NUR 622 Final Exam

1. A 23-year-old sexually active woman presents for her first Pap smear. Herhistory includes nulligravida, age at first intercourse 14, and more than 10 sexualpartners. Which of the following conditions should the clinician be particularly alert for during her examination? a. Human papillomavirus (HPV) b. Endometrial hyperplasia c. Vagismus d. Polycystic ovarian syndrome

a. Human papillomavirus (HPV)

5. Which of the following medications is the treatment of choice for trichomonas? a. Metronidazole b. Ceftriaxone c. Diflucan d. Doxycycline

a. Metronidazole

. A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority? a. Pregnancy test b. Pelvic ultrasound c. Endometrial biopsy d. Platelet count

a. Pregnancy test

A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate? A. "It is probably just a cyst because that is the most common breast mass." B. "We will order a mammogram and ultrasound to help establish a diagnosis." C. "We will go ahead and schedule you for a biopsy because that is the only way to know for sure." D. "Because your lump is painful, it is most likely not cancer."

B. "We will order a mammogram and ultrasound to help establish a diagnosis."

A 45-year-old woman is seen in the clinic with complaints of a vaginal discharge. The clinician identifies clue cells on the vaginal smear. Which of the following diagnoses is associated with this finding? A. Trichomonas B. Bacterial vaginosis C. HPV D. Herpes simplex virus

B. Bacterial vaginosis

A 47-year-old client comes to the clinic for a Papanicolaou (Pap) smear. She tells the nurse that she has been experiencing hot flashes and that her periods have been occurring at longer, less regular intervals, with a scanty flow. What does the nurse conclude is the most likely cause of these changes? 1 Uterine cancer 2 Lack of estrogen 3 Early cervical carcinoma 4 Expected menopausal changes

-Expected menopausal changes The adaptations described and the client's age suggest that the client is experiencing menopause. Irregular spotting and bleeding occur with uterine cancer and are not associated with the menstrual cycle. Estrogen is reduced, not eliminated, during and after menopause; the adrenal glands produce a small amount of estrogen throughout life. Early cervical cancer is asymptomatic; an irregular bloody vaginal discharge is a late sign of cervical cancer.

When discussing future health management with a client who has had a total hysterectomy, the nurse advises regular physical examinations. The client agrees and adds, "It won't be so hard to go now that I won't need the pelvic examination and Pap smear." How should the nurse respond? 1 Discuss the need to have pelvic examinations and Pap smears until healing is complete. 2 Suggest that the client discuss the need for future pelvic examinations with her practitioner. 3 Agree that other components of the physical examination will be more important in the future. 4 Explain why regular pelvic examinations and Pap smears of vaginal secretions will be necessary in the future

-Explain why regular pelvic examinations and Pap smears of vaginal secretions will be necessary in the futurePelvic examinations and Pap smears will always be necessary to screen for atypical changes in vaginal tissue and will always remain a priority for this client. Suggesting that the client talk with her practitioner transfers the nurse's responsibility for client teaching to the practitioner.

A client has been taking clomiphene citrate (Clomid) for 3 months to treat anovulatory cycles. Which finding should be reported to the health care provider immediately? 1 Nausea and vomiting 2 Blurred vision 3 Weight gain 4 Hot flashes

-Nausea and vomiting Clomid is classified in pregnancy category X, and it should be discontinued if the client is pregnant. The client should notify her health care provider of the presumptive signs of pregnancy. Weight gain, blurred vision, and hot flashes are all common side effects of this ovulation inducer.

A 25-year-old woman is seen in the clinic complaining of painful menstruation. Which of the following pelvic pathologies is the most common cause of secondary dysmenorrhea? A. Pelvic inflammatory disease B. Endometriosis C. Sexually transmitted infections D. Ovarian cyst

B. Endometriosis

A 22-year-old woman is diagnosed with premenstrual syndrome. Which of the following lifestyle changes should the clinician suggest to help minimize the patient's symptoms? A. At least 4 cups of green tea daily B. Regular exercise C. Take vitamin A supplements D. Eat a diet high in iron

B. Regular exercise

Which client is most at risk for osteoporosis? 1 A nonsmoking 60-year-old woman, 5 foot 7 inches tall and 173 lb 2 A 66-year-old white woman, 5 foot 1 inch and 100 lb, who is a paralegal 3 A 68-year-old black woman, 5 foot 5 and 140 lb, who is a retired receptionist 4 A 62-year-old woman, 5 foot 4 inches tall and 135 lb, who takes calcium carbonate daily

2-A 66-year-old white woman, 5 foot 1 inch and 100 lb, who is a paralegal

Which of the following is true of the IUD (intrauterine device)? A. The IUD is 95% effective at preventing pregnancy. B. The IUD has an inhibitory effect on sperm capacitation. C. The IUD can only be inserted at menses. D. The IUD can only be inserted in women with multiparity.

