NU 661 Exam 4 V2 | NU 661 Primary Care
of Childbearing Woman | Actual Q&A with
Rationale (NU661 Exam 4) | Regis
1. A 24-year-old primigravida presents for her initial prenatal visit at 10 weeks gestation.
According to standard ACOG guidelines and the Regis curriculum, which of the following
laboratory tests should be included in the initial prenatal screening panel? (Select all that
apply)
A. Complete Blood Count (CBC)
B. Blood Type and Rh factor
C. Syphilis screening (RPR/VDRL)
D. Hepatitis B Surface Antigen (HBsAg)
E. Group B Streptococcus (GBS) culture
F. Rubella immunity status
Correct Answer: A, B, C, D, F
The initial prenatal visit requires a comprehensive screening panel to identify baseline
health status and potential risks. CBC, Blood Type/Rh, Syphilis, Hep B, and Rubella are
standard at the first visit to screen for anemia, blood incompatibilities, and infectious
diseases. Group B Strep (GBS) is generally not screened until 36 0/7 to 37 6/7 weeks
gestation unless the patient has a history of GBS bacteriuria in the current pregnancy.
,2. A patient reports her last menstrual period (LMP) began on April 12th. Using Naegele’s
Rule, what is her estimated date of delivery (EDD)?
A. January 12th
B. January 19th
C. January 5th
D. January 26th
Correct Answer: B
Naegele’s Rule provides a standardized method for calculating the estimated date of
delivery by adding seven days to the first day of the LMP and subtracting three months. For
an LMP of April 12th, adding 7 days results in April 19th, and subtracting 3 months brings
the date to January 19th. This calculation assumes a regular 28-day menstrual cycle and
remains a primary tool in clinical obstetric practice.
3. Which of the following physical exam findings is considered a ‘probable’ sign of pregnancy?
A. Amenorrhea
B. Goodell’s sign
C. Fetal heart tones heard via Doppler
D. Nausea and vomiting
Correct Answer: B
, Probable signs of pregnancy are objective findings observed by the clinician, such as
Goodell’s sign (softening of the cervix) or Hegar’s sign. Amenorrhea and nausea are
presumptive signs, which are subjective feelings reported by the patient. Fetal heart tones
are a positive sign of pregnancy, as they provide definitive evidence of a live fetus.
4. A patient at 28 weeks gestation presents for a follow-up. Her fundal height measures 32
cm. What is the most appropriate next step for the clinician?
A. Order an ultrasound to assess fetal growth and amniotic fluid volume
B. Document the finding as normal for this gestational age
C. Schedule a follow-up in one week to re-measure
D. Initiate immediate induction of labor
Correct Answer: A
Between 20 and 36 weeks gestation, fundal height in centimeters should roughly equal
the number of weeks of gestation within a 2 cm margin. A measurement of 32 cm at 28
weeks represents a 4 cm discrepancy, which is significant and requires further
investigation. An ultrasound is necessary to evaluate for polyhydramnios, macrosomia, or
multiple gestations.
5. A 32-year-old G2P1 at 36 weeks gestation presents with sudden onset, painful vaginal
bleeding and a firm, tender uterus. Which condition should the nurse practitioner suspect
first?
A. Placenta Previa
, B. Cervix insufficiency
C. Placental Abruption
D. Vasa Previa
Correct Answer: C
Placental abruption is classically characterized by painful vaginal bleeding and uterine
tenderness or rigidity. This differs from placenta previa, which typically involves painless
vaginal bleeding. Immediate assessment is required as abruption can lead to fetal distress
and maternal hemorrhage.
6. According to the CDC and ACOG, when should a pregnant woman be screened for Group B
Streptococcus (GBS)?
