Gender Health

Susan, age 28, is 9 months pregnant and asks you about using umbilical cord blood after birth for newborn DNA identification. What do you tell her? 1. "A cord blood sample is identical to the genetic profile of the infant." 2. "The fingerprinting and footprinting that have been done in the past work perfectly." 3. "A better method of obtaining newborn DNA is with a buccal swab." 4. "The traditional method of using a newborn heel stick to obtain a DNA sample is tried and true."

"A cord blood sample is identical to the genetic profile of the infant."

Josh and Martha have 5 children and do not want any more. Josh said he heard about a no-scalpel vasectomy (NSV) and asks the nurse practitioner how it works. What would be the best response? 1. "For the vasectomy to be permanent, you must have the vas deferens excised." 2. "It's safer for Martha to be sterilized." 3. "A loop of vas deferens is delivered through the scrotal skin and occluded." 4. "The testes are twisted, which occludes the vas deferens."

"A loop of vas deferens is delivered through the scrotal skin and occluded."

Gerri, age 26, is thinking about getting pregnant in the near future, and she asks you what kind of vitamins she should be taking. You respond: 1. "You don't need any additional supplementation to your diet until you become pregnant." 2. "You need to increase your iron level by taking one 325-mg iron tablet twice a day." 3. "You need to start taking an extra 1500 mg of calcium a day now to help promote bone growth of the fetus when you become pregnant." 4. "All women capable of becoming pregnant should take a daily supplement of 0.4 mg of folic acid a day to reduce the risk of neural tube defects."

"All women capable of becoming pregnant should take a daily supplement of 0.4 mg of folic acid a day to reduce the risk of neural tube defects."

Joy has been breastfeeding and has developed puerperal mastitis. You tell her: 1. "Using cool compresses to the affected breast before pumping will increase milk expression." 2. "Continue breastfeeding the baby to avoid milk stasis." 3. "Continue doing your normal activities during the acute phase to keep things flowing." 4. "Do not massage the breasts."

"Continue breastfeeding the baby to avoid milk stasis."

Lynne, age 43, comes to your office in tears, stating that last night she had unprotected sex and forgot to take her birth control pill. She wants to know about the "morning-after pill." You tell her: 1. "If your period does not start at the scheduled time, come back and see me." 2. "I'll go ahead and order the estrogen-only postcoital contraception pill." 3. "I'll go ahead and order the Yuzpe regimen." 4. "I'll refer you to a gynecologist."

"I'll go ahead and order the Yuzpe regimen."

Mikey had an undescended testicle at birth, and at age 2 it remains in the inguinal region. His mother is afraid of surgery and asks for your advice. How do you respond? 1. "In many children, the testicle descends close to the sixth birthday." 2. "Even with only one normal testicle, he will have normal development." 3. "If it hasn't descended by now, it probably won't. He needs to have surgery by age six." 4. "Don't worry; it can remain in that position forever with no problems."

"If it hasn't descended by now, it probably won't. He needs to have surgery by age six."

Julia, age 60, asks you about taking alendronate (Fosamax). What do you tell her about using this medication? 1. "If you decide to take it, stick with a lower dose of 5 mg because the side effects are much worse with a 10-mg dose." 2. "Fosamax works better in younger women, so you should start this now rather than wait until you're 70." 3. "You should take a daily dose because the weekly dose is not as effective." 4. "In addition to its efficacy in the treatment of osteoporosis in postmenopausal women, it is also useful for the prevention of osteoporosis."

"In addition to its efficacy in the treatment of osteoporosis in postmenopausal women, it is also useful for the prevention of osteoporosis."

Mrs. Green, age 43, called the office to make an appointment for her annual Pap smear. Which of the following instructions does she need to be given prior to her appointment? 1. "Insert nothing in the vagina for 24 hours before the examination." 2. "Douching enhances visualization of the cervix and should be done before the appointment." 3. "An infection or menstrual period is no reason to cancel the appointment." 4. "The procedure is completely painless."

"Insert nothing in the vagina for 24 hours before the examination."

Mrs. Green, age 43, called the office to make an appointment for her annual Pap smear. Which of the following instructions does she need to be given prior to her appointment? 1. "Insert nothing in the vagina for 24 hours before the examination." 2. "Douching enhances visualization of the cervix and should be done before the appointment." 3. "An infection or menstrual period is no reason to cancel the appointment." 4. "The procedure is completely painless."

