NSG 6430 Midterm Women's gynecological health

Document Content and Description Below

NSG 6430 Midterm Women's gynecological health Midterm Womens gynecological health  Menstrual Cycle Physiology (from Chapter 5)  Menstrual phase - endometrium becomes very thin d/t low estroge... n levels - Hypophysis secretes more FSH - FSH stimulates secretion of estrogen and estrogen serves as proliferation signal to the endometrial basal layer - Follicular phase - Follicles secrete as they mature, increasing amts of estrogen which thickens the new functional layer of endometrium in uterus -simulates crypts in cervix to produce fertile cervical mucus -end of phase= ovulation  Menstrual Cycle Pain and Premenstrual Conditions - Dysmenorrhea- originates from uterine cx during menstrual phase, triggers prostaglandin production and release. This increases contraction of uterus, reduces uterine blood flow, and causes ischemia/pain  Risk factors- age <30, smoking, bmi <20, early menarche, hx pelvic surgery, depression  Primary- 6-12 months after menarche, continues 8-72 hours into cycle  Secondary- caused by pelvic pathology, pain increases over time, occurs before, during, and after menses  Adenomysis, IBS, endometriosis, leiomyoma, interstitial cystitis - #1 cause of secondary dysmenorrhea is endometriosis- it causes tissue to attach to surrounding organs and breaks off and bleeds. Patients can also have constipation, diarrhea, and bloating. 1. Which uterine positions is most associated with dysparenunia and dysmenorrhea - Retroverted and retroflexed 2. Post coital bleeding - Atrophic vaginitis 3. PMS occurs with greatest frequency and severity in - Late luteal phase 4. Which layer of the ovaries contains lymphatics and blood vessels - Central medulla  Normal and Abnormal Uterine Bleeding - Structural  P- Polyps- deep bright red growths, bleed easily  A- Adenomyosis- occurs in multiparous, over age 40, occurs with tamoxifen use  L- Leiomyoma- fibroids- leading indication for hysterectomy  M- Malignancy- hyperplasia - Non-structural  C- Coagulopathy- von willebrands disease (easy bruising, bleeds heavy) O- Ovulatory dysfunction- anovulation (occurs with pregnancy, bmi<18, lactation, excessive exercise, perimenopause, pcos, thyroid/pituitary issues)  E- Endometrial- predictive, cyclic manner, can also be caused by chlamydia/gonorrhea  I- Iatrogenic- example- mirena, skyla, SSRIs  N- Not yet classified  Women’s Health from a Feminist Perspective - Characteristics of a feminist perspective include the use of critical analysis to question assumptions about societal expectations and the value of various roles on both sociopolitical and individual levels  Women’s Growth and Development Across the Lifespan 1. Lobar growth and alveolar budding of the breast is directly stimulated by - Progesterone  Using Evidence to Support Clinical Practice  Health Promotion - Primary  Prevention of disease - Secondary  Early detection - Tertiary  Limit disability and promote rehab - Recommended topics for health promotion according to USPSTF  Alcohol use  Breastfeeding  Diet/exercise  STIs  Skin cancer  Tobacco use  Gynecologic Anatomy and Physiology 1. Procidentia describes uterine descent beyond the - Vulva 2. In characterizing the degree of prolapse, a situation where the leading part of the prolapse is more than 1cm beyond the hymen but less than or equal to the toal vaginal length is defined as - Stage 3 3. First sign of virilization is - Enlargement of the clitoris 4. Which muscle is considered to be the most critical component of pelvic support- Levator ani muscle 5. The bartholins glands are located at - 4 and 8 o clock 6. What is responsible for regulating gynecologic organ activities - FSH AND LH 7. The proliferative, secretory and menstrual phases make up - Endometrial cycle  Gynecologic History and Physical Examination 1. Which kind of speculum is often most suitable for examination of the nulliparous patient? - Peterson speculum 2. Which speculum is most appropriate for the exam of a parous menstrual woman - Graves 3. Elevating the head of the examining table 30 degrees facilitates the - Observation of the patients responses 4. In the cooperative model, creating an interaction where the patient feels that she being heard and accepted is an illustration of the principle of - Empathy 5. Which of the follow about breast exam is correct - Inspection is done first 6. During bimanual exam of the adnexa in normal premenopausal women, the ovaries are palpable - About half of the time 7. Which uterine configuration is most difficult to assess for size, shape, configuration, and mobility - Retroverted 8. Inquiry concerning adult and child history of sexual abuse and assault should be included in the sexual history - Always even for a new patient 9. A transducer is placed in the vagina to measure intra abdominal pressure as part of - Multichannel urodynamic testing 10. A cystocele may best be demonstrated clinically by - Use of valvsalva maneuver 11. The use of Q tip test is used to evaluate the - Amount of urethral mobility / associated with upward rotation of 30 degrees 12. The situation when the cervix descends below the vulva is termed - Procidentia 13. Cystocele is best defined as - Descent or prolapse of the bladder 14. Breast exams should be done during what phase of the menstrual cycle - Follicular phase 15. Most acute cause of pelvic pain are prob - Salpingo-oophoritis secondary to PID  Periodic Screening and Health Maintenance- Mammograms recommended every 1-2 years in women 40 and older - Pap every 3 years for all women 21-65 - Pap with co testing of HPV every 5 years 30-65 - No pap for women over 65 and who have had a hysterectomy - Clinical breast exam yearly age 20 and older - Bone density for women age 65 and older - Colorectal screening with colonoscopy every 10 and sigmoid every 5 age 50 and older unless African American and they get screened at age 45 / don’t screen for age 85 and older - Fecal occult blood testing every year starting at age 50 -75  Contraception - Progestin only is recommended for high risk patients  Smokers  Hypertension  History of dvts/family history stroke, clots  History of migraines with aura 1. Continuous administration of combo oral contraceptives is effective in treating endometriosis because the treatment - Induces a decidual reaction in the endometrial implants 2. Progesterone component of OCP does what - Decrease LH  Breast Conditions  Types of mastalgia (breast pain)  Cyclic- occurs with menses, poorly localized, outer quadrants, soreness and aching bilateral  Non cyclic- not occurring with menses, constant or intermittent, unilateral, localized, sharp or burning  Chest wall- localized, increased with movement  Nipple discharge -causes: OCPs, antipsychotics, reglan, methadone, verapamil, CCBs, amphetamines, hypothyroidism, stress, stimulation, pregnancy, menstrual cycles, marijuana use, intraductal papilloma, mammary duct ectasia, and pituitary tumors. -pituitary tumors- cause changes in vision and headaches -mammary duct ectasia- causes bilateral sticky green, brown or black discharge (occurs in age >50). - evaluation- order pregnancy test, f negative, order prolactin and tsh. If elevated order an MRI to evaluate for pituitary tumors. 1. Peau d-organge change in the breast is associated with - Edema of the lymphatics 2. A patient with an intraductal papilloma of the breast will most likely present with - Unilateral bloody nipple discharge 3. A patient has an abnormal screening mammogram. The next step should be- Order a diagnostic mammogram 4. The relative risk of developing invasive breast cancer in a woman with fibroadenoma is - 1 5. What is most commonly associated with fibroadenomas - Pain in pregnancy 6. A patient is c/o cyclic breast tenderness and diffuse nodularity on monthly breast exams. Your exam finds multiple firm, mobile masses, predominately in the upper outer quadrants of each breast. You aspirate one of these masses and obtain clear straw colored fluid. What is the best initial action - Mechanical support of breast 7. What is the most common presenting complaint of women with fibrocystic breast change - Bilateral cyclic pain 8. Lobular carcinoma in situ has which of the following characteristics - May lead to cancer in either breast 9. During what age range is a patient most likely to develop mammary duct ectasia - 40-50 10. Which of the following mimics invasive carcinoma in appearance - Complex sclerosing adenosis 11. The pain associated with cyclic mastalgia is best described as - Generally bilateral 12. Collecting ducts arising from breast lobes terminate drain at the - Nipple 13. The advantage of mammogram is that it an - Identify suspicious lesions 2 or more years before they are palpable 14. A 23 year old presented with a 2-3 cm firm, painless, freely movable mass in her left breast. The mass does not change during menstrual cycle and has grown slowly over the last year. What is likely dx - Fibroadenoma 15. A 29 year old c/o breast mass what is your initial modality - Ultrasound - Ultrasound should be ordered for women under 30 and a mammogram for women over age 30 16. Green sticky nipple discharge is associated with - Ductal ectasia 17. Where does lymph from the medial outer area of breast flow - Opposite breast 18. Myomas in 42 year old - Will decrease with withdrawal of estrogen  Infertility 1. In women describing sufficiently frequent sexual encounters, infertility is typically described as a failure to conceive after - 12 months 2. What is the most common cause for infertility in patients with endometriosis- Pelvic scarring - Major female infertility is due to  Ovulatory dysfunction and tubal/peritoneal pathology - Letrozole  First line med for ovulation induction in women who have PCOS  Hyperandrogenic Disorders 1. Constitutional hirsutism is typically treated by admin of - Androgen blockers 2. The signs of cushing syndrome result from excess - Corticosteroid 3. A 28 year old is diagnosed with PCOs and is given oral contraceptive. The treatment is intended to improve symptoms by - Suppression of androgen production 4. PCOs can be viewed as disorder involving - Excess androgen, excess estrogen 5. Women seen in office, on exam has hair growth on her nipples and lower abdomen, temporal thinning. Blood tests show high normal level of free and total testosterone. Most likely cause is - Pcos 6. The most common etiology of hirsutism - Idiopathic hirsutism Pregnancy Congenitial CMV-causes increased chance for MR, cerebral palsy, and hearing loss Parvo virus 5th disease- increased risk for hydrocephalus Toxoplasmosis- increased risk during 1st trimester for hearing loss, neuro delays, and seizures Rubella- risk for miscarriage, still birth, birth defects HSV- risk for Preterm birth, SAB, intrauterine growth, MR, begin antiviral at 36 weeks gestation and consider c sect to prevent transmission Chlamydia- increased risk for ectopic pregnancy, still birth, and premature rupture of membranes (tx with azithromycin) Nutrition during pregnancy - Folic acid- 400mcg per day to reduce neural tube defects, spina bifida, and ancephaly - Food sources of folic acid- leafy greens, eggs, citrus, pasta, cereals, rice Smoking during pregnancy- Increased risk for low birth weight, premature delivery, stillbirth, SIDS Alcohol use during pregnancy - Increased risk for growth problems, fetal alcohol syndrome, and learning disabilities GTPAL- GRAVA, TERM, PRETERM, ABORTION, LIVING Ectopic pregnancy - Adnexal mass/tenderness, bluish discoloration of cervix, culdesac bulge Hydatidiform Mole pregnancy - Abnormal proliferation of placental tissue - Result in development of benign malignant tumor - Partial vs complete - Ultrasound shows snowstorm pattern - Symptoms- passage of grapelike villae, n/v, abd pain, hemoptysis, and shortness of breath 1.embryo becomes biopotential at what week of gestation - 6th Hormone therapy - Premarin- associated with endometrial cx, take for shortest time possible - EPT- increased risk for breast cancer limit to 3-5 years Menopause - 12 consecutive months of no menstrual cycles - FSH no longer recommended - Increased urinary symptoms