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A series of questions and answers related to a whnp final prep exam, covering topics such as pregnancy complications, medication use during pregnancy, and gynecological conditions. Each question includes a brief explanation of the correct answer, offering insights into the reasoning behind the choices. While the document provides a basic overview of these topics, it lacks in-depth analysis and may not be sufficient for comprehensive study.
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In the pregnant woman with asthma, in what part of her pregnancy are symptoms and bronchospasm likely to worsen? 15 - 23 weeks 24 - 33 weeks 29 - 36 weeks Correct answer is: 29-36 weeks. General Feedback:
Bronchospasm can be triggered as a consequence of increased external pressure on the smooth muscle of the bronchial structures. The increasing size of the fetus during weeks 29- 36 creates significant displacement of abdominal and thoracic structures and places external pressures on the bronchi. In the last four weeks, as the fetus "drops" into the pelvis, pressure on the bronchi is actually relieved a bit and symptoms often improve. Medications most commonly pass through the placenta via: Facilitated transport Passive diffusion Capillary pump action General Feedback:
In both the pregnant and non-pregnant woman, E. coli is the most common cause of uncomplicated UTI. Nitrofurantoin is a recommended first-line agent during pregnancy (pregnancy category B). Azithromycin is not recommended for UTIs, and the use of ciprofloxacin (pregnancy category C) should be limited given trends of increasing resistance by E. coli and the availability of a safer alternative during pregnancy. In treating a pregnant woman with acute bacterial rhinosinusitis, the NP would likely avoid prescribing: Amoxicillin Azithromycin Levofloxacin Correct answer is: Levofloxacin. General Feedback:
Amoxicillin and azithromycin are both indicated for acute bacterial rhinosinusitis (ABRS) and are pregnancy category B. While levofloxacin is indicated for ABRS in certain circumstances, levofloxacin is not indicated as a first-line agent in the otherwise healthy patient. Additionally, levofloxacin is pregnancy category C and would not be used when safer, effective alternatives are available. The recommended duration of antimicrobial therapy for treatment of a urinary tract infection in a pregnant woman is: 3 days 5 days 7 days Correct answer is: 7 days. General Feedback:
SSRIs have been widely used during pregnancy as prenatal depression has been linked to postpartum depression. As more and more data become available about the effects of SSRI use during pregnancy, it has become apparent that there is a small but persistent increased risk of pulmonary hypertension in the exposed neonates. There is no link to neural tube defects, macrosomia, of gestational diabetes. The most likely causative organism in uncomplicated UTI during pregnancy is: Klebsiella spp Proteus mirabilis E. coli Correct answer is: E. coli. General Feedback:
In both the pregnant and non-pregnant woman, E. coli is the most common cause of uncomplicated UTI. The organism is a common intestinal inhabitant and the close proximity of the anus and urethra puts women at risk for ascension of the organism into the lower urinary tract. In pregnancy, hormonal changes and dilation of the renal pelvis actually favor ascension into the upper urinary tract and, therefore, UTI is treated aggressively. When a pregnant woman takes a teratogenic drug, the fetal effects are usually seen in: Certain target organs in a predictable manner Random body systems without a predictable pattern Select organ systems with random outcomes Correct answer is: Certain target organs in a predictable manner. General Feedback:
Dysmenorrhea (painful menstruation) is classified as primary (from the onset of menstruation) or secondary (due to some physical cause and usually of later onset). Primary dysmenorrhea is due to the production of prostaglandins made by cells in the inner lining of the uterus. Prostaglandins cause the uterine muscles to contract and help the uterus shed the lining that has formed during the menstrual cycle. If excessive prostaglandins are produced, the woman can experience excessive pain with her menstrual cycle. What statement concerning the pathogenic mechanisms of polycystic ovarian syndrome (PCOS) is true? PCOS causes a decrease in leptin levels; this decrease reduces the hypothalamic pulsatility of gonadotropin-releasing hormone, which reduces the number of follicles that mature PCOS is a result of a combination of conditions that include oligoovulation or anovulation, elevated levels of androgens, or clinical signs of hyperandrogenism and polycystic ovaries PCOS inhibits testosterone, which stimulates androgen secretion by the ovarian stroma and indirectly reduces sex hormone- binding globulin
Correct answer is: PCOS is a result of a combination of conditions that include oligoovulation or anovulation, elevated levels of androgens, or clinical signs of hyperandrogenism and polycystic ovaries. General Feedback: Polycystic ovarian syndrome (POS or PCOS) is associated with abnormalities in the metabolism of androgens and estrogen and in the control of androgen production. Patients typically have high serum concentrations of androgens, including testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS). POS is also associated with peripheral insulin resistance and hyperinsulinemia. In POS, oligoovulation or anovulation can occur, leading to the production of cysts in the ovaries that can contribute to infertility. Considering the mediating factors of premenstrual syndrome (PMS), which medication can be used either continually or only during the menstrual period luteal phase of the menstrual cycle as a treatment for the condition? NSAIDs Select SSRIs
General feedback: Uterine prolapse is the downward displacement of the uterus into the vaginal canal taking the vaginal wall with it. 1st degree = cervix drops into lower part of the vagina 2nd degree = the body of the uterus lies in the vagina; cervix is at the vaginal opening 3rd degree = the uterus and cervix protrude through the vaginal introitus. Which term is used to identify the descent of the posterior bladder and trigone into the vaginal canal? Rectocele Cystocele Enterocele Correct answer is: Cystocele.
