NU 661 Final Exam V1 | NU 661 Primary
Care of Childbearing Woman | Actual Q&A
with Rationale (NU661 Final Exam) | Regis
1. A 26-year-old primigravida presents for her initial prenatal visit at 9 weeks gestation.
According to standard clinical guidelines, which laboratory tests should be included in the
initial prenatal screening panel? (Select all that apply)
A. Complete Blood Count (CBC)
B. ABO and Rh typing
C. Hepatitis B Surface Antigen (HBsAg)
D. HIV Screening
E. Syphilis Screening (RPR or VDRL)
F. Rubella Immunity Titer
Correct Answer: A, B, C, D, E, F
The initial prenatal laboratory panel is designed to identify underlying health conditions
and infectious diseases that could impact the health of the mother or the fetus. Standard
testing includes a CBC to assess for anemia, blood typing for Rh status, and screening for
HIV, Syphilis, and Hepatitis B to initiate early treatment or prophylaxis. Rubella titers are
also essential to determine immunity, as the vaccine is contraindicated during pregnancy
and non-immune women require postpartum vaccination.
,2. Using Naegele’s rule, what is the estimated date of delivery (EDD) for a patient whose last
menstrual period (LMP) began on February 14, 2023?
A. November 7, 2023
B. November 21, 2023
C. November 14, 2023
D. December 21, 2023
Correct Answer: B
Naegele’s rule is a standard method used to estimate the due date by adding one year,
subtracting three months, and adding seven days to the first day of the last menstrual
period. In this case, subtracting three months from February leads back to November, and
adding seven days to the 14th results in the 21st. This calculation assumes a standard 28-
day menstrual cycle and remains the primary clinical tool for gestational dating in the
absence of early ultrasound.
3. A woman at 36 weeks gestation tests positive for Group B Streptococcus (GBS) via vaginal-
rectal culture. What is the most appropriate management plan for this patient during labor?
A. Administer intravenous Penicillin G at the onset of labor or rupture of membranes.
B. Administer intramuscular Penicillin G immediately upon diagnosis.
C. Schedule a repeat culture at 39 weeks to confirm persistent colonization.
D. Wait until the newborn is delivered to evaluate for sepsis before treating.
,Correct Answer: A
Intrapartum antibiotic prophylaxis (IAP) is required for women who test positive for GBS
during the routine screening window of 36 0/7 to 37 6/7 weeks. Intravenous Penicillin G
remains the first-line treatment and should be initiated once the patient enters active labor
or experiences rupture of membranes. This intervention significantly reduces the incidence
of early-onset neonatal GBS sepsis, which can be life-threatening to the newborn.
4. Which of the following physiological changes is considered a normal adaptation of the
cardiovascular system during pregnancy?
A. Decrease in blood volume by 20%
B. Elevation of systemic vascular resistance
C. Increase in cardiac output by 30% to 50%
D. Decrease in maternal heart rate by 10 bpm
Correct Answer: C
Maternal blood volume and cardiac output increase significantly during pregnancy to
meet the metabolic demands of the fetus and the placenta. Cardiac output typically rises by
30% to 50% above non-pregnant levels, primarily due to an increase in stroke volume and
heart rate. Conversely, systemic vascular resistance decreases due to progesterone-
mediated vasodilation, which helps maintain a stable blood pressure despite the increased
volume.
, 5. A patient at 28 weeks gestation presents with persistent heartburn and indigestion. Which
non-pharmacological intervention should the provider recommend first?
A. Prescribe a proton pump inhibitor immediately.
B. Suggest eating small, frequent meals and avoiding spicy foods.
C. Recommend lying flat immediately after eating.
D. Advise drinking large amounts of fluid with every meal.
Correct Answer: B
Gastroesophageal reflux is common in the third trimester due to both hormonal relaxation
of the lower esophageal sphincter and mechanical pressure from the growing uterus. Initial
management should focus on lifestyle modifications such as consuming small, frequent
meals and remaining upright after eating. These conservative measures often alleviate
symptoms without the need for pharmacological therapy, though antacids can be added if
symptoms persist.
6. Which clinical findings would lead a provider to diagnose a patient with preeclampsia
without severe features? (Select all that apply)
A. Blood pressure ≥ 140/90 mmHg on two occasions at least 4 hours apart after 20 weeks
gestation.
