Module 2 Unit A-C Practice Quiz

Question 1

A patient is interested in getting pregnant in the next few months and presents for a preconception visit. Which of these factors should have the most significant effect on the clinician’s decision about performing a full physical exam?

a) Whether the person is between 25 and 34 years old
b) Whether a full physical exam has been performed recently
c) Whether the person has had a vaginal birth in the past.
d) Whether the person has a history of alcohol or drug abuse

Answer 1

Whether a full physical exam has been performed recently

[A full physical exam is not always necessary for preconception care. If a full physical exam was recently done, clinicians usually do not repeat it. If the clinician performs a preconception physical exam, the purpose is to identify conditions that can impact the pregnancy.]

Question 2

The clinician is seeing a person who plans to become pregnant sometime in the next year. While reviewing the patient’s vaccination history, the clinician notes that the patient never had a measles, mumps, rubella (MMR) vaccine. What should the clinician advise?

Answer 2

Get an MMR vaccine as soon as possible and wait at least one month before getting pregnant.

[This is correct! MMR is one of the most important vaccinations to encourage patients to get BEFORE PREGNANCY because it should be given at least one month prior to pregnancy.]

Question 3

Why is gonorrhea testing important for preconception patients at increased risk of being infected with gonorrhea?

Answer 3

Because untreated gonorrhea can increase risks of infertility and ectopic pregnancy.

[This is correct! Untreated gonorrhea can lead to pelvic inflammatory disease, tubal scarring, difficulty getting pregnant, and ectopic pregnancy.]

Question 4

A person is interested in getting pregnant soon. She reports that she and her partner are not mutually monogamous. Which of the following is it most important to screen this patient for as she prepares for pregnancy?

a) Cytolomegalovirus
b) Toxoplasmosis
c) Hepatitis A
d) Chlamydia

Answer 4

Chlamydia

[This is correct! As with gonorrhea, chlamydia is an STI that can lead to pelvic inflammatory disease, tubal scarring, difficulty getting pregnant, and ectopic pregnancy.]

Question 5

A patient is actively trying to get pregnant and presents for a preconception discussion in November. When discussing recommendations for influenza vaccination, what should the clinician advise?

Answer 5

Recommend getting a flu vaccine now, preferably an injected (inactivated) type, rather than a nasal mist type.

[This is correct. It is flu season, the flu vaccine is recommended and could be given to anyone at any point in the pregnancy.]

Question 6

A nurse who is planning to get pregnant soon tells the clinician that she has only received one hepatitis B vaccine so far since starting her first job out of nursing school. She wants to be protected from hepatitis B. What is the preferred approach to managing this nurse’s hepatitis B vaccine series?

Answer 6

Complete the series before becoming pregnant.

[It is ideal to complete the series prior to pregnancy. However, pregnancy is not a contraindication for Hepatitis B vaccination.]

Question 7

A patient seeking preconception care reports fatigue, dry skin, and constipation. Her previous pregnancy history includes 2 spontaneous abortions. Which laboratory screening should the clinician recommend based on this history?

Answer 7

Thyroid stimulating hormone (TSH)

[Correct! Unmanaged hypothyroidism is associated with fatigue, dry skin, constipation, and a greater risk for miscarriage.]

Question 8

A person who is HIV-positive is interested in getting pregnant. How should the CNM/WHNP approach preconception care for this patient?

Answer 8

The CNM/WHNP should ensure that this patient receives care from an interdisciplinary team led by an HIV specialist.

[Correct! HIV requires expert interdisciplinary management to achieve optimal health before conception and to reduce transmission to a future pregnancy.]

Question 9

The clinician is seeing a preconception patient whose BMI is 32.2. Which of the following is the most appropriate counseling for this patient?

a) “I recommend that you begin a weight-loss drug and plan to continue it until you establish a healthy weight gain pattern during your upcoming pregnancy.”
b) “There aren’t any significant risks to your upcoming pregnancy related to your weight.”
c) “Obesity increases the risks of pregnancy complications. I’m interested to know how you’re feeling about this topic?”
d) “You must get your BMI down to less than 30 or you are putting your health and your baby’s health at risk.”

Answer 9

“Obesity increases the risks of pregnancy complications. I’m interested to know how you’re feeling about this topic?”

[Correct! This answer provides factual information and also explores your patients readiness to discuss the subject. The question is open ended and allows the patient to discuss where they are in their health/weight loss journey.]

Question 10

A preconception patient reports that she was screened for cystic fibrosis with her last pregnancy and she is not a carrier. What should the clinician recommend at this time?

Answer 10

The patient does not need to be rescreened.

[Correct! Once a carrier screening has been performed it does not need to be repeated.]

Question 11

A woman who was born in 1992 received 2 doses of the varicella vaccine, on schedule and well-documented. Does this woman need to have labs drawn for varicella immunity during a preconception visit?

Answer 11

No, we assume immunity with documented varicella vaccination.

