NU661/ NU 661 Final Exam: (Latest Update)
Primary Care of Childbearing Woman Actual Qs & As Grade A
100% Correct (Verified Answers)- Regis
This advanced practice nursing examination covers comprehensive primary care of women across the
childbearing continuum, including prenatal risk assessment, management of common and high-risk obstetric
conditions, postpartum care, contraception, and evidence-based screening. It integrates current national
guidelines and requires clinical reasoning, differential diagnosis, and patient-centered decision-making. It
contains 120 multiple-choice questions, each with four distractors and a fully worked rationale that explains why
the keyed answer is correct. Questions are organized into clearly labelled sections that mirror the major content
areas of the course. Targeted learning outcomes include: Apply current evidence-based guidelines to the primary
care of childbearing women across the reproductive lifespan.; Differentiate normal physiologic changes from
pathological conditions in pregnancy and the postpartum period.; Formulate comprehensive management plans
for common and complex obstetric and gynecologic presentations.; Evaluate the impact of chronic conditions and
lifestyle factors on pregnancy outcomes.. Every item has been reviewed for clinical accuracy, current guidelines,
and clarity so that students can study with confidence and self-correct as they work through the bank. Use it as a
high-yield review immediately before the exam, or as a structured practice tool during the unit - the rationales
double as concise teaching notes. The recommended writing time is 3 hours, with a passing score of 85%. Aligned
with Aligned with the National Organization of Nurse Practitioner Faculties (NONPF) and the American
Section 1: General (Questions 1-120)
1 A woman at 24 weeks gestation with a history of two prior cesarean deliveries
presents with a fundal height 4 cm greater than expected and an ultrasound
revealing polyhydramnios. Which maternal condition is most strongly associated
with this presentation and requires immediate additional screening?
A) Gestational diabetes mellitus
B) Fetal neural tube defect
C) Maternal systemic lupus erythematosus
D) Placenta accreta spectrum
Answer: A
Rationale: Polyhydramnios in the second half of pregnancy is commonly associated
with fetal anomalies, but maternal diabetes-especially poorly controlled gestational
diabetes-is a leading cause. While neural tube defects can cause polyhydramnios due
to impaired swallowing, the most strongly associated maternal condition among
these options is gestational diabetes. SLE and placenta accreta are not typical causes
of polyhydramnios.
2 Which of the following pathophysiologic mechanisms best explains the increased
risk of venous thromboembolism (VTE) during the postpartum period compared
to the antepartum period?
A) Decreased venous capacitance and increased stasis due to uterine involution
,B) Upregulation of fibrinolysis and decreased platelet aggregation
C) Persistent elevation of estrogen levels causing endothelial injury
D) Enhanced coagulation factor activity and reduced fibrinolytic activity
Answer: D
Rationale: Postpartum hypercoagulability is driven by elevated coagulation factors
(e.g., factors VIII, IX, and fibrinogen) and decreased fibrinolysis, which persist for
up to 6 weeks. Uterine involution contributes stasis but is not the primary
mechanism. Estrogen levels drop sharply after delivery, and fibrinolysis is impaired,
not upregulated.
3 A primigravid woman at 37 weeks gestation presents with a blood pressure of
158/104 mmHg and proteinuria (urine protein-to-creatinine ratio 0.5). Laboratory
results show elevated liver enzymes and a platelet count of 80,000/µL. In addition
to magnesium sulfate, which antihypertensive agent is most appropriate for acute
management?
A) Labetalol 20 mg IV
B) Atenolol 50 mg oral
C) Enalapril 5 mg oral
D) Amlodipine 5 mg oral
Answer: A
Rationale: For acute severe hypertension in pregnancy, IV labetalol is a first-line
agent. Atenolol is associated with fetal growth restriction and is not recommended.
ACE inhibitors and ARBs are contraindicated in pregnancy due to fetotoxicity.
Amlodipine is not a preferred agent for acute management.
4 A woman who delivered vaginally 3 hours ago has a fundus that is firm, midline,
and at the umbilicus, but she is experiencing heavy bleeding with clots. Perineal
examination shows intact episiotomy. Which step should the clinician take next?
