SOAP NOTES AND CULTURAL COMPETENCY QUESTIONS AND
ANSWERS VERIFIED BY EXPERT 100% CORRECT | ALREADY
SCORED A+ | NEW 2025
Question 1
A pregnant client in her second trimester complains of frequent heartburn. Which of the
following medications can be safely recommended?
A) Sodium Bicarbonate antacids
B) Calcium Carbonate (Tums)
C) Bismuth subsalicylate (Pepto-Bismol)
D) Magnesium Trisilicate
Correct Answer: B) Calcium Carbonate (Tums)
Rationale: Calcium carbonate is considered a first-line treatment and is safe for
intermittent use for GERD in pregnancy. Sodium bicarbonate (A) should be avoided due to
the risk of fluid overload and metabolic alkalosis. Bismuth subsalicylate is contraindicated.
Magnesium trisilicate (D) has been associated with adverse fetal effects.
Question 2
A client at 8 weeks gestation is experiencing nausea and vomiting. Which of the following is
considered a first-line, safe pharmacological treatment?
A) Dicyclomine (Bentyl)
B) Ondansetron (Zofran)
C) Promethazine (Phenergan)
D) Doxylamine and Pyridoxine (Diclegis)
Correct Answer: D) Doxylamine and Pyridoxine (Diclegis)
Rationale: The combination of the antihistamine doxylamine and vitamin B6 (pyridoxine)
is the only FDA-approved medication for nausea and vomiting in pregnancy and is
recommended as a first-line option. Ondansetron (B) has a small associated risk of cardiac
malformations.
Question 3
A pregnant client is experiencing round ligament pain. Which of the following self-care
measures is NOT recommended?
A) Avoiding sudden movements
B) Flexing the hips before coughing or laughing
C) Soaking in a hot tub or jacuzzi for 10 minutes
D) Using a maternity support girdle
Correct Answer: C) Soaking in a hot tub or jacuzzi for 10 minutes
Rationale: Pregnant women should avoid activities that can raise their core body
temperature, such as using hot tubs or saunas. Maternal hyperthermia, especially in the
first trimester, is associated with an increased risk of neural tube defects and other birth
defects. The other options are appropriate measures to manage round ligament pain.
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Question 4
A pregnant client has been diagnosed with an uncomplicated urinary tract infection (UTI). Which
of the following antibiotics should be AVOIDED?
A) Amoxicillin
B) Cephalexin
C) Ciprofloxacin
D) Fosfomycin
Correct Answer: C) Ciprofloxacin
Rationale: Fluoroquinolones (like Ciprofloxacin) and sulfonamides are generally
contraindicated during pregnancy. Fluoroquinolones have been associated with potential
cartilage damage in the fetus. Amoxicillin, cephalosporins, and fosfomycin are commonly
used and considered safe.
Question 5
What is the appropriate dose of Cephalexin for treating an uncomplicated UTI in a pregnant
woman?
A) 125 mg orally twice daily for 3 days
B) 250-500 mg orally four times daily for 5-7 days
C) 750 mg orally once daily for 5-7 days
D) 1 g orally in a single dose
Correct Answer: B) 250-500 mg orally four times daily for 5-7 days
Rationale: The standard treatment regimen for Cephalexin for a UTI in pregnancy is 250
to 500 mg every 6 hours (QID) for a course of 5 to 7 days to ensure adequate eradication of
the bacteria and prevent complications like pyelonephritis.
Question 6
A pregnant client with a UTI is prescribed a single-dose therapy. What is the correct dose of
Fosfomycin?
A) 1 gram orally
B) 3 grams orally
C) 5 grams orally
D) 500 mg orally
Correct Answer: B) 3 grams orally
Rationale: Fosfomycin is an effective single-dose treatment for uncomplicated cystitis in
pregnancy. The standard dose is a 3-gram sachet of powder mixed with water and taken
once.
Question 7
A pregnant client presents with a fever, chills, and costovertebral angle (CVA) tenderness,
suggesting pyelonephritis. Is Fosfomycin an appropriate antibiotic choice?
