Facts read from nccwebsite.org · last checked Nov 7, 2026
Obstetrics is 29% of the exam; this page handles the prenatal part: the physiology of pregnancy, routine prenatal visits, screening and fetal well-being. The decisions are an outpatient NP's: what to order, when, and when to refer. Labor and birth management are outside this page.
Practice questions
60 questions written to the WHNP-BC outline; each choice is explained once you pick.
From the guide's obstetrics study list, sections I to III (guide, p. 13):
Normal fetal-placental development and changes in maternal anatomy and physiology
Initial and return visits: gestational age, risk assessment, nutrition, medication reconciliation and health guidance
Immunizations, screening tests, the prenatal exam and common discomforts of pregnancy
Fetal well-being: nonstress test, biophysical profile, amniotic fluid index and ultrasound
Genetic screening and diagnostic tests
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15 prenatal care questions
0 / 15 answered15 questions
Tap an option: why each one is right or wrong appears under it.
Prenatal care
A patient with a certain last menstrual period (LMP) is 10 0/7 weeks by dates. Crown-rump length on her first ultrasound corresponds to 9 1/7 weeks. The estimated due date should be
Averaging the LMP and ultrasound dates is never recommended; one source is chosen by the size of the discrepancy.
For a crown-rump length at 9 0/7 to 13 6/7 weeks, ACOG redates only when the difference from a certain LMP exceeds 7 days; here it is 6 days, so the LMP-based date stays unchanged.
Changing the date for a 6-day difference applies the stricter cutoff used before 9 weeks (more than 5 days) to a scan at 9 1/7 weeks.
A patient at 11 weeks' gestation has chronic hypertension. The recommended regimen for preeclampsia prophylaxis is aspirin
Starting at 20 weeks loses much of the benefit, which is greatest when aspirin starts before 16 weeks, and 81 mg is the US dose.
Preeclampsia prophylaxis uses low-dose aspirin; 325 mg adds bleeding risk without proven extra benefit.
USPSTF and ACOG recommend low-dose aspirin 81 mg daily for patients at high risk of preeclampsia, such as those with chronic hypertension, starting at 12 to 28 weeks (ideally before 16) and continuing until delivery.
At 30 weeks' gestation, a patient has aching leg varicosities by evening. There is no calf tenderness, swelling or skin change. The nurse practitioner should recommend
Varicose veins alone are not an indication for anticoagulation; LMWH is reserved for patients with VTE risk factors or prior thrombosis.
Uncomplicated varicose veins in pregnancy are managed with graduated compression stockings, leg elevation and avoiding long standing.
Sclerotherapy is deferred until after pregnancy, because many varicosities improve postpartum and the procedure is not done in pregnancy.
Routine antenatal fetal surveillance (such as weekly NSTs from 32 weeks) is indicated for which patient?
Maternal age becomes an indication only from 35 (testing is considered at 35 to 39 and advised weekly from 36 weeks at 40 or older); 32 is not an indication.
Pregestational diabetes raises the risk of stillbirth, so weekly or twice-weekly fetal testing from about 32 weeks is routine.
A prior low transverse cesarean affects labor planning, not fetal well-being, and does not call for antenatal testing.
At 32 weeks' gestation, the amniotic fluid index is 27 cm. A detailed ultrasound shows normal fetal anatomy and growth. She did not have the routine screening usually done at 24–28 weeks. The nurse practitioner should next order
Polyhydramnios with normal anatomy and growth is most often linked to maternal diabetes, and she has not been screened, so a glucose tolerance test comes next.
MSAFP screens for neural tube defects at 15 to 22 weeks; at 32 weeks with normal anatomy it adds nothing.
Drug exposure is not a usual cause of excess amniotic fluid; diabetes is the treatable cause to exclude.
At the 20-week anatomy scan, an isolated echogenic intracardiac focus is seen. Earlier cell-free DNA screening was low risk. The nurse practitioner should
An isolated echogenic intracardiac focus is a normal variant; with low-risk cell-free DNA it carries no added aneuploidy risk and needs no follow-up.
Offering invasive testing after low-risk cell-free DNA for a soft marker exposes her to procedure risk with essentially no gain.