General Feedback: Prolapses can occur in the anterior, middle, or posterior compartment of the pelvis. A cystocele comprises of a prolapse of the bladder into the vagina. An enterocele is a herniation of the pouch of Douglas (including small intestine/omentum) into the vagina. A rectocele is a prolapsed of the rectum into the vagina. A vaginocele (or colpocele) occurs when the base of the vagina drops from its normal position in women who have previously undergone a hysterectomy. What type of cyst develops when an ovarian follicle is stimulated but no dominant follicle develops and completes the maturity process? Follicular Corpus albicans Benign ovarian Correct answer is: Benign ovarian.
General Feedback: Cervical dysplasia refers to abnormal changes in the cells on the surface of the cervix. Cervical dysplasia that is seen on a Pap smear is called a squamous intraepithelial lesion (SIL). If an SIL is detected, a biopsy is often needed for confirmation. A dysplasia seen on biopsy of the cervix is called cervical intraepithelial neoplasia (CIN), and these are grouped into 3 categories (I, II, III) based on severity. A progressive neoplastic change that involves the full epithelial thickness of the cervix describes cervical carcinoma in situ (CIS), or stage 0 cervical cancer. At this stage, the cancer is noninvasive and confined to the surface of the cervix Which benign breast tumor affects postmenopausal women and is characterized by the principal lactiferous ducts becoming dilated and filled with cellular debris? Mammary duct ectasia Intraductal papilloma
Phyllodes tumor Correct answer is: Mammary duct ectasia. General Feedback: Mammary duct ectasia most often affects women in their 40s and 50s and is caused by inflammation of the ducts behind the nipple, causing the ducts to become clogged with thick, sticky cellular debris. Intraductal papillomas consist of small wart-like growths that project into lactiferous ducts near the nipple and usually affect women 30-50 years of age. Phyllodes tumors are rare breast tumors most common in women in their 30s and 40s. When ovarian cancer is associated with a known pattern of inheritance, the majority are associated with: Mutation of the BRCA1 gene Mutation of the BRCA2 gene Hereditary nonpolyposis colorectal cancer (HNPCC) syndrome Correct answer is: Mutation of the BRCA1 gene.
Congenital abnormalities in the uterine structure Correct answers are: Progesterone deficiency Estrogen excess General Feedback: Anovulatory bleeding results from a disruption in the normal cyclic pattern of ovulatory stimulation to the endometrial lining. The bleeding in these patients is unpredictable (heavy or light, short or prolonged, frequent or random). As a result of cyclic disruption, patients have constant, non-cycling estrogen levels along with progesterone deficiency (normally released during the luteal phase) that stimulates endometrial growth. The size of benign uterine tumors, such as leiomyomas, is thought to be caused by the influence of which hormone(s)? (Select all that apply.) Progesterone Estrogen
Luteinizing hormone Gonadotropin-stimulating hormone Growth factors Correct answers are: Progesterone, Estrogen & Growth factors. General Feedback: Benign uterine tumors, or fibroid tumors, are non-cancerous and comprised of fibrous tissue. Tumors can range in size and number, and can range from 1 mm to more than 20 cm We have an expert-written solution to this problem! What are the two most common clinical manifestations of endometriosis? (Select all that apply.) Infertility Amenorrhea
