AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentHard
A 28-year-old female presents with a 2-day history of unilateral lower abdominal pain, vaginal spotting, and mild nausea. Her last menstrual period was 6 weeks ago. She reports a history of pelvic inflammatory disease (PID) 2 years prior. On examination, she has mild guarding and tenderness in the right lower quadrant, and cervical motion tenderness. A urine pregnancy test is positive. What is the most critical immediate diagnostic step for this patient?
- ACervical cultures for STIs.
- BQuantitative beta-hCG level.
- CTransvaginal ultrasound.
- DComplete blood count (CBC).
Show answer & explanationAnswer & explanation
Correct answer: C. Transvaginal ultrasound.
Given the positive pregnancy test, unilateral lower abdominal pain, vaginal spotting, and history of PID (a risk factor for ectopic pregnancy), the most critical immediate diagnostic step is a transvaginal ultrasound. This will help determine the location of the pregnancy (intrauterine vs. ectopic) and assess for signs of rupture, which is a life-threatening emergency. While CBC and beta-hCG are important, they do not provide the immediate localization needed.
Why the other options are wrong
- A. Cervical cultures for STIs are important for overall gynecological health but are not the immediate priority for a suspected ectopic pregnancy.
- B. A quantitative beta-hCG level helps monitor pregnancy progression but does not provide immediate information about the location of the pregnancy, which is critical in this scenario.
- D. A CBC can assess for anemia or infection but will not localize the pregnancy or rule out an ectopic pregnancy immediately.
Ectopic Pregnancy Evaluation
Evaluation of suspected ectopic pregnancy involves identifying pregnancy location in a patient with positive pregnancy test, abdominal pain, and/or vaginal bleeding.
- Risk factors include PID, previous ectopic, tubal surgery.
- Symptoms: amenorrhea, abdominal pain, vaginal spotting/bleeding.
- Transvaginal ultrasound is the definitive diagnostic tool.
Memory trick: Ectopic Emergency: Ultrasound Shows the Scene