Practice Questions Flashcards
1
Q
What items should be provided to women after diagnosis of pregnancy? Select all that apply.
A. Prenatal vitamin subscription
B. Proof of pregnancy
C. Information about applying for health insurance
D. Printout of ultrasound
A
A, B, C.
Women should be provided with PNV prescription, proof of pregnancy (for WIC and health insurance), lab work (if not drawn at clinic), information about applying for health insurance, information about prenatal care, ultrasound order (if needed).
2
Q
Which stage of pregnancy? Fertilized ovum. A. Embryo B. Fetus C. Blastocyst D. Zygote
A
D. Zygote
3
Q
Which stage of pregnancy? Up to 2 weeks postconception. A. Embryo B. Fetus C. Blastocyst D. Zygote
A
C. Blastocyst
4
Q
Which stage of pregnancy? Up to 8-10 weeks. A. Embryo B. Fetus C. Blastocyst D. Zygote
A
A. Embryo
5
Q
Which stage of pregnancy? 10 weeks to term. A. Embryo B. Fetus C. Blastocyst D. Zygote
A
B. Fetus
6
Q
Match each sign with its correct characteristic.
Hegar sign.
A. Blue-violet vaginal color.
B. Softening of the uterus isthmus.
C. Softening of the vaginal portion of the cervix.
A
B. Softening of the uterus isthmus.
7
Q
Match each sign with its correct characteristic.
Goodell sign.
A. Blue-violet vaginal color.
B. Softening of the uterus isthmus.
C. Softening of the vaginal portion of the cervix.
A
C. Softening of the vaginal portion of the cervix.
8
Q
Match each sign with its correct characteristic.
Chadwick sign.
A. Blue-violet vaginal color.
B. Softening of the uterus isthmus.
C. Softening of the vaginal portion of the cervix.
A
A. Blue-violet vaginal color.
9
Q
Match the uterine size with stages of pregnancy. Nongravid. A. Size of baseball. B. Size of softball or grapefruit. C. Size of large lemon. D. Size of tennis ball or orange. E. Uterine fundus at umbilicus. F. Uterine fundus halfway between symphysis pubis and umbilicus.
A
C. Size of large lemon.
10
Q
Match the uterine size with stages of pregnancy. 8 weeks. A. Size of baseball. B. Size of softball or grapefruit. C. Size of large lemon. D. Size of tennis ball or orange. E. Uterine fundus at umbilicus. F. Uterine fundus halfway between symphysis pubis and umbilicus.
A
D. Size of tennis ball or orange.
11
Q
Match the uterine size with stages of pregnancy. 10 weeks. A. Size of baseball. B. Size of softball or grapefruit. C. Size of large lemon. D. Size of tennis ball or orange. E. Uterine fundus at umbilicus. F. Uterine fundus halfway between symphysis pubis and umbilicus.
A
A. Size of baseball.
12
Q
Match the uterine size with stages of pregnancy. 12 weeks. A. Size of baseball. B. Size of softball or grapefruit. C. Size of large lemon. D. Size of tennis ball or orange. E. Uterine fundus at umbilicus. F. Uterine fundus halfway between symphysis pubis and umbilicus.
A
B. Size of softball or grapefruit.
13
Q
Match the uterine size with stages of pregnancy. 16 weeks. A. Size of baseball. B. Size of softball or grapefruit. C. Size of large lemon. D. Size of tennis ball or orange. E. Uterine fundus at umbilicus. F. Uterine fundus halfway between symphysis pubis and umbilicus.
A
F. Uterine fundus halfway between symphysis pubis and umbilicus.
14
Q
Match the uterine size with stages of pregnancy. 20 weeks. A. Size of baseball. B. Size of softball or grapefruit. C. Size of large lemon. D. Size of tennis ball or orange. E. Uterine fundus at umbilicus. F. Uterine fundus halfway between symphysis pubis and umbilicus.
A
E. Uterine fundus at umbilicus.
15
Q
Approximately \_\_\_% of fetuses are in vertex position by the 36th week of pregnancy. A. 30 B. 50 C. 75 D. 95
A
D. 95
16
Q
The recommended weight gain during pregnancy for a woman with a desirable or healthy pre-pregnancy body mass index (BMI) is: A. 15 to 20 lb (6.8 to 9.1 kg) B. 20 to 30 lb (9.1 to 13.6 kg) C. 25 to 35 lb (11.3 to 15.9 kg) D. 35 to 45 lb (15.9 to 20.4 kg)
A
C. 25 to 35 lb (11.3 to 15.9 kg)
17
Q
For a healthy woman with a desirable or healthy prepregnancy BMI, daily caloric requirements during pregnancy are typical baseline caloric needs plus \_\_\_ kcal. A. 100 B. 300 C. 600 D. 1000
A
B. 300 (our book states about 350)
18
Q
For a healthy woman with a healthy or desirable prepregnancy BMI, daily caloric requirements during lactation are typical baseline caloric needs plus \_\_\_ kcal. A. 250 B. 500 C. 750 D. 1000
A
B. 500
19
Q
Recommended calcium intake for a woman during
pregnancy is ____________ mg of elemental calcium
per day.
A. 400 to 600
B. 600 to 800
C. 800 to 1000
D. 1000 to 1300
A
D. 1000 to 1300
20
Q
Increased folic acid intake before conception is likely
to reduce the risk of which of the following birth
defects?
A. congenital cataract
B. pyloric stenosis
C. clubfoot
D. open neural tube defects
A
D. open neural tube defects
21
Q
Maternal iron requirements are greatest during what part of pregnancy? A. first trimester B. second and third trimesters C. equal throughout pregnancy D. preconception
A
B. second and third trimesters
22
Q
The most common form of acquired anemia during pregnancy is: A. iron deficiency. B. folate deficiency. C. vitamin B12 deficiency. D. primary hypoproliferative.
A
A. iron deficiency.
23
Q
Concerning the use of alcohol during pregnancy, which
of the following statements is most accurate?
A. Although potentially problematic, maternal
alcohol intake does not increase the risk of
miscarriage.
B. Risk to the fetus from alcohol exposure is greatest in
the third trimester.
C. No level or time of exposure is considered to be safe.
D. Risk of fetal alcohol syndrome is present only if
alcohol exposure has occurred throughout the
pregnancy.
A
C. No level or time of exposure is considered to be safe.
24
Q
Pica (ingestion of nonfood substances) during pregnancy
should be considered:
A. a harmless practice common in certain ethnic
groups.
B. problematic only if more nutritious food sources are
left out of the diet and are replaced by the nonfood
substance.
C. a way of providing select micronutrients not usually
found in food products.
D. potentially dangerous because of contaminants in the nonfood substance.
A
D. potentially dangerous because of contaminants in the nonfood substance.
25
```
Examples of neural tube defects include all of the following
except:
A. anencephaly.
B. spina bifida.
C. encephalocele.
D. omphalocele.
```
D. omphalocele.
26
Identify the following changes in a normal pregnancy
as true (normal, anticipated finding) or false
(not associated with normal pregnancy).
Blood volume increases by 40% to 50%, peaking at
week 32.
True
27
Identify the following changes in a normal pregnancy
as true (normal, anticipated finding) or false
(not associated with normal pregnancy).
Decrease in diastolic blood pressure most notable
during second trimester.
True
28
Identify the following changes in a normal pregnancy
as true (normal, anticipated finding) or false
(not associated with normal pregnancy).
S1 heart sound becomes louder.
True
29
Identify the following changes in a normal pregnancy
as true (normal, anticipated finding) or false
(not associated with normal pregnancy).
Physiologic systolic ejection murmur usually evident.
True
30
Identify the following changes in a normal pregnancy
as true (normal, anticipated finding) or false
(not associated with normal pregnancy).
Dilation of renal collecting system.
True
31
Identify the following changes in a normal pregnancy
as true (normal, anticipated finding) or false
(not associated with normal pregnancy).
Physiologic glucosuria and proteinuria common.
True
32
Identify the following changes in a normal pregnancy
as true (normal, anticipated finding) or false
(not associated with normal pregnancy).
Decrease in transverse thoracic diameter and diaphragmatic
contraction.
False
33
Identify the following changes in a normal pregnancy
as true (normal, anticipated finding) or false
(not associated with normal pregnancy).
Lower esophageal sphincter more relaxed.
True
34
```
Identify the following changes in a normal pregnancy
as true (normal, anticipated finding) or false
(not associated with normal pregnancy).
Increased intestinal motility.
```
False
35
```
Identify the following changes in a normal pregnancy
as true (normal, anticipated finding) or false
(not associated with normal pregnancy).
