Facts read from nccwebsite.org · last checked Nov 7, 2026
The second half of obstetrics (29% of the exam with prenatal care): medical and obstetric complications as they appear in the office, and care of the patient in the weeks after birth, from involution and lactation to mood and blood pressure.
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 IV and V (guide, p. 13):
Maternal medical disorders: diabetes, hypertension, thyroid disease, anemia, thrombocytopenia, epilepsy, infections including STI and HIV, substance and alcohol use, obesity, GERD and perinatal mood disorders
Bleeding in pregnancy: placenta previa, abruption, accreta, vasa previa, trophoblastic disease and ectopic pregnancy
Hyperemesis, hypertensive disorders, gestational diabetes, preterm labor and cervical insufficiency
Multiple gestation, postdates, malpresentation, growth restriction and macrosomia, Rh alloimmunization and thromboembolism
Fetal death and coping with pregnancy loss
Postpartum changes and care: involution, lactation, perineal and breast care, lochia, sleep, nutrition, contraception and emotional changes
15 questions on complications and the postpartum period
0 / 15 answered15 questions
Tap an option: why each one is right or wrong appears under it.
Pregnancy complications and postpartum
On third-trimester ultrasound, oligohydramnios is defined as an amniotic fluid index of
An AFI of 8 cm is low-normal; calling it oligohydramnios would label many normal pregnancies and prompt early delivery.
Ten centimeters is within the normal range of roughly 5 to 24 cm; it is not a diagnostic cutoff.
Oligohydramnios is an amniotic fluid index of 5 cm or less, or a single deepest vertical pocket under 2 cm; the pocket measure is preferred because it leads to fewer unneeded interventions.
At 2 weeks postpartum, a patient has painful, nonthrombosed external hemorrhoids. The nurse practitioner should recommend
Postpartum external hemorrhoids that are not thrombosed are treated conservatively with sitz baths, stool softeners, fiber and fluids, and they usually shrink within weeks.
Opioids worsen constipation and straining, which aggravates hemorrhoids; nonopioid analgesia and stool softening come first.
Band ligation treats symptomatic internal hemorrhoids; external hemorrhoids lie below the dentate line, where banding is painful and not used.
A patient with a dichorionic twin pregnancy and a normal cervical length asks how to prevent preterm birth. The nurse practitioner should explain that
Bed rest does not prevent preterm birth in twins and raises the risk of thrombosis and deconditioning.
In a dichorionic twin pregnancy with a normal cervix, no routine measure (cerclage, progestogens or bed rest) reduces preterm birth, so none is recommended.
17-OHPC did not prevent preterm birth in twins, and the FDA withdrew Makena in 2023 after a confirmatory trial failed in singletons.
In a patient with preeclampsia, which laboratory result is a severe feature?
Uric acid often rises in preeclampsia, but it is not one of the defining severe features and does not change the classification.
A platelet count below 100,000/µL is a severe feature of preeclampsia under ACOG criteria, along with severe-range BP, transaminases twice normal, creatinine above 1.1 mg/dL or doubled, pulmonary edema and new cerebral or visual symptoms.
The amount of proteinuria, even above 5 g a day, is no longer a severe feature in ACOG criteria.
On postpartum day 6, a patient with bipolar disorder has not slept for 2 nights, is confused and says she hears voices about the baby. The nurse practitioner should
An SSRI treats depression and can trigger mania in bipolar disorder; outpatient follow-up in 2 weeks leaves a psychotic patient and infant unsafe.
Screening fits a patient without symptoms; this patient already has psychotic features and needs evaluation today, not a questionnaire weeks later.
Insomnia, confusion and hallucinations about the baby in the first postpartum week, especially with bipolar disorder, signal postpartum psychosis, an emergency that needs same-day psychiatric care because of suicide and infanticide risk.
An Rh-negative, antibody-negative patient has a complete spontaneous abortion at 9 weeks' gestation. According to ACOG (2024), Rh immune globulin
Giving RhIG within 72 hours of every pregnancy event is the older rule; for losses before 12 weeks current guidance no longer requires it.
ACOG's 2024 update states that Rh testing and RhIG may be forgone for spontaneous or induced abortion and pregnancy loss before 12 weeks, because fetal red cell exposure is too small to sensitize.
The amount of bleeding is not the deciding factor; gestational age under 12 weeks is what allows RhIG to be omitted.
A hemodynamically stable patient with an unruptured tubal ectopic pregnancy is being considered for methotrexate. Which finding makes her a poor candidate?
A mass of 2.5 cm is within the size usually treated medically; masses above about 3.5 cm raise the failure rate.
