Module 3 Unit B Practice Quiz Flashcards
At the new OB visit at 8 weeks’ gestation, a 36 year-old patient reports breast changes and wants to know if they are normal. The changes include: larger and darker areolae, more pronounced veins on both breasts, a very firm mass in the left breast, and extreme tenderness of both breasts. Which of these elements is NOT an expected pregnancy breast change?
a very firm mass in the left breast
Which lab test is used for the routine maternal prenatal antibody screen?
Indirect Coombs
[The antibody screen clinicians order in the initial prenatal lab panel is the indirect Coombs test
The Kleihauer Betke test determines if there is fetal blood in maternal circulation, and the Rosette test determines the quantitative amount of fetal cells in maternal circulation.
You do not need to memorize specifics of complications such as hemolytic disease of the newborn or atypical blood group incompatibilities.]
Hemoglobin Electrophoresis is useful in identifying which of the following conditions?
hemoglobinopathies
[Hbg electrophoresis detects hemoglobinopathies like sickle cell anemia, thalassemia major, and hemoglobin C]
Which of the following CBC results would the CNM/WHNP be most likely to see in patients with iron deficiency anemia?
Decreased MCHC, Decreased MCV, Decreased MCH
[Easy trick, Remember that all are low!
-Mean cell hemoglobin concentration (MCHC): the average concentration of Hgb inside a red cell {The MCHC basically tells you whether a person’s red blood cells have more or less hemoglobin than what would be expected}
-Mean corpuscular volume (MCV): a measurement of the average size of RBCs. Iron deficiency is microcytic.
-Mean corpuscular hemoglobin (MCH): the average amount of oxygen-carrying hemoglobin inside a red blood cell {The MCH value directly parallels the MCV value. If the size of the red blood cells is small (as measured by the MCV), the amount of hemoglobin per red blood cells will be low (as measured by the MCH).}
Is performing a routine urine dip at every prenatal visit a necessary component of providing evidence-based prenatal care?
No
Routine urine dips at every visit is an entrenched practice that is not supported by a solid evidence base. If a patient has a UTI at the initial prenatal visit a test of cure would be performed at the next visit. I’m sure most women would report having had a urinary tract at some point in their lives. This would not be an indication for routine urine dips in the absence of suggestive signs/symptoms.
A patient presents for an initial prenatal visit. She has one ten year old child born at 28 weeks. In the past ten years, she has lost three pregnancies in the first trimester and given birth to one child at 22 weeks who lived for two days.
G6 P0231
Gravida, Para-Term/Preterm (>20 weeks)/AB/Living
A patient presents for an initial prenatal visit. (G1) She has one (G2) ten year old child (living-1) born at 28 weeks (preterm-1). In the past ten years, she has lost three pregnancies in the first trimester (G5) and (SAB-3) and given birth to one child at (G6) 22 weeks (Preterm 2) who lived for two days.
Which initial OB labs Hepatitis B result would be most urgent for the CNM/WHNP to follow up?
Hepatitis B surface antigen (HBsAg) positive
[Hepatitis B surface antigen is what you will order for routine prenatal labs and a positive result means that the person is infectious.
Hepatitis B surface antibody means that the person has been successfully immunized (like most of you as health care providers) or recovery/immunity from having the illness.]
A G2 P10010 comes to clinic to review her initial prenatal lab results. Her blood type is B negative and her antibody screen is positive. What is the most appropriate information to provide to her?
“The expected/normal result for an antibody screen is negative. Yours is positive so I will consult with a physician colleague so we can develop an appropriate plan of care for you.”
[An antibody screen evaluates for antibodies in the mother’s blood that might cross the placenta and attack fetal red blood cells, causing hemolytic disease of the newborn. If positive, it would be prudent to consult with a physician.]
While reviewing prenatal lab results, the CNM/WHNP notes that a woman has a positive RPR. Which of the following is the most appropriate action for the CNM/WHNP to take first?
Order treponema antibody testing (FTA-ABS).
[There are occasional false positive RPR/VDRL results. If the RPR is reactive, to confirm the presence of Treponema Pallidum, either the fluorescent treponemal antibody-absorption test (FTA-ABS) or the microhemagglutination assay for Treponema Pallidum antibodies (TP-NHA) is ordered. These tests specifically determine if the individual has developed antibodies to the spirochete.]
A pregnant person at 8 weeks reports excessive saliva secretion associated with nausea and once/day vomiting. What can the clinician tell the patient about when the excessive saliva secretion should subside?
It is likely to subside by about 12 weeks’ gestation.
[Excessive salivation, also known as ptyalism gravidarum is common, particularly during the first trimester and usually subsides by 12 weeks gestation.]
A pregnant individual reports fatigue that began shortly after the first missed period. What history and physical exam findings would cause the clinician to be suspicious that this patient is experiencing something other than normal pregnancy fatigue?
Dizziness when lying down or standing.
[Fatigue is common especially very early in pregnancy. Patients will often need more frequent rest periods and naps. They may also be much less interested in exercise. However, dizziness while lying or standing would be suspicious for something other than a normal pregnancy symptom.]
A 24 year old woman has just arrived for her first prenatal visit with her 7 year old twins born at 35.6 weeks gestation and her 2 year old born at 38.3 weeks gestation. She had one spontaneous miscarriage at 7 weeks gestation. Her gravida and parity status is:
G4 P11131
[A 24 year old woman has just arrived for her first prenatal visit (G1) with her 7 year old twins (G-2/multiple-1/Living-2) born at 35.6 weeks gestation (preterm-1) and her 2 year old (G-3/living-3) born at 38.3 weeks gestation (term-1). She had one (G-4) spontaneous miscarriage at 7 weeks gestation (AB-1).]
Which of the following hormones has thyroid stimulating (TSH)- like properties?
Human chorionic gonadotropin (HCG)
[The patient has lots of hCG which acts like TSH»_space; stimulating the mother’s thyroid]
Which lab test is most appropriate to order when screening for thyroid dysfunction in pregnancy?
Thyroid stimulating hormone (TSH)
[Screen using trimester-specific TSH values for comparison
If abnormal, may order additional labs such as T3 and T4, and if newly identified, refer to endocrinology.]
A systolic murmur at the left sternal border, third intercostal space occurs:
commonly during pregnancy, and expected to be present until delivery
[A systolic murmur at the left sternal border, third intercostal space is commonly auscultated during pregnancy and in the early postpartum period. It is typically a grade 1 or 2, and is not pathologic.]
