Final Exam: NU661/ NU 661 (Latest 2024/ 2025 Update) Primary Care of
Childbearing Woman Review| Qs & As | Grade A| 100% Correct (Verified
Answers)- Regis
Question 1
A 26-year-old female presents for a preconception visit. She reports a history of neural tube
defects in her family. Which dosage of folic acid should the Nurse Practitioner recommend
she begin taking daily?
A) 0.4 mg
B) 1 mg
C) 4 mg
D) 0.8 mg
E) 0.1 mg
Correct Answer: C) 4 mg
Rationale: While the standard prophylactic dose for women of childbearing age is 0.4 mg to
0.8 mg, women with a history of a previous pregnancy affected by a neural tube defect or a
strong family history are recommended to take a higher dosage of 4 mg daily starting at
least one month before conception and continuing through the first trimester to
significantly reduce the recurrence risk.
Question 2
During a first-trimester ultrasound, the "double bleb sign" is visualized. What clinical
significance does this finding hold?
A) It indicates a twin gestation with diamniotic/dichorionic sacs.
B) It confirms an ectopic pregnancy.
C) It is the earliest sonographic sign of an intrauterine pregnancy, consisting of the yolk sac and
amniotic sac.
D) It suggests a molar pregnancy.
E) It indicates a blighted ovum.
Correct Answer: C) It is the earliest sonographic sign of an intrauterine pregnancy,
consisting of the yolk sac and amniotic sac.
Rationale: The "double bleb sign" is a distinct sonographic appearance seen around 5.5 to
6 weeks of gestation. It consists of the yolk sac and the amniotic sac with the embryonic disc
between them. It confirms an early intrauterine pregnancy before the heartbeat is clearly
established.
Question 3
A pregnant patient at 32 weeks gestation presents with complaints of a sudden gush of fluid
followed by continuous leaking. Which diagnostic test is the gold standard for confirming
rupture of membranes (ROM)?
A) Nitrazine paper test
B) Ferning test
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C) Speculum examination for pooling
D) Amnisure (PAMG-1) test
E) Ultrasound for amniotic fluid index
Correct Answer: D) Amnisure (PAMG-1) test
Rationale: While ferning and nitrazine are commonly used, the Amnisure test detects the
Placental Alpha Microglobulin-1 (PAMG-1) protein and is considered the most sensitive
and specific (gold standard) rapid test for diagnosing rupture of membranes, especially
when clinical signs are equivocal.
Question 4
Which vaccine is strictly contraindicated during pregnancy due to the theoretical risk of
teratogenicity?
A) Tdap (Tetanus, diphtheria, and pertussis)
B) Inactivated Influenza
C) MMR (Measles, Mumps, Rubella)
D) Hepatitis B
E) COVID-19 mRNA vaccine
Correct Answer: C) MMR (Measles, Mumps, Rubella)
Rationale: The MMR vaccine contains live attenuated viruses. Live vaccines are
contraindicated during pregnancy because of the theoretical risk of transmission of the
virus to the fetus. Women should be advised to avoid pregnancy for at least 28 days after
receiving the MMR vaccine.
Question 5
A patient at 10 weeks gestation asks about the safety of eating seafood. Which advice is
most appropriate regarding methylmercury exposure?
A) Avoid all seafood until after delivery.
B) Avoid shark, swordfish, king mackerel, and tilefish.
C) Limit tuna consumption to 6 ounces of albacore per week.
D) Eat only raw shellfish to preserve nutrients.
E) Both B and C.
Correct Answer: E) Both B and C.
Rationale: Pregnant women should avoid high-mercury fish like shark, swordfish, king
mackerel, and tilefish. They can eat up to 12 ounces of low-mercury fish (like shrimp,
salmon, pollock, and catfish) per week. Albacore ("white") tuna has more mercury than
canned light tuna, so it should be limited to 6 ounces per week.
Question 6
A 30-year-old G2P1001 presents at 24 weeks gestation. Her fundal height measures 28 cm.
What is the most appropriate initial management step?
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A) Schedule an immediate induction of labor.