because bladder is dependent upon estrogen - s/s night sweats, hot flashes, mood swings, insomnia, weight gain, hot flushes, vaginal dryness - menopause occurs earlier in: smokers, undernourished, vegetarians, - menopause occurs later in women who are obese because body fat stores androstenedione which converts to estrogen. - Considered premature menopause is before age 40 - Tx; reduce spicy foods, triggers, hot drinks, caffeine, alcohol, increase activity and water intake - >50 increase calcium to 1200 and vit d to 600 - >70 increase to 800-1000 vit d1. adrostenedione is secreted from - adrenals Osteoporosis - Primary r/t aging - Secondary r/t medications and conditions (corticosteroids, anticonvulsants, mtx), (hyperthyroidism, liver disease, gi malabsorption) - Idiopathic- no cause identified - DEXA- performed on women over 65 - Less -2.5 indicates osteoporosis - Tx- alendronate (fosfamax), risedronate (Actonel), reclast, forteo, prolia - Prevention- calcium 1200mg, vita d 800-1000, weight bearing exercise, fall prevention, tobacco cessation, less than 2 alcoholic drinks per day 1.difference between type 1 and 2 bone loss in osteoporosis - type 1 bone loss results from loss of ovarian fct Infertility - Older than 35 refer to fertility specialist after trying for 6 months - Under 35 1 year of trying to conceive - Spermatogenesis takes 72 days - # 1 cause of fertility issues in women is ovulatory dysfunction  Hyperandrogenic, PCOS - #2 cause is tubal or peritoneal pathology  PID, endometriosis - Other- asherman syndrome- intrauterine adhesions - Metformin and lotrezole for pcos - Clomid for everything else 50mg once daily for 5 days to start on day 3 of cycle - From your course textbook, Adolescent and Young Adult Health Care, read the following chapters:  Health of the World's Adolescents and Young Adults  Psycosocial Development in Normal Adolescents and Young Adults o Two crises during early adulthood? o *development of intimacy versus isolation: entering life partnership with another individual *Ability to become generative versus stagnation  Office Visit, Interview Techniques, and Recommendations To Parents Preventive Health Care for Adolescents and Young Adults  Gynecologic Examination of the Adolescent and Young Adult Female  Normal Menstrual Physiology 1.Precocious puberty starts before age 8  Dysmenorrhea and Premenstrual Disorders  Abnormal Uterine Bleeding  Contraception  Barrier Contraceptives and Spermicides  Contraceptives Pills, Patches, Rings and Injections  Intrauterine Devices and Long-acting Reversible Contraception  Thyroid Function and Disease in Adolescents and Young Adults  Amenorrhea, the Polycystic Ovary Syndrome, and Hirsutism  Breast Disorders and Gynecomastia Terms in this set (113) Cyclic mastalgia is more likely to be caused by? Hormonal changes and Menstrual cycle The possibility of cancer is associated with MASTALGIA when the pain is ______? Accompanied by skin changes & palpable abnormalites What is the 1ST treatment effectve for 85% of mild to moderate SX's of MASTALGIA ? Reassurance What is Mammary Duct Ectasia ? Discharge may be green, brown & black in color If a woman is complaining of bilateral milky nipple discharge, NP should do _____? Perform pregnancy test What are the most common benign breast masses ? Fibroadenoma & Breast Cysts OriginalWhat breast tssue sampling procedure is best used when density/calcifcaton is seen by mammogram in a locaton that cannot be effectvely accessed w/ core biopsy? Localized needle breast biopsy (BX) Regarding Breast Masses among women 55 y/o and older, always presume _____? Always presume mass is MALIGNANT untl proven otherwise A woman's lifetme risk of being diagnosed w/ breast cancer is _____? 1 in 8 (12.5% chance) No risk factors other than age are identfed in what % of women w/ breast cancer? 85% Natonal study with 31,581 respondents found what % of women reported having sexual difculty ? 44% Which of the following statements about androgen supplementaton is FALSE ? FALSE: Correlaton betw. testosterone level & sexual dysfuncton are found consistent among multple studies All the following meds may cause sexual arousal problems EXCEPT ? NOT: SILDENAFIL Management for arousal disorder in women may include all EXCEPT ? NOT: A treatment that increases blood flow to genital tssue In a randomized control trial of women, who used what med, had signifcantly greater mean improvement in desire & arousal domains of the FSFI, compared to women who used placebo ? Zestra, topical formulaton, that contains botanic oils and extracts For women who have never experienced an orgasm, what should the NP do?Draw diagram (give image handout) and describe female genital anatomy to her (Recommend books to read) About 1/2 of all pregnancies in the USA are "Unintended Pregnancies" for women who are in what age group ? Between ages of 18 and 24 Estmates from 2002 NSFG indicate that what % of infants born to never-married women younger than age 45 were placed for adopton between 1996 and 2002 ? 1% When a patent's decision about unintended pregnancy causes an irreconcilable conflict between the NP's personal beliefs & professional responsibilites, the NP should do what? Refer patent to a colleague or a different setng entrely All are alternatves for optonal pregnancy counseling, EXCEPT what ? NOT: Assess need for additonal atenton afer aborton Women who present for pregnancy optons counseling need to know what? Gestatonal age of fetus Most recent data on the tming of aborton indicates what % were performed prior to 13 wks.' gestaton? 88% Of aborton methods used in USA, what are the most common methods in order? Aspiraton, Medicaton, Inducton surgical The World Health Organizaton estmates what number of unsafe abortons took place annually betw. 1993-2003, resultng in enough deaths to render unsafe aborton one of Leading causes maternal mortality? 19 - 20 million deaths due to unsafe abortonsFor women younger than 35 y/o, "infertlity" is defned as failure to achieve a successful pregnancy afer how many months ? 12 months For women older than 35 y/o, the NP will consider infertlity treatment afer 6 mos. of atemptng pregnancy because of ? High risk of pregnancy loss in older women Approximately ____: Fill in the blank: days, hours, minutes or seconds - are required for spermatogenesis, sperm to mature in Epididymis, then travel out of the Vas Deferens during ejaculaton? 72 days Among causes of infertlity in women, all are causes EXCEPT what ? NOT: Endometriosis Fertlity test that transports a radiopaque contrast traveling through the female reproductve system is? Hysterosalpingogram All diagnostc testng & procedures are frequently performed in clinical practce EXCEPT for what ? NOT: Hysterosalpingogram The infertlity evaluaton is a great tme to suggest health-promoton behaviors that make specifc improvements for fertlity, including what ? Reducing alcohol consumpton to 4 drinks/week; losing weight; smoking cessaton What is the form of assisted reproductve technology that requires fertlizaton to occur in a pt.'s Fallopian Tube, instead of a laboratory dish? Gamete IntraFallopian Transfer (GIFT)For women and men with infertlity issues, one opton that involves a sperm or egg donor is called what ? Collaboratve Reproducton Ethical questons that specifcally address pre-implantaton with testng w/ ART had to do with what ? Genetc engineering and the ability to reject embryos affected by inherited disorders What is the major source of vaginal secretons ? Cervical mucosa What is the term for inflammaton of the vagina characterized by an increased vaginal discharge containing numerous WBCs ? Vaginits How is Vaginosis different from Vaginits? Vaginosis discharge does NOT contain WBCs What is the most important step in preventng vaginal infecton? Good hygiene What bacterial infecton does Vaginosis lead to ? Pelvic Inflammatory Disease (PID) Approximately what % of women with bacterial vaginosis (BV) are asymptomatc? 50% What is the common symptom of bacterial vaginosis (BV)? Fishy odor Which organism causes 90% of vulvovaginal candidiasis episodes in women? Candida albicans What is the most common SX of vulvovaginal candidiasis?Itching Why is it more difcult to detect STI's in women than men ? Female anatomy is more difcult to examine With more than 100 known genotypes of HPV, approximately how many can affect the genital tract ? 40% Routne HPV vaccinaton is recommend for girls of what age ? Females 11 - 12 y/o Inital or primary genital herpes infectons usually last how long ? 3 weeks How does a systemic antviral drug treat general Herpes Virus ? By controlling its symptoms Which of the following is caused by anaerobic protozoa that commonly live in the vagina? Trichomonas The second most commonly reported STI afer chlamydia is what ? Gonorrhea What is the most common UTI that affects women? Acute Bacterial Cystts Uncomplicated acute bacterial cystts occurs in women who _____ ? Have NO signs of urinary tract infecton (UTI) What distnguishes Pyelonephrits from Cystts? In Pyelonephrits: infecton has ascended to the kidneys Inexpensive screening tool to confrm UTI Dx, if history is ambiguous, is what ?Why should symptoms, such as bloatng and breast tenderness, NOT be considered as part of premenstrual disorder symptoms ? Because most women naturally have bloatng and breast tenderness How is Secondary Dysmenorrhea defned ? Underlying pathology causing painful cramps w/ menses Which of following is the diagnostc label listed in the DSM menu for PMS depression ? Premenstrual Dysphoric Disorder Which diagnosis is the key criteria to diagnosis PMS ? A cluster of mild to moderate physical & psychological SX's that occur during the late Luteal Phase of menses, resolving with menstruaton; SEVERITY of SX's differentates PMS from PMDD. (p. 558-559) What is the best defniton of Abnormal Uterine Bleeding (AUB) ? Irregular bleeding in amount & frequency What is a good frst queston to ask a woman who presents w/ concerns about abnormal bleeding ? What is the normal patern for you? For women of reproductve age, what is the most common cause of a bleeding patern that is suddenly different ? Complicatons of pregnancy Progesterone break-through bleeding is seen in women who ______ ? Use progesterone-only contracepton Signs of endometrial or cervical cancer may present with abnormal bleeding described as what ? Heavy, prolonged bleeding, or menometrorrhagiaExercise reduces Amenorrhea due to low body fat and decreases secreton of what ? GNRH When is a pelvic exam unnecessary for a woman who is experiencing abnormal uterine bleeding ? "When pt. is an Adolescent, ... not sexually actve, has only recently begun menstruatng, & has a normal Hematocrit = a pelvic exam is most likely UNNECESSARY." (p. 586) On which hormone is Ovulaton dependent? LH surge What is the preferred routne manual examinaton for Pap smear? External inspecton, Palpaton, Speculum, Bimanual examinaton Best predictor of developing Osteoporosis (OP) ? People who have low body weight Emergency Contraceptve Pills (Plan B, "morning-afer pill") can do what ? Stop Fertlizaton Primary side effect of Estrogen Therapy? Breast Cancer Most common site of Metastatc spread of Invasive Breast CA includes ALL of following, EXCEPT ? NOT: Does NOT go to the Pituitary Gland What is the most common cause of Female Infertlity ? Ovulatory Dysfuncton What has helped decrease incidence of Hep. B over past 20 years ? Hepatts B vaccine Common type of UTI in women ?Acute Bacterial Cystts What dietary supplement helps with PMS ? Calcium Which CA has the highest mortality rate of all Gynecological Cancers ? Ovarian Cancer Why are the majority of Ovarian CA cases diagnosed when the disease is already at advanced stages ? Because of vague symptoms What factor may actually increase the risk for developing Ovarian Cancer ? Not giving Birth What is the most common cause of chronic Pelvic Pain ? IBS Pelvic pain in adolescents is usually due to ? Gynecological problems Uterine Fundal Height usually reaches the Umbilicus at how many weeks' gestaton ? 20 Weeks During pregnancy, blood volume increases 30-50 % and peaks at what gestaton ? 