Deck 19: Pregnant Patients

Question 1

A pregnant woman with hyperemesis gravidarum should be checked for:

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

Answer 1

Hyperthyroidism

Question 2

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

Answer 2

Breech presentation

Question 3

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 & C

Answer 3

A & C

Question 4

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

Question 5

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 6

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

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

Question 7

The clinician should be aware of the Wells' Criteria when evaluating a patient for deep vein thrombosis (DVT).Wells' Criteria are risk factors that are assigned points toward the likelihood of DVT.Wells' Criteria include:

A) Active cancer
B) Recent bedridden condition
C) Pitting edema
D) All of the above

Question 8

A diagnosis of hyperemesis gravidarum is made in a pregnant woman when there is a condition of vomiting that causes:

A) Metabolic alkalosis
B) Hyperkalemia
C) Metabolic acidosis
D) None of the above

Question 9

A pregnant woman under your care complains of indigestion,belching,flatulence,and upper right quadrant cramping pain that "comes and goes." What diagnostic test should be ordered?

A) Gall bladder HIDA scan
B) Ultrasound of the gall bladder
C) Abdominal CT scan
D) Upper endoscopy

Question 10

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 causes nasal edema
C) Elevated estrogen and progesterone cause nasal turbinate enlargement
D) All of the above

Question 11

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 12

Estimated date of delivery is calculated by:

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

Question 13

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 14

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 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

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

A) Number of times pregnant and the number of pregnancies beyond 20 weeks
B) Number of times pregnant and the 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 17

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 18

Your pregnant patient is at 8 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 sign
B) Teach the patient that carpal tunnel syndrome is common during pregnancy
C) Tap the patient's right wrist to try to elicit tingling in the fingers for Tinel's sign
D) All of the above

Question 19

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

A) Ultrasound
B) CT scan
C) MRI
D) Doppler equipment

Question 20

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

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

Question 21

A pregnant patient at 5 weeks' gestation reports slight amount of vaginal bleeding.The clinician should recognize that the following laboratory test should be done:

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

Question 22

Your pregnant patient complains of hemorrhoids.On physical examination,vital signs are 98.6 T,80 pulse,14 resps/min,110/ 60.Heart has 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 non-pitting edema.Dorsalis pedis pulses +2/4 bilaterally.Rectal exam: + external haemorrhoid.Urine dipstick is negative for protein.The clinician should:

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

Question 23

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 24

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 prolonged time
B) Weight gain of approximately 1 lb per week
C) A systolic rise of 30 mm Hg or diastolic rise of 15 mm Hg over the patient's baseline BP
D) Uterine fundus above the umbilicus

Question 25

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

A) CBC
B) TSH
C) T4
D) All of the above

Question 26

A pregnant patient at 24 weeks' gestation complains of fever,chills,flank pain,frequency,dysuria,and abdominal pain.A urinalysis demonstrates 100,000 proteus bacteria per mL.The clinician should recognize these findings as:

A) Glomerulonephritis
B) Cystitis
C) Pyelonephritis
D) Nephrolithiasis

Question 27

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

A) Pre-eclampsia is diagnosed in pregnant women who have a BP 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 of BP
C) Gestational HTN is defined as a rise in systolic blood pressure of 15 mm Hg and a diastolic blood pressure rise of 30 mmHg
D) Gestational HTN is diagnosed if the patient has proteinuria and ankle edema regardless of BP measures

Question 28

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 T 98.6,pulse 100,resps 18/min,BP 120/ 70.On physical examination,heart has 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 umbilicus.Ankles: no edema.Dorsalis pedis pulses +2/4 bilaterally.Urine dipstick is negative for protein.Laboratory tests reveal CBC: Hgb 10 microcytic hypochromic RBCs.Which of the following conditions should be suspected?

A) Iron deficiency anemia
B) Folic acid deficiency anemia
C) Vitamin B12 deficiency anemia
D) None of the above

Question 29

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 30

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 T 98.6,pulse 88,resps 18/min,BP 120/70.On physical examination,heart has 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 umbilicus.Ankles: no edema.Dorsalis pedis pulses +2/4 bilaterally.Urine dipstick is negative for protein,+ for glucose and + for ketones. The clinician should:

A) Obtain a 3-hour glucose tolerance test
B) Order a Hgb A1c blood test
C) Obtain a fasting serum glucose
D) Order a 24-hour urine for creatinine,ketones,and glucose

Question 31

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 LMP
B) Fetus in tranverse lie
C) Error in calculation of fundal height
D) All of the above

Question 32

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 33

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

A) Inaccurate LMP date
B) Excessive amniotic fluid
C) Maternal obesity
D) All of the above

Question 34

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) 1cm
D) 0.5cm

Question 35

Which of the following can cause abruptio placenta?

A) Uterine trauma
B) Gestational HTN
C) Coagulopathy
D) All of the above