Module 5 Unit A&B Practice Questions Flashcards
On March 5, the clinician is seeing a patient for a late-third trimester visit. The EHR calculation indicates that the patient is 39 0/7 weeks. As a commonsense double check, the clinician checks that the current gestational age makes sense with the patient’s EDB. What should the EDB be for this patient?
March 12
[It is March 5th, and the EDB is based on 40 weeks 0/7 days. Since the patient is 39 0/7 weeks, March 5th +7 days= March 12th]
A patient is 38 weeks’ gestation on April 5. Which of these dates would be most likely as the first day of the patient’s LMP?
July 13
[Using a pregnancy wgeel, you would turn the wheel until 38 w0d landed on today’s date (April 5th). Then look at First LMP, and you will see that the date was July 13th.]
On February 10, a patient presents to care in late pregnancy with uncertain dates. She thinks her last period was sometime in mid-June and she might have started feeling fetal movement in early October. Her fundal height measures 34 cm and an ultrasound measures the fetus as 34 2/7 weeks with an EDB of March 22.
Based on these subjective and objective data points, does the March 22 EDB seem reasonable?
Yes, given what we know, the EDB seems to match.
[Place the EDB as March 22th on the wheel, then look for today’s date (February 10th). You will see that this date would reflect a fetus that is 34 2/7 days. This is consistent with the US report and fundal height measurement of 34 cm.]
A patient has an EDB of April 1. That date was set by LMP and confirmed with a 19 week ultrasound. The patient has another ultrasound at 32 weeks that calculates an EDB of April 17. Should the clinician change the EDB?
No, the clinician should not change the EDB because it does not meet criteria.
[At 28 weeks and beyond, the EDB should be changed only if menstrual dates and US dates differ by more than 21 days. In this case you have an ultrasound performed during the second trimester which was confirmed with the patient’s LMP. A difference in dating at this point is more of a reflection of fetal size than actual gestational age. ]
Describe the physiology of expected blood pressure changes in the third trimester?
At around 32 weeks, blood pressures usually rise back to prepregnant levels.
A person at 36 weeks’ gestation has blood pressure measured sitting and the result is 134/80. Given the expected blood pressure changes with different maternal positions, what is an expected blood pressure as this person is lying on their left side?
128/68
A patient is at a 38 week prenatal visit and has trace - 1+ proteinuria and large glucose on a urine dip. She is asymptomatic. Which of the following are most likely to be causes for these findings? [select all that apply]
a) undiagnosed gestational diabetes
b) preeclampsia
c) vaginitis
d) asymptomatic bacteruria
c) vaginitis
d) asymptomatic bacteruria
[Proteinuria can be seen in hypertensive disorders, but is also seen in vaginitis and bacteriuria (particularly if blood is also present in the urine). Glycosuria is not a great indicator of undiagnosed gestational diabetes. Glycosuria, also increases the risk of urinary tract infections. Pre-eclampsia would present with hypertension (not mentioned here) along with other features.]
A patient whose prepregnancy BMI was in the normal range should gain approximately how much total throughout the pregnancy?
25-35 lbs.
A patient is being seen at 37 weeks and the clinician is assessing weight gain. Prepregnancy weight was 178 lbs. and prepregnancy BMI was 28.1. Here are the patient’s weights to date:
11w-177lb
15w-180lb
19w-181lb
24w-186lb
28w-185lb
30w-187lb
32w-189lb
34w-190lb
36w-192lb
37w-193lb
How should the clinician assess this patient’s weight gain?
Although the weight gain pattern has not followed a textbook pattern, the total amount is on track for the recommended amount for the pregnancy.
A pregnant patient at 32 weeks tells the clinician that she recently learned that her male partner is having sex with men. Should the clinician encourage the patient to have a 3rd trimester HIV test?
Yes
A 23 year-old had a positive chlamydia result with her new OB labs. She has two current sexual partners. Which of these STI screening tests should the clinician encourage the patient to have in the 3rd trimester? [select all that apply]
a) chlamydia
b) gonorrhea
c) hepatitis A
d) hepatitis B
a) chlamydia
b) gonorrhea
d) hepatitis B
At what gestational age(s) is it acceptable per ACOG guidelines to collect a vaginal/rectal GBS swab?
36 0/7 - 37 6/7
[All pregnant individuals should be screened with a vaginal/rectal swab for GBS at 36 0/7 - 37 6/7 weeks’ gestation. Recall that this gestational age range is a change per an ACOG guidelines update in 2020. Previously the recommendation was 35-37 weeks but the new range provides more valid results for births that occur up to 41 weeks gestation.]
Describe appropriate technique for collecting a 3rd trimester GBS vaginal-rectal swab?
Do not place a speculum; insert swab in vaginal introitus and then into anal opening.
[You do not need a speculum to collect GBS. Remove swab from packaging. Insert swab about 2cm into vagina. Do not touch cotton end with fingers. Then insert the same swab 1cm into anus.]
Should the clinician collect a vaginal-rectal GBS swab for this patient?
Patient is 37 weeks’ gestation. Had been treated for asymptomatic bacteriuria with 100,000 cfu of GBS at 12 weeks’ gestation.
No, do not collect GBS swab today.
[Recall that any amount of GBS bacteriuria during pregnancy would render a vaginal/rectal GBS swab as unnecessary.]
Should the clinician collect a vaginal-rectal GBS swab for this patient?
Patient is 37 weeks’ gestation. She reports that she had her GBS test was positive with her last baby. The baby was healthy.
Yes, collect GBS swab today.
[Although her previous baby was GBS positive, it was healthy. Given her hx and gestational age (between 35-37 weeks) she should be screened for GBS at this time.]