30-34 Weeks Early pregnancy loss is due to what ? Embryo chromosomal abnormalites What is the leading cause of 1ST Trimester maternal death ? Ectopic PregnancyWhat newer, common prenatal care model shows women having the 1ST OB visit with their provider & next with a group of pregnant patents & group facilitator ? "CenteringPregnancy", developed by Sharon Schindler Rising (CNM): a OB facilitator meets w/ group of 8-12 women monthly untl the last few weeks of pregnancy, then OB/GYN MD covers fnal visits. Which parasite may be transmited from animals to women ? Toxoplasmosis How is Chlamydia transmited from mother to baby ? During delivery from infected cervix Name the color of vaginal discharge lighter than red ? SEROSA TRUE or FALSE: Post-menopausal women cannot produce estrogen ? FALSE: post-menopausal women may produce Estrogen Why do adolescents have the highest risk of developing HPV ? Immunity is weaker What hormone helps with Mood Disorders of PMS ? Estrogen & Progesterone, Combined Oral Contraceptves are widely used to treat mood disorders of PMS; & also SSRI's for treatment (p. 568) TRUE or FALSE: Hormonal replacement is considered safe for all women ? FALSE: hormone replacement is NOT safe for all women Treatment, although not curatve, is critcal for the best outcome possible. One important principle of antretroviral therapy is: Therapy should be started when symptoms first appear. Monotherapy is recommended. Response to drug therapy is monitored by HIV RNA levels. Response to drug therapy is monitored with CD4+ counts. Response to drug therapy is monitored by HIV RNA levels.The HIV is positive, and the chest X-ray reflects bilateral infiltrates. The radiologist telephones you with a diagnosis of pneumonia. Further evaluation and report are sent to you with a diagnosis of pneumocystis pneumonia. What stage is this HIV presentation? Acute HIV infection Early-stage infection AIDS Symptomatic but likely to begin a latency period AIDS Women often tend to reschedule a well-woman visit, but they don't do so often with a problem such as pelvic pain. This symptom can present as an acute, or chronic, insult. When a woman presents with pelvic pain, the term can encompass many possibilities. Differentiating acute from chronic assists with narrowing down the possibilities but nonetheless can originate from more than one system as a referred pain or discomfort. The focus here will be of reproductive/pelvic origin. As you know, the most common cause of pelvic pain can be noted as endometriosis. But you also know that the most acute causes of pelvic pain are probably: Vertical transmission from a mother to her baby, blood transfusion, or exchange of any blood products Question : HIV risk factors are all of these except: Unprotected sex or trauma with sexual activity or multiple partners IV drug use, including shared syringes Exchange of saliva Exchange of saliva Whether you order diagnostic testing or refer the patient to an HIV-specific facility, laboratory confirmation for documentation for appropriate care rendered. The test confirming HIV infection is _____________. HIV-1/2 Ag/Ab combination immunoassay enzyme-linked immunosorbent HIV RNA CD4+ lymphocyte count quantitative plasma HIV RNA HIV-1/2 Ag/Ab combination immunoassay Treatment, although not curative, is critical for the best outcome possible. One important principle of antiretroviral therapy is: Therapy should be started when symptoms first appear. Monotherapy is recommended. Response to drug therapy is monitored by HIV RNA levels. Response to drug therapy is monitored with CD4+ counts. Response to drug therapy is monitored by HIV RNA levels. The HIV is positive, and the chest X-ray reflects bilateral infiltrates. The radiologist telephones you with a diagnosis of pneumonia. Further evaluation and report are sent to you with a diagnosisof pneumocystis pneumonia. What stage is this HIV presentation? Acute HIV infection Early-stage infection AIDS Symptomatic but likely to begin a latency period AIDS Women often tend to reschedule a well-woman visit, but they don't do so often with a problem such as pelvic pain. This symptom can present as an acute, or chronic, insult. When a woman presents with pelvic pain, the term can encompass many possibilities. Differentiating acute from chronic assists with narrowing down the possibilities but nonetheless can originate from more than one system as a referred pain or discomfort. The focus here will be of reproductive/pelvic origin. As you know, the most common cause of pelvic pain can be noted as endometriosis. But you also know that the most acute causes of pelvic pain are probably: Salpingo-oophoritis (fallopian tube/ovary) secondary to PID Gynecologic malignancy Adhesions Myomata uteri Salpingo-oophoritis (fallopian tube/ovary) A twenty-five-year-old presents with a report of a very tender area just near her introitus and to the left of her perineum. Very painful sex is how she knew "something wasn't right." She showered and when washing, she felt a "pea-sized" painful lump on the left side of her "bottom." She tells you she looked at it with a mirror and it was very small, but now it is the size of a pingpong ball and getting worse. When you inspect her external genitalia, you are amazed at the size and appearance of the "lump." You note what appears to be an abscess on the left medial side of the labia minora, and there is some edema extending into the perineum. Your diagnosis for this presentation is: Lipoma Dermoid cyst Bartholin's cyst Skene's duct cyst Bartholin's cyst Bartholin's Cyst If a Bartholin duct gets blocked, fluid builds up in the gland. The blocked gland is called a Bartholin gland cyst You explain to this young woman what this "lump" is and let her know you will be referring her to a gynecologist you consult with regularly. You explain to her the likely treatment as follows: She will need to take sitz baths three times per day and a broad-spectrum antibiotic. This is likely a fatty tumor and will need to be surgically removed. A possible incision might be necessary and a catheter placed for two to four weeks to allow for drainage and appropriate healing.This is a folliculitis that has become infected and needs a needle aspiration and broad-spectrum antibiotic treatment. A possible incision might be necessary and a catheter placed for two to four weeks to allow for drainage and appropriate healing. You are at the office and a thirty-year-old woman presents with an abrupt onset of pain when attempting to urinate. She is also complaining of frequency and urgency and thinks she may have seen some blood as well.You take her history and she tells you she had sex three days ago with her long-term significant other, but she realized she left her diaphragm in until today when these symptoms occurred. Her BP is unremarkable, pulse is 90, temperature is 99, no costovertebral angle tenderness (CVAT), and is experiencing slight suprapubic discomfort. You review her urine dip and you note 2+ blood, +nitrates, +leukocyte esterase. You send the urine for a microscopic and culture and sensitivity but your management plan is: Pending the culture and sensitivities, you will treat accordingly. Advise her to drink cranberry juice and you will give her a pain medication. Provide broad spectrum antibiotic while waiting for culture and sensitivity lab to return for specific microbe. Refer to a urologist. Provide broad spectrum antibiotic while waiting for culture and sensitivity lab to return for specific microbe. The diagnosis of stress incontinence can be confirmed by __________. your suspected etiology the woman's symptom history to date urodynamic evaluation pelvic muscle evaluation the woman's symptom history to date Anticholinergic medications are a type of treatment for which type of incontinence? Urge incontinence Stress incontinence Vulvodynia Vestibulitis Urge incontinence Treatment for stress incontinence can include: Student Answer: Pelvic muscle exercises/kegel floor exercises Biofeedback Weight loss if obese All of the above All of the above A well-woman visit for an adolescent should include which of the following?A general health history and physical examination, including a breast examination, pelvic with Pap smear, screening tests, counseling, immunizations, risk factors, and patient concerns A general health history focusing on reproductive and sexual health concerns (menses, gynecologic, and pregnancy related) and psychosocial (family related, peer related, emotional, and physical as well as related to abuse, drug use, and alcohol use) concerns Physical exam, screening tests, and immunizations as indicated by the health history and gynecologic considerations for an external-only inspection of the genitalia Both b and c Both b and c A myriad of influencing factors can affect adolescent women in a positive or negative way. As an advanced practice nurse, you will need to be cognizant of such influences and address them from a health promotion/prevention lens. Today, Marie, a sixteen-year-old woman, arrives for a well-woman visit, hoping to begin birth control since "all her friends are using it." After a thorough history, you note that Marie resides in a community with very high risk factors. These include poverty, violence, and lack of recreational facilities. She tells you that she "hangs out" at a convenience store near the apartment complex she lives at with her mother. "All the group hangs there," she reports proudly. She shares that she has been menstruating for two years now although she has irregular cycles. She also lets you know that she has had coitus only one time and that he "pulled out." She does not want to get pregnant, and this is why she is here today. What is your management plan for Marie today? (Select those that apply.) You will assess all predisposing factors that lead to premarital sex and the negative consequences, tell Marie to be careful, and prescribe birth-control pills. One by one, you will plan to carefully address the risks (red flags) in Marie's history. Your goal will be to clarify and address misconceptions, as well as share valuable sex education in a sensitive, nonjudgmental way. You will let her know you are her advocate and are very protective of her health. Without preaching, you want her to be aware of the negative possibilities of premarital, unprotected sexual activities. You will also share a clear understanding of the risk of STIs with Marie. After processing all of the history Marie has shared, you will write a referral for psychiatric evaluation and tell her she needs ongoing counseling for her behavior at such a young age and she likely needs to learn to cope within her environment (home and community). Your goal is to include healthy sexual-health decision making, including decisions regarding abstinence, birth-control efficacy and choice, and condom use. Depending on the need, you may include a referral to an effective program for teens (for example, a program that deals with STI prevention and or a family-based intervention program if available). CORRECT You will assess all predisposing factors that lead to premarital sex and the negative consequences, tell Marie to be careful, and prescribe birth-control pills. CORRECT One by one, you will plan to carefully address the risks (red flags) in Marie's history. Your goal will be to clarify and address misconceptions, as well as share valuable sex education in a sensitive, nonjudgmental way. You will let her know you are her advocate and are very protective of her health. Without preaching, you want her to be aware of the negative possibilitiesof premarital, unprotected sexual activities. You will also share a clear understanding of the risk of STIs with Marie. CORRECT After processing all of the history Marie has shared, you will write a referral for psychiatric evaluation and tell her she needs ongoing counseling for her behavior at such a young age and she likely needs to learn to cope within her environment (home and community). Abnormal uterine bleeding (AUB) has multiple causes. When a woman presents and reports menstrual irregularity with