenderness, enlargement, tingling, changes in shape/color
o Fatigue
o Nausea/vomiting
o Urinary frequency, nocturia
o Perception of fetal movement
o Pigmentation changes
o Sustained basal body temperature
· Memory tip: presumptive has an S as the 4th letter in the word; preSumptive = Subjective
What signs make a clinician suspect a patient is pregnant?
· This includes PROBABLE data Objective; detected by physical exam or lab test
· Probably pregnancy (especially if skilled examiner) but could be due to other causes.
o Enlargement of abdomen or uterus
o Pelvic exam changes: Chadwick’s, Goodell’s, Hegar’s, or Piskacek’s signs
o Ballottment
,o Palpation of fetal outline, fetal movements, or uterine contractions
o Positive pregnancy test: Urine or serum pregnancy tests are on the list as probable, rather
than positive, because some conditions other than pregnancy can secrete hCG e.g. some
tumors.
· Memory tip: probable has an O as the 3rd letter in the word; prObable = Objective.
How does a clinician definitively diagnose pregnancy?
· This includes POSITIVE data. Confirms pregnancy. Cannot be due to anything other than
pregnancy
o Audible fetal heart tones
o Sonographic evidence of pregnancy
When should a clinician use pregnancy testing vs serum pregnancy testing?
· Most practices do a urine pregnancy test in the office (a qualitative, point-of-care urine test)
to verify that a person is pregnant and should begin prenatal care.
· Most practices reserve serum pregnancy tests for special circumstances. Remember that
serum pregnancy tests can be either qualitative or quantitative.
o A serum qualitative pregnancy test (with a result being either positive or negative) is
usually done only when a urine test is unavailable and blood work is going to the lab anyway.
o A serum quantitative pregnancy test is usually done to monitor when there is clinical doubt
about the health of an early pregnancy.
Why is a false negative urine pregnancy test more likely than a false positive urine
pregnancy test?
,· False positive tests are uncommon but can occur in a woman who has recently been
pregnant and in women with selected cancers and other medical conditions.
· False negative rates can be high in early pregnancy. The tests are most likely to be
inaccurate when the level of hCG is the lowest during the first 2-3 weeks after conception, so
a serum test performed very early in pregnancy may detect a pregnancy when the urine test is
still negative.
o Different commercially available urine pregnancy tests have varying sensitivity thresholds.
This corresponds to approximately the date of the missed menses, at which time beta-hCG is
detectable in urine.
o Furthermore, the concentration of beta-hCG in urine can vary within the same woman
throughout the day depending on fluctuations in urine concentration.
How can quantitative beta hCG patterns assist in clinical decision making?
· A serum quantitative pregnancy test is usually done to monitor when there is clinical doubt
about the health of an early pregnancy.
· 4 weeks gestation (18-22 days post conception), in a healthy pregnancy, hCG doubles
approximately every 2-3 days and continues this pattern until it reaches 100,000 mIU/mL
then plateaus and then begins to decline. Accurate gestational age must be determined and
used in conjunction with quantitative hCG testing.
o Ectopic pregnancy or an impending miscarriage quantitative hCG levels are often lower
than expected for gestational age and/or do not rise as expected every 2-3 days.
o The quantitative hCG levels for a person with a multiple gestation or molar pregnancy will
often, but not always, be higher than expected.
EDB vs EDC vs EDD
, Estimated date of birth, Estimated date of confinement, estimated date of delivery
1st trimester weeks
1-13 weeks
2nd trimester weeks
13-28 weeks
3rd trimester weeks
28-40 weeks
How to calculate due date based on Naegele's rule
Naegel’s Rule: LMP + 7 days - 3 months + 1 year = estimated date of birth.
Naegele's rule criteria
· Rule to calculate the estimated date of birth if the person they meet the 4 criteria:
1. Has a known LMP
2. Has regular cycles
3. Did not conceive on hormonal contraception or while breastfeeding
4. Has a clinical picture that fits
· Regular, 30-day cycles, the clinician can calculate the EDB by Naegele's Rule and then add
2 days to the EDB
Likewise, regular cycles that are shorter than 28 days would have the difference subtracted
from the EDB.
In which clinical situations is ultrasound based pregnancy dating clinically preferable?
· The person cannot remember the first day of last menstrual period
Correct Answers
What symptoms might make a person suspect they are pregnant?
