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Women's Health (Exam Practice
Questions) 2023 A+ Graded
VAGINITIS DIAGNOSIS AND TREATMENT
Organism Discharge Odor Microscopy pH Treatment Bacterial vaginosis Thin, gray, homogeneous Fishy with positive "whif test" Clue cells
4.5 Metronidazole 500 mg BID × 7 days or clindamycin 300 mg BID × 7 days or topical metronidazole 1 applicatorful intravaginally daily × 5 days (lower success rate) Candida Adherent, white, "cottage cheese" like Neutral Pseudohyphae but only 65-85% sensitive <4.5 Fluconazole oral, topical clotrimazole, miconazole, etc. Trichomonas Copious yellow, gray, green, foamy. Friable "strawberry" cervix Malodorous Trichomonads >4. Metronidazole 2 g PO once (recommended), or 500 mg BID × 7 days (alternative) - HELPFUL TIP: The most recent evidence points to insulin resistance as the underlying cause of PCOS, and these patients may have acanthosis nigricans. Insulin resistance can be quantified by calculating the ratio of fasting glucose to insulin. A ratio of less than 4.5 indicates insulin resistance. Insulin resistance stimulates ovarian androgen production, which leads to anovulation. HELPFUL TIP: As with other STIs, a patient with Trichomonas should have her partner tested and treated (or just treated depending whether or not this is allowable under your state law). HELPFUL TIP: While it makes sense that single-dose azithromycin would work better in treating Chlamydial cervicitis because of compliance issues, the cure rate is the same whether azithromycin or the doxycycline is used. There is about a 3% failure rate with azithromycin which isn't seen with doxycycline. HELPFUL TIP: For hirsutism associated with PCOS, spironolactone is usually first-line therapy unless the patient has a contraindication; traditional hair removal techniques will still be required for the existing hair growth. Since spironolactone can result in feminization of a male fetus, patients taking spironolactone must be using reliable birth control. HELPFUL TIP: Not all women with PCOS are obese and hirsute. Many patients may be thin with sparse body hair and present with menstrual irregularities and fertility concerns.
HELPFUL TIP:
Initial treatment for lichen sclerosus involves local steroid ointment application. High- potency steroids are initiated and then tapered to the lowest effective potency and frequency that maintain symptom control. Testosterone creams have fallen out of favor due to lesser efficacy and secondary virilization. Vaginal dilators can be used if there is constriction of the vaginal opening causing dyspareunia. - Question 1: A 16-year-old female presents with her mother. They don't look happy. Her mother says, "She needs a Pap smear because she's been having sex with a couple of boys— in my house, I will have you know—for a year!" The patient rolls her eyes. Consistent with published guidelines, you recommend: A Pap smear B Gonorrhea and chlamydia testing C Pap smear and gonorrhea and chlamydia testing D Return for a Pap after sexually active for 3 years (age 18 for this patient) E A chastity belt Explanation: The correct answer is "B." It is now recommended to delay cervical cancer screening until age 21, even if the woman has been sexually active. The reasoning: although adolescent females are frequently infected with HPV, they also easily clear these infections, with 95% of lesions spontaneously regressing. Exceptions to this rule include patients who are immunocompromised (e.g., organ transplant, HIV infection). For this patient, ensuring that she has completed her HPV serious and counseling on safe sexual behavior is also warranted. Question 2: A 65-year-old female presents for a health maintenance examination. She complains of a vulvar itching due to what she calls "recurrent yeast infections," and her symptoms have worsened over the last few months. She is sexually active with her husband and has experienced dyspareunia with penetration lately. She always uses a water-based lubricant with intercourse. On examination, you find complete loss of the borders of the labia minora, constriction of the vaginal outlet, and several thin white plaques (like parchment paper) on the vulva. There is no other skin or mucosal involvement.
