TEST BANK FOR HAM’S
PRIMARY CARE
GERIATRICS: A CASE-
BASED APPROACH 7TH
EDITION BY RICHARD J
Answer D
The clinical consequences of persistent anovulation include infertility; menstrual bleeding problems,
ranging from amenorrhea to dysfunctional uterine bleeding; an increased risk of cardiovascular disease;
,hirsutism and acne; an increased risk of endometrial cancer and breast cancer; and an increased risk of
diabetes mellitus in clients with
hyperinsulinemia. Therapy depends on the client. If the client wants to get pregnant, she is a candidate
for the medical induction of ovulation. For the client who does not wish to become pregnant and does
not complain of hirsutism but is anovulatory and has irregular bleeding, therapy is directed toward
interruption of the steady-state effect on the endometrium and breast. Mastalgia is breast pain. The
breast is a complex organ that is sensitive to hormones. Estradiol and progesterone stimulate breast
tissue. Breast pain that positively correlates with menses is cyclic - ANSWER-Endometrial cancer,
hirsutism, acne, breast cancer, increased risk of diabetes, infertility, men- strual bleeding problems, and
an increased risk of cardiovascular disease are clinical consequences of
A. mastalgia. B. abnormal uterine bleeding. C. endometriosis. D. persistentanovulation.
Answer B
In a cone-needle biopsy, a large-gauge cutting needle is used to provide a large core of tissue from the
lesion for histological examination. The results of a core-needle biopsy are as accurate as a surgical
biopsy, but the procedure is less invasive with better cosmetic results. A stereotactic or ultrasound-
guided biopsy can be performed on nonpalpable lesions. A 21- or 22-gauge needle is used to aspirate a
cyst or extract cells from a palpable solid lesion for analysis in a fine-needle aspiration (FNA). An
incisional biopsy in which a large wedge of tissue is removed for histological examination may be done
when a mass is very large and cannot be removed without major surgery. An open surgical excisional
biopsy (lumpectomy) involves the entire removal of a palpable mass or a nonpalpable lesion (after
stereotactic or ultrasound-guided biopsy or mammographic needle localization). - ANSWER-Darcy, age
57, is to undergo a cone-needle biopsy for a suspicious breast mass. This procedure includes
A. a 21- or 22-gauge needle that is used to aspirate cells from the lesion for analysis.
B. removal of a large core of tissue from the lesion for histological evaluation utilizing a large-gauge
cutting needle.
C. removal of a wedge of tissue for examination. D. removaloftheentirelesion.
5 Answer B
A woman with an intact uterus needs to add progestin to her estrogen replacement therapy— estrogen
plus progestin therapy (EPT)—because it reduces the incidence of endometrial hyperplasia
and cancer, both of which are associated with long- term estrogen use. Decreased estrogen levels
account for hot flashes as well as mood swings and are related to osteoporosis. - ANSWER-Mrs.
Henderson, age 54, asks why she needs progesterone in addition to her estrogen for hormone
replacement. Women who have an intact uterus need to add progesterone to their prescribed estrogen
because progestin
A. assists in relieving the typical hot flashes of menopause.
,B. reduces the incidence of endometrial hyperplasia and cancer.
C. decreases the risk of osteoporosis. D. controlsmoodswings.
Answer B
CA 125 is a tumor marker that is highly specific to epithelial ovarian cancer. Increased levels (greater
than 35 U/mL) may indicate peritoneal diseases such as endometriosis, although significant elevations
are usually found with ovarian cancer. About 11% to 17% of women who inherit a harmful BRCA2
mutation will develop ovarian cancer by age 70, whereas CA 125 is highly specific. CA
15-3 level is elevated in metastatic breast disease and may be elevated in benign breast or ovarian
disease. CA 19-9 level is elevated in pancreatic and hepatobiliary cancer. - ANSWER-Which blood tumor
marker is highly spe- cific to epithelial ovarian cancer?