Gallbladder doubles in size.
```
True
36
Identify the following changes in a normal pregnancy
as true (normal, anticipated finding) or false
(not associated with normal pregnancy).
Insulin levels increase by 2-fold to 10-fold over
pre-pregnancy levels.
True
37
Identify the following changes in a normal pregnancy
as true (normal, anticipated finding) or false
(not associated with normal pregnancy).
Fasting plasma glucose increases slightly.
False
38
Identify the following changes in a normal pregnancy
as true (normal, anticipated finding) or false
(not associated with normal pregnancy).
Thyroid decreases in size.
False
39
```
The recommended frequency of prenatal visits in weeks 28 to 32 of pregnancy is every:
A. 1 week.
B. 2 weeks.
C. 3 weeks.
D. 4 weeks.
```
B. 2 weeks.
40
Testing for sexually transmitted infection should be initially
obtained:
A. as early as possible in pregnancy.
B. during the second trimester.
C. during the third trimester.
D. as close to the anticipated date of birth as possible.
A. as early as possible in pregnancy.
41
```
Which of the following is a diagnostic test?
A. cell free fetal DNA test
B. serum alpha-fetoprotein
C. serum inhibin-A
D. amniocentesis
```
D. amniocentesis
42
```
The “quad screen” should be obtained at about _____
weeks of pregnancy.
A. 6 to 10
B. 11 to 15
C. 16 to 20
D. 21 to 25
```
C. 16 to 20
43
Aneuploidy is defined as:
A. a physical malformation of the fetus of unknown
origin.
B. a birth defect originating from the use of a teratogenic drug.
C. the presence of an abnormal number of chromosomes.
D. a birth defect originating from a nutritional
deficiency.
C. the presence of an abnormal number of chromosomes.
44
The “quad screen” is used to help detect increased risk
for which of the following conditions in the fetus?
A. trisomy 21 and open neural tube defects
B. cystic fibrosis and Angelman syndrome
C. Tay-Sachs disease and trisomy 18
D. sickle cell anemia and beta-thalassemia major
A. trisomy 21 and open neural tube defects
45
Prenatal assessment for aneuploidy should be
offered to:
A. only women older than 35 years of age.
B. only women younger than 21 years of age.
C. only women either younger than 21 years or older
than 35 years of age.
D. all women regardless of age.
D. all women regardless of age.
46
Tina is a 26-year-old woman who is pregnant and has
an abnormal “quad screen.” When sharing this information with Tina, you consider that:
A. this testing is diagnostic of specific conditions.
B. further testing is recommended.
C. the testing should be repeated.
D. no further testing is required.
B. further testing is recommended.
47
```
The rate of spontaneous fetal loss related to amniocentesis that is done at a facility that performs these procedures on a regular basis is approximately 1 in _______ procedures
A. 75
B. 200
C. 400
D. 800
```
C. 400
48
Women at high risk for aneuploidy include all of the
following except:
A. maternal age 35 years and older at delivery.
B. history of prior pregnancy with trisomy.
C. fetal ultrasonographic findings indicating an increased
risk of aneuploidy.
D. history of multiparity.
D. history of multiparity.
49
```
All of the following can cause an elevated maternal
alpha-fetoprotein (AFP) except:
A. underestimated gestational age.
B. open neural tube defect.
C. meningomyelocele.
D. Down syndrome.
```
D. Down syndrome.
50
```
Edwards syndrome is the clinical manifestation of
trisomy ____.
A. 13
B. 15
C. 18
D. 21
```
C. 18
51
In Edwards syndrome, which of the following statements is true?
A. Edwards syndrome is more common than Down
syndrome.
B. Most affected infants with Edwards syndrome die
during the first year of life.
C. Edwards syndrome is unlikely to cause developmental
disability.
D. Edwards syndrome is associated with elevated AFP.
B. Most affected infants with Edwards syndrome die
52
In Down syndrome, which of the following is true?
A. Most infants affected with Down syndrome are born
to women older than age 35 years.
B. Down syndrome is noted in about 1 in 10,000 live
births.
C. Down syndrome is associated with decreased maternal serum AFP level.
D. Antenatal serum analysis is sufficient to make the
diagnosis.
C. Down syndrome is associated with decreased maternal serum AFP level.
53
```
Down syndrome is the clinical manifestation of
trisomy ___.
A. 13
B. 15
C. 18
D. 21
```
D. 21
54
Components of the antenatal screening test known as
the “quad screen” include all of the following except:
A. AFP.
B. hCG.
C. unconjugated estriol.
D. progesterone.
D. progesterone.
55
Elevated inhibin-A is noted when a pregnant woman is
at increased risk of having an infant with:
A. Down syndrome.
B. Edwards syndrome.
C. open neural tube defect.
D. hemolytic anemia.
A. Down syndrome.
56
A 25-year-old woman presents in the 10th week of
gestation requesting antenatal screening for Down
syndrome. What advice should the NP give?
A. Because of her age, no specific testing is
recommended.
B. She should be referred for second-trimester
ultrasound.
C. Screening that combines nuchal translucency measurement and biochemical testing is available.
D. She should be referred to a genetic counselor.
C. Screening that combines nuchal translucency measurement and biochemical testing is available.
57
```
Increased risk for:
Tay-Sachs disease.
A. Ashkenazi Jewish ancestry
B. Northern European
ancestry
C. African ancestry
```
A. Ashkenazi Jewish ancestry
58
```
Increased risk for:
Cystic fibrosis.
A. Ashkenazi Jewish ancestry
B. Northern European ancestry
C. African ancestry
```
B. Northern European ancestry
59
```
Increased risk for:
Sickle cell trait.
A. Ashkenazi Jewish ancestry
B. Northern European
ancestry
C. African ancestry
```
C. African ancestry
60
```
Medications most commonly pass through the
placenta via:
A. facilitated transport.
B. passive diffusion.
C. capillary pump action.
D. mechanical carrier state.
```
B. passive diffusion.
61
During pregnancy, the most intense organogenesis
occurs how many days following the last menstrual
period (LMP)?
A. 12–30 days
B. 31–81 days
C. 92–120 days
D. 121–150 days
B. 31–81 days
62
A drug with demonstrated safety for use in all
trimesters of pregnancy is categorized as U.S. Food
and Drug Administration (FDA) risk category:
A. A.
B. B.
C. C.
D. D.
A. A.
63
A drug shown to cause teratogenic effects in human
study, but the benefit of which could outweigh the risk
of use in a life-threatening situation, is assigned FDA
risk category:
A. A.
B. B.
C. C.
D. D.
D. D.
64
A drug that has not been shown to be harmful to the
fetus in animal studies, but for which no human study
is available, is assigned FDA risk category:
A. A.
B. B.
C. C.
D. D.
B. B.
65
A drug shown to cause teratogenic effect in animal
studies, but for which no human study is available, is
assigned FDA risk category:
A. A.
B. B.
C. C.
D. D.
C. C.
66
Prior to day 31 post-LMP, the embryo is best
described as:
A. a single, undifferentiated cell.
B. a group of poorly differentiated cells.
C. a conglomerate of highly differentiated cells and
primitive organs.
D. a small fetus with developed organs.
B. a group of poorly differentiated cells.
67
What is the molecular weight requirement for a drug to
easily pass through the placental barrier?
A. <250 daltons
B. <500 daltons
C. <1000 daltons
D. <5000 daltons
B. <500 daltons
68
What is the molecular weight requirement for a drug to
be unable to pass through the placental barrier?
A. >250 daltons
B. >500 daltons
C. >1000 daltons
D. >5000 daltons
C. >1000 daltons
69
When treating a woman with a urinary tract infection
who is 28 weeks pregnant, the NP considers prescribing:
A. trimethoprim-sulfamethoxazole (TMP-SMX).
B. cephalexin.
C. ciprofloxacin.
D. doxycycline.
B. cephalexin.
70
```
According to Hale’s Lactation Risk Category, a medication in which there is no controlled study on its use during lactation, or controlled study shows minimal, non–life-threatening risk, is listed as category:
A. L2.
B. L3.
C. L4.
D. L5.
```
B. L3.
71
According to Hale’s Lactation Risk Category, a medication in which there is evidence of risk for its use in lactation, but it can be used if there is a maternal
life-threatening situation, is listed as category:
A. L2.
B. L3.
C. L4.
D. L5.
C. L4.
72
In a pregnant woman with asthma, in what part of her
pregnancy do symptoms and bronchospasm often
worsen?
