Practice Questions Flashcards
Which of the following is a contraindication to estrogen / progestin-containing methods (combined oral
contraception [COC], patch [Ortho Evra], or ring
[NuvaRing])?
A. mother with a history of breast cancer
B. personal history of hepatitis A at age 10 years
C. presence of factor V Leiden mutation
D. cigarette smoking one pack per day in a 22-year-old
C. presence of factor V Leiden mutation
A 22-year-old woman taking a 35-mcg ethinyl estradiol COC calls after forgetting to take her pills for 2 consecutive days. She is 2 weeks into the pack. You advise her to:
A. take the last pill missed immediately, even if this means taking 2 pills today.
B. discard two pills and take two pills today.
C. discard the rest of the pack and start a new pack with the first day of her next menses.
D. continue taking one pill daily for the rest of
the cycle.
A. take the last pill missed immediately, even if this means taking 2 pills today.
When counseling a woman about COC use, you advise that:
A. long-term use of COC is discouraged because the body needs a “rest” from birth control pills from time to time.
B. fertility is often delayed for many months after
discontinuation of COC.
C. there is an increase in the rate of breast cancer after protracted use of COC.
D. premenstrual syndrome symptoms are often improved with use of COC.
D. premenstrual syndrome symptoms are often improved with use of COC.
Noncontraceptive benefits of COC use include a decrease in all of the following except: A. iron-deficiency anemia. B. pelvic inflammatory disease (PID). C. cervicitis. D. ovarian cancer.
C. cervicitis.
Which of the following women is the best candidate for progestin-only pill (POP) use?
A. an 18-year-old woman who frequently forgets to take prescribed medications
B. a 28-year-old woman with multiple sexual
partners
C. a 32-year-old woman with adequately-controlled hypertension
D. a 26-year-old woman who wants to use the pill
to help “regulate” her menstrual cycle
C. a 32-year-old woman with adequately-controlled hypertension
The most common reasons for discontinuing oral contraception use is breakthrough bleeding and: A. nausea/vomiting. B. inconvenience of use. C. cost. D. high failure rate.
B. inconvenience of use.
A 38-year-old nulliparous woman who smokes two and a half packs a day is in an “on-and-off” relationship. The woman presents seeking contraception. Which of the following represents the most appropriate method? A. contraceptive ring (NuvaRing) B. COC C. contraceptive patch (Ortho Evra) D. vaginal diaphragm
D. vaginal diaphragm
Due to an increased risk of blood clots, an alternative to the contraceptive ring (NuvaRing) or patch
(Ortho Evra) is preferred in all of the following women except:
A. a 42-year-old nulliparous woman.
B. 31-year-old woman with history of naturally
occurring multiple gestation pregnancy
C. 28-year-old who smokes one pack per day.
D. 33-year-old woman with a family history of venous thrombosis.
B. 31-year-old woman with history of naturally
occurring multiple gestation pregnancy
Which of the following statements is true concerning vaginal diaphragm use?
A. When in place, the woman is aware that the diaphragm fits snugly against the vaginal walls.
B. This is a suitable form of contraception for women with recurrent urinary tract infection.
C. After insertion, the cervix should be smoothly covered.
D. The device should be removed within 2 hours of coitus to minimize the risk of infection.
C. After insertion, the cervix should be smoothly covered.
According to the U.S. Medical Eligibility Criteria for Contraception Use, which of the following is a clinical condition in which use of a copper-containing IUD should be approached with caution? A. uncomplicated valvular heart disease B. AIDS-defining illness C. hypertension D. dysmenorrhea
B. AIDS-defining illness
Which of the following is the most appropriate response to a 27-year-old woman who is taking phenytoin (Dilantin) for the treatment of a seizure disorder and is requesting hormonal contraception?
A. “A barrier method would be the preferable choice.”
B. “COC is the best option.”
C. “Depo-Provera (medroxyprogesterone acetate in a depot injection [DMPA]) use will likely not
interact with your seizure medication.”
D. “Copper-containing IUD use is contraindicated.”
C. “Depo-Provera (medroxyprogesterone acetate in a depot injection [DMPA]) use will likely not
interact with your seizure medication.”
Which of the following is commonly found after 1 year of using DMPA (Depo-Provera)?
A. weight gain
B. hypermenorrhea
C. acne
D. rapid return of fertility when discontinued
A. weight gain
Yes or no? According to the U.S. Medical Eligibility Criteria for Contraception
Use, who is a category 1 or 2 COC candidate?
A 22-year-old woman who smokes one pack per day.
Yes
Yes or no? According to the U.S. Medical Eligibility Criteria for Contraception
Use, who is a category 1 or 2 COC candidate? A 29-year-old woman with PID.
Yes
Yes or no? According to the U.S. Medical Eligibility Criteria for Contraception
Use, who is a category 1 or 2 COC candidate? A 45-year-old woman with tension-type headache.
Yes
Yes or no? According to the U.S. Medical Eligibility Criteria for Contraception
Use, who is a category 1 or 2 COC candidate? A 32-year-old woman breastfeeding a 6-month-old infant.
Yes
Yes or no? According to the U.S. Medical Eligibility Criteria for Contraception
Use, who is a category 1 or 2 COC candidate? A 28-year-old woman with type 1 diabetes mellitus.
Yes, in the absence of advanced vascular disease.
Yes or no? According to the U.S. Medical Eligibility Criteria for Contraceptive Use, is this person a candidate for a copper-containing IUD? A 45-year-old woman with fibroids with uterine cavity distortion.
No
Yes or no? According to the U.S. Medical Eligibility Criteria for Contraceptive Use, is this person a candidate for a copper-containing IUD? A 33-year-old woman who smokes 2 packs per day.
Yes
Yes or no? According to the U.S. Medical Eligibility Criteria for Contraceptive Use, is this person a candidate for a copper-containing IUD? A 25-year-old woman with hypertension.
Yes
Yes or no? According to the U.S. Medical Eligibility Criteria for Contraceptive Use, is this person a candidate for a copper-containing IUD? A 33-year-old woman with low-grade squamous intraepithelial lesions noted on PAP test?
Yes
As you prescribe COC containing the progestin drospirenone (Loryna, Ocella, Vestura, Yasmin, Yaz),
you offer the following advice:
A. “Always take this pill on a full stomach.”
B. “You should not take acetaminophen when using this birth control pill.”
C. “Avoid using potassium-containing salt substitutes.”
D. “You will likely notice that premenstrual syndrome symptoms might become worse.”
C. “Avoid using potassium-containing salt substitutes.”
A 26-year-old mother who breastfeeds her 10-monthold child queries about contraceptives. In counseling her on the use of the progestin-only pill (POP), you mention all of the following except:
A. the pill is taken every day.
B. POP is a more effective contraceptive than COC.
C. POP does not alter the quality or quantity of breastmilk.
D. POP is associated with bleeding irregularity, ranging from prolonged flow to amenorrhea.
B. POP is a more effective contraceptive than COC.
By using a diaphragm with spermicide nonoxynol-9 during sexual intercourse, a woman is likely at
increased risk for:
A. cervical stenosis.
B. urinary tract infection.
C. increased perivaginal lactobacilli colonization.
D. ovarian malignancy.
B. urinary tract infection.
With the use of a levonorgestrel intrauterine system (Mirena), which one of the following is normally noted? A. endometrial hyperplasia B. hypermenorrhea C. increase in PID rates D. reduction in menstrual flow
D. reduction in menstrual flow
The reduction in free androgens noted in a woman using COC can yield an improvement in: A. cycle control. B. acne vulgaris. C. breast tenderness. D. rheumatoid arthritis.
B. acne vulgaris.
With DMPA in depot injection (Depo-Provera), the recommended length of use is usually:
A. less than 1 year.
B. no more than 2 years.
C. as long as the woman desires this form of contraception.
D. as determined by her lipid response to the medication.
B. no more than 2 years.
Irregular bleeding associated with DMPA (Depo-Provera) can be minimized with the use of all of the following except: A. acetaminophen. B. ibuprofen. C. naproxen sodium. D. estrogen supplements.
A. acetaminophen.
When can a woman safely conceive after discontinuing COC use? A. immediately B. after 1 to 2 months C. after 3 to 4 months D. after 5 to 6 months
A. immediately
When prescribing the contraceptive patch (Ortho Evra) or vaginal ring (NuvaRing), the
NP considers that:
A. these are progestin-only products.
B. candidates include women who have difficulty remembering to take a daily pill.
C. there is significant drug interactions with both products.
D. contraceptive efficacy is less than with COC.
B. candidates include women who have difficulty remembering to take a daily pill.
True/False. The use of combined oral contraception (COC) reduces menstrual volume by approximately
60%, thereby reducing the risk of iron deficiency anemia.
True
True/False. Nausea with oral contraceptive use can be minimized by taking the pill on an empty stomach.
False
True/False. Calcium and vitamin D supplementation is recommended for those taking DMPA (Depo-
Provera) injections to minimize the risk of a loss in bone density.
