Test Bank For Primary Care of Women 2nd Edition By Barbara
K. Hackley 9781284045970 Chapter 1-26 Complete Guide .
A 24-year-old female presents to the clinic complaining of nausea and headache for
the last week. She denies any fever, changes in bowel movements, or sinus
symptoms. She is sexually active with one partner, and admits to not being
consistent with her birth control pills. She does not remember the date of her last
menstrual period, and reports a history of irregular menstrual cycles. She has not
taken a home pregnancy test. Her vital signs reveal a blood pressure of 124/76
mmHg, a pulse of 78/min, respirations of 20/min, temperature of 98.1o F (taken
orally), and an oxygen saturation of 98% on room air. The first most appropriate step
in management is to:
A. Obtain a urine hCG.
B. Admit the patient to the hospital for monitoring.
C. Obtain a serial serum hCG.
D. Perform a pelvic exam to test for sexually transmitted infections.
E. Ask the patient to return to the clinic after she has taken a home pregnancy test,
and - ANSWER: A. Obtain a urine hCG.
Obtaining a urine hCG is the most appropriate first step in the case of a female of
childbearing age, whose history includes the patient unable to remember her LMP
date and is inconsistent with her contraception method. Admission to the hospital is
unnecessary, as her vital signs are normal and her symptoms not life-threatening.
Serial serum hCG tests are used when monitoring fetal viability, not to make the
diagnosis of pregnancy. The patient does not complain of symptoms that would
indicate a sexually transmitted infection, and if pregnancy can be confirmed in the
office, it would make no sense to send her home to take a home pregnancy test.
A 31-year-old female, G1P0 at 26 weeks gestation, presents to the clinic for her
gestational diabetes screening. Her pregnancy has been uncomplicated. Vital signs
are stable. Which of the following would require a follow up three-hour glucose
tolerance test?
A. Fasting serum glucose concentration of 91 mg/dL
B. Fasting serum glucose concentration of 112 mg/dL, and a one-hour serum glucose
concentration of 128 mg/dL
C. Two-hour serum glucose concentration of 146 mg/dL
D. Fasting serum glucose concentration of 113 mg/dL, and a two-hour serum glucose
concentration of 134 mg/dL
E. Fasting serum glucose concentration of 130 mg/dL, and a one-hour serum glucose
concentration of 158 mg/dL - ANSWER: E. Fasting serum glucose concentration of
130 mg/dL, and a one-hour serum glucose concentration of 158 mg/dL
Screening for gestational diabetes is usually performed between 24 and 28 weeks
gestation, using a fasting glucose and a one-hour glucose following a 50g glucose
load. If the fasting glucose is greater than 126 mg/dL, OR the one-hour glucose is
greater than 130mg/dL (90% sensitivity) or 140mg/dL (80% sensitivity), then the
patient is considered to have a positive result. In the case of a positive one-hour
, glucose, the patient should undergo a three-hour GTT with a 100g glucose load. Only
answer choice 'E' has a result that would require a follow up three-hour GTT.
A 27-year old female, G2P1, returns to the clinic for her second prenatal visit. Her
labs reveal that her blood type is A Rh-. She states she has done research online, and
is concerned that this pregnancy will result in her baby dying if it has a different
blood type than her own. To reassure the patient, you explain that her team of
health care providers will:
A. perform a cesarean section to prevent fetal demise
B. treat the baby with Rhogam within the first 72 hours after delivery to prevent
hemolytic anemia of the newborn
C. treat the mother with Rhogam when she is at 28-weeks gestation to prevent
development of antibodies against Rh+ antigens, and if it is determined the neonate
is Rh+, the mother will receive a second dose of Rhogam postpartum.
D. treat the mother with penicillin during labor to prevent transmission of gram-
positive bacteria
E. treat the mother with Rhogam when she is at 28-weeks gestation to p - ANSWER:
C. treat the mother with Rhogam when she is at 28-weeks gestation to prevent
development of antibodies against Rh+ antigens, and if it is determined the neonate
is Rh+, the mother will receive a second dose of Rhogam postpartum.