B) Reassure the patient this is a normal variation.
C) Order an ultrasound to assess fetal growth and amniotic fluid volume.
D) Perform a sterile vaginal exam.
E) Prescribe prophylactic antibiotics.
Correct Answer: C) Order an ultrasound to assess fetal growth and amniotic fluid volume.
Rationale: A discrepancy of more than 2-3 cm between fundal height and gestational age
requires further investigation. Measuring 28 cm at 24 weeks suggests "large for dates,"
which could indicate polyhydramnios, macrosomia, multiple gestation, or a molar
pregnancy. An ultrasound is the diagnostic tool of choice to determine the etiology.
Question 7
Which physiological change in the cardiovascular system is expected during a normal
pregnancy?
A) Systemic vascular resistance increases by 20%.
B) Blood volume increases by 40-50%.
C) Blood pressure significantly increases in the second trimester.
D) Resting heart rate decreases by 10-15 beats per minute.
E) Cardiac output decreases by 10%.
Correct Answer: B) Blood volume increases by 40-50%.
Rationale: During pregnancy, maternal blood volume increases by approximately 40-50%
to meet the metabolic demands of the fetus and protect against blood loss during delivery.
Systemic vascular resistance typically decreases, and resting heart rate increases by 10-20
beats per minute.
Question 8
A patient at 36 weeks gestation presents with painless, bright red vaginal bleeding. Which
intervention is absolutely contraindicated?
A) Continuous fetal monitoring.
B) Transabdominal ultrasound.
C) Digital cervical examination.
D) Drawing a CBC and type and screen.
E) Establishing IV access.
Correct Answer: C) Digital cervical examination.
Rationale: Painless bright red bleeding in the third trimester is the hallmark sign of
placenta previa. A digital cervical exam is contraindicated because it can disrupt the
placenta and cause catastrophic hemorrhage. Diagnosis should first be confirmed via
ultrasound.
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Question 9
You are managing a patient with Gestational Diabetes Mellitus (GDM) A2 (requiring
medication). Which antenatal testing regimen is standard for this patient starting at 32
weeks?
A) Monthly growth ultrasounds only.
B) Twice weekly Non-Stress Tests (NSTs) or Biophysical Profiles (BPPs).
C) Daily kick counts only.
D) Induction of labor at 37 weeks.
E) No specific testing is required if blood sugars are controlled.
Correct Answer: B) Twice weekly Non-Stress Tests (NSTs) or Biophysical Profiles (BPPs).
Rationale: Patients with GDM requiring medication (A2) are at higher risk for intrauterine
fetal demise. Standard of care typically involves twice-weekly fetal surveillance (NST or
BPP) starting at 32 weeks gestation to monitor fetal well-being.
Question 10
A woman presents with a "fishy" vaginal odor, especially after intercourse. A wet mount
reveals clue cells. What is the most likely diagnosis and treatment?
A) Candidiasis; Fluconazole
B) Trichomoniasis; Metronidazole
C) Bacterial Vaginosis; Metronidazole
D) Gonorrhea; Ceftriaxone
E) Chlamydia; Azithromycin
Correct Answer: C) Bacterial Vaginosis; Metronidazole
Rationale: Bacterial Vaginosis (BV) is characterized by a thin, greyish-white discharge, a
positive "whiff" test (fishy odor with KOH), and the presence of clue cells on microscopy.
Metronidazole (oral or vaginal) is the treatment of choice. Treatment is indicated in
symptomatic pregnant women to reduce the risk of preterm labor.
Question 11
According to the 2024/2025 guidelines, when should screening for Group B Streptococcus
(GBS) typically occur?
A) 12-14 weeks
B) 20-24 weeks
C) 28-32 weeks
D) 36-37 weeks
E) Only upon admission for labor
Correct Answer: D) 36-37 weeks
Rationale: Universal screening for rectovaginal GBS colonization is recommended for all
pregnant women at 36 0/7 to 37 6/7 weeks of gestation. This allows for timely identification
and intrapartum antibiotic prophylaxis to prevent early-onset neonatal GBS sepsis.