True
An 18-year-old woman requests emergency contraception after having unprotected vaginal intercourse approximately 18 hours ago. Today is day 12 of her normally 27- to 29-day menstrual cycle and she has no contraindications to the use of any currently available forms of emergency contraception. You advise her that:
A. emergency hormonal contraception use reduces the risk of pregnancy by approximately 33%.
B. all forms of emergency contraception must be used within 12 hours after unprotected intercourse.
C. the likelihood of conception is minimal.
D. insertion of a copper-containing IUD offers a effective form of emergency and ongoing contraception.
D. insertion of a copper-containing IUD offers a effective form of emergency and ongoing contraception.
Which of the following is likely not among the proposed mechanisms of action of all forms of oral emergency contraception? A. inhibits ovulation B. acts as an abortifacient C. slows sperm transport D. slows ovum transport
B. acts as an abortifacient
A 24-year-old woman who requests emergency contraception pills wants to know the effects if pregnancy does occur. You respond that there is the risk of increased rate of: A. spontaneous abortion. B. birth defects. C. placental abruption. D. none of the above.
D. none of the above.
In contrast to progestin-only emergency contraception, a possible mechanism of action of ulipristal is: A. inhibiting embryo implantation. B. impairing sperm transport. C. through spontaneous abortion. D. impairing ovum transport.
A. inhibiting embryo implantation.
You see a 34-year-old woman who reports having unprotected sexual intercourse 4 days ago and requests emergency contraception. She has a recent history of gonorrhea that was treated successfully. The most acceptable and effective option in this clinical scenario is:
A. progestin-only emergency contraception.
B. ulipristal.
C. copper-containing IUD.
D. nothing, as 4 days is too long for emergency contraception to be effective.
B. ulipristal.
Which of the following statements is false?
A. Progestin-only emergency contraception can be taken as one dose or two doses.
B. Ulipristal is available by prescription only.
C. Progestin-only emergency contraception is available OTC for women 17 years old and older.
D. Ulipristal is taken in two doses 12 hours apart.
D. Ulipristal is taken in two doses 12 hours apart
A woman who has used emergency contraception pills should be advised that if she does not have a normal menstrual period within \_\_\_\_\_ weeks, a pregnancy test should be obtained. A. 1 to 2 B. 2 to 3 C. 3 to 4 D. 4 to 5
C. 3 to 4
You are testing a patient for Hep B. The results come back: HBsAG: Negative anti-HBc: Negative anti-HBs: Negative This indicates: A. Immune due to natural infection. B. Susceptible. C. Immune due to Hep B vaccination. D. Chronically infected. E. Acutely infected.
B. Susceptible.
You are testing a patient for Hep B. The results come back: HBsAG: Negative anti-HBc: Positive anti-HBs: Positive This indicates: A. Immune due to natural infection. B. Susceptible. C. Immune due to Hep B vaccination. D. Chronically infected. E. Acutely infected.
A. Immune due to natural infection.
You are testing a patient for Hep B. The results come back: HBsAG: Negative anti-HBc: Negative anti-HBs: Positive This indicates: A. Immune due to natural infection. B. Susceptible. C. Immune due to Hep B vaccination. D. Chronically infected. E. Acutely infected.
C. Immune due to Hep B vaccination.
You are testing a patient for Hep B. The results come back: HBsAG: Positive anti-HBc: Positive IgM anti-HBc: Positive anti-HBs: Negative This indicates: A. Immune due to natural infection. B. Susceptible. C. Immune due to Hep B vaccination. D. Chronically infected. E. Acutely infected.
D. Chronically infected.
You are testing a patient for Hep B. The results come back: HBsAG: Positive anti-HBc: Positive IgM anti-HBc: Negative anti-HBs: Negative IgG anti-HBc: Positive This indicates: A. Immune due to natural infection. B. Susceptible. C. Immune due to Hep B vaccination. D. Chronically infected. E. Acutely infected.
D. Chronically infected.
You are testing a patient for Hep B. The results come back: HBsAG: Negative anti-HBc: Positive anti-HBs: Negative This indicates: A. Immune due to natural infection. B. Susceptible. C. Immune due to Hep B vaccination. D. Chronically infected. E. Acutely infected. F. None of the above.
F. None of the above.
Interpretation unclear; four possibilities:
Resolved infection (most common)
False-positive anti-HBc, thus susceptible
“Low level” chronic infection
Resolving acute infection.
Your patient has been exposed to Hep C. Lab results are as follows:
HCV antibody: Nonreactive.
What is your next action?
A. Infection unlikely. No further action required.
B. Consistent with current HCV infection, or past HCV infection that has resolved, or false positive. Test for HCV RNA to identify current infection.
C. Provide person with appropriate counseling and refer for care and treatment.
D. No further action required in most cases. Possibly false positive.
A. Infection unlikely. No further action required.
Your patient has been exposed to Hep C. Lab results are as follows:
HCV antibody: Reactive.
What is your next action?
A. Infection unlikely. No further action required.
B. Consistent with current HCV infection, or past HCV infection that has resolved, or false positive. Test for HCV RNA to identify current infection.
C. Provide person with appropriate counseling and refer for care and treatment.
D. No further action required in most cases. Possibly false positive.
B. Consistent with current HCV infection, or past HCV infection that has resolved, or false positive. Test for HCV RNA to identify current infection.
Your patient has been exposed to Hep C. Lab results are as follows:
HCV antibody: Reactive.
HCV RNA: Detected.
What is your next action?
A. Infection unlikely. No further action required.
B. Consistent with current HCV infection, or past HCV infection that has resolved, or false positive. Test for HCV RNA to identify current infection.
C. Provide person with appropriate counseling and refer for care and treatment.
D. No further action required in most cases. Possibly false positive.
C. Provide person with appropriate counseling and refer for care and treatment.
Your patient has been exposed to Hep C. Lab results are as follows:
HCV antibody: Reactive.
HCV RNA: Not detected.
What is your next action?
A. Infection unlikely. No further action required.
B. Consistent with current HCV infection, or past HCV infection that has resolved, or false positive. Test for HCV RNA to identify current infection.
C. Provide person with appropriate counseling and refer for care and treatment.
D. No further action required in most cases. Possibly false positive.
D. No further action required in most cases. Possibly false positive.
A patient has a positive ELISA test. What is your next action?
A. HIV counseling and medication.
B. Hep B counseling and medication.
C. Education about the need for confirmatory testing, followed by a Western blot test.
D. Nothing. This is the expected result.
C. Education about the need for confirmatory testing, followed by a Western blot test.
A patient with HIV informs you she has not told anyone except her partner about her diagnosis. How do you counsel her?
A. Affirm that the choice is hers and talk to her about identifying supportive persons who can be helpful as the patient adapts to her treatment.
B. Inform her that she is being reckless and family members living with her need to know.
C. Inform her mandatory reporting allows you to inform any close relatives of their risk.
D. None of the above.
A. Affirm that the choice is hers and talk to her about identifying supportive persons who can be helpful as the patient adapts to her treatment.
All of the following are infections that affect mostly the labia and vagina except: A) Bacterial vaginosis B) Candidiasis C) Trichomoniasis D) Chlamydia trachomatis
D) Chlamydia trachomatis.
Infections that commonly affect the labia and vagina
include bacterial vaginosis, candidiasis, and trichomoniasis. Chlamydia trachomatis
commonly affects the cervix, endometrial lining , fallopian tubes, and pelvic cavity.
Patients who are diagnosed with gonorrhea should also be treated for which of the following infections? A) Chancroid B) Chlamydia trachomatis C) Herpes genitalis D) PID (pelvic infl ammatory disease)
B) Chlamydia trachomatis.
When diagnosed with gonorrhea, the patient should also be treated for Chlamydia trachomatis.
Human papilloma virus (HPV) infection of the larynx has been associated with:
A) Laryngeal neoplasia
B) Esophageal stricture
C) Cervical cancer
D) Metaplasia of esophageal squamous cells
A) Laryngeal neoplasia.
HPV infection of the larynx has been associated with
laryngeal neoplasia; HPV infection of the cervix is associated with cervical cancer.
A 30-year-old female who is sexually active complains of a large amount of milk-like
vaginal discharge for several weeks. A microscopy slide reveals a large amount
of squamous epithelial cells that have blurred margins. Very few white blood cells
are seen. The vaginal pH is at 6.0. What is most likely?
A) Trichomonas infection
B) Bacterial vaginosis
C) Candidal infection
D) A normal fi nding
B) Bacterial vaginosis.
Bacterial vaginosis is a bacterial infection of the vagina.
Signs and symptoms include copious off-white to gray discharge with foul odor
without vaginal erythema or irritation. Wet prep will show positive for clue cells.
When performing a wet prep, the “whiff test” will be positive for a strong “fi shy”
odor when vaginal discharge is mixed with one drop of KOH.
The Pap smear result on a 20-year-old sexually active student who uses condoms
inconsistently shows a large amount of infl ammation. Which of the following is the
best follow-up action?
A) The NP needs to do cervical cultures to verify the presence of gonorrhea
B) Prescribe metronidazole vaginal cream for the patient over the phone
C) Call the patient and tell her she needs a repeat Pap smear in 6 months
D) Advise the patient to use a Betadine douche at bedtime x 3 days
A) The NP needs to do cervical cultures to verify the presence of gonorrhea.