A) Perform manual exploration of the uterine cavity for retained products
B) Administer an additional dose of oxytocin and massage the fundus
C) Assess for vaginal lacerations and perform a bimanual examination
D) Insert a urinary catheter to decompress the bladder
Answer: B
Rationale: Because the fundus is firm, uterine atony is less likely, but the most
common cause of early postpartum hemorrhage is still atony, and the first step is to
ensure adequate uterine tone with oxytocin and massage. If bleeding continues
despite a firm fundus, then evaluate for lacerations or retained tissue. Manual
exploration and catheterization are subsequent steps if initial measures fail.
,5 When counseling a woman with an unintended pregnancy who is considering a
medication abortion, which of the following factors would be an absolute
contraindication to the use of mifepristone?
A) Gestational age of 70 days or less
B) Current use of an intrauterine device (IUD)
C) Chronic adrenal failure
D) History of prior cesarean delivery
Answer: C
Rationale: Mifepristone is contraindicated in women with chronic adrenal failure due
to its glucocorticoid antagonism. Gestational age 70 days is an indication, not a
contraindication. An IUD should be removed but is not an absolute contraindication.
Prior cesarean delivery is not a contraindication to medication abortion.
6 Which of the following findings on a postpartum depression screening tool would
most strongly suggest a need for immediate referral to emergency psychiatric
services rather than routine outpatient follow-up?
A) Edinburgh Postnatal Depression Scale (EPDS) score of 15
B) Endorsement of thoughts of self-harm on item 10
C) Persistent low mood and anhedonia for more than 2 weeks
D) Difficulty bonding with the infant and excessive anxiety
Answer: B
Rationale: Any endorsement of suicidal ideation or self-harm on the EPDS item 10
requires immediate evaluation to ensure safety. A score of 15 indicates probable
depression but does not necessarily require emergency referral. Low mood,
anhedonia, and bonding difficulties are concerning but do not carry the same
urgency as active suicidal thoughts.
7 A woman with a prepregnancy body mass index of 33 kg/m² is planning a
pregnancy. Which of the following interventions has the strongest evidence for
reducing the risk of gestational diabetes mellitus in this population?
A) Initiation of low-dose aspirin at 12 weeks gestation
B) Strict glycemic control with metformin from preconception
C) Participation in a structured lifestyle modification program targeting weight
loss
D) Screening for diabetes earlier than 24 weeks gestation
Answer: C
Rationale: Lifestyle modification, including diet and exercise, has been shown to
, reduce the incidence of gestational diabetes, particularly in women with obesity.
Low-dose aspirin is used for preeclampsia prevention, not GDM. Metformin is not
recommended solely for GDM prevention. Early screening identifies preexisting
diabetes but does not prevent GDM.
8 A woman at 16 weeks gestation presents with a positive rubella IgG test. She is
concerned because she cannot recall being vaccinated. Which of the following is
the most appropriate recommendation?
A) Administer MMR vaccine now to ensure immunity
B) Recheck rubella IgG titers in the third trimester
C) Reassure that she is immune and recommend postpartum vaccination if needed
D) Advise termination due to risk of congenital rubella syndrome
Answer: C
Rationale: A positive rubella IgG indicates immunity, so no vaccination is needed
during pregnancy. MMR is a live vaccine and is contraindicated during pregnancy.
Rechecking titers is unnecessary. Since she is immune, there is no risk of congenital
rubella syndrome, so termination is not indicated.
9 Which of the following represents the most appropriate management for a woman
who presents at 9 weeks gestation with a hemoglobin of 9.4 g/dL and a mean
corpuscular volume (MCV) of 72 fL?
A) Initiate oral iron supplementation and recheck hemoglobin in 4 weeks
B) Order hemoglobin electrophoresis to rule out thalassemia
C) Administer parenteral iron if oral iron is poorly tolerated
D) Perform serum ferritin and C-reactive protein testing to confirm iron deficiency
Answer: D
Rationale: Microcytic anemia in pregnancy is most commonly due to iron deficiency,
but thalassemia and anemia of chronic disease are differentials. Serum ferritin (with
CRP to interpret) is the recommended initial diagnostic test to confirm iron
deficiency before starting supplementation. While oral iron is often initiated
empirically, confirming the diagnosis is more appropriate, especially when MCV is
significantly low. Hemoglobin electrophoresis is not first-line unless ferritin is
normal.
10 A woman with a history of a prior preterm birth at 32 weeks gestation is
currently at 14 weeks gestation. Which of the following interventions has been
shown to reduce the risk of recurrent preterm birth and is recommended as
first-line therapy?