Question 12

A person with a mood disorder tells their CNM/WHNP that they are planning to become pregnant soon. What should the clinician recommend concerning medications for this person’s mood disorder?

Answer 12

Because untreated mood disorders have significant risks, the person should probably stay on the medications. The CNM/WHNP should confer with the patient’s mental health provider and with an obstetrician colleague.

Question 13

How should the clinician approach carrier screening for a preconception patient who identifies as Black?

Answer 13

The clinician should offer information about- and screening for all carrier conditions. (Ie pan-ethnic approach)

Question 14

A patient elected to have cystic fibrosis carrier screening during the preconception period and the results were negative. Does this eliminate the possibility that her offspring could have cystic fibrosis?

Answer 14

No, a mother who has a negative CF carrier screen has a greatly reduced chance of having offspring with CF but it’s possible that a rare mutation that wasn’t included in the test could cause CF in her offspring.

Question 15

If both prospective parents are Cystic Fibrosis (CF) carriers, the chance that they will have a child who is also a CF carrier is:

Answer 15

50%

Question 16

A woman presents for preconception care. She informs the CNM/WHNP that she does not want screening for cystic fibrosis (CF) because her other children do not have it and she and her partner are healthy. What is the most appropriate response?

Answer 16

“Each pregnancy carries a 25% chance of having a child with CF if you and your partner are carriers, regardless of whether or not your other children are affected.”

Question 17

True or false? When clinicians assess a person’s risk for developing a condition during an upcoming pregnancy, that risk assessment is primarily objective and not subject to clinician bias.

Answer 17

False

[The concept of “risk” is variable among individuals. Hannah Dahlen (a well-known midwifery researcher from Australia) says:

“The perception of risk is a subjective assessment that is made by people and is informed by what matters most to them, what has happened in their lives previously, how trusting they are of those providing information, and how much they perceive they have to lose or gain.” (Dahlen, H. (2016). The politicization of risk”. Midwifery , 38. p. 6).

A nurse in a level 3b NICU in South Bronx New York may have a different perception of risk than a patient who delivered all 4 our her children at home. Each individual’s unique experiences are valid, the key is letting the data guide our clinical decisions, and trying not to let our biases impair our ability to provide autonomist patient driven care.]

Question 18

Which of the following are potential outcomes of risk assessments for a person who is planning to get pregnant? [select all that apply]

a) A “high risk” label can cause a person to doubt their ability to have a successful pregnancy.
b) A health care provider might intervene when it is unnecessary.
c) The person might be viewed as having a condition, rather than simply being at risk for the condition.

Answer 18

All of them

Question 19

Which of these is an accurate statement regarding the relationship between a patient’s race and risks for specific outcomes?

a) Black individuals are at increased risk for specific health outcomes because of biological differences compared with white individuals.
c) Race is a social construct rather than a biological fact. Thus it is structural factors (racism) rather than race that leads to different outcomes.

Answer 19

Race is a social construct rather than a biological fact. Thus it is structural factors (racism) rather than race that leads to different outcomes.

Question 20

In the preconception module, our “genetic screening” focus is limited to carrier screening for inherited gene variants. We will study chromosome conditions and fetal anatomical conditions in subsequent modules. However, we want you to have these major categories clear in your mind now and throughout the course.

To help you know whether these categories are clear in your mind, match the 3 categories of conditions (inherited gene variants, chromosome conditions, and fetal anatomical conditions) with examples in each category.

Spina Bifida, Trisomy 21, Cystic Fibrosis

Answer 20

Inherited gene variant conditions- Cystic fibrosis

Chromosome conditions-Trisomy 21 (Down Syndrome)

Fetal anatomical development conditions-Spina bifida

Question 21

What is the major goal of offering carrier screening for inherited gene variants to patients in the preconception setting?

Answer 21

To give information that patients/couples can use to make reproductive decisions that are right for them.

Question 22

A patient in the preconception setting is interested in carrier screening for inherited gene variants. The patient is not aware of any family history of genetic conditions.

If the clinician uses the pan-ethnic approach to offering carrier screening, should cystic fibrosis (CF) be included in the screen and why?

Answer 22

Yes. Include CF because that is a recommended condition for pan-ethnic screening for all patients.

Question 23

True or false? We have strong evidence that getting 150 minutes of moderate physical activity per week is healthy AND we have strong evidence to guide the health promotion approaches clinicians should use to make that activity happen.

Answer 23

False

[Despite clear evidence of the benefits of being physically active during pregnancy, it is unknown what behavior change strategies are effective to increase or maintain physical activity during pregnancy.]

Question 24

True or false? The best approach to use for health promotion counseling is consistency, providing each patient the same information.

Answer 24

False

Question 25

True or false? The USPSTF states that there is no known evidence of harm in advising preconception patients to supplement with folic acid.