B
"Given your use of warfarin, you should not use oral fluconazole" C "You will need to stop warfarin while taking oral fluconazole" D "You should take extra warfarin if you take oral fluconazole" Explanation: The correct answer is "B." There are numerous drug interactions with oral fluconazole, including warfarin (both inhibit CYP3A4). The INR will increase after even one dose of fluconazole therapy. Similarly, the ubiquitous statins are affected by oral fluconazole with several case reports of rhabdomyolysis in the literature. In this case, stick with topical antifungals, although your patient satisfaction scores may plummet. (Incidentally, patient satisfaction has been inversely correlated with healthcare quality—although there appears to be a direct link between increased satisfaction and increased health care expenditure.) - A 25-year-old woman comes to the clinic complaining of increased vaginal discharge, milky gray in color with a "fishy" odor that both she and her husband have noticed. A wet smear is performed and the presence of "clue cells" confirmed. Which type of infection does the nurse suspect? 1 Candidiasis 2 Trichomoniasis 3 Bacterial vaginosis 4 Group B Streptococcus - - Bacterial vaginosis Signs of bacterial vaginosis include a milky gray vaginal discharge that has a characteristic fishy odor. "Clue cells" noted on wet smear are indicative of BV. Candidiasis is a yeast infection caused by the organism Candida albicans. The most common symptom of a yeast infection is vulvar and vaginal pruritus. Vaginal discharge in a candidal infection is thick, white, and lumpy. A woman with a trichomoniasis infection may present with a frothy yellowish-green vaginal discharge. Vulvar irritation, pruritus, and dyspareunia are usually present. Group B Streptococcus may be considered part of the normal vaginal flora in a woman who is not pregnant, and no treatment is necessary.
A 20-year-old woman visiting the clinic says that she wishes to begin using depot medroxyprogesterone acetate (Depo-Provera) as a form of birth control. What important information should the nurse include when teaching the client about Depo-Provera? 1 Depo-Provera offers protection against the herpes simplex virus. 2 To continue the contraceptive effects the client will need to return for another injection in 6 months. 3 Women using Depo-Provera may lose more blood each month with their periods, so it is important to add iron-rich foods to the diet to help prevent anemia. 4 Calcium intake and exercise should be increased because of possible loss of bone mineral density with increasing duration of use - - Calcium intake and exercise should be increased because of possible loss of bone mineral density with increasing duration of use Loss of bone mineral density is a significant side effect of Depo-Provera, and increased calcium intake and exercise should be encouraged. Depo-Provera should be administered every 11 to 13 weeks; 6 months is too long before the next dose. Menstrual periods usually lighten or disappear over time. Depo-Provera confers no protection against herpes simplex virus. A 24-year-old woman wants to use her basal body temperature (BBT) in natural family planning but is unsure when to take her temperature. The nurse informs her that an accurate BBT is best taken: 1 Each night right before bed 2 On the first day of her next menstrual cycle 3 Each morning prior to getting out of bed or increasing her activity 4 At bedtime beginning on day 14 of her menstrual cycle and continuing until her next period - - Each morning prior to getting out of bed or increasing her activity The most accurate BBT is taken before a woman gets out of bed and begins any type of activity that could increase the body's temperature even slightly. BBT should be charted daily on a calendar to permit interpretation of temperature fluctuations. A BBT taken in the evening may be increased after a day of activity. Daily assessment and recording of BBT during the first half of the menstrual cycle is also crucial, because a woman's BBT is lower then than during the second half of her cycle. The BBT temperature may rise slightly with ovulation. A 37-year-old woman is admitted to the unit with severe menorrhagia. During assessment the nurse learns that she has a history of fibroids, menorrhagia, pelvic pain,
Intermittent diarrhea 3 Pale mucous membranes 4 Difficulty emptying the bladder 5 High hemoglobin and hematocrit - - Pale mucous membranes, Difficulty emptying the bladder Menorrhagia (heavy menstrual bleeding) can cause anemia (acute or chronic). Because this client has a history of menorrhagia, the nurse can anticipate chronic anemia. Urinary frequency, urgency, and incontinence are symptoms of fibroids, which can cause menorrhagia. Constipation, not diarrhea, is a common symptom of fibroids, which can cause menorrhagia. Menorrhagia would cause hypovolemia, not hypervolemia. Menorrhagia would cause the hemoglobin and hematocrit levels to decrease, not increase. After treatment for a bladder infection, a client asks whether there is anything she can do to prevent cystitis in the future. What is the best response by the nurse? 1 Avoid regular use of tampons. 2 Decrease intake of prune juice. 3 Increase daily fluid consumption. 