Childbearing Woman Review| Qs & As | Grade A| 100% Correct (Verified
Answers)- Regis
Question 1
A 26-year-old female presents for a preconception visit. She reports a history of neural tube
defects in her family. Which dosage of folic acid should the Nurse Practitioner recommend
she begin taking daily?
A) 0.4 mg
B) 1 mg
C) 4 mg
D) 0.8 mg
E) 0.1 mg
Correct Answer: C) 4 mg
Rationale: While the standard prophylactic dose for women of childbearing age is 0.4 mg to
0.8 mg, women with a history of a previous pregnancy affected by a neural tube defect or a
strong family history are recommended to take a higher dosage of 4 mg daily starting at
least one month before conception and continuing through the first trimester to
significantly reduce the recurrence risk.
Question 2
During a first-trimester ultrasound, the "double bleb sign" is visualized. What clinical
significance does this finding hold?
A) It indicates a twin gestation with diamniotic/dichorionic sacs.
B) It confirms an ectopic pregnancy.
C) It is the earliest sonographic sign of an intrauterine pregnancy, consisting of the yolk sac and
amniotic sac.
D) It suggests a molar pregnancy.
E) It indicates a blighted ovum.
Correct Answer: C) It is the earliest sonographic sign of an intrauterine pregnancy,
consisting of the yolk sac and amniotic sac.
Rationale: The "double bleb sign" is a distinct sonographic appearance seen around 5.5 to
6 weeks of gestation. It consists of the yolk sac and the amniotic sac with the embryonic disc
between them. It confirms an early intrauterine pregnancy before the heartbeat is clearly
established.
Question 3
A pregnant patient at 32 weeks gestation presents with complaints of a sudden gush of fluid
followed by continuous leaking. Which diagnostic test is the gold standard for confirming
rupture of membranes (ROM)?
A) Nitrazine paper test
B) Ferning test
,[Type here]
C) Speculum examination for pooling
D) Amnisure (PAMG-1) test
E) Ultrasound for amniotic fluid index
Correct Answer: D) Amnisure (PAMG-1) test
Rationale: While ferning and nitrazine are commonly used, the Amnisure test detects the
Placental Alpha Microglobulin-1 (PAMG-1) protein and is considered the most sensitive
and specific (gold standard) rapid test for diagnosing rupture of membranes, especially
when clinical signs are equivocal.
Question 4
Which vaccine is strictly contraindicated during pregnancy due to the theoretical risk of
teratogenicity?
A) Tdap (Tetanus, diphtheria, and pertussis)
B) Inactivated Influenza
C) MMR (Measles, Mumps, Rubella)
D) Hepatitis B
E) COVID-19 mRNA vaccine
Correct Answer: C) MMR (Measles, Mumps, Rubella)
Rationale: The MMR vaccine contains live attenuated viruses. Live vaccines are
contraindicated during pregnancy because of the theoretical risk of transmission of the
virus to the fetus. Women should be advised to avoid pregnancy for at least 28 days after
receiving the MMR vaccine.
Question 5
A patient at 10 weeks gestation asks about the safety of eating seafood. Which advice is
most appropriate regarding methylmercury exposure?
A) Avoid all seafood until after delivery.
B) Avoid shark, swordfish, king mackerel, and tilefish.
C) Limit tuna consumption to 6 ounces of albacore per week.
D) Eat only raw shellfish to preserve nutrients.
E) Both B and C.
Correct Answer: E) Both B and C.
Rationale: Pregnant women should avoid high-mercury fish like shark, swordfish, king
mackerel, and tilefish. They can eat up to 12 ounces of low-mercury fish (like shrimp,
salmon, pollock, and catfish) per week. Albacore ("white") tuna has more mercury than
canned light tuna, so it should be limited to 6 ounces per week.
Question 6
A 30-year-old G2P1001 presents at 24 weeks gestation. Her fundal height measures 28 cm.
What is the most appropriate initial management step?
,[Type here]
A) Schedule an immediate induction of labor.
B) Reassure the patient this is a normal variation.