A. BRCA 2 B. CA 125 C. CA 15-3 D. CA19-9
Answer A
DNA is the only reliable source of newborn identification and is easily obtained from an umbilical cord
blood sample at birth. The American Academy of Pediatrics (AAP) and the American College of
Obstetricians and Gynecologists (ACOG) stopped recommending the use of fingerprinting or footprinting
for newborn identification purposes because children do not produce well-defined fingerprints until 4 to
6
years of age and newborn footprinting has been shown to be inaccurate. A buccal swab is another
possible method of obtaining newborn DNA, but if it is not processed or frozen soon after collection,
degradation may occur. Many additional factors can influence buccal cell DNA as well. A newborn heel
stick is commonly used to obtain the blood specimen for a newborn DNA sample. Because the
procedure is painful and there are many potential complications that may result, some parents are
hesitant to agree to this. - ANSWER-Susan, age 28, is 9 months pregnant and asks you about using
umbilical cord blood after birth for newborn DNA identification. What do you tell her?
A. "This cord blood sample is identical to the genetic profile of the infant."
B. "Fingerprinting and footprinting that have been done in the past work perfectly."
C. "A better method of obtaining newborn DNA is with a buccal swab."
D. "The traditional method of a newborn heel stick for a DNA sample is 'tried and true.'"
Answer C
Phenobarbital (Luminal) is the drug of choice in a pregnant woman with a seizure disorder. Ideally, if the
woman has not had a seizure for 5 years before the pregnancy, a prepregnancy trial of withdrawal from
seizure medication should be tried. Valproate (Depakene) and trimethadione (Tridione) are
, contraindicated during pregnancy, and phenytoin (Dilantin) is teratogenic during the first trimester. If
phenobarbital is used, serum levels should be measured in each trimester, and the dosage should
be such that it maintains the serum levels in the low-normal therapeutic range. - ANSWER-Judi, age 24,
has a seizure disorder. She would like to conceive within the next year. Her visit is for preconceptual
counseling. What is the drug of choice for her during pregnancy?
A. Valproate(Depakene) B. Trimethadione (Tridione) C. Phenobarbital (Luminal) D. Phenytoin(Dilantin)
Answer B
Emotional support is best given to the client with a sexually transmitted infection (STI) by authentic
active listening. During times of increased psychological stress, minimizing choices is better than offering
too many choices. The client with an STI needs support from others, and emphasis should focus on the
prevention of recurrences rather than the specifics of the duration of the disease. - ANSWER-Emotional
support is best given to the client with a sexually transmitted infection by
A. offeringmanyalternatives. B. authentic active listening. C. assuring the client that everything will be
okay. D. emphasizing the duration of the disease.
Answer A
Toxic shock syndrome (TSS) is a potentially lethal disorder that is caused in almost all cases by
absorption of one or more toxins produced by colonized Staphylococcus aureus. Several mechanisms
are implicated as causative, although not proven. They include tampon contamination with S aureus,
damaged cervical and vaginal mucosa, the use of overly absorbent tampons (or the synthetic materials
they are made of) for an extended period of time, absorption of bacteriostatic cervical secretions,
alterations in the normal vaginal flora, mechanical blockage of menstrual fluids, and the enhanced
multiplication of the organism in the menstrual efflux. The incidence of TSS has decreased steadily as a
result of education, altered patterns of tampon use, and the removal of extremely high-absorbency
tampons from the market. A urinary tract infection involving the bladder and kidneys does not cause
TSS. The risk of getting - ANSWER-Toxic shock syndrome (TSS) may be caused by which of the following?