An isolated focus is a calcified papillary muscle, not a heart defect, so it is not an indication for fetal echo.
At 30 weeks in September, a patient asks about protecting her newborn from respiratory syncytial virus. The nurse practitioner should plan to give the maternal RSV vaccine at
CDC recommends one dose of the maternal RSV vaccine (Abrysvo) at 32 0/7 to 36 6/7 weeks during September through January, so she is due as soon as she reaches 32 weeks.
Weeks 24 to 28 are when gestational diabetes screening is done; the RSV vaccine is not given that early.
Weeks 27 to 36 are the Tdap window; the RSV vaccine window is narrower and starts at 32 weeks.
At her first prenatal visit, an asymptomatic patient has a reactive RPR (1:16) and a reactive treponemal test. She has never been tested or treated for syphilis. Benzathine penicillin G 2.4 million units IM should be given
A reactive RPR and treponemal test with no symptoms and unknown timing is latent syphilis of unknown duration, treated with benzathine penicillin G 2.4 million units IM weekly for 3 doses.
A single dose treats primary, secondary or early latent syphilis acquired within a year; without proof of recent infection, the 3-dose regimen is used.
Two doses is not a standard regimen; stopping short leaves latent infection undertreated, and a missed dose in pregnancy means restarting the series.
A primigravida at 36 weeks has intensely itchy papules and plaques that began in abdominal striae and spare the umbilicus. The most likely diagnosis is
Intensely itchy papules starting in the striae and sparing the umbilicus in a first pregnancy near term is polymorphic eruption of pregnancy (PUPPP), which is benign for the fetus.
Pemphigoid gestationis usually begins around the umbilicus and evolves into tense blisters; periumbilical sparing argues against it.
Atopic eruption usually starts earlier in pregnancy in patients with atopy and favors flexural surfaces, not abdominal striae.
At the first prenatal visit, an Rh-negative patient has a positive anti-D antibody titer. The nurse practitioner should
Waiting until after birth misses fetal anemia and hydrops, which develop during the pregnancy.
Routine RhIG prevents sensitization in patients who are antibody-negative; it has no effect once anti-D is present.
A positive anti-D titer means she is already alloimmunized, so RhIG cannot help; the pregnancy needs serial titers and MCA Doppler under maternal-fetal medicine care.
At 32 weeks, a patient has severe itching of the palms and soles, worse at night, with no rash. The most useful diagnostic test is
Immunofluorescence biopsy confirms pemphigoid gestationis, which has blisters; there is no rash here to biopsy.
Hepatitis B serology is routine prenatal screening, but it does not explain itching without jaundice; bile acids test the likely diagnosis.
Itching of the palms and soles without a rash in the third trimester suggests intrahepatic cholestasis, confirmed by raised total bile acids, which also guide delivery timing.
A running total sits here; it fills in after your last pick.
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Prenatal decisions candidates get wrong
Screening is not diagnosis. Cell-free DNA and serum screens estimate risk; a high-risk result needs CVS or amniocentesis before any irreversible decision (ACOG Practice Bulletin 226, 2020).
Group B strep timing. Universal vaginal-rectal culture is done from 36 weeks 0 days through 37 weeks 6 days (ACOG Committee Opinion 797, 2020). GBS in the urine at any point in pregnancy already calls for intrapartum prophylaxis, so a later culture adds nothing.
Bacteriuria without symptoms. The USPSTF (2019) recommends screening by urine culture in pregnancy (grade B) and advises against the same screen outside pregnancy (grade D).
Vaccines. ACIP recommends Tdap in every pregnancy at 27 to 36 weeks, even after a recent dose, and inactivated influenza vaccine in any trimester. Live vaccines such as MMR and varicella wait until after birth.
Weight gain depends on BMI. The 2009 Institute of Medicine ranges run from 28–40 lb for an underweight patient to 11–20 lb with obesity; 25–35 lb applies only to a normal BMI.
Antepartum fetal testing is: the outline names assessment of fetal well-being, and the guide's study list includes the nonstress test and biophysical profile. Monitoring during labor is not covered on this page.
Are the questions about high-risk pregnancy?
Some are, at the level of recognizing risk and referring. Ongoing management of a high-risk pregnancy belongs to maternal-fetal medicine.