B. The IUD has an inhibitory effect on sperm capacitation.

A 32-year-old woman is admitted to the unit with a history of fibroids and menorrhagia. Which findings does the nurse expect to encounter during assessment of the client? Select all that apply. 1 Fluid overload 2 Intermittent diarrhea 3 Pale mucous membranes 4 Difficulty emptying the bladder 5 High hemoglobin and hematocrit

3 Pale mucous membranes 4 Difficulty emptying the bladder

A client asks the nurse at the family planning clinic whether contraception is needed while she is breastfeeding. How should the nurse reply? 1 As long as you aren't having periods, you won't need a contraceptive." 2 It would be best to delay sexual relations until you have your first period. 3 You should use contraceptives, because ovulation may occur without a period. 4 Breastfeeding suppresses ovulation, so you don't need to worry about pregnancy."

3 You should use contraceptives, because ovulation may occur without a period.

A 23-year-old woman comes to the clinic for a Pap smear. After the examination, the client confides that her mother died of endometrial cancer 1 year ago and says that she is afraid that she will die of the same cancer. Which risk factor stated by the client after an education session on risk factors indicates that further teaching is needed? 1 Obesity 2 High-fat diet 3 Hypertension 4 Late-onset menarche

4 Late-onset menarche

A woman is being evaluated by the nurse practitioner for complaints of dyspareunia. A microscopy slide reveals a large number of atrophic squamous epithelial cells. The vaginal pH is 4.0. There are very few leukocytes and no RBCs are seen on the wet smear. Which of the following is most likely? A) Atrophic vaginitis B) Bacterial vaginosis C) Trichomoniasis D) This is a normal finding

A) Atrophic vaginitis Symptoms of atrophic vaginitis include painful intercourse, atrophic squamous epithelial cells, and a decrease in pH. Vaginal atrophy is caused by lack of or imbalance of estrogen. Normal pH of the vagina is 4.0-5.0 (acidic).

Some pharmacologic agents may cause confusion in the elderly. Which of the following pharmacologic agents is most likely to cause confusion in this population? A) Cimetidine (Tagamet), digoxin (Lanoxin), diphenhydramine (Benadryl) B) Acetaminophen (Tylenol), aspirin (Bayer), indomethacin (Indocin) C) Sucralfate (Carafate), docusate sodium (Surfak), psyllium (Metamucil) D) Cephalexin (Keflex), amoxicillin (Amoxil), clarithromycin (Biaxin)

A) Cimetidine (Tagamet), digoxin (Lanoxin), diphenhydramine (Benadryl) Medications that commonly cause confusion in the elderly include cimetidine, lanoxin, and diphenhydramine.

A 35-year-old smoker is being evaluated for birth control choices. The patient has a history of PID along with an embolic episode after her last pregnancy. Which of the following methods of birth control would you recommend? A) Condoms and the vaginal sponge (Today Sponge )B) Estrogen patches C) Intrauterine device D) Depo-Provera (depot medroxyprogesterone)

A) Condoms and the vaginal sponge (Today Sponge) Contraindications for hormonal contraception include: Migraine headaches; cigarette smoking or obesity in women older than 35 years; history of thromboembolic disease; hypertension or vascular disease if over 35 years of age; systemic lupus erythematosus with vascular disease, nephritis, or antiphospholipid antibodies; breastfeeding (may use progestin-only pills); hypertriglyceridemia; CAD; CHF; and strokes.

A 25-year-old woman complains of dysuria, severe vaginal pruritis, and a malodorous vaginal discharge. Pelvic examination reveals a strawberry-colored cervix and frothy yellow discharge. Microscopic exam of the discharge reveals mobile organisms that have flagella. The correct pharmacologic therapy for the condition is: A) Metronidazole (Flagyl) B) Ceftriaxone sodium (Rocephin) C) Doxycycline hyclate (Vibramycin) D) Clotrimazole (Gyne-Lotrimin)

A) Metronidazole (Flagyl) Trichomoniasis symptoms include dysuria, severe vaginal pruritis, and malodorous vaginal discharge. Wet prep will show trichomonads that are pear-shaped and have several flagella (whiplike tails) at one end. CDC recommendation for treatment is metronidazole.