A. TamponcontaminationwithStaphylococcus aureus
B. A short vaginal canal
C. The use of super absorbency tampons
D. A urinary tract infection involving the bladder and kidneys
Answer B
In clients with pelvic inflammatory disease, leukocytosis is present in about 50% of cases, the
erythrocyte sedimentation rate is classically elevated, and the C-reactive protein level is usually elevated
PRIMARY CARE
GERIATRICS: A CASE-
BASED APPROACH 7TH
EDITION BY RICHARD J
Answer D
The clinical consequences of persistent anovulation include infertility; menstrual bleeding problems,
ranging from amenorrhea to dysfunctional uterine bleeding; an increased risk of cardiovascular disease;
,hirsutism and acne; an increased risk of endometrial cancer and breast cancer; and an increased risk of
diabetes mellitus in clients with
hyperinsulinemia. Therapy depends on the client. If the client wants to get pregnant, she is a candidate
for the medical induction of ovulation. For the client who does not wish to become pregnant and does
not complain of hirsutism but is anovulatory and has irregular bleeding, therapy is directed toward
interruption of the steady-state effect on the endometrium and breast. Mastalgia is breast pain. The
breast is a complex organ that is sensitive to hormones. Estradiol and progesterone stimulate breast
tissue. Breast pain that positively correlates with menses is cyclic - ANSWER-Endometrial cancer,
hirsutism, acne, breast cancer, increased risk of diabetes, infertility, men- strual bleeding problems, and
an increased risk of cardiovascular disease are clinical consequences of
A. mastalgia. B. abnormal uterine bleeding. C. endometriosis. D. persistentanovulation.
Answer B
In a cone-needle biopsy, a large-gauge cutting needle is used to provide a large core of tissue from the
lesion for histological examination. The results of a core-needle biopsy are as accurate as a surgical
biopsy, but the procedure is less invasive with better cosmetic results. A stereotactic or ultrasound-
guided biopsy can be performed on nonpalpable lesions. A 21- or 22-gauge needle is used to aspirate a
cyst or extract cells from a palpable solid lesion for analysis in a fine-needle aspiration (FNA). An
incisional biopsy in which a large wedge of tissue is removed for histological examination may be done
when a mass is very large and cannot be removed without major surgery. An open surgical excisional
biopsy (lumpectomy) involves the entire removal of a palpable mass or a nonpalpable lesion (after
stereotactic or ultrasound-guided biopsy or mammographic needle localization). - ANSWER-Darcy, age
57, is to undergo a cone-needle biopsy for a suspicious breast mass. This procedure includes
A. a 21- or 22-gauge needle that is used to aspirate cells from the lesion for analysis.
B. removal of a large core of tissue from the lesion for histological evaluation utilizing a large-gauge
cutting needle.
C. removal of a wedge of tissue for examination. D. removaloftheentirelesion.
5 Answer B
A woman with an intact uterus needs to add progestin to her estrogen replacement therapy— estrogen
plus progestin therapy (EPT)—because it reduces the incidence of endometrial hyperplasia
and cancer, both of which are associated with long- term estrogen use. Decreased estrogen levels
account for hot flashes as well as mood swings and are related to osteoporosis. - ANSWER-Mrs.
Henderson, age 54, asks why she needs progesterone in addition to her estrogen for hormone
replacement. Women who have an intact uterus need to add progesterone to their prescribed estrogen
because progestin
A. assists in relieving the typical hot flashes of menopause.
,B. reduces the incidence of endometrial hyperplasia and cancer.
C. decreases the risk of osteoporosis. D. controlsmoodswings.
Answer B
CA 125 is a tumor marker that is highly specific to epithelial ovarian cancer. Increased levels (greater
than 35 U/mL) may indicate peritoneal diseases such as endometriosis, although significant elevations
are usually found with ovarian cancer. About 11% to 17% of women who inherit a harmful BRCA2
mutation will develop ovarian cancer by age 70, whereas CA 125 is highly specific. CA
15-3 level is elevated in metastatic breast disease and may be elevated in benign breast or ovarian
disease. CA 19-9 level is elevated in pancreatic and hepatobiliary cancer. - ANSWER-Which blood tumor
marker is highly spe- cific to epithelial ovarian cancer?