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A) Yes, because it is safe in pregnancy.
B) No, because it does not achieve adequate therapeutic levels in the kidney tissue.
C) Yes, if given in a multi-dose regimen.
D) No, because it is teratogenic.
Correct Answer: B) No, because it does not achieve adequate therapeutic levels in the
kidney tissue.
Rationale: While Fosfomycin is effective for bladder infections (cystitis), it is not
recommended for kidney infections (pyelonephritis). It does not reliably concentrate in the
renal parenchyma to the levels needed to effectively treat the infection, which requires
parenteral antibiotics in pregnancy.
Question 8
The vaginal bleeding associated with an ectopic pregnancy is typically characterized as:
A) Bright red, heavy, and containing clots.
B) Dark brown, tarry, and intermittent (spotting).
C) Pink-tinged and watery.
D) Completely absent.
Correct Answer: B) Dark brown, tarry, and intermittent (spotting).
Rationale: The bleeding in an ectopic pregnancy is usually from the breakdown of the
uterine decidua due to insufficient hormonal support from the misplaced pregnancy. This
results in old, slow bleeding that appears as dark brown spotting, not the heavy, bright red
bleeding of a typical miscarriage.
Question 9
A client with a ruptured ectopic pregnancy may experience referred pain to the shoulder. This is
known as Kehr's sign and is caused by:
A) Irritation of the diaphragm by intraperitoneal blood.
B) Pressure on the sciatic nerve.
C) Stretching of the round ligament.
D) Inflammation of the fallopian tube.
Correct Answer: A) Irritation of the diaphragm by intraperitoneal blood.
Rationale: When a fallopian tube ruptures, blood accumulates in the peritoneal cavity. This
blood can track up and irritate the diaphragm. The phrenic nerve, which innervates the
diaphragm, shares a nerve root with nerves that provide sensation to the shoulder area,
causing the brain to interpret the diaphragmatic irritation as shoulder pain.
Question 10
What are the two most important diagnostic tests for confirming a suspected ectopic pregnancy?
A) CBC and progesterone level
B) Urinalysis and pelvic exam
ANSWERS VERIFIED BY EXPERT 100% CORRECT | ALREADY
SCORED A+ | NEW 2025
Question 1
A pregnant client in her second trimester complains of frequent heartburn. Which of the
following medications can be safely recommended?
A) Sodium Bicarbonate antacids
B) Calcium Carbonate (Tums)
C) Bismuth subsalicylate (Pepto-Bismol)
D) Magnesium Trisilicate
Correct Answer: B) Calcium Carbonate (Tums)
Rationale: Calcium carbonate is considered a first-line treatment and is safe for
intermittent use for GERD in pregnancy. Sodium bicarbonate (A) should be avoided due to
the risk of fluid overload and metabolic alkalosis. Bismuth subsalicylate is contraindicated.
Magnesium trisilicate (D) has been associated with adverse fetal effects.
Question 2
A client at 8 weeks gestation is experiencing nausea and vomiting. Which of the following is
considered a first-line, safe pharmacological treatment?
A) Dicyclomine (Bentyl)
B) Ondansetron (Zofran)
C) Promethazine (Phenergan)
D) Doxylamine and Pyridoxine (Diclegis)
Correct Answer: D) Doxylamine and Pyridoxine (Diclegis)
Rationale: The combination of the antihistamine doxylamine and vitamin B6 (pyridoxine)
is the only FDA-approved medication for nausea and vomiting in pregnancy and is
recommended as a first-line option. Ondansetron (B) has a small associated risk of cardiac
malformations.
Question 3
A pregnant client is experiencing round ligament pain. Which of the following self-care
measures is NOT recommended?
A) Avoiding sudden movements
B) Flexing the hips before coughing or laughing
C) Soaking in a hot tub or jacuzzi for 10 minutes
D) Using a maternity support girdle
Correct Answer: C) Soaking in a hot tub or jacuzzi for 10 minutes
Rationale: Pregnant women should avoid activities that can raise their core body
temperature, such as using hot tubs or saunas. Maternal hyperthermia, especially in the
first trimester, is associated with an increased risk of neural tube defects and other birth
defects. The other options are appropriate measures to manage round ligament pain.
