Pregnancy (physical assessment, pharm and
pathophysiology)
1. When should folic acid be initiated in a female patient contemplating
pregnancy if she is not taking it at this time?
A. Now
B. At the diagnosis of pregnancy
C. In the second trimester
D. In the third trimester - ANS - A. Now (Folic acid has been found to significantly
decrease the incidence of neural tube defects (NTDS). It should be supplemented
at a dosage of 0.4 mg daily in all women of childbearing age before becoming
pregnant. Folate plays an essential role in synthesis of amino acids and DNA.
Since these are critical in cell division and adequate amounts should be on board
when cell division begins, folic acid should be taken prior to conception,
whenever possible. NTDs are the second most common congenital anomaly.)
\2. Hyperemesis gravidarum is:
A. morning sickness.
B. persistent, intractable vomiting during pregnancy.
C. always associated with hydatiform mole.
D. indicative of multiple gestation. - ANS - B. persistent, intractable vomiting
during pregnancy. (Hyperemesis gravidarum (HEG) is a severe form of nausea
and vomiting that occurs during pregnancy. In contrast, morning sickness is
milder. A common definition used to define HEG is persistent vomiting that
produces a weight loss exceeding 5% of prepregnancy body weight. The
etiology of morning sickness and HEG is unknown.)
\3. Few pregnant patients actually deliver on their due dates. Why is a due date
established?
A. To evaluate fetal growth
B. For evaluation of maternal uterine size
C. For determination of adequate fetal nutrition
D. To determine timing of maternal/fetal screenings - ANS - D. To determine
timing of maternal/fetal screenings
(Accurate dating is critical so that maternal and fetal screening tests may be done
at the most appropriate time. If a screening test is supposed to take place at 20
, weeks, and it is done too early, the opportunity to identify an abnormality may be
missed. In the U.S., if a last menstrual period (LMP) cannot be established, or a
woman becomes pregnant while taking contraceptives, an ultrasound should be
performed to establish an accurate due date. Naegele's rule is an acceptable
means of predicting gestational age of the fetus. This calculated by adding 7 days
to the last menstrual period and subtracting 3 months.)
\4. A 24-year-old patient presents to your clinic with
intermittent nausea and vomiting for the past 5 days. She feels well otherwise.
She is afebrile. Her vital signs are within normal limits. What should the nurse
practitioner order initially?
A. CBC and urine for ketones
B. Electrolytes and qualitative beta hCG
C. Electrolytes and quantitative beta hCG
D. Metabolic panel and potassium level - ANS - B. Electrolytes and qualitative
beta hCG (There are a number of possible etiologies for her vomiting. Without
knowing her last menstrual period (and even if she reported one), pregnancy
must be ruled in or out. The other concem is her electrolyte status, especially her
potassium.)
\5. A patient in her frst trimester of pregnancy is found to be infected with
chlamydia and gonorrhea. Which statement below is true?
A. She should be treated now and rescreened later in pregnancy.
B. She should be treated in the second trimester.
C. She should be screened for other STDs later in pregnancy.
D. She should be treated now and rescreened if symptoms reappear. - ANS - A.
She should be treated now and rescreened later in pregnancy. (She should be
treated for chlamydia and gonorrhea now with azithromycin 1 gm orally in a
single dose and ceftriaxone 250 mg IM in a single dose. Since the percentage of
patients who become reinfected with an STD later in pregnancy (even after being
treated and educated) is great, this patient should be rescreened later in
pregnancy regardless of whether symptoms emerge. Deleterious effects can
occur if she is infected and left untreated.)
\6. Routine screening for gestational diabetes:
A. takes place only if the mother is symptomatic.
B. takes place at about 16-20 weeks.
C. takes place at about 24-28 weeks.
D. takes place routinely in each trimester. - ANS - C. takes place at about 24-28
weeks. (The routine time for screening is at 24 to 28 weeks. This has been
pathophysiology)
1. When should folic acid be initiated in a female patient contemplating
pregnancy if she is not taking it at this time?
A. Now
B. At the diagnosis of pregnancy
C. In the second trimester
D. In the third trimester - ANS - A. Now (Folic acid has been found to significantly
decrease the incidence of neural tube defects (NTDS). It should be supplemented
at a dosage of 0.4 mg daily in all women of childbearing age before becoming
pregnant. Folate plays an essential role in synthesis of amino acids and DNA.
Since these are critical in cell division and adequate amounts should be on board
when cell division begins, folic acid should be taken prior to conception,
whenever possible. NTDs are the second most common congenital anomaly.)
\2. Hyperemesis gravidarum is:
A. morning sickness.
B. persistent, intractable vomiting during pregnancy.
C. always associated with hydatiform mole.
D. indicative of multiple gestation. - ANS - B. persistent, intractable vomiting
during pregnancy. (Hyperemesis gravidarum (HEG) is a severe form of nausea
and vomiting that occurs during pregnancy. In contrast, morning sickness is
milder. A common definition used to define HEG is persistent vomiting that
produces a weight loss exceeding 5% of prepregnancy body weight. The
etiology of morning sickness and HEG is unknown.)
\3. Few pregnant patients actually deliver on their due dates. Why is a due date
established?
A. To evaluate fetal growth
B. For evaluation of maternal uterine size
C. For determination of adequate fetal nutrition
D. To determine timing of maternal/fetal screenings - ANS - D. To determine
timing of maternal/fetal screenings
(Accurate dating is critical so that maternal and fetal screening tests may be done
at the most appropriate time. If a screening test is supposed to take place at 20
, weeks, and it is done too early, the opportunity to identify an abnormality may be
missed. In the U.S., if a last menstrual period (LMP) cannot be established, or a
woman becomes pregnant while taking contraceptives, an ultrasound should be
performed to establish an accurate due date. Naegele's rule is an acceptable
means of predicting gestational age of the fetus. This calculated by adding 7 days
to the last menstrual period and subtracting 3 months.)
\4. A 24-year-old patient presents to your clinic with
intermittent nausea and vomiting for the past 5 days. She feels well otherwise.
She is afebrile. Her vital signs are within normal limits. What should the nurse
practitioner order initially?
A. CBC and urine for ketones
B. Electrolytes and qualitative beta hCG
C. Electrolytes and quantitative beta hCG
D. Metabolic panel and potassium level - ANS - B. Electrolytes and qualitative
beta hCG (There are a number of possible etiologies for her vomiting. Without
knowing her last menstrual period (and even if she reported one), pregnancy
must be ruled in or out. The other concem is her electrolyte status, especially her
potassium.)
\5. A patient in her frst trimester of pregnancy is found to be infected with
chlamydia and gonorrhea. Which statement below is true?
A. She should be treated now and rescreened later in pregnancy.
B. She should be treated in the second trimester.
C. She should be screened for other STDs later in pregnancy.
D. She should be treated now and rescreened if symptoms reappear. - ANS - A.
She should be treated now and rescreened later in pregnancy. (She should be
treated for chlamydia and gonorrhea now with azithromycin 1 gm orally in a
single dose and ceftriaxone 250 mg IM in a single dose. Since the percentage of
patients who become reinfected with an STD later in pregnancy (even after being
treated and educated) is great, this patient should be rescreened later in
pregnancy regardless of whether symptoms emerge. Deleterious effects can
occur if she is infected and left untreated.)
\6. Routine screening for gestational diabetes:
A. takes place only if the mother is symptomatic.
B. takes place at about 16-20 weeks.
C. takes place at about 24-28 weeks.
D. takes place routinely in each trimester. - ANS - C. takes place at about 24-28
weeks. (The routine time for screening is at 24 to 28 weeks. This has been