Cultures should be taken at the time of the Pap smear, as the patient may not return for later diagnostic testing.
While performing a Pap smear on a postmenopausal patient, several areas of flat white skin lesions that are irregularly shaped are found on the patient’s labia. The patient reports that the lesions are extremely itchy and have been present for several
years without much change. Which condition is best described?
A) Chronic scabies infection
B) Lichen sclerosus
C) Chronic candidal vaginitis
D) A physiologic variant found in some older women
B) Lichen sclerosus.
Lichen sclerosus is a disease of the skin, in which white
spots appear on the skin and change over time. It is most commonly seen in the
genital and rectal areas, but can appear in other areas. The spots are usually shiny and smooth and can eventually spread into patches. The skin appears thin and
crinkled. Then the skin tears easily, and bright red or purple bruises are common.
Sometimes, the skin becomes scarred. If the disease is a mild case, there may be no
symptoms.
A sexually active woman is complaining of amenorrhea and vaginal spotting. On
exam, her left adnexa is tender and cervical motion tenderness is positive. Which
test should the nurse practitioner initially order?
A) Flat plate of the abdomen
B) Complete blood count (CBC) with white cell differentials
C) Urine pregnancy test
D) Pelvic ultrasound
C) Urine pregnancy test.
A urine pregnancy test should be performed to rule out
miscarriage and/or tubal pregnancy.
Fitz-Hugh-Curtis syndrome is associated with which following infection? A) Syphilis B) Chlamydia trachomatis C) Herpes genitalis D) Lymphogranuloma venereum
B) Chlamydia trachomatis.
Fitz-Hugh-Curtis is a complication of having pelvic
inflammatory disease that was caused by a vaginal infection, such as gonorrhea or
Chlamydia trachomatis. This causes infl ammation and infection in the pelvic cavity.
Left untreated, this infection can cause adhesions that stretch from the peritoneum
to the liver.
A 44-year-old female who is undergoing treatment for infertility complains of not
having a menstrual period for a few months. The night before, she started spotting
and is now having cramp-type pains in her pelvic area. Her blood pressure (BP) is
160/80, the pulse rate is 110, and she is afebrile. Her labs reveal a mild anemia with
mild leukocytosis. On pelvic exam, the uterine fundus is found above the symphysis
pubis. The cervical os is dilated at 3 cm. Which of the following is most likely?
A) Inevitable abortion
B) Threatened abortion
C) Incomplete abortion
D) Acute pelvic infl ammatory disease
A) Inevitable abortion.
Inevitable abortion is defined as vaginal bleeding with pain and cervical dilation and/or effacement. Threatened abortion is defi ned as
vaginal bleeding with absent or minimal pain and a closed, long, and thick cervix. Incomplete abortion is moderate to diffuse vaginal bleeding, with the passage of
tissue and painful uterine cramping or contractions. Acute pelvic inflammatory
disease is a sudden onset of infl ammation and pain that affects the pelvic area, cervix, uterus, and ovaries, which is caused by infection.
Stella works in the housekeeping department of a hospital. She presents to the
employee health clinic with a complaint of a needlestick to her left thumb. The needle
was in one of the garbage bags from the emergency room. The patient had a little
bleeding that stopped spontaneously. Which of the following is the next step?
A) Order an enzyme-linked immunosorbent assay (ELISA) test as soon as possible
B) Recommend a tetanus booster in 1 week
C) Offer the patient hepatitis B immunoglobulin
D) Order a chest x-ray
A) Order an enzyme-linked immunosorbent assay (ELISA) test as soon as possible.
Employee health clinic protocols for needlesticks recommend ordering an
ELISA test as soon as possible to establish baseline blood work for the employee.
A college student has recently been informed that he has an HPV (human papilloma
virus) infection on the shaft of his penis. Which of the following may reveal
subclinical lesions on the penile skin?
A) Perform a KOH (potassium hydroxide) exam
B) Scrape off some of the affected skin and send it for a culture and sensitivity
C) Apply acetic acid to the penile shaft and look for acetowhite changes
D) Order a serum herpes virus titer
C) Apply acetic acid to the penile shaft and look for acetowhite changes.
Lesions of HPV infection will turn white with application of acetic acid.
The ELISA and Western Blot tests are both used to test for HIV. Which of the following
statements is correct?
A) It is a test to detect viral RNA
B) A positive ELISA screening does not mean the person has HIV infection
C) It is a test to detect viruses
D) It is a diagnostic test for the AIDS virus
B) A positive ELISA screening does not mean the person has HIV infection.
The ELISA test is always followed by a Western blot test to confirm diagnosis.
The Jarisch-Herxheimer reaction is best described as:
A) An immune-mediated reaction precipitated by the destruction of a large number
of spirochetes due to an antibiotic injection
B) Severe chills and elevated blood pressure
C) Caused by infection with either Chlamydia trachomatis or gonorrheal infection
of the liver capsule
D) Associated with certain viral illnesses
A) An immune-mediated reaction precipitated by the destruction of a large
number of spirochetes due to an antibiotic injection.
The Jarisch-Herxheimer
reaction is defi ned as an immune-mediated reaction precipitated by the destruction
of a large number of spirochetes due to the antibioitic injection.
During a breast exam of a 30-year-old nulliparous female, the nurse practitioner
palpates several rubbery mobile areas of breast tissue. They are slightly tender to
palpation. Both breasts have symmetrical fi ndings. There are no skin changes or any
nipple discharge. The patient is expecting her menstrual period in 5 days. Which of
the following would you recommend?
A) Referral to a gynecologist for further evaluation
B) Tell her to return 1 week after her period so her breasts can be rechecked
C) Advise the patient to return in 6 months to have her breasts rechecked
D) Schedule the patient for a mammogram
B) Tell her to return 1 week after her period so her breasts can be rechecked. Prior
to having menses, women will experience breast changes of tenderness with palpation, with symmetrical soft, mobile areas of breast tissue that are benign. Her symptoms should improve after her menses and repeating the exam in 1 week would be recommended.
Which of the following should you expect to fi nd on a wet-mount slide of a patient
diagnosed with bacterial vaginosis?
A) Tzanck cells
B) A large amount of leukocytes and epithelial cells
C) A large amount of bacteria coating the squamous cells and very few leukocytes
D) Epithelial cells and a small amount of blood
C) A large amount of bacteria coating the squamous cells and very few leukocytes.
Results of the wet mount for bacterial vaginosis include bacteria coating
the squamous cells (clue cells) and very few leukocytes or RBCs.
A 14-year-old teen is worried that she has not started to menstruate like most of
her friends. During the gynecological examination, the nurse practitioner tells the
mother, who is in the room with the patient, that her daughter is starting Tanner
Stage II. What are the physical exam findings during this stage?
A) Breast buds and some straight pubic hair
B) Fully developed breasts and curly pubic hair
C) Breast tissue with the areola on a separate mound with curly pubic hair
D) No breast tissue and no pubic hair
A) Breast buds and some straight pubic hair. Tanner Stage II in females includes
breast buds and few straight, fi ne pubic hairs.
A patient is positive for anti-HCV (hepatitis C virus antibody). What is the next
step to further evaluate this patient?
A) Refer the patient to a gastroenterologist
B) Order a hepatitis C PCR (polymerase chain reaction) test
C) Order a hepatitis B comprehensive panel
D) The patient is immune to hepatitis C and no further testing is indicated
B) Order a hepatitis C PCR (polymerase chain reaction) test.
When a patient
tests positive for anti-HCV (hepatitis C virus antibody), labs ordered should
include hepatitis C PCR to further evaluate the patient.
Jenny, a 21-year-old, complains to you of a 1-week episode of dysuria, frequency,
and a strong odor to her urine. This is her second episode of the year. What is the
most appropriate follow-up for this patient?
A) Order a urinalysis and urine for culture and sensitivity (C&S) and treat the
patient with antibiotics
B) Order a urine C&S and hold treatment until you get the results from the lab
C) Treat the patient with a 7-day course of antibiotics and order a urine for culture
and sensitivity (urine C&S) now and after she completes her antibiotics
D) Treat the patient with a stronger drug such as ofl oxacin (Floxin) for 10 days
A) Order a urinalysis and urine for culture and sensitivity (C&S) and treat the patient with antibiotics. The best treatment for this patient is to order the urinalysis
and urine C&S to identify the organism causing the infection. Treatment may
begin while waiting for the culture results. However, occasionally treatment may have to be changed after the culture/sensitivity results return, due to resistance to the antibiotic used.
The following are patients who are at high risk for complications due to urinary
tract infections. Who does not belong in this category?
A) A 38-year-old diabetic patient with a HbA1C of 7.5%
B) A woman with a history of rheumatoid arthritis who is currently being treated
with a regimen of methotrexate and low-dose steroids
C) A 21-year-old woman who is under treatment for 2 sexually transmitted
infections
D) Pregnant women
C) A 21-year-old woman who is under treatment for 2 sexually transmitted
infections.
Risk factors for complications due to urinary tract infection include pregnancy, diabetes, and steroid therapy.
