Module 6 Practice Questions

Question 1

During an initial obstetric visit at approximately 8 weeks gestation, which of the following would the clinician appropriately do? [Select all that apply]

a) Assess whether the pregnancy should be dated with Naegele’s Rule or ultrasound
b) Auscultate fetal heart tones with a handheld Doppler
c) Encourage the patient to have a Tdap vaccine today.
d) Ask about interest in undergoing carrier screening for inherited gene variants, if it has not been done previously.
e) Palpate uterine size with the expected size being above the symphysis.
f) Assess for presence of nausea/vomiting and any effects on dietary intake.
g) Assess maternal weight and blood pressure.
h) Offer the first trimester screen (nuchal translucency and maternal serum analytes), to be done within the next 1-2 weeks if the patient desires this screening.

Answer 1

a) Assess whether the pregnancy should be dated with Naegele’s Rule or ultrasound [Yes, pregnancy dates should be determined (or a plan made for a dating ultrasound) at the initial obstetric visit.]

d) Ask about interest in undergoing carrier screening for inherited gene variants, if it has not been done previously.[Yes, carrier screening for inherited gene variants can be offered and performed at any point before or during pregnancy, although preconceptually is ideal.]

f) Assess for presence of nausea/vomiting and any effects on dietary intake. [Yes, this is an important time to assess for the very common first trimester discomfort of nausea/vomiting and effects on dietary intake.]

g) Assess maternal weight and blood pressure. [Yes, these are usual assessments at each prenatal visit.]

Question 2

As the clinician is finishing a routine 24-week prenatal visit with a patient who has received all usual prenatal care, what does the clinician need to do to plan for the NEXT visit? [Select all that apply]

a) Provide the patient with an order to have a fetal anatomy screen ultrasound
b) Arrange for the patient to have a 1-hour glucose tolerance test at the next visit.
c) If they are Rh negative, inform the patient that they will have an antibody screen drawn at the next visit and then a RhoGAM injection after that.
d) Inform the patient that the clinician at the next visit will perform Leopold’s Maneuvers to ensure the baby is head-down (which the baby should be by then).
e) Let the patient know that the next visit will be an ideal time to receive a Tdap vaccine.
f) Inform the patient that it will be the right time to collect the group B strep vaginal/rectal swab at the next visit.

Answer 2

b) Arrange for the patient to have a 1-hour glucose tolerance test at the next visit. [Yes, according to the traditional prenatal visit schedule, the next visit would be at about 28 weeks, which is the usual time for a 1-hour glucose tolerance test.]

c) If they are Rh negative, inform the patient that they will have an antibody screen drawn at the next visit and then a RhoGAM injection after that. [Yes, according to the traditional prenatal visit schedule, the next visit would be at about 28 weeks, which is the usual time for the antibody screen and RhoGAM for Rh negative patients.]

e) Let the patient know that the next visit will be an ideal time to receive a Tdap vaccine.

Question 3

At what visit would it be appropriate to tell a pregnant person (G2 P0010) that they will likely begin to feel fetal movement between now and the next visit?

Answer 3

at a 16 week visit

[Between 16 and 20 weeks is a very common time for a nullipara to first feel fetal movement. Notice, though, that we said “likely” rather than absolutely because some pregnant individuals, particularly nulliparas and those with anterior placentas, may not feel fetal movement until closer to 22 weeks.]

Question 4

During a 16 week visit, which of the following would the clinician appropriately do? [Select all that apply]

a) Assess the patient’s weight gain according to their current BMI (calculated from their height and current weight)
b) Assess the patient’s blood pressure and expect that it will be lower than their prepregnant blood pressure.
c) Assess whether the patient is experiencing any discomforts.
d) Assess the uterine size using a measuring tape.
e) Plan for a 1-hour glucose tolerance test at the next visit.

Answer 4

b) Assess the patient’s blood pressure and expect that it will be lower than their prepregnant blood pressure. [Yes, remember that the arteries relax and peripheral vascular resistance decreases, beginning at about 7 weeks’ gestation and continuing until about 32 weeks when blood pressure rises to pre-pregnant levels.]

c) Assess whether the patient is experiencing any discomforts. [Yes! This is important at every visit.]

Question 5

The clinician is ordering initial obstetric labs (a standard new OB panel). Which of the following labs is considered ROUTINE/included in the panel for ALL patients? [Select all that apply]

a) Hemoglobin/hematocrit or CBC
b) Tuberculosis skin testing (PPD)
c) RPR or VDRL
d) Blood group and Rh factor
e) Antibody screen
f) Rubella titre
g) 1 hour glucose tolerance test
h) Hepatitis B surface antigen
i) HIV
j) chlamydia and gonorrhea NAAT
k) Hepatitis C
l) Herpes Simplex Virus serology
m) Pap test
n) Urine drug screen

Answer 5

a) Hemoglobin/hematocrit or CBC
c) RPR or VDRL
d) Blood group and Rh factor
e) Antibody screen
f) Rubella titre
h) Hepatitis B surface antigen
i) HIV
k) Hepatitis C

Question 6

The clinician sees the following result for a patient at 28 weeks. What decision should they make?
-1-hour glucose tolerance test: 141 mg/dL

Answer 6

Order 3-hour glucose tolerance test

Question 7

On an initial OB lab panel, the clinician sees the following result. What decision should they make?
Blood group: A
Rh: negative

Answer 7

Plan to offer RhoGAM at about 28 weeks

Question 8

On an initial OB lab panel, the clinician sees the following result. What decision should they make?
RPR nonreactive

Answer 8

Nothing is needed for these results

Question 9

The clinician sees the following result for a patient at 28 weeks. The patient has not received RhoGAM during this pregnancy. What decision should they make?
Rh negative
Antibody screen positive

Answer 9

Consult or refer immediately. A positive antibody screen is NOT an expected finding even with Rh negative blood type.