A. BRCA 2 B. CA 125 C. CA 15-3 D. CA19-9
Answer A
DNA is the only reliable source of newborn identification and is easily obtained from an umbilical cord
blood sample at birth. The American Academy of Pediatrics (AAP) and the American College of
Obstetricians and Gynecologists (ACOG) stopped recommending the use of fingerprinting or footprinting
for newborn identification purposes because children do not produce well-defined fingerprints until 4 to
6
years of age and newborn footprinting has been shown to be inaccurate. A buccal swab is another
possible method of obtaining newborn DNA, but if it is not processed or frozen soon after collection,
degradation may occur. Many additional factors can influence buccal cell DNA as well. A newborn heel
stick is commonly used to obtain the blood specimen for a newborn DNA sample. Because the
procedure is painful and there are many potential complications that may result, some parents are
hesitant to agree to this. - ANSWER-Susan, age 28, is 9 months pregnant and asks you about using
umbilical cord blood after birth for newborn DNA identification. What do you tell her?
A. "This cord blood sample is identical to the genetic profile of the infant."
B. "Fingerprinting and footprinting that have been done in the past work perfectly."
C. "A better method of obtaining newborn DNA is with a buccal swab."
D. "The traditional method of a newborn heel stick for a DNA sample is 'tried and true.'"
Answer C
Phenobarbital (Luminal) is the drug of choice in a pregnant woman with a seizure disorder. Ideally, if the
woman has not had a seizure for 5 years before the pregnancy, a prepregnancy trial of withdrawal from
seizure medication should be tried. Valproate (Depakene) and trimethadione (Tridione) are
, contraindicated during pregnancy, and phenytoin (Dilantin) is teratogenic during the first trimester. If
phenobarbital is used, serum levels should be measured in each trimester, and the dosage should
be such that it maintains the serum levels in the low-normal therapeutic range. - ANSWER-Judi, age 24,
has a seizure disorder. She would like to conceive within the next year. Her visit is for preconceptual
counseling. What is the drug of choice for her during pregnancy?
A. Valproate(Depakene) B. Trimethadione (Tridione) C. Phenobarbital (Luminal) D. Phenytoin(Dilantin)
Answer B
Emotional support is best given to the client with a sexually transmitted infection (STI) by authentic
active listening. During times of increased psychological stress, minimizing choices is better than offering
too many choices. The client with an STI needs support from others, and emphasis should focus on the
prevention of recurrences rather than the specifics of the duration of the disease. - ANSWER-Emotional
support is best given to the client with a sexually transmitted infection by
A. offeringmanyalternatives. B. authentic active listening. C. assuring the client that everything will be
okay. D. emphasizing the duration of the disease.
Answer A
Toxic shock syndrome (TSS) is a potentially lethal disorder that is caused in almost all cases by
absorption of one or more toxins produced by colonized Staphylococcus aureus. Several mechanisms
are implicated as causative, although not proven. They include tampon contamination with S aureus,
damaged cervical and vaginal mucosa, the use of overly absorbent tampons (or the synthetic materials
they are made of) for an extended period of time, absorption of bacteriostatic cervical secretions,
alterations in the normal vaginal flora, mechanical blockage of menstrual fluids, and the enhanced
multiplication of the organism in the menstrual efflux. The incidence of TSS has decreased steadily as a
result of education, altered patterns of tampon use, and the removal of extremely high-absorbency
tampons from the market. A urinary tract infection involving the bladder and kidneys does not cause
TSS. The risk of getting - ANSWER-Toxic shock syndrome (TSS) may be caused by which of the following?
A. TamponcontaminationwithStaphylococcus aureus
B. A short vaginal canal
C. The use of super absorbency tampons
D. A urinary tract infection involving the bladder and kidneys
Answer B
In clients with pelvic inflammatory disease, leukocytosis is present in about 50% of cases, the
erythrocyte sedimentation rate is classically elevated, and the C-reactive protein level is usually elevated
