NU 661 Exam 4 V1 | NU 661 Primary Care
of Childbearing Woman | Actual Q&A with
Rationale (NU661 Exam 4) | Regis
1. A 26-year-old primigravida at 32 weeks gestation presents with a headache that is not
relieved by Tylenol. Which of the following findings would indicate a diagnosis of
preeclampsia with severe features? (Select All That Apply)
A. Blood pressure of 162/112 mmHg
B. Platelet count of 95,000/mcL
C. Trace proteinuria on dipstick
D. Serum creatinine of 1.3 mg/dL
E. Right upper quadrant abdominal pain
F. Edema in the lower extremities
Correct Answer: A, B, D, E
Severe features of preeclampsia include a systolic blood pressure of 160 mmHg or higher
or a diastolic blood pressure of 110 mmHg or higher. Additionally, evidence of organ
dysfunction such as thrombocytopenia, renal insufficiency, and hepatic involvement
manifest as RUQ pain or elevated liver enzymes. Lower extremity edema and trace
proteinuria are no longer considered diagnostic criteria for severe features in current
clinical guidelines.
,2. When screening a pregnant woman for gestational diabetes mellitus (GDM) using the two-
step approach, what is the standard threshold for the 1-hour 50g glucose tolerance test (GTT)
that necessitates a 3-hour GTT?
A. 120 mg/dL
B. 160 mg/dL
C. 140 mg/dL
D. 180 mg/dL
Correct Answer: C
The standard screening for GDM typically occurs between 24 and 28 weeks of gestation. A
blood glucose level of 140 mg/dL or higher after a 50g oral glucose load is generally
considered a positive screen. Patients meeting this threshold must undergo a diagnostic 3-
hour 100g glucose tolerance test to confirm the diagnosis.
3. A patient at 36 weeks gestation is confirmed to be Group B Streptococcus (GBS) positive.
What is the appropriate management plan for this patient?
A. Immediate induction of labor
B. Oral penicillin daily until delivery
C. Stat Cesarean section
D. Intravenous penicillin G during labor
Correct Answer: D
, GBS colonization is common and requires intrapartum antibiotic prophylaxis to prevent
neonatal early-onset GBS disease. Penicillin G is the first-line agent and should be
administered intravenously once labor has started or membranes have ruptured.
Treatment before labor is not effective as the bacteria can quickly recolonize the birth
canal.
4. Which of the following are recognized risk factors for postpartum hemorrhage (PPH)?
(Select All That Apply)
A. Multiple gestation
B. Nulliparity
C. Chorioamnionitis
D. Polyhydramnios
E. Prolonged use of Oxytocin
Correct Answer: A, C, D, E
Uterine atony is the most common cause of postpartum hemorrhage, often driven by
overdistention of the uterus. Factors such as multiple gestation and polyhydramnios
stretch the uterine fibers, making it harder for them to contract effectively after birth.
Chorioamnionitis and muscle fatigue from prolonged oxytocin use also significantly
increase the risk of atonic bleeding.
, 5. A breastfeeding mother presents with a painful, erythematous, wedge-shaped area on her
right breast and a fever of 101.4 F. What is the most likely diagnosis?
A. Engorgement
B. Breast abscess
C. Plugged duct
D. Mastitis
Correct Answer: D
Mastitis is characterized by systemic symptoms like fever and chills combined with
localized breast pain and redness. It is distinct from a plugged duct, which typically lacks
the systemic febrile response and intense erythema. Treatment usually involves antibiotics
and continued frequent emptying of the breast through nursing or pumping.
6. During a fetal heart rate (FHR) assessment, you note late decelerations. Which of the
following is the primary physiological cause of this pattern?
A. Umbilical cord compression
B. Fetal head compression
C. Fetal sleep cycle
D. Uteroplacental insufficiency
Correct Answer: D
of Childbearing Woman | Actual Q&A with
Rationale (NU661 Exam 4) | Regis
1. A 26-year-old primigravida at 32 weeks gestation presents with a headache that is not
relieved by Tylenol. Which of the following findings would indicate a diagnosis of
preeclampsia with severe features? (Select All That Apply)
A. Blood pressure of 162/112 mmHg
B. Platelet count of 95,000/mcL
C. Trace proteinuria on dipstick
D. Serum creatinine of 1.3 mg/dL
E. Right upper quadrant abdominal pain
F. Edema in the lower extremities
Correct Answer: A, B, D, E
Severe features of preeclampsia include a systolic blood pressure of 160 mmHg or higher
or a diastolic blood pressure of 110 mmHg or higher. Additionally, evidence of organ
dysfunction such as thrombocytopenia, renal insufficiency, and hepatic involvement
manifest as RUQ pain or elevated liver enzymes. Lower extremity edema and trace
proteinuria are no longer considered diagnostic criteria for severe features in current
clinical guidelines.
,2. When screening a pregnant woman for gestational diabetes mellitus (GDM) using the two-
step approach, what is the standard threshold for the 1-hour 50g glucose tolerance test (GTT)
that necessitates a 3-hour GTT?
A. 120 mg/dL
B. 160 mg/dL
C. 140 mg/dL
D. 180 mg/dL
Correct Answer: C
The standard screening for GDM typically occurs between 24 and 28 weeks of gestation. A
blood glucose level of 140 mg/dL or higher after a 50g oral glucose load is generally
considered a positive screen. Patients meeting this threshold must undergo a diagnostic 3-
hour 100g glucose tolerance test to confirm the diagnosis.
3. A patient at 36 weeks gestation is confirmed to be Group B Streptococcus (GBS) positive.
What is the appropriate management plan for this patient?
A. Immediate induction of labor
B. Oral penicillin daily until delivery
C. Stat Cesarean section
D. Intravenous penicillin G during labor
Correct Answer: D
, GBS colonization is common and requires intrapartum antibiotic prophylaxis to prevent
neonatal early-onset GBS disease. Penicillin G is the first-line agent and should be
administered intravenously once labor has started or membranes have ruptured.
Treatment before labor is not effective as the bacteria can quickly recolonize the birth
canal.
4. Which of the following are recognized risk factors for postpartum hemorrhage (PPH)?
(Select All That Apply)
A. Multiple gestation
B. Nulliparity
C. Chorioamnionitis
D. Polyhydramnios
E. Prolonged use of Oxytocin
Correct Answer: A, C, D, E
Uterine atony is the most common cause of postpartum hemorrhage, often driven by
overdistention of the uterus. Factors such as multiple gestation and polyhydramnios
stretch the uterine fibers, making it harder for them to contract effectively after birth.
Chorioamnionitis and muscle fatigue from prolonged oxytocin use also significantly
increase the risk of atonic bleeding.
, 5. A breastfeeding mother presents with a painful, erythematous, wedge-shaped area on her
right breast and a fever of 101.4 F. What is the most likely diagnosis?
A. Engorgement
B. Breast abscess
C. Plugged duct
D. Mastitis
Correct Answer: D
Mastitis is characterized by systemic symptoms like fever and chills combined with
localized breast pain and redness. It is distinct from a plugged duct, which typically lacks
the systemic febrile response and intense erythema. Treatment usually involves antibiotics
and continued frequent emptying of the breast through nursing or pumping.
6. During a fetal heart rate (FHR) assessment, you note late decelerations. Which of the
following is the primary physiological cause of this pattern?
A. Umbilical cord compression
B. Fetal head compression
C. Fetal sleep cycle
D. Uteroplacental insufficiency
Correct Answer: D