A 40-year-old female is positive for anti-hepatitis C virus (HCV). Which test is appropriate for follow-up? A) HCV RNA B) HCV antibodies C) HCV core antigen D) Hepatitis C surface antigen
A) HCV RNA.
HCV RNA is performed following a positive anti-hepatitis C virus test.
You are reviewing a Pap smear report on a 25-year-old female. Which of the following
cells should be on a Pap smear to be classifi ed as a satisfactory specimen?
A) Clue cells and endometrial cells
B) Vaginal cells and cervical cells
C) Squamous epithelial cells and endocervical cells
D) Leukocytes and RBCs
C) Squamous epithelial cells and endocervical cells.
Squamous epithelial cells and endocervical cells must be obtained when performing a Pap smear to be considered
satisfactory to evaluate the cells from the endocervix.
What does a KOH (potassium hydroxide) prep help the nurse practitioner diagnose? A) Herpes zoster infections B) Yeast infections C) Herpes simplex infections D) Viral infections
B) Yeast infections.
The KOH prep test is performed by placing a sample of discharge
on a glass slide, with one drop of potassium hydroxide and a coverslip on top to evaluate for yeast infections. Budding spores and pseudohyphae will be
seen with Candida, with a pH of 3.5–4.5.
All of the following infections are reportable diseases except: A) Lyme disease B) Gonorrhea C) Nongonococcal urethritis D) Syphilis
C) Nongonococcal urethritis.
The public health department requires all agencies to report Lyme disease, gonorrhea, and syphilis. Statistics of these reportable
diseases are kept in each state.
A woman is being evaluated by the nurse practitioner for complaints of dyspareunia.
A microscopy slide reveals a large number of atrophic squamous epithelial
cells. The vaginal pH is 4.0. There are very few leukocytes and no RBCs are seen on
the wet smear. Which of the following is most likely?
A) Atrophic vaginitis
B) Bacterial vaginosis
C) Trichomoniasis
D) This is a normal fi nding
A) Atrophic vaginitis.
Symptoms of atrophic vaginitis include painful intercourse, atrophic squamous epithelial cells, and a decrease in pH. Vaginal atrophy
is caused by lack of or imbalance of estrogen. Normal pH of the vagina is acidic.
The following conditions are absolute contraindications for the use of oral contraceptives
except:
A) Hepatomas
B) History of emboli that resolved with heparin therapy 15 years ago
C) A family history of migraines with aura
D) A history of gallbladder disease during pregnancy
C) A family history of migraines with aura.
All of the items are contraindications, but a family history does not substantiate a need to avoid oral contraceptives.
A newborn’s mother is discovered to be HBsAg (hepatitis B surface antigen) positive.
Which of the following would you recommend for this infant?
A) Give the baby hepatitis B immunoglobulin
B) Give the baby both hepatitis B vaccine and hepatitis B immunoglobulin
C) Give the baby hepatitis B vaccine only
D) Send the baby home because he is not infected
B) Give the baby both hepatitis B vaccine and hepatitis B immunoglobulin.
For a mother who tests positive for HBsAg, the newborn infant should be given hepatitis B vaccine and hepatitis B immunoglobulin for protection.
Which of the following is the confi rmatory test for the HIV screening test? A) ELISA test for HIV B) Western blot C) HIV polymerase chain reaction test D) HIV antibody
B) Western blot.
A positive Western blot test confirms an HIV screening test.
All of the following findings are associated with the secondary stage of an infection by the organism Treponema pallidum except:
A) Condyloma acuminata
B) Maculopapular rash of the palms and soles
C) Lymphadenopathy
D) Condyloma lata
A) Condyloma acuminata.
Findings consistent with the diagnosis of syphilis, caused by the Treponema pallidum organism, include maculopapular rash of the palms and soles, lymphadenopathy, and condyloma lata. Condyloma acuminata
(genital warts) are caused by the human papilloma virus (HPV) and spread to others
by skin-to-skin contact.
The following are acceptable methods of birth control for breastfeeding mothers
except:
A) Diaphragm with spermicidal gel
B) Progesterone-only pills (Micronor)
C) Condoms
D) Low-dose oral contraceptives with at least 20 mcg of estradiol (Alesse,
Lo-estrin)
D) Low-dose oral contraceptives with at least 20 mcg of estradiol (Alesse, Lo-estrin).
Low-dose oral contraceptives that contain estradiol are contraindicated for breastfeeding mothers.
Women with a history of pelvic inflammatory disease (PID) have an increased risk
for all of the following complications except:
A) Ectopic pregnancy
B) Scarring of the fallopian tube(s)
C) Infertility
D) Ovarian cysts
D) Ovarian cysts.
Women with a history of pelvic infl ammatory disease (PID) have a higher risk of ectopic pregnancy, scarring of the fallopian tubes, and infertility due to the scarring and trauma caused by the pelvic inflammation.
The differential diagnosis for genital ulceration includes all of the following except: A) Syphilis B) Genital herpes C) Chancroid D) Molluscum contagiosum
D) Molluscum contagiosum.
Genital ulcers may occur with syphilis, genital herpes, and chancroid. Molluscum contagiosum is a viral infection that causes
smooth, round tiny papules, approximately 5 mm or less, that have a central umbilication with a white plug present.
Which type of hepatitis virus infection is more likely to result in chronic hepatitis
and increased risk of developing hepatocellular carcinoma?
A) Hepatitis A virus
B) Hepatitis B virus
C) Hepatitis C virus
D) Both hepatitis B and hepatitis C
D) Both hepatitis B and hepatitis C.
Of the primary hepatitis viruses, only B and C are associated with hepatocellular cancer.
A 19-year-old female has recently been diagnosed with acute hepatitis B. She is sexually
active and is monogamous. She reports using condoms inconsistently. What
would you recommend for her male sexual partner who was also tested for hepatitis
with the following results: HBsAg (−), anti-HBs (−), anti-HCV (−), anti-HAV (+)?
A) A hepatitis B vaccination
B) Hepatitis B immunoglobulin
C) Hepatitis B vaccination and hepatitis B immunoglobulin
D) No vaccination is needed at this time
C) Hepatitis B vaccination and hepatitis B immunoglobulin.
Hepatitis B vaccination
is given for long-term prophylaxis treatment to prevent hepatitis B infection. Hepatitis B immunoglobulin is given for prevention of hepatitis B infection
when the person has been directly exposed to the hepatitis B infection. The immunoglobulin
is not a vaccine and does not protect against long-term prophylaxis.
In most states, patients younger than age 18 years may consent to health care without
parental or legal guardian consent except for which of the following?
A) Contraception
B) Pregnancy
C) School physicals
D) STD evaluation and treatment
C) School physicals.
Any student younger than 18 years of age must have parental permission to have a school physical exam done.
The Pap smear result for a 20-year-old sexually active college student who used
condoms inconsistently reveals a large number of white blood cells and blood
along with infl ammatory changes. During the speculum exam, the nurse practitioner
who examined the patient noticed that the patient’s cervix bled very easily
(friable) and a small amount of purulent discharge was present on the cervical surface.
No cervical motion tenderness was noted during the bimanual vaginal exam.
What is the next step in the management of this patient?
A) The NP needs to do cervical cultures to verify gonorrhea
B) Prescribe metronidazole vaginal cream for the patient over the phone
C) Call the patient and tell her she needs a repeat Pap smear in 6 months
D) Advise her to use a Betadine douche at bedtime x 3 days
A) The NP needs to do cervical cultures to verify gonorrhea.
Cultures should be
taken at the time of the Pap smear, as the patient may not return for later diagnostic
testing.
Human papilloma virus infection in women has been associated with the development of: A) Ectopic pregnancy B) Infertility C) Cervical cancer D) Pelvic infl ammatory disease
C) Cervical cancer.
HPV is a virus associated with cervical cancer. HPV vaccine is now availabe for girls and boys between the ages of 15–21 years of age to help prevent 4 strains of this virus that is linked to cervical cancer.
When Molluscum contagiosum is found on the genital area of children, which of the
following is the best explanation?
A) It should raise the suspicion of child sexual abuse
B) It is not considered a sexually transmitted disease
C) It is caused by atypical bacteria
D) It is caused by the poxvirus and will resolve on its own
A) It should raise the suspicion of child sexual abuse.
Molluscum contagiosum is spread by skin-to-skin contact. Lesions found in the genital area of young children should be evaluated for suspicion of child sexual abuse.
Which of the following methods is used to diagnose gonorrheal pharyngitis or
proctitis?
A) Serum chlamydia titer
B) Gen-Probe
C) Thayer-Martin culture
D) Culture and sensitivity of the purulent discharge
C) Thayer-Martin culture.
Thayer-Martin culture is recommended for screening to diagnose gonorrheal pharyngitis or proctitis.
An 18-year-old waitress is diagnosed with pelvic infl ammatory disease (PID).
The cervical Gen-Probe result is positive for Neisseria gonorrhoeae and negative for
Chlamydia trachomatis. All of the following statements are true regarding the management
of this patient except:
A) This patient should be treated for chlamydia even though the Gen-Probe for
chlamydia is negative
B) Ceftriaxone 250 mg IM and doxycycline 100 mg PO BID x 14 days are appropriate
treatment for this patient
C) Advise the patient to return to the clinic for a repeat pelvic exam in
48 hours
D) Repeat the Gen-Probe test for Chlamydia trachomatis to ensure that the previous
test was not a false-negative result
D) Repeat the Gen-Probe test for Chlamydia trachomatis to ensure that the previous
test was not a false-negative result.
