NU 661 Exam 2 V2 | NU 661 Primary Care
of Childbearing Woman | Actual Q&A with
Rationale (NU661 Exam 2) | Regis
1. A 34-week gestation patient presents with a blood pressure of 165/114 mmHg. Which of
the following findings would lead the clinician to diagnose preeclampsia with severe
features? Select all that apply.
A. Platelet count of 95,000/mcL
B. Serum creatinine of 1.2 mg/dL or doubling of serum creatinine
C. New-onset cerebral or visual disturbances
D. Persistent epigastric or right upper quadrant pain
E. Proteinuria of 300 mg per 24-hour urine collection
F. Pulmonary edema
Correct Answer: A, B, C, D, F
Preeclampsia with severe features is defined by specific clinical and laboratory criteria
beyond just blood pressure elevations. Severe features include a platelet count below
100,000, impaired liver function, progressive renal insufficiency, pulmonary edema, or
new-onset cerebral/visual symptoms. While proteinuria is a diagnostic feature of
preeclampsia, it is no longer required for the diagnosis and specifically does not qualify as a
‘severe feature’ under the updated ACOG guidelines.
,2. A primigravida at 28 weeks gestation is Rh-negative. Which of the following statements is
correct regarding the administration of Rho(D) immune globulin (RhoGAM)?
A. RhoGAM is only needed if the patient experiences abdominal trauma.
B. RhoGAM is not necessary if the father of the baby is also Rh-negative.
C. RhoGAM should be administered at 28 weeks gestation and again within 72 hours of
delivery if the infant is Rh-positive.
D. A single dose at the first prenatal visit is sufficient for the entire pregnancy.
Correct Answer: C
Standard prenatal care for Rh-negative women involves the administration of RhoGAM at
approximately 28 weeks gestation to prevent isoimmunization. If the newborn is
determined to be Rh-positive at birth, a second dose is administered to the mother within
72 hours. This protocol significantly reduces the risk of hemolytic disease of the newborn
in subsequent pregnancies.
3. A patient at 26 weeks gestation is undergoing a 1-hour glucose challenge test (GCT). The
result is 145 mg/dL. What is the most appropriate next step for the clinician?
A. Diagnose the patient with gestational diabetes mellitus (GDM).
B. Repeat the 1-hour GCT in two weeks.
C. Schedule the patient for a 3-hour oral glucose tolerance test (OGTT).
D. Initiate medical nutrition therapy and insulin immediately.
,Correct Answer: C
The 1-hour GCT is a screening tool, not a diagnostic one, typically performed between 24
and 28 weeks gestation. A value of 140 mg/dL or higher (or sometimes 130-135 mg/dL
depending on the practice) is considered a positive screen. Therefore, the patient must
undergo a diagnostic 3-hour OGTT to confirm or rule out gestational diabetes.
4. Which fetal heart rate pattern is characterized by a gradual decrease and return to baseline
associated with a uterine contraction, where the nadir occurs at the same time as the peak of
the contraction?
A. Prolonged decelerations
B. Late decelerations
C. Variable decelerations
D. Early decelerations
Correct Answer: D
Early decelerations are visually apparent, symmetrical, gradual decreases and returns of
the fetal heart rate baseline. They are typically caused by fetal head compression during a
contraction and are considered a benign finding. In contrast, late decelerations occur after
the peak of the contraction and indicate uteroplacental insufficiency.
, 5. A patient at 30 weeks gestation reports a sudden gush of clear fluid from the vagina. The
clinician performs a sterile speculum exam. Which findings confirm the diagnosis of Preterm
Premature Rupture of Membranes (PPROM)? Select all that apply.
A. Positive nitrazine test (paper turns blue)
B. Presence of ferning on a dried slide of vaginal fluid
C. Vaginal pH of 4.5
D. Visualization of fluid pooling in the posterior vaginal fornix
E. Cervical dilation of 4 cm
Correct Answer: A, B, D
The diagnosis of PPROM is primarily clinical and relies on the visualization of amniotic
fluid in the vagina. Nitrazine paper turns blue in the presence of alkaline amniotic fluid, and
a fern pattern appears when amniotic fluid dries on a slide. These tests, combined with
visual pooling, are the gold standard for confirming the rupture of membranes.
6. Magnesium sulfate is being administered to a patient with severe preeclampsia. Which
assessment finding is most indicative of magnesium toxicity?
