CHAPTER 17- Women’s Health

Question 1

A woman at 38 weeks gestation has been setting up her baby’s nursery over the weekend. This was done with a lot of bending and lifting. Today, which is Tuesday, she calls the FNP’s office to get clearance to use ibuprofen for body aches. She denies fever or chills but “complains of sore muscles.” The FNP advises her against using ibuprofen because ibuprofen is what?

1. Pregnancy category A drug
2. Pregnancy category B drug
3. Pregnancy category C drug
4. Pregnancy category X drug

Answer 1

4. Pregnancy category X drug

Ibuprofen is considered a Pregnancy category X drug and should not be given in the third trimester.

Question 2

A 15-year-old adolescent who is 12 weeks pregnant with her first child comes for a prenatal visit. The FNP notes that the adolescent had been taking Ortho Tri-cyclen 28 for acne. Upon questioning, the adolescent reports that “I only took the medication when my acne was really bad. I want to continue it because my skin has had a bad breakout for the past month.” The FNP’s best response is:

1. “Feel free to continue the Ortho Tri-cyclen 28 as it will help your acne.”
2. “Do not continue the Ortho Tri-cyclen because it won’t help reduce your acne during pregnancy.”
3. “Ortho Tri-cyclen 28 should not be taken during pregnancy because it can affect the baby’s development.”
4. “Ortho Tri-cyclen 28 should not be taken during pregnancy because it can increase your incidence of morning sickness.”

Answer 2

3. “Ortho Tri-cyclen 28 should not be taken during pregnancy because it can affect the baby’s development.”

Ortho Tri-cyclen 28 should not be taken during pregnancy because it can affect the baby’s development and is a pregnancy category X medication.

Question 3

A woman reports having her last menstrual period on August 13. The FNP knows that using Naegele’s rule will give this woman an estimated due date of which of the following?

1. 42875
2. 42861
3. 43059
4. 43045

Answer 3

1. 42875

Naegele’s rule is used to determine an EDD based on the woman’s reported LMP. To calculate the EDD, take the first day of the LMP + 7 days – 3 months + one year.

Question 4

A woman comes to the FNP for her second prenatal exam. The FNP knows that the woman, by her dates, is 16 weeks gestation. When the FNP measures the fundal height, she gets 16 cm. This is which of the following?

1. Too small for dates
2. Too large for dates
3. Exactly correct size for dates
4. Possible sign of more than one fetus

Answer 4

3. Exactly correct size for dates

For each week gestation after 12 weeks, the normal growth pattern of a single-fetus uterus is 1 cm per week of gestation.

Question 5

A woman at 25 weeks gestation reports to the FNP that after intercourse she had bright red bleeding that lasted for a few hours, soaking one peripad. She denies pain, cramps, or other problems. The FNP knows that this is an indication for what type of testing?

1. Ultrasound
2. CBC
3. Estimated fetal weight
4. Cervical culture

Answer 5

1. Ultrasound

The woman is describing a potential for a placenta previa with bright red bleeding after intercourse. The course of action is to ascertain if this is the diagnosis; an ultrasound would clarify this. If there is no partial or complete placenta previa, then the FNP will rule out other potential causes, such as a friable cervix. A CBC would not ascertain the cause of the blood loss. Measuring estimated fetal weight has no connection to the woman’s reported signs and symptoms. A cervical culture or vaginal exam would never be done before ascertaining if the bleeding is from a placenta previa first.

Question 6

A woman at 25 weeks gestation reports to the FNP that after intercourse she had bright red bleeding that lasted for a few hours soaking one peripad. She denies pain, cramps, or other problems and asks what could have caused this bleeding. The FNP’s best response is which of the following?

1. “Bleeding after intercourse is a normal finding. Don’t worry about it.”
2. “Vaginal bleeding occurs during transition in labor.”
3. “Having painless vaginal bleeding can be a troublesome sign.”
4. “Having painless vaginal bleeding is a sign that labor is imminent.”

Answer 6

3. “Having painless vaginal bleeding can be a troublesome sign.”

“Having painless vaginal bleeding can be a troublesome sign.” Vaginal bleeding after intercourse is never normal. In regard to bleeding with labor, the woman is 25 weeks gestation and if the bleeding is a sign of labor there are usually other signs such as low back pain or cramping that accompany the bleeding, which is generally dark red in color. Further, if the woman was in preterm labor, that would be a troubling sign.

Question 7

A woman at 25 weeks gestation reports to the FNP that after intercourse she had bright red bleeding that lasted for a few hours, soaking one peripad. She denies pain, cramps, or other problems. The FNP knows that these are signs of which of the following?