"Insert nothing in the vagina for 24 hours before the examination."

Regular testicular self-exams have not been studied enough to show if they lower the risk of dying from testicular cancer. This is why the American Cancer Society and other agencies do not have a recommendation about regular testicular self-exams for all men. Still, some practitioners do recommend that all men examine their testicles monthly after reaching puberty. If you are teaching a patient how to do a testicular self-examination, which of the following do you tell him? 1. "Examine your testicles when you are cold because this makes them more sensitive." 2. "Make sure your hands are dry to create friction." 3. "If you feel firmness above and behind the testicle, make an appointment." 4. "Make an appointment if you note any hard lumps directly on the testicle, regardless of whether they are tender."

"Make an appointment if you note any hard lumps directly on the testicle, regardless of whether they are tender."

The Joneses are thinking about going for infertility counseling because they have been married for 5 years and have been unable to conceive. They ask you whether the man or the woman is usually the cause of infertility. What do you tell them about the etiology of infertility? 1. "In most cases, infertility is related to a female factor." 2. "In most cases, infertility is related to a male factor." 3. "In the majority of cases, the etiology cannot be identified." 4. "Male and female infertility rates are almost the same in the majority of cases."

"Male and female infertility rates are almost the same in the majority of cases."

The Joneses are thinking about going for infertility counseling because they have been married for 5 years and have been unable to conceive. They ask you whether the man or the woman is usually the cause of infertility. What do you tell them about the etiology of infertility? 1. "In most cases, infertility is related to a female factor." 2. "In most cases, infertility is related to a male factor." 3. "In the majority of cases, the etiology cannot be identified." 4. "Male and female infertility rates are almost the same in the majority of cases."

"Male and female infertility rates are almost the same in the majority of cases."

John asks for a prescription for sildenafil (Viagra). He says that the only medication he takes is isosorbide mononitrate (Monoket) oral tablets and that he has diabetes that he controls with diet alone. What should the nurse practitioner tell him? 1. "Let's try a sample and see how you do." 2. "Viagra is contraindicated with isosorbide mononitrate; let's discuss other options." 3. "Because of your history of diabetes, we can't use it." 4. "I'd better refer you to a urologist."

"Viagra is contraindicated with isosorbide mononitrate; let's discuss other options."

Laura, age 65, presents to the office complaining of vaginal bleeding for 12 days. She reports she has not had a menses since the age of 52 and that this bleeding looks much like her menses used to look. The initial workup for postmenopausal bleeding (PMB) should include: 1. A pregnancy test. 2. A diagnostic pelvic laparoscopy. 3. An endometrial biopsy. 4. A colonoscopy.

An endometrial biopsy.

Michael complains of a urinary tract infection (UTI). Which of the following is a risk factor for UTIs in men? 1. A history of circumcision. 2. A history of testicular torsion. 3. Unprotected anal sex. 4. Presence of an inguinal hernia.

Unprotected anal sex.

During a pelvic examination, you ask Mrs. Krane, age 54, to perform a Valsalva maneuver (ie, forcibly exhaling while keeping the mouth and nose closed). While doing this strain maneuver, a pouching is seen on the anterior wall of the vagina. This is indicative of: 1. A cystocele. 2. A rectocele. 3. An enterocele. 4. Uterine prolapse.

A cystocele.

During a pelvic examination, you ask Mrs. Krane, age 54, to perform a Valsalva maneuver (ie, forcibly exhaling while keeping the mouth and nose closed). While doing this strain maneuver, a pouching is seen on the anterior wall of the vagina. This is indicative of: 1. A cystocele. 2. A rectocele. 3. An enterocele. 4. Uterine prolapse.

A cystocele.

A vaginal pH of 4.2 is an expected finding in: 1. A healthy girl of prepubertal age. 2. A woman with Trichomonas vaginalis. 3. A postmenopausal woman with atrophic vaginitis. 4. A healthy woman of reproductive age.

A healthy woman of reproductive age.

