AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentMedium
A 28-year-old female presents with a 2-day history of unilateral lower abdominal pain, vaginal spotting, and mild dizziness. Her last menstrual period was 7 weeks ago. She reports a history of pelvic inflammatory disease (PID). On physical exam, she has mild tenderness in the right adnexa. Which of the following diagnostic tests is most crucial to perform immediately?
- AUrine human chorionic gonadotropin (hCG)
- BTransvaginal ultrasound (TVUS)
- CComplete blood count (CBC)
- DCervical cultures for STIs
Show answer & explanationAnswer & explanation
Correct answer: A. Urine human chorionic gonadotropin (hCG)
The patient's symptoms (unilateral lower abdominal pain, vaginal spotting, amenorrhea for 7 weeks, dizziness) and history (PID, a risk factor for ectopic pregnancy) strongly suggest an ectopic pregnancy. A urine hCG test is crucial to immediately confirm pregnancy status, which then guides the need for further urgent evaluation like a transvaginal ultrasound to locate the pregnancy.
Why the other options are wrong
- B. A TVUS is essential, but only after pregnancy is confirmed. An immediate urine hCG is the first step.
- C. A CBC can assess for anemia from bleeding, but confirming pregnancy and its location is more urgent.
- D. While STIs can cause pelvic pain, the amenorrhea and dizziness point to pregnancy-related complications as the immediate concern.
Ectopic Pregnancy Initial Workup
Ectopic pregnancy presents with a triad of amenorrhea, abdominal pain, and vaginal bleeding. Prompt diagnosis is critical to prevent rupture. Initial diagnostic step is confirmation of pregnancy.
- Classic triad: Amenorrhea, abdominal pain, vaginal bleeding/spotting.
- Risk factors: PID, previous ectopic, tubal surgery, IUD use.
- Initial diagnostic test: Urine or serum hCG to confirm pregnancy.
- Subsequent test: Transvaginal ultrasound to determine pregnancy location.
Memory trick: Pain, Spotting, and Late Period? HCG First, then Ultrasound Deed!