1. A placental abruption
2. A friable cervix
3. A placenta previa
4. A sexually transmitted infection

Answer 7

3. A placenta previa

A placenta previa presents with the classic signs of painless, bright red, vaginal bleeding, especially in the second trimester. A placental abruption presents with abdominal pain, dark red bleeding, and is not generally related to intercourse. A friable cervix would generally not present with bleeding that lasted a few hours and soaked a peripad. An STI could potentially cause cervical friability, but not this heavy vaginal bleeding.

Question 8

A woman comes to the FNP for her fifth prenatal visit and is 34 weeks by dates and size. She shares with the FNP that she is afraid to be alone at home with her partner. The best response from the FNP would be which of the following?

1. “He doesn’t hit you, does he?”
2. “Many women feel that way at this point in their pregnancies.”
3. “Would you like to tell me more about this?”
4. “That is silly since he is the father of your baby.”

Answer 8

3. “Would you like to tell me more about this?”

In a pattern of IPV, the woman needs to understand she can tell someone whom she trusts about her violent situation. The best way for the FNP to react is to open the door for the woman to discuss it more.

Question 9

A woman comes for her first prenatal visit and reports she has a three-year-old with spina bifida. The FNP knows that this is a neural tube problem and decides to put the woman on folic acid daily. This is done to:

1. Reduce the chances of a neural tube defect in this pregnancy.
2. Increase the risk of neural tube defects.
3. Increase the woman’s hematocrit.
4. Decrease the woman’s hematocrit.

Answer 9

1. Reduce the chances of a neural tube defect in this pregnancy.

Giving the woman oral folic acid has been shown to reduce the risk of neural tube defects, especially with those woman who have had an infant with such a defect in the past.

Question 10

A woman comes to her prenatal visit at 38 weeks gestation reporting regular fetal movement until this morning. She reports that she has not felt the baby move since last night. She reports having a full breakfast today as well. The FNP’s priority action is to do which of the following?

1. Calm the woman with soothing words.
2. Take the woman’s vital signs.
3. Listen to the fetal heart rate with a Doppler.
4. Measure the woman’s fundal height.

Answer 10

3. Listen to the fetal heart rate with a Doppler.

The priority action is to assess the fetal heart rate and the fetal well-being. Once a fetal heart rate has been auscultated, then other things can be done.

Question 11

An adolescent girl comes to the FNP with vesicular lesions around her vaginal introitus that burn and hurt. She reports having intercourse with her boyfriend two weeks before. The FNP knows that this is a primary case of which of the following?

1. Genital Chlamydia
2. Genital herpes
3. Vulvovaginitis
4. Monilia

Answer 11

2. Genital herpes

The most likely diagnosis is genital herpes that occurs 2–7 days after exposure and presents with painful, burning vesicles.

Question 12

A 57-year-old woman who went through menopause 6 years ago comes to see the FNP today. She tells the FNP that she has been having vaginal bleeding for the last 5 days. She denies intercourse in the past few weeks. The FNP decides to look into this further by ordering which of the following tests?

1. Uterine ultrasound
2. Complete blood count to rule out anemia
3. An endometrial biopsy
4. A mammogram

Answer 12

3. An endometrial biopsy

A woman who has been postmenopausal and presents with vaginal bleeding needs to have an endometrial biopsy to rule out endometrial cancer.

Question 13

A woman comes to the FNP for her first prenatal appointment. By her dates and LMP, the FNP believes her to be 12 weeks gestation. The FNP is able to assess the uterine size and finds it to be consistent with the woman’s dates at what size/location?

1. Uterine size of a lemon
2. Uterine size of a baseball
3. Uterine fundus at umbilicus
4. Uterine fundus at symphysis pubis

Answer 13

4. Uterine fundus at symphysis pubis

The normal uterine size and location for 12 weeks gestation is just above the symphysis pubis. Eight weeks gestation is the size of a lemon; 10 weeks is the size of a baseball; uterine fundus at the umbilicus is 20–22 weeks gestation.

Question 14

The best time for the genetic assessment of an Alpha-fetoprotein (AFP) screening test is which of the following?

1. 12–14 weeks gestation
2. 16–18 weeks gestation
3. 22–24 weeks gestation
4. 28–30 weeks gestation

Answer 14

2. 16–18 weeks gestation

The best time to get the most accurate reading of an AFP test is at 16–18 weeks gestation. Alpha-Fetoprotein is produced by the fetal liver and can be tested for via the maternal blood. It is a screening test to assess the risk for Neural Tube Defects (NTD) in each pregnancy. This test is best performed between 16 and 18 weeks gestation for increased reliability. If the test is abnormal, follow-up procedures to rule out NTD include genetic counseling for families with history of NTD, repeated AFP, high resolution ultrasound, and potentially an amniocentesis.

