1.
Worldwide, which of the following is the most common problem during pregnancy?
Correct Answer
A. Iron-deficiency anemia
Explanation
Iron-deficiency anemia is the most common problem during pregnancy worldwide. This condition occurs when there is a lack of iron in the body, leading to a decrease in the number of red blood cells and a decrease in the amount of oxygen carried to the body's tissues. During pregnancy, the demand for iron increases to support the growth and development of the baby, making pregnant women more susceptible to developing iron-deficiency anemia. It can lead to fatigue, weakness, and complications for both the mother and the baby if left untreated.
2.
In the United States, it appears that maternal mortality is increasing after years of decline. To address this increase, efforts must be directed toward the leading causes. Which of the following choices lists those leading causes?
Correct Answer
A. Embolism, hypertension, and ectopic pregnancy
Explanation
The leading causes of maternal mortality in the United States are embolism, hypertension, and ectopic pregnancy. These conditions have been identified as contributing factors to the increase in maternal mortality rates. Efforts should be focused on addressing these causes in order to reduce the number of maternal deaths.
3.
A patient presents with a positive pregnancy test, the exact date of the start of her last normal menses, and the date of her luteinizing hormone (LH) surge from a urine kit. Her expected date of delivery can most correctly be calculated by which of the following?
Correct Answer
A. Counting 280 from the first day of the LMP
Explanation
The expected date of delivery can be most accurately calculated by counting 280 days from the first day of the last menstrual period (LMP). This method, known as Naegele's rule, is a commonly used method to estimate the due date of a pregnancy. It assumes a regular 28-day menstrual cycle and that conception occurs on day 14 of the cycle. By counting 280 days from the first day of the LMP, it provides an estimate of when the baby is likely to be born.
4.
A friend mentions to you she just had a positive pregnancy test and wonders if you can tell her when she is likely due. The LMP was June 30. Her expected date of confinement (EDC) is approximate which of the following?
Correct Answer
A. April 7
Explanation
Based on the given information, the friend's last menstrual period (LMP) was on June 30. To estimate the expected date of confinement (EDC), we can add 9 months and 7 days to the LMP. Adding 9 months brings us to March 30, and adding 7 days brings us to April 6. Therefore, the approximate EDC is April 7.
5.
A patient presents to your clinic complaining of nausea and vomiting. She is currently ingesting combined oral contraceptive pills (OCP) and has used them for over a year. When you tell her she has a positive pregnancy test, she reports that her last bleeding on the OCPs was 8 weeks ago. In such a situation, determine
Correct Answer
A. Obtaining fetal biometry by ultrasound prior to 20 weeks’ gestation
Explanation
In this situation, obtaining fetal biometry by ultrasound prior to 20 weeks' gestation is the most appropriate action. The patient has been using combined oral contraceptive pills (OCP) for over a year and her last bleeding on the OCPs was 8 weeks ago. However, she has a positive pregnancy test, indicating that she may have become pregnant while using the OCPs. It is important to determine the gestational age accurately in order to provide appropriate prenatal care. Obtaining fetal biometry by ultrasound is the most reliable method to determine gestational age in early pregnancy.
6.
A 24-year-old patient who has signs and symptoms of renal lithiasis is to have an intravenous pyelogram (IVP) as part of a urologic investigation. Before proceeding with the study, which of the following should you determine?
Correct Answer
A. Whether she may be pregnant
Explanation
Before proceeding with an intravenous pyelogram (IVP), it is important to determine whether the 24-year-old patient may be pregnant. This is because an IVP involves the use of contrast dye, which can be harmful to a developing fetus. Therefore, it is crucial to confirm the patient's pregnancy status and take appropriate precautions to ensure the safety of both the patient and any potential pregnancy.
7.
A 20-year-old primigrávida, who is 24 weeks pregnant, expresses concern about the normality of her fetus after learning that a close friend has just delivered an infant with hydrocephalus. Which of the following details about hydrocephalus should be included in her counseling?
