Additional Quizzes Flashcards
A young woman is complaining of tenderness and burning of her vulva. On exam, the vulva is edematous and excoriated. The FNP performs a wet mount preparation of vaginal secretions. It reveals pseudohyphae and spores. What is the diagnosis for this patient?
vulvovaginal candidiasis
chlamydial infection
bacterial vaginosis
gonorrhea
vulvovaginal candidiasis
Feedback: Pseudohyphae and spores on the wet mount with potassium hydroxide are diagnostic for candida infection.
young woman presents with complaints of irritation in the vaginal area. This is the first time this has occurred. On exam, the cervix is inflamed and friable. Flagellated protozoa are seen on the wet mount. What is the most likely diagnosis?
trichomoniasis
cervicitis
chlamydial infection
bacterial vaginosis
trichomoniasis
Feedback: Flagellated protozoan confirms the diagnosis of trichomoniasis.
21-year-old female patient presents for her first well-woman exam. She has never been sexually active. Her family history and past medical history are negative for any gynecologic diseases. Her menses occur every 28 days, lasting 5 days, with a relatively moderate flow and no significant dysmenorrhea. Her physical exam should include which tests?
Pap smear
Cultures for gonorrhea and chlamydia
stool hemoccult
baseline mammogram
Pap smear
A young adult patient presents with a history of vaginal itching and heavy white discharge. The patient denies a history of sexual activity. On exam, the FNP finds a red, edematous vulva and white patches on the vaginal walls. The discharge has no odor. What finding would the FNP suspect in the patient’s history?
vegetarian diet
recent diarrhea
early menopause
recent antibiotic use
recent antibiotic use
Feedback: Almost half of all vaginal infections are caused by candida. The majority of women who develop this infection have recently taken antibiotics.
A 46-year-old female patient is being seen in the clinic by the FNP. She was last seen 2 weeks ago for an upper respiratory tract infection and was treated with amoxicillin 250mg PO TID x 10days. She completed her medication last week, but now complains of vaginal itching and thick white discharge. She states that she has never experienced such intense itching. She is in a mutually monogamous relationship. Her LMP was 2 weeks ago. Her partner had a vasectomy. Wet mount shows negative whiff test, rare clue cells, positive lactobacilli, positive hyphae, positive spores, few WBCs, and no trichomonads. She is leaving tomorrow for a week long cruise. She is not taking any medications and has no known drug allergies. The FNP should prescribe which of the following?
metronidazole 500mg PO BID x 7days
clindamycin vaginal cream one applicator full vaginally at HS x 7days
fluconazole 150mg 1 tab PO x1 dose
terconazole vaginal cream 1 applicator @ HS x 7 days.
fluconazole 150mg 1 tab PO x1 dose
Feedback: Fluconazole is approved for a single-dose oral treatment of uncomplicated vulvovaginal candidiasis. It is the most convenient treatment for this patient who will is unlikely to be compliant with vaginal creams given the upcoming travel.
A 25-year-old patient presents with complaints of malodorous vaginal discharge, which is white and watery. She douches with vinegar and water every 2 weeks. She uses a diaphragm for contraception and has been sexually active with her boyfriend for two years, using condoms for STD prevention. Her LMP was 1 week ago, and there are no noted changes in her normal menstrual pattern. Her wet mount shows a positive whiff test, clue cells too numerous to count, no lactobacilli, no hyphae, no spores. What is the diagnosis and treatment for this patient?
chlamydia: doxycycline 100mg PO BID x 10days
candida albicans: terconazole vaginal cream 1 applicator HS x 7days
HSV type 2: acyclovir 200mg PO q4h X 5days
bacterial vaginosis: metronidazole vaginal gel 1 applicator HS x 5 days.
bacterial vaginosis: metronidazole vaginal gel 1 applicator HS x 5 days.
Feedback: Metronidazole vaginal gel is the treatment of choice for bacterial vaginosis in the non-pregnant female. The presence of clue cells, and the associated malodorous discharge and absence of lactobacilli are markers for the diagnosis of bacterial vaginosis.