Question 15

The FNP is caring for a pregnant women who reports her obstetric history as having three children, all of whom are living. One was born at 39 weeks gestation, another at 34 weeks gestation, and another at 35 weeks gestation. How will the FNP document the patient’s gravity and parity using the G-TPAL system?

1. G3 1-2-0-3
2. G3 0-3-0-3
3. G4 1-1-1-3
4. G4 1-2-0-3

Answer 15

4. G4 1-2-0-3

The pregnant woman is now experiencing her fourth pregnancy, which is documented as G4. One child was full term and two children were born prematurely at less than 38 weeks. All three children are living. She is a G4, P = 1 FT, 2 (premature), 0 abortions, and 3 living.

Question 16

The FNP is caring for a woman in the prenatal clinical who is in her sixth week of pregnancy. The patient reports urinary frequency and asks if this will continue throughout the pregnancy. Which response by the FNP is MOST accurate?

1. “If you decrease your fluid intake, the problem will be less bothersome.”
2. “Urinary frequency persists until the 12th week, but it may continue if you have poor bladder tone.”
3. “It is difficult to predict how long this will last for individuals.”
4. “This may last until the 12th week of your pregnancy but will be alleviated as your due date approaches.”

Answer 16

4. “This may last until the 12th week of your pregnancy but will be alleviated as your due date approaches.”

Urinary frequency usually disappears around week 12 of gestation (the fetus takes up more space higher in the uterus with less pressure on the bladder), but as the enlarging uterus puts pressure on the bladder, the problem returns near the due date.

Question 17

A 28-year-old woman who is eight weeks pregnant comes to see the FNP with complaints of nausea, vomiting, and frequent urination. Based on this information, the FNP knows these are most indicative of which signs of pregnancy?

1. Presumptive signs of pregnancy
2. Positive signs of pregnancy
3. Probable signs of pregnancy
4. Signs of a urinary tract infection

Answer 17

1. Presumptive signs of pregnancy

Presumptive signs of pregnancy are breast changes, amenorrhea, nausea, vomiting, and urinary frequency and quickening. Signs of a urinary tract infection are burning and pain on urination, strong malodorous urine. Positive signs of pregnancy are visualization of the fetus via ultrasound and the auscultation of fetal heart tones. Probable signs include a positive pregnancy test; Goodell’s, Hegar’s, and Chadwick signs; and ballottement.

Question 18

A woman returns for her second prenatal visit at 14 weeks gestation. The FNP measures her fundal height at the woman’s umbilicus. The FNP will order which diagnostic test to assess the situation?

1. Amniocentesis to assess for fetal genetic abnormality
2. GCT to assess for gestational diabetes
3. Maternal serum AFP to assess for Down syndrome
4. Ultrasound to assess for number of fetuses

Answer 18

4. Ultrasound to assess for number of fetuses

At approximately 16 weeks gestation, the maternal uterine size will be greater than dates if there is more than one fetus. An ultrasound will assist in the determination of the number of fetuses in the woman’s uterus. An amniocentesis, GCT, or AFP test does not address the larger-than-normal uterus.

Question 19

The nurse practitioner is working in an outpatient obstetric office and assesses four primigravida clients. Which of the following client findings would the nurse prioritize for a potential referral?

1. 17 weeks gestation; denies feeling fetal movement
2. 24 weeks gestation; fundal height at umbilicus
3. 27 weeks gestation; complaints of excessive salivation
4. 34 weeks gestation; complaints of hemorrhoid pain

Answer 19

2. 24 weeks gestation; fundal height at umbilicus

A normal fundal height for 24 weeks gestation is 1–2 fingerbreadths above the umbilicus/24 cm from the symphysis pubis to the uterine fundus. Since this is smaller than expected, the FNP will consider a referral to an OB/GYN. The other findings are normal changes that happen with pregnancy.

Question 20

Susan comes to the FNP for her first prenatal appointment with this pregnancy. Using Naegele’s rule and the woman’s last menstrual period date, the FNP determines she is 12 weeks gestation. Susan reports previous pregnancies, and the FNP documents them as G3 T-1, P-1, A-0, L-1. She reports having a fetal demise at 34 weeks gestation during her second pregnancy and states the autopsy revealed a male infant, weighing 4300 grams with no evident cause of death. Upon questioning, the woman reports “I think they told me my sugar testing was high but they never did anything about it.” What does the FNP know that could have contributed to Susan’s fetal demise?