Primary Care of Childbearing Woman Actual Qs & As Grade A
100% Correct (Verified Answers)- Regis
This advanced practice nursing examination covers comprehensive primary care of women across the
childbearing continuum, including prenatal risk assessment, management of common and high-risk obstetric
conditions, postpartum care, contraception, and evidence-based screening. It integrates current national
guidelines and requires clinical reasoning, differential diagnosis, and patient-centered decision-making. It
contains 120 multiple-choice questions, each with four distractors and a fully worked rationale that explains why
the keyed answer is correct. Questions are organized into clearly labelled sections that mirror the major content
areas of the course. Targeted learning outcomes include: Apply current evidence-based guidelines to the primary
care of childbearing women across the reproductive lifespan.; Differentiate normal physiologic changes from
pathological conditions in pregnancy and the postpartum period.; Formulate comprehensive management plans
for common and complex obstetric and gynecologic presentations.; Evaluate the impact of chronic conditions and
lifestyle factors on pregnancy outcomes.. Every item has been reviewed for clinical accuracy, current guidelines,
and clarity so that students can study with confidence and self-correct as they work through the bank. Use it as a
high-yield review immediately before the exam, or as a structured practice tool during the unit - the rationales
double as concise teaching notes. The recommended writing time is 3 hours, with a passing score of 85%. Aligned
with Aligned with the National Organization of Nurse Practitioner Faculties (NONPF) and the American
Section 1: General (Questions 1-120)
1 A woman at 24 weeks gestation with a history of two prior cesarean deliveries
presents with a fundal height 4 cm greater than expected and an ultrasound
revealing polyhydramnios. Which maternal condition is most strongly associated
with this presentation and requires immediate additional screening?
A) Gestational diabetes mellitus
B) Fetal neural tube defect
C) Maternal systemic lupus erythematosus
D) Placenta accreta spectrum
Answer: A
Rationale: Polyhydramnios in the second half of pregnancy is commonly associated
with fetal anomalies, but maternal diabetes-especially poorly controlled gestational
diabetes-is a leading cause. While neural tube defects can cause polyhydramnios due
to impaired swallowing, the most strongly associated maternal condition among
these options is gestational diabetes. SLE and placenta accreta are not typical causes
of polyhydramnios.
2 Which of the following pathophysiologic mechanisms best explains the increased
risk of venous thromboembolism (VTE) during the postpartum period compared
to the antepartum period?
A) Decreased venous capacitance and increased stasis due to uterine involution
,B) Upregulation of fibrinolysis and decreased platelet aggregation
C) Persistent elevation of estrogen levels causing endothelial injury
D) Enhanced coagulation factor activity and reduced fibrinolytic activity
Answer: D
Rationale: Postpartum hypercoagulability is driven by elevated coagulation factors
(e.g., factors VIII, IX, and fibrinogen) and decreased fibrinolysis, which persist for
up to 6 weeks. Uterine involution contributes stasis but is not the primary
mechanism. Estrogen levels drop sharply after delivery, and fibrinolysis is impaired,
not upregulated.
3 A primigravid woman at 37 weeks gestation presents with a blood pressure of
158/104 mmHg and proteinuria (urine protein-to-creatinine ratio 0.5). Laboratory
results show elevated liver enzymes and a platelet count of 80,000/µL. In addition
to magnesium sulfate, which antihypertensive agent is most appropriate for acute
management?
A) Labetalol 20 mg IV
B) Atenolol 50 mg oral
C) Enalapril 5 mg oral
D) Amlodipine 5 mg oral
Answer: A
Rationale: For acute severe hypertension in pregnancy, IV labetalol is a first-line
agent. Atenolol is associated with fetal growth restriction and is not recommended.
ACE inhibitors and ARBs are contraindicated in pregnancy due to fetotoxicity.
Amlodipine is not a preferred agent for acute management.
4 A woman who delivered vaginally 3 hours ago has a fundus that is firm, midline,
and at the umbilicus, but she is experiencing heavy bleeding with clots. Perineal
examination shows intact episiotomy. Which step should the clinician take next?