4 Cleanse the perineum from back to front. - - Increase daily fluid consumption. Increasing fluid intake flushes the urinary tract of microorganisms. Tampons do not increase the risk of cystitis. Fluids should be increased, not decreased; prune juice promotes acidic urine, which is desirable because it discourages the growth of microorganisms. The preferred method of cleansing is from front to back (urethra to vagina); however, studies have shown that this method of cleansing is not a significant factor in the prevention of cystitis. A nurse in the family planning clinic reviews the health history of a sexually active 16- year-old girl whose chief concern is a thick, burning discharge accompanied by a burning sensation and lower abdominal pain. After an examination the girl is informed that she may have a sexually transmitted infection (STI) that requires treatment. The adolescent is concerned that her parents will discover that she has been sexually active and asks the nurse whether her parents will be contacted. The nurse explains that her parents will: Incorrect Need to know to sign a consent form for testing and treatment 2
Not be contacted, because treatment at the clinic is confidential 3 Be notified when the insurance company is billed for testing and treatment 4 Remain uninformed if the adolescent ensures that her sexual contacts will come for testing - - Not be contacted, because treatment at the clinic is confidential Federal law allows family planning clinics to maintain minors' confidentiality, although individual states may have different regulations; there is a concern that these teenagers will not seek or continue treatment if they fear disclosure. To maintain confidentiality, family planning clinics treat these adolescents as emancipated minors who can sign their own consent forms. Most family planning clinics receive funding and charge on a sliding scale based on income, thus encouraging adolescents to seek treatment. Telling the client that her parents will not be notified as long as she ensures that her sexual contacts come in for testing could be viewed as coercion; if the STI is reportable, follow- up of sexual partners is indicated, but the adolescent is not responsible for ensuring that they report for testing. A client asks the nurse at the family planning clinic whether contraception is needed while she is breastfeeding. How should the nurse reply? 1 "As long as you aren't having periods, you won't need a contraceptive." 2 "It would be best to delay sexual relations until you have your first period." Correct "You should use contraceptives, because ovulation may occur without a period." 4 "Breastfeeding suppresses ovulation, so you don't need to worry about pregnancy." - - "You should use contraceptives, because ovulation may occur without a period." Anovulation occurs in nursing mothers for varying periods; breastfeeding is not a reliable method of birth control. Periods may not occur for several months; sexual relations need not be delayed this long. Ovulation can occur without menstruation. Lactation may delay menses but does not reliably suppress ovulation. A client with active genital herpes has a cesarean birth. The nurse teaches the mother how to limit transmission of the virus to her newborn. The nurse concludes that the instructions have been understood when the mother states: 1 "I should avoid kissing the baby on the lips." 2 "I have to wear gloves when I'm holding the baby." 3 "I should wash my clothes and my baby's clothes separately." 4
A postpartum client is scheduled to have a tubal ligation. She has asked that her husband not be told about the procedure because she has told him that she is having exploratory surgery. The client's husband asks the nurse why his wife needs to have exploratory surgery. How should the nurse respond? "What has the physician told you?" 2 "I don't know the answer to that question." 3 "I'm not allowed to give you that information." 4 "Have you talked to your wife about your concerns?" - - "Have you talked to your wife about your concerns?" The correct response protects the wife's confidentiality while fostering open communication between the couple. Asking about communication with the physician does not foster communication between the client and the client's husband. Claiming not to know the answer to the question or claiming not to be able to supply the information in question supports neither the wife nor the husband. A woman questions the nurse about the effectiveness of oral contraceptives. What most important factor about the effectiveness of oral contraceptives should be included in the reply to this question? 1 User motivation 2 Simplicity of use 3 Reliability record 4 Identified risk factors - - User motivation Conception will not be prevented unless the user is motivated to use the method correctly and consistently. No matter how simple, the method must be used consistently. Reliability record is not relevant if the method is not used correctly and consistently by the woman. Risk factors have little influence on the effectiveness of the contraceptive method A woman visits the clinic for an annual physical examination, and herpes genitalis is diagnosed. The client asks how the disease can be diagnosed without any tests. How should the nurse reply? 1 "There's a sore in your vagina." 2 "There's a rash near your vagina." 3 "You have a typical discharge from your vagina."