A 17-year-old female patient requests to start medroxyprogesterone acetate (Depo-Provera) injections as her method of birth control. She discloses that she has had 4 sexual partners in the past year. Her last menstrual period was 12 days ago, and she had unprotected intercourse 3 days ago. The appropriate management for this patient would be to: 1. Administer the injection today. 2. Advise her to use another method for now and return with her next menses. 3. Give the injection after a negative pregnancy test and tell her to use condoms for the next 7 days. 4. Give the injection and tell her to use a barrier method for 7 days.

Advise her to use another method for now and return with her next menses.

A patient is being treated for erectile dysfunction. The patient is morbidly obese and is also being treated for cardiovascular disease and coagulopathy. Which of the following medications would be contraindicated? 1. Topical testosterone (AndroGel). 2. Sildenafil (Viagra). 3. Alprostadil (Caverject). 4. Subcutaneous pellet testosterone (Testopel).

Alprostadil (Caverject).

Drew has erectile dysfunction and says that a friend told him about a method that uses a constricting ring around the base of the penis. What is he referring to? 1. Intracavernous injection therapy. 2. An external vacuum device. 3. Urethral suppositories. 4. Surgery.

An external vacuum device.

Sidney, age 72, presents to the clinic with complaints of a weak urine stream, hesitancy, and painful ejaculation. On digital rectal examination, you note that his prostate is boggy. The most common cause of his symptoms is: 1. Acute bacterial prostatitis. 2. Chronic bacterial prostatitis. 3. Chronic nonbacterial prostatitis with chronic pelvic pain syndrome. 4. Noninflammatory prostatitis.

Chronic bacterial prostatitis.

The nurse practitioner is performing a rectal examination on James, age 46, for follow-up of melena. What would the provider expect his stool to look like if his condition has not resolved? 1. Grayish tan. 2. Bright red. 3. Pale yellow, greasy, and fatty. 4. Black and tarry.

Black and tarry.

Jennifer, age 42, presents for her well-woman examination, and you notice "dimpling" on her left breast. Your differential diagnosis includes: 1. Breast cancer. 2. Fibrocystic breast disease. 3. Paget disease. 4. Striae from recent dieting.

Breast cancer

Julia is nursing her 8-week-old baby and states that he is very irritable and sleeps poorly. What medication or substance do you ask her if she is taking or using? 1. Cimetidine (Tagamet). 2. Ergotamine tartrate (Ergostat). 3. Nicotine. 4. Caffeine.

Caffeine.

Herb, a 47-year-old with diabetes, is complaining of a rash on his penis. Before examining him, you suspect that he may have: 1. Tinea cruris. 2. Genital herpes. 3. Candida. 4. Intraepithelial neoplasia.

Candida.

Which of the following terms describes the bluish or purplish discoloration of the vulva, vagina, and a portion of the cervix that occurs in pregnancy? 1. Goodell sign. 2. Hegar sign. 3. Piskacek sign. 4. Chadwick sign.

Chadwick sign.

Susan, age 35, has been diagnosed with fibrocystic breast disease. Which of the following may exacerbate the condition? 1. A daily dose of aspirin. 2. Spicy foods. 3. Chocolate. 4. Wearing tight bras.

Chocolate.

Martin is complaining of erectile dysfunction. He also has a condition that has reduced arterial blood flow to his penis. The most common cause of this condition is: 1. Epilepsy. 2. Multiple sclerosis. 3. Diabetes mellitus. 4. Parkinson disease.

Diabetes mellitus.

Joanne, age 23, wants to use some form of birth control, but because she is getting married next year, she wants to be able to stop the birth control method after the wedding and have her fertility restored almost immediately. Which method do you recommend for her? 1. Birth control pills. 2. Vaginal ring. 3. Depot medroxyprogesterone acetate (DMPA) injections. 4. Diaphragm.

Diaphragm.

Max, age 70, is obese. He is complaining of a bulge in his groin that has been there for months. He states that it is not painful, but it is annoying. The practitioner notes that the origin of the swelling is above the inguinal ligament and directly behind and through the external ring. This finding is most indicative of a(n): 1. Indirect inguinal hernia. 2. Direct inguinal hernia. 3. Femoral hernia. 4. Strangulated hernia.

Direct inguinal hernia.

