A 23-year-old woman has been referred to a fertility clinic after 1 year of attempting to become pregnant. Her diagnostic workup has resulted in a diagnosis of polycystic ovary syndrome (PCOS). What will the first line of treatment most likely consist of?
Selected Answer:
D.
Lifestyle modifications to include weight loss by lowering calories and fat consumption.
Answers:
A.
Estrogen-progesterone hormone therapy and the administration of clomiphene.
B.
Surgical resection of the ovaries using laparoscopy.
C.
Temporary use of oral contractive agents.
D.
Lifestyle modifications to include weight loss by lowering calories and fat consumption.
Response Feedback:
Rationale: Lifestyle modifications are the treatment of choice for PCOS. Hormone therapy, surgery, and use of oral contraceptives are less likely to be a primary treatment option.
Question 2
0 out of 2 points
A 40-year-old female client tells the nurse she was diagnosed at a walk-in clinic several months ago with lichen sclerosus when she thought she had a yeast infection. Based on this statement, what actions should the nurse advocate for in the client’s plan of care? Select all that apply.
Selected Answers:
B.
A topical corticosteroid
Answers:
A.
Screening for autoimmune disorders
B.
A topical corticosteroid
C.
Surgical excision of the lesions
D.
Follow-up examinations for vulvar cancer
E.
A topical antibiotic cream
Response Feedback:
Rationale: Lichen sclerosus is also seen with autoimmune disorders such as thyroiditis and vitiligo. Treatment involves topical corticosteroids and no surgical procedures are recommended. Hyperplastic areas that occur may be sites of malignant change and the client should be screened for vulvar malignancy. It is not a bacterial infection so antibiotics are not part of treatment.
Question 3
2 out of 2 points
While educating parents about the benefits of giving human papillomavirus recombinant vaccine to their child for prevention of human papillomavirus (HPV), which statements by the parents indicate that the nurse will need to clarify for more accuracy? Select all that apply.
Selected Answers:
C.
Only recommended for females between the ages of 9 and 26.
E.
100% effective against development of cervical cancer for their lifespan.
Answers:
A.
Best administered before the child becomes sexually active.
B.
Effective against the two most common strains of genital warts.
C.
Only recommended for females between the ages of 9 and 26.
D.
Recommended prior to exposure to HPV and if your child has genital warts, he or she is already exposed.
E.
100% effective against development of cervical cancer for their lifespan.
Response Feedback:
Rationale: The HPV vaccine has decreased the risk of cervical cancer by 97%. HPV 9-valent recombinant vaccine is one type of HPV vaccine to prevent infection with the HPV subtypes 16, 18, 9, and 11. This vaccine has been approved for girls and boys between 9 and 26 years of age (prior to becoming sexually active) to prevent HPV 6 and 11 genital warts. The vaccine targets the two strains of HPV (16, 18) responsible for 70% of cervical cancer. There is no treatment that is 100% effective against cervical cancer.
Question 4
2 out of 2 points
Following a work-up which included endocrine studies (FSH/LH, prolactin, testosterone, DHEAS levels), a college student complaining of abnormal bleeding has been diagnosed with dysmenorrhea due to alterations in their hormone levels. The nurse should anticipate that which type of medication will be prescribed? Select all that apply.
Selected Answers:
B.
Oral contraceptives.
E.
Prostaglandin synthetase inhibitors.
Answers:
A.
Estrogen only.
B.
Oral contraceptives.
C.
Anxiolytic medications.
D.
Androgens.
E.
Prostaglandin synthetase inhibitors.
Response Feedback:
Rationale: The treatment of dysfunctional bleeding of a nonhormonal nature is usually treated with oral contraceptives or cyclic progesterone therapy. Prostaglandin synthetase inhibitors are prescribed for dysmenorrhea. Anxiolytic drugs treat mood changes of PMS.
Question 5
2 out of 2 points
While teaching a class on female cancers, the instructor emphasizes to the nursing students that many clients with ovarian cancer may display:
Selected Answer:
A.
abdominal pain, bloating, feeling full quickly after ingesting food.
Answers:
A.
abdominal pain, bloating, feeling full quickly after ingesting food.
B.
lower abdominal pain localized to one side, referred shoulder pain.
C.
pain after intercourse, bleeding irregularities, perineal tenderness.
D.
colicky low abdominal pain, adnexal mass present without palpation.
Response Feedback:
Rationale: Symptoms that are believed to have a strong correlation to ovarian cancer include abdominal pain, increased abdominal size or bloating, and difficulty eating or feeling full quickly after ingesting food. Pain and bleeding after intercourse is usually associated with an inflammatory process. Colicky, low abdominal pain and adnexal mass is associated with cancer of the fallopian tube. Localized abdominal pain to one side with referred shoulder pain is common in ectopic pregnancy.