Which of the following medications is indicated for the treatment ofobsessive-compulsive disorder? A) Paroxetine (Paxil CR) B) Haldoperidol (Haldol) C) Lorazepam (Xanax) D) Imipramine (Elavil

A) Paroxetine (Paxil CR) Antidepressants are the most common medications used for OCD. Those antidepressants that are approved for OCD by the Food and Drug Administration (FDA) include clomipramine (Anafranil), fluvox- amine (Luvox), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft).

The Pap smear result on a 20-year-old sexually active student who uses condoms inconsistently shows a large amount of inflammation. Which of the following is the best follow-up action? A) The NP needs to do cervical cultures to verify the presence of gonorrhea B) Prescribe metronidazole vaginal cream for the patient over the phone C) Call the patient and tell her she needs a repeat Pap smear in 6 months D) Advise the patient to use a Betadine douche at bedtime x 3 days

A) The NP needs to do cervical cultures to verify the presence of gonorrhea Cultures should be taken at the time of the Pap smear, as the patient may not return for later diagnostic testing.

A 20-year-old woman is seen in the clinic because her boyfriend was found to have gonorrhea. Which of the following is the treatment of choice for gonorrhea? A. Ceftriaxone B. Doxycycline C. Acyclovir D. Metronidazole

A. Ceftriaxone

A 36-year-old woman is seen with complaints of vaginal itching, burning, and discharge. On potassium hydroxide (KOH) wet mount of vaginal discharge, the clinician notices hyphae. Which of the following treatments would be appropriate? A. Fluconazole B. Estrogen vaginal cream C. Metronidazole D. Doxycycline

A. Fluconazole

A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her examination? A. Human papillomavirus B. Endometrial hyperplasia C. Vaginismus D. Polycystic ovarian syndrome

A. Human papillomavirus

A 42-year-old woman presents to the clinic with complaints of painful intercourse for the last month. Which of the following should be explored as the likely cause of her dyspareunia? A. Menopause B. Dehydration C. Excess progesterone D. Excess lubrication

A. Menopause

Which of the following medications is the treatment of choice for Trichomonas? A. Metronidazole B. Ceftriaxone C. Diflucan D. Doxycycline

A. Metronidazole

Tina is an 18-year-old female who would like to start using the transdermal contraceptive patch. Which of the following instructions should the clinician discuss with Tina? A. Obesity can decrease the effectiveness of the patch. B. The patch should be applied to the buttocks or breasts. C. The patch is changed every 10 days. D. If a patch becomes detached for less than 24 hours, it cannot be reapplied.

A. Obesity can decrease the effectiveness of the patch.

Which of the following would be appropriate treatment for a woman with mild endometriosis? A. Oral contraceptives B. Leuprolide acetate injections C. Nafarelin nasal spray D. Hysterectomy

A. Oral contraceptives

A 32-year-old woman is seen in the clinic because she has been unable to get pregnant after 12 months of unprotected sex. In order to determine the cause of the infertility, the clinician should question her about which of these possible causes? A. Pelvic inflammatory disease B. Oral contraceptive use for 15 years C. Early menarche D. Diet high in soy protein

A. Pelvic inflammatory disease

What is the most common cause of secondary amenorrhea? A. Pregnancy B. Pituitary dysfunction C. Inadequate estrogen levels D. Genetic disorders

A. Pregnancy

Which of the following tests is essential for a 46-year-old woman who the clinician suspects is perimenopausal? A. Pregnancy B. Estrogen level C. Progesterone level D. LH level

A. Pregnancy

A 21-year-old woman is seen in the clinic requesting birth control pills. Which of the following tests is essential before prescribing any oral contraceptive? A. Pregnancy test B. Complete blood cell count C. Thyroid-stimulating hormone D. Urine dip for protein

A. Pregnancy test

A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority? A. Pregnancy test B. Pelvic ultrasound C. Endometrial biopsy D. Platelet count

A. Pregnancy test

A 48-year-old woman is seen in the clinic with complaints of prolonged heavy menstrual periods. She is pale and states she can no longer exercise. Pelvic exam reveals a single, very large mass. Which of the following diagnostic tests should the clinician order first? A. Transvaginal ultrasound B. Endometrial biopsy C. MRI D. Abdominal computed tomography scan