Treatment for both gonorrhea and chlamydia are recommended for the diagnosis of PID, regardless if the chlamydia test was negative.
A 35-year-old smoker is being evaluated for birth control choices. The patient has
a history of PID along with an embolic episode after her last pregnancy. Which of
the following methods of birth control would you recommend?
A) Condoms and the vaginal sponge (Today Sponge)
B) Estrogen patches
C) Intrauterine device
D) Depo-Provera (depot medroxyprogesterone)
A) Condoms and the vaginal sponge (Today Sponge).
Contraindications for
hormonal contraception include: Migraine headaches; cigarette smoking or obesity in women older than 35 years; history of thromboembolic disease; hypertension
or vascular disease if over 35 years of age; systemic lupus erythematosus with
vascular disease, nephritis, or antiphospholipid antibodies; breastfeeding (may
use progestin-only pills); hypertriglyceridemia; CAD; CHF; and strokes.
A 21-year-old woman complains of left-sided pelvic pain accompanied by dyspareunia.
During the gynecological exam, the nurse practitioner notices green cervical
discharge. The patient mentions a new onset of a painful and swollen left knee and
denies a history of trauma. This best describes:
A) Septic arthritis
B) Reiter’s syndrome
C) Chondromalacia of the patella
D) Disseminated gonorrheal infection
D) Disseminated gonorrheal infection.
Symptoms of PID with painful, swollen
joints of extremities indicate disseminated gonorrheal infection. Untreated disseminated
gonorrhea can lead to septic arthritis. Symptoms may be mild from slight
joint pain and no fever to severe joint pain with high fever. PID symptoms do not
occur with septic arthritis, Reiter’s syndrome, or chondromalacia of the patella.
A 25-year-old woman complains of dysuria, severe vaginal pruritis, and a
malodorous vaginal discharge. Pelvic examination reveals a strawberry-colored
cervix and frothy yellow discharge. Microscopic exam of the discharge reveals
mobile organisms that have fl agella. The correct pharmacologic therapy for the
condition is:
A) Metronidazole (Flagyl)
B) Ceftriaxone sodium (Rocephin)
C) Doxycycline hyclate (Vibramycin)
D) Clotrimazole (Gyne-Lotrimin)
A) Metronidazole (Flagyl).
Trichomoniasis symptoms include dysuria, severe vaginal pruritis, and malodorous vaginal discharge. Wet prep will show trichomonads that are pear-shaped and have several fl agella (whiplike tails) at one end. CDC recommendation for treatment is metronidazole.
Metronidazole (Flagyl) produces the disulfi ram (Antabuse) effect when combined
with alcoholic drinks or medicine. You would educate the patient to avoid:
A) Alcoholic drinks during the time she takes the medicine
B) Alcoholic drinks 1 day before, during therapy, and a few days after therapy
C) Alcoholic drinks after she takes the medicine
D) There is no need to avoid any food or drink.
B) Alcoholic drinks 1 day before, during, therapy and a few days after therapy.
Alcohol is contraindicated during the use and up until 3 days following the
administration of Flagyl. Severe side effects may occur, such as tachycardia, flushing,
tingling sensations, nausea, and vomiting.
Spermatogenesis occurs at the: A) Vas deferens B) Seminal vesicles C) Testes D) Epididymis
C) Testes.
Spermatogenesis occurs in the testes, taking approximately 3 months to develop.
All of the following drugs interfere with the metabolism of oral contraceptives except: A) Tetracycline B) Rifampin C) Phenytoin (Dilantin) D) Ciprofl oxacin (Cipro)
D) Ciprofl oxacin (Cipro).
Cipro is the only medication listed that will not interfere with the metabolism and absorption of OCPs.
Which of the following is a CDC-recommended treatment for a case of uncomplicated
gonorrheal and chlamydial infection?
A) Metronidazole (Flagyl) 250 mg PO TID x 7 days
B) Valacyclovir (Valtrex) 500 mg PO BID x 10 days
C) Azithromycin 1 g orally OR doxycycline 100 mg orally twice a day for 7 days
D) 1 dose of oral fl uconazole (Difl ucan) 150 mg
C) Azithromycin 1 g orally OR doxycycline 100 mg orally twice a day for 7 days.
Drug therapy is based on the 2010 CDC STD guidelines for treatment.
Which of the following is not a relative contraindication for oral contraceptive pills? A) Active hepatitis A infection B) Thrombosis related to an IV needle C) Undiagnosed vaginal bleeding D) Migraine headache without focal aura
B) Thrombosis related to an IV needle.
Thrombosis related to either a known
trauma or IV needle does not represent a contraindication for use of oral contraceptives.
Which of the following is the most common cause of nongonococcal urethritis? A) Escherichia coli B) Chlamydia trachomatis C) Neisseria gonorrhoeae D) Mycoplasma
B) Chlamydia trachomatis.
The most common cause of nongonococcal urethritis is Chlamydia trachomatis.
Which of the following is considered a relative contraindication for combined oral contraceptive pills? A) Undiagnosed vaginal bleeding B) A hepatoma of the liver C) Suspected history of TIAs D) Depression
D) Depression.
Depression is a relative contraindication for combined OCPs due
to the hormonal effects that can affect mood. Absolute contraindications include hepatoma of the liver, history of embolic episode, history of TIAs, and undiagnosed
vaginal bleeding. OCP should not be considered in these instances due to
the high risk factors and health risks.
All of the following are correct statements regarding oral contraceptives except:
A) The actual failure rate of oral contraceptives is 3%
B) Desogestrel belongs to the progesterone family of drugs
C) The newer low-dose birth control pills do not require back-up during the first 2 weeks of use
D) Oral contraceptives are contraindicated for women 35 years of age or older who smoke
C) The newer low-dose birth control pills do not require backup during the first 2 weeks of use.
Low-dose OCPs require a second backup method of contraception
during the fi rst 2 weeks of use.
A postmenopausal female complains of random episodes of vaginal bleeding for
the past 6 months. Which of the following is recommended management for this
condition?
A) Cervical biopsy
B) Pap smear
C) Colposcopy
D) Endometrial biopsy
D) Endometrial biopsy.
Random episodes of vaginal bleeding in a postmenopausal
woman are not normal. Endometrial biopsy is needed to biopsy the endometrial lining for abnormal cells, which may indicate cancer.
You are performing a pelvic exam on a 25-year-old sexually active woman. You
palpate a tender and warm cystic mass on the lower edge of the left labia majora,
which is red. The most likely diagnosis is:
A) Skene’s gland cyst
B) Cystocele
C) Lymphogranuloma venereum
D) Bartholin’s gland abscess
D) Bartholin’s gland abscess.
Bartholin’s glands are located in the base of the labia minora at about the 4 o’clock and 8 o’clock positions. Their function is to provide moisture for the vestibule. They are small (about pea sized) unless they
become clogged or infected. If glands become clogged or infected, an abscess may form and glands will enlarge and become painful.
Mary Walker is a 16-year-old who presents in the clinic for a physical exam. She
tells the triage nurse that she would like contraception as well. How should the
nurse practitioner proceed?
A) Refuse to see the patient until consent can be obtained from her parent or legal
guardian
B) Perform a physical exam and discuss contraceptive options
C) Speak with the patient about contraception and have her obtain parental consent
for the physical exam
D) Have the nurse discuss contraception with the patient
C) Speak with the patient about contraception and have her obtain parental
consent for the physical exam.
In the United States, state laws and policies may vary regarding contraceptive counseling and treatment for anyone under the age of 18 years. It is required that you be familiar with the state laws. In all states, anyone under the age of 18 years must have parental consent for the physical exam.
A patient diagnosed with bacterial vaginosis should be advised that her sexual
partner be treated with:
A) Ceftriaxone (Rocephin) 250 mg IM with doxycycline 100 mg BID for 14 days
B) Metronidazole (Flagyl) 500 mg PO BID for 7 days and 1 dose of azithromycin
(Zithromax)
C) Her partner does not need treatment
D) Clotrimazole cream (Lotrimin) on his penis BID for 1 to 2 weeks
C) Her partner does not need treatment.
Bacterial vaginosis is a bacterial infection, but is not considered an STD for which the partner needs treatment. Studies show that men rarely carry this infection.
A 25-year-old female presents with an onset of severe right-sided pelvic pain for
the past 48 hours. She reports small amounts of vaginal bleeding. The pain is
aggravated by jumping or any movement that jars her pelvis. The best initial intervention
is which of the following?
A) Follicle-stimulating hormone (FSH)
B) Serum quantitative pregnancy test
C) Pelvic ultrasound
D) CBC with white cell differentials
B) Serum quantitative pregnancy test.
Severe right-sided pain with vaginal bleeding in a 25-year-old patient requires an evaluation for pregnancy, by performing a serum quantitative pregnancy test. Ectopic pregnancy and/or miscarriage should be ruled out.
