WHNP EXAM QUESTIONS COMPLETE
WITH CORRECT ANSWERS AND
RATIONALES
\.In counseling women about the use of a SSRI during pregnancy, the NP considers
that studies to date reveal:
An increased risk of neural tube defect if taken in the first trimester
The drugs increase the risk of macrosomia
In exposed neonates, increased rates of pulmonary hypertension have been
reported - ANSWERS-Correct answer is: In exposed neonates, increased rates of
pulmonary hypertension have been reported.
General Feedback:
SSRIs have been widely used during pregnancy as prenatal depression has been
linked to postpartum depression. As more and more data become available about
the effects of SSRI use during pregnancy, it has become apparent that there is a
small but persistent increased risk of pulmonary hypertension in the exposed
neonates. There is no link to neural tube defects, macrosomia, of gestational
diabetes.
,\.In the pregnant woman with asthma, in what part of her pregnancy are
symptoms and bronchospasm likely to worsen?
15-23 weeks
24-33 weeks
29-36 weeks - ANSWERS-Correct answer is: 29-36 weeks.
General Feedback:
Bronchospasm can be triggered as a consequence of increased external pressure
on the smooth muscle of the bronchial structures. The increasing size of the fetus
during weeks 29-36 creates significant displacement of abdominal and thoracic
structures and places external pressures on the bronchi. In the last four weeks, as
the fetus "drops" into the pelvis, pressure on the bronchi is actually relieved a bit
and symptoms often improve.
\.Medications most commonly pass through the placenta via:
Facilitated transport
Passive diffusion
Capillary pump action - ANSWERS-General Feedback:
The placenta is freely permeable and most medications that are administered to
the mother just pass through the placenta along their concentration gradient until
a steady state is achieved (i.e., passive diffusion). Facilitated transport and
,mechanical carrier state are mechanisms by which a medication requires another
compound to allow the drug to pass through the membrane barrier. Pump actions
are required when a medication or other compound is being actively pumped
across a membrane against its concentration gradient.
\.When treating a woman with a UTI who is 22-weeks pregnant, the NP
prescribes:
Nitrofurantoin
Ciprofloxacin
Azithromycin - ANSWERS-Correct answer is: Nitrofurantoin.
General Feedback:
In both the pregnant and non-pregnant woman, E. coli is the most common cause
of uncomplicated UTI. Nitrofurantoin is a recommended first-line agent during
pregnancy (pregnancy category B). Azithromycin is not recommended for UTIs,
and the use of ciprofloxacin (pregnancy category C) should be limited given trends
of increasing resistance by E. coli and the availability of a safer alternative during
pregnancy.
\.In treating a pregnant woman with acute bacterial rhinosinusitis, the NP would
likely avoid prescribing:
Amoxicillin
Azithromycin
, Levofloxacin - ANSWERS-Correct answer is: Levofloxacin.
General Feedback:
Amoxicillin and azithromycin are both indicated for acute bacterial rhinosinusitis
(ABRS) and are pregnancy category B. While levofloxacin is indicated for ABRS in
certain circumstances, levofloxacin is not indicated as a first-line agent in the
otherwise healthy patient. Additionally, levofloxacin is pregnancy category C and
would not be used when safer, effective alternatives are available.
\.The recommended duration of antimicrobial therapy for treatment of a urinary
tract infection in a pregnant woman is:
3 days
5 days
7 days - ANSWERS-Correct answer is: 7 days.
General Feedback:
UTIs are common during pregnancy and the most common causative pathogen is
Escherichia coli. In pregnancy, hormonal changes and dilation of the renal pelvis
actually favor ascension into the upper urinary tract and, therefore, UTI is treated
aggressively. Because of the dangers of maternal and fetal complications from a
UTI during pregnancy, a 7-day regimen of antimicrobial therapy is recommended
to ensure eradication of the bacteria.
WITH CORRECT ANSWERS AND
RATIONALES
\.In counseling women about the use of a SSRI during pregnancy, the NP considers
that studies to date reveal:
An increased risk of neural tube defect if taken in the first trimester
The drugs increase the risk of macrosomia
In exposed neonates, increased rates of pulmonary hypertension have been
reported - ANSWERS-Correct answer is: In exposed neonates, increased rates of
pulmonary hypertension have been reported.
General Feedback:
SSRIs have been widely used during pregnancy as prenatal depression has been
linked to postpartum depression. As more and more data become available about
the effects of SSRI use during pregnancy, it has become apparent that there is a
small but persistent increased risk of pulmonary hypertension in the exposed
neonates. There is no link to neural tube defects, macrosomia, of gestational
diabetes.
,\.In the pregnant woman with asthma, in what part of her pregnancy are
symptoms and bronchospasm likely to worsen?
15-23 weeks
24-33 weeks
29-36 weeks - ANSWERS-Correct answer is: 29-36 weeks.
General Feedback:
Bronchospasm can be triggered as a consequence of increased external pressure
on the smooth muscle of the bronchial structures. The increasing size of the fetus
during weeks 29-36 creates significant displacement of abdominal and thoracic
structures and places external pressures on the bronchi. In the last four weeks, as
the fetus "drops" into the pelvis, pressure on the bronchi is actually relieved a bit
and symptoms often improve.
\.Medications most commonly pass through the placenta via:
Facilitated transport
Passive diffusion
Capillary pump action - ANSWERS-General Feedback:
The placenta is freely permeable and most medications that are administered to
the mother just pass through the placenta along their concentration gradient until
a steady state is achieved (i.e., passive diffusion). Facilitated transport and
,mechanical carrier state are mechanisms by which a medication requires another
compound to allow the drug to pass through the membrane barrier. Pump actions
are required when a medication or other compound is being actively pumped
across a membrane against its concentration gradient.
\.When treating a woman with a UTI who is 22-weeks pregnant, the NP
prescribes:
Nitrofurantoin
Ciprofloxacin
Azithromycin - ANSWERS-Correct answer is: Nitrofurantoin.
General Feedback:
In both the pregnant and non-pregnant woman, E. coli is the most common cause
of uncomplicated UTI. Nitrofurantoin is a recommended first-line agent during
pregnancy (pregnancy category B). Azithromycin is not recommended for UTIs,
and the use of ciprofloxacin (pregnancy category C) should be limited given trends
of increasing resistance by E. coli and the availability of a safer alternative during
pregnancy.
\.In treating a pregnant woman with acute bacterial rhinosinusitis, the NP would
likely avoid prescribing:
Amoxicillin
Azithromycin
, Levofloxacin - ANSWERS-Correct answer is: Levofloxacin.
General Feedback:
Amoxicillin and azithromycin are both indicated for acute bacterial rhinosinusitis
(ABRS) and are pregnancy category B. While levofloxacin is indicated for ABRS in
certain circumstances, levofloxacin is not indicated as a first-line agent in the
otherwise healthy patient. Additionally, levofloxacin is pregnancy category C and
would not be used when safer, effective alternatives are available.
\.The recommended duration of antimicrobial therapy for treatment of a urinary
tract infection in a pregnant woman is:
3 days
5 days
7 days - ANSWERS-Correct answer is: 7 days.
General Feedback:
UTIs are common during pregnancy and the most common causative pathogen is
Escherichia coli. In pregnancy, hormonal changes and dilation of the renal pelvis
actually favor ascension into the upper urinary tract and, therefore, UTI is treated
aggressively. Because of the dangers of maternal and fetal complications from a
UTI during pregnancy, a 7-day regimen of antimicrobial therapy is recommended
to ensure eradication of the bacteria.