amenorrhea, which is the most common cause of amenorrhea? Ectopic pregnancy Adenomyosis Coagulopathy Anovulation Anovulation Anovulation when the ovaries do not release an oocyte during a menstrual cycle. Therefore, ovulation does not take place. However, a woman who does not ovulate at each menstrual cycle is not necessarily going through menopause. Chronic anovulation is a common cause of infertility. The most common cause of chronic pelvic pain for women in the prime of their reproductive years is: PID Fibroids Endometriosis Endometritis Endometriosis Polycystic ovaries predispose women to a higher incidence of: Adrenal tumors Ovarian cancer Endometrial cancer Endometriosis Endometrial cancer A definitive diagnosis of endometriosis cannot be made until which of these is completed? CT scan Transvaginal ultrasound Exploratory laparoscopy MRI Exploratory laparoscopy A woman has just stopped birth control pills in efforts to become pregnant. You recall that estrogen withdrawal reflects activity primarily from the _________. hypothalamus uterus ovary pituitary ovary A prescription is being written by the nurse practitioner for birth control pills. When completing patient education, which of the following would be an accurate statement about oral contraceptive use? It is unnecessary to double up on missed pills for combined oral contraception.Oral contraceptives do not provide protection against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). Most women will not notice a change in their periods once they go on the pill. The pill provides added protection against cervical and uterine cancer. Oral contraceptives do not provide protection against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). A twenty-one-year-old woman presents for her initial well-woman examination. She has never been sexually active and has a negative family history for gynecology problems. Personal history is negative for abuse, and she exercises regularly and eats a balanced diet. Menstrual history reveals that she experienced menarche at fourteen years of age, has a regular twenty-eight-day cycle, and denies dysmenorrhea. Which of the following would be included in her physical examination today? Stool for occult blood Baseline mammography Cultures for gonorrhea and chlamydia Pap smear Pap smear Which of the following characteristics is not associated with psychosocial development problems in adolescence? Being different than others or feeling different Late onset of pubertal sexual maturity Sexual identity as GLBTQ Having a disability or chronic health condition Late onset of pubertal sexual maturity During a pelvic exam on a seventy-year-old, the nurse practitioner notices the position of the cervix at the introitus. The diagnosis is most likely _____. cystocele rectocele urethral prolapse uterine prolapse uterine prolapse While participating in a woman's health fair, a parent comes to you with the concern of her daughter participating prematurely in sex. Which of the following factors is strongly associated with early onset of unwanted sexual activity? Dating a partner that is >3 years older than the teen Planning on attending college in the near future Poor academic performance in school Presence of strong religious convictions Dating a partner that is >3 years older than the teen Iris is a thirty-two-year-old married woman with three children. She comes in for information on using the copper T intrauterine device (IUD) for contraception. Which of the following would be a contraindication to using this appliance? Nulliparity Heart diseasePrior ectopic pregnancy History of multiple births Heart disease Cara is in the clinic for what you have diagnosed as dysfunctional uterine bleeding (DUB). She is concerned about why this is happening to her. You recall which of the following is the most common cause of DUB? Endocrine disorders Stress Anovulation Anatomical abnormality Anovulation Anovulation when the ovaries do not release an oocyte during a menstrual cycle. Therefore, ovulation does not take place. However, a woman who does not ovulate at each menstrual cycle is not necessarily going through menopause. Chronic anovulation is a common cause of infertility. You are starting Ella, a twenty-one-year-old, on Ortho Tri-Cyclen, a combined oral contraceptive. Which of the following would not be included in your instructions and advice? Try to take the pill at the same time every day. If you miss one day, double up the next day. You need to use backup protection consistently for the first month to avoid pregnancy. Breakthrough bleeding may occur in the first few cycles. Please do not stop taking the pill due to this. If you are uncomfortable with this, come in for a follow-up appointment to discuss other options. Oral contraceptives offer protection against breast cancer for as long as you are using them. Oral contraceptives offer protection against breast cancer for as long as you are using them. A woman comes to the clinic with the chief complaint of disruption of urine flow. Which of the following is not a risk factor for pelvic floor relaxation? Obesity Menopause Vaginal delivery Cesarean section Cesarean section The nurse practitioner understands that premenstrual syndrome (PMS) occurs with greatest frequency and severity in the ___________. late luteal phase follicular phase proliferative phase ovulatory phase late luteal phase A twenty-one-year-old woman comes into your practice seeking birth control. She has only recently become sexually active and has consistently used condoms for safe sex. Your history reveals that she does not use tampons during her menses and has very little knowledge about female reproductive anatomy. Based on this information, which of the following birth control choices would be least likely to meet her needs for contraceptive management?Combined oral contraceptive (COC) pill Depo-Provera Ortho Evra patch NuvaRing NuvaRing A pregnant client in your practice is experiencing nausea and vomiting in her first trimester. Which of the following would you suggest to alleviate the problem? Avoiding all carbonated beverages, including sodas and seltzer water Eating small meals at frequent intervals, avoiding spicy or fatty foods Avoiding eating the first thing on awakening in the morning Taking additional iron and prenatal vitamins Eating small meals at frequent intervals, avoiding spicy or fatty foods Natasha is an eleven-year-old girl brought to your office for an annual well-child visit. When discussing the onset of puberty with Natasha and her mother, you would emphasize which of the following? Pubic hair develops before breast buds. Breast development delayed beyond twelve years of age may be considered pathological. The average age of menarche is twelve years. It usually takes about three-and-half years to go from breast buds to menarche. The average age of menarche is twelve years. Suzanne, a forty-six-year-old client, reports shortened menstrual cycles for one year. The most likely diagnosis is __________. anovulatory bleeding menopause perimenopause breakthrough bleeding perimenopause Maria, fifty-two years old, comes in for her annual well-woman examination. LMP was fourteen months ago. You would document this as ____________. secondary amenorrhea menopause perimenopause primary ovarian failure menopause Strategies to protect teenagers from risks include all of the following except _________. involving them in community activities for a worthy cause encouraging them to participate in teambuilding sports pairing young adolescents with middle adolescentsinvolving them in school-related activities pairing young adolescents with middle adolescents In caring for a menopausal client who has had a total hysterectomy, the nurse practitioner would include which of the following options? Estrogen alone Estrogen and progestin Progestin and testosterone Testosterone alone Estrogen alone Alicia lived in foster care for several years before being placed in a new city. She is in tenth grade. Which of the following aspects of her life protect her from risk? Her recent move to a new city and school Occasional alcohol use while at parties Friendships with two teen girls who have "been around the foster care system" A female teacher with whom she can talk about her problems A female teacher with whom she can talk about her problems Elizabeth, twenty-four years old, is pregnant, and you are educating her on common problems during the first trimester. Which of the following is abnormal and requires immediate attention? Nausea and vomiting (aka "morning sickness") Fatigue and tiredness Back ache in the lumbar area Vaginal bleeding Vaginal bleeding Beth, a sixty-two-year-old woman, is seen for a follow-up discussion of DEXA scan result of minus 1.5 standard deviation (SD) at the hip. Her PMH includes a recent myocardial infarction and a fractured wrist at fifty-eight years of age. Which of the following would not be an option for her? Continuous conjugated estrogen 0.625 mg and medroxyprogesterone acetate (MPA) 2.5 mg (Prempro) p.o. daily Counseling on smoking cessation and alcohol consumption Ibandronate (Boniva) 150 mg p.o. once monthly in the a.m. Encouraging weight-bearing exercises and increased calcium intake Continuous conjugated estrogen 0.625 mg and medroxyprogesterone acetate (MPA) 2.5 mg (Prempro) p.o. daily A woman has been diagnosed with polycystic ovary syndrome (PCOS). Management of PCOS includes all of the following except ___________. oral contraceptives to establish a regular menstrual cycle a planned program of regular exerciseconsult with dietician for weight management daily basal insulin to reduce blood sugar daily basal insulin to reduce blood sugar A nurse practitioner is educating a woman who has a colposcopy ordered. Which of the following most accurately describes a colposcopy? A procedure that visualizes the vaginal, vulvar, or cervical epithelium with magnification to identify abnormal areas that may need to be biopsied A procedure to visualize the uterine cavity through a small, fiber-optic scope introduced through the cervix A procedure to remove a sample of endometrial tissue with a curette or an aspiration tool for biopsy A procedure to visualize the abdominal and pelvic cavity by fiber-optic endoscope via a subumbilical incision A procedure that visualizes the vaginal, vulvar, or cervical epithelium with magnification to identify abnormal areas that may need to be biopsied Lakeisha, seventeen years old, is seeing her regular nurse practitioner for a sports physical. While participating in a psychosocial screen, Lakeisha volunteers that she "hasn't had sex yet." What is the best initial response to Lakeisha's statement? Congratulate her for abstaining and move on to another topic. Clarify which behaviors are included in Lakeisha's definition of "having sex." Demonstrate condom use and give Lakeisha some condoms for future partners. Encourage Lakeisha to be screened for STIs. Clarify which behaviors are included in Lakeisha's definition of "having sex." A fourteen-year-old patient is accompanied by her mother, who is concerned about irregular and infrequent periods. Her last menstrual period was two months ago. What would be the initial test performed? Urine HCG Serum beta HCG Hemoglobin and hematocrit Chlamydia culture Urine HCG Lenore, fifty-five years old, comes in for evaluation of a breast mass. Which of the following is not usually linked with carcinoma of the breast? Scaly lesions similar to eczema on one areola and nipple Peau d'orange dimpling of skin over breast Unilateral retraction and deviation of nippleWell-circumscribed, rubbery, and tender lesion Well-circumscribed, rubbery, and tender lesion Frankie is concerned that she has an ultrasound ordered after the results of her mammogram of been reviewed by the nurse practitioner. You emphasize that the primary role of a breast ultrasound is to _____. screen for breast cancer definitively diagnose breast cancer determine if a breast lesion is cystic or solid locate small lesions before surgery determine if a breast lesion is cystic or solid A patient is complaining of a milky nipple