Answer 25

True

[The USPTF has the following grade A recommendation (There is high certainty that the net benefit is substantial):

Women who are planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400 to 800 µg) of folic acid.]

Question 26

According to the USPSTF, which health promotion approach has been shown to improve 6-month quit smoking rates?

Answer 26

FDA-approved drug therapies

[Among all adults, there is strong evidence that all forms of smoking cessation intervention (FDA-approved drug therapies and behavioral interventions) improve 6-month quit rates compared to usual care or minimal interventions.]

Question 27

What did the USPSTF identify as the evidence base for health promotion approaches for prenatal alcohol use?

Answer 27

Overall lack of evidence to evaluate benefits or harms

[No studies with sufficient quality evidence exist to indicate that screening for unhealthy alcohol use in pregnant women, reduces alcohol use, improves other risky behaviors, or reduces morbidity or mortality or improves other health, social, or legal outcomes.]

Question 28

A preconception patient is interested in quitting smoking. Which of these is the best way for the clinician to respond?

a) I’m glad you’re thinking about that because smoking will put your baby at increased risk of growth abnormalities and sudden infant death syndrome.
b) Tell me more about why you’re interested in quitting smoking?
c) Let’s get you a prescription for a nicotine patch right away.

Answer 28

Tell me more about why you’re interested in quitting smoking?

[Correct! This answer engages in motivational interviewing.]

Question 29

Teratogens that affect which organ can cause damage at any time during pregnancy?

Answer 29

The brain

Question 30

After ovulation, progesterone is first produced by which structure?

Answer 30

Corpus luteum

Question 31

The process of implantation begins at approximately how many days after fertilization?

Answer 31

7 days

Question 32

A preconception patient who is planning pregnancy very soon is beginning to work on a home renovation. Plans include painting and laying hardwood floors in the older house that has never been remodeled. Which would be most important for the CNM/WHNP to share?

a) “Do not strip old paint off the walls yourself because of the potential for lead exposure.”
b) “You may want to consider getting a built-in intercom system installed since you’re already remodeling the room.”
c) “Be sure to secure all of the strings on the window blinds of the bay window to prevent infant strangulation.”
c) “Be sure to put a soft rug next to the crib to stand on while holding the baby to prevent low back pain after the birth.”

Answer 32

“Do not strip old paint off the walls yourself because of the potential for lead exposure.”

Question 33

True or false: A couple who wants to use basal body temperature charting to determine the fertile window may use any type of thermometer to measure the BBT.

Answer 33

False

Question 34

During which period is exposure to a teratogen most likely to cause PREGNANCY LOSS? (think about the all-or-nothing principle)

Answer 34

During the first 15 days after conception

Question 35

Which part of the cycle is PROGESTERONE-dominated?

Answer 35

Luteal phase

Question 36

Which part of the cycle is ESTROGEN-dominated?

Answer 36

Follicular phase

Question 37

Which hormone is responsible for cervical mucus becoming slippery, egg white-like, and fertile?

Answer 37

Estrogen

Question 38

Which of these timeframes is typical for implantation bleeding?

Answer 38

1-2 weeks after ovulation

Question 39

The clinician is talking with a person who may become pregnant about exposure to some substances that can cause pregnancy loss. The CNM/WHNP knows that substances considered to be teratogenic. Explain how teratogens are identified.

Answer 39

Must have a stage-sensitive effect depending on the time of exposure during pregnancy

[The final manifestations of abnormal development are not just limited to structural abnormalities in the fetus. It may also include death, growth retardation, and a functional disorder.]

Question 40

True or false: For a couple assessing cervical mucus to determine the fertile window, fertility is highest when the mucus is slippery and clear, rather than thick and cloudy.

Answer 40

True

Question 41

When counseling a couple about maximizing the chance of getting pregnant, which of these is the best way for the clinician to begin?

a) The most accurate way to determine when you’re fertile is to use ovulation predictor kits. You can buy them online or at the drug store.
b) There are several ways for you to figure out when you’re most fertile, including counting days of the cycle, checking cervical mucus or body temperature, and using a test kit from the drug store. Would you like to hear more about any of these options?
c) It’s best to just have sexual intercourse every day for several months and see what happens.

Answer 41

There are several ways for you to figure out when you’re most fertile, including counting days of the cycle, checking cervical mucus or body temperature, and using a test kit from the drug store. Would you like to hear more about any of these options?

Question 42

What do ovulation predictor kits identify?

Answer 42

Luteinizing hormone (LH)

Question 43

Where does fertilization usually occur?

Answer 43

In the fallopian tube

Question 44

The neural groove is the precursor to the

Answer 44

nervous system.

Question 45

Which of the following hormones of pregnancy stimulates the corpus luteum to continue to function?

Answer 45

Human chorionic gonadotropin

Question 46

What is the relationship between a person’s weight and exercise patterns and ovulatory cycles?

Answer 46

Normal BMI and regular exercise supports ovulatory cycles