Module 4 Unit B Practice Questions Flashcards
For a patient at a 24 week visit, the medical assistant records the following urine dip results:
Protein: 1+
Glucose: 1+
Nitrites: positive
Leukocytes: moderate
What should the clinician do concerning these results?
Ask the patient about dysuria, new urinary frequency, vaginal irritation, or vaginal discharge
[Glycosuria during pregnancy does not correlate with abnormal glucose tolerance and is actually quite commonly seen.
A vaginal-rectal GBS swab is not collected until 36-37 weeks of pregnancy.
The presence of nitrites and leukocytes should prompt further evaluation for a UTI. Urine-dip leukocytes can indicate possible vaginitis based on the presence of vaginal secretions in the urine.]
Below is a patient’s visit record with weeks’ gestation and weight. Prepregnancy weight was 182 lbs. (BMI 30.1) 8 3/7:184 lbs., 12 5/7:186 lbs., [today’s visit] 16 2/7:192 lbs.
What should the clinician conclude about her weight gain to date at today’s visit?
She has gained more than the recommended amount to date.
Which of these are common presentations of hemorrhoids during pregnancy that can be managed conservatively by the midwife/WHNP ? [select all that apply]
a) anal itching
b) rectal bleeding with stool passage
c) dark blue-purple rectal tissue
d) rectal pain with stool passage
a) anal itching
b) rectal bleeding with stool passage
d) rectal pain with stool passage
[Dark blue-purple rectal tissue is a sign of a thrombosed hemorrhoid. This warrants further evaluation.]
How should blood pressure for a patient at 28 weeks compare with their prepregnant blood pressure?
BP should be a bit lower at 28 weeks, compared with prepregnant BP
[The arteries continue to be relaxed and peripheral vascular resistance continues to be lower than nonpregnant people. Therefore, decreased blood pressure is normal until about 32 weeks gestation.]
A person is 24 weeks’ gestation and gained 6 lbs. since the last visit at 20 weeks. What should the clinician evaluate next?
Pattern of wt gain between previous visits
[The key is to gather more information. Total weight gain is not a rigid parameter that must be followed to a tee, but rather, a guideline from which to individualize care. For this patient the NEXT step is to check the amount of weight gain during the previous visits. For example, if this patient gained 0 lbs her entire pregnancy, would you be concerned that she gained 6 lbs over the last 4 weeks, no not likely.]
For a patient at a 24 week visit, the medical assistant records the following urine dip results:
Protein: trace
Glucose: 2+
All other elements negative
What should the clinician do concerning these results?
Nothing is needed for these results
[Recall that a little bit of protein apparent on a urine dip is often normal, and can be due to the presence of vaginal secretions in the urine or just an isolated finding. Glucose is unlikely to be a significant finding on a urine dip. At least half of all pregnant people have detectable or even marked glycosuria. Taking this into inconsideration, given the information presented to you, no further work-up is needed for these results.]
What is the physiologic cause for expected blood pressure changes in the second trimester?
Arteries are relaxed and peripheral vascular resistance is lower than prepregnancy
[Arteries continue to be relaxed and peripheral vascular resistance continues to be lower than non-pregnant people so decreased blood pressure is normal until about 32 weeks gestation]
Why do we generally order a CBC in the late 2nd trimester?
Because that is the point of maximum physiologic hemodilution in pregnancy
[Blood plasma increases by ~50%. RBC production does not increase at the same rate. This causes a physiologic hemodilution, and subsequent anemia. Increasing iron, stimulates more RBC production, to combat this mismatch.
We do not routinely screen for preeclampsia in normal asymptomatic pregnancies.]
The clinician asks the office nurse to administer RhoGAM to a patient at 28 weeks’ gestation. The patient is receiving RhoGAM as a routine due to her O negative blood type. Which of the following should the nurse administer?
300 µg dose
[Recall that the 50 µg dose is recommended for bleeding before 12 weeks, and 300 µg is the standard dose given for routine antepartum prophylaxis at 26 to 28 weeks of gestation.]
The clinician thinks that a patient at 14 weeks’ gestation might be experiencing round ligament pain. What presentation is consistent with round ligament pain?
Sudden, sharp, brief groin pain upon standing
[To answer this question, first think, where is the round ligament and why would one experience pain particularly during pregnancy.
The round ligament comes from the top of the uterus, on each side, and inserts at the pubic bone. As the uterus grows in size the ligament is stretched. When a patient stands, twists, or makes sudden movements, the ligament is also stretched, and therefore can create a sharp painful sensation. This discomfort tends to be noted earlier and earlier during the pregnancy with increasing parity.]
The clinician is reviewing the results of a patient’s late-2nd trimester hemoglobin and hematocrit. See below for those results as well as the patient’s new OB results.
11 weeks: H/H 12.2 g/dL 34.7%
27 weeks:H/H 11.2 g/dL33.2%
How should the clinician interpret these results?
All of these results are normal
First trimester Second trimester Third trimester Hemoglobin (Hgb) <11 g/dL <10.5 g/dL <11 g/dL Hematocrit (Hct) <33% <32% <33%
A patient reports distress about flatulence. Which of these relief measures is appropriate to recommend? [select all that apply]
a) Eat smaller and more frequent meals
b) Increase fiber intake with raw vegetables and beans
c) Take over-the-counter simethicone preparations
d) Take a probiotic
e) Replace sugar sweetened drinks with sorbitol-sweetened diet drinks
a) Eat smaller and more frequent meals
c) Take over-the-counter simethicone preparations
d) Take a probiotic
[Prevention and relief of flatulence:
-eat smaller meals per day
-avoid gas producing foods (including beans)
-avoid artificial sweeteners (such as sorbitol)
-keep a food diary
-eat slowly
-avoid using a straw
-lightly steaming veggies verses raw foods
-take a probiotic
-massage the abdomen in a clockwise rotation
-yoga, brisk walking, or exercise
-OTC gas relief such as simethicone]
[True or false?] When caring for Black women, clinicians should adjust the cutoffs they use to diagnose anemia to account for Black race.
False
[This is an example of what we now know to be an inaccurate, non-science-based, and racist interpretation of lab values.]
A patient at 18 weeks’ gestation is concerned about increased but uneven pigmentation on their temples and forehead. How should the clinician respond?
This is a normal pigmentation change. Consistent use of sunscreen can be helpful.
[This is melasma (the mask of pregnancy) and it is due to the rise in estrogen and progesterone during pregnancy. These dark patches or splotches on the forehead, cheeks, chin, or around the mouth, may get darker with more exposure to the sun.]
The members of a practice decide that they will use 130 as the cutoff for a positive 1-hour glucose tolerance test. What is accurate about the pros and cons of choosing 130 as the cutoff, rather than a cutoff of 135 or 140?
Fewer false negative screens (doesn’t miss many GDM diagnoses) but more false positives (positive screens but the person doesn’t really have GDM)
[1st recall what a false negative and positive screen means. A lower cutoff (e.g. 130 in this example) will lead to more false-positive screens (so a screen looks abnormal but the patient doesn’t really have GDM) but there will be few false-negative screens (which means that we don’t have too many times that the screen looks fine but the person really has GDM and we missed it.)]