If a pregnant woman is Rh-, she is given Rhogam (anti-Rh antibodies) in order to
prevent sensitization of her immune system to the fetus' Rh+ antigens. Rhogam is
given at 28 weeks gestation, within 72 hours post delivery, or with any episode of
vaginal or intrauterine bleeding. If untreated, the antibody containing blood of a
sensitized Rh- mother may cross the placenta and cause hemolytic anemia in her Rh+
fetus. Answer C gives the correct time frame for administering Rhogam, as well as
the reason for giving Rhogam.
A 36-year-old female, G3P2 at 21 weeks gestation, returns to clinic for an ultrasound.
She currently smokes a half pack of cigarettes per day. Her last two children were
delivered by cesarean section. She reports no vaginal bleeding, no urinary
symptoms, and no fluid leaking. She states her baby moves "all the time." Her vitals
reveal a blood pressure of 130/74 mmHg, a temperature of 98.3o F, a pulse of 82, a
respiration rate of 18, and a pulse oximetry of 98%. The ultrasound reveals no fetal
abnormalities, but the location of the placenta is partially covering the cervical os.
The diagnosis and treatment plan is:
A. Placenta previa with immediate cesaerean section
B. Placenta previa with admittance to the hospital for fetal and maternal monitoring
C. Placenta previa with subsequent ultrasound surveillance to monitor for any
progression or resolution
D. Placenta previa with no additional education or counseling given - ANSWER: C.
Placenta previa with subsequent ultrasound surveillance to monitor for any
progression or resolution
Placenta previa is a condition in which the placenta is attached at a position that
gives it the potential to cover the cervical os. A pregnant woman with placenta
previa will usually present after 24 weeks gestation with painless vaginal bleeding. If
detected early in gestation, the condition has a higher chance of resolving without
K. Hackley 9781284045970 Chapter 1-26 Complete Guide .
A 24-year-old female presents to the clinic complaining of nausea and headache for
the last week. She denies any fever, changes in bowel movements, or sinus
symptoms. She is sexually active with one partner, and admits to not being
consistent with her birth control pills. She does not remember the date of her last
menstrual period, and reports a history of irregular menstrual cycles. She has not
taken a home pregnancy test. Her vital signs reveal a blood pressure of 124/76
mmHg, a pulse of 78/min, respirations of 20/min, temperature of 98.1o F (taken
orally), and an oxygen saturation of 98% on room air. The first most appropriate step
in management is to:
A. Obtain a urine hCG.
B. Admit the patient to the hospital for monitoring.
C. Obtain a serial serum hCG.
D. Perform a pelvic exam to test for sexually transmitted infections.
E. Ask the patient to return to the clinic after she has taken a home pregnancy test,
and - ANSWER: A. Obtain a urine hCG.
Obtaining a urine hCG is the most appropriate first step in the case of a female of
childbearing age, whose history includes the patient unable to remember her LMP
date and is inconsistent with her contraception method. Admission to the hospital is
unnecessary, as her vital signs are normal and her symptoms not life-threatening.
Serial serum hCG tests are used when monitoring fetal viability, not to make the
diagnosis of pregnancy. The patient does not complain of symptoms that would
indicate a sexually transmitted infection, and if pregnancy can be confirmed in the
office, it would make no sense to send her home to take a home pregnancy test.
A 31-year-old female, G1P0 at 26 weeks gestation, presents to the clinic for her
gestational diabetes screening. Her pregnancy has been uncomplicated. Vital signs
are stable. Which of the following would require a follow up three-hour glucose
tolerance test?