A 41-year-old patient is seen for her 6-week postpartum exam by the FNP. She is breastfeeding without difficulty and plans to continue for a year. She wants to begin using contraception and plans no further pregnancies. Which of the following is not an appropriate choice for this patient?
Depo-Provera 150mg IM Q 3 months
IUD
Progestin only oral contraceptive
Combination OC
Combination OC
Feedback: Combination OCs are not recommended for breastfeeding mothers because of the effect of estrogen on milk supply. Progestin only OCs, IUDs, and Depo-Provera are acceptable methods of contraception for breastfeeding mothers.
Which two patients should have a Pap smear test performed by the FNP?
An 18-year-old female who reports sexual activity with multiple partners.
A 45-year-old female patient who denies sexual activity but has two children.
A 21-year-old female who denies sexual activity.
A 16-year-old patient who denies sexual activity.
A 45-year-old female patient who denies sexual activity but has two children.
A 21-year-old female who denies sexual activity.
What finding is considered a normal surface characteristic of the cervix?
Small, yellow, raised round area on the cervix.
Red patches with occasional white spots.
Friable, bleeding tissue at the opening of the cervical os.
Irregular granular surface with red patches.
Small, yellow, raised round area on the cervix.
Feedback: A nabothian cyst is a small, white or yellow, raised round area on the cervix and is considered to be a normal variant.
The FNP is reviewing the lab results of a 28-year-old patient recently seen for a pap smear. Classification is high-grade squamous intraepithelial lesion, endocervical cells seen, and adequate smear. The FNP phones the patient and tells her which of the following?
Your pap smear was normal. Follow up in one year or sooner if problems arise.
Your pap smear shows invasive cancer. I would like you to see a gynecologic oncologist for treatment.
Your pap smear shows abnormal tissue that needs to be evaluated. Please schedule an appointment for a colposcopy.
Your pap smear shows a minor abnormality. Sometimes this can signify a disease process that is just beginning. Please schedule a follow up pap smear in 4 months.
Your pap smear shows abnormal tissue that needs to be evaluated. Please schedule an appointment for a colposcopy.
Feedback: The pap smear is a screening test for cervical cancer and precancerous states. The diagnostic test needed to confirm the diagnosis of a high-grade lesion is a colposcopy with guided biopsies.
The FNP is reviewing the lab results of a 61-year-old patient recently seen for a pap smear. Results are: atrophic changes, scent endocervical cells, and adequate smear. She has been treated for breast cancer with mastectomy and tamoxifen. She has never received hormone replacement therapy. What is appropriate for the FNP to tell the patient?
Your pap smear is slightly abnormal. I would recommend the use of some estrogen vaginal cream nightly for 3 weeks, then return to the office to have the pap smear repeated.
Your pap smear is normal but shows some mild thinning of the tissue. This is to be expected in someone who is postmenopausal and not on hormones. It does not pose a threat to your health. Please return to the office in 1 year for your annual exam or sooner if needed.
Your pap smear shows that you don’t have enough endocervical cells. Please make an appointment for endocervical curettage.
Your pap smear is abnormal. This could signify a disease state of the cervix. Please schedule a colposcopy at your earliest convenience.
Your pap smear is normal but shows some mild thinning of the tissue. This is to be expected in someone who is postmenopausal and not on hormones. It does not pose a threat to your health. Please return to the office in 1 year for your annual exam or sooner if needed.
Feedback: Atrophic changes on the cervix of a postmenopausal woman are to be expected, as is the paucity of endocervical cells. Because of her past medical history, she is not a candidate for HRT, and the pap smear results are not abnormal.
An adult patients LMP was 2 months ago. She has had and IUD in place for the last 4 months. She is complaining of nausea, fatigue, breast tenderness, and abdominal bloating. Physical exam reveals the following: Abdomen- no abnormalities noted; Pelvic- cervix with positive Chadwick’s sign, IUD strings protruding from cervix; Uterus- enlarged and non-tender; Adnexa- non-tender, without masses and no CMT. What would be the likely diagnosis?