discharge. Galactorrhea is usually a finding with which other diagnosis? Cancer Mastalgia Hyperprolactinemia Fibroma Hyperprolactinemia The nurse practitioner is completing a follow-up visit on a woman who was previously prescribed hormonal therapy (HT), which she has not taken for the last month. The primary reason the patient discontinued HT is _________. weight gain vaginal bleeding breast tenderness mood changes vaginal bleeding A nurse practitioner is educating a high school class about sexual education. Teaching should include that protective factors against repeat adolescent pregnancy include all of the following except: Use of effective contraception Participation in specialized adolescent parent program Continued sexual relationship with the same partner Continued school attendance Continued sexual relationship with the same partner A pathology report has been returned on a woman's breast mass malignancy. The most common type of invasive breast cancer is ______________. lobular infiltrating ductal infiltrating papillary medullary infiltrating ductal A college professor is creating a lecture about the prevention and diagnosis of osteoporosis. A point that needs to be included about measures that have no impact on osteoporosis is_____________. educating young women about importance of calcium and nutrition in attaining peak bone mass educating women of all ages to the importance of regular weight-bearing exercise obtaining a DEXA scan on postmenopausal women to assess for osteopenia obtaining a spinal X-ray after a suspected osteoporotic compression fracture obtaining a spinal X-ray after a suspected osteoporotic compression fracture You are seeing twelve-year-old Sonya for a well-adolescent checkup. She is accompanied by her mother who agrees to having you see Sonya alone but wants to talk with you at the end. After examining Sonya and assuring her of confidentiality, you meet with her mother briefly. Sonya's mother states, "I don't know how to say this, but I am so worried that my daughter is homosexual. She spends so much time with her girlfriends, and they are the focus of her entire life." From your understanding of normal adolescent stages and development, how would you respond to her concern? Advise Sonya's mother that same-sex close friendships are normal at this age. Offer to refer Sonya's mother to a counselor who is experienced with gay teens. Caution the mother that you can't disclose any information that Sonya has told you. Explain that Sonya is old enough to decide her own sexual identity and to "let go." Advise Sonya's mother that same-sex close friendships are normal at this age. Anna, twenty-five years old, presents with dysmenorrhea. She states that her sister and mother have endometriosis; so she would like to be evaluated for it. Which if the following is consistent with a diagnosis of endometriosis? Erythema and edema of the vulva Postcoital bleeding with malodorous discharge Pelvic pain and dyspareunia Frequent diarrhea and amenorrhea Pelvic pain and dyspareunia A thirty-three-year-old woman presents to your clinic complaining of a dark brown, watery vaginal discharge and postcoital bleeding. There is a strong history of multiple unprotected sexual encounters. She has not been immunized for human papillomavirus (HPV). Which of the following examination findings would be suspicious for cervical cancer? Lymphadenopathy of the femoral area A soft, pink cervix with no ulcerations An anteverted cervix with lateral displacement A very firm cervix with an ulcer A very firm cervix with an ulcer Abby, twenty years old, presents with pelvic pain. Which of the following is not a first-line diagnostic test for evaluation of pelvic pain? Pregnancy test CBC with differentialCT of pelvis Urinalysis CT of pelvis A woman presents to the office seeking the birth control measure that is 100% effective. When counseling a woman on effectiveness of these methods, which of the following fulfills this requirement? Implanon Combined oral contraceptive Abstinence Intrauterine device (IUD) Abstinence Lauren, twenty-three years old, presents to your office with a complaint of severe menstrual cramps for four months since she quit using an oral contraceptive. Your tentative diagnosis is primary dysmenorrhea. What would be the first-line treatment for this condition? Acetaminophen Naproxen Ergotamine Elavil Naproxen The nurse practitioner is prescribing an oral contraception to Sally. She is concerned about having one that has "two hormones" as the active ingredients. You instruct her that adding progestin to estrogen therapy will decrease the risk of ___________. breast cancer withdrawal bleeding endometrial cancer osteoporosis endometrial cancer The National Osteoporosis Foundation has screening guidelines for DEXA scans. Which of the following women would be most in need of bone mineral density testing? A fifty-four-year-old postmenopausal woman receiving hormone replacement therapy (HRT) A fifty-year-old woman who is having irregular menstrual cycles A fifty-one-year-old woman with systemic lupus erythematosus (SLE) on long-term corticosteroid therapy A forty-nine-year-old Caucasian woman who smokes and has an excessive alcohol intake A fifty-one-year-old woman with systemic lupus erythematosus (SLE) on long-term corticosteroid therapy A Pap smear result of atypical squamous cells of undetermined significance—rule out high-grade squamous intraepithelial lesion (ASCUS r/o HGSIL) will require which procedure next? Cold knife cone (CKC) Follow-up Pap smear Colposcopy Loop electro-excision procedure (LEEP) ColposcopyYou are meeting with twenty-two-year-old Emily to discuss birth control options. She has tried "the pill" in the past but failed to take it regularly. She is interested in depo because she only has to come in every three months for a shot. She also heard that one does not get a period on depo, and she likes the thought of that. Which of the following would be a specific consideration with depo that you would need to discuss? Depo offers no protection from STIs. Depo depletes skeletal mass, so it is necessary to take calcium supplements. As with any hormonal birth control, changes in weight can occur. Depo does not offer pregnancy protection for those who are obese. Depo depletes skeletal mass, so it is necessary to take calcium supplements. Mitzi, a twenty-three-year-old, is here for her well-woman checkup. She asks about douching. Which of the following statements about douching is true? Douching is a reliable contraceptive method. Douching may increase the risk of infection and ectopic pregnancy. Douching effectively prevents sperm from entering the uterus. Douching should be used after intercourse and after menses. Douching may increase the risk of infection and ectopic pregnancy. You are completing a pelvic exam on thirty-two-year-old Nancy. You detect a left adnexal mass on the bimanual exam. With an adnexal mass, the practitioner must always suspect ________ until proven otherwise. Pelvic inflammatory disease (PID) Malignancy Pregnancy Polycystic ovary disease Malignancy Which of the following is true regarding education of a forty-two-year-old woman diagnosed with uterine myoma? Myomas usually resolve with menopause. Myomas will become larger with the withdrawal of estrogen. Hysterectomy is the treatment of choice. Myomas are never responsible for uterine bleeding. Myomas usually resolve with menopause. Myomas A myoma, commonly known as a fibroid, is a benign (noncancerous) tumor that develops in or around the uterus. You are interviewing a teen with suspected substance abuse. Which of the following screening tools would give you the most specific information regarding substance abuse in teens?GAPS CAGE CRAFFT HEADSS CRAFFT What does CRAFFT stand for CRAFFT stands for the key words of the 6 items in the second section of the assessment - Car, Relax, Alone, Forget, Friends, Trouble. Elisabeth comes for a consultation. She has been in a committed relationship for five years now and wants to become pregnant. She is seeking information on the menstrual cycle and her "fertile period." Her cycle is twenty-eight days and regular. She and her partner have used condoms consistently to avoid pregnancy. Which of the following would be most valuable to her initially The viability period for sperm is twenty-four hours. Ovulation occurs on day 14 +/- 2 days, before the next period. Taking her temperature daily will tell her when she is fertile. Cervical mucus evaluation can be used to determine fertility. Ovulation occurs on day 14 +/- 2 days, before the next period. Jackie is a fifteen-year-old African American female who resides in a housing plan. You realize that barriers exist in providing preventive services to adolescents that include all of the following except: Reluctance of adolescents to seek care Concept that adolescents are "healthy" and don't need services Concerns about lack of confidentiality Availability of guidelines for preventive care Availability of guidelines for preventive care Lab results on your twenty-six-year-old patient show a negative Pap smear with a positive human papillomavirus (HPV) screen. Which procedure will be required next? Repeat Pap and HPV screen Colposcopy Cold knife cone (CKC) Loop electro-excision procedure (LEEP) Repeat Pap and HPV screen Malignant ovarian masses are very uncommon in young women. Which of the following information would be least helpful in the assessment, diagnosis, or management of pelvic malignancies in young women? Malignant germ cell tumors are the most common ovarian tumors in young women.Mutations in the breast cancer gene-1 (BRCA-1) are responsible for a small percentage of ovarian cancers in women. Oral contraceptives are effective in minimizing the risks of functional ovarian masses. The most common metastatic ovarian lesions in young women are lymphomas and leukemias. Mutations in the breast cancer gene-1 (BRCA-1) are responsible for a small percentage of ovarian cancers in women. During puberty, linear growth is determined by the amount of growth hormone (GH) and the feedback loop. Which of the following patterns describes the release of GH in patients in puberty? Rapid secretion of GH with activity Pulsatile release in the morning GH release that increases at rest Pulsatile release at the onset of slow wave sleep Pulsatile release at the onset of slow wave sleep A thirty-two-year-old patient comes in for a workup of infertility. During the history, the nurse practitioner suspects that the patient may be experiencing anovulatory cycles. In order to confirm ovulation, which of the following tests would be most appropriate to order? Endometrial biopsy Basal body temperature Hysterosalpingogram Postcoital testing Basal body temperature A twenty-five-year-old female presents with vaginal irritation and discharge. On examination, the cervix is easily friable and erythematous. There is no adnexal tenderness. The wet prep microscopic examination reveals mobile protozoa on the normal saline slide. This most likely represents _________. trichomonas mucopurulent cervicitis bacterial vaginosis gonorrhea trichomonas A nurse practitioner is caring for a woman with primary and secondary amenorrhea. The pelvic exam was normal. Which of the following may be the cause if etiology originates in the hypothalamus? Sheehan's syndrome Ovarian failureThyroid dysfunction Asherman's syndrome Sheehan's syndrome Sheehan's syndrome postpartum hypopituitarism or postpartum pituitary gland necrosis, is hypopituitarism (decreased functioning of the pituitary gland), caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth. The Tanner scale of sexual maturity rating allows for accurate classification of physical pubertal maturation. During the examination of your patient, you notice that the pubic hair is increased in quantity, is darker, and is present in the typical female triangle but in a smaller quantity. Which of the following Tanner stages does this description meet? Tanner stage I Tanner stage II Tanner stage III Tanner stage IV Tanner stage III The onset and duration of puberty varies greatly from patient to patient and is