NU 661 Exam 4 V1 | NU 661 Primary Care
of Childbearing Woman | Actual Q&A with
Rationale (NU661 Exam 4) | Regis
1. A 32-year-old primigravida at 35 weeks’ gestation is evaluated for elevated blood pressure.
Which of the following findings would be classified as preeclampsia with severe features?
Select all that apply.
A. Platelet count less than 100,000/microliter
B. Proteinuria of 400 mg in a 24-hour collection
C. Serum creatinine greater than 1.1 mg/dL or doubling of baseline
D. New-onset cerebral or visual disturbances
E. Severe persistent right upper quadrant or epigastric pain
F. Blood pressure of 145/95 mmHg on two occasions
Correct Answer: A, C, D, E
Severe features of preeclampsia include specific laboratory abnormalities and clinical
symptoms indicating end-organ involvement. Thrombocytopenia, impaired renal function,
and hepatic pain are critical indicators of disease severity. Visual disturbances or persistent
headaches signify central nervous system involvement and require immediate medical
intervention to prevent seizures.
,2. A pregnant woman who is Rh-negative is being seen for her 28-week prenatal visit. She has
no evidence of sensitization. What is the appropriate management at this time?
A. Administer 300 mcg of Rho(D) immune globulin intramuscularly
B. Administer Rho(D) immune globulin only if the father is Rh-positive
C. Wait until delivery to administer Rho(D) immune globulin
D. Perform an amniocentesis to determine fetal blood type
Correct Answer: A
Standard practice involves administering Rho(D) immune globulin at 28 weeks’ gestation
to all unsensitized Rh-negative women. This prophylactic dose helps prevent maternal
sensitization to the fetal Rh-positive antigen that may occur during the third trimester. A
second dose is typically given within 72 hours of delivery if the newborn is confirmed to be
Rh-positive.
3. A patient at 10 weeks’ gestation reports persistent nausea and vomiting, inability to keep
down liquids, and a weight loss of 5% of her pre-pregnancy body weight. Laboratory results
show ketonuria. What is the most likely diagnosis?
A. Morning sickness
B. Hyperemesis gravidarum
C. Gestational diabetes
D. Molar pregnancy
,Correct Answer: B
Hyperemesis gravidarum is a severe form of nausea and vomiting in pregnancy
characterized by weight loss and electrolyte imbalances. The presence of ketonuria
indicates that the body is breaking down fat for energy due to starvation. Management
focuses on hydration, electrolyte replacement, and antiemetic therapy to stabilize the
patient.
4. A pregnant woman tests positive for Group B Streptococcus (GBS) via vaginal-rectal
screening at 36 weeks. What is the recommended treatment plan during labor?
A. Oral amoxicillin for 7 days starting at 37 weeks
B. Immediate cesarean section before rupture of membranes
C. Intravenous Penicillin G during the intrapartum period
D. No treatment is necessary unless the patient is symptomatic
Correct Answer: C
Intrapartum antibiotic prophylaxis is the standard of care for women who screen positive
for GBS to prevent neonatal early-onset GBS disease. Penicillin G is the preferred agent due
to its narrow spectrum and effectiveness against GBS. Ideally, antibiotics should be
administered at least four hours prior to delivery to ensure adequate fetal protection.
5. A 24-year-old G2P1 at 32 weeks’ gestation presents with painless, bright red vaginal
bleeding. Which diagnostic procedure should be avoided until placenta previa is ruled out?
A. Abdominal ultrasound
, B. Digital vaginal examination
C. External fetal monitoring
D. Venipuncture for hemoglobin and hematocrit
Correct Answer: B
A digital vaginal exam is strictly contraindicated in the presence of painless vaginal
bleeding until placenta previa has been excluded by ultrasound. Inserting a finger into the
cervix could cause catastrophic hemorrhage by disrupting the placenta. Initial assessment
must prioritize maternal stability and fetal well-being through non-invasive means.
6. Which of the following conditions are considered significant risk factors for postpartum
hemorrhage? Select all that apply.
A. Uterine atony
B. Retained placental fragments
C. Polyhydramnios
D. Prolonged labor with oxytocin use
E. Primigravida status
Correct Answer: A, B, C, D
Uterine atony is the most common cause of postpartum hemorrhage, often resulting from
overdistension due to polyhydramnios or multiple gestations. Prolonged labor and the use
of oxytocin can lead to uterine muscle fatigue, preventing effective contraction after
of Childbearing Woman | Actual Q&A with
Rationale (NU661 Exam 4) | Regis
1. A 32-year-old primigravida at 35 weeks’ gestation is evaluated for elevated blood pressure.
Which of the following findings would be classified as preeclampsia with severe features?