Question 10

On an initial OB lab panel, the clinician sees the following result. What decision should they make?
Hepatitis B surface antigen negative

Answer 10

Nothing is needed for these results

Question 11

The clinician sees the following result for a patient at 28 weeks. What decision should they make?
hemoglobin 11.0 g/dL
hematocrit 33.0%

Answer 11

Nothing is needed for these results

Question 12

On an initial OB lab panel, the clinician sees the following result. What decision should they make?
Urine culture: 100,000 cfu/mL of group B strep

Answer 12

Treat for UTI now; offer intrapartum GBS prophylaxis

Question 13

On an initial OB lab panel, the clinician sees the following result. What decision should they make?
hemoglobin 11.2 g/dL
hematocrit 33.7%

Answer 13

Nothing is needed for these results

Question 14

On an initial OB lab panel, the clinician sees the following result. What decision should they make?
Antibody screen positive

Answer 14

Consult or refer immediately

Question 15

The clinician sees the following result for a patient at 28 weeks. What decision should they make?
1-hour glucose tolerance test: 128 mg/dL

Answer 15

Nothing is needed for these results

Question 16

When can carrier screening for inherited gene variants be performed? [Select all that apply]

a) At a preconception visit
b) At a gynecologic health visit
c) With the initial OB labs
d) During the second trimester
e) During the third trimester

Answer 16

All of them

[Yes! Individuals may choose to undergo carrier screening at any of these visits, although it is ideal for reproductive decision-making for the prospective parent(s) to get the information prior to pregnancy.]

Question 17

What does carrier screening assess?

Answer 17

Whether a parent/prospective parent carries changes in a genetic sequence.

Question 18

What does ethnic-specific; targeted carrier screening entail?

Answer 18

Screens for conditions considered to be common in the ethnic group with which the patient identifies and

Question 19

What does pan-ethnic; nondirective carrier screening entail?

Answer 19

Screens all patients for specific conditions, regardless of identifies ethnic groups or ancestry

Question 20

What does expanded carrier screening entail?

Answer 20

Screens for 100+ conditions simultaneously, without regard to ethnic group or ancestry

Question 21

Give an example of how to start/open a conversation with a patient about carrier screening for inherited gene conditions?

Answer 21

Would it be useful to you and your family to have information about the chance of having a child with a genetic condition?

[Yes! This is a nice way to begin because whether/what information you provide to the patient should be closely aligned with what they tell you about the potential value to them. Likewise, if they say that they know nothing about genetic conditions, you can thoughtfully provide enough information for them to understand the topic enough to discuss it.]

Question 22

Which conditions might be included in carrier screening for inherited gene variants? [Select all that apply]

a) Tay-Sachs
b) Cystic fibrosis
c) Down Syndrome
d) Spinal muscular atrophy
e) Anencephaly
f) Fragile X syndrome
g) Canavan disease and familial dysautonomia
h) Spina bifida
i) Trisomy 13
j) Trisomy 18

Answer 22

a) Tay-Sachs
b) Cystic fibrosis
d) Spinal muscular atrophy
f) Fragile X syndrome
g) Canavan disease and familial dysautonomia

Question 23

True or false?

A patient has chosen expanded carrier screening. The conditions included in the panel will be limited to those for which their identified ethnic group is most at risk.

Answer 23

False

[You’re right; this is a FALSE statement. Expanded panels screen for a large number of conditions simultaneously, without regard to ethnic group or ancestry.]

Question 24

Which of the following include screening/diagnostic testing for aneuploidies? [Select all that apply]

a) Chorionic villus sampling
b) Cell-free DNA
c) Amniocentesis
d) Nuchal translucency (NT)

Answer 24

All of them

Question 25

What is the “first-trimester screen” composed of? [Select all that apply]

a) Ultrasound to measure nuchal translucency (NT)
b) Cell-free DNA
c) Blood draw for maternal serum markers
d) Full fetal anatomy ultrasound

Answer 25

a) Ultrasound to measure nuchal translucency (NT)
c) Blood draw for maternal serum markers

Question 26

A patient would like to have a first trimester screen. WHEN should it be done?

Answer 26

10-14 weeks

Question 27

What is the difference between integrated and sequential screens?

Answer 27

The TIMING of sharing results and the opportunity to make a different testing decision between components.

Question 28

A patient had cell-free DNA screening at 11 weeks. The patient is now 15 weeks and has decided to undergo screening or testing for neural tube defects (NTDs). Which options can the patient consider now for NTD screening/diagnostic testing? [Select all that apply]

a) Carrier screening
b) Nuchal translucency
c) Chorionic villus sampling
d) Amniocentesis
e) Maternal serum alpha-fetoprotein
f) Fetal anatomy ultrasound

Answer 28

d) Amniocentesis
e) Maternal serum alpha-fetoprotein
f) Fetal anatomy ultrasound

Question 29

A patient had cell-free DNA screening at 11 weeks. The patient is now 15 weeks and has decided to undergo screening or testing for neural tube defects (NTDs). Which options can the patient consider now for NTD screening/diagnostic testing? [Select all that apply]

a) Carrier screening
b) Nuchal translucency
c) Chorionic villus sampling
d) Amniocentesis
e) Maternal serum alpha-fetoprotein
f) Fetal anatomy ultrasound