A low hCG like 1,800 mIU/mL predicts methotrexate success; high values above about 5,000 mIU/mL are the concern.
Fetal cardiac activity in an ectopic pregnancy predicts methotrexate failure and is a relative contraindication, as are an hCG above 5,000 mIU/mL and a mass over 3.5 to 4 cm.
A breastfeeding patient being treated with cephalexin for mastitis still has a 3-cm tender, fluctuant mass after 5 days of therapy. The most appropriate next step is
Breastfeeding can continue on the affected side, and stopping risks engorgement and loss of supply; milk from an abscess-affected breast is not harmful to a healthy term infant.
A fluctuant tender mass that persists after several days of antibiotics suggests a breast abscess, which is confirmed by ultrasound and drained by needle aspiration while breastfeeding continues.
Changing antibiotics does not drain pus; an abscess needs aspiration or incision, not another drug alone.
Which laboratory finding best distinguishes acute fatty liver of pregnancy from HELLP syndrome?
Impaired hepatic gluconeogenesis makes hypoglycemia a feature of acute fatty liver of pregnancy; it is uncommon in HELLP, along with coagulopathy and renal failure that point to AFLP.
LDH rises with hemolysis in HELLP and is also often raised in AFLP; it does not distinguish the two.
Transaminases are raised in both AFLP and HELLP, so they cannot separate the two.
An asymptomatic patient with a singleton pregnancy and no prior preterm birth has a cervical length of 15 mm at 22 weeks. The recommended treatment is
Tocolysis is short-term treatment of active preterm labor; it has no role in an asymptomatic patient with a short cervix.
17-OHPC was studied for prior preterm birth, not a short cervix, and it was withdrawn from the US market in 2023.
In a singleton pregnancy without prior preterm birth, a cervical length of 20 mm or less before 24 weeks is treated with daily vaginal progesterone, which lowers preterm birth risk.
On day 4 after birth, a patient is tearful and irritable with rapid mood swings but is sleeping when the baby sleeps, caring for the newborn and has no thoughts of self-harm. This is most consistent with
Postpartum thyroiditis usually appears 1 to 4 months after birth with hyperthyroid or hypothyroid symptoms, not on day 4.
Tearfulness, irritability and mood swings peaking around days 3 to 5, with normal sleep, normal infant care and no self-harm thoughts, are postpartum blues, which resolve within 2 weeks.
Postpartum depression needs at least 2 weeks of depressed mood or loss of interest with impaired function; mood swings on day 4 with intact functioning are too early and too mild.
A breastfeeding patient at 10 days postpartum requests a birth control method. She has no other medical conditions. Which method should be avoided?
In the first 21 days after birth, combined hormonal methods are US MEC category 4 because of high VTE risk, and for breastfeeding patients they remain category 3 until day 30.
Progestin-only pills are category 2 in the first 21 days with breastfeeding and can be started immediately.
DMPA is category 2 in breastfeeding patients before 21 days and has no estrogen-related clot risk.
A running total sits here; it fills in after your last pick.
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Errors that cost points here
The order for nausea and vomiting. ACOG Practice Bulletin 189 (2018) starts with pyridoxine, alone or with doxylamine, before other antiemetics.
Early pregnancy loss. For a stable patient, expectant care, medication (misoprostol, with mifepristone pretreatment where available) and uterine aspiration are all acceptable (ACOG Practice Bulletin 200). The patient's preference decides.
Gestational diabetes does not end at birth. A 75-g oral glucose tolerance test at 4 to 12 weeks after birth, then screening every 1 to 3 years for life (ADA Standards of Care).
Blood pressure after birth. Preeclampsia can first appear after delivery. ACOG Committee Opinion 736 asks for a blood pressure check no later than 7 to 10 days after birth for hypertensive disorders, and within 72 hours with severe hypertension.
Postpartum care is a process. The same opinion advises contact within the first 3 weeks and a comprehensive visit by 12 weeks, not a single check at 6 weeks.
Mastitis care changed. The Academy of Breastfeeding Medicine's protocol 36 (2022) advises continuing to feed on demand while avoiding deep massage and pumping beyond the infant's needs.
Postpartum thyroiditis. The hyperthyroid phase is treated for symptoms with a beta-blocker; antithyroid drugs have no role (ATA 2017 pregnancy guideline).
Yes, as screening and recognition at postpartum visits. Choosing and dosing psychiatric medication is covered on PMHNP-BC diagnosis and treatment.
How far into the postpartum period does the exam go?
Through the weeks after birth: involution, lactation, contraception, infections, mood and follow-up of conditions such as gestational diabetes and hypertension.