A. 6 to 14 weeks
B. 15 to 23 weeks
C. 24 to 33 weeks
D. 29 to 36 weeks
D. 29 to 36 weeks
73
```
In treating a pregnant woman with acute bacterial rhinosinusitis,
the NP would likely avoid prescribing:
A. amoxicillin.
B. cefuroxime.
C. cefpodoxime.
D. levofloxacin.
```
D. levofloxacin.
74
The duration of antimicrobial therapy for treatment of
symptomatic urinary tract infection in a pregnant
woman is:
A. 3 days.
B. 5 days.
C. 7 days.
D. 10 days.
C. 7 days.
75
Selective serotonin reuptake inhibitor (SSRI) withdrawal syndrome is best characterized as:
A. bothersome but not life-threatening.
B. potentially life-threatening.
C. most often seen with medications with a longer
half-life.
D. associated with seizure risk.
A. bothersome but not life-threatening.
76
The placenta is best described as:
A. poorly permeable.
B. an effective drug barrier.
C. able to transport lipophilic substances.
D. capable of impeding substances with molecular
weight < than 300 daltons.
C. able to transport lipophilic substances.
77
Preferred treatment options for a pregnant woman in
the second trimester with migraine include:
A. sumatriptan.
B. codeine.
C. aspirin.
D. acetaminophen.
D. acetaminophen.
78
In counseling women about SSRI use during pregnancy, the NP considers that studies reveal:
A. a clear teratogenic pattern has been identified for all
drugs in this class.
B. the drugs have a negative effect on intellectual development.
C. the use of paroxetine during pregnancy is associated
with an increase in risk for congenital cardiac defect.
D. an increased rate of seizure disorder in exposed
offspring.
C. the use of paroxetine during pregnancy is associated
79
```
All of the following SSRIs are pregnancy risk category C
except:
A. paroxetine
B. fluoxetine
C. citalopram
D. sertraline
```
A. paroxetine
80
Among the most commonly used medications by
women in the first trimester of pregnancy are:
A. antiepileptic drugs.
B. antibiotics.
C. antihypertensives.
D. opioids.
B. antibiotics.
81
Benzodiazepine withdrawal syndrome is best characterized as:
A. bothersome but not life-threatening.
B. not observed during pregnancy.
C. most often seen with agents that have a long half-life.
D. associated with seizure risk.
D. associated with seizure risk.
82
```
The cornerstone controller therapy for moderate persistent asthma during pregnancy is the use of:
A. oral theophylline.
B. mast cell stabilizers.
C. leukotriene receptor antagonist.
D. inhaled corticosteroids.
```
D. inhaled corticosteroids.
83
You examine a 24-year-old woman with mild intermittent asthma who is 24 weeks pregnant and has an acute asthma flare. Her medication regimen should be adjusted to include:
A. titration to a therapeutic theophylline level.
B. addition of timed salmeterol (Serevent) use.
C. a short course of oral prednisone.
D. use of montelukast (Singulair) on a regular basis.
C. a short course of oral prednisone.
84
For a pregnant woman with asthma, bronchospasm
symptoms are often reported to improve during
______weeks of gestation.
A. 8 to 13
B. 20 to 26
C. 29 to 36
D. 36 to 40
D. 36 to 40
85
```
Most SNRI are FDA pregnancy risk category:
B
C
D
X
```
C
86
```
The benzodiazepines are FDA pregnancy risk category:
B
C
D
X
```
D
87
```
Bupropion is FDA pregnancy risk category:
B
C
D
X
```
C
88
Most tricyclic antidepressants are FDA pregnancy risk
category:
A. A or B.
B. C. or D
C. X.
D. Unrated as these are older medications.
B. C. or D
89
The use of NSAIDs during pregnancy can potentially
increase the risk for:
A. premature birth.
B. neural tube defects.
C. premature closure of ductus arteriosis.
D. ventricular septal defects.
C. premature closure of ductus arteriosis.
90
A 26-year-old woman has been taking an SSRI for depression during the entire course of her pregnancy. She gives birth to a full-term healthy girl. Five days after the birth, she reports that the baby is irritable with protracted periods of crying. This is likely a result of:
A. increased intracranial pressure from en utero SSRI
exposure.
B. SSRI withdrawal.
C. colic.
D. impending sepsis.
B. SSRI withdrawal.
91
```
An example of an antimicrobial that is FDA pregnancy
risk category B is:
A. clarithromycin.
B. doxycycline.
C. erythromycin.
D. ofloxacin.
```
C. erythromycin.
92
```
An antimicrobial that is FDA pregnancy risk
category D is:
A. amoxicillin.
B. levofloxacin.
C. doxycycline.
D. TMP-SMX.
```
C. doxycycline.
93
```
The penicillins are ranked as FDA pregnancy risk category:
A. B.
B. C.
C. D.
D. X.
```
A. B.
94
```
All of the following uropathogens are capable of reducing urinary nitrates to nitrites except:
A. Escherichia coli.
B. Proteus species.
C. Klebsiella pneumoniae.
D. Staphylococcus saprophyticus.
```
D. Staphylococcus saprophyticus.
95
```
Which of the following is FDA pregnancy risk category
B until the 36th week of pregnancy?
A. gentamicin
B. nitrofurantoin
C. clarithromycin
D. ciprofloxacin
```
B. nitrofurantoin
96
In a pregnant woman, asymptomatic bacteruria:
A. should be treated only if bladder instrumentation
or surgery is planned.
B. needs to be treated to avoid complicated urinary tract infection (UTI).
C. is a common, benign finding.
D. is a risk factor for the development of hypertension.
B. needs to be treated to avoid complicated urinary tract infection (UTI).
97
```
Which of the following is the most common UTI
organism in pregnant women?
A. Pseudomonas aeruginosa
B. E. coli
C. K. pneumoniae
D. Proteus mirabilis
```
B. E. coli
98
Recommended length of antimicrobial therapy for a
pregnant woman with asymptomatic bacteruria is:
A. 1 to 3 days.
B. 3 to 7 days.
C. 8 to 10 days.
D. 2 weeks.
B. 3 to 7 days.
99
Postpartum “baby blues” typically begin:
A. 1–2 weeks prior to the birth.
B. within a few days following the birth.
C. 1–2 weeks following the birth.
D. approximately 1 month following the birth.
B. within a few days following the birth.
100
Risk factors for postpartum depression include all of
the following except:
A. history of depression.
B. financial problems.
C. history of carrying two or more pregnancies to term.
D. unplanned pregnancy.
C. history of carrying two or more pregnancies to term.
101
```
Symptoms of postpartum depression include all of the
following except:
A. hallucinations.
B. overwhelming fatigue.
C. insomnia.
D. severe mood swings.
```
A. hallucinations.
102
```
Treatment of postpartum depression can typically
include all of the following except:
A. counseling.
B. antidepressants.
C. electroconvulsive therapy.
D. hormone therapy.
```
C. electroconvulsive therapy.
103
The risk of infanticide is greatest in a woman with
which of the following conditions?
A. postpartum depression
B. postpartum “baby blues”
C. postpartum psychosis
D. There is little risk of infanticide with any of the
above conditions.
C. postpartum psychosis
104
A risk factor for postpartum psychosis is:
A. history of depression.
B. multiple births (i.e., twins, triplets, etc.).
C. history of bipolar disorder.
D. illegal drug use.
C. history of bipolar disorder.
105
```
Treatment of postpartum psychosis typically includes
all of the following except:
A. hospitalization.
B. estrogen replacement therapy.
C. antipsychotic therapy.
D. electroconvulsive therapy.
```
B. estrogen replacement therapy.
106
Match hypertensive disorder with its characteristic.
Chronic HTN
A. high blood pressure diagnosed
after the 20th week of pregnancy
B. presence of tonic-clonic seizures or other alteration in mental status
C. high blood pressure diagnosed before pregnancy
D. preeclampsia
accompanied by elevated hepatic enzymes and low
platelets
E. high blood pressure diagnosed after the 20th week of pregnancy and
accompanied by significant proteinuria
C. high blood pressure diagnosed before pregnancy
107
Match hypertensive disorder with its characteristic.
Gestational HTN
A. high blood pressure diagnosed after the 20th week of pregnancy
B. presence of tonic-clonic seizures or other alteration in mental status
C. high blood pressure diagnosed before pregnancy
D. preeclampsia
accompanied by elevated hepatic enzymes and low
platelets
E. high blood pressure diagnosed after the 20th week of pregnancy and accompanied by significant proteinuria
A. high blood pressure diagnosed after the 20th week of pregnancy
108
Match hypertensive disorder with its characteristic.