Uterine fibroid
Ovarian cancer
Dislodged IUD
Pregnancy
Pregnancy
he FNP is talking with a young woman who has been diagnosed with herpes simplex type 2. In discussing her care, it would be important for the FNP to include what information?
The initial lesions are usually worse than lesions that occur in outbreaks at later time.
Her sexual partner will not contract the virus if she does not have sex when the lesions are present.
This condition can be treated and cured if she takes all of the antibiotics for two weeks.
If she becomes pregnant in the future, she will need to have a cesarean section.
The initial lesions are usually worse than lesions that occur in outbreaks at later time.
The initial outbreak is usually the worst. HSV can be transmitted even when lesions are not present, there is no cure. Vaginal delivery is allowed if no lesions are present at the time of labor.
Which is NOT a criterion for the diagnosis of bacterial vaginosis?
Positive amine (whiff) test.
Presence of clue cells.
Vaginal pH greater than 4.5.
Presence of pseudohyphae.
Presence of pseudohyphae.
Feedback: The criteria for diagnosis of bacterial vaginosis are the characteristic milky homogenous discharge, pH greater than 4.5, amine odor with addition of potassium hydroxide, and presence of epithelial cells studded with coccobacilli that obscure borders (clue cells). Pseudohyphae are present in candidiasis.
How does progesterone affect the GI system during pregnancy?
Causes nausea and vomiting early in pregnancy
Causes hypertrophy and bleeding of the gums
Delays gastric emptying time and decreases intestinal peristalsis
Causes diarrhea caused by increased intestinal peristalsis
Delays gastric emptying time and decreases intestinal peristalsis
Feedback: Progesterone affects the GI system by decreasing smooth muscle tone, delaying gastric emptying, and decreasing intestinal peristalsis.
During pregnancy, what is estrogen responsible for?
Hyperpigmentation
Facilitating implantation
Reducing smooth muscle tone
Decreased uterine contractility
Hyperpigmentation
estrogen is responsible for stimulation of the melanin-stimulating hormone, resulting in hyperpigmentation. The other factors are related to progesterone.
What is a positive sign of pregnancy?
Softening of the cervix
Fetal heartbeat
Enlargement of the uterus and abdomen
Mother’s perception of fetal movement
Fetal heartbeat
What are the normal cardiovascular physiologic responses to pregnancy?
Increase HR, increased cardiac output, decreased blood volume, and systolic murmur
Increased HR, decreased cardiac output, increased blood volume, and systolic murmur
Increased HR, increased cardiac output, increased blood volume, and systolic murmur
Decreased HR, increased cardiac output, increased blood volume, and diastolic murmur
ncreased HR, increased cardiac output, increased blood volume, and systolic murmur
Feedback: During pregnancy, a hyperdynamic state is caused by an increase in blood volume, which results in a slightly increased heart rate and increased cardiac output. Systolic ejection murmurs are common and are caused by increased flow across the pulmonic and aortic valves.
During the regular prenatal visits, what assessment data other than vital signs and weight are determined with each visit?
Fundal height, fetal heart rate, urine dip for protein and glucose, and presence of edema
Urinalysis, glucose screen, fundal height, and fetal heart rate
Presence of/changes in Chadwick’s sign, CBC, and blood glucose screening
Pelvic measurements, fundal height, urinalysis, and CBC
Fundal height, fetal heart rate, urine dip for protein and glucose, and presence of edema
Feedback: Fundal height, fetal heart rate, urine dip and assessment of edema are performed with each prenatal visit. The other assessments are not done at every visit.
The recommended office visit interval for a low-risk patient at 28 weeks of pregnancy is every:
4 weeks until 36 weeks
week for the remainder of the pregnancy
2 weeks until 36 weeks
6 weeks until 38 weeks
2 weeks until 36 weeks
The interval for prenatal visits for low-risk women is every 4 weeks until 28 weeks, every 2 weeks from 28-36 weeks, and weekly after 36 weeks.