Question 6
2 out of 2 points
A 70-year-old woman who delivered 4 children during her reproductive years has weakened pelvic floor muscles. Which of her anatomical structures is least susceptible to inappropriate herniation into her vagina?
Selected Answer:
C.
Peritoneum
Answers:
A.
Bladder
B.
Uterus
C.
Peritoneum
D.
Rectum
Response Feedback:
Rationale: While displacement of the uterus, bladder and rectum can result in uterine prolapse, cystocele and rectocele, the peritoneum is unlikely to prolapse into the vagina.
Question 7
2 out of 2 points
Following a visit to her campus medical clinic motivated by persistent abdominal pain and dyspareunia, a 20 year-old female college student has been referred for a diagnostic workup to rule out pelvic inflammatory disease. Her elevated white cell and C-reactive protein levels lead her care provider to suspect pelvic inflammatory disease (PID). What follow-up question is most likely to help with the differential diagnosis?
Selected Answer:
C.
“How many sexual partners have you had?”
Answers:
A.
“Have you ever had a therapeutic abortion in the past?”
B.
“What does your daily hygiene routine usually consist of?”
C.
“How many sexual partners have you had?”
D.
“Are you using tampons during your period or do you normally use pads?”
Response Feedback:
Rationale: Having multiple sex partners is a factor that has been identified in the development of PID. The use of tampons, inadequate hygiene, and a history of TA are less likely to predispose to PID.
Question 8
2 out of 2 points
An older female client calls and reports, “Another cyst in my private area. I had this years ago, but after 15 years it has returned. What should I do?” Which advice should the health care provider give to this client?
Selected Answer:
C.
“You should call and make an appointment. I would like to evaluate this further.”
Answers:
A.
“I will call your pharmacy and order some antibiotic cream.”
B.
“Are you allergic to any medication?”
C.
“You should call and make an appointment. I would like to evaluate this further.”
D.
“Try sitting in a warm bath to see if it helps.”
Response Feedback:
Rationale: Because the Bartholin glands usually shrink during menopause, a vulvar growth in postmenopausal women is suspicious and should be evaluated for malignancy. Antibiotics and creams may be appropriate after physical assessment of the site, but these should not be the first line of action. If this cyst is at the Bartholin gland, local application of moist heat may be an appropriate course of action as well, following physical examination.
Question 9
2 out of 2 points
After a long and frustrating course of constant vaginal pain, a 38-year-old woman has diagnosed with generalized vulvodynia by her gynecologist. What treatment plan is most likely to be prescribed by her health care provider?
Selected Answer:
D.
Tricyclic antidepressants and gabapentin, an antiepileptic medication.
Answers:
A.
Lifestyle modifications aimed at accommodating and managing neuropathic pain.
B.
Narcotic analgesia and nonsteroidal anti-inflammatory medications.
C.
Alternative herbal therapies coupled with antifungal medications.
D.
Tricyclic antidepressants and gabapentin, an antiepileptic medication.
Response Feedback:
Rationale: Treatment of vulvodynia necessitates a long-term, chronic pain approach; antidepressants and antiepileptic medications are often used. Alternative therapies, standard analgesic regimens, and simple lifestyle modifications are less likely to be effective.
Question 10
2 out of 2 points
The nurse is working with a couple who have been unsuccessful in becoming pregnant after trying for the past 6 months. The male client has just been told he had an abnormal semen sample. What should the nurse include in the plan of care? Select all that apply.
Selected Answers:
B.
Recommend the female client keep a record of her menstrual cycle.
C.
Advise the male client he should submit a second semen sample for analysis.
D.
Inquire about past viral infections the male client may have experienced.
Answers:
A.
Refer the couple to a specialist since they meet the criteria for infertility.
B.
Recommend the female client keep a record of her menstrual cycle.
C.
Advise the male client he should submit a second semen sample for analysis.
D.
Inquire about past viral infections the male client may have experienced.
E.
Advise the male client to ejaculate several times a day to stimulate sperm production.
Response Feedback:
Rationale: The couple does not meet the definition of infertility (unsuccessful attempts at pregnancy after 1 year of trying to conceive). The male client should have a repeat semen sample examined as the quality of samples varies. The female client’s menstrual cycle can help aid in identifying female contributors to infertility. History of mumps orchitis should also be determined in the male client. Frequent ejaculation does not simulate increased sperm production.
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