C) Order an ultrasound to assess fetal growth and amniotic fluid volume.
D) Perform a sterile vaginal exam.
E) Prescribe prophylactic antibiotics.
Correct Answer: C) Order an ultrasound to assess fetal growth and amniotic fluid volume.
Rationale: A discrepancy of more than 2-3 cm between fundal height and gestational age
requires further investigation. Measuring 28 cm at 24 weeks suggests "large for dates,"
which could indicate polyhydramnios, macrosomia, multiple gestation, or a molar
pregnancy. An ultrasound is the diagnostic tool of choice to determine the etiology.
Question 7
Which physiological change in the cardiovascular system is expected during a normal
pregnancy?
A) Systemic vascular resistance increases by 20%.
B) Blood volume increases by 40-50%.
C) Blood pressure significantly increases in the second trimester.
D) Resting heart rate decreases by 10-15 beats per minute.
E) Cardiac output decreases by 10%.
Correct Answer: B) Blood volume increases by 40-50%.
Rationale: During pregnancy, maternal blood volume increases by approximately 40-50%
to meet the metabolic demands of the fetus and protect against blood loss during delivery.
Systemic vascular resistance typically decreases, and resting heart rate increases by 10-20
beats per minute.
Question 8
A patient at 36 weeks gestation presents with painless, bright red vaginal bleeding. Which
intervention is absolutely contraindicated?
A) Continuous fetal monitoring.
B) Transabdominal ultrasound.
C) Digital cervical examination.
D) Drawing a CBC and type and screen.
E) Establishing IV access.
Correct Answer: C) Digital cervical examination.
Rationale: Painless bright red bleeding in the third trimester is the hallmark sign of
placenta previa. A digital cervical exam is contraindicated because it can disrupt the
placenta and cause catastrophic hemorrhage. Diagnosis should first be confirmed via
ultrasound.
, [Type here]
Question 9
You are managing a patient with Gestational Diabetes Mellitus (GDM) A2 (requiring
medication). Which antenatal testing regimen is standard for this patient starting at 32
weeks?
A) Monthly growth ultrasounds only.
B) Twice weekly Non-Stress Tests (NSTs) or Biophysical Profiles (BPPs).
C) Daily kick counts only.
D) Induction of labor at 37 weeks.
E) No specific testing is required if blood sugars are controlled.
Correct Answer: B) Twice weekly Non-Stress Tests (NSTs) or Biophysical Profiles (BPPs).
Rationale: Patients with GDM requiring medication (A2) are at higher risk for intrauterine
fetal demise. Standard of care typically involves twice-weekly fetal surveillance (NST or
BPP) starting at 32 weeks gestation to monitor fetal well-being.
Question 10
A woman presents with a "fishy" vaginal odor, especially after intercourse. A wet mount
reveals clue cells. What is the most likely diagnosis and treatment?
A) Candidiasis; Fluconazole
B) Trichomoniasis; Metronidazole
C) Bacterial Vaginosis; Metronidazole
D) Gonorrhea; Ceftriaxone
E) Chlamydia; Azithromycin
Correct Answer: C) Bacterial Vaginosis; Metronidazole
Rationale: Bacterial Vaginosis (BV) is characterized by a thin, greyish-white discharge, a
positive "whiff" test (fishy odor with KOH), and the presence of clue cells on microscopy.
Metronidazole (oral or vaginal) is the treatment of choice. Treatment is indicated in
symptomatic pregnant women to reduce the risk of preterm labor.
Question 11
According to the 2024/2025 guidelines, when should screening for Group B Streptococcus
(GBS) typically occur?
A) 12-14 weeks
B) 20-24 weeks
C) 28-32 weeks
D) 36-37 weeks
E) Only upon admission for labor
Correct Answer: D) 36-37 weeks
Rationale: Universal screening for rectovaginal GBS colonization is recommended for all
pregnant women at 36 0/7 to 37 6/7 weeks of gestation. This allows for timely identification
and intrapartum antibiotic prophylaxis to prevent early-onset neonatal GBS sepsis.