"You have blisters on the skin around your vagina." - - "You have blisters on the skin around your vagina." Herpes genitalis is characterized by a cluster of vesicles, not one lesion or a rash or vaginal discharge. The characteristic sign of herpes genitalis is a cluster of vesicles (blisters) on the vulva, perineum, vagina, cervix, and/or perianal area. These rupture spontaneously, leaving painful erosions. While being admitted for a lumpectomy the client begins to cry and says, "I found the lump a few months ago, but I didn't go to the doctor because of what it could be." How should the nurse reply? 1 "This has been frightening for you." 2 "About 80% of breast lumps are benign." 3 "Cry as long as you like and get it out of your system." 4 "More than 95% of breast lumps are discovered by the woman herself." - - "This has been frightening for you." The correct response involves the use of reflective technique to acknowledge the client's feelings. Providing statistics does not acknowledge the client's feelings and may cut off communication. Providing false reassurance that crying will ease her concerns is inappropriate A nurse is assessing a 55-year-old client who is experiencing postmenopausal bleeding. The tentative diagnosis is endometrial cancer. Which findings in the client's history are risk factors associated with endometrial cancer? Select all that apply. 1 Obesity 2 Multiparity 3 Cigarette smoking 4 Early onset of menopause 5 Family history of endometrial cancer 6 Previous hormone replacement therapy - - Obesity,Family history of endometrial cancer, Correct 6 Previous hormone replacement therapy.
usually remain sexually active. Spermicidal creams do not have a protective effect against sexually transmitted infections; spermicides kill sperm and limit the risk for pregnancy. A nurse is counseling an obese postmenopausal client how to prevent bone loss. Which statements indicate understanding of the strategies to prevent bone loss? Select all that apply. 1 "I need to go on a strict diet." 2 "I'll take 400 mg of vitamin D every day." 3 "I should take 1200 mg of calcium every day." 4 "Swimming or bike riding five times a week is good for me." 5 "Going to an aerobics class three times a week will help my bones." - - "I should take 1200 mg of calcium every day.Going to an aerobics class three times a week will help my bones." The recommended daily intake of calcium for a postmenopausal woman is 1200 mg. Weight-bearing activities (e.g., walking, dancing, weightlifting, aerobic exercise) are best for building bone mass.Weight loss should be slow and reasonable; restricting calories promotes production of the hormone leptin, which stimulates bone loss. Eight hundred or more (up to 2,000), international units, not 400, of vitamin D are the recommended daily intake for a postmenopausal woman. Swimming and bike riding promote overall health and joint preservation but do not increase the strength or mass of bone. A thin older adult client is found to have osteoporosis. What should the nurse include in the discharge plan for this client? 1 Encouraging gradual weight gain 2 Monitoring for decreased urine calcium 3 Providing instructions relative to diet and exercise 4 Teaching about safety factors in the use of opioids and nonsteroidal antiinflammatory drugs - - Providing instructions relative to diet and exercise A diet high in calcium and exercise, which helps deposit calcium into bone, are the most important factors in limiting the extent of osteoporosis. Weight gain should be discouraged to limit stress on the client's bones. Increased, not decreased, urine calcium should be monitored because it reflects demineralization of bone. Opioids are usually not prescribed; other analgesics are used for pain
A nurse is assessing a client for the potential for osteoporosis. Which factor in the client's history increases the risk for this disorder? 1 Estrogen therapy 2 Hypoparathyroidism 3 Prolonged immobility 4 Excessive calcium intake - - Prolonged immobility Prolonged immobility results in bone demineralization because there is decreased bone production by osteoblasts and increased resorption by osteoclasts. Estrogen helps prevent bone demineralization. Hypoparathyroidism decreases mobilization of calcium from the bones, thereby reducing the serum level of calcium. Decreased calcium intake or absorption may precipitate osteoporosis. After an abdominal hysterectomy the client returns to the unit with an indwelling catheter. The nurse notes that the urine in the client's collection bag has become increasingly sanguineous. What complication does the nurse suspect? 1 An incisional nick in the bladder 2 A urinary infection from the catheter 3 Disseminated intravascular coagulopathy 4 Uterine relaxation with increased bleeding - - An incisional nick in the bladder Uterine relaxation with increased bleeding During an abdominal hysterectomy the urinary bladder may be nicked accidentally. The client is not likely to have an infection with bleeding so soon. Bleeding would be present from other sites, such as the incision, as well as in the urine bag. The uterus is removed with a hysterectomy; therefore there is no uterine bleeding. A 45-year-old client is to undergo a hysterectomy and expresses concern because she has heard from friends that she will experience severe symptoms of menopause after surgery. What is the nurse's most appropriate response? 1 "You're right, but there are medicines you can take that will ease the symptoms." 2 "Sometimes that happens in women of your age, but you don't need to worry about it right now." 3 "You should probably talk to your surgeon, because I am not allowed to discuss this with you."
