Review Practice Exercise 3

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Practice Exercise 3

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Total Questions : 5

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Question 1:

What is the primary mechanism of action of mifepristone when used for medical abortion?

A. It induces uterine contractions. B. It acts as a prostaglandin analog. C. It blocks progesterone receptors. D. It inhibits folic acid synthesis.

Answer and Explanation

Choice A:

Mifepristone does not directly induce uterine contractions. That role is fulfilled by misoprostol, a prostaglandin E1 analog given after mifepristone. While mifepristone increases uterine sensitivity to prostaglandins, its primary action is hormonal antagonism, not myometrial stimulation.

Choice B:

Mifepristone is not a prostaglandin analog. It is a steroidal compound that acts on hormone receptors, not prostaglandin pathways. Misoprostol, given after mifepristone, is the prostaglandin analog responsible for uterine contractions and cervical dilation.

Choice C:

Mifepristone blocks progesterone receptors, disrupting the hormonal support required to maintain the endometrial lining. This leads to decidual necrosis and detachment of the trophoblast. The question asks for the primary mechanism, which is receptor blockade, not downstream effects. This action initiates the abortion process before prostaglandins are administered.

Choice D:

Mifepristone does not inhibit folic acid synthesis. That mechanism is associated with drugs like methotrexate, which is used in ectopic pregnancy management. Mifepristone acts on progesterone, not folate metabolism, and has no antifolate properties.

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Question 2:

Dilation and Evacuation (D&E) is typically the surgical method of choice for which gestational age range of pregnancy termination?

A. Less than 6 weeks B. 6 to 10 weeks C. 14 to 24 weeks D. Beyond 28 weeks

Answer and Explanation

Choice A:

D&E is not used for pregnancies less than 6 weeks. At this early stage, the gestational sac is small and easily removed by manual vacuum aspiration or medical abortion using mifepristone and misoprostol. Surgical instrumentation is unnecessary and increases risk without benefit.

Choice B:

Between 6 to 10 weeks, suction curettage or medical abortion is preferred. The uterine contents are soft and easily evacuated without the need for forceps. D&E is excessive and not standard practice in this gestational range.

Choice C:

D&E is the standard method for termination between 14 to 24 weeks gestation due to increased fetal size and calcification. At this stage, suction curettage alone is insufficient, and forceps are needed for complete evacuation. The question asks for the gestational age range where D&E is typically used, which aligns precisely with this window.

Choice D:

Beyond 28 weeks, termination is legally and ethically complex and typically involves induction abortion or cesarean delivery. D&E is contraindicated due to fetal viability and increased risk of uterine rupture and maternal morbidity. Surgical evacuation at this stage is rarely performed and not considered standard.

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Question 3:

When is vacuum aspiration most commonly used as a method for induced abortion?

A. First trimester B. Second trimester C. Third trimester D. Post-term

Answer and Explanation

Choice A:

Vacuum aspiration is most commonly used in the first trimester, specifically between 5 to 12 weeks gestation. At this stage, the uterine contents are soft and easily evacuated by suction. The question asks for the most common use, which aligns with early gestational termination where vacuum aspiration is standard.

Choice B:

In the second trimester, fetal size and ossification increase, making vacuum aspiration less effective. Dilation and evacuation (D&E) becomes the preferred method due to the need for forceps and ultrasound guidance. Vacuum aspiration is not routinely used beyond 12 weeks due to incomplete evacuation risks.

Choice C:

During the third trimester, termination is rare and legally restricted. Methods include induction abortion or cesarean delivery, not vacuum aspiration. The fetal size and viability make suction techniques inappropriate and unsafe. Vacuum aspiration is contraindicated due to high risk of uterine rupture and maternal morbidity.

Choice D:

Post-term pregnancy refers to gestation beyond 42 weeks, where termination is managed by labor induction or cesarean section. Vacuum aspiration has no role in post-term management. The uterus is large, the fetus is viable, and suction evacuation is neither effective nor safe.

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Question 4:

A nurse is preparing a patient for a medical abortion. What information should the nurse include in the education regarding what to expect? Select all that apply.

A. Severe cramping and heavy bleeding are normal. B. The process of expulsion will be immediate and painless. C. Follow-up is required to confirm complete abortion. D. Nausea and diarrhea are common side effects of misoprostol. E. You will not need any pain medication.

Answer and Explanation

Choice A:

Severe cramping and heavy bleeding are expected due to uterine contractions induced by misoprostol and decidual shedding. These mimic labor-like symptoms and are necessary for complete expulsion of the gestational sac. The question stem asks what to expect, and this is a physiologic response to the medication.

Choice B:

Expulsion is rarely immediate and never painless. Misoprostol induces strong uterine contractions and cervical dilation, which cause significant discomfort. Expulsion typically occurs within 24 to 48 hours, not instantly. The claim of painless and immediate expulsion contradicts the pharmacologic mechanism.

Choice C:

Follow-up is essential to confirm complete abortion and exclude retained products of conception, which can lead to infection or hemorrhage. Ultrasound or serial β-hCG levels are used. The question tests knowledge of post-abortion care, and this is a standard protocol.

Choice D:

Misoprostol commonly causes nausea and diarrhea due to its prostaglandin activity on smooth muscle. These side effects are dose-dependent and transient. The question asks about expected effects, and these are well-documented.

Choice E:

Pain medication is often required due to cramping and uterine contractions. NSAIDs like ibuprofen are commonly prescribed. The statement that no pain medication is needed is inaccurate and disregards patient comfort and standard practice.

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Question 5:

Which of the following are methods used for induced abortion? Select all that apply.

A. Vacuum aspiration B. Expectant management C. Medical induction with prostaglandins D. Dilation and curettage (D&C) E. Cerclage placement

Answer and Explanation

Choice A:

Vacuum aspiration is a standard surgical method for induced abortion, especially effective between 6 and 14 weeks gestation. It uses suction to evacuate the uterine contents. It is associated with low complication rates and is widely used due to its efficacy and safety.

Choice B:

Expectant management is not a method of induced abortion. It refers to watchful waiting in cases of spontaneous abortion or miscarriage, allowing the body to expel the products of conception naturally. It lacks active intervention and is inappropriate for elective termination.

Choice C:

Medical induction with prostaglandins, such as misoprostol or mifepristone, is a recognized method for early abortion. These agents cause cervical softening and uterine contractions, leading to expulsion of the embryo or fetus. It is preferred in pregnancies under 12 weeks and is non-invasive.

Choice D:

Dilation and curettage (D&C) is a surgical abortion technique involving cervical dilation followed by scraping of the uterine lining. It is used for first-trimester abortions and post-abortion retained products. It provides direct visual control and is effective in complete evacuation.

Choice E:

Cerclage placement is a procedure used to prevent miscarriage or preterm birth in cases of cervical insufficiency. It involves placing a suture around the cervix to keep it closed. It is a pregnancy-preserving intervention, not a termination method, and contraindicated in abortion.

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