Preeclampsia
A. high blood pressure diagnosed
after the 20th week of pregnancy
B. presence of tonic-clonic seizures or other alteration in mental status
C. high blood pressure diagnosed before pregnancy
D. preeclampsia
accompanied by elevated hepatic enzymes and low
platelets
E. high blood pressure diagnosed after the 20th week of pregnancy and
accompanied by significant proteinuria
E. high blood pressure diagnosed after the 20th week of pregnancy and accompanied by significant proteinuria
109
Match hypertensive disorder with its characteristic.
Eclampsia
A. high blood pressure diagnosed
after the 20th week of pregnancy
B. presence of tonic-clonic seizures or other alteration in mental status
C. high blood pressure diagnosed before pregnancy
D. preeclampsia
accompanied by elevated hepatic enzymes and low
platelets
E. high blood pressure diagnosed after the 20th week of pregnancy and
accompanied by significant proteinuria
B. presence of tonic-clonic seizures or other alteration in mental status
110
Match hypertensive disorder with its characteristic.
HELLP Syndrome
A. high blood pressure diagnosed
after the 20th week of pregnancy
B. presence of tonic-clonic seizures or other alteration in mental status
C. high blood pressure diagnosed before pregnancy
D. preeclampsia accompanied by elevated hepatic enzymes and low platelets
E. high blood pressure diagnosed after the 20th week of pregnancy and
accompanied by significant proteinuria
D. preeclampsia accompanied by elevated hepatic enzymes and low platelets
111
Risk factors for preeclampsia include all of the following
except:
A. low maternal weight.
B. age younger than 16 years or older than 40 years.
C. collagen vascular disease.
D. first pregnancy with a new partner.
A. low maternal weight.
112
For a woman who was normotensive before 20 weeks
of gestation, an indication of preeclampsia is blood
pressure of more than ___ mm Hg systolic and more
than ___ mm Hg diastolic.
A. 130, 80
B. 140, 90
C. 150, 95
D. 160, 100
B. 140, 90
113
```
Preeclampsia presentation is noted after the ___ week
of pregnancy.
A. 10th
B. 15th
C. 20th
D. 25th
```
C. 20th
114
```
The components of HELLP syndrome include all of
the following except:
A. hepatic enzyme elevations.
B. thrombocytosis.
C. hemolysis.
D. eclampsia.
```
B. thrombocytosis.
115
```
Which of the following is the most important part of
care of a woman with preeclampsia?
A. antihypertensive therapy
B. anticonvulsant therapy
C. prompt recognition of the condition
D. induction of labor
```
C. prompt recognition of the condition
116
Regarding the risk for neonatal group B streptococcus
(GBS) disease, the NP considers that:
A. about 50% to 70% of all pregnant women harbor
this organism.
B. there is no risk of disease with cesarean birth.
C. the organism is most often acquired by vertical
transmission in the second trimester of pregnancy.
D. intrapartum antimicrobials should be given to all
women with evidence of GBS colonization.
D. intrapartum antimicrobials should be given to all
117
```
GBS cultures should be obtained from:
A. the cervix.
B. the urethra.
C. urine.
D. the lower vagina and rectum.
```
D. the lower vagina and rectum.
118
You note that a 28-year-old woman who is 4 months
pregnant has bruises on her right shoulder. She states,
“I fell up against the wall.” The bruises appear fingershaped.
She denies that another person injured her.
What is your best response to this?
A. “Your bruises really look as if they were caused by
someone grabbing you.”
B. “Was this really an accident?”
C. “I notice the bruises are in the shape of a hand.”
D. “How did you fall?”
C. “I notice the bruises are in the shape of a hand.”
119
Which of the following statements is true concerning
domestic violence during pregnancy?
A. This is found largely among women of lower socioeconomic status.
B. Women in an abusive relationship usually seek help.
C. Routine screening is indicated during pregnancy.
D. A predictable cycle of violent activity followed by a
period of calm is the norm.
C. Routine screening is indicated during pregnancy.
120
T/F Domestic abuse is uncommon in same-sex relationships.
False
121
T/F Access to a firearm does not increase the rate of
| fatal episodes of domestic abuse.
False
122
T/F Child abuse is present in about half of all homes
| where partner mistreatment occurs.
True
123
```
Approximately ___% of all clinically recognized pregnancies end in spontaneous abortion.
A. 10
B. 20
C. 30
D. 40
```
B. 20
124
```
Approximately __% of spontaneous abortions are associated with chromosomal defects.
A. 20
B. 40
C. 60
D. 80
```
C. 60
125
```
The classic clinical triad of ectopic pregnancy includes
all of the following except:
A. abdominal pain.
B. vaginal bleeding.
C. large-for-gestational-age uterus.
D. adnexal mass.
```
C. large-for-gestational-age uterus.
126
The classic clinical triad of ectopic pregnancy is found
in no more than ___% of women presenting with this
condition.
A. 10
B. 25
C. 50
D. 75
C. 50
127
In the first weeks of a viable intrauterine pregnancy,
serum quantitative hCG levels usually doubles every
___ hours until approximately 10,000-20,000mIU/mL.
A. 24
B. 48
C. 72
D. 96
B. 48
128
In ectopic pregnancy, all of the following statements
are true except:
A. hCG is low for gestational age and is not increasing
normally.
B. Ultrasound evaluation fails to reveal abnormality
in 20% to 30% of cases.
C. Location of the pregnancy is often on the ovary or cervix.
D. Risk factors include current pregnancy via assisted
reproduction.
C. Location of the pregnancy is often on the ovary or cervix.
129
Complete abortion.
A. Uterine contents include a nonviable pregnancy that is in the process of being expelled.
B. Some portion of the products of conception remains in the uterus, although the pregnancy is no longer viable.
C. The products of conception have been completely expelled.
D. Ultrasound evaluation shows a viable pregnancy, although vaginal bleeding is present.
C. The products of conception have been completely expelled.
130
Inevitable abortion.
A. Uterine contents include a nonviable pregnancy that is in the process of being expelled.
B. Some portion of the products of conception remains in the uterus, although the pregnancy is no longer viable.
C. The products of conception have been completely expelled.
D. Ultrasound evaluation shows a viable pregnancy, although vaginal bleeding is present.
A. Uterine contents include a nonviable pregnancy that is in the process of being expelled.
131
Threatened abortion.
A. Uterine contents include a nonviable pregnancy that is in the process of being expelled.
B. Some portion of the products of conception remains in the uterus, although the pregnancy is no longer viable.
C. The products of conception have been completely expelled.
D. Ultrasound evaluation shows a viable pregnancy, although vaginal bleeding is present.
D. Ultrasound evaluation shows a viable pregnancy, although vaginal bleeding is present.
132
Incomplete abortion.
A. Uterine contents include a nonviable pregnancy that is in the process of being expelled.
B. Some portion of the products of conception remains in the uterus, although the pregnancy is no longer viable.
C. The products of conception have been completely expelled.
D. Ultrasound evaluation shows a viable pregnancy, although vaginal bleeding is present.
B. Some portion of the products of conception remains in the uterus, although the pregnancy is no longer viable.
133
```
First-time mothers usually have an average of ______
hours of active first-stage labor.
A. 6 to 8
B. 9 to 12
C. 13 to 15
D. 16 to 18
```
B. 9 to 12
134
For women who have previously given birth vaginally,
first-stage and second-stage labor usually lasts a total
of ______ hours.
A. 3 to 5
B. 6 to 8
C. 9 to 10
D. 11 to 13
B. 6 to 8
135
Treatment for mild preeclampsia includes all of the following except:
A) Bed rest except for bathroom privileges
B) Close monitoring of weight and blood pressure
C) Close follow-up of urinary protein, serum creatinine, and platelet count
D) A prescription of methyldopa (Aldomet) to control blood pressure
D) A prescription of methyldopa (Aldomet) to control blood pressure.
Recommended
care for women diagnosed with preeclampsia includes bed rest with bathroom
privileges, weight and BP monitoring, and closely following urine protein
and serum protein, creatinine, and platelet counts. Oral medications are not used
as fi rst-line treatment.
136
Which of the following findings is most likely in young primigravidas with pregnancy-
induced hypertension?
A) Abdominal cramping and constipation
B) Edema of the face and the upper extremities
C) Shortness of breath
D) Dysuria and frequency
B) Edema of the face and the upper extremities
Common signs and symptoms
of pregnancy-induced hypertension include edema of the face and the
upper extremities, weight gain, blurred vision, elevated BP, proteinuria, and
headaches.