B. Visual disturbances or severe headache.
C. Proteinuria ≥ 300 mg per 24-hour urine collection.
D. Platelet count less than 100,000/microliter.
Care of Childbearing Woman | Actual Q&A
with Rationale (NU661 Final Exam) | Regis
1. A 26-year-old primigravida presents for her initial prenatal visit at 9 weeks gestation.
According to standard clinical guidelines, which laboratory tests should be included in the
initial prenatal screening panel? (Select all that apply)
A. Complete Blood Count (CBC)
B. ABO and Rh typing
C. Hepatitis B Surface Antigen (HBsAg)
D. HIV Screening
E. Syphilis Screening (RPR or VDRL)
F. Rubella Immunity Titer
Correct Answer: A, B, C, D, E, F
The initial prenatal laboratory panel is designed to identify underlying health conditions
and infectious diseases that could impact the health of the mother or the fetus. Standard
testing includes a CBC to assess for anemia, blood typing for Rh status, and screening for
HIV, Syphilis, and Hepatitis B to initiate early treatment or prophylaxis. Rubella titers are
also essential to determine immunity, as the vaccine is contraindicated during pregnancy
and non-immune women require postpartum vaccination.
,2. Using Naegele’s rule, what is the estimated date of delivery (EDD) for a patient whose last
menstrual period (LMP) began on February 14, 2023?
A. November 7, 2023
B. November 21, 2023
C. November 14, 2023
D. December 21, 2023
Correct Answer: B
Naegele’s rule is a standard method used to estimate the due date by adding one year,
subtracting three months, and adding seven days to the first day of the last menstrual
period. In this case, subtracting three months from February leads back to November, and
adding seven days to the 14th results in the 21st. This calculation assumes a standard 28-
day menstrual cycle and remains the primary clinical tool for gestational dating in the
absence of early ultrasound.
3. A woman at 36 weeks gestation tests positive for Group B Streptococcus (GBS) via vaginal-
rectal culture. What is the most appropriate management plan for this patient during labor?
A. Administer intravenous Penicillin G at the onset of labor or rupture of membranes.
B. Administer intramuscular Penicillin G immediately upon diagnosis.
C. Schedule a repeat culture at 39 weeks to confirm persistent colonization.
D. Wait until the newborn is delivered to evaluate for sepsis before treating.
,Correct Answer: A
Intrapartum antibiotic prophylaxis (IAP) is required for women who test positive for GBS
during the routine screening window of 36 0/7 to 37 6/7 weeks. Intravenous Penicillin G
remains the first-line treatment and should be initiated once the patient enters active labor
or experiences rupture of membranes. This intervention significantly reduces the incidence
of early-onset neonatal GBS sepsis, which can be life-threatening to the newborn.
4. Which of the following physiological changes is considered a normal adaptation of the
cardiovascular system during pregnancy?
A. Decrease in blood volume by 20%
B. Elevation of systemic vascular resistance
C. Increase in cardiac output by 30% to 50%
D. Decrease in maternal heart rate by 10 bpm
Correct Answer: C
Maternal blood volume and cardiac output increase significantly during pregnancy to
meet the metabolic demands of the fetus and the placenta. Cardiac output typically rises by
30% to 50% above non-pregnant levels, primarily due to an increase in stroke volume and
heart rate. Conversely, systemic vascular resistance decreases due to progesterone-
mediated vasodilation, which helps maintain a stable blood pressure despite the increased
volume.
, 5. A patient at 28 weeks gestation presents with persistent heartburn and indigestion. Which
non-pharmacological intervention should the provider recommend first?
A. Prescribe a proton pump inhibitor immediately.
B. Suggest eating small, frequent meals and avoiding spicy foods.
C. Recommend lying flat immediately after eating.
D. Advise drinking large amounts of fluid with every meal.
Correct Answer: B
Gastroesophageal reflux is common in the third trimester due to both hormonal relaxation
of the lower esophageal sphincter and mechanical pressure from the growing uterus. Initial
management should focus on lifestyle modifications such as consuming small, frequent
meals and remaining upright after eating. These conservative measures often alleviate
symptoms without the need for pharmacological therapy, though antacids can be added if
symptoms persist.
6. Which clinical findings would lead a provider to diagnose a patient with preeclampsia
without severe features? (Select all that apply)
A. Blood pressure ≥ 140/90 mmHg on two occasions at least 4 hours apart after 20 weeks
gestation.
B. Visual disturbances or severe headache.
C. Proteinuria ≥ 300 mg per 24-hour urine collection.
D. Platelet count less than 100,000/microliter.