also dependent upon race. Which of the following phrases can you expect to have the earlier onset of puberty in boys? African American boys Native American boys Caucasian boys Hispanic boys African American boys A woman is experiencing symptoms after initial estrogen withdrawal. Which of the following would not be one of those? Vaginal dryness Hot flashes Sleep disturbances Breast tenderness Breast tenderness A couple is presenting for a first trimester pregnancy exam. They are curious about the sex of the baby. You recall that the human embryo becomes bipotential at what week of gestation? Sixth Tenth Twelfth Eighth Eighth A patient has symptoms consistent with Chlamydia. Which laboratory test would aid in the diagnosis? Detecting the presence of inflammatory cells on a Pap smearTissue examination using direct fluorescent antibody Culture and sensitivity Wet prep with potassium hydroxide (KOH) assessing for positive "whiff" test Culture and sensitivity Bodily image concerns can be a major problem during the adolescent years. Which of the following psychosocial developmental phases of adolescence represents a period of greatest concern over bodily image? Middle adolescence Late adolescence Preadolescence Early adolescence Early adolescence Which of the following is an approved treatment for premenstrual dysphoric disorder (PMDD)? Amitriptyline (Elavil) Spironolactone (Aldactone) Drospirenone/ethinyl estradiol/levomefolate calcium (Beyaz) Conjugated estrogen (Premarin) Drospirenone/ethinyl estradiol/levomefolate calcium (Beyaz) A patient who a nurse practitioner is seeing for the first time has the past medical history of primary dysmenorrhea. She recalls that which of the following is considered as the primary etiology? Ovarian cysts Prostaglandin production Endometriosis Adenomyosis Prostaglandin production A nurse practitioner is reviewing the chart of a woman who has findings consistent with polycystic ovary syndrome (PCOS).The diagnostic criteria for PCOS include all of the following except: irregular menstrual cycles hyperandrogenism infertility male pattern baldness male pattern baldness A fifty-five-year-old postmenopausal female patient presents with pain in the upper outer quadrant of her left breast for over one month now. The best course of action would be to_______. reassure the patient that pain is often not a presenting symptom of breast cancer teach the patient breast self-examination order laboratory studies as most likely this is secondary to a hormonal fluctuation perform a breast examination and order a mammogram perform a breast examination and order a mammogram A fifteen-year-old patient who presents with symptoms consistent with premenstrual syndrome (PMS) is concerned that she may have ovarian cancer. Your best advice to this patient is that PMS is typically caused by which of the following? Polycystic ovarian disease Pituitary tumor Genetic, psychosocial, and hormonal fluctuations Psychosocial issues and sleep disturbance Genetic, psychosocial, and hormonal fluctuations A fifty-five-year-old woman presents to the clinic for evaluation of a breast mass. Which of the following is not a typical presenting sign of breast cancer? Engorgement of one areola and nipple Dimpling of skin over breast Unilateral retraction and deviation of nipple A 2 cm, rubbery, tender lesion A 2 cm, rubbery, tender lesion A patient has been diagnosed with interstitial cystitis. The nurse practitioner remembers that this is best defined as _____. the recurrence of lower urinary tract infections with bacterium A noninfectious disorder of the urinary bladder histologic changes of the urinary bladder lining an acute, inflammatory urinary bladder disorder A noninfectious disorder of the urinary bladder You are examining a twenty-nine-year-old female with a three day history of dysuria and urinary frequency. On examination, the patient has mild abdominal pain with palpation in the umbilical area without rebound tenderness. Her test for cerebrovascular accident tenderness is negative. This most likely represents which of the following? PyelonephritisInterstitial cystitis Ectopic pregnancy Ascending urinary tract infection Ascending urinary tract infection You are completing a well visit on a fourteen-year-old female who is currently not menstruating. Primary amenorrhea is best described as ________. cessation of menstruation for six months failure of menstruation to occur by age fifteen failure of menstruation to occur by age thirteen cessation of menstruation for six months after menarche failure of menstruation to occur by age fifteen A thirty-five-year-old female presents for her normal annual examination and complains of recent changes in her breasts. She reports that they feel tender and "lumpy" during certain times of the month. As a result, she does not perform self-breast examination as she had been doing in the past. Which of the following statements would offer the best advice to this patient? Order a mammogram to establish baseline data. Recommend that she perform a self-breast examination every two months. Determine the time of the month when her breasts are tender and recommend a change to her breast self-examination schedule. Stress the importance of breast self-examination to detect unusual lumps. Determine the time of the month when her breasts are tender and recommend a change to her breast self-examination schedule. A twenty-one-year-old female presents to the practice with the chief complaint of a breast mass. Considering the differential diagnoses, the most common cause of the mass in this age group is ____. intraductal papilloma fibroadenoma fibrocystic breast disease lobular carcinoma fibroadenoma A patient has been diagnosed with trichomoniasis. Which of the following single dose medications would be the best option? Azithromycin 1 gClindamycin 300 mg Ofloxacin 500 mg Metronidazole 2 g Metronidazole 2 g A female patient is concerned about having irregular menstrual bleeding. Which of the following is not a common cause of this problem? Endocrine disorders Stress Anovulation Anatomical abnormality Anovulation A twenty-seven-year old comes in to see you for a consultation. She has been in a committed relationship for five years now and wants to become pregnant. She is seeking information on the menstrual cycle and her "fertile period." Her cycle is every twenty-eight days and is regular; she and her partner have used condoms consistently to avoid pregnancy. Which of the following would be most valuable to her initially? The viability period for sperm is twelve hours Ovulation occurs on day 7 +/- 2 days Taking her temperature at midcycle will tell her when she is fertile Cervical mucus evaluation can be used to determine fertility Taking her temperature at midcycle will tell her when she is fertile A patient is coming to the clinic for a follow-up of some diagnostic testing that she had done. When you review the chart, you find that she now has findings consistent with a diagnosis of polycystic ovary syndrome (PCOS).You recall that PCOS is characterized by which of the following? Menorrhagia Infertility Menometrorrhagia Hypoadrogenism Infertility A nurse practitioner is participating in a women's health fair. When educating the women about risk factors for breast cancer, which of the following statements is incorrect? Pregnancy after age of thirty-five years Late menopause after age of fifty-seven yearsHistory of maternal breast cancer Fibrocystic breast disease Fibrocystic breast disease Fibrocystic breast disease An eighteen-year-old patient presents with secondary amenorrhea. On physical exam, there is normal secondary sex characteristics in addition to the appearance of normal genitalia. Pregnancy has been ruled out through urine human chorionic gonadotropin (HCG). Which of the following signs or symptoms would necessitate further evaluation in this patient? Elevated blood cholesterol levels Androgen deficiency Galactorrhea Hirsutism Galactorrhea A fifty-one-year-old postmenopausal patient presents with renewed onset of vaginal bleeding. She had not menstruated for more than one year. Physical examination, including abdominal and pelvic examination appears grossly normal. Your initial treatment for this patient would include which of the following? Observe the patient and have her return of the bleeding continues Medroxyprogesterone acetate 5 to 10 mg daily to control bleeding Monophasic oral contraceptives for three months and then reassess Referral to a gynecologist for consideration for endometrial biopsy Referral to a gynecologist for consideration for endometrial biopsy It is known that a woman who is menopausal has an increased risk of heart disease. Which of the following lipid changes occur with estrogen withdrawal in menopause? Decrease in HDL, LDL, and triglycerides Decrease in HDL, LDL, and increase in triglycerides Increase in HDL with a decrease in LDL and triglycerides Decrease in HDL with an increase in LDL and triglycerides Decrease in HDL with an increase in LDL and triglycerides The initiation of puberty develops in various phases and is determined by a complex set of hormonal changes. During the prepubertal phase, hormones are secreted into the circulation from the adrenal cortex. Which of the following hormones is not considered an adrenal female androgen? Dehydroepiandrosterone Dehydroepiandrosterone sulfateAndrostenedione Estrogen Estrogen A diagnosis has been formulated on a patient as premenstrual syndrome (PMS). Which of the following medication regimes is the best treatment for the PMS? Vitamin B6, Antiprostaglandins, and Diuretics Calcium, Antidepressants, and Vitamin D Vitamin B6, Calcium, and Acetaminophen Evening Primrose Oil, Ginkgo Biloba, and Antidepressants Vitamin B6, Antiprostaglandins, and Diuretics A forty-year-old female presents with an abnormal menstrual cycle with menorrhagia and intermenstrual bleeding. The nurse practitioner suspects the patient may have dysfunctional uterine bleeding (DUB) and orders tests for follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. Both of these lab values are elevated. What is the most likely cause of DUB in this patient? Onset of climacteric Hypothalamus disorder Anterior pituitary disorder Premature ovarian failure Onset of climacteric A thirty-one-year-old female presents for contraceptive counseling following the birth of their first child. She is interested in using the diaphragm as her method of contraception. Which of the following statements is true regarding the use of this device? The device may be inserted up to twenty-four hours prior to intercourse. The device may be left in place for up to twelve hours. The device may be inserted at any time up to six hours prior to intercourse. The device should be removed within one hour after intercourse. The device may be inserted at any time up to six hours prior to intercourse. A forty-one-year-old patient is currently on griseofulvin for the treatment of onychomycosis. As an advanced practice nurse, you would advise the patient that this medication has the potential for which of the following? Increase estrogen secretion Decrease steroid levels Increase follicle-stimulating hormone (FSH) secretionDecrease progesterone secretion Decrease steroid levels Pelvic pain is a common complaint in young women. Which of the following is not a first-line diagnostic test for evaluation of pelvic pain? Urine human chorionic gonadotropin (HCG) CBC with differential CT of pelvis Pelvic ultrasound CT of pelvis Breast masses are a common finding in adolescents and most typically are benign. Which of the following descriptions of a breast mass most likely represents a benign finding? Bilateral, round, or oval firm mass Unilateral, round mass with hard consistency Bilateral, round, or oval for mass with dimpling of the nipple Multiple unilateral masses with hard consistency found in the axilla Bilateral, round, or oval firm mass Drug interactions are an important consideration when helping a patient decide the appropriate contraceptive method. Anticonvulsant medications may interfere with oral contraception by what mechanism? Decreasing