1. A second pregnancy
2. A small-for-gestational age fetus
3. A normal-sized fetus
4. An elevated blood sugar level

Answer 20

4. An elevated blood sugar level

A woman who has “high sugar” levels is possibly a gestational diabetic. With these pregnancies, the woman will have a large-for-gestational-age infant, with the potential for a fetal demise due to uncontrolled maternal blood sugar levels. A second pregnancy has nothing to do with the fetal demise. The fetus was a large-for-gestational-age fetus, being over 4000 g.

Question 21

The FNP is caring for a patient at 24 weeks gestation, complaining of low back pain and increased vaginal secretions. She denies flu-like symptoms or other problems. What is the most likely diagnosis for this patient?

1. Vaginal infection
2. Premature rupture of membranes
3. Preterm labor
4. Back strain due to heavy lifting

Answer 21

3. Preterm labor

A 24-week gestation pregnancy with these symptoms should alert the FNP to potential signs of preterm labor. The other answers do not fit this scenario. The FNP will need to do a thorough history and vaginal exam to rule all of this out or to confirm the diagnosis.

Question 22

A 22-year-old woman comes to the FNP to discuss her menstrual cycle. She reports irregular menses with light vaginal bleeding every 30–40 days. She also reports facial hair and an increase in her weight. Based on this information, the FNP suspects what diagnosis for this patient?

1. Premenstrual syndrome (PMS)
2. Polycystic ovarian syndrome (PCOS)
3. Pregnancy
4. Perimenopause at an early age

Answer 22

2. Polycystic ovarian syndrome (PCOS)

These symptoms reported by this woman are consistent with PCOS. The symptoms that support this diagnosis are light, irregular periods, weight gain, and androgenic changes. The symptoms are not consistent with the other choices.

Question 23

The FNP knows that giving a teenager the three-injection vaccine series of Gardasil will reduce the teen’s chances of contracting what?

1. Breast cancer
2. Rubella
3. Human papilloma virus
4. Syphilis

Answer 23

3. Human papilloma virus

Gardasil is a recombinant human papillomavirus vaccine [types 6, 11, 16, 18] used in the prevention of certain strains of human papillomavirus, specifically HPV types 6, 11, 16, and 18. It also reduces the potential for getting cervical cancers by reducing HPV that is correlated to cervical cancer. There is no vaccine for the prevention of breast cancer or syphilis. Rubella occurrences are reduced by giving a single-dose vaccine against that virus.

Question 24

The menopausal woman has many hormonal changes that may cause her to have dyspareunia. The FNP knows that, in order to reduce dyspareunia, the woman could be put on hormone replacement therapy (HRT). What is an absolute contraindication to doing this?

1. History of hirsutism
2. History of fibrocystic disease
3. History of a mastectomy
4. History of mood changes

Answer 24

3. History of a mastectomy

A history of breast cancers for which a mastectomy was done is an absolute contraindication to HRT. History of hirsutism and fibrocystic disease are not contraindications for HRT. Mood changes are potential side effects of HRT but are not absolute contraindications.

Question 25

A patient who is 27 weeks gestation comes for her fourth prenatal appointment with the FNP. She reports no issues but asks, “Is it okay for me to use peripads to keep my panties dry? I continue to have wet panties since last week.” What is the best response from the FNP?

1. “Peripads are fine to Just don’t use tampons.”
2. “Tell me more about this wetness that you are describing.”
3. “Any wetness in your panties during pregnancy is due to what we call leukorrhea. It is normal in pregnancy.”
4. “Don’t worry about anything. I will make sure everything is okay with your pregnancy.”

Answer 25

2. “Tell me more about this wetness that you are describing.”

The best response is this therapeutic one. The others are not accurate or helpful.

Question 26

A woman who is 32 weeks gestation comes to the FNP’s office reporting leaking of clear, odorless fluid since two days ago. The woman denies fever, chills, or reduced fetal movement. What test will give the FNP the best information to address this issue and form a diagnosis?

1. Doing the first sonogram
2. Doing a ferning test
3. Doing a Leopold’s maneuver
4. Doing a HA1C

Answer 26

2. Doing a ferning test

The ferning test will evaluate whether the woman has spontaneous rupture of membranes (SROM). An initial sonogram cannot be compared to anything to assess if amniotic fluid volume is reduced. A Leopold’s maneuver or hA1C do not evaluate for SROM.