137
A second triple screen on a 35-year-old primigravida reveals abnormally low levels of the alpha fetoprotein and estriol and high levels of human chorionic gonadotropin. Which of the following interventions is the best choice for this patient?
A) Order an ultrasound
B) Order a computed tomography (CT) scan of the abdomen
C) Order a 24-hour urine for protein clearance
D) Assess for a history of illicit drug or alcohol use
A) Order an ultrasound
Abnormally low levels of alpha fetoprotein and estriol
and high levels of human chorionic gonadotropin are abnormal during pregnancy.
An ultrasound should be ordered to further evaluate the fetus for characteristics
of Down syndrome and/or fetal demise.
138
```
A 35-year-old primigravida who is at 28 weeks of gestation is expecting twins. What would you would expect her alpha fetoprotein (AFP) values to be?
A) Normal
B) Higher than normal
C) Lower than normal
D) None of the above
```
B) Higher than normal
Alpha fetoprotein is produced in the fetal and maternal
liver. Higher levels of alpha fetoprotein are commonly seen in multiple gestations
due to the growing fetuses and enlargement of the livers.
139
Fetal TORCH infections can cause microcephaly, mental retardation, hepatosplenomegaly, and intrauterine growth retardation. The acronym TORCH stands for:
A) Toxoplasma gondii, other infections, rubella, cytomegalovirus, and herpes
B) Toxic shock syndrome, ocular infections, rubella, cytomegalovirus, and herpes
zoster
C) Tetanus, ophthalmic infections, roseola, cancer, and head abnormalities
D) Toxins, other infections, roseola, candidiasis, and head abnormalities
A) Toxoplasma gondii, other infections, rubella, cytomegalovirus, and herpes
The
acronym TORCH stands for Toxoplasma gondii, other infections, rubella, cytomegalovirus,
and herpes. Although several of the conditions listed in the other answer options
can also cause fetal problems, they are not included in the TORCH acronym.
140
A multigravida who is at 28 weeks of gestation has a fundal height of 29 cm. Which of the following is the best recommendation for this patient?
A) Advise the mother that her pregnancy is progressing well
B) Order an ultrasound of the uterus
C) Refer her to an obstetrician for an amniocentesis
D) Recommend bed rest with bathroom privileges
A) Advise the mother that her pregnancy is progressing well
From 20–35
weeks’ gestation, fundal height should equal weeks gestation. If greater than 2 cm
within the gestational week of pregnancy, further testing should be performed to
evaluate fetal growth.
141
A multigravida who is at 34 weeks of gestation wants to know at what level her uterine fundus should be. The best answer is to advise the mother that her fundus is:
A) Midway between the umbilicus and the lower ribs
B) At the level of the umbilicus
C) From 33 to 35 cm
D) From 32 to 34 cm
C) From 33 to 35 cm
After 20 weeks gestation, fundal height in centimeters
should measure approximately the same as the number of weeks of gestation.
142
A 28-year-old multipara who is at 32 weeks of gestation presents to your offi ce complaining
of a sudden onset of small amounts of bright red vaginal bleeding. She has had several episodes and appears anxious. On exam, her uterus is soft to palpation.
Which of the following is most likely?
A) Placenta abruptio
B) Placenta previa
C) Acute cervicitis
D) Molar pregnancy (hydatidiform mole)
B) Placenta previa
Placenta previa occurs when abnormal implantation of the
placenta occurs. A common symptom of placenta previa is painless, bright red
bleeding.
143
```
A 48-year-old woman is told by a physician that she is starting menopause. All of the following are possible findings except:
A) Hot flashes
B) Irregular menstrual periods
C) Severe vaginal atrophic changes
D) Cyclic mood swings
```
C) Severe vaginal atrophic changes
As women reach menopause, changes
that may occur include hot fl ashes, irregular menstrual periods, and cyclic mood
swings. Vaginal changes, such as dryness and thinning, may also begin to occur.
144
A 30-year-old primigravida is diagnosed with a possible threatened abortion. The result of the urine pregnancy test is positive. Which of the following statements is
true regarding a threatened abortion?
A) Vaginal bleeding and cramping are present, but the cervix remains closed
B) Vaginal bleeding and cramping are present along with a dilated cervix
C) The fetus and placenta are all expelled
D) The products of conception and the placenta remain inside the uterus along with a dilated cervix
A) Vaginal bleeding and cramping are present, but the cervix remains
closed
Threatened abortion is defined as vaginal bleeding and cramping without
the presence of cervical dilation.
145
A pelvic exam on a woman who is 12 weeks pregnant would reveal that her uterus is located at which of the following areas?
A) Between the umbilicus and the suprapubic bone
B) Just rising above the suprapubic bone
C) Between the suprapubic bone and the xiphoid process
D) Between the umbilicus and the xiphoid process
B) Just rising above the suprapubic bone
At 12 weeks gestation, the uterus measures approximately the size of a grapefruit, which would be felt just above the suprapubic bone on bimanual exam.
146
All of the following are not recommended for the outpatient treatment of mild preeclampsia except:
A) Severe sodium restriction
B) Restrict fl uid intake to less than 1 liter per 24 hours
C) Aldomet (methyldopa) 250 mg PO (orally) BID
D) Bed rest on the left side with bathroom privileges
D) Bed rest on the left side with bathroom privileges
Outpatient treatment
for mild preeclampsia includes bed rest on the left lateral side with bathroom
privileges.
147
A positive Coombs test on an Rh-negative pregnant woman means:
A) The mother has autoantibodies against Rh-positive red blood cells (RBCs)
B) The fetus has autoantibodies against maternal RBCs
C) The mother does not have Rh factor against fetal RBCs
D) The fetus does not have RBC autoantibodies
A) The mother has autoantibodies against Rh-positive red blood cells
(RBCs)
The mother’s autoantibodies can attack the fetus’s Rh-positive red blood
cells and cause destruction of these cells, which can cause severe anemia and complications
in the fetus. Today this is preventable with the administration of anti-
RhD immunoglobulin (Rho(D) immune globulin) to an Rh-negative mother at
28 weeks gestation and after birth if the newborn is Rh positive.
148
```
Folic acid supplementation is recommended for women who are planning pregnancy in order to:
A) Prevent renal agenesis
B) Prevent anencephaly
C) Prevent kidney defects
D) Prevent heart defects
```
B) Prevent anencephaly
Folic acid supplementation during pregnancy has been
shown to decrease the risk of neural tube defects of the fetus.
149
A 44-year-old female who is undergoing treatment for infertility complains of not having a menstrual period for a few months. The night before, she started spotting
and is now having cramp-type pains in her pelvic area. Her blood pressure (BP) is 160/80, the pulse rate is 110, and she is afebrile. Her labs reveal a mild anemia with
mild leukocytosis. On pelvic exam, the uterine fundus is found above the symphysis pubis. The cervical os is dilated at 3 cm. Which of the following is most likely?
A) Inevitable abortion
B) Threatened abortion
C) Incomplete abortion
D) Acute pelvic infl ammatory disease
A) Inevitable abortion
Inevitable abortion is defined as vaginal bleeding with
pain and cervical dilation and/or effacement. Threatened abortion is defi ned as
vaginal bleeding with absent or minimal pain and a closed, long, and thick cervix.
Incomplete abortion is moderate to diffuse vaginal bleeding, with the passage of
tissue and painful uterine cramping or contractions. Acute pelvic infl ammatory
disease is a sudden onset of infl ammation and pain that affects the pelvic area,
cervix, uterus, and ovaries, which is caused by infection.
150
An Rh-negative pregnant woman with negative rubella titers should be vaccinated at what time period in pregnancy?
A) She can be vaccinated at any time in her pregnancy
B) During the second trimester
C) During the third trimester
D) During the postpartum period
D) During the postpartum period
Rubella should be administered to the woman
during the postpartum period. Rubella is contraindicated during pregnancy.
151
```
Human chorionic gonadotropin (hCG) is produced by the:
A) Placenta
B) Hypothalamus
C) Anterior pituitary
D) Ovaries
```
A) Placenta
152
```
The majority of serum alpha fetoprotein is produced by the:
A) Fetal liver
B) Mother’s liver
C) Placenta
D) Fetal neural tube
```
A) Fetal liver
153
You note the following result on a routine urinalysis of a 37-year-old primigravida who is at 30 weeks of gestation. Leukocyte = trace, nitrite = negative, protein = 2 +, blood = negative. Her weight has increased by 5 lbs during the past week. Which of the following is most likely?