A. Fasting serum glucose concentration of 91 mg/dL
B. Fasting serum glucose concentration of 112 mg/dL, and a one-hour serum glucose
concentration of 128 mg/dL
C. Two-hour serum glucose concentration of 146 mg/dL
D. Fasting serum glucose concentration of 113 mg/dL, and a two-hour serum glucose
concentration of 134 mg/dL
E. Fasting serum glucose concentration of 130 mg/dL, and a one-hour serum glucose
concentration of 158 mg/dL - ANSWER: E. Fasting serum glucose concentration of
130 mg/dL, and a one-hour serum glucose concentration of 158 mg/dL
Screening for gestational diabetes is usually performed between 24 and 28 weeks
gestation, using a fasting glucose and a one-hour glucose following a 50g glucose
load. If the fasting glucose is greater than 126 mg/dL, OR the one-hour glucose is
greater than 130mg/dL (90% sensitivity) or 140mg/dL (80% sensitivity), then the
patient is considered to have a positive result. In the case of a positive one-hour
, glucose, the patient should undergo a three-hour GTT with a 100g glucose load. Only
answer choice 'E' has a result that would require a follow up three-hour GTT.
A 27-year old female, G2P1, returns to the clinic for her second prenatal visit. Her
labs reveal that her blood type is A Rh-. She states she has done research online, and
is concerned that this pregnancy will result in her baby dying if it has a different
blood type than her own. To reassure the patient, you explain that her team of
health care providers will:
A. perform a cesarean section to prevent fetal demise
B. treat the baby with Rhogam within the first 72 hours after delivery to prevent
hemolytic anemia of the newborn
C. treat the mother with Rhogam when she is at 28-weeks gestation to prevent
development of antibodies against Rh+ antigens, and if it is determined the neonate
is Rh+, the mother will receive a second dose of Rhogam postpartum.
D. treat the mother with penicillin during labor to prevent transmission of gram-
positive bacteria
E. treat the mother with Rhogam when she is at 28-weeks gestation to p - ANSWER:
C. treat the mother with Rhogam when she is at 28-weeks gestation to prevent
development of antibodies against Rh+ antigens, and if it is determined the neonate
is Rh+, the mother will receive a second dose of Rhogam postpartum.
If a pregnant woman is Rh-, she is given Rhogam (anti-Rh antibodies) in order to
prevent sensitization of her immune system to the fetus' Rh+ antigens. Rhogam is
given at 28 weeks gestation, within 72 hours post delivery, or with any episode of
vaginal or intrauterine bleeding. If untreated, the antibody containing blood of a
sensitized Rh- mother may cross the placenta and cause hemolytic anemia in her Rh+
fetus. Answer C gives the correct time frame for administering Rhogam, as well as
the reason for giving Rhogam.
A 36-year-old female, G3P2 at 21 weeks gestation, returns to clinic for an ultrasound.
She currently smokes a half pack of cigarettes per day. Her last two children were
delivered by cesarean section. She reports no vaginal bleeding, no urinary
symptoms, and no fluid leaking. She states her baby moves "all the time." Her vitals
reveal a blood pressure of 130/74 mmHg, a temperature of 98.3o F, a pulse of 82, a
respiration rate of 18, and a pulse oximetry of 98%. The ultrasound reveals no fetal
abnormalities, but the location of the placenta is partially covering the cervical os.
The diagnosis and treatment plan is:
A. Placenta previa with immediate cesaerean section
B. Placenta previa with admittance to the hospital for fetal and maternal monitoring
C. Placenta previa with subsequent ultrasound surveillance to monitor for any
progression or resolution
D. Placenta previa with no additional education or counseling given - ANSWER: C.
Placenta previa with subsequent ultrasound surveillance to monitor for any
progression or resolution
Placenta previa is a condition in which the placenta is attached at a position that
gives it the potential to cover the cervical os. A pregnant woman with placenta
previa will usually present after 24 weeks gestation with painless vaginal bleeding. If
detected early in gestation, the condition has a higher chance of resolving without