Acyclovir (Zovirax) may be prescribed in a 7-day course for a genital herpes outbreak. Ceftriaxone (Rocephin) 250 mg intramuscularly in a single dose is the drug therapy recommended for gonorrhea. Benzathine penicillin G given intramuscularly as a single 2.4 million unit dose is the treatment for primary, secondary, and early latent syphilis. A client has just been told that she has cervical erosion. The nurse would expect to help explain that early treatment of the erosion can help prevent: 1 Cancer of the cervix 2 Pelvic inflammatory disease 3 Unexpected vaginal bleeding 4 Additional cervical erosions - - Cancer of the cervix Erosion of the cervix frequently occurs at the columnosquamous junction, the most common site for carcinoma of the cervix. Treatment of cervical erosions does not prevent pelvic inflammatory disease; early onset of sexual intercourse (before 16 years of age), multiple sexual partners, and history of human papillomavirus (HPV) infection are risk factors for cancer of the cervix rather than consequences of precervical cancer. Metrorrhagia, abnormal bleeding from the uterus, may be present as erosion develops into carcinoma; however, spotting may be the earliest sign and will be eliminated when the cancer is treated. The goal of treatment of the erosion is to prevent cancer. A client at the women's health clinic tells the nurse that she has endometriosis. What factors associated with endometriosis does the nurse anticipate the client will report? Select all that apply. 1 Insomnia 2 Ecchymosis 3 Rectal pressure 4 Abdominal pain 5 Skipped periods 6 Pelvic infections - - Rectal pressure, Abdominal pain Endometriosis is the presence of aberrant endometrial tissue outside the uterus. The tissue responds to ovarian stimulation and bleeds during menstruation, which causes rectal pressure and abdominal pain. Insomnia, ecchymoses, and skipped periods are not related to endometriosis. Pelvic infections are not caused by endometriosis; most frequently they are sexually transmitted.
A 15-year-old client tells a school nurse, "I have this awful pain during my periods—it never stops." What should the nurse encourage her to do? 1 Continue daily activities. 2 Have a gynecologic examination. 3 Eat a nutritious diet containing iron. 4 Practice relaxation of abdominal muscles. - - Have a gynecologic examination. Persistent pain of any kind during menstruation (dysmenorrhea) usually indicates a problem, and the client should seek medical attention. Although diversion is a means of altering pain perception, the presence of pain requires investigation of possible causes. Although a nutritious diet is beneficial, iron does not prevent the pain of dysmenorrhea. Voluntary relaxation of the abdominal muscles does not result in cessation of dysmenorrhea. A client who menstruates regularly every 30 days asks a nurse on what day she is most likely to ovulate. Because the client's last menses started on January 1, the nurse should tell her that ovulation should occur on which day in January? 7 , 16, 24 or 29 - - 16 Ovulation should occur on January 16. The time between ovulation and the next menstruation is relatively constant. In a 30-day cycle the first 15 days are preovulatory, ovulation occurs on day 16, and the next 14 days are postovulatory. January 7, January 24, and January 29 all reflect inaccurate calculation of the date of ovulation. Contraceptives that contain estrogen-like and/or progesterone-like compounds are prepared in a variety of forms. Which contraceptives should the nurse tell clients have a hormonal component? Select all that apply. 1 Oral drugs 2 Diaphragm 3 Cervical cap 4 Female condoms 5 Foam spermicide 6 Transdermal agents - - Oral drugs,Transdermal agents