Correct Answer
A. Has a multifactorial etiology
Explanation
Hydrocephalus is a condition characterized by an abnormal accumulation of cerebrospinal fluid in the brain, leading to enlargement of the ventricles. It has a multifactorial etiology, meaning that it is caused by a combination of genetic and environmental factors. This information is important to include in counseling because it helps the patient understand that the condition is not solely caused by a single factor and that there may be a variety of factors contributing to its development.
8.
Fundal height, part of the obstetric examination, is taken from the top of the symphysis pubis to the top of the fundus. How is it measured?
Correct Answer
A. In centimeters, approximating the weeks of gestation beyond 22 weeks
Explanation
Fundal height is measured in centimeters and is used to estimate the gestational age of the fetus. It is taken from the top of the symphysis pubis to the top of the fundus, which is the highest point of the uterus. The measurement is an approximation of the number of weeks of gestation, typically done after 22 weeks. This measurement helps healthcare providers monitor the growth and development of the fetus during pregnancy.
9.
Using your knowledge of normal maternal physiology, which of the following would you employ if a patient at 38 weeks became faint while lying supine on your examination table?
Correct Answer
A. Turning the patient on her side
Explanation
When a patient at 38 weeks becomes faint while lying supine, it is likely due to a condition called supine hypotensive syndrome. This occurs when the weight of the uterus compresses the inferior vena cava, reducing venous return and cardiac output. Turning the patient on her side helps to relieve this compression and restore blood flow, alleviating the symptoms of fainting. Aromatic ammonia spirit, oxygen, IV drugs to increase blood pressure, and IV saline solution are not appropriate interventions for this specific situation.
10.
A woman in early pregnancy is worried because of some recent discomfort in her left breast. On examination, her skin appears normal, she has no axillary or clavicular adenopathy, but you palpate a smooth, nontender, 2-cm mass. Your immediate management should be which of the following?
Correct Answer
A. Breast ultrasound
Explanation
The correct answer is breast ultrasound. In early pregnancy, mammography is not recommended due to the potential harm of radiation to the fetus. Since the woman's skin appears normal and there are no signs of lymph node involvement, needle aspiration or excisional biopsies are not immediately necessary. Warm compresses and antibiotics would be appropriate if there were signs of infection, but in this case, a breast ultrasound would be the most appropriate initial step to further evaluate the mass.
11.
The management of vaginal bleeding in a first-trimester pregnancy requires a trending of human chorionic gonadotropin (hCG) levels. Because urine pregnancy tests can typically be less expensive and results are more rapidly available, it is important to know their sensitivity. Immunologic tests for pregnancy can detect hCG in the urine in which of the following concentrations?
Correct Answer
B. 20 IU/L
12.
The new obstetrical visit typically includes a general well-woman assessment as well as pregnancy evaluation. Which of the following is true about Pap smears taken from the uterine cervix during a normal pregnancy?
Correct Answer
A. They should be part of routine obstetric care, if needed, based on pap frequency for the
Explanation
Pap smears taken from the uterine cervix during a normal pregnancy should be part of routine obstetric care, if needed, based on pap frequency for the individual patient. This means that if a patient has a history of abnormal Pap smears or is due for a routine Pap smear during pregnancy, it should be included as part of their prenatal care. However, it is not necessary for all pregnant women to have a Pap smear if they do not have any specific risks or indications for it.
13.
Prenatal care is a structured approach to obstetric care to assess for increase risk of complications or the actual development of problems. Which of the following would most predispose the patient to obstetrical complications?
Correct Answer
A. Maternal age 39
Explanation
Maternal age is a known risk factor for obstetrical complications. Advanced maternal age (over 35 years) is associated with an increased risk of gestational diabetes, preeclampsia, preterm birth, and chromosomal abnormalities in the baby. Therefore, being 39 years old would most predispose the patient to obstetrical complications compared to the other options provided.
14.
