APEA 3P EXAM PREP1–WOMEN’S HEALTH WITH VERIFIED QUESTIONS AND ANSWERS WITH RATIONALE

APEA 3P EXAM PREP1–WOMEN’S HEALTH WITH VERIFIED QUESTIONS AND ANSWERS WITH RATIONALE A 16-year-old female is diagnosed with primary dysmenorrhea. She has taken over-the-counter ibuprofen in 800-mg increments every 8 hours during menses for the past 3 months, with minimal relief of symptoms. What intervention will provide greatest relief of dysmenorrhea symptoms? Flurbiprofen during menses Combined oral contraceptives Daily multivitamin with B12 supplementation 30 minutes of regular exercise daily B. NSAIDs and hormonal contraceptives represent the mainstay of pharmacologic treatment for dysmenorrhea. NSAIDs produce an 80-86% response rate when used for dysmenorrhea. The general recommendation is that when one agent (NSAIDs or hormonal contraceptives) does not produce relief of symptoms, the other agent should be tried. Hence, the best choice is oral contraceptives. Both agents should be considered for women who are symptomatic with one agent only. A 22-year-old female states that she has multiple sexual partners and inconsistently uses barrier protection. Which form of birth control should the nurse practitioner avoid prescribing in this patient? Intrauterine device Progestin-only pill Diaphragm Oral contraceptives A. Multiple sexual partners place the patient at increased risk for infection with sexually transmitted diseases. The patient is at very high risk of developing pelvic inflammatory disease (PID) when there is an implanted foreign body. An example of this is an intrauterine device (IUD). The risk is also increased with a diaphragm, but, because it is not implanted for long periods at a time, the risk of PID is less than with an IUD. Three of the following interventions are appropriately used to prevent osteoporosis after menopause. Which one is NOT? Avoidance of corticosteroids Performance of weight-bearing activities for 40 mins at least 5 days/week Estrogen replacement therapy Adequate calcium & vitamin D intake C. Prevention of osteoporosis may be optimized by elimination of risk factors and engaging in interventions that maximize bone density. Good nutrition from infancy throughout adulthood is a major component of good bone health. Others include engaging in weight-bearing exercises, adequate intake of calcium and vitamin D, smoking cessation, limiting alcohol consumption to moderate amounts, and avoidance when possible of medications that may decrease bone density (corticosteroids, anticonvulsants). Osteoporosis occurs at accelerated rates in women who are post-menopausal. The lack of estrogen can produce rapid bone loss due to bone resorption. Estrogen replacement is not used to prevent or treat osteoporosis. A patient who is scheduled for pelvic exam with PAP smear should be advised to avoid douching, sexual intercourse, and tampon use before her exam. For how long should she be advised to avoid these activities for optimal evaluation? 24 hours 48 hours 36 hours 1 week B. The general recommendation is to avoid these activities and any vaginal medication for 48 hours prior to the PAP smear. Douching and tampon use can remove superficial cells, which are the ones collected and used as representative samples on PAP smear. Sexual intercourse should be avoided because there can be specimen contamination by the male partner. With vaginal medications or creams, either can serve as a barrier to epithelial cell sampling. When collecting cervical cells for a PAP smear, when are the endocervical cells typically collected? After the ectocervical specimen with a broom After the ectocervical specimen with a brush Before the ectocervical specimen with a broom Before the ectocervical specimen with a brush B. Ectocervical specimens are collected first to minimize any bleeding that can occur when the endocervical cells are sampled. The brush is considered a superior tool for the collection of endocervical specimens because it produces the highest yield of endocervical cells, and thus, is a good reflection of the health of the cervix. Alternatively, a cervical broom can be used to collect endocervical cells and ectocervical cells simultaneously. It is rotated for 5 turns before the samples are placed on the slide. This may be used in pregnant women. The first step in evaluating a breast lump is: history and physical exam. mammogram. ultrasound. Incorrect MRI. A. Although most patients will need further work-up of a breast mass, historical information is critically important in directing the health care provider to the next step. Historical information that should be ascertained is the location of the lump, how and when it was first noticed, whether there is nipple discharge, and whether it changes in size related to menses. Other historical information is the patient’s personal and family history of breast cancer and/or history of breast biopsies. A patient who takes oral contraceptive pills is at increased risk of: gallbladder disease. depression. hypothyroidism. varicose veins. A. One of the major components of gallstones is estrogen. A patient with underlying gallbladder disease should not take oral contraceptives (OC) since they will increase estrogen exposure and theoretically, formation of gallstones. Depression, hypothyroidism and varicose veins are not increased by use of oral contraceptives. A 14-year-old female has never menstruated. She and her mother are concerned. What is most important for the NP to assess? Stature Tanner stage Anemia Family history of amenorrhea B. Tanner staging, or sexual maturity ratings, are predictable changes that occur with puberty. These should be assessed. In females, breasts and pubic hair signify specific pubertal changes that constitute maturation. These are not age specific, but at 14 years, a Tanner Stage 3 or more would be characteristic of expected maturation. Menses should follow soon. After a vaginal exam, a patient received a prescription for metronidazole 500 mg twice daily for 7 days. What was her likely diagnosis? Bacterial vaginosis Syphilis Chlamydia Gonorrhea A. Bacterial vaginosis can be treated with metronidazole orally. The most effective dose is 500 mg twice daily for 7 days. This is generally well tolerated as long as the patient avoids alcohol. Alcohol in the presence of metronidazole can produce a disulfiram reaction. Another medication used to treat bacterial vaginosis is tinidazole. It may provide more effective coverage if metronidazole fails because it has a longer half-life. A 54-year-old female presents with a small to moderate amount of vaginal bleeding of recent onset. She has been postmenopausal for approximately 2 years. What diagnosis is least likely? Endometrial carcinoma Ovarian cancer Endometrial hyperplasia Uterine polyps B. Ovarian cancer may present as an adnexal mass, pelvic or abdominal symptoms and a variety of others. Postmenopausal bleeding (PMB) is an uncommon presentation of ovarian cancer, but can present this way. In women with PMB, likely causes of uterine pathology should be evaluated before considering ovarian pathology. In early menopause, the most common etiology is atrophy of the endometrium or vaginal mucosa. This patient has been postmenopausal for approximately 2 years. Other common causes of PMB are polyps, fibroids, and endometrial hyperplasia. Athletic amenorrhea increases the risk of: osteoporosis. an eating disorder. covert hypothyroidism. breast cancer. A. Athletic amenorrhea is a secondary cause of amenorrhea that is observed in females who engage in excessive amounts of exercise. Excessive exercise can produce significant loss of body fat. Since estrogen is produced by the body’s fat tissue, there is a subsequent loss in the ability to produce adequate amounts of estrogen. When this occurs, infertility, vaginal and breast atrophy, and osteopenia are very likely.