,[Type here]
Question 4
A pregnant client has been diagnosed with an uncomplicated urinary tract infection (UTI). Which
of the following antibiotics should be AVOIDED?
A) Amoxicillin
B) Cephalexin
C) Ciprofloxacin
D) Fosfomycin
Correct Answer: C) Ciprofloxacin
Rationale: Fluoroquinolones (like Ciprofloxacin) and sulfonamides are generally
contraindicated during pregnancy. Fluoroquinolones have been associated with potential
cartilage damage in the fetus. Amoxicillin, cephalosporins, and fosfomycin are commonly
used and considered safe.
Question 5
What is the appropriate dose of Cephalexin for treating an uncomplicated UTI in a pregnant
woman?
A) 125 mg orally twice daily for 3 days
B) 250-500 mg orally four times daily for 5-7 days
C) 750 mg orally once daily for 5-7 days
D) 1 g orally in a single dose
Correct Answer: B) 250-500 mg orally four times daily for 5-7 days
Rationale: The standard treatment regimen for Cephalexin for a UTI in pregnancy is 250
to 500 mg every 6 hours (QID) for a course of 5 to 7 days to ensure adequate eradication of
the bacteria and prevent complications like pyelonephritis.
Question 6
A pregnant client with a UTI is prescribed a single-dose therapy. What is the correct dose of
Fosfomycin?
A) 1 gram orally
B) 3 grams orally
C) 5 grams orally
D) 500 mg orally
Correct Answer: B) 3 grams orally
Rationale: Fosfomycin is an effective single-dose treatment for uncomplicated cystitis in
pregnancy. The standard dose is a 3-gram sachet of powder mixed with water and taken
once.
Question 7
A pregnant client presents with a fever, chills, and costovertebral angle (CVA) tenderness,
suggesting pyelonephritis. Is Fosfomycin an appropriate antibiotic choice?
, [Type here]
A) Yes, because it is safe in pregnancy.
B) No, because it does not achieve adequate therapeutic levels in the kidney tissue.
C) Yes, if given in a multi-dose regimen.
D) No, because it is teratogenic.
Correct Answer: B) No, because it does not achieve adequate therapeutic levels in the
kidney tissue.
Rationale: While Fosfomycin is effective for bladder infections (cystitis), it is not
recommended for kidney infections (pyelonephritis). It does not reliably concentrate in the
renal parenchyma to the levels needed to effectively treat the infection, which requires
parenteral antibiotics in pregnancy.
Question 8
The vaginal bleeding associated with an ectopic pregnancy is typically characterized as:
A) Bright red, heavy, and containing clots.
B) Dark brown, tarry, and intermittent (spotting).
C) Pink-tinged and watery.
D) Completely absent.
Correct Answer: B) Dark brown, tarry, and intermittent (spotting).
Rationale: The bleeding in an ectopic pregnancy is usually from the breakdown of the
uterine decidua due to insufficient hormonal support from the misplaced pregnancy. This
results in old, slow bleeding that appears as dark brown spotting, not the heavy, bright red
bleeding of a typical miscarriage.
Question 9
A client with a ruptured ectopic pregnancy may experience referred pain to the shoulder. This is
known as Kehr's sign and is caused by:
A) Irritation of the diaphragm by intraperitoneal blood.
B) Pressure on the sciatic nerve.
C) Stretching of the round ligament.
D) Inflammation of the fallopian tube.
Correct Answer: A) Irritation of the diaphragm by intraperitoneal blood.
Rationale: When a fallopian tube ruptures, blood accumulates in the peritoneal cavity. This
blood can track up and irritate the diaphragm. The phrenic nerve, which innervates the
diaphragm, shares a nerve root with nerves that provide sensation to the shoulder area,
causing the brain to interpret the diaphragmatic irritation as shoulder pain.
Question 10
What are the two most important diagnostic tests for confirming a suspected ectopic pregnancy?
A) CBC and progesterone level
B) Urinalysis and pelvic exam
