Family Nurse Practitioner Exam

In a sexually active woman with amenorrhea and vaginal spotting, which test should be initially ordered to rule out pregnancy-related issues?

1. Flat plate of the abdomen

2. Complete blood count (CBC) with white cell differentials

3. Urine pregnancy test

4. Pelvic ultrasound

The correct answer is: Urine pregnancy test

In a sexually active woman presenting with amenorrhea and vaginal spotting, the primary concern is to rule out the possibility of pregnancy. A urine pregnancy test is the most appropriate initial test for this purpose due to its ease of administration, rapid results, and high sensitivity for detecting human chorionic gonadotropin (hCG), which is produced during early pregnancy. Confirming or ruling out pregnancy is essential because it can help to determine the management of the patient's symptoms. If the urine pregnancy test is positive, further evaluation would focus on the reasons for the vaginal spotting, which could indicate possible complications such as a miscarriage or ectopic pregnancy. If negative, other causes of amenorrhea and vaginal spotting can be explored. Other options, such as imaging studies or blood tests, while valuable in other contexts, are not the first-line approach for assessing pregnancy status and would not provide the necessary information as promptly as a urine pregnancy test. Thus, the urine pregnancy test serves as a crucial initial step in evaluating the patient's condition.