A nurse is teaching a family planning class about ovulation and conception. The nurse should instruct the class that the ovum is thought to be viable for what period of time after ovulation? 1 1 to 6 hours 2 12 to 18 hours 3 24 to 36 hours 4 48 to 72 hours - - 24 to 36 hours The ovum is capable of being fertilized for 24 to 36 hours after ovulation. After this time it travels a variable distance between the fallopian tube and uterus and, if not fertilized, disintegrates and is phagocytized by leukocytes. The ovum is viable for longer than 36 hours, but the ovum is not fertilizable after 36 hours. A nurse is teaching a group of women about the side effects of different types of contraceptives. What frequent side effect associated with the use of an intrauterine device (IUD) should the nurse discuss during the teaching session? 1 Tubal pregnancy 2 Rupture of the uterus 3 Expulsion of the device 4 Excessive menstrual flow - - Excessive menstrual flow After IUD insertion there may be excessive menstrual flow for several cycles. Because the IUD is a foreign body, there is an increase in the blood supply, a result of the inflammatory process. There is no documentation of a tubal pregnancy. Rupture of the uterus may occur on insertion but is uncommon. Expulsion of the device may occur, but it is not classified as a side effect. A nurse from the pediatric clinic who is strongly opposed to any chemical or mechanical method of birth control is asked to work in the family planning clinic. What is the most professional response that this nurse could give to the requesting supervisor? 1 "I will go, but it is against my beliefs and values." 2 "I won't do it, because I do not believe in birth control at all." 3 "I would prefer another assignment that is not contrary to my beliefs." 4
"I will have to stress that the rhythm method is the method of choice." - - "I would prefer another assignment that is not contrary to my beliefs." Expressing a preference for another assignment that is not contrary to the nurse's beliefs is a positive negotiation to be reassigned to an area where the nurse's personal values will not pose a problem. Fulfilling the request even though it is against the nurse's beliefs is an ineffective way to resolve value conflict; undoubtedly a client would sense this conflict. The nurse may not have the legal, ethical, or professional right to refuse this assignment if employed by the facility. Stressing that the rhythm method is the method of choice is unethical and unprofessional. Azithromycin (Zithromax) 0.45 Gm IVPB is prescribed for a client with gonorrhea who is unable to tolerate oral medications. The medication is available in powdered form in a vial containing 500 mg. Instructions indicate that the medication must be reconstituted with 4.8 mL of sterile water and that the powdered medication displaces 0.2 mL. What volume of reconstituted medication should the nurse add to the intravenous piggyback solution? Record your answer using one decimal place. ___ mL - - 4.5mL The prescribed dose of 0.45 Gm should be first converted to 450 mg so what is desired and what you have are expressed in the same unit of measurement. Because the problem does not specify the volume of reconstituted solution, it must be calculated: Add the volume of sterile water (diluent) and the volume displaced by the powdered medication: 4.8 mL + 0.2 mL = 5 mL of solution. Solve the problem with the use of A client is found to have pelvic inflammatory disease, and the health care provider prescribes intravenous cefotetan 2 g twice a day. The instructions on the vial of cefotetan say to reconstitute 20 mL of diluent to yield 1 g/10.5 mL. How much solution (mL) should the nurse add to the 100-mL bag of 0.9% sodium chloride? Record your answer using a whole number. ___ mL - 2x 10.5 = 21mL Which client care activity may a nurse safely delegate to a nursing assistant? 1 Assessing a client's mastectomy incision for signs of inflammation 2 Assisting a client who is recovering from an abdominal hysterectomy to the bathroom 3 Providing information about side effects to a client receiving chemotherapy for breast cancer 4 Evaluating the effectiveness of an antiemetic that was administered to a client to relieve nausea - - Assisting a client who is recovering from an abdominal hysterectomy to the bathroom A nursing assistant is taught how to safely ambulate clients; this activity does not require extensive nursing knowledge or expert clinical judgment. Assessment, teaching,
