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 mild dizziness. Her last menstrual period was 7 weeks ago. She reports a positive home pregnancy test. On examination, she has mild suprapubic tenderness and a closed cervical os. What is the most crucial diagnostic test to perform next?
- AComplete blood count (CBC)
- BTransvaginal ultrasound
- CQuantitative beta-human chorionic gonadotropin (hCG) level
- DUrinalysis
Show answer & explanationAnswer & explanation
Correct answer: B. Transvaginal ultrasound
The patient's symptoms (unilateral abdominal pain, vaginal spotting, dizziness, delayed menses, positive pregnancy test) are highly suggestive of an ectopic pregnancy. A transvaginal ultrasound is the most crucial diagnostic test to determine the location of the pregnancy and rule out an ectopic pregnancy, especially given the symptoms and gestational age.
Why the other options are wrong
- A. A CBC can assess for anemia or infection but won't diagnose an ectopic pregnancy.
- C. Quantitative hCG levels are important, but in this symptomatic patient, an ultrasound is more critical to locate the pregnancy immediately.
- D. A urinalysis might rule out a UTI but will not help diagnose an ectopic pregnancy.
Ectopic Pregnancy Evaluation
Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tube. It is a medical emergency requiring prompt diagnosis and management due to the risk of rupture and hemorrhage.
- Classic triad: abdominal pain, amenorrhea, vaginal bleeding/spotting.
- Risk factors include PID, previous ectopic, tubal surgery, IUD use.
- Diagnosis relies on a combination of hCG levels and transvaginal ultrasound.
Memory trick: Ectopic: Early Pain, Spotting, Dizzy, Pregnant!