A couple comes in for an infertility workup, having attempted to get pregnant for 2 years. The woman, 37, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional test is needed?

Correct Answer: B

Rationale: The correct answer is B: Antisperm antibodies. In this case, the man's history of vasectomy reversal and normal semen analyses with clumped sperm suggest a possible presence of antisperm antibodies. These antibodies can cause sperm agglutination, affecting fertility. Testing for antisperm antibodies can provide valuable information on potential immune-related infertility issues. A: FSH level is not the most appropriate test in this scenario as the man's semen analyses were normal, indicating potential issues with sperm-egg interaction rather than hormonal imbalances. C: Testicular biopsy is invasive and not necessary at this stage when the issue seems to be related to sperm clumping rather than a structural problem within the testes. D: Test of testicular infection is unlikely as the man's semen analyses were normal, and there are no indications of infection based on the information provided.

Correct Answer: B

Rationale: The correct answer is B: Uterine tenderness and rigidity. This finding is most indicative of abruptio placentae, which is the premature separation of the placenta from the uterine wall. Uterine tenderness and rigidity are classic signs due to the internal bleeding and blood accumulating between the placenta and uterine wall. This results in a tense and tender uterus. A: Soft abdomen is incorrect as abruptio placentae typically presents with a firm, board-like abdomen due to uterine rigidity. C: Bright red, painless vaginal bleeding is incorrect as abruptio placentae typically presents with dark red, painful vaginal bleeding. D: Decreased fetal movements are incorrect as fetal distress can occur with abruptio placentae, but uterine tenderness and rigidity are more specific indicators of this condition.

Correct Answer: C

Rationale: The correct answer is C: Fetal descent and position. In the second stage of labor, the priority assessment is to monitor fetal descent and position to ensure the baby is progressing through the birth canal correctly. This assessment helps determine if interventions are needed to prevent complications such as fetal distress or prolonged labor. Assessing the frequency of contractions (A) and cervical dilation (B) are important but not the priority in the second stage. Intensity of contractions (D) is also important but not as crucial as monitoring fetal descent and position.

Correct Answer: C

Rationale: The correct answer is C: Spinach. 1. Spinach is high in iron, which is important for pregnant women to prevent anemia. 2. Milk (A) does not contain a significant amount of iron. 3. Chicken (B) is a good source of protein but not as high in iron as spinach. 4. Bananas (D) are rich in potassium but not iron, making them a less suitable choice for iron supplementation during pregnancy.

Correct Answer: B

Rationale: The correct answer is B: HELLP syndrome. In the third trimester, severe right upper quadrant pain and nausea can indicate HELLP syndrome, a serious pregnancy complication involving hemolysis, elevated liver enzymes, and low platelet count. The pain and nausea are due to liver and gallbladder involvement. Placenta previa typically presents with painless vaginal bleeding, not upper quadrant pain. Hyperemesis gravidarum causes severe nausea and vomiting but not specific upper quadrant pain. Abruptio placentae presents with sudden-onset abdominal pain and vaginal bleeding.