A. Transvaginal ultrasound

2. A 20-year-old woman is seen in the clinic because her boyfriend wasfound to have gonorrhea. Which of the following is the treatment of choice for gonorrhea? a. Ceftriaxone b. Doxycycline c. Acyclovir d. Metronidazole

a. Ceftriaxone

A 30-year-old female who is sexually active complains of a large amount of milk- like vaginal discharge for several weeks. A microscopy slide reveals a large amount of squamous epithelial cells that have blurred margins. Very few white blood cells are seen. The vaginal pH is at 6.0. What is most likely? A) Trichomonas infection B) Bacterial vaginosis C) Candidal infection D) A normal finding

B) Bacterial vaginosis Bacterial vaginosis is a bacterial infection of the vagina. Signs and symptoms include copious off-white to gray discharge with foul odor without vaginal erythema or irritation. Wet prep will show positive for clue cells. When performing a wet prep, the "whiff test" will be positive for a strong "fishy" odor when vaginal discharge is mixed with one drop of KOH.

Fitz-Hugh-Curtis syndrome is associated with which following infection? A) Syphilis B) Chlamydia trachomatis C) Herpes genitalis D) Lymphogranuloma venereum

B) Chlamydia trachomatis Fitz-Hugh-Curtis is a complication of having pelvic inflammatory disease that was caused by a vaginal infection, such as gonorrhea or Chlamydia trachomatis. This causes inflammation and infection in the pelvic cavity. Left untreated, this infection can cause adhesions that stretch from the peritoneum to the liver.

Which of the following is contraindicated in the care of pregnant women with placenta previa? A) Echocardiogram B) Intravaginal ultrasound C) Abdominal ultrasound D) Pelvic ultrasound

B) Intravaginal ultrasound No type of vaginal exam should be performed in patients diagnosed with placenta previa. Intravaginal ultrasound and pelvic exams are contraindicated

A pelvic exam on a woman who is 12 weeks pregnant would reveal that her uterus is located at which of the following areas? A) Between the umbilicus and the suprapubic bone B) Just rising above the suprapubic bone C) Between the suprapubic bone and the xiphoid process D) Between the umbilicus and the xiphoid process

B) Just rising above the suprapubic bone At 12 weeks gestation, the uterus measures approximately the size of a grapefruit, which would be felt just above the suprapubic bone on bimanual exam.

While performing a Pap smear on a postmenopausal patient, several areas of flat white skin lesions that are irregularly shaped are found on the patient's labia. The patient reports that the lesions are extremely itchy and have been present for several years without much change. Which condition is best described? A) Chronic scabies infection B) Lichen sclerosus C) Chronic candidal vaginitis D) A physiologic variant found in some older women

B) Lichen sclerosus Lichen sclerosus is a disease of the skin, in which white spots appear on the skin and change over time. It is most commonly seen in the genital and rectal areas, but can appear in other areas. The spots are usually shiny and smooth and can eventually spread into patches. The skin appears thin and crinkled. Then the skin tears easily, and bright red or purple bruises are common. Sometimes, the skin becomes scarred. If the disease is a mild case, there may be no symptoms

Which of the following is the most common cause of cancer deaths for women in the United States? A) Breast cancer B) Lung cancer C) Colon cancer D) Heart disease

B) Lung cancer Lung cancer is the most common cause of cancer deaths in women as well as men.

You are checking a 75-year-old woman's breast during an annual gynecologi- cal exam. The left nipple and areola are scaly and reddened. The patient denies pain and pruritis. She has noticed this scaliness on her left nipple for the past 8 months. Her dermatologist gave her a potent topical steroid, which she used twice a day for 1 month. The patient never went back for the follow-up. She still has the rash and wants an evaluation. Which of the following is the best intervention for this patient? A) Prescribe another potent topical steroid and tell the patient to use it twice a day for 4 weeks B) Order a mammogram and refer the patient to a breast surgeon C) Advise her to stop using soap on both breasts when she bathes to avoid dryingup the skin on her areolae and nipples D) Order a sonogram and fine-needle biopsy of the breast

B) Order a mammogram and refer the patient to a breast surgeon A scaly, reddened rash on the breast that does not resolve after a few weeks of medical treatment may indicate breast cancer. She should have a mammogram performed and see a breast surgeon for evaluation and treatment.