A. Hyperreflexia
B. Tachycardia
C. Increased urinary output
D. Loss of deep tendon reflexes
of Childbearing Woman | Actual Q&A with
Rationale (NU661 Exam 2) | Regis
1. A 34-week gestation patient presents with a blood pressure of 165/114 mmHg. Which of
the following findings would lead the clinician to diagnose preeclampsia with severe
features? Select all that apply.
A. Platelet count of 95,000/mcL
B. Serum creatinine of 1.2 mg/dL or doubling of serum creatinine
C. New-onset cerebral or visual disturbances
D. Persistent epigastric or right upper quadrant pain
E. Proteinuria of 300 mg per 24-hour urine collection
F. Pulmonary edema
Correct Answer: A, B, C, D, F
Preeclampsia with severe features is defined by specific clinical and laboratory criteria
beyond just blood pressure elevations. Severe features include a platelet count below
100,000, impaired liver function, progressive renal insufficiency, pulmonary edema, or
new-onset cerebral/visual symptoms. While proteinuria is a diagnostic feature of
preeclampsia, it is no longer required for the diagnosis and specifically does not qualify as a
‘severe feature’ under the updated ACOG guidelines.
,2. A primigravida at 28 weeks gestation is Rh-negative. Which of the following statements is
correct regarding the administration of Rho(D) immune globulin (RhoGAM)?
A. RhoGAM is only needed if the patient experiences abdominal trauma.
B. RhoGAM is not necessary if the father of the baby is also Rh-negative.
C. RhoGAM should be administered at 28 weeks gestation and again within 72 hours of
delivery if the infant is Rh-positive.
D. A single dose at the first prenatal visit is sufficient for the entire pregnancy.
Correct Answer: C
Standard prenatal care for Rh-negative women involves the administration of RhoGAM at
approximately 28 weeks gestation to prevent isoimmunization. If the newborn is
determined to be Rh-positive at birth, a second dose is administered to the mother within
72 hours. This protocol significantly reduces the risk of hemolytic disease of the newborn
in subsequent pregnancies.
3. A patient at 26 weeks gestation is undergoing a 1-hour glucose challenge test (GCT). The
result is 145 mg/dL. What is the most appropriate next step for the clinician?
A. Diagnose the patient with gestational diabetes mellitus (GDM).
B. Repeat the 1-hour GCT in two weeks.
C. Schedule the patient for a 3-hour oral glucose tolerance test (OGTT).
D. Initiate medical nutrition therapy and insulin immediately.
,Correct Answer: C
The 1-hour GCT is a screening tool, not a diagnostic one, typically performed between 24
and 28 weeks gestation. A value of 140 mg/dL or higher (or sometimes 130-135 mg/dL
depending on the practice) is considered a positive screen. Therefore, the patient must
undergo a diagnostic 3-hour OGTT to confirm or rule out gestational diabetes.
4. Which fetal heart rate pattern is characterized by a gradual decrease and return to baseline
associated with a uterine contraction, where the nadir occurs at the same time as the peak of
the contraction?
A. Prolonged decelerations
B. Late decelerations
C. Variable decelerations
D. Early decelerations
Correct Answer: D
Early decelerations are visually apparent, symmetrical, gradual decreases and returns of
the fetal heart rate baseline. They are typically caused by fetal head compression during a
contraction and are considered a benign finding. In contrast, late decelerations occur after
the peak of the contraction and indicate uteroplacental insufficiency.
, 5. A patient at 30 weeks gestation reports a sudden gush of clear fluid from the vagina. The
clinician performs a sterile speculum exam. Which findings confirm the diagnosis of Preterm
Premature Rupture of Membranes (PPROM)? Select all that apply.
A. Positive nitrazine test (paper turns blue)
B. Presence of ferning on a dried slide of vaginal fluid
C. Vaginal pH of 4.5
D. Visualization of fluid pooling in the posterior vaginal fornix
E. Cervical dilation of 4 cm
Correct Answer: A, B, D
The diagnosis of PPROM is primarily clinical and relies on the visualization of amniotic
fluid in the vagina. Nitrazine paper turns blue in the presence of alkaline amniotic fluid, and
a fern pattern appears when amniotic fluid dries on a slide. These tests, combined with
visual pooling, are the gold standard for confirming the rupture of membranes.
6. Magnesium sulfate is being administered to a patient with severe preeclampsia. Which
assessment finding is most indicative of magnesium toxicity?
A. Hyperreflexia
B. Tachycardia
C. Increased urinary output
D. Loss of deep tendon reflexes
