AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentMedium
A 32-year-old female presents with a 2-day history of unilateral lower abdominal pain, vaginal spotting, and a positive home pregnancy test. Her last menstrual period was 7 weeks ago. On physical examination, she has mild tenderness in the right adnexa. Which of the following diagnostic tests is most crucial for immediate evaluation?
- AQuantitative serum beta-human chorionic gonadotropin (hCG)
- BComplete blood count (CBC)
- CUrinalysis
- DTransvaginal ultrasound
Show answer & explanationAnswer & explanation
Correct answer: D. Transvaginal ultrasound
Given the symptoms of unilateral lower abdominal pain, vaginal spotting, and a positive pregnancy test, an ectopic pregnancy is highly suspected. Transvaginal ultrasound is the most crucial diagnostic test to confirm an intrauterine pregnancy or identify an ectopic pregnancy, especially in early gestation.
Why the other options are wrong
- A. Quantitative serum hCG levels are critical, but a transvaginal ultrasound is needed to visualize the location of the pregnancy and correlate with hCG levels.
- B. CBC is important for assessing anemia or infection, but does not confirm or rule out ectopic pregnancy.
- C. Urinalysis would assess for urinary tract infection, which is less likely given the specific symptoms of spotting and adnexal pain in a pregnant patient.
Ectopic Pregnancy Evaluation
Diagnostic steps taken to identify and manage a pregnancy implanted outside the uterine cavity.
- Suspect with positive pregnancy test, abdominal pain, and vaginal bleeding.
- Transvaginal ultrasound is key for location.
- Quantitative hCG levels help monitor and correlate with ultrasound findings.
Memory trick: When 'Ectopic' is the fear, 'Echo' (ultrasound) must be clear.