Which of the following conditions is a possible complication of severe eclampsia? A) Placenta previa B) Placenta abruptio C) Erythroblastosis fetalis D) Uterine rupture

B) Placenta abruptio Abruptio placenta is a possible complication of severe eclampsia. With elevated blood pressure, the placenta can pull away from the uterine lining and cause painful, bright red bleeding.

A 38-year-old multigravida who is at 32 weeks of gestation calls the family nurse practitioner complaining of bright red vaginal bleeding. There is no watery dis- charge. She complains that her uterus feels hard and is very painful. Which of the following conditions is most likely? A) Placenta previa B) Placenta abruptio C) A molar pregnancy D) An ectopic pregnancy

B) Placenta abruptio Abruptio placenta symptoms are bright red vaginal bleeding, board-like uterus on palpation, and pain. However, there can be concealed hemorrhage and the patient may not have vaginal bleeding. Placenta previa is painless bleeding. Ectopic and molar pregnancy would not progress to 32 weeks gestation

A 28-year-old multipara who is at 32 weeks of gestation presents to your office complaining of a sudden onset of small amounts of bright red vaginal bleeding. She has had several episodes and appears anxious. On exam, her uterus is soft to palpation. Which of the following is most likely? A) Placenta abruptio B) Placenta previa C) Acute cervicitis D) Molar pregnancy (hydatidiform mole)

B) Placenta previa Placenta previa occurs when abnormal implantation of the placenta occurs. A common symptom of placenta previa is painless, bright red bleeding.

A 15-year-old girl is seen in the clinic because she has not yet had her first period. Which of the following questions would help the clinician determine the cause? A. "Are you sexually active?" B. "How long have you been underweight?" C. "Was your mother pregnant with you when she was of advanced maternal age?" D. "Have you noticed any changes in your moods lately?"

B. "How long have you been underweight?"

A 44-year-old patient with breast cancer is prescribed tamoxifen by her surgeon. She is complaining about hot flashes. Which of the following responses by the clinician would be most appropriate? A. "You must be having menopause." B. "The hot flashes are a result of the antiestrogenic effects of tamoxifen." C. "Tamoxifen use has no increased incidence of endometrial cancer." D. "The drug will have no effect on vaginal lubrication."

B. "The hot flashes are a result of the antiestrogenic effects of tamoxifen."

A 37-year-old woman is admitted to the unit with severe menorrhagia. During assessment the nurse learns that she has a history of fibroids, menorrhagia, pelvic pain, and depression. The client has been undergoing hormone therapy in hopes of easing the symptoms and reducing the size of the fibroids, without success. The lab reports hemoglobin and hematocrit readings of 6.8 and 20.2, respectively. The client begins to sob and cries, "I don't know what to do—the doctor is recommending a hysterectomy, but I haven't had children yet!" What is the best response by the nurse? A. "There are so many orphans looking for a mother.. B. This must be so difficult for you. Children are really important to you. C. You really have no choice but to follow the recommendation; the doctor is right. D. Believe me when I tell you that kids are so difficult to raise—you're better off without them."

B. This must be so difficult for you. Children are really important to you.

The following conditions are absolute contraindications for the use of oral contraceptives except: A) Hepatomas B) History of emboli that resolved with heparin therapy 15 years ago C) A family history of migraines with aura D) A history of gallbladder disease during pregnancy

C) A family history of migraines with aura All of the items are contraindications, but a family history does not substantiate a need to avoid oral contraceptives.

Human papilloma virus infection in women has been associated with the development of: A) Ectopic pregnancy B) Infertility C) Cervical cancer D) Pelvic inflammatory disease

C) Cervical cancer HPV is a virus associated with cervical cancer. HPV vaccine is now available for girls and boys between the ages of 15-21 years of age to help prevent 4 strains of this virus that is linked to cervical cancer.

A patient diagnosed with bacterial vaginosis should be advised that her sexual partner be treated with: A) Ceftriaxone(Rocephin)250mgIMwithdoxycycline100mgBIDfor14days B) Metronidazole (Flagyl) 500 mg PO BID for 7 days and 1 dose of azithromycin (Zithromax) C) Her partner does not need treatment D) Clotrimazole cream (Lotrimin) on his penis BID for 1 to 2 weeks

C) Her partner does not need treatment Bacterial vaginosis is a bacterial infection, but is not considered an STD for which the partner needs treatment. Studies show that men rarely carry this infection.