Sharon, age 37, states she has heard that douching effectively washes out sperm after intercourse and that she has been using this as a method of birth control. Which of the following statements about douching is true? 1. Douching prevents sperm from entering the uterus. 2. If not used after intercourse, douching should be used at least once a month after menses. 3. Douching is a reliable contraceptive. 4. Douching may increase the risk of ectopic pregnancy.

Douching may increase the risk of ectopic pregnancy.

A 33-year-old woman complains of dyspareunia in the lower back during orgasm. The nurse practitioner should consider: z 1. Endometriosis. 2. Cystitis 3. Vaginitis. 4. Pelvic inflammatory disease.

Endometriosis.

Sandra, age 63, says that her previous doctor never discussed why he took her off hormone replacement therapy (HRT) 3 years ago. Her last menstrual period was at age 49, and she started HRT that same year. You share with her some of the results of the Women's Health Initiative (WHI). Which statement regarding the study is true? 1. Estrogen plus progestin increased the risk of a cardiac event in apparently healthy women after 10 years of use. 2. Women on HRT have a higher risk of colorectal cancer. 3. Postmenopausal hormones do not actually prevent fractures of the hip. 4. Estrogen alone is associated with a greater risk of breast cancer than a combination of estrogen plus progestin.

Estrogen plus progestin increased the risk of a cardiac event in apparently healthy women after 10 years of use.

Jeb, a 72-year-old male, is seen at your practice for follow-up of several episodes of orthostatic hypotension. After obtaining a review of systems and a digital rectal examination, it also appears that he has benign prostatic hyperplasia (BPH) with lower urinary tract symptoms. The nurse practitioner reviews his recent ultrasound evaluation, which reports a prostate volume of over 40 mL, and the results of the American Urological Association (AUA) symptom index for BPH, which shows his score to be 12. Based on the preceding information and the patient's desire for noninvasive medical therapy, what management should he be offered? 1. Prazosin (Minipress). 2. Doxazosin (Cardura). 3. Finasteride (Proscar). 4. Phenoxybenzamine (Dibenzyline).

Finasteride (Proscar).

Jeb, a 72-year-old male, is seen at your practice for follow-up of several episodes of orthostatic hypotension. After obtaining a review of systems and a digital rectal examination, it also appears that he has benign prostatic hyperplasia (BPH) with lower urinary tract symptoms. The nurse practitioner reviews his recent ultrasound evaluation, which reports a prostate volume of over 40 mL, and the results of the American Urological Association (AUA) symptom index for BPH, which shows his score to be 12. Based on the preceding information and the patient's desire for noninvasive medical therapy, what management should he be offered? 1. Prazosin (Minipress). 2. Doxazosin (Cardura). 3. Finasteride (Proscar). 4. Phenoxybenzamine (Dibenzyline).

Finasteride (Proscar).

Samantha, age 19, has a diagnosis of a Chlamydia vaginal infection. You believe it is questionable whether she will fill the prescription you write or take it for 7 days as ordered. What do you do? 1. Give azithromycin (Zithromax) 1 g orally now. 2. Emphasize the importance of the drug and tell her the consequences of not taking it. 3. Send out the public health nurse to follow up on whether she takes the drug for 7 days. 4. Assume that Samantha is an adult and will follow your instructions.

Give azithromycin (Zithromax) 1 g orally now.

Reiter syndrome is a complication of: 1. Bacterial vaginosis. 2. Syphilis. 3. Chlamydia. 4. Gonorrhea.

Gonorrhea.

The best method to diagnose uterine polyps is a: 1. Hysteroscopy. 2. Dilation and curettage. 3. Colposcopy. 4. Laparoscopy.

Hysteroscopy.

A 27-year-old female presents to your office for a levonorgestrel-releasing intrauterine system (Mirena) insertion. She reports that her menses started 3 days ago and is normal. How soon after insertion will she be able to safely rely on the intrauterine device (IUD) for contraception? 1. Immediately. 2. After 48 hours. 3. In 1 week. 4. In 1 month.

Immediately.

Sarah, age 29, complains of premenstrual syndrome (PMS). She states she was told that changing her diet might help in managing some of the symptoms. What change in her diet do you recommend? 1. Decreased intake of protein. 2. Increased intake of complex carbohydrates. 3. Increased intake of salt and salty foods. 4. Decreased intake of fatty foods.