Which of the following effects is seen in every woman using Depo-Provera
(medroxyprogesterone injection) for more than 5 years?
A) Melasma
B) Amenorrhea
C) Weight loss
D) Headaches
B) Amenorrhea.
One common side effect seen in women who have been taking Depo-Provera for more than 5 years is amenorrhea. It is a progesterone hormone that causes cessation of periods.
All of the following are considered risk factors for UTIs in women except: A) Diabetes mellitus B) Diaphragms and spermicide use C) Pregnancy D) Intrauterine device
D) Intrauterine device.
Risk factors for UTIs include diabetes mellitus, pregnancy, and use of diaphragms and spermicide.
All of the following do not require parental consent to be obtained by the nurse
practitioner except:
A) A 17-year-old who wants to be treated for a sexually transmitted infection
B) A 12-year-old who wants a serum pregnancy test
C) A 15-year-old who wants birth control pills
D) A 14-year-old who wants to be treated for dysmenorrhea
D) A 14-year-old who wants to be treated for dysmenorrhea.
Treatment for teenagers
may be done without parental consent for sexually transmitted infections, pregnancy testing, contraception counseling and treatment. Parental consent is required for any type of physical exam for other problems.
Which of the following is responsible for the symptoms of dysmenorrhea? A) Estrogen B) Human chorionic gonadotropin C) Prostaglandins D) Progesterone
C) Prostaglandins.
Prostaglandins are hormones the body produces prior to
menses; they eventually cause the uterus to contract to shed the endometrial lining. Contractions cause pain. The greater the amount of prostaglandins that are
released, the more pain one will experience. Contractions of the uterus cause vasoconstriction
of blood supply to the uterus, which in turn will cause pain.
Which of the following is the best method for diagnosing candidiasis in the primary care setting? A) Wet smear B) Tzanck smear C) KOH (potassium hydroxide) smear D) Clinical fi ndings only
A) Wet smear.
The wet prep smear is best used to diagnose candidiasis in the primary care setting. To perform the wet prep, the vaginal smear is placed on a slide,
then a drop of saline solution is applied. Organisms viewed under the microscope can include WBCs, clue cells, bacteria, yeast cells, and trichomonads.
Females with polycystic ovarian syndrome are at higher risk for: A) Heart disease and breast cancer B) Uterine fi broids and ovarian cancer C) Premature menopause D) PID (pelvic infl ammatory disease)
A) Heart disease and breast cancer.
Females with PCOS are at higher risk of developing heart disease, stroke, and breast cancer.
A college freshman who is on oral contraceptives calls the nurse practitioner’s offi ce
asking for advice. She forgot to take her pills 2 days in a row during the second
week of the pill cycle and wants to know what to do. What is the best advice?
A) Start a new pack of pills and dispose of the old one
B) Take 2 pills today and 2 pills the next day; use condoms for the rest of the
cycle
C) Stop taking the pills right away and start a new pill cycle in 2 weeks
D) Take 1 pill now and 2 pills the next day and use condoms
B) Take 2 pills today and 2 pills the next day; use condoms for the rest of the cycle.
When forgetting to take the birth control pill on 2 consecutive days, it is
recommended that she take 2 pills today and 2 pills tomorrow, then continue the rest of her pack. Stress the importance of the use of condoms for protection against pregnancy and STIs.
A sexually active 22-year-old man is asking to be screened for hepatitis B because
his new girlfriend has recently been diagnosed with hepatitis B infection. His lab
results are the following: anti-HBV is negative, HBsAg is positive, and HBeAg is
negative. Which of the following is indicated?
A) The patient is immune to the hepatitis B virus
B) The patient is not infected with hepatitis B virus
C) The patient needs hepatitis B vaccine and hepatitis B immunoglobulin
D) The patient needs only hepatitis B immunoglobulin
C) The patient needs hepatitis B vaccine and hepatitis B immunoglobulin. Because he is HBsAg positive, and anti-HBV negative and HBeAg negative, he needs hepatitis B immunoglobulin and hepatitis B vaccine.
A middle-aged male who is homeless reports to the local Public Health Clinic complaining
of a painless and shallow ulcer on the penile shaft for the past 2 weeks. He is
sexually active and had unprotected intercourse with two male partners over the past
few months. The patient is tested for HIV, syphilis, gonorrhea, hepatitis B, and herpes
types 1 and 2. The syphilis and HIV tests are both positive. The gonorrhea, hepatitis B, and herpes tests are negative. The nurse practitioner is aware of Nationally Notifi able
Infectious Conditions. Which of the following is true regarding reporting of any of
these sexually transmitted infections?
A) Obtain the patient’s permission before reporting the positive HIV and syphilis
test results to the local public health department
B) Obtain the patient’s and sexual partner’s permission before reporting the positive
test results to the local health department
C) Health care providers are mandated by law to report certain types of diseases
to the local health department even if the patient does not give permission
D) The nurse practitioner should consult with the supervising physician about
this issue
C) Health care providers are mandated by law to report certain types of diseases to the local health department even if the patient does not give permission.
Physicians and laboratories are legally mandated to report certain types of
diseases. STDs, HIV infection/AIDS, gonorrhea, and syphilis must be reported to
the local health department even if the patient does not give permission. Partner
tracing and notifi cation are done by the local health department. The CDC website contains a list of nationally reportable diseases. Other diseases that are on the CDC 2012 list of reportable diseases (i.e., diseases that must be reported) are TB, diphtheria, hepatitis A, B, and C, measles, mumps, pertussis, Lyme disease, Rocky Mountain spotted fever, and many others.
What is the most common cause of infertility among women in the United States?
A) Scarring of the fallopian tubes due to a history of pelvic infl ammatory disease
(PID)
B) Ovulation disorders
C) Age older than 35 years
D) Endometriosis
B) Ovulation disorders.
Ovulation disorders are the top cause of female infertility (25%). There is no ovulation (anovulation) or infrequent ovulation that results in oligoamenorrhea (i.e., PCOS). The second cause is endometriosis (15%). About 10% of women in the United States (ages 15 to 44 years) have difficulty getting pregnant (CDC, 2009). PCOS is one of the most common causes of female infertility.
Infertility in males is often caused by a varicocele (heats up the testes) and abnormal and/or low sperm count.
A 19-year-old student who is on a prescription of Triphasil is being seen for an
annual gynecologic exam in the college health center. The nurse practitioner has
obtained the Pap smear and is about to perform the bimanual exam. She gently
removes the plastic speculum from the vagina. While the NP is performing the
bimanual vaginal exam, the patient complains of slight discomfort during deep
palpation of the ovaries. Which of the following is a true statement?
A) The uterus and the ovaries are both very sensitive to any type of palpation
B) The fallopian tubes and ovaries are not sensitive to light or deep palpation
C) The ovaries are sensitive to deep palpation but they should not be painful
D) The uterus and the ovaries are not important organs of reproduction
C) The ovaries are sensitive to deep palpation but they should not be painful.
The ovaries are usually slightly sensitive to deep palpation, but they should not be painful. Unilateral adnexal pain accompanied by cervical motion tenderness
and purulent endocervical discharge is suggestive of PID.
A 17-year-old high school student is considering her birth control options. She wants to know more about Seasonale. Which of the following statements is false?
A) Taking Seasonale results in only 4 periods per year
B) Her period will occur within the 7 days when she is on the inert pills
C) It is a progesterone-only method of birth control and does not contain
estrogen
D) Take 1 tablet daily for 84 consecutive days followed by 7 days of inert pills
C) It is a progesterone-only method of birth control and does not contain
estrogen.
Seasonale is an extended-cycle form of birth control. It contains both
levonorgestrel and ethinyl estradiol. There are 84 pink tablets (active) and 7 white
pills (inert). In general, more spotting (breakthrough bleeding) is experienced
with extended-cycle pills during the first few months of use (compared with the
monthly birth control pills).
All of the following clinical fi ndings are classifi ed as major criteria that are necessary
to diagnose pelvic infl ammatory disease (PID). Which of the following is classifi
ed as a minor criterion?
A) Cervical motion tenderness
B) Adnexal tenderness
C) Uterine tenderness
D) Oral temperature of more than 101°F (more than 38°C)
D) Oral temperature of more than 101°F (more than 38°C).
PID is a clinical diagnosis. The presence of at least 1 of the major criteria (cervical motion tenderness, adnexal tenderness, uterine tenderness) when combined with the history is highly suggestive of PID. Minor criteria are not necessary, but they help to support the diagnosis of PID (oral temperature of more than 101°F or more than 38°C), mucopurulent cervical or vaginal discharge, elevated sedimentation rate, elevated C-reactive protein, large amount of WBCs on saline microscopy of the vaginal fluid, or laboratory documentation of cervical infection with N. gonorrhoeae or C.
trachomatis).
An 13-year-old girl is brought in by the mother because her daughter is complaining
of vaginal discharge and pain. The mother tells the nurse practitioner that her
daughter is not sexually active yet. The mother is divorced and lives with her boyfriend
and works full time. During the exam, the nurse practitioner notes that the
vaginal introitus is red, with tears and a torn hymen. The cervix is covered with
green discharge. The nurse practitioner suspects that the child has been sexually
abused by the mother’s boyfriend. What is the best action for the nurse practitioner
to take?