A 48-year-old woman is told by a physician that she is starting menopause. All of the following are possible findings except: A) Hot flashes B) Irregular menstrual periods C) Severe vaginal atrophic changes D) Cyclic mood swings

C) Severe vaginal atrophic changes

Julia, a 16-year-old patient, is being treated for her first urinary tract infection. Julia had an allergic reaction with hives after taking sulfa as a child. Which of the following antibiotics would be contraindicated? A) Cephalexin (Keflex) B) Ampicillin (Amoxil) C) Trimethoprim-sulfamethoxazole (Bactrim) D) Nitrofurantoin crystals (Macrobid)

C) Trimethoprim-sulfamethoxazole (Bactrim) With the allergic history to sulfa drugs, it would be safest to avoid Bactrim.

A sexually active woman is complaining of amenorrhea and vaginal spotting. On exam, her left adnexa is tender and cervical motion tenderness is positive. Which test should the nurse practitioner initially order? A) Flat plate of the abdomen B) Complete blood count (CBC) with white cell differentials C) Urine pregnancy test D) Pelvic ultrasound

C) Urine pregnancy test A urine pregnancy test should be performed to rule out miscarriage and/or tubal pregnancy.

A college student has recently been informed that he has an HPV (human papilloma virus) infection on the shaft of his penis. Which of the following may reveal subclinical lesions on the penile skin? A) Perform a KOH (potassium hydroxide) exam B) Scrape off some of the affected skin and send it for a culture and sensitivity C) Apply acetic acid to the penile shaft and look for acetowhite changes D) Order a serum herpes virus titer

C)Apply acetic acid to the penile shaft and look for acetowhite changes Lesions of HPV infection will turn white with application of acetic acid.

The clinician is seeing Jalissa, a 17-year-old patient, for a well woman's exam. She mentions that she has been depressed and has been yo-yo dieting because she feels "so fat." She marked "no" to whether she feels safe in her home on her intake form, and mentions she is worried about getting STIs from her boyfriend of three months. Which of the following is the correct way to interact with the patient, based on her history? A. "The amount of time allotted for your well woman exam does not allow time to talk about depression today." B. "I know you said you are concerned about your body image, but your weight looks good to me." C. "You mentioned on your intake form that you do not feel safe in your home. Why is that?" D. "You've been dating your boyfriend for three months, but you haven't had an STI screening yet? That's not safe."

C. "You mentioned on your intake form that you do not feel safe in your home. Why is that?"

When assessing a woman for infertility, which of the following tests should be done first? A. Hysterosalpingogram B. Magnetic resonance imaging (MRI) C. Analysis of partner's sperm D. Estrogen level

C. Analysis of partner's sperm

A 25-year-old woman comes to the clinic complaining of increased vaginal discharge, milky gray in color with a "fishy" odor that both she and her husband have noticed. A wet smear is performed and the presence of "clue cells" confirmed. Which type of infection does the nurse suspect? A. Candidiasis B. Trichomoniasis C. Bacterial vaginosis D. Group B Streptococcus

C. Bacterial vaginosis

A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease has she most probably been exposed to? A. Gonorrhea B. HPV C. Chlamydia D. Trichomoniasis

C. Chlamydia

A 40-year-old woman is seen for her yearly examination. She is single and not in a monogamous relationship. Her social history includes smoking cigarettes "occasionally" and drinking about two beers a day. Her body mass index (BMI) is 25. She is requesting birth control. Which of the following methods would be best and most effective for this patient? A. Transdermal contraceptive patch B. Oral contraceptive C. Condom D. Vaginal contraceptive sponge

C. Condom

Treatment for mild preeclampsia includes all of the following except: A) Bed rest except for bathroom privileges B) Close monitoring of weight and blood pressure C) Close follow-up of urinary protein, serum creatinine, and platelet count D) A prescription of methyldopa (Aldomet) to control blood pressure

D) A prescription of methyldopa (Aldomet) to control blood pressure Recommended care for women diagnosed with preeclampsia includes bed rest with bath- room privileges, weight and BP monitoring, and closely following urine protein and serum protein, creatinine, and platelet counts. Oral medications are not used as first-line treatment.

Which of the following is most likely to cause delirium? A) Dehydration B) Multiple brain infarcts C) Malnutrition D) Acute infection

D) Acute infection Delirium is an acute decline in mental status and is temporary. Common causes are fever, shock, drugs, alcohol, severe dehydration, and acute infection.