serum steroid levels Decreased hepatic clearance Increased renal tubular absorption Increased serum steroid levels Decreasing serum steroid levels A sixteen-year-old girl who comes to your office with a history of secondary amenorrhea. She experienced menarche at age ten, with regular cycles for two years. She has not menstruated now for four years. In your initial consideration of differential diagnoses, what is the most frequent etiology of this problem? Eating disorder Pregnancy Anovulatory cycles StressEating disorder A nurse practitioner is performing a wet mount with potassium hydroxide (KOH) to assist with a diagnosis in a woman experiencing vaginal discharge. Which of the following would this confirm? Herpes simplex Trichomonas Candidiasis Chlamydia Candidiasis Which of the following statements best describe the difference between type I and type II bone loss in patients with osteoporosis? Type II bone loss involves the trabecular compartment Type II bone loss results from loss of ovarian function Type I bone loss involves the cortical bone Type I bone loss results from loss of ovarian function Type I bone loss results from loss of ovarian function A twenty-five-year-old patient presents with irregular bleeding after being on oral contraceptives for six months. It is important to rule out which of the following? Chlamydial cervicitis Uterine fibroids Endometriosis Anovulation Chlamydial cervicitis A sixty-one-year-old thin, Caucasian female presents to your practice for a well-woman examination. She remarks that she feels like she is shrinking over the past year, despite keeping active and incorporating sources of calcium in her diet. Which of the following is not a risk factor for osteoporosis? Excessive exercise History of maternal osteoporosis Routine use of alcohol or caffeine Use of opposed Estrogen use Use of opposed Estrogen use Your fifteen-year-old patient has been diagnosed with secondary amenorrhea. The urine human chorionic gonadotropin (HCG) is negative and Prolactin levels are within normal limits. The physical examination reveals growth of breast tissue and Tanner stage III. Which of the followingmedication regimes would be most appropriate? Oral estrogen 1.25 mg daily for three weeks Medroxyprogesterone acetate 5 mg every other day for one month Medrol 16 mg dose pack Medroxyprogesterone acetate 5 mg daily for five to ten days Medroxyprogesterone acetate 5 mg daily for five to ten days A twenty-five-year-old pregnant client presents with a complaint of headaches that are confined to the base of the head as well as the upper neck and feels "tight" in nature. She denies visual changes, photophobia, or nausea. The most likely diagnosis is which type of headache? Common migraine Cluster Muscular tension Sinus Muscular tension A twenty-one-year-old patient presents with symptoms of lower urinary tract infection, including dysuria, frequency, and urgency. The urinalysis reveals the presence of leukocytes but is negative for nitrates. This most likely represents ______. vaginitis specimen contamination sexually transmitted disease interstitial cystitis specimen contamination A nurse practitioner is completing a speculum exam on a female patient. Which of the following findings would be considered a normal surface characteristic of the cervix? Small, yellow, raised around area on the cervix Friable, bleeding tissue opening of the cervical os Red patch areas with occasional white spots Irregular, granular surface with red patches Small, yellow, raised around area on the cervix There are several phases to the menstrual cycle. What phase begins with menses cessation and ends with ovulation? Ovulatory phase Follicular phaseProliferative phase Luteal phase Follicular phase During pregnancy and lactation, the nutritional needs of the woman are increased with deficiencies resulting in harm to the woman or her baby. Neural tube defects are one of the most common birth defects. Deficiency of which nutrient is responsible for these conditions? Vitamin C Folic acid Vitamin B12 Riboflavin Folic acid A nurse practitioner is caring for a woman who is post-op from a total hysterectomy. It is important to recall that estrogen withdrawal reflects hormonal activity primarily from the ______. hypothalamus posterior pituitary ovary anterior pituitary ovary During a community education program, a nurse practitioner is discussing the usefulness of mammography in the screening and detection of breast cancer. Which of the following statements is accurate? A mammogram should be done if there is any breast pain or nipple retraction. All women over forty years of age should have a mammogram on an annual basis. A mammography should be done annually for all women of child-bearing age. Mammograms should be performed annually after the initial pregnancy, especially if the woman does not breast-feed. All women over forty years of age should have a mammogram on an annual basis. A patient asks why she needs a breast ultrasound when she already has had a mammogram. Which of the following would be the best response of the use? To locate small lesions prior to surgery As a screening test for breast cancer To determine if a breast lesion is cystic or solidFor definitive diagnosis of breast cancer To determine if a breast lesion is cystic or solid A nurse practitioner is reviewing the signs of polycystic ovary syndrome (PCOS) for a differential diagnosis for a female patient. Which of the following would be a positive finding? Chronic anovulation Increased estradiol levels Hyperprolactinemia Weight loss Chronic anovulation anovulation failure to release an egg or ovulate A fifty-two-year-old female patient comes in for her annual well-woman examination. Her LMP was fourteen months ago without any breakthrough bleeding. She has also developed some hirsutism. You would document this as __. secondary amenorrhea menopause perimenopause polycystic ovary syndrome (PCOS) menopause A woman is completing a symptom diary of her symptoms associated with premenstrual syndrome (PMS). In which of the following phases would the problems most likely appear? Ovulatory Follicular Proliferative Late luteal Late luteal An adolescent female patient is considering starting contraception. She reports that she has asthma that is well controlled on inhaled corticosteroids. You would advise this patient that ____. the use of oral contraceptives is contraindicated in patients with asthma injectable methods of contraception are best for patients with asthma all methods of contraception may be used by patients with asthma the use of hormone patches is indicated for patients with asthma all methods of contraception may be used by patients with asthmaWhich of the following choices represents a disorder of the reproductive tract that causes pain, erythema, dyspareunia, and a perineal mass? Syphilis Bartholin's cyst Labial adhesion Herpes simplex type 2 Bartholin's cyst Long-acting progestins used in contraception do not always contain estrogen. As a result of the lack of this hormone, there will be no alteration in which of the following? Hepatic globulin production Serum androgen levels Blood pressure Decreased serum insulin levels Hepatic globulin production A twenty-four-year-old female patient has been diagnosed with primary dysmenorrhea. Which of the following medications would be used as a first line to help control her symptoms? Antianxiety agents Progesterone-only contraception Oral steroids Nonsteroidal anti-inflammatory drugs Nonsteroidal anti-inflammatory drugs Anna, aged twenty-five years, presents with dysmenorrhea. She states that her sister and her mother have endometriosis and she would like to be evaluated for it as well. Which if the following is consistent with a diagnosis of endometriosis? Frequent episodes of bacterial vaginosis Postcoital bleeding with malodorous discharge Infertility and dysmenorrhea Constipation and amenorrhea Infertility and dysmenorrhea Which of the following conditions is not an absolute contraindication to estrogen-containing contraception? Migraine headachesHypercoagulable state Thromboembolism History of coronary artery disease Migraine headaches A female child presents for a well-child exam. Her mother is concerned about changes in her daughter's body, which indicate to you precocious puberty. Which of the following findings would be consistent with this diagnosis? Delay in any of the Tanner stages takes longer than one year between stages Breast budding occurs after the development of pubic hair Puberty starts before eight years of age in a female The growth spurt in a female occurs after puberty is complete Puberty starts before eight years of age in a female A nurse practitioner is counseling a woman with fibrocystic changes in the breast. Which of the following is not caused by this change? Breast pain An increased risk of breast cancer Hard masses Painless lumps An increased risk of breast cancer A patient is completing a diary of her premenstrual syndrome (PMS) symptoms. The nurse practitioner understands that PMS occurs with greatest frequency and severity in the ____. late luteal phase midfollicular phase proliferative phase early luteal phase late luteal phase Long-acting progestins may be used in patients as a contraceptive method. One of the long-acting progestins is Depo-Provera. Which of the following best describes the mechanism of action of long-acting progestins in contraception? Decrease in cervical mucus production and thinning of the circle os Thickening of cervical mucus and suppression of gonadotropin levels Increased gonadotropin levels and thinning of the circle osAnovulation caused by increased gonadotropin levels Thickening of cervical mucus and suppression of gonadotropin levels Urinary tract infections are commonly seen in primary care. A twenty-five-year-old female presents with a new onset of dysuria and suprapubic pain for the last twenty-four hours. The examination reveals only mild tenderness without any peritoneal signs on the lower abdomen. A urinalysis reveals the presence of WBCs. The urine is sent for a culture and sensitivity. In addition to Escherichia coli one might typically expect to see the presence of which bacterium? Klebsiella Staphylococcus aureus Staphylococcus saprophyticus Pseudomonas Staphylococcus saprophyticus Changes in hormonal regulation during menopause result in the gradual cessation of menstruation. From which gland is Androstenedione secreted? Anterior pituitary Posterior pituitary Corpus Luteum Adrenals Adrenals When prescribing a combined oral contraceptive for a young patient, which of the following would not be included in your discharge instructions? If you miss one day, double up the next day. You need to use backup protection consistently for the first month to avoid pregnancy. Breakthrough bleeding may occur in the first few cycles. Oral contraceptives offer protection against cervical cancer. Oral contraceptives offer protection against cervical cancer. A nurse practitioner is educating a pregnant female about breast changes. Common normal physiologic changes include all of the following except: Development of straie Fibrocystic changes Nipple pigmentation Venous engorgementFibrocystic changes A nurse practitioner is teaching an undergraduate course in woman's health. A student asks about the etiology of the pain that occurs with primary dysmenorrhea. Which of the following responses is correct? Sloughing of the endometrium Prostaglandin release and synthesis Anovulatory cycles Excess progesterone production Prostaglandin release and synthesis A nurse practitioner is educating a patient who has just been diagnosed with polycystic ovary syndrome (PCOS). She needs to be aware that PCOS is associated with which of the following clinical manifestations? Excessive menstrual flow Dry, flaking skin Obesity Hair loss Obesity When reviewing the risk factors for breast cancer with your patient, which of the following would not be a contributing factor? Early menarche High fat diet Early menopause Advanced age Early menopause When educating patients about the use of combination oral contraceptive medications, they