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 examination, her vital signs are stable, and she has mild right adnexal tenderness. Which diagnostic test is the most crucial initial step in her evaluation?
- AComplete blood count (CBC)
- BQuantitative beta-human chorionic gonadotropin (hCG) level
- CTransvaginal ultrasound
- DUrinalysis
Show answer & explanationAnswer & explanation
Correct answer: B. Quantitative beta-human chorionic gonadotropin (hCG) level
Given the symptoms of unilateral abdominal pain, vaginal spotting, and a positive pregnancy test, ectopic pregnancy is a primary concern. A quantitative beta-hCG level, along with a transvaginal ultrasound, is crucial for diagnosis and management. Obtaining the hCG level first helps interpret ultrasound findings and monitor pregnancy progression.
Why the other options are wrong
- A. A CBC can assess for anemia or infection but is not the most crucial initial diagnostic test for ectopic pregnancy.
- C. While a transvaginal ultrasound is critical, often the hCG level is needed to guide interpretation or indicate when an intrauterine pregnancy should be visible.
- D. Urinalysis is important to rule out urinary tract infection, but it doesn't directly address the primary concern of ectopic pregnancy.
Ectopic Pregnancy Initial Workup
Initial evaluation for suspected ectopic pregnancy involves a combination of quantitative beta-hCG levels and transvaginal ultrasound to determine pregnancy location and viability.
- Symptoms: amenorrhea, abdominal pain (often unilateral), vaginal bleeding/spotting.
- hCG levels are crucial for monitoring and interpreting ultrasound findings.
- Transvaginal ultrasound is used to visualize intrauterine or extrauterine pregnancy.
Memory trick: Ectopic Emergency: hCG Helps Confirm.