At an initial prenatal visit occurring in the first trimester, which blood test is NOT recommended?
Antibody screen
Rubella
Maternal serum alpha-fetoprotein
Hepatitis B surface antigen
Maternal serum alpha-fetoprotein
Feedback: Routine laboratory tests include CBC, blood type and Rh, antibody screen, HBSAg, syphilis screen, and rubella immune titer. The MSAFP is done between 15 and 20 weeks and is time-sensitive.
The FNP teaches a prenatal patient that a significant source of toxoplasmosis is:
Rare red meat
Fresh fruits
Raw oysters
Raw vegetables
Rare Red Meat
The FNP would note which finding as a possible sign of preeclampsia?
Urinary urgency at night
Edema in all extremities and a puffy face
Stomach cramps
Clear fluid discharge from the nipple
Edema in all extremities and a puffy face
Which is an abnormal complaint in the second trimester of pregnancy?
Frequent uterine contractions
Frequent fetal movement
Calf cramps
Heartburn
Frequent uterine contractions
Feedback: Contractions can represent preterm labor and should always be evaluated to rule out early cervical change.
Which is an abnormal complaint in the third trimester of pregnancy?
leukorrhea
headache with blurred vision
urinary frequency
uterine contractions
headache with blurred vision
Feedback: Headache associated with visual changes can represent early symptoms of pre-eclampsia and warrants further evaluation.
The FNP is assessing a patient who has a positive pregnancy test. Laboratory data indicate that the mother’s blood type is O positive and the father’s blood type is AB negative. What risk is associated with this pregnancy?
The mother may build up antibodies to the infants blood if the infant is blood type B, which will be significant in future pregnancies.
The mother is Rh positive, if the infant is Rh negative, there is an increased incidence of the infant building up antibodies.
Because the mother is O and the father is AB, there is an increased risk of ABO incompatibility leading to jaundice in the newborn.
Type O blood is the dominant characteristic. The baby’s blood type will be O and there are no associated risks.
Because the mother is O and the father is AB, there is an increased risk of ABO incompatibility leading to jaundice in the newborn.
There is an increased risk of ABO incompatibility if the mother is type O and the father is AB, A, or B.
A young adult female, G2P1A0L1, 10 weeks gestation with intrauterine pregnancy is seen for her first intake and history visit. She knows when she conceived and denies any vaginal bleeding or abdominal pain. The patient has a soft, non-tender fundus that measures 14cm; adnexal exam negative for masses or tenderness, no FHR audible with doppler. What is the most likely diagnosis seen on ultrasound?
Multiple gestation
Fibroid uterus
Ectopic pregnancy
14-week viable IUP
Multiple gestation pregnancies will cause the uterus to enlarge faster than normal. FHR may be inaudible with the doppler due to the 10 weeks gestation. At 10 weeks, the fundus should not be above the pubic bone.
Ten days after delivery, a patient is diagnosed with mastitis. Which of the following should the FNP expect to find on physical exam?
Tender, hard, hot, reddened area on the breast.
Dimpled skin on breasts and firm nodules around the areola.
Decreased milk production, inverted nipples, and firm, inflamed breast tissue.
Soft, tender palpable masses with cracked bleeding nipples.
Tender, hard, hot, reddened area on the breast.
Feedback: A tender, hard, hot and reddened area on the breast over the affected area is typically found with mastitis. The patient with mastitis can also be febrile with flu-like symptoms.
A new first-time mother is being evaluated for a complaint of breast pain. Her infant is 3-weeks-old and she is breastfeeding. The infant is gaining weight and seems satisfied after feeding. On exam, the FNP finds red, irritated nipples on both breasts but no masses or tenderness to the breasts themselves. What is the most important part of the FNPs continued evaluation?
Mammogram of the breast.
Exam of the infant’s mouth.
STAT CBC
Analysis of the milk.
