Deck 19: Pregnant Patients

Question 1

The normal fetal heart rate is:

A) 70 to 100 beats/minute
B) 100 to 110 beats/minute
C) 110 to 120 beats/minute
D) 120 to 160 beats/minute

Answer 1

120 to 160 beats/minute

Question 2

A pregnant patient complains of severe fatigue and exercise intolerance. Laboratory tests that should be investigated include:

A) Complete blood count
B) Thyroid-stimulating hormone
C) T4
D) All of the above

Answer 2

All of the above

Question 3

Your pregnant patient is at 28 weeks gestation and complains of pain that radiates from the wrist into the fingers in the right hand. She is a computer programmer and uses a keyboard daily for 6 hours or more. The clinician should:

A) Ask the person to place dorsal surfaces of hands together to check for Phalen's test
B) Teach the patient that carpal tunnel syndrome is common during the last trimester
C) Tap the patient's right wrist to try to elicit tingling in the fingers for Tinel's sign
D) All of the above

Answer 3

All of the above

Question 4

A diagnosis of hyperemesis gravidarum is associated with:

A) Multiparity
B) Low body weight
C) Increased body weight
D) Food allergies

Question 5

If radiological studies are needed to evaluate intra-abdominal conditions during pregnancy, it is important for the clinician to recognize that a(n) _______________ exposes a fetus to ionizing radiation.

A) Ultrasound
B) Computed tomography scan
C) Magnetic resonance imaging
D) Doppler equipment

Question 6

A pregnant woman with hyperemesis gravidarum should be checked for:

A) Multiple pregnancy
B) Hyperadrenalism
C) Hyperthyroidism
D) Fibroid tumor

Question 7

The fundus of a pregnant woman is located just above the symphysis pubis. This indicates a pregnancy of:

A) 16 weeks
B) 12 weeks
C) 10 weeks
D) 6 weeks

Question 8

A pregnant woman under your care complains of indigestion, belching, flatulence, and upper right quadrant cramping pain that comes and goes. Which of the following is not true concerning use of upper endoscopy as a diagnostic procedure during pregnancy?

A) Upper endoscopy is not associated with preterm labor or other complication.
B) Upper endoscopy is associated with an increase in preterm labor and should not be performed during pregnancy.
C) As a general rule, procedures are usually postponed during pregnancy or at least until after the first trimester.
D) Upper endoscopy is associated with fetal demise.

Question 9

A pregnant patient complains of nasal stuffiness and rapid breathing. The clinician should recognize that:

A) Elevated progesterone directly stimulates the central respiratory center in pregnancy to enhance loss of CO₂
B) Elevated estrogen and progesterone levels cause nasal edema
C) Elevated estrogen and progesterone cause nasal turbinate enlargement
D) All of the above

Question 10

When measuring the fundal height, if you find the fundus at the umbilicus, this usually indicates a pregnancy at:

A) 20 weeks
B) 16 weeks
C) 12 weeks
D) 10 weeks

Question 11

A fetal heart rate is auscultated in the upper abdomen above the umbilicus. This commonly indicates the fetus is in the:

A) Vertex presentation position
B) Transverse lie position
C) Breech presentation
D) Upper region of the uterus

Question 12

In a pregnant woman, a glucose screening test should be done at:

A) 24 weeks
B) 20 weeks
C) 16 weeks
D) 10 weeks

Question 13

An ultrasound should be performed on all pregnant women at:

A) 5 to 6 weeks
B) 10 to 12 weeks
C) 16 to 20 weeks
D) None of the above

Question 14

The schedule of prenatal care should be:

A) Every 2 weeks between 28 and 36 weeks
B) Every week between 28 and 36 weeks
C) Every week between 36 and 40 weeks
D) A and C

Question 15

Your pregnant patient complains of back pain. When inquiring about the pain, the clinician should use the PQRST method. This includes asking the patient about:

A) Radiation
B) Severity
C) Timing
D) All of the above

Question 16

The fetal heartbeat can be first heard using Doppler equipment at:

A) 2 weeks
B) 5 weeks
C) 10 weeks
D) 20 weeks

Question 17

A sustained fetal heart rate below _______________ is indicative of fetal health jeopardy.

A) 160 beats/minute
B) 140 beats/minute
C) 120 beats/minute
D) 100 beats/minute

Question 18

A reproductive history is recorded in terms of gravida and para, which indicates:

A) Number of times pregnant and number of pregnancies beyond 20 weeks
B) Number of times pregnant and number of spontaneous or medically induced abortions
C) Number of live births and number of times pregnant
D) Number of times pregnant and number of vaginal births

Question 19

Estimated date of delivery is calculated by:

A) Adding 7 days to the date of the last menstrual period and subtracting 3 months
B) Adding 9 months to the date of the last menstrual period
C) Most accurately by ultrasound examination
D) A and C

Question 20

The American College of Obstetricians and Gynecologists (ACOG, 2013) recommends a total pregnancy weight gain of:

A) 10 to 11 kg
B) 11.5 to 16 kg
C) 18 to 19 kg
D) 20 to 21 kg

Question 21

The diagnosis of preterm labor is confirmed by:

A) Effacement of the cervix
B) Dilation of the cervix
C) Sensation of contractions
D) None of the above

