NU 661 Exam 1 V1 | NU 661 Primary Care
of Childbearing Woman | Actual Q&A with
Rationale (NU661 Exam 1) | Regis
1. A 24-year-old female presents for a preconception counseling visit. She has no significant
medical history. Which daily dosage of folic acid should the provider recommend to reduce
the risk of neural tube defects (NTDs)?
A. 0.4 mg
B. 0.1 mg
C. 1.0 mg
D. 4.0 mg
Correct Answer: A
The standard recommendation for all women of childbearing age is 0.4 mg (400 mcg) of
folic acid daily to prevent neural tube defects. For women with a prior history of an NTD-
affected pregnancy, the dosage is increased to 4.0 mg daily starting at least one month prior
to conception. Adequate folate levels are critical during the first few weeks of gestation,
often before a woman realizes she is pregnant.
2. A patient reports her last menstrual period (LMP) began on June 10, 2023. Using Naegele’s
Rule, what is her estimated date of delivery (EDD)?
A. March 10, 2024
,B. March 3, 2024
C. April 17, 2024
D. March 17, 2024
Correct Answer: D
Naegele’s Rule calculates the estimated date of delivery by taking the first day of the last
menstrual period, subtracting three months, and adding seven days plus one year. In this
case, June minus three months is March, and 10 plus seven days is 17. This rule assumes a
regular 28-day menstrual cycle and may require adjustment for longer or shorter cycles.
3. During a first-trimester prenatal assessment, the clinician evaluates for signs of pregnancy.
Which of the following findings are categorized as presumptive signs? (Select All That Apply)
A. Amenorrhea
B. Goodell’s sign
C. Breast tenderness
D. Positive urine hCG test
E. Quickening
F. Fetal heart tones heard via Doppler
Correct Answer: A, C, E
Presumptive signs are subjective changes experienced by the woman, such as nausea,
fatigue, amenorrhea, and quickening. Probable signs are objective findings observed by the
,examiner, such as Hegar’s sign, Goodell’s sign, and positive pregnancy tests. Positive signs
are those attributed only to the presence of a fetus, including visualization by ultrasound or
audible fetal heart tones.
4. At how many weeks of gestation should a pregnant woman be screened for Group B
Streptococcus (GBS) via vaginal-rectal culture?
A. 24–28 weeks
B. 28–32 weeks
C. 36 0/7 to 37 6/7 weeks
D. At the time of admission for labor
Correct Answer: C
Current guidelines recommend universal GBS screening for all pregnant women between
36 0/7 and 37 6/7 weeks of gestation. If a woman has GBS bacteriuria during the current
pregnancy or a previous infant with invasive GBS disease, screening is not required as she
is automatically a candidate for intrapartum prophylaxis. Timely screening allows for the
identification of colonization and the administration of antibiotics during labor to prevent
neonatal early-onset GBS disease.
, 5. A clinician is reviewing the Quad Screen results for a 35-year-old patient at 16 weeks
gestation. A low level of maternal serum alpha-fetoprotein (MSAFP) and unconjugated estriol
(uE3), combined with a high level of human chorionic gonadotropin (hCG) and inhibin-A, is
most suggestive of:
A. Neural tube defects
B. Trisomy 21 (Down Syndrome)
C. Trisomy 18 (Edwards Syndrome)
D. Gastroschisis
Correct Answer: B
The Quad Screen is used between 15 and 22 weeks to assess for chromosomal
abnormalities and neural tube defects. In Trisomy 21, MSAFP and uE3 are typically low,
while hCG and inhibin-A are elevated. High MSAFP levels are more commonly associated
with neural tube defects or multiple gestations.
6. A pregnant patient in her second trimester presents with a fundal height measurement of
26 cm at 22 weeks gestation. What is the most appropriate next step for the primary care
provider?