Carol M. is a 40-year-old bank teller who has recently been diagnosed with obsessive-compulsive disorder by her therapist. Her symptoms would include: A) Ritualistic behaviors that the patient feels compelled to repeat B) Attempts to ignore or suppress the repetitive behaviors, which increase anxiety C) Frequent intrusive and repetitive thoughts and impulses D) All of the above

D) All of the above Signs and symptoms of obsessive-compulsive disorder include ritualistic behaviors that are repeated, increased anxiety with attempting to ignore repetitive behaviors, and frequent intrusive and repetitive thoughts and impulses.

All of the following are infections that affect mostly the labia and vagina except: A) Bacterial vaginosis B) Candidiasis C) Trichomoniasis D) Chlamydia trachomatis

D) Chlamydia trachomatis Infections that commonly affect the labia and vagina include bacterial vaginosis, candidiasis, and trichomoniasis. Chlamydia trachomatis commonly affects the cervix, endometrial lining , fallopian tubes, and pelvic cavity.

All of the following are true statements regarding elder abuse except: A) Those aged 80 years or older are at the highest risk for abuse B) A delay in medical care is a common finding C) A new onset of an STD in an elderly patient may signal sexual abuse D) Decreased anxiety and depression are common symptoms of abuse in the elderly

D) Decreased anxiety and depression are common symptoms of abuse in the elderly Elder abuse is commonly seen in elderly patients over the age of 80 years. Common signs/symptoms include anxiety and depression. A new onset of an STD may indicate signs of sexual abuse. These patients will commonly delay treatment for acute/chronic conditions.

A 21-year-old woman complains of left-sided pelvic pain accompanied by dyspareunia. During the gynecological exam, the nurse practitioner notices green cervical discharge. The patient mentions a new onset of a painful and swollen left knee and denies a history of trauma. This best describes: A) Septic arthritis B) Reiter's syndrome C) Chondromalacia of the patella D) Disseminated gonorrheal infection

D) Disseminated gonorrheal infection Symptoms of PID with painful, swollen joints of extremities indicate disseminated gonorrheal infection. Untreated disseminated gonorrhea can lead to septic arthritis. Symptoms may be mild from slight joint pain and no fever to severe joint pain with high fever. PID symptoms do not occur with septic arthritis, Reiter's syndrome, or chondromalacia of the patella.

A postmenopausal female complains of random episodes of vaginal bleeding for the past 6 months. Which of the following is recommended management for this condition? A) Cervical biopsy B) Pap smear C) Colposcopy D) Endometrial biopsy

D) Endometrial biopsy Random episodes of vaginal bleeding in a postmenopausal woman are not normal. Endometrial biopsy is needed to biopsy the endometrial lining for abnormal cells, which may indicate cancer.

All of the following are considered risk factors for UTIs in women except: A) Diabetes mellitus B) Diaphragms and spermicide use C) Pregnancy D) Intrauterine device

D) Intrauterine device Risk factors for UTIs include diabetes mellitus, pregnancy, and use of diaphragms and spermicide.

The following are acceptable methods of birth control for breastfeeding mothers except: A) Diaphragm with spermicidal gel B) Progesterone-only pills (Micronor) C) Condoms D) Low-dose oral contraceptives with at least 20 mcg of estradiol (Alesse, Lo-estrin)

D) Low-dose oral contraceptives with at least 20 mcg of estradiol (Alesse, Lo-estrin) Low-dose oral contraceptives that contain estradiol are contraindi- cated for breastfeeding mothers.

All of the following are considered Category X drugs except :A) Misoprostol (Cytotec) B) Isotretinoin (Accutane) C) Finasteride (Proscar) D) Meperidine (Demerol)

D) Meperidine (Demerol) is in drug Category C and and treated by the FDA as a controlled drug Schedule II.

Women with a history of pelvic inflammatory disease (PID) have an increased risk for all of the following complications except: A) Ectopic pregnancy B) Scarring of the fallopian tube(s) C) Infertility D) Ovarian cysts

D) Ovarian cysts Women with a history of pelvic inflammatory disease (PID) have a higher risk of ectopic pregnancy, scarring of the fallopian tubes, and infertility due to the scarring and trauma caused by the pelvic inflammation.