Question 22

A pregnant patient at 6 months gestation who is 37 years old complains of urinary frequency, thirst, increased appetite, and candida vaginitis that is refractory to treatment. The patient has a history of vaginal delivery of a 10-pound neonate 3 years ago. On physical examination, vital signs are: temperature 98.6°F, pulse 88 beats/min, respirations 18 breaths/min, blood pressure 120/70. Heart has a regular rate and rhythm at 88 beats/min, no S₃, no murmurs. Lungs are clear to auscultation. Abdominal examination is negative. Uterus fundus is above the umbilicus. Ankles: no edema. Dorsalis pedis pulses +2/4 bilaterally. Urine dipstick is negative for protein, + for glucose and + for ketones. The clinician should consider all of the following except:

A) Obtain a 3-hour glucose tolerance test
B) Order an HbA1c blood test
C) Obtain a fasting serum glucose
D) Review family history of diabetes, including gestational diabetes mellitus

Question 23

A pregnant patient at 5 weeks gestation reports a slight amount of vaginal bleeding. The clinician should obtain the following laboratory test:

A) Serial human chorionic gonadotropin levels over the next several days
B) Measurement of estrogen levels
C) Cervical mucus analysis
D) Pap smear for sexually transmitted infection

Question 24

A pregnant patient complains of urinary frequency. She denies fever, dysuria, back pain, or hematuria. Urine dipstick is negative for leukocytes, protein, or blood. The clinician should:

A) Explain to the patient that the uterus places pressure on the bladder during pregnancy
B) Advise the patient she needs urine culture and sensitivity
C) Obtain a glucose tolerance test
D) Obtain 24-hour urine for protein

Question 25

A pregnant patient at 24 weeks gestation complains of shortness of breath on exertion, fatigue, weakness, and constant cravings for ice chips. On physical examination, vital signs are: temperature 98.6°F, pulse 100 beats/min, respirations 18 breaths/min, blood pressure 120/70. On physical examination, the heart has a regular rate and rhythm at 100 beats/min, no S₃, no murmurs. Lungs are clear to auscultation. Abdominal examination is negative. Uterus fundus is above the umbilicus. Ankles: no edema. Dorsalis pedis pulses +2/4 bilaterally. Urine dipstick is negative for protein. Laboratory tests reveal complete blood count: hemoglobin 10 microcytic hypochromic red blood cells. Which of the following conditions should be suspected?

A) Iron-deficiency anemia
B) Folic acid deficiency anemia
C) Vitamin B₁₂ deficiency anemia
D) Pernicious anemia

Question 26

A pregnant patient at 12 weeks gestation complains of yellow vaginal discharge. Laboratory tests reveal bacterial vaginosis. The clinician should recognize that bacterial vaginosis is:

A) A normal finding in pregnancy
B) Associated with preterm labor and delivery
C) Diagnosed by a nitrazine test
D) Often accompanied by vaginal bleeding

Question 27

Your pregnant patient at 8 months gestation complains of bilateral ankle swelling and no other symptoms. Which of the following findings require further investigation?

A) Ankle swelling that is noticed at the end of the day after standing for a prolonged time
B) Weight gain of approximately 1 pound per week
C) A systolic rise of 30 mm Hg or diastolic rise of 15 mm Hg over the patient's baseline blood pressure
D) Uterine fundus above the umbilicus

Question 28

The clinician should recognize that in a pregnant patient the fundus should be at the umbilicus at 20 weeks gestation and rise by _______ per week until 32 weeks.

A) 3 cm
B) 2 cm
C) 1 cm
D) 0.5 cm

Question 29

Which of the following statements is true regarding gestational blood pressures?

A) Pre-eclampsia is diagnosed in pregnant women who have a blood pressure greater than 130/80 mm Hg in the third trimester.
B) Pre-eclampsia can occur even if the blood pressure is within the accepted normal range.
C) Gestational hypertension is defined as a rise in systolic blood pressure of 15 mm Hg and a diastolic blood pressure rise of 30 mm Hg.
D) Gestational hypertension is diagnosed if the patient has proteinuria and ankle edema, regardless of blood pressure measures.

Question 30

As you assess a pregnant patient, you suspect false small-for-dates presentation. You should recognize that a possible cause for this is:

A) Error in date of last menstrual period
B) Fetus in transverse lie
C) Error in calculation of fundal height
D) All of the above

Question 31

Your pregnant patient complains of hemorrhoids. On physical examination, vital signs are: temperature 98.6°F, pulse 80 beats/min, respirations 14 breaths/min, blood pressure 110/60. The heart has a regular rate and rhythm, no S₃, no murmurs. Lungs are clear to auscultation. Abdominal examination is negative. Uterus fundus is at the umbilicus. Ankles show +1/4 bilateral ankle nonpitting edema. Dorsalis pedis pulses + 2/4 bilaterally. Rectal exam: + external hemorrhoid. Urine dipstick is negative for protein. The clinician should:

A) Explain to the patient to lie in a left lateral recumbent position at night
B) Refer the patient to an obstetric physician for a diuretic prescription
C) Obtain 24-hour urine for protein
D) Obtain HbA1c and fasting serum glucose