A) HELLP syndrome
B) Pregnancy-induced hypertension (preeclampsia)
C) Eclampsia of pregnancy
D) Primary hypertension
B) Pregnancy-induced hypertension (preeclampsia)
The classic triad of
symptoms of preeclampsia includes hypertension, edema (weight gain), and
proteinuria.
154
The positive signs of pregnancy include:
A) Palpation of the fetus and auscultation of the fetal heart tones by the nurse
practitioner
B) Palpation of the fetus and a positive quantitative serum pregnancy test
C) Fetal heart tones and a positive quantitative serum pregnancy test
D) Fetal heart tones and feeling of movement of the baby by the mother
A) Palpation of the fetus and auscultation of the fetal heart tones by the nurse practitioner
Presumptive signs of pregnancy are symptoms experienced by the woman, such as amenorrhea, breast tenderness, nausea/vomiting, fatigue, and increased urinary frequency. Probable signs of pregnancy are signs detected by the examiner, such as an enlarged uterus. Positive signs of pregnancy are
direct evidence of pregnancy such as audible fetal heart tones or cardiac activity on ultrasound.
155
Chadwick’s sign is characterized by:
A) Softening of the cervix
B) Blue coloration of the cervix and vagina
C) Softening of the uterine isthmus
D) Nausea and vomiting during the fi rst trimester of pregnancy
B) Blue coloration of the cervix and vagina Chadwick’s sign is defined as a bluish discoloration of the cervix and vagina. These changes are caused by the
increased vascularity and congestion in the pelvic area during pregnancy.
156
```
Hegar’s sign is considered a:
A) Positive sign of pregnancy
B) Probable sign of pregnancy
C) Presumptive sign of pregnancy
D) Problem in pregnancy
```
B) Probable sign of pregnancy
Hegar’s sign is softening of the lower portion of
the uterus and is considered a probable sign of pregnancy.
157
When palpating a woman who is at 20 weeks of gestation, the nurse practitioner should be able to feel the uterine fundus at what level?
A) Just rising above the level of the pubic symphysis
B) Between the pubic symphysis and the umbilicus
C) At the level of the umbilicus
D) Above the level of the umbilicus
C) At the level of the umbilicus
Uterine growth at 12 weeks gestation, palpable
just above the symphysis pubis; 20 weeks gestation, at the level of the
umbilicus; after this, measurements in cm should approximately equal weeks of
gestation.
158
```
A 25 -year-old woman’s last menstrual period was 6 weeks ago. She is complaining of nausea with vomiting in the morning and fatigue. Her breasts feel bloated. The nurse practitioner suspects that she is pregnant. Her symptoms would be considered:
A) Positive signs of pregnancy
B) Probable signs of pregnancy
C) Presumptive signs of pregnancy
D) Possible signs of pregnancy
```
C) Presumptive signs of pregnancy
Presumptive signs of pregnancy are symptoms
experienced by the woman, such as amenorrhea, breast tenderness, nausea/vomiting, fatigue, and increased urinary frequency.
159
```
A 38-year-old multigravida who is at 32 weeks of gestation calls the family nurse practitioner complaining of bright red vaginal bleeding. There is no watery discharge. She complains that her uterus feels hard and is very painful. Which of the following conditions is most likely?
A) Placenta previa
B) Placenta abruptio
C) A molar pregnancy
D) An ectopic pregnancy
```
B) Placenta abruptio
Abruptio placenta symptoms are bright red vaginal bleeding,
board-like uterus on palpation, and pain. However, there can be concealed
hemorrhage and the patient may not have vaginal bleeding. Placenta previa is painless bleeding. Ectopic and molar pregnancy would not progress to 32 weeks
gestation.
160
During a breast exam of a 30-year-old nulliparous female, the nurse practitioner palpates several rubbery mobile areas of breast tissue. They are slightly tender to palpation. Both breasts have symmetrical findings. There are no skin changes or any nipple discharge. The patient is expecting her menstrual period in 5 days. Which of the following would you recommend?
A) Referral to a gynecologist for further evaluation
B) Tell her to return 1 week after her period so her breasts can be rechecked
C) Advise the patient to return in 6 months to have her breasts rechecked
D) Schedule the patient for a mammogram
B) Tell her to return 1 week after her period so her breasts can be rechecked
Prior to having menses, women will experience breast changes of tenderness with palpation, with symmetrical soft, mobile areas of breast tissue that are benign. Her
symptoms should improve after her menses and repeating the exam in 1 week would be recommended.
161
```
Jane, a young primigravida, reports to you that she is starting to feel the baby’s movements in her uterus. This is considered to be which of the following?
A) Presumptive sign
B) Probable sign
C) Positive sign
D) Possible sign
```
A) Presumptive sign
| Presumptive signs of pregnancy are symptoms of pregnancy that are felt by the woman.
162
Physiologic anemia of pregnancy is due to:
A) An increase in the cardiac output at the end of the second trimester
B) A physiologic decrease in the production of RBCs in pregnant women
C) An increase of up to 50% of the plasma volume in pregnant women
D) An increase in the need for dietary iron in pregnancy
C) An increase of up to 50% of the plasma volume in pregnant women
Physiologic anemia of pregnancy is caused by the increased volume of plasma during pregnancy when compared to the production of RBCs.
163
```
Which of the following is contraindicated in the care of pregnant women with placenta previa?
A) Echocardiogram
B) Intravaginal ultrasound
C) Abdominal ultrasound
D) Pelvic ultrasound
```
B) Intravaginal ultrasound
No type of vaginal exam should be performed in
patients diagnosed with placenta previa. Intravaginal ultrasound and pelvic exams are contraindicated.
164
You are checking a 75-year-old woman’s breast during an annual gynecological exam. The left nipple and areola are scaly and reddened. The patient denies
pain and pruritis. She has noticed this scaliness on her left nipple for the past 8 months. Her dermatologist gave her a potent topical steroid, which she used
twice a day for 1 month. The patient never went back for the follow-up. She still has the rash and wants an evaluation. Which of the following is the best
intervention for this patient?
A) Prescribe another potent topical steroid and tell the patient to use it twice a day
for 4 weeks
B) Order a mammogram and refer the patient to a breast surgeon
C) Advise her to stop using soap on both breasts when she bathes to avoid drying
up the skin on her areolae and nipples
D) Order a sonogram and fi ne-needle biopsy of the breast
B) Order a mammogram and refer the patient to a breast surgeon
A scaly, reddened
rash on the breast that does not resolve after a few weeks of medical treatment
may indicate breast cancer. She should have a mammogram performed and see a
breast surgeon for evaluation and treatment.
165
The following are patients who are at high risk for complications due to urinary tract infections. Who does not belong in this category?
A) A 38-year-old diabetic patient with a HbA1C of 7.5%
B) A woman with a history of rheumatoid arthritis who is currently being treated
with a regimen of methotrexate and low-dose steroids
C) A 21-year-old woman who is under treatment for 2 sexually transmitted
infections
D) Pregnant women
C) A 21-year-old woman who is under treatment for 2 sexually transmitted
infections
Risk factors for complications due to urinary tract infection include pregnancy, diabetes, and steroid therapy.
166
All of the following statements are true regarding domestic abuse except:
A) There is no delay in seeking medical treatment
B) The pattern of injuries is inconsistent with the history reported
C) Injuries are usually in the “central” area of the body instead of the extremities
D) Pregnant women have a higher risk of domestic abuse
A) There is no delay in seeking medical treatment
When assessing for domestic
abuse, the most common body area that is abused is the “swim-suit” area,
which is usually covered by clothing. Suspect abusive relationships when the history
is inconsistent with the injury. Most victims do not seek medical attention until after several episodes of violence. Studies have shown that the incidence of
battery escalates during pregnancy.
167
A newborn’s mother is discovered to be HBsAg (hepatitis B surface antigen) positive. Which of the following would you recommend for this infant?
A) Give the baby hepatitis B immunoglobulin
B) Give the baby both hepatitis B vaccine and hepatitis B immunoglobulin
C) Give the baby hepatitis B vaccine only
D) Send the baby home because he is not infected
B) Give the baby both hepatitis B vaccine and hepatitis B immunoglobulin
For
a mother who tests positive for HBsAg, the newborn infant should be given hepatitis
B vaccine and hepatitis B immunoglobulin for protection.
168
```
Lead poisoning can cause which type of anemia?
A) A mild macrocytic anemia
B) Normocytic anemia
C) Microcytic anemia
D) A mild hemolytic anemia
```
C) Microcytic anemia
Lead poisoning can cause microcytic anemia. Signs and symptoms of lead poisoning are abdominal pain, constipation, vomiting, and blue-black line on the gums. Lead causes anemia by mimicking healthful minerals
such as calcium, iron, and zinc. It is absorbed by the bones, where it interferes with the production of RBCs. This absorption can also interfere with calcium absorption that is needed to keep the bones healthy.