A pregnant woman at 4 weeks’ gestation had an upper gastrointestinal (GI) series and is worried about possible fetal effects from radiation. You inform her that the risk for mental retardation to the fetus is greatest during which phase of pregnancy?
Correct Answer
A. 8th through 15th week of gestation
Explanation
During the 8th through 15th week of gestation, the fetus is in the embryonic period of development. This is a critical time for organogenesis, when the organs and structures of the fetus are forming. Exposure to radiation during this period can increase the risk of developmental abnormalities, including mental retardation. Therefore, the risk for mental retardation to the fetus is greatest during this phase of pregnancy.
15.
Advising a 34-year-old woman at 12 weeks’ gestation about the risk of chromosomal defects in the fetus, you can correctly state which of the following?
Correct Answer
A. Efficacy of screening for Down Syndrome is improved by adding estriol, inhibin A, and hCG concentration to the MSAFP (quadruple screen)
Explanation
Adding estriol, inhibin A, and hCG concentration to the MSAFP (quadruple screen) can improve the efficacy of screening for Down Syndrome. This suggests that these additional markers can help in identifying the risk of chromosomal defects in the fetus more accurately.
16.
The most worrisome sign or symptom of potentially serious pathology in late pregnancy is which of the following?
Correct Answer
A. Visual changes
Explanation
Visual changes in late pregnancy can be a worrisome sign of potentially serious pathology. These changes can include blurred vision, double vision, or flashing lights. These symptoms may indicate conditions such as preeclampsia or gestational diabetes, which can be harmful to both the mother and the baby. Therefore, it is important for pregnant women to report any visual changes to their healthcare provider for further evaluation and management.
17.
During late pregnancy, which of the following implies urinary tract disease?
Correct Answer
A. Decreased creatinine clearance
Explanation
During late pregnancy, a decreased creatinine clearance implies urinary tract disease. Creatinine clearance is a measure of how well the kidneys are able to filter waste products from the blood. A decrease in creatinine clearance suggests that the kidneys are not functioning properly, which could be indicative of a urinary tract disease. The other options, such as dilation of the ureters, failure to excrete concentrated urine, and glucosuria, may also be associated with urinary tract disease, but they are not specifically mentioned in the question. Decreased serum creatinine is not a symptom of urinary tract disease.
18.
Because the treatment of HIV during pregnancy and labor can significantly decrease fetal transmission as well as maternal morbidity, which of the following is the standard of care regarding HIV testing in pregnancy?
Correct Answer
A. Universal screening using an opt-out approach is recommended.
Explanation
The correct answer is "Universal screening using an opt-out approach is recommended." This means that all pregnant individuals should be tested for HIV unless they specifically decline the test. This approach is recommended because it has been shown to be effective in reducing fetal transmission and maternal morbidity associated with HIV. It allows for early detection and initiation of treatment, which can greatly improve outcomes for both the mother and the baby.
19.
Routine screening procedures at her first prenatal care visit for a 35-year-old primigravida with an estimated gestational age (EGA) of 8 weeks should include which of the following?
Correct Answer
A. Family history
Explanation
Routine screening procedures at the first prenatal care visit for a 35-year-old primigravida with an estimated gestational age (EGA) of 8 weeks should include family history. This is because family history can provide important information about any genetic or hereditary conditions that may affect the pregnancy or the health of the baby. By gathering information about the family's medical history, healthcare providers can identify any potential risks or concerns and provide appropriate care and interventions.
20.
Many fetal anomalies found on ultrasound are associated with other anomalies that the sonographer must assess. Which of the following abnormal ultrasound findings of the fetus are usually found in isolation and not as part of a collection of abnormalities or a syndrome?
Correct Answer
A. Posturethral value
21.
An abnormal biophysical profile (BPP) predicts which of the following?