Exam of the infant’s mouth.
Feedback: Nipple irritation in breastfeeding mothers is often caused by candida albicans. The source is usually the infant’s mouth (thrush).
.Which immunization is contraindicated in pregnancy?
Polio
Hepatitis B
MMR
Tetanus
MMR
The patient comes in for her first prenatal visit. She is healthy and has no history that would contribute to complications to the pregnancy. She asks the FNP what she can take for occasional headaches caused by eyestrain and allergies. Which of the following would be appropriate for the FNP to recommend?
Ibuprofen 200mg Q4-6 hours, not to exceed 600mg in 24 hours
Naproxen 220mg Q 8-12 hours
Aspirin 60mg Q6 hours, not to exceed 300mg in 24 hours
Acetaminophen 650mg Q4-6 hours, not to exceed 4000mg in 24 hours
Acetaminophen 650mg Q4-6 hours, not to exceed 4000mg in 24 hours
Acetaminophen is a risk category drug B, problems have not been documented. Aspirin is a risk category D. NSAIDs are also a risk category B, but have been associated with prolonging pregnancy and prematurely closing the fetal ductus arteriosus because of antiprostaglandin effects.
Which medication would be considered safe to use in all trimesters of pregnancy?
metronidazole
tetracycline
isotretinoin
ACE inhibitors
metronidazole
For the patient who wants to breastfeed and take oral contraceptives, what is the pill of choice?
1/35 preparation
Triphasic preparation
Progestin-only preparation
1/50 preparation
progestin-only preparation
Feedback: Estrogen inhibits milk production. Progestin only pills are ideal for breastfeeding because they do not contain estrogen and will not impact milk production.
A pregnant patient in the last trimester complains of a constant back ache aggravated by walking, moving, and bending. The pain does not radiate to either leg. In addition to rest, massage, and physiotherapy, which of the following medications is approved?
Acetaminophen
Codeine
Naproxen
Aspirin
Acetaminophen
Feedback: Acetaminophen is the best option for this patient. Naproxen and Aspirin are contraindicated during pregnancy. Codeine, although used at times during pregnancy, is not indicated for this patient.
A 45-year-old male presents with a several-week history of scrotal pain that worsens with coughing, lifting and straining. He states that his scrotum feels “full” at the end of the day. What would the FNP be suspicious of?
Spermatocele
Inguinal hernia
Epididymitis
Testicular torsion
Inguinal hernia
Feedback: An inguinal hernia presents with the stated symptoms, along with a bulge in either the groin or scrotum that becomes more obvious when standing.
A 65-year-old male presents with a history of well-controlled hypertension and diabetes mellitus. He is a non-smoker. He has been married for 35 years and is monogamous with his partner. He reports that his relationship with his wife is good. He complains of new-onset erectile dysfunction (ED). What is the first line therapy for ED?
Relationship counseling
Oral phosphodiesterase-5 inhibitors
Intraurethral injections of alprostadil
Use of a vacuum device
Oral phosphodiesterase-5 inhibitors
Oral phosphodiesterase-5 inhibitors are safe, effective, and a reasonable choice for first line therapy for ED. This class includes commonly known medications such as sildenafil, vardenafil, tadalafil, and avanafil. Patients should be educated on proper use and potential side effects prior to use.
Which of the following is a common cause of erectile dysfunction?
The use of antihypertensives.
Dietary supplements
Masturbation
It is a natural part of aging.
The use of antihypertensives.
Feedback: Erectile dysfunction can be commonly caused by the use of antihypertensives, particularly thiazide diuretics and beta blockers.
A male patient presents with a complaint of sexual dysfunction. The FNP understands that sexual dysfunction is an impairment of:
Erection only
Emission only
Ejaculation only
Erection, emission, or ejaculation
Erection, emission, or ejaculation
Feedback: In sexual dysfunction, erection, emission, or ejaculation may not be functioning because of multifactorial causes such as medications, vascular disorders, neuropathy, and trauma.