169
```
All of the following conditions are associated with an increased risk for normocytic
anemia except:
A) Rheumatoid arthritis
B) Lupus
C) Chronic autoimmune disorders
D) Pregnancy
```
D) Pregnancy
During pregnancy, women may experience microcytic, hypochromic anemia due to the dilutional effect of the increased blood volume during the pregnancy.
170
All of the following statements reflect inadequate breast milk production except:
A) Full-term infant is at birth weight by the second week of life
B) Less than 6 wet diapers per day or less than 4 stools per day
C) Infant is nursing fewer than 8 times per 24-hour period
D) Weight loss of > 10% of birth weight
A) Full-term infant is at birth weight by the second week of life
The fullterm infant should be back to birth weight at 2 weeks of age. The infant should be nursing every 2–4 hours and should wet 6–10 diapers a day (24 h).
171
RhoGAM’s mechanism of action is:
A) The destruction of Rh-positive fetal RBCs that are present in the mother’s circulatory system
B) The destruction of maternal antibodies against Rh-positive fetal RBCs
C) The stimulation of maternal antibodies so that there is a decreased risk of hemolysis
D) The destruction of maternal antibodies against fetal RBCs
A) The destruction of Rh-positive fetal RBCs that are present in the mother’s cirulatory system
RhoGAM is given to mothers with Rh-negative blood when the fetus has Rh-positive blood. RhoGAM protects the mother from developing antibodies by destroying the Rh-positive fetal RBCs in the mother’s blood system.
172
A 30-year-old female complains of having no period for the last 12 weeks. She is sexually active and has been using condoms inconsistently. The patient has a history
of irregular menstrual cycles and severe dysmenorrhea. The urine pregnancy test result is positive. Which of the following is a true statement regarding this pregnancy?
A) The fundus of the uterus should be at the level of the symphysis pubis
B) The cervix should be dilated about 0.5 in. at this time of gestation
C) “Quickening” starts during this period
D) Hegar’s sign is present during this period of pregnancy
A) The fundus of the uterus should be at the level of the symphysis pubis
At 12 weeks gestation, the fundus of the uterus should be located approximately at the symphysis pubis.
173
A woman at 32 weeks gestation has a positive throat culture for strep pyogenes. She denies allergies but gets very nauseated with erythromycin. Which of the following
is the best choice for this pregnant patient?
A) Clarithromycin (Biaxin)
B) Trimethoprim/sulfamethoxazole (Bactrim DS)
C) Ofl oxacin (Floxin)
D) Penicillin (Pen VK)
D) Penicillin (Pen VK)
Pen VK is safe to use for strep throat during pregnancy.
Pen VK is a category B medication for pregnancy and lactation.
174
```
Which of the following tests would you recommend to patients to confirm the diagnosis of beta thalassemia or sickle cell anemia?
A) Hemoglobin electrophoresis
B) Bone morrow biopsy
C) Peripheral smear
D) Reticulocyte count
```
A) Hemoglobin electrophoresis
Patients with the diagnosis of beta thalassemia
and/or sickle cell anemia would be screened using hemoglobin electrophoresis to identify the blood disorder.
175
```
All of the following are considered Category X drugs except:
A) Misoprostol (Cytotec)
B) Isotretinoin (Accutane)
C) Finasteride (Proscar)
D) Meperidine (Demerol)
```
D) Meperidine (Demerol)
| Demerol is in drug Category C and and treated by the FDA as a controlled drug Schedule II.
176
```
Spermatogenesis occurs at the:
A) Vas deferens
B) Seminal vesicles
C) Testes
D) Epididymis
```
C) Testes
| Spermatogenesis occurs in the testes, taking approximately 3 months to develop.
177
Women who are pregnant during the winter months are recommended to have which of the following?
A) Increased intake of Vitamin C and folate
B) Vaccination against the infl uenza virus
C) Increased caloric intake of fruits and vegetables
D) Heavier winter clothes to avoid chilling the fetus
B) Vaccination against the influenza virus
Influenza vaccine is recommended for all pregnant patients for prevention due to the decrease in immune status during pregnancy. The vaccine is safe to use during pregnancy.
178
```
Which of the following conditions is a possible complication of severe eclampsia?
A) Placenta previa
B) Placenta abruptio
C) Erythroblastosis fetalis
D) Uterine rupture
```
B) Placenta abruptio
Abruptio placenta is a possible complication of severe
eclampsia. With elevated blood pressure, the placenta can pull away from the uterine lining and cause painful, bright red bleeding.
179
```
All of the following are considered risk factors for UTIs in women except:
A) Diabetes mellitus
B) Diaphragms and spermicide use
C) Pregnancy
D) Intrauterine device
```
D) Intrauterine device
| Risk factors for UTIs include diabetes mellitus, pregnancy, and use of diaphragms and spermicide.
180
```
All of the following vaccines are contraindicated in pregnant women except:
A) Infl uenza
B) Mumps
C) Varicella
D) Rubella
```
A) Influenza
Influenza vaccine is recommended for all pregnant patients for prevention, due to the decrease in immune status during pregnancy. The vaccine is safe to use during pregnancy. The other vaccines are live viruses and are contraindicated during pregnancy.
181
What is the most common cause of infertility among women in the United States?
A) Scarring of the fallopian tubes due to a history of pelvic inflammatory disease (PID)
B) Ovulation disorders
C) Age older than 35 years
D) Endometriosis
B) Ovulation disorders
Ovulation disorders are the top cause of female infertility (25%). There is no ovulation (anovulation) or infrequent ovulation that results in oligoamenorrhea (i.e., PCOS). The second cause is endometriosis (15%). About 10% of women in the United States (ages 15 to 44 years) have difficulty getting pregnant (CDC, 2009). PCOS is one of the most common causes of female infertility. Infertility in males is often caused by a varicocele (heats up the testes) and abnormal and/or low sperm count.
182
```
A woman who is in the third trimester of pregnancy presents to the nurse practitioner for a physical exam. During the physical exam, the nurse practitioner finds all of the following cardiac changes associated with pregnancy except:
A) Systolic ejection murmur
B) Diastolic murmur
C) Displaced apical impulse
D) Louder S1 and S2
```
B) Diastolic murmur
Diastolic murmurs are more likely to be pathologic. The
heart is displaced in a more transverse position that is lateral to the midclavicular line. The systolic ejection murmur is due to increased stroke volume caused by increased cardiac output and higher basal heart rate.
183
A new mother is planning on breastfeeding her newborn infant for at least 6 months. She wants to know whether she should give the infant vitamins. Which of the following vitamin supplements is recommended by the American Academy of Pediatrics (APA) latest guideline during the first few days of life?
A) Vitamin D drops
B) Multi vitamin drops
C) It is not necessary to give breastfed infants vitamin supplements because breast milk contains enough vitamins and minerals that are necessary for the infant’s growth and development
D) Folic acid drops
A) Vitamin D drops
According to the APA, all infants should be given Vitamin
D supplementation within the first few days of life. Mothers who plan to breastfeed their infants should be taught how to use Vitamin D drops. Infant formula is
supplemented with Vitamin D (and many other vitamins, minerals, and omega-3 oil), so there is no need to give it separately.
184
Which of the following statements is false regarding jaundice in breastfed infants?
A) Breastfed infants have a higher incidence of hyperbilirubinemia compared with formula-fed infants
B) The mechanism of breast milk jaundice is still not known
C) Phytotherapy is usually not indicated for these infants
D) It usually starts in the first week of life
D) It usually starts in the first week of life
Onset is later than physiologic jaundice. Breast jaundice usually starts to show after seven days of life. It peaks in 2 to 3 weeks and can take more than 1 month to clear.
185
A new mother is breastfeeding her full-term 4-week-old infant. She wants to know whether she should give the infant vitamin supplements. The best advice is:
A) Since she is breastfeeding, the infant does not need any vitamin supplements until he is at least 6 months of age
B) Breast milk gives the infant all the vitamins he needs until 12 months of age
C) Breastfed infants require iron and Vitamin D supplementation right away
D) Breastfed infants require iron and Vitamin E supplementation at 3 months of age
C) Breastfed infants require iron and Vitamin D supplementation right away
While infants do receive Vitamin D through human milk, the AAP recommends a daily supplement of 200 IU Vitamin D for all breastfed infants.