A) Ask the mother questions about her boyfriend’s behaviors
B) Advise the mother to watch how her boyfriend interacts with her daughter
and to call within 1 week to discuss his behavior with her
C) Advise the mother that you suspect that her daughter has been sexually
abused and that she is legally required to report the case to the child protection
program
D) Report the child abuse to the local police department
C) Advise the mother that you suspect that her daughter has been sexually abused and that she is legally required to report the case to the child protection program.
The NP is legally required to report the case to the child protection program. If the child is in danger, child protective services may ask for a court order to take the child away for protection until the investigation is completed. Talking about the boyfriend’s behavior will not be effective and may put the child and/or mother in danger if the boyfriend suspects that he is being watched.
All of the following are true statements about the human papilloma virus vaccine
(Gardasil) except:
A) The Centers for Disease Control and Prevention (CDC) recommends the fi rst
dose at age 11 to 12 years
B) The CDC does not recommend the HPV vaccine for males
C) The vaccine is not complete until a total of 3 doses have been administered
D) The minimum age the vaccine can be given is 9 years
B) The CDC does not recommend the HPV vaccine for males.
The HPV vaccine is now recommended for both males and females. It can be given until the age of
26 years, especially if the individual is at high risk. Do not use the vaccine if age is less than 9 years.
An 18-year-old woman requests emergency contraception after having unprotected vaginal intercourse approximately 18 hours ago. Today is day 12 of her normally 27-to 29-day menstrual cycle and she has no contraindications to the use of any currently available forms of emergency contraception. You advise her that:
A. emergency hormonal contraception use reduces the
risk of pregnancy by approximately 33%.
B. all forms of emergency contraception must be used
within 12 hours after unprotected intercourse.
C. the likelihood of conception is minimal.
D. insertion of a copper-containing IUD offers an
effective form of emergency and ongoing
contraception.
D. insertion of a copper-containing IUD offers an
effective form of emergency and ongoing
contraception.
Which of the following is likely not among the proposed mechanisms of action of all forms of oral emergency contraception? A. inhibits ovulation B. acts as an abortifacient C. slows sperm transport D. slows ovum transport
B. acts as an abortifacient
A 24-year-old woman who requests emergency contraception pills wants to know the effects if pregnancy does occur. You respond that there is the risk of increased rate of: A. spontaneous abortion. B. birth defects. C. placental abruption. D. none of the above.
D. none of the above.
In contrast to progestin-only emergency contraception, a possible mechanism of action of ulipristal is: A. inhibiting embryo implantation. B. impairing sperm transport. C. through spontaneous abortion. D. impairing ovum transport.
A. inhibiting embryo implantation.
You see a 34-year-old woman who reports having unprotected
sexual intercourse 4 days ago and requests
emergency contraception. She has a recent history of
gonorrhea that was treated successfully. The most acceptable and effective option in this clinical scenario is:
A. progestin-only emergency contraception.
B. ulipristal.
C. copper-containing IUD.
D. nothing, as 4 days is too long for emergency contraception to be effective.
B. ulipristal.
Which of the following statements is false?
A. Progestin-only emergency contraception can be
taken as one dose or two doses.
B. Ulipristal is available by prescription only.
C. Progestin-only emergency contraception is available
OTC for women 17 years old and older.
D. Ulipristal is taken in two doses 12 hours apart.
D. Ulipristal is taken in two doses 12 hours apart.
A woman who has used emergency contraception pills
should be advised that if she does not have a normal menstrual period within _____ weeks, a pregnancy test should be obtained.
A. 1 to 2
B. 2 to 3
C. 3 to 4
D. 4 to 5
C. 3 to 4
The answer in the review book is 4-5 but the other review book and Up to Date both say 3-4 weeks.
Chlamydial infections occur most frequently among women in which age group? A. younger than 25 years B. 25 to 35 years C. 40 to 50 years D. over 60 years
A. younger than 25 years
Common sites of C. trachomatis infection in women include all of the following except: A. ovaries. B. cervix. C. endometrium. D. urethra.
A. ovaries.
The incubation period for C. trachomatis is approximately: A. 24 hours. B. 3 days. C. 7 to 14 days. D. 24 days.
C. 7 to 14 days.
Which of the following include characteristics of a
friable cervix?
A. presence of a dull pain, particular prior to menses
B. a constant burning sensation
C. presence of multiple polyps
D. easily irritated and prone to bleeding, especially following intercourse
D. easily irritated and prone to bleeding, especially following intercourse
An annual screening for C. trachomatis infection is
recommended for:
A. all sexually active women.
B. sexually active women 25 years of age and younger.
C. sexually active women who have had 2 or more
partners in the past 12 months.
D. sexually active men 25 years of age and younger.
B. sexually active women 25 years of age and younger.
- Which of the following is not a normal finding in a
woman during the reproductive years?
A. vaginal pH of 4.5 or less
B. Lactobacillus as the predominant vaginal organism
C. thick, white vaginal secretions during the luteal phase
D. vaginal epithelial cells with adherent bacteria
D. vaginal epithelial cells with adherent bacteria
Which of the following findings is most consistent with vaginal discharge during ovulation? A. dry and sticky B. milky and mucoid C. stringy and clear D. tenacious and odorless
C. stringy and clear
What is the approximate incubation period for Neisseria gonorrhoea? A. 1 to 5 days B. 7 to 10 days C. 18 days D. 28 days
A. 1 to 5 days
A recommended treatment for rectal gonorrhea is: A. oral amoxicillin. B. oral azithromycin. C. oral ciprofloxacin. D. ceftriaxone injection.
D. ceftriaxone injection.
Physical examination of a 19-year-old woman with a
3-day history of vaginal itch reveals moderate perineal
excoriation, vaginal erythema, and a white, clumping
discharge. Expected microscopic examination findings
include:
A. a pH greater than 6.0.
B. an increased number of lactobacilli.
C. hyphae.
D. an abundance of white blood cells.
C. hyphae.
Women with bacterial vaginosis typically present with: A. vulvitis. B. pruritus. C. dysuria. D. malodorous discharge.
D. malodorous discharge.
Treatment of vulvovaginitis caused by Candida albicans includes: A. metronidazole gel. B. clotrimazole cream. C. hydrocortisone ointment. D. clindamycin cream.
B. clotrimazole cream.
A 24-year-old woman presents with a 1-week history of
thin, green-yellow vaginal discharge with perivaginal irritation.
Physical examination findings include vaginal
erythema with petechial hemorrhages on the cervix,
numerous white blood cells, and motile organisms on
microscopic examination. These findings most likely
represent:
A. motile sperm with irritative vaginitis.
B. trichomoniasis.
C. bacterial vaginosis.
D. condyloma acuminatum.
B. trichomoniasis.
A preferred treatment option for trichomoniasis is: A. oral metronidazole. B. clindamycin vaginal cream. C. topical acyclovir. D. oral azithromycin.
A. oral metronidazole.
Treatment options for bacterial vaginosis include all of the following except: A. oral metronidazole. B. clindamycin cream. C. oral clindamycin. D. oral azithromycin.
D. oral azithromycin.
A 30-year-old woman presents without symptoms but
states that her male partner has dysuria without penile
discharge. Examination reveals a friable cervix covered
with thick yellow discharge. This description is most
consistent with an infection caused by:
A. Chlamydia trachomatis.
B. Neisseria gonorrhoeae.
C. human papillomavirus (HPV).
D. Trichomonas vaginalis.
A. Chlamydia trachomatis.
Which of the following agents is active against N. gonorrhoeae? A. ceftriaxone B. metronidazole C. ketoconazole D. amoxicillin
A. ceftriaxone
Which of the following agents is most active against C. trachomatis? A. amoxicillin B. metronidazole C. azithromycin D. ceftriaxone
C. azithromycin
Which of the following statements is true of gonococcal
infection?
A. The risk of transmission from an infected woman to
a male sexual partner is about 80%.
B. Most men have asymptomatic infection.
C. The incubation period is about 2 to 3 weeks.
D. The organism rarely produces beta-lactamase.
B. Most men have asymptomatic infection.
Complications of gonococcal and chlamydial genitourinary
infection in women include all of the following
except:
A. pelvic inflammatory disease (PID).
B. tubal scarring.
C. acute pyelonephritis.
D. acute peritoneal inflammation.
C. acute pyelonephritis.
What percentage of sexually active adults has serological
evidence of human herpes virus 2 (HHV-2 or herpes
simplex type 2)?
A. 5.8%
B. 14.5%
C. 18.9%
D. 35.6%
C. 18.9%
All of the following are likely reported in a woman with
an initial episode of genital HSV-2 (HHV-2) infection
except:
A. painful ulcer.
B. inguinal lymphadenopathy.
C. thin vaginal discharge.
D. pustular lesions.
D. pustular lesions.
In the person with HSV-2 infection, the virus can spread via: A. genital secretions. B. oral secretions. C. normal-looking skin. D. all of the above.
D. all of the above.
During asymptomatic HSV-2 infections, genital shedding
of virus occurs during approximately ________ of days.