· This includes PRESUMPTIVE data. Subjective; what a woman reports. Could be
pregnancy but could be due to other causes.
o Amenorrhea
o Breast tenderness, enlargement, tingling, changes in shape/color
o Fatigue
o Nausea/vomiting
o Urinary frequency, nocturia
o Perception of fetal movement
o Pigmentation changes
o Sustained basal body temperature
· Memory tip: presumptive has an S as the 4th letter in the word; preSumptive = Subjective
What signs make a clinician suspect a patient is pregnant?
· This includes PROBABLE data Objective; detected by physical exam or lab test
· Probably pregnancy (especially if skilled examiner) but could be due to other causes.
o Enlargement of abdomen or uterus
o Pelvic exam changes: Chadwick’s, Goodell’s, Hegar’s, or Piskacek’s signs
o Ballottment
,o Palpation of fetal outline, fetal movements, or uterine contractions
o Positive pregnancy test: Urine or serum pregnancy tests are on the list as probable, rather
than positive, because some conditions other than pregnancy can secrete hCG e.g. some
tumors.
· Memory tip: probable has an O as the 3rd letter in the word; prObable = Objective.
How does a clinician definitively diagnose pregnancy?
· This includes POSITIVE data. Confirms pregnancy. Cannot be due to anything other than
pregnancy
o Audible fetal heart tones
o Sonographic evidence of pregnancy
When should a clinician use pregnancy testing vs serum pregnancy testing?
· Most practices do a urine pregnancy test in the office (a qualitative, point-of-care urine test)
to verify that a person is pregnant and should begin prenatal care.
· Most practices reserve serum pregnancy tests for special circumstances. Remember that
serum pregnancy tests can be either qualitative or quantitative.
o A serum qualitative pregnancy test (with a result being either positive or negative) is
usually done only when a urine test is unavailable and blood work is going to the lab anyway.
o A serum quantitative pregnancy test is usually done to monitor when there is clinical doubt
about the health of an early pregnancy.
Why is a false negative urine pregnancy test more likely than a false positive urine
pregnancy test?
,· False positive tests are uncommon but can occur in a woman who has recently been
pregnant and in women with selected cancers and other medical conditions.
· False negative rates can be high in early pregnancy. The tests are most likely to be
inaccurate when the level of hCG is the lowest during the first 2-3 weeks after conception, so
a serum test performed very early in pregnancy may detect a pregnancy when the urine test is
still negative.
o Different commercially available urine pregnancy tests have varying sensitivity thresholds.
This corresponds to approximately the date of the missed menses, at which time beta-hCG is
detectable in urine.
o Furthermore, the concentration of beta-hCG in urine can vary within the same woman
throughout the day depending on fluctuations in urine concentration.
How can quantitative beta hCG patterns assist in clinical decision making?
· A serum quantitative pregnancy test is usually done to monitor when there is clinical doubt
about the health of an early pregnancy.
· 4 weeks gestation (18-22 days post conception), in a healthy pregnancy, hCG doubles
approximately every 2-3 days and continues this pattern until it reaches 100,000 mIU/mL
then plateaus and then begins to decline. Accurate gestational age must be determined and
used in conjunction with quantitative hCG testing.
o Ectopic pregnancy or an impending miscarriage quantitative hCG levels are often lower
than expected for gestational age and/or do not rise as expected every 2-3 days.
o The quantitative hCG levels for a person with a multiple gestation or molar pregnancy will
often, but not always, be higher than expected.
EDB vs EDC vs EDD
, Estimated date of birth, Estimated date of confinement, estimated date of delivery
1st trimester weeks
1-13 weeks
2nd trimester weeks
13-28 weeks
3rd trimester weeks
28-40 weeks
How to calculate due date based on Naegele's rule
Naegel’s Rule: LMP + 7 days - 3 months + 1 year = estimated date of birth.
Naegele's rule criteria
· Rule to calculate the estimated date of birth if the person they meet the 4 criteria:
1. Has a known LMP
2. Has regular cycles
3. Did not conceive on hormonal contraception or while breastfeeding
4. Has a clinical picture that fits
· Regular, 30-day cycles, the clinician can calculate the EDB by Naegele's Rule and then add
2 days to the EDB
Likewise, regular cycles that are shorter than 28 days would have the difference subtracted
from the EDB.
In which clinical situations is ultrasound based pregnancy dating clinically preferable?
· The person cannot remember the first day of last menstrual period