A. Document the finding as normal for this stage
B. Order an ultrasound for growth and amniotic fluid volume
C. Recheck the fundal height in 4 weeks
D. Immediately admit the patient for induction of labor
of Childbearing Woman | Actual Q&A with
Rationale (NU661 Exam 1) | Regis
1. A 24-year-old female presents for a preconception counseling visit. She has no significant
medical history. Which daily dosage of folic acid should the provider recommend to reduce
the risk of neural tube defects (NTDs)?
A. 0.4 mg
B. 0.1 mg
C. 1.0 mg
D. 4.0 mg
Correct Answer: A
The standard recommendation for all women of childbearing age is 0.4 mg (400 mcg) of
folic acid daily to prevent neural tube defects. For women with a prior history of an NTD-
affected pregnancy, the dosage is increased to 4.0 mg daily starting at least one month prior
to conception. Adequate folate levels are critical during the first few weeks of gestation,
often before a woman realizes she is pregnant.
2. A patient reports her last menstrual period (LMP) began on June 10, 2023. Using Naegele’s
Rule, what is her estimated date of delivery (EDD)?
A. March 10, 2024
,B. March 3, 2024
C. April 17, 2024
D. March 17, 2024
Correct Answer: D
Naegele’s Rule calculates the estimated date of delivery by taking the first day of the last
menstrual period, subtracting three months, and adding seven days plus one year. In this
case, June minus three months is March, and 10 plus seven days is 17. This rule assumes a
regular 28-day menstrual cycle and may require adjustment for longer or shorter cycles.
3. During a first-trimester prenatal assessment, the clinician evaluates for signs of pregnancy.
Which of the following findings are categorized as presumptive signs? (Select All That Apply)
A. Amenorrhea
B. Goodell’s sign
C. Breast tenderness
D. Positive urine hCG test
E. Quickening
F. Fetal heart tones heard via Doppler
Correct Answer: A, C, E
Presumptive signs are subjective changes experienced by the woman, such as nausea,
fatigue, amenorrhea, and quickening. Probable signs are objective findings observed by the
,examiner, such as Hegar’s sign, Goodell’s sign, and positive pregnancy tests. Positive signs
are those attributed only to the presence of a fetus, including visualization by ultrasound or
audible fetal heart tones.
4. At how many weeks of gestation should a pregnant woman be screened for Group B
Streptococcus (GBS) via vaginal-rectal culture?
A. 24–28 weeks
B. 28–32 weeks
C. 36 0/7 to 37 6/7 weeks
D. At the time of admission for labor
Correct Answer: C
Current guidelines recommend universal GBS screening for all pregnant women between
36 0/7 and 37 6/7 weeks of gestation. If a woman has GBS bacteriuria during the current
pregnancy or a previous infant with invasive GBS disease, screening is not required as she
is automatically a candidate for intrapartum prophylaxis. Timely screening allows for the
identification of colonization and the administration of antibiotics during labor to prevent
neonatal early-onset GBS disease.
, 5. A clinician is reviewing the Quad Screen results for a 35-year-old patient at 16 weeks
gestation. A low level of maternal serum alpha-fetoprotein (MSAFP) and unconjugated estriol
(uE3), combined with a high level of human chorionic gonadotropin (hCG) and inhibin-A, is
most suggestive of:
A. Neural tube defects
B. Trisomy 21 (Down Syndrome)
C. Trisomy 18 (Edwards Syndrome)
D. Gastroschisis
Correct Answer: B
The Quad Screen is used between 15 and 22 weeks to assess for chromosomal
abnormalities and neural tube defects. In Trisomy 21, MSAFP and uE3 are typically low,
while hCG and inhibin-A are elevated. High MSAFP levels are more commonly associated
with neural tube defects or multiple gestations.
6. A pregnant patient in her second trimester presents with a fundal height measurement of
26 cm at 22 weeks gestation. What is the most appropriate next step for the primary care
provider?
A. Document the finding as normal for this stage
B. Order an ultrasound for growth and amniotic fluid volume
C. Recheck the fundal height in 4 weeks
D. Immediately admit the patient for induction of labor
