Practice Quiz

CNM Certified Nurse Midwife

Category - Antepartum

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A 20-year-old female client comes to the clinic due to abdominal cramping. She informs the nurse midwife that it is more than a month and a half past the date of her expected menstrual period. The client’s human chorionic gonotropin level is 5,500 mIU/mL. Pregnancy is suspected. Which diagnostic test should the nurse midwife order to obtain the most accurate diagnosis of pregnancy at this time?
  1. Transabdominal ultrasound
  2. Transvaginal ultrasound
  3. Serum progesterone
  4. Serum estrogen
Explanation
Answer: B - The nurse midwife orders a transvaginal ultrasound to verify the pregnancy. Transvaginal ultrasound or TVU is considered the most accurate means of verifying pregnancy during the early first trimester. Transabdominal ultrasound may be ordered when the hCG level is greater than 6,500 mIU/mL. Intrauterine gestation can only be visualized if the amount of hCG is above the this level. A TVU can detect pregnancy once the hCG level is between 1,000 and 1,500 mIU/mL. Serum progesterone is a useful addition for evaluating abnormal early pregnancies.
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