should be advised that pregnancy is prevented primarily by ____________. cervical mucus thinning inflammation of the endometrium ovulation suppression decreased fallopian tube motility ovulation suppression Gynecomastia or breast development in males is a common issue in clinical practice. Which of the following statements defines Gynecomastia most accurately?It is always unilateral. Onset coincides with the start of puberty. Illegal drug use is rarely a cause. An endocrine workup should be instituted in all cases. Onset coincides with the start of puberty Which of the following is true regarding education of a forty-two-year-old woman diagnosed with uterine myoma? Myomas usually does not resolve with menopause. Myomas will decrease with the withdrawal of estrogen. Hysterectomy is the treatment of choice. Myomas are never responsible for uterine bleeding. Myomas will decrease with the withdrawal of estrogen. Follicle-stimulating hormone (FSH) is released from the anterior pituitary gland and is responsible for which of the following normal physiologic response of the female menstrual cycle? Breast milk production Stimulation of ovarian follicles Maturation of ovarian follicles Luteinizing hormone (LH) inhibition Stimulation of ovarian follicles A seventeen-year-old presents with an appointment for unilateral breast tenderness and swelling. Which of the following would be the most likely etiology for this problem? Breast cancer Mastitis Fibrocystic breast Fibroadenoma Mastitis When educating a patient about the rationale for obtaining a mammogram, which of the following statements is false? Mammography is a cost-effective method to screen for breast cancer Mammography detects all breast cancers Mammography should be accompanied by breast examinationNegative mammography should not delay biopsy of a clinically suspicious mass Mammography detects all breast cancers A woman is experiencing a milky white nipple discharge. Galactorrhea is usually a finding with which other diagnosis? Fibrocystic breast disease Mastalgia Hyperprolactinemia Breast cancer Hyperprolactinemia A thirty-five-year-old female presents with perimenopausal symptoms. You recall that this may begin during which age group? Forty-five to fifty years Thirty-five to forty years Fifty to fifty-five years Thirty to thirty-five years Thirty-five to forty years A forty-four-year-old woman with dysfunctional uterine bleeding (DUB) presents for treatment. Which of the following medications can be used for management of DUB? Ethinyl estradiol Medroxyprogesterone Estrogen/progesterone combination Conjugated estrogen Medroxyprogesterone The twenty-eight-year-old female is interested in the use of an intrauterine device (IUD) as a method of birth control. The nurse practitioner would advise the patient that the action of the IUD _______. blocks the transportation of sperm through the cervical os has a similar action to that of spermicide prevents the implantation of a fertilized ovum decreases transit time of the ovum into the uterus prevents the implantation of a fertilized ovum Adolescence is a period of time where patients undergo significant biological, psychological, and emotional growth. Which of the following characteristics describe the psychosocial development of middle adolescence?Middle school years between ages ten and thirteen Late elementary school from ages eight to nine High school years from ages fourteen to seventeen Ages seventeen to twenty-one and posthigh school years High school years from ages fourteen to seventeen A nurse practitioner is teaching an undergraduate pathophysiology class about changes associated with puberty. Which of the following is an inaccurate point that should not be included? A decrease in the sensitivity of the hypothalamus An elevation of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) Decreasing estrogen levels and a reduction in gonadotropin-releasing hormone (GnRH) Nocturnal secretion of pulsatile LH Decreasing estrogen levels and a reduction in gonadotropin-releasing hormone (GnRH) A woman presents to your practice with vaginal itching and a white discharge. She has been in good health except for recent treatment for strep throat. Pelvic examination reveals a tender vulvovaginal area with edema and nonmalodorous white patches. Which of the following is the most likely cause of this problem? Bacterial vaginitis Trichomonas Lactobacillus overgrowth Candidiasis Candidiasis A Pap smear result of atypical squamous cells of undetermined significance (ASCUS) will require which procedure next? Cold knife cone (CKC) Follow-up Pap smear Colposcopy Loop electro-excision procedure (LEEP) Follow-up Pap smear A twenty-five-year-old patient is on oral contraception and comes in with an elevated blood pressure after being on the medication for six months. Prior to the initiation of the medication, the patient's blood pressure had been within normal limits. The patient should be advised that ____. most likely the oral contraceptive is not causing the blood pressure elevation approximately over 3% oral contraceptive users develop hypertensionmost likely progesterone is causing blood pressure elevation blood pressure elevation results from fluid retention approximately over 3% oral contraceptive users develop hypertension A woman is experiencing urinary symptoms. Which of the following is a risk factor in her pelvic floor relaxation? Thin stature Perimenopause Vaginal delivery Cesarean section Vaginal delivery A nurse practitioner instructor is reviewing the anatomy of the external genitalia. At the opening of the vagina are the Bartholin's glands. Which of the following describes the function of these glands? Hormone production for ovulation Production of alkaline secretion for sperm viability Development of mucous plug for pregnancy Maintenance of vaginal pH to prevent vaginitis Production of alkaline secretion for sperm viability When discussing contraception with a patient, which of the following statements is true regarding progestin-only therapy? There is an decreased risk of ectopic pregnancy. There is an increased risk in the development of functional ovarian cysts. Ovulation suppression is equal to combined oral contraceptive methods. Women that are breast-feeding should not use progestin-only treatment. There is an increased risk in the development of functional ovarian cysts. The World Health Organization (WHO) has determined absolute contraindications to estrogen containing contraceptives. Which of the following is not an absolute contraindication? History of cerebrovascular accident (CVA) Greater than age of thirty-five years Hypertension with vascular disease Active viral hepatitis Greater than age of thirty-five years You are instructing a patient in the proper use of the diaphragm, a barrier contraceptive method. Which of the following would you include in your instructions? The diaphragm should be removed within two hours after intercourse. The diaphragm may be inserted up to twelve hours prior to intercourse. The diaphragm is more effective when used with spermicidal jelly. Douching is safe immediately upon removal of the diaphragm. The diaphragm is more effective when used with spermicidal jelly. A woman has developed acne and hirsutism while taking oral contraceptives. These changes result from _____. increased estrogen levels decreased estrogen levels increased free androgens decreased free androgens increased free androgens In reviewing cancer statistics, after breast cancer, what would you find to be the most common female genital malignancy? Endometrialovarian Vulvovaginal Cervical Endometrial A seventeen-year-old female patient presents with amenorrhea for four months. She did experience menarche at the age of fifteen but had not had a menstrual cycle since. On physical examination, it is noted that she has normal secondary sexual characteristics. The nurse practitioner will consider a progesterone challenge to determine the presence of adequate __. CORRECT endogenous estrogen prolactin L-thyroxine follicle-stimulating hormone (FSH) endogenous estrogen A nurse practitioner has just completed education with a female adolescent about intrauterine contraceptive devices. Which of the following statements by the patient would suggest that further education is needed? They are only indicated for women with stable monogamous relationships. It is not commonly used for nulliparous women as there are better options. They are contraindicated in women with a past history of pelvic inflammatory disease. They may be used by a woman who has had a previous ectopic pregnancy. They may be used by a woman who has had a previous ectopic pregnancy. Question : A twenty-four-year-old female presents to the office with a complaint of vaginal itching in addition to thick mucoid discharge. She also has some mild urinary discomfort. A wet mount preparation using potassium hydroxide (KOH) reveals a negative whiff test and few clue cells. There were no trichomonads visualized but the WBCs were too numerous to count. Which of the following would be the most likely diagnosis in this patient? Bacterial vaginosis Herpes simplex Chlamydia Cystitis with cervicitis Chlamydia A postmenopausal female is taking hormone replacement therapy (HRT). Which of the following risk factors would not be a contraindication? Abnormal vaginal bleeding Uncontrolled hypertension Chronic active hepatitis Recent deep vein thrombosis Uncontrolled hypertension The ovaries are located near the pelvic wall at the level of the anterior superior iliac spine. Which layer of the ovaries contains the lymphatics and blood vessels? Endometrium Central medulla Cuboidal epithelium Ovarian stroma Central medulla A twenty-eight-year-old female presents with breast tenderness, fatigue, abdominal bloating, fluid retention, and irritability one week prior to the onset of her menses. The nurse practitioner suspects the patient may have premenstrual syndrome (PMS). What is the most important information to obtain from this patient to make the determination? Severity of symptomsOccurrence of symptoms in the menstrual cycle Frequency and number of symptoms over the past four months Presence or absence of depression or anxiety Occurrence of symptoms in the menstrual cycle A thirty-five-year-old woman, presents with a six-month history of hypermenorrhea, backache, and pelvic pressure. On examination, you discover a twelve-week size uterus with irregular contour. Which of the following does this represent? Uterine cancer Dysfunctional uterine bleeding (DUB) Uterine fibroid Fecal impaction Uterine fibroid Natasha is an eleven-year-old girl brought to your office for an annual well-child visit. When discussing the onset of puberty with Natasha and her mother, you would emphasize which of the following? (Points : 2) Pubic hair develops before breast buds. Breast development delayed beyond twelve years of age may be considered pathological. The average age of menarche is twelve years. It usually takes about three-and-half years to go from breast buds to menarche. The average age of menarche is twelve years. A nurse practitioner student is researching as to why menopausal women have an increased risk of heart disease. Which of the following lipid changes occur with estrogen withdrawal in menopause? (Points : 2) Increase in HDL, LDL, and triglycerides Decrease in HDL, LDL, and triglycerides Increase in HDL with a decrease in LDL and triglycerides Decrease in HDL with an increase in LDL and triglycerides Decrease in HDL with an increase in LDL and triglycerides Lakeisha, seventeen years old, is seeing her regular nurse practitioner for a sports physical. While participating in a psychosocial screen, Lakeisha volunteers that she "hasn't had sex yet." What is the best initial response to Lakeisha's statement? (Points : 2) Congratulate her for abstaining and move on to another topic. Clarify which behaviors are included in Lakeisha's definition of "having sex." Demonstrate condom use and give Lakeisha some condoms for future partners. Encourage Lakeisha to be screened for STIs. [Show More]

Last updated: 2 years ago

Preview 1 out of 56 pages