A) Perform manual exploration of the uterine cavity for retained products
B) Administer an additional dose of oxytocin and massage the fundus
C) Assess for vaginal lacerations and perform a bimanual examination
D) Insert a urinary catheter to decompress the bladder
Answer: B
Rationale: Because the fundus is firm, uterine atony is less likely, but the most
common cause of early postpartum hemorrhage is still atony, and the first step is to
ensure adequate uterine tone with oxytocin and massage. If bleeding continues
despite a firm fundus, then evaluate for lacerations or retained tissue. Manual
exploration and catheterization are subsequent steps if initial measures fail.
,5 When counseling a woman with an unintended pregnancy who is considering a
medication abortion, which of the following factors would be an absolute
contraindication to the use of mifepristone?
A) Gestational age of 70 days or less
B) Current use of an intrauterine device (IUD)
C) Chronic adrenal failure
D) History of prior cesarean delivery
Answer: C
Rationale: Mifepristone is contraindicated in women with chronic adrenal failure due
to its glucocorticoid antagonism. Gestational age 70 days is an indication, not a
contraindication. An IUD should be removed but is not an absolute contraindication.
Prior cesarean delivery is not a contraindication to medication abortion.
6 Which of the following findings on a postpartum depression screening tool would
most strongly suggest a need for immediate referral to emergency psychiatric
services rather than routine outpatient follow-up?
A) Edinburgh Postnatal Depression Scale (EPDS) score of 15
B) Endorsement of thoughts of self-harm on item 10
C) Persistent low mood and anhedonia for more than 2 weeks
D) Difficulty bonding with the infant and excessive anxiety
Answer: B
Rationale: Any endorsement of suicidal ideation or self-harm on the EPDS item 10
requires immediate evaluation to ensure safety. A score of 15 indicates probable
depression but does not necessarily require emergency referral. Low mood,
anhedonia, and bonding difficulties are concerning but do not carry the same
urgency as active suicidal thoughts.
7 A woman with a prepregnancy body mass index of 33 kg/m² is planning a
pregnancy. Which of the following interventions has the strongest evidence for
reducing the risk of gestational diabetes mellitus in this population?
A) Initiation of low-dose aspirin at 12 weeks gestation
B) Strict glycemic control with metformin from preconception
C) Participation in a structured lifestyle modification program targeting weight
loss
D) Screening for diabetes earlier than 24 weeks gestation
Answer: C
Rationale: Lifestyle modification, including diet and exercise, has been shown to
, reduce the incidence of gestational diabetes, particularly in women with obesity.
Low-dose aspirin is used for preeclampsia prevention, not GDM. Metformin is not
recommended solely for GDM prevention. Early screening identifies preexisting
diabetes but does not prevent GDM.
8 A woman at 16 weeks gestation presents with a positive rubella IgG test. She is
concerned because she cannot recall being vaccinated. Which of the following is
the most appropriate recommendation?
A) Administer MMR vaccine now to ensure immunity
B) Recheck rubella IgG titers in the third trimester
C) Reassure that she is immune and recommend postpartum vaccination if needed
D) Advise termination due to risk of congenital rubella syndrome
Answer: C
Rationale: A positive rubella IgG indicates immunity, so no vaccination is needed
during pregnancy. MMR is a live vaccine and is contraindicated during pregnancy.
Rechecking titers is unnecessary. Since she is immune, there is no risk of congenital
rubella syndrome, so termination is not indicated.
9 Which of the following represents the most appropriate management for a woman
who presents at 9 weeks gestation with a hemoglobin of 9.4 g/dL and a mean
corpuscular volume (MCV) of 72 fL?
A) Initiate oral iron supplementation and recheck hemoglobin in 4 weeks
B) Order hemoglobin electrophoresis to rule out thalassemia
C) Administer parenteral iron if oral iron is poorly tolerated
D) Perform serum ferritin and C-reactive protein testing to confirm iron deficiency
Answer: D
Rationale: Microcytic anemia in pregnancy is most commonly due to iron deficiency,
but thalassemia and anemia of chronic disease are differentials. Serum ferritin (with
CRP to interpret) is the recommended initial diagnostic test to confirm iron
deficiency before starting supplementation. While oral iron is often initiated
empirically, confirming the diagnosis is more appropriate, especially when MCV is
significantly low. Hemoglobin electrophoresis is not first-line unless ferritin is
normal.
10 A woman with a history of a prior preterm birth at 32 weeks gestation is
currently at 14 weeks gestation. Which of the following interventions has been
shown to reduce the risk of recurrent preterm birth and is recommended as
first-line therapy?