Increased intake of complex carbohydrates.

A 26-year-old female comes to your office to discuss birth control options. Her history includes migraine headaches with aura while on combination oral contraceptives in the past. She does not want to become pregnant. Which of the following birth control options would be the best choice for her? 1. Combined hormonal contraceptive pills. 2. Birth control patch (Ortho Evra). 3. Mirena intrauterine device (IUD). 4. Vaginal contraceptive ring (NuvaRing).

Mirena intrauterine device (IUD).

Morris, age 52, is in a new relationship and is not sure whether his erectile dysfunction is organic or is caused by stress about his performance. What simple test could you suggest to determine if he has the ability to have an erection? 1. Nocturnal penile tumescence and rigidity (NPTR) test. 2. Penile duplex ultrasonography. 3. Intracavernous injection. 4. Serum prostate-specific antigen (PSA).

Nocturnal penile tumescence and rigidity (NPTR) test.

Mrs. Thomas, age 69, comes to your office for the results of her dual-energy x-ray absorptiometry (DXA) scan. She reports that her mother had osteopenia before she died. The DXA scan results show a T score of -2.7 in the hip and -2.8 in the spine. You explain to her that her results show: 1. Normal bone density. 2. Osteopenia. 3. Osteoporosis. 4. Osteoarthritis.

Osteoporosis.

Which of the following statements do you use when instructing women about their fertile period (ie, when they are most likely to become pregnant)? 1. Ovulation occurs on the 14th day, plus or minus 2 days, before the next menses. 2. Sperm are viable for 24 hours. 3. The ovum is viable for 6 hours. 4. The ovaries always release 1 ovum per month.

Ovulation occurs on the 14th day, plus or minus 2 days, before the next menses.

Jennifer, age 27, is complaining of lower abdominal pain. After doing some laboratory studies, you find leukocytosis, an elevated erythrocyte sedimentation rate, and an elevated C-reactive protein level. Which of the following is the most appropriate diagnosis? 1. Ovarian cyst. 2. Pelvic inflammatory disease. 3. Tubal pregnancy. 4. Diverticulitis.

Pelvic inflammatory disease.

Judi, age 24, has a seizure disorder. She would like to conceive within the next year. Her visit is for preconceptual counseling. What is the drug of choice for her during pregnancy? 1. Valproic acid (Depakene). 2. Trimethadione (Tridione). 3. Phenobarbital (Luminal). 4. Phenytoin (Dilantin).

Phenobarbital (Luminal).

Bernard, age 59, presents to the emergency department with a diagnosis of priapism. Despite application of cold compresses and pain medications, relief is unsuccessful. What is the treatment of choice? 1. Terbutaline 0.25 mg subcutaneously. 2. Phenylephrine 0.3 to 0.5 mL injected into the corpora cavernosa. 3. Doxazosin 5 mg sublingually. 4. Lidocaine 1% via the glans.

Phenylephrine 0.3 to 0.5 mL injected into the corpora cavernosa.

. You are performing a school physical examination on Damon, age 5. You are unable to retract his foreskin over the glans while inspecting his penis. This is referred to as: 1. Phimosis. 2. Paraphimosis. 3. Microphallus. 4. Priapism.

Phimosis.

Harry, age 60, has benign prostatic hyperplasia and complains of some incontinence. The nurse practitioner's first step in diagnosing overflow incontinence would be to order a: 1. Urinalysis. 2. Cystometrogram. 3. Cystoscopy. 4. Postvoid residual (PVR) measurement.

Postvoid residual (PVR) measurement.

A 63-year-old man presents to your office with hematuria, hesitancy, and dribbling. Digital rectal examination (DRE) reveals a smooth, moderately enlarged prostate. The client's prostate-specific antigen (PSA) is 1.2. What is the most appropriate management strategy at this time? 1. Prescribing an alpha-adrenergic blocker. 2. Recommending saw palmetto extract. 3. Prescribing an antibiotic. 4. Referring the client to urology.

Prescribing an alpha-adrenergic blocker.