Correct Answer
A. Higher risk for antepartum death within 1 week
Explanation
An abnormal biophysical profile (BPP) predicts a higher risk for antepartum death within 1 week. This means that if a pregnant woman's BPP is abnormal, there is an increased likelihood that the baby may die within a week before delivery. The BPP is a prenatal test that assesses the baby's well-being by evaluating certain parameters such as fetal heart rate, fetal movement, fetal breathing, fetal muscle tone, and the amount of amniotic fluid. If any of these parameters are abnormal, it indicates potential fetal distress and an increased risk of antepartum death.
22.
A pregnant woman not previously known to be diabetic, who is at 26 weeks’ gestation, had a routine 50-g (GTT) with a 1-hour blood glucose value of 144 mg/dL. A follow-up 100-g, 3-hour oral GTT revealed plasma values of fasting blood sugar of 102; 1 hour, 180; 2 hours, 162; and 3 hours, 144. You should do which of the following?
Correct Answer
A. Begin American Diabetes Association (ADA) diet and daily glucose monitoring
Explanation
Based on the given information, the pregnant woman has elevated blood glucose levels during the GTT, indicating gestational diabetes mellitus (GDM). The follow-up 100-g, 3-hour oral GTT results also show elevated plasma glucose levels at various time points. Therefore, the appropriate course of action is to begin the American Diabetes Association (ADA) diet and daily glucose monitoring to manage and monitor her blood glucose levels throughout the rest of her pregnancy. This will help to prevent complications for both the mother and the baby.
23.
A patient is measuring size larger than dates at her initial obstetric visit at 24 weeks’ EGA. She is worried about twins since they “run” in the family. The best method to safely and reliably diagnose twins is by which of the following?
Correct Answer
A. UltrasonograpHy
Explanation
Ultrasonography is the best method to safely and reliably diagnose twins. It uses high-frequency sound waves to create images of the inside of the body. It is a non-invasive and accurate method for determining the number of fetuses present in the uterus. Leopold's maneuvers, auscultation, X-rays, and CT scans are not suitable for diagnosing twins and may pose risks to the mother and the developing fetuses.
24.
Of the following evaluations done during routine prenatal care in a normal pregnancy, which of the following is most important in the initial clinic visit?
Correct Answer
A. Determination of the gestational age
Explanation
During the initial clinic visit, determining the gestational age is the most important evaluation in routine prenatal care. This is because knowing the gestational age helps in determining the due date and assessing the progress of the pregnancy. It also helps in determining the appropriate timing for certain prenatal tests and interventions. Additionally, accurate gestational age assessment is crucial for identifying any potential issues or complications that may arise during the pregnancy.
25.
There is good evidence that a woman who gave birth to an infant with a neural tube defect (NTD) can substantially reduce the risk of recurrence by taking periconceptional folic acid supplementation. What is the recommended dose?
Correct Answer
D. 4 mg
Explanation
Taking periconceptional folic acid supplementation has been shown to reduce the risk of recurrence of neural tube defects (NTDs) in infants. The recommended dose of folic acid for this purpose is 4 mg. This dosage is higher than the commonly recommended daily intake of 0.4 mg for women of childbearing age. The higher dosage is specifically recommended for women who have previously given birth to an infant with an NTD, as it has been found to be more effective in reducing the risk of recurrence.
26.
A 24-year-old G1P0 at 38 weeks’ EGA presents to labor and delivery for a complaint of decreased fetal movement. The nonstress test (NST) results are shown in Figure 8–1. What is the interpretation of this NST? (grafico)
Correct Answer
A. This is a reactive NST, indicating that the fetus is not likely to be acidotic.
Explanation
The nonstress test (NST) results show a reactive pattern, which means that there are at least two accelerations of fetal heart rate within a 20-minute period, each lasting for at least 15 seconds and peaking at least 15 beats per minute above the baseline. This is a reassuring finding because it suggests that the fetus is not likely to be acidotic, meaning that there is no evidence of fetal distress or oxygen deprivation. Therefore, the correct interpretation of this NST is that it is reactive, indicating a healthy fetal status.
27.
Which of the following is the most prominent cause of pregnancy loss?