A. 10%
B. 25%
C. 50%
D. 100%
A. 10%
Diagnostic testing of a person with primary HSV-2 infection
would likely show:
A. negative virological and serological test results.
B. negative virological test result and positive serological test result.
C. positive virological test result and negative serological test result.
D. positive virological and serological test results.
C. positive virological test result and negative serological test result.
Treatment options for HSV-2 genital infection include: A. ribavirin. B. indinavir. C. famciclovir. D. cyclosporine.
C. famciclovir.
Suppressive therapy reduces the frequency of genital herpes recurrences by: A. 5% to 10%. B. 20% to 25%. C. 40% to 50%. D. 70% to 80%.
D. 70% to 80%.
Recommended comprehensive STI testing includes testing for all of the following except: A. hepatitis B. B. syphilis. C. hepatitis A. D. HIV.
C. hepatitis A.
Women with PID typically present with all of the following except: A. dysuria. B. leukopenia. C. cervical motion tenderness. D. abdominal pain.
B. leukopenia.
A 22-year-old woman complains of pelvic pain. Physical
examination reveals cervical motion tenderness and
uterine tenderness. Which of the following would further
support a diagnosis of PID?
A. temperature less than 100ºF (37.8ºC)
B. absence of white blood cells in vaginal fluid
C. mucopurulent vaginal discharge
D. laboratory documentation of cervical infection with
E. coli
C. mucopurulent vaginal discharge
The most likely causative pathogen in a 23-year-old woman with PID is: A. Escherichia coli. B. Enterobacteriaceae. C. C. trachomatis. D. Pseudomonas.
C. C. trachomatis.
The presence of an adnexal mass in the woman with
PID most likely indicates the presence of:
A. uterine fibroids.
B. an ectopic pregnancy.
C. ovarian malignancy.
D. a tubo-ovarian abscess.
D. a tubo-ovarian abscess.
Expected laboratory findings for the woman with PID include all of the following except: A. elevated ESR. B. elevated CRP. C. elevated CrCl. D. leukocytosis.
C. elevated CrCl.
A transvaginal ultrasound in the woman with PID
will likely show:
A. tubal thickening with or without free pelvic fluid.
B. cervical thickening.
C. endometrial thinning.
D. inflammation of the ovaries.
A. tubal thickening with or without free pelvic fluid.
Which of the following is a treatment option for a 28-year-old woman with PID who has no history of medication allergy and has undergone a bilateral tubal ligation? A. ofloxacin with metronidazole B. gentamicin with cefpodoxime C. ceftriaxone with doxycycline D. clindamycin with azithromycin
C. ceftriaxone with doxycycline
Which of the following is a treatment option for a 30-year-old woman with PID and a history of severe
hive-form reaction when taking a penicillin or cephalosporin?
A. ofloxacin with metronidazole
B. amoxicillin with gentamicin
C. cefixime with vancomycin
D. clindamycin with azithromycin
A. ofloxacin with metronidazole
Which of the following best describes lesions associated
with condyloma acuminatum (gential warts)?
A. verruciform
B. plaque-like
C. vesicular-form
D. bullous
A. verruciform (wart-like)
Treatment options for patients with condyloma acuminatum include all of the following except: A. topical acyclovir. B. cryotherapy. C. podofilox. D. trichloroacetic acid.
A. topical acyclovir.
Which HPV types are most likely to cause genital condyloma acuminatum? A. 1, 2, and 3 B. 6 and 11 C. 16 and 18 D. 22 and 24
B. 6 and 11
Which HPV types are most often associated with cervical and anogenital cancer? A. 1, 2, and 3 B. 6 and 11 C. 16 and 18 D. 22 and 24
C. 16 and 18
What percentage of anogenital and cervical cancers can be attributed to HPV infection? A. less than 30% B. at least 50% C. at least 70% D. 95% or greater
C. at least 70%
Which of the following terms describes the mechanism of action of imiquimod (Aldara)? A. keratolytic B. immune modulator C. cryogenic D. cytolytic
B. immune modulator
About \_\_\_\_ of patients with genital warts have spontaneous regression of the lesions? A. 10% B. 25% C. 50% D. 75%
C. 50%
How long after contact do clinical manifestations of syphilis typically occur? A. less than 1 week B. 1 to 3 weeks C. 2 to 4 weeks D. 4 to 6 weeks
C. 2 to 4 weeks
Which of the following is not representative of the presentation of primary syphilis? A. painless ulcer B. localized lymphadenopathy C. flu-like symptoms D. spontaneously healing lesion
C. flu-like symptoms
Which of the following is not representative of the presentation of secondary syphilis? A. generalized rash B. chancre C. arthralgia D. lymphadenopathy
B. chancre
Which of the following is found in tertiary syphilis?
A. arthralgia
B. lymphadenopathy
C. macular or papular lesions involving the palms and soles
D. gumma
D. gumma.
A gumma is a soft, non-cancerous growth resulting from the tertiary stage of syphilis. It is a form of granuloma. Gummas are most commonly found in the liver (gumma hepatis), but can also be found in brain, heart, skin, bone, testis, and other tissues, leading to a variety of potential problems including neurological disorders or heart valve disease.
Syphilis is most contagious during which of the following? A. before onset of signs and symptoms B. at the primary stage C. at the secondary stage D. at the tertiary stage
C. at the secondary stage
First-line treatment options for primary syphilis include: A. penicillin. B. ciprofloxacin. C. erythromycin. D. ceftriaxone.
A. penicillin.
You see an 18-year-old woman with a history of C. trachomatis infection and a total of five lifetime partners. You recommend: A. Pap smear only. B. Pap smear and HPV testing. C. Pap smear and STI testing. D. STI testing only.
D. STI testing only.
During well-women visits for 21- to 29-year-old sexually active women who report more than 1 sex
partner within the past 6 months, all of the following are appropriate screening tests except:
A. Pap smear.
B. HPV testing.
C. Pelvic examination.
D. STI screening.
B. HPV testing.
A 45-year-old woman just had a normal Pap test result
and has an absence of high-risk HPV. You recommend
her next Pap test in:
A. 1 year.
B. 3 years.
C. 5 years.
D. 7 years.
C. 5 years.
Which of the following is not part of the criteria for an older woman to cease having any future Pap tests performed?
A. over 55 years of age
B. negative screening results on three consecutive
cytology or two consecutive co-test results
within 10 years
C. the most recent cytology occurring within the past
5 years
D. no history of cervical intraepithelial neoplasm
(CIN) 2 or greater within the past 20 years
A. over 55 years of age
You see a 48-year-old woman who underwent an abdominal
hysterectomy with cervical removal for uterine fibroids 6 months ago. She last had a normal Pap test 1.5 years ago. You recommend her next Pap test.
A. immediately.
B. in 1 1⁄2 years.
C. in 3 1⁄2 years.
D. She does not need to have a pap test now or in the future.
D. She does not need to have a pap test now or in the future.
You see a 24-year-old woman who received the HPV
vaccine (three doses) as a teenager. She had a normal Pap test 3 years ago. You recommend:
A. conducting a Pap test.
B. conducting a Pap test and HPV testing.
C. waiting 2 years for the next Pap test.
D. ceasing future Pap tests until she turns 30 years old.
A. conducting a Pap test.
You see a 33-year-old woman whose Pap smear result reveals atypical cells of undetermined significance (ASC-US). She is also positive for HPV, with
genotype testing revealing the presence of HPV type 16. You recommend:
A. repeating Pap test immediately.
B. repeating the Pap test in 3 to 4 months.
C. referral for colposcopy.
D. administering the HPV vaccine.
C. referral for colposcopy.
You see a 41-year-old woman whose Pap smear result
reveals high-grade squamous intraepithelial lesion
(HSIL). The HPV test is negative. You recommend:
A. repeating the Pap test in 3 to 4 months.
B. repeating the Pap test in 1 year.
C. referral for colposcopy.
D. referral for biopsy.
C. referral for colposcopy.
Use of a mammogram every 2 years for women ages 50-74 is assigned a(n) \_\_\_\_\_ by the USPSTF. A. grade C B. grade B C. I statement D. grade A
B. grade B
T/F The I statement is used for services in which the USPSTF recommends neither for or against.
True
The USPSTF assigns a grade B recommendation for all adults for: A. depression B. HIV infection C. Tobacco use D. Hypertension
A. depression
T/F The USPSTF has assigned an I statement to screening for rubella immunity in women of childbearing age.
False
The USPSTF assigns teaching breast self-examination a grade: A. A B. B C. C D. D
D. D
For adults age 50-75, the USPSTF assigns screening for \_\_\_\_ a grade A. A. osteoporosis B. obesity C. colorectal cancer D. Hep C infection
C. colorectal cancer
The decision to screen women for BRCA-related cancer is based on:
A. country of birth
B. family history showing an increased risk for gene mutations
C. smoking history
D. weight
B. family history showing an increased risk for gene mutations
T/F The USPSTF assigned screening of nonpregnant women who are not at increased risk for syphilis a grade D.
True
T/F Every patient encounter should include straightforward questions to assess possible changes in the patient’s health history.
True
T/F Healthcare providers should be aware that many women’s screening needs remain static from year to year.
False