Select all that apply.
A. Platelet count less than 100,000/microliter
B. Proteinuria of 400 mg in a 24-hour collection
C. Serum creatinine greater than 1.1 mg/dL or doubling of baseline
D. New-onset cerebral or visual disturbances
E. Severe persistent right upper quadrant or epigastric pain
F. Blood pressure of 145/95 mmHg on two occasions
Correct Answer: A, C, D, E
Severe features of preeclampsia include specific laboratory abnormalities and clinical
symptoms indicating end-organ involvement. Thrombocytopenia, impaired renal function,
and hepatic pain are critical indicators of disease severity. Visual disturbances or persistent
headaches signify central nervous system involvement and require immediate medical
intervention to prevent seizures.
,2. A pregnant woman who is Rh-negative is being seen for her 28-week prenatal visit. She has
no evidence of sensitization. What is the appropriate management at this time?
A. Administer 300 mcg of Rho(D) immune globulin intramuscularly
B. Administer Rho(D) immune globulin only if the father is Rh-positive
C. Wait until delivery to administer Rho(D) immune globulin
D. Perform an amniocentesis to determine fetal blood type
Correct Answer: A
Standard practice involves administering Rho(D) immune globulin at 28 weeks’ gestation
to all unsensitized Rh-negative women. This prophylactic dose helps prevent maternal
sensitization to the fetal Rh-positive antigen that may occur during the third trimester. A
second dose is typically given within 72 hours of delivery if the newborn is confirmed to be
Rh-positive.
3. A patient at 10 weeks’ gestation reports persistent nausea and vomiting, inability to keep
down liquids, and a weight loss of 5% of her pre-pregnancy body weight. Laboratory results
show ketonuria. What is the most likely diagnosis?
A. Morning sickness
B. Hyperemesis gravidarum
C. Gestational diabetes
D. Molar pregnancy
,Correct Answer: B
Hyperemesis gravidarum is a severe form of nausea and vomiting in pregnancy
characterized by weight loss and electrolyte imbalances. The presence of ketonuria
indicates that the body is breaking down fat for energy due to starvation. Management
focuses on hydration, electrolyte replacement, and antiemetic therapy to stabilize the
patient.
4. A pregnant woman tests positive for Group B Streptococcus (GBS) via vaginal-rectal
screening at 36 weeks. What is the recommended treatment plan during labor?
A. Oral amoxicillin for 7 days starting at 37 weeks
B. Immediate cesarean section before rupture of membranes
C. Intravenous Penicillin G during the intrapartum period
D. No treatment is necessary unless the patient is symptomatic
Correct Answer: C
Intrapartum antibiotic prophylaxis is the standard of care for women who screen positive
for GBS to prevent neonatal early-onset GBS disease. Penicillin G is the preferred agent due
to its narrow spectrum and effectiveness against GBS. Ideally, antibiotics should be
administered at least four hours prior to delivery to ensure adequate fetal protection.
5. A 24-year-old G2P1 at 32 weeks’ gestation presents with painless, bright red vaginal
bleeding. Which diagnostic procedure should be avoided until placenta previa is ruled out?
A. Abdominal ultrasound
, B. Digital vaginal examination
C. External fetal monitoring
D. Venipuncture for hemoglobin and hematocrit
Correct Answer: B
A digital vaginal exam is strictly contraindicated in the presence of painless vaginal
bleeding until placenta previa has been excluded by ultrasound. Inserting a finger into the
cervix could cause catastrophic hemorrhage by disrupting the placenta. Initial assessment
must prioritize maternal stability and fetal well-being through non-invasive means.
6. Which of the following conditions are considered significant risk factors for postpartum
hemorrhage? Select all that apply.
A. Uterine atony
B. Retained placental fragments
C. Polyhydramnios
D. Prolonged labor with oxytocin use
E. Primigravida status
Correct Answer: A, B, C, D
Uterine atony is the most common cause of postpartum hemorrhage, often resulting from
overdistension due to polyhydramnios or multiple gestations. Prolonged labor and the use
of oxytocin can lead to uterine muscle fatigue, preventing effective contraction after