Darcy, age 57, is to undergo a core needle biopsy for a suspicious breast mass. This procedure includes: 1. A 21- or 22-gauge needle that is used to aspirate cells from the lesion for analysis. 2. Removal of a large core of tissue from the lesion for histological evaluation utilizing a large-gauge cutting needle. 3. Removal of a wedge of tissue for examination. 4. Removal of the entire lesion.

Removal of a large core of tissue from the lesion for histological evaluation utilizing a large-gauge cutting needle.

Which of the following ovarian tumors or cysts have the potential for malignancy? 1. Follicular cysts. 2. Brenner tumors. 3. Fibromas. 4. Secondary ovarian tumors.

Secondary ovarian tumors.

A 21-year-old woman comes to your office and reports a history of genital warts. In reference to the human papillomavirus (HPV) vaccination (ie, Gardasil, Gardasil 9, and Cervarix), she should be educated that: 1. She is not in the correct age group and is not a candidate for vaccination. 2. She should receive HPV vaccination. 3. She has already been exposed to HPV; therefore, she is not a candidate for vaccination. 4. There is a vaccine coming out shortly specifically for those who have been exposed. She should wait.

She should receive HPV vaccination.

On physical exam, Judy has pubic hair that spreads over her mons pubis with a slight lateral spread. In addition, her breast development shows breast enlargement with secondary mound formation by the developing areolae. Which Tanner stage best describes Judy's development? 1. Stage II. 2. Stage III. 3. Stage IV. 4. Stage V.

Stage IV.

On physical exam, Judy has pubic hair that spreads over her mons pubis with a slight lateral spread. In addition, her breast development shows breast enlargement with secondary mound formation by the developing areolae. Which Tanner stage best describes Judy's development? 1. Stage II. 2. Stage III. 3. Stage IV. 4. Stage V.

Stage IV.

Marcia, age 59, presents with depression. According to the diagnostic criteria for major depressive disorder (MDD), which of the following must be present? 1. The depression must be related to alcohol, drugs, medication side effects, or physical illness. 2. The symptoms must be severe enough to upset the client's daily routine, impact his or her work, or interfere with relationships. 3. The depression must be a normal reaction to the death of a loved one. 4. There must be some type of sleep disturbance.

The symptoms must be severe enough to upset the client's daily routine, impact his or her work, or interfere with relationships.

Milton, a 72-year-old unmarried, sexually active white man, presents to your clinic with complaints of hesitancy, urgency, and occasional uncontrolled dribbling. Although the nurse practitioner suspects benign prostatic hyperplasia, what else should the differential diagnosis include? 1. Antihistamine use. 2. Urethral stricture. 3. Detrusor hyperreflexia. 4. Renal calculi.

Urethral stricture.

Ms. Russo, age 59, is a postmenopausal woman who comes to your office complaining of vaginal dryness. She has been sexually active with a new partner and says that penetration is very painful. She has tried over-the-counter lubricants but has not found one that works. Her history is significant for hypertension only. After examination and wet prep, you diagnose her with atrophic vaginitis. The treatment for this condition includes: 1. Terconazole cream. 2. Metronidazole gel 3. Vaginal estrogen cream. 4. Hydrocortisone ointment.

Vaginal estrogen cream.

A male patient presents to the clinic for evaluation of infertility. Subjectively, the patient complains of pain and fullness of the testes and states, "My testicles feel like a bag of worms." On physical examination, the nurse practitioner notes tortuous veins posterior to and above the testes that extend up into the external inguinal ring. Based on the preceding assessment, the nurse practitioner refers the patient to surgery for a diagnosis of: 1. Hydrocele. 2. Orchitis. 3. Urethritis. 4. Varicocele.

Varicocele.

Cynthia says that her health care provider wants to do a colposcopy. She asks you what this is. You tell her that a colposcopy: 1. Visualizes the cervical, vaginal, or vulvar epithelium under magnification to identify abnormal areas that may require a biopsy. 2. Involves removal of one or more areas of the endometrium by means of a small device without widening the cervix. 3. Allows visual examination of the uterine cavity with a small scope passed through the cervix. 4. Allows visualization of the abdominal and pelvic cavities through a small scope passed through a small abdominal incision.

Visualizes the cervical, vaginal, or vulvar epithelium under magnification to identify abnormal areas that may require a biopsy.