Correct Answer
A. Abortion
Explanation
Abortion is the most prominent cause of pregnancy loss. Abortion refers to the intentional termination of a pregnancy, either through medical procedures or medication. It is a common cause of pregnancy loss and can occur for various reasons, such as medical complications, fetal abnormalities, or personal choice. Fetal deaths in utero, neonatal mortality, stillbirths, and contraception are not the most prominent causes of pregnancy loss.
28.
A 32-year-old G2P1 female presents for routine prenatal visit at 36 weeks’ EGA. You note a 7-lb weight gain in the last 2 weeks? Which of the following should be your first priority?
Correct Answer
A. Assess for signs and symptoms of preeclampsia
Explanation
The first priority should be to assess for signs and symptoms of preeclampsia. Preeclampsia is a serious condition that can occur during pregnancy and is characterized by high blood pressure and damage to organs such as the liver and kidneys. Rapid weight gain can be a sign of fluid retention, which is a symptom of preeclampsia. Therefore, it is important to evaluate for other signs and symptoms of preeclampsia, such as swelling, headaches, and changes in vision, to ensure the safety and well-being of both the mother and the baby.
29.
An 18-year-old single, sedentary, obese female (gravida 1, para 0) is first seen by you for prenatal care at 16 weeks’ gestation. Her history is unremarkable, and she claims to be in good health. Her dietary history includes high carbohydrate intake with no fresh vegetables. Physical examination is within normal limits except that she is somewhat pale. Suggested nutritional counseling should include which of the following?
Correct Answer
A. Folic acid supplementation
Explanation
The suggested nutritional counseling for this patient should include folic acid supplementation. Folic acid is important for pregnant women as it helps in the development of the baby's neural tube, which eventually becomes the brain and spinal cord. This is especially crucial in the early stages of pregnancy. Since the patient's dietary history does not include fresh vegetables, which are a good source of folic acid, supplementation is necessary to ensure adequate intake. The other options, such as calorie intake, protein intake, weight maintenance, and exercise, are important considerations in prenatal care but are not specifically related to the patient's need for folic acid supplementation.
30.
A 19-year-old primigravida with unsure LMP presents to initiate prenatal care. You attempt to estimate gestational age. The uterine fundus is palpable at the level of the pubic symphysis, and fetal heart tones are audible by electronic Doppler. On the basis of this information, what is the approximate gestational age?
Correct Answer
A. 12 weeks
Explanation
Based on the information provided, the uterine fundus being palpable at the level of the pubic symphysis indicates a gestational age of approximately 12 weeks. This is because the fundus of the uterus starts to rise above the pubic symphysis at around 12 weeks of gestation. Additionally, the presence of audible fetal heart tones by electronic Doppler further supports the estimation of 12 weeks gestational age.
31.
A 28-year-old (gravida 3, para 1, abortus 1) at 30 weeks’ gestation reports some recent intermittent contractions. Which of the following correlates with the greatest risk for preterm labor?
Correct Answer
A. Prior 32-week delivery
Explanation
A prior 32-week delivery is the greatest risk factor for preterm labor because it indicates a history of delivering a baby prematurely. This suggests that the patient may have an increased susceptibility to preterm labor in subsequent pregnancies. The other options, such as smoking, history of colposcopy, history of Chlamydia trachomatis, and prior 8-week spontaneous abortion, may have their own associated risks, but they are not as strongly correlated with preterm labor as a prior preterm delivery.
32.
A 32-year-old (gravida 2, para 1) initiates care at 8 weeks’ gestation. Which of the following is most worrisome for the poor obstetric outcomes?
Correct Answer
A. Blood pressure of 144/92 mm Hg
Explanation
The most worrisome factor for poor obstetric outcomes in this scenario is the blood pressure of 144/92 mm Hg. This reading indicates hypertension, which can lead to complications such as preeclampsia and eclampsia. These conditions can cause harm to both the mother and the fetus, including organ damage, premature birth, and even death. Monitoring and managing blood pressure is crucial during pregnancy to prevent these adverse outcomes. The other options, such as trace proteinuria, inaudible fetal heart tone, maternal height, and candida discharge, may also require attention, but they are not as concerning as hypertension.