An Rh-negative pregnant woman with negative rubella titers should be vaccinated at what time period in pregnancy? A) She can be vaccinated at any time in her pregnancy B) During the second trimester C) During the third trimester D) During the postpartum period

D)During the post partum period Rubella should be administered to the woman during the postpartum period. Rubella is contraindicated during pregnancy.

A 20-year-old woman visiting the clinic says that she wishes to begin using depot medroxyprogesterone acetate (Depo-Provera) as a form of birth control. What important information should the nurse include when teaching the client about Depo-Provera? A. Depo-Provera offers protection against the herpes simplex virus. B. To continue the contraceptive effects the client will need to return for another injection in 6 months. C. Women using Depo-Provera may lose more blood each month with their periods, so it is important to add iron-rich foods to the diet to help prevent anemia. D. Calcium intake and exercise should be increased because of possible loss of bone mineral density with increasing duration of use

D. Calcium intake and exercise should be increased because of possible loss of bone mineral density with increasing duration of use

Which of these patients needs a cervical cancer screening? A. Lisa, a 45-year-old patient who has atypical squamous cells of uncertain significance (ASCUS) and a human papillomavirus (HPV) positive Pap 1 month ago B. April, a 26-year-old patient who had a negative Pap with negative HPV 1 year ago C. Sondra, a 66-year-old patient who had a negative Pap with negative HPV 11 years, 6 years, and 1 year ago D. Gillian, a 33-year-old patient who had a negative Pap with negative HPV 5 years ago

D. Gillian, a 33-year-old patient who had a negative Pap with negative HPV 5 years ago

A 60-year-old woman is seen for an annual checkup. Her obstetric history reveals para 6, gravida 6. She reports that she went through menopause at age 45. Her grandmother died at age 80 of colon cancer, and her father died of lung cancer. What in her history would be a risk factor for ovarian cancer? A. Her numerous pregnancies B. Her age at menopause C. Her father's history of lung cancer D. Her grandmother's history of colon cancer

D. Her grandmother's history of colon cancer

A 26-year-old woman tells the clinician that she has endometriosis, because she has frequent pelvic pain. The clinician also should consider which of these differential diagnoses? A. Diverticulitis B. Cholelithiasis C. Kidney stones D. Ovarian cysts

D. Ovarian cysts

A 45-year-old woman is seen in the clinic with abnormal uterine bleeding and pain during intercourse. The clinician should consider which of the following diagnoses? A. Postmenopausal syndrome B. Infertility C. Mittelschmerz D. Polyp

D. Polyp

Which of the following medications is an oral estrogen product for women with menopause? A. Provera 2.5 mg B. Estrace 0.01% C. Alora 0.025 mg D. Premarin 0.3 mg

D. Premarin 0.3 mg

A 47-year-old woman presents with complaints of pain with intercourse, intense itching "down there," and states "it looks different down there." She denies bleeding, foul odor. Which of the following diagnoses should the clinician consider most likely? A. Atrophic vaginitis B. Trichomoniasis C. Candidiasis D. Vulvar lichen sclerosus

D. Vulvar lichen sclerosus

Syphilis treatment

Penicillin G

6. A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate? a. "It is probably just a cyst because that is the most common breast mass." b. "We will order a mammogram and ultrasound to help establish a diagnosis." c. "We will go ahead and schedule you for a biopsy because that is the only way to know for sure." d. "Because your lump is painful, it is most likely not cancer."

b. "We will order a mammogram and ultrasound to help establish a diagnosis."

A 45-year-old woman is seen in the clinic with complaints of a vaginal discharge. The clinician identifies clue cells on the vaginal smear. Which of the following diagnoses is associated with this finding?a. Trichomonas b. Bacterial vaginosis c. HPV d. Herpes simplex virus

b. Bacterial vaginosis

A 58-year-old woman, who had a total abdominal hysterectomy at the age of 45, is diagnosed with atrophic vaginitis. Which of the following is the most appropriate treatment? a. Conjugated estrogen, 0.625 mg/day oral b. Estradiol, 7.5 mcg/24 hr vaginal ring c. Medroxyprogesterone, 10 mg/day oral d. Conjugated estrogen, 0.3 mg +medroxyprogesterone 1.5 mg/day oral

b. Estradiol, 7.5 mcg/24 hr vaginal ring

3. A 24-year-old woman presents to the clinic with dysuria, dyspareunia, anda mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease has she most probably been exposed to? a. Gonorrhea b. HPV c. Chlamydia d. Trichomonas

c. Chlamydia