NR602 PRIMARY CARE OF THE
CHILDBEARING AND CHILDREARING
FAMILY ADVANCED PRACTICE EXAM
1. A 28-year-old primigravida at 32 weeks gestation presents with a blood pressure of 145/95
mmHg and 1+ proteinuria on dipstick. She denies headaches or visual changes. Which of the
following is the most appropriate next step?
A. Immediate delivery via Cesarean section
B. Order a 24-hour urine collection for protein and creatinine clearance
C. Initiate oral antihypertensive therapy with Lisinopril
D. Diagnose chronic hypertension and follow up in two weeks
Answer: B
Conceptual Explanation: New onset hypertension and proteinuria after 20 weeks
gestation suggest preeclampsia. A 24-hour urine collection or protein/creatinine ratio is
required to confirm the diagnosis of proteinuria. ACE inhibitors like Lisinopril are
contraindicated in pregnancy.
,2. In evaluating a 6-month-old infant for developmental milestones, which of the following
findings would be considered a ‘red flag’ requiring further investigation?
A. Failure to roll from prone to supine
B. Inability to sit unsupported
C. Lack of social smiling
D. Inability to pincher grasp small objects
Answer: A
Conceptual Explanation: Most infants roll from prone to supine by 4 months and supine
to prone by 5-6 months. Failure to roll by 6 months is a developmental delay. Sitting
unsupported is usually an 8-9 month milestone, and pincher grasp is 9-10 months.
3. A 34-year-old female presents with irregular menses, hirsutism, and a BMI of 31.
Laboratory results show elevated testosterone levels and a normal TSH. To confirm Polycystic
Ovary Syndrome (PCOS) using the Rotterdam criteria, how many criteria must be met?
A. Two out of three
B. One out of three
C. All three
D. Four including metabolic syndrome
Answer: A
, Conceptual Explanation: The Rotterdam criteria require two of the following three: oligo-
or anovulation, clinical and/or biochemical signs of hyperandrogenism, and polycystic
ovaries on ultrasound.
4. At a 24-week prenatal visit, the fundal height is measured at 28 cm. After ensuring the
bladder is empty, what is the most appropriate next step?
A. Schedule a repeat measurement in 4 weeks
B. Advise the patient to increase caloric intake immediately
C. Order an obstetric ultrasound for fetal growth assessment
D. Perform a glucose challenge test immediately
Answer: C
Conceptual Explanation: Fundal height should correlate with gestational age (+/- 2 cm)
between 20 and 36 weeks. A discrepancy of 4 cm (size greater than dates) necessitates an
ultrasound to evaluate for polyhydramnios, macrosomia, or multiple gestation.
5. A 14-year-old female presents for a well-child exam. During the physical exam, the
practitioner notes breast budding and the appearance of pubic hair. According to Tanner
Staging, which stage is she most likely in?
A. Tanner Stage 1
B. Tanner Stage 4
C. Tanner Stage 2
CHILDBEARING AND CHILDREARING
FAMILY ADVANCED PRACTICE EXAM
1. A 28-year-old primigravida at 32 weeks gestation presents with a blood pressure of 145/95
mmHg and 1+ proteinuria on dipstick. She denies headaches or visual changes. Which of the
following is the most appropriate next step?
A. Immediate delivery via Cesarean section
B. Order a 24-hour urine collection for protein and creatinine clearance
C. Initiate oral antihypertensive therapy with Lisinopril
D. Diagnose chronic hypertension and follow up in two weeks
Answer: B
Conceptual Explanation: New onset hypertension and proteinuria after 20 weeks
gestation suggest preeclampsia. A 24-hour urine collection or protein/creatinine ratio is
required to confirm the diagnosis of proteinuria. ACE inhibitors like Lisinopril are
contraindicated in pregnancy.
,2. In evaluating a 6-month-old infant for developmental milestones, which of the following
findings would be considered a ‘red flag’ requiring further investigation?
A. Failure to roll from prone to supine
B. Inability to sit unsupported
C. Lack of social smiling
D. Inability to pincher grasp small objects
Answer: A
Conceptual Explanation: Most infants roll from prone to supine by 4 months and supine
to prone by 5-6 months. Failure to roll by 6 months is a developmental delay. Sitting
unsupported is usually an 8-9 month milestone, and pincher grasp is 9-10 months.
3. A 34-year-old female presents with irregular menses, hirsutism, and a BMI of 31.
Laboratory results show elevated testosterone levels and a normal TSH. To confirm Polycystic
Ovary Syndrome (PCOS) using the Rotterdam criteria, how many criteria must be met?
A. Two out of three
B. One out of three
C. All three
D. Four including metabolic syndrome
Answer: A
, Conceptual Explanation: The Rotterdam criteria require two of the following three: oligo-
or anovulation, clinical and/or biochemical signs of hyperandrogenism, and polycystic
ovaries on ultrasound.
4. At a 24-week prenatal visit, the fundal height is measured at 28 cm. After ensuring the
bladder is empty, what is the most appropriate next step?
A. Schedule a repeat measurement in 4 weeks
B. Advise the patient to increase caloric intake immediately
C. Order an obstetric ultrasound for fetal growth assessment
D. Perform a glucose challenge test immediately
Answer: C
Conceptual Explanation: Fundal height should correlate with gestational age (+/- 2 cm)
between 20 and 36 weeks. A discrepancy of 4 cm (size greater than dates) necessitates an
ultrasound to evaluate for polyhydramnios, macrosomia, or multiple gestation.
5. A 14-year-old female presents for a well-child exam. During the physical exam, the
practitioner notes breast budding and the appearance of pubic hair. According to Tanner
Staging, which stage is she most likely in?
A. Tanner Stage 1
B. Tanner Stage 4
C. Tanner Stage 2