33.
Between obesity, irregular menses, erratic use of contraception and unknown LMP ultrasound is commonly used to determine the EDC. How many weeks after LMP is ultrasound most accurate in dating a pregnancy?
Correct Answer
A. Between 7 and 9 weeks after LMP
Explanation
Ultrasound is most accurate in dating a pregnancy between 7 and 9 weeks after the last menstrual period (LMP). This is because during this time, the fetal size is relatively consistent, allowing for more accurate measurements. Additionally, the earlier the ultrasound is performed, the more accurate it is in determining the estimated due date (EDC). Therefore, between 7 and 9 weeks after LMP is the optimal time for ultrasound dating of pregnancy.
34.
How many weeks after LMP is ultrasound most useful in evaluating fetal anatomy?
Correct Answer
A. Between 19 and 21 weeks after LMP
Explanation
Ultrasound is most useful in evaluating fetal anatomy between 19 and 21 weeks after LMP. This is because at this stage of pregnancy, the fetus has developed enough for the ultrasound to provide clear images of its anatomy. This is the ideal time for detecting any abnormalities or potential issues with the fetus's development. Ultrasound performed during this period can provide important information about the baby's organs, limbs, and overall growth, allowing healthcare providers to monitor the pregnancy and make any necessary interventions or plans for the baby's care.
35.
Which of the following nutrients is most likely to be deficient during pregnancy?
Correct Answer
A. Iron
Explanation
During pregnancy, the body requires more iron to support the increased blood volume and to help the baby's development. Iron is essential for the production of hemoglobin, which carries oxygen to the cells. A deficiency in iron during pregnancy can lead to iron-deficiency anemia, which can have negative effects on both the mother and the baby. Therefore, iron is the most likely nutrient to be deficient during pregnancy.
36.
A 32-year-old woman has a twin pregnancy at 8 weeks’ gestation. During her initial prenatal care visit, you review risks for multifetal pregnancies. Which of the following statements reflects the most frequent risks in twin pregnancies?
Correct Answer
A. Pregnancy-induced hypertension occurs at a higher rate than in singletons.
Explanation
In twin pregnancies, the most frequent risk is pregnancy-induced hypertension occurring at a higher rate than in singletons. This is because the presence of two fetuses puts increased strain on the mother's cardiovascular system, leading to higher blood pressure. This can increase the risk of complications such as preeclampsia and gestational hypertension. The other options are not as commonly associated with twin pregnancies. Cesarean delivery may be necessary in some cases, but it is not necessary in greater than 90% of twin deliveries. Shoulder dystocia is more common in singleton pregnancies, not aftercoming vertex twins. The perinatal death rate is higher in twin pregnancies compared to singletons. Congenital anomalies occur at the same rate as in singletons.
37.
Periconceptional dietary adjustments have been shown to have a profound impact on which of the following diseases or malformations?
Correct Answer
A. Diabetes mellitus
Explanation
Periconceptional dietary adjustments have been shown to have a profound impact on diabetes mellitus. This means that making dietary adjustments before and around the time of conception can greatly affect the development and occurrence of diabetes mellitus.
38.
Which of the following should be prescribed for the average pregnant woman?
Correct Answer
A. Continuation of moderate exercise
39.
Pregnancy should be avoided within 1 month of receiving which of the following vaccinations?
Correct Answer
A. Measles, mumps, rubella (MMR)
Explanation
Pregnancy should be avoided within 1 month of receiving the measles, mumps, rubella (MMR) vaccination because it is a live attenuated vaccine, which means it contains a weakened form of the virus. While the vaccine is generally safe, there is a small risk of the virus causing harm to the developing fetus if the woman becomes pregnant shortly after vaccination. Therefore, it is recommended to wait at least one month after receiving the MMR vaccine before trying to conceive.