A. 24-28 weeks gestation
B. 36 0/7 to 37 6/7 weeks gestation
C. 12-16 weeks gestation
D. At the onset of labor only
Correct Answer: B
The current standard of care dictates universal GBS screening between 36 0/7 and 37 6/7
weeks gestation. This window ensures the results are valid for the most likely time of
delivery, as the colonization status can change over time. If a patient tests positive,
of Childbearing Woman | Actual Q&A with
Rationale (NU661 Exam 4) | Regis
1. A 24-year-old primigravida presents for her initial prenatal visit at 10 weeks gestation.
According to standard ACOG guidelines and the Regis curriculum, which of the following
laboratory tests should be included in the initial prenatal screening panel? (Select all that
apply)
A. Complete Blood Count (CBC)
B. Blood Type and Rh factor
C. Syphilis screening (RPR/VDRL)
D. Hepatitis B Surface Antigen (HBsAg)
E. Group B Streptococcus (GBS) culture
F. Rubella immunity status
Correct Answer: A, B, C, D, F
The initial prenatal visit requires a comprehensive screening panel to identify baseline
health status and potential risks. CBC, Blood Type/Rh, Syphilis, Hep B, and Rubella are
standard at the first visit to screen for anemia, blood incompatibilities, and infectious
diseases. Group B Strep (GBS) is generally not screened until 36 0/7 to 37 6/7 weeks
gestation unless the patient has a history of GBS bacteriuria in the current pregnancy.
,2. A patient reports her last menstrual period (LMP) began on April 12th. Using Naegele’s
Rule, what is her estimated date of delivery (EDD)?
A. January 12th
B. January 19th
C. January 5th
D. January 26th
Correct Answer: B
Naegele’s Rule provides a standardized method for calculating the estimated date of
delivery by adding seven days to the first day of the LMP and subtracting three months. For
an LMP of April 12th, adding 7 days results in April 19th, and subtracting 3 months brings
the date to January 19th. This calculation assumes a regular 28-day menstrual cycle and
remains a primary tool in clinical obstetric practice.
3. Which of the following physical exam findings is considered a ‘probable’ sign of pregnancy?
A. Amenorrhea
B. Goodell’s sign
C. Fetal heart tones heard via Doppler
D. Nausea and vomiting
Correct Answer: B
, Probable signs of pregnancy are objective findings observed by the clinician, such as
Goodell’s sign (softening of the cervix) or Hegar’s sign. Amenorrhea and nausea are
presumptive signs, which are subjective feelings reported by the patient. Fetal heart tones
are a positive sign of pregnancy, as they provide definitive evidence of a live fetus.
4. A patient at 28 weeks gestation presents for a follow-up. Her fundal height measures 32
cm. What is the most appropriate next step for the clinician?
A. Order an ultrasound to assess fetal growth and amniotic fluid volume
B. Document the finding as normal for this gestational age
C. Schedule a follow-up in one week to re-measure
D. Initiate immediate induction of labor
Correct Answer: A
Between 20 and 36 weeks gestation, fundal height in centimeters should roughly equal
the number of weeks of gestation within a 2 cm margin. A measurement of 32 cm at 28
weeks represents a 4 cm discrepancy, which is significant and requires further
investigation. An ultrasound is necessary to evaluate for polyhydramnios, macrosomia, or
multiple gestations.
5. A 32-year-old G2P1 at 36 weeks gestation presents with sudden onset, painful vaginal
bleeding and a firm, tender uterus. Which condition should the nurse practitioner suspect
first?
A. Placenta Previa
, B. Cervix insufficiency
C. Placental Abruption
D. Vasa Previa
Correct Answer: C
Placental abruption is classically characterized by painful vaginal bleeding and uterine
tenderness or rigidity. This differs from placenta previa, which typically involves painless
vaginal bleeding. Immediate assessment is required as abruption can lead to fetal distress
and maternal hemorrhage.
6. According to the CDC and ACOG, when should a pregnant woman be screened for Group B
Streptococcus (GBS)?
A. 24-28 weeks gestation
B. 36 0/7 to 37 6/7 weeks gestation
C. 12-16 weeks gestation
D. At the onset of labor only
Correct Answer: B
The current standard of care dictates universal GBS screening between 36 0/7 and 37 6/7
weeks gestation. This window ensures the results are valid for the most likely time of
delivery, as the colonization status can change over time. If a patient tests positive,
