NURSE PRACTITIONER CONCEPTS AND
SOLVED ITEMS
◉ 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
Answer: 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.
◉ 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 inflammatory disease)
Answer: B) Chlamydia trachomatis
When diagnosed with gonorrhea, the patient should also be treated
for Chlamydia trachomatis.
◉ The Pap smear result on a 20-year-old sexually active student who
uses condoms inconsistently shows a large amount of inflammation.
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
Answer: 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.
◉ 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
Answer: 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 inflammatory
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 man- agement 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
Answer: 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.
, ◉ 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 fluconazole (Diflucan) 150 mg
Answer: 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.
(1 GRAM for the CHLAM!)
◉ Fitz-Hugh-Curtis syndrome is associated with which following
infection?
A) Syphilis
B) Chlamydia trachomatis
C) Herpes genitalis
D) Lymphogranuloma venereum
Answer: 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 inflammation and infection in