186
```
What is the primary carbohydrate found in breast milk and commercial infant formulas?
A) Fructose
B) Lactose
C) Glucose
D) Sucrose
```
B) Lactose
187
```
What is the caloric content of infant formula and breast milk?
A) 10 kcal/30 mL
B) 15 kcal/30 mL
C) 20 kcal/30 mL
D) 25 kcal/30 mL
```
C) 20 kcal/30 mL
188
A new mother who is on her fourth day of breastfeeding complains to the nurse practitioner of very sore breasts. The nurse practitioner would:
A) Recommend a decrease in the number of times she breastfeeds her infant per day
B) Recommend that she stop breastfeeding and use infant formula for the next
48 hours
C) Educate the mother that this is normal during the first week or 2 of breastfeeding and the soreness will eventually go away
D) Recommend that she purchase plastic nipple pads for her nursing bra and use them daily
C) Educate the mother that this is normal during the first week or 2 of breastfeeding and the soreness will eventually go away
Nursing during the first 2 weeks after delivery may cause tenderness and soreness of the nipples and usually
resolves after this. The mother should continue to breastfeed as she has been advised, and she should make sure the infant is latching on appropriately.
189
```
The average onset of perimenopause is between the
ages of:
A. 35 to 40 years.
B. 40 to 45 years.
C. 45 to 50 years.
D. 50 to 55 years.
```
B. 40 to 45 years.
190
Which of the following statements regarding perimenopause is false?
A. Menstruation ceases during perimenopause.
B. Hot flashes and flushes are common during the
week before menses.
C. Pregnancy is still possible during perimenopause.
D. Ovulation becomes more erratic during perimenopause.
A. Menstruation ceases during perimenopause.
191
In advising a woman about menopause, the NP considers that:
A. the average age at last menstrual period for a North
American woman is 47 to 48 years.
B. hot flashes and night sweats occur in about 60% to 90% of women.
C. women with surgical menopause usually have
milder symptoms.
D. follicle-stimulating hormone (FSH) and luteinizing
hormone (LH) levels are suppressed.
B. hot flashes and night sweats occur in about 60% to 90% of women.
192
Findings in estrogen deficiency (atrophic) vaginitis
include:
A. a malodorous vaginal discharge.
B. an increased number of lactobacilli.
C. a reduced number of white blood cells.
D. a pH greater than 5.0.
D. a pH greater than 5.0.
193
A 53-year-old woman who is taking hormone therapy
(HT) with conjugated equine estrogen, 0.45 mg/d, with
MPA, 1.5 mg, has bothersome atrophic vaginitis symptoms. You advise that:
A. her oral estrogen dose should be increased.
B. the addition of a topical estrogen can be helpful.
C. the MPA component should be discontinued.
D. baking soda douche should be tried.
B. the addition of a topical estrogen can be helpful.
194
```
For a woman with bothersome hot flashes who cannot take HT, alternative options with demonstrated efficacy and limited adverse effects include the use of all of the following except:
A. venlafaxine.
B. sertraline.
C. gabapentin.
D. clonidine.
```
D. clonidine.
| While clonidine is an option, it is not as effective as SSRIs.
195
```
Absolute contraindications to postmenopausal
HT include:
A. unexplained vaginal bleeding.
B. seizure disorder.
C. dyslipidemia.
D. migraine headache.
```
A. unexplained vaginal bleeding.
196
In advising a perimenopausal woman about HT, you
consider that it may:
A. reduce the risk of venous thrombotic events.
B. significantly reduce serum triglyceride levels.
C. worsen hypertension in most women.
D. help preserve bone density.
D. help preserve bone density.
197
Postmenopausal HT used for use can result in:
A. a reduction in the rate of cardiovascular disease.
B. an increase in the rate of rheumatoid arthritis.
C. a reduction in the frequency and severity of vasomotor symptoms.
D. a disturbance in sleep patterns.
C. a reduction in the frequency and severity of vasomotor symptoms.
198
The progestin component of HT is given to:
A. counteract the negative lipid effects of estrogen.
B. minimize endometrial hyperplasia.
C. help with vaginal atrophy symptoms.
D. prolong ovarian activity.
B. minimize endometrial hyperplasia.
199
Concerning selective estrogen receptor modulator therapy such as raloxifene (Evista), which of the following statements is correct?
A. Concurrent progestin opposition is needed.
B. Hot flashes are reduced in frequency and severity.
C. Use is contraindicated when a woman has a history
of breast cancer.
D. Osteoporosis risk is reduced with use.
D. Osteoporosis risk is reduced with use.
200
During perimenopause, which of the following is likely
to be noted?
A. Symptoms are most likely in the week before the onset of the menses.
B. The length of the perimenopausal period is predictable.
C. Symptoms are less severe in women who smoke.
D. Hot flashes are uncommon.
A. Symptoms are most likely in the week before the onset of the menses.
201
A 48-year-old woman complains of increased frequency and severity of hot flashes. Her last menses
occurred 6 months ago. You would expect all of the following laboratory findings except:
A. increased levels of LH.
B. elevated levels of testosterone.
C. reduced levels of estradiol.
D. reduced levels of progesterone.
B. elevated levels of testosterone.
202
Which of the following is likely to be noted with
short-term (less than 1 to 2 years) HT use in a postmenopausal woman?
A. reduction in dementia risk
B. significant increase in breast cancer risk
C. minimized hot flashes.
D. increase in cardiovascular risk
C. minimized hot flashes.
203
```
Which body area has the greatest concentration of
estrogen receptors?
A. vulva
B. vascular bed
C. heart
D. brain
```
A. vulva
204
When counseling a 46-year-old woman who is experiencing debilitating hot flashes, you advise all of the following regarding higher and lower dose hormone replacement therapy (HT) except:
A. current clinical guidelines recommend using the
lowest effective dose possible.
B. higher-dose HT will relieve hot flashes faster than
lower-dose regimens.
C. lower-dose HT is better tolerated than higherdose
HT.
D. the duration of lower-dose HT is usually shorter
than that of higher-dose regimens.
D. the duration of lower-dose HT is usually shorter
205
You see a 45-year-old woman who is considering HT.
She has a family history of cervical dysplasia, hyperlipidemia, and VTE. You advise her on all of the following except:
A. the use of progestin can minimize the risk of endometrial cancer for a woman on HT and who has
not had a hysterectomy.
B. supplemental estrogen should be avoided in women
who are at high risk of breast cancer or uterine
cancer.
C. supplemental estrogen should be avoided in
women who are at high risk of cardiovascular
disease.
D. short-term studies demonstrate that oral HT is associated with lower thromboembolic risk than transdermal forms of HT.
D. short-term studies demonstrate that oral HT is associated with lower thromboembolic risk than transdermal forms of HT.
206
```
Examples of phytoestrogens include all of the following except:
A. red clover.
B. ginseng.
C. vitamin E.
D. soy products.
```
C. vitamin E.
207
```
The typical HT regimen contains ______ or less of the estrogen dose of COC.
A. one-eighth
B. one-fourth
C. one-half
D. three-fourths
```
B. one-fourth
208
For the woman with a history of DVT who is having
significant vasomotor symptoms, which of the following
can be can be used for symptom management?
A. 17- 17β-estradiol patch
B. drospirenone
C. estrone.
D. paroxetine.
D. paroxetine.
209
```
Long term calcium supplementation is recommended in postmenopausal women as its use reduces the risk of fracture by approximately:
A. 25%.
B. 50%.
C. 65%.
D. 80%.
```
B. 50%.
210
```
In postmenopausal women, a major benefit from the
use of topical or local estrogen is:
A. decreased rate of breast cancer.
B. reduced risk of recurrent UTIs.
C. reduced risk of type 2 diabetes.
D. increased levels of androgens.
```
B. reduced risk of recurrent UTIs.
211
When reviewing the use of nutritional supplements for the management of menopausal symptoms, the NP
considers that:
A. few high-quality studies support the use of these products.
B. the use of these products is consistently reported to
be helpful.
C. the products can be safely used as long as blood hormone
levels are carefully evaluated.
D. the use of these products is associated with a greater
reduction in menopausal symptoms than with prescription
HT.
A. few high-quality studies support the use of these products.
212
Which of the following statements is true?
A. Many over-the-counter progesterone creams
contain sterols that the human body is unable
to use.
B. All progesterones are easily absorbed via
the skin.
C. Alfalfa is an example of a phytoprogesterone.
D. Progesterones, whether synthetic or plant-based,
should not be used by a woman who has undergone
a hysterectomy.
A. Many over-the-counter progesterone creams
