NR 602 My final Study set questions with
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precise detailed answers
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A |16yearold |sexually |active |female |has |a |fever, |bilateral |lower |abdominal
pain,and |malaise. |A |speculum |and |bimanual |exam |reveals |adnexal |tenderness.
The |urinalysis |is |normal |and |cervical |cultures |are |pending. |What |medications |will |the |primary |
care |pediatric |nurse |practitioner |prescribe |for |this |patient? |- |correct |answer |PID- |she |is |
Sexually |active+Adnexal |Tenderness |and |negative |for |UTI. |
Ceftriaxone, |doxycycline, |and |metronidazole |
Rational- |This |is |PID |the |treatment |is |Ceftriaxone |250 |mg |IM |plus |Doxyclicline |100 |mg |BID |for |
14 |days |plus |with |or |without |Metronidazole |500 |mg |PO |bid |for |14 |days.
4. |A |sexually |active |adolescent |female |tests |positive |for |N. |gonorrhea |
and |Chalmydia. |She |tells |the |primary |care |pediatric |nurse |practitioner |that |she |
wants |to |be |treated |today |since |she |is |moving |out |of |town |the |next |day. |What |will |the |nurse |
practitioner |order?What |is |the |treatment |for |her |- |correct |answer |Ceftriaxone |250 |mg |IM |and |
azithromycin |1 |g |PO |one |time |each
Rational- |Remember |the |G |in |Gonorehea |for |or |Ceftriaxone |and |Chlamydia |you |can |give |either
|Doxycycline |100 |mg |for |7 |days |or |Azithromycin |1 |g |PO |x1 |because |she |is |moving |she |are |
giving |this |combination.
A |14yearold |female |has |menometrorrhagia |with |moderate |increase |in |menstrual |flow |and |
irregular |periods. |Her |hemoglobin |is |13.1 |g/dL. |How |will |this |be |managed? |- |correct |answer |
Iron |supplementation |and |prostaglandin |inhibitors
Rationale: |Her |hemoglobin |level |is |at |13.1 |and |the |normal |range |for |this |age |group |is |11.9-15. |
It |is |better |to |give |Iron |because |of |the |bleeding |and |for |pain |reliefe |Prostoglandins |such |as |
Ibuprofen.
,An |adolescent |female |has |heavy |periods |that |are |also |irregular. |The |physical |exam |is |normal. |A
|complete |blood |count |reveals |a |hemoglobin |of |8.9 |g/dL. |What |test |will |the |primary |care |
pediatric |nurse |practitioner |order |next? |- |correct |answer |Coagulation |studies
Rational-The |normal |Hemoglobin |range |is |11.9-13.1 |and |she |is |outside |the |range. |We |need |to |
look |for |reasons |of |this.
An |adolescent |female |has |periods |every |30 |days |that |are |consistently |
heavy |and |last |from |5 |to |8 |days. |What |is |her |diagnosis? |- |correct |answer |Menorrhagia- |
Rationale- |The |diagnosis |for |this |is |periods |lasting |longer |than |7 |days. |Hers |are |lasting |8 |days. |
She |is |consistant |with |when |her |periods |start |so |it |won't |be |menometrorrhagia |because |that |
is |irregular |periods.
A |16yearold |female |has |not |had |a |menstrual |period |yet |and |is |concerned. |She
denies |sexual |activity. |An |exam |reveals |an |adult |sexual |maturity |rating. |
Which |laboratory |test |will |the |primary |care |pediatric |nurse |practitioner |order |initially? |- |
correct |answer |Pregnancy |Test
Rationale- |All |people |lie |and |the |number |one |reason |for |Ammenorrhea |is |pregnancy. |After |I |
rule |out |that |then |I |can |look |at |other |things |such |as |nutrition, |is |she |an |athlete |and |is |it |
Primary |Amenorrhea |which |is |failure |to |have |a |period |for |3 |years |or |creast |development |or |by
|age |15. |or |Secondary |Anemia |which |is |no |menstrual |periods |for |3 |months |or |absent |of |period
|for |6 |months |for |those |on |irregular |periods.
A |16yearold |female |reports |breast |tenderness |and |a |"lump." |The |primary |care |pediatric |nurse |
practitioner |palpates |a |small |fluidfilled |mass |in |her |right |breast. |- |correct |answer |Order |an |
Ultra |Sound |of |Breast
Rationale- |First |thing |you |always |do |is |order |an |ultra |sound |first |to |determine |reason. |Most |
girls |this |age |do |not |have |breast |cancer.
, A |15yearold |n |female |has |a |positive |pregnancy |test |and |asks |the |primary |care
pediatric |nurse |practitioner |not |to |tell |her |parents. |She |is |tearful |and |says |she |isn't |sure |she |
wants |to |keep |the |baby. |What |will |the |nurse |practitioner |do |first? |- |correct |answer |Determine |
the |state |mandated |reporting |laws. |
Rationale- |Each |state |has |different |laws |on |reporting |to |parents |about |STIs |and |Pregnancy.
A |17yearold |sexually |active |female |who |began |having |periods |at |age |14 |reports |having |
moderate |to |severe |dull |lower |abdominal |pain |associated |
predominantly |with |periods |but |that |occurs |at |other |times |as |well. |The |history |reveals |a |
recent |onset |of |these |symptoms. |A |pregnancy |test |is |negative. |Which |course |of |action |is |most |
important? |- |correct |answer |Perform |a |full |diagnostic |workup |to |evaluate |potential |causes. |
Rationale- |This |is |not |normal |and |needs |more |workup |to |determine |the |reason |for |it. |She |is |
sexually |active |so |this |raises |more |concerns |for |other |things |that |might |be |going |on |such |as |
PID |or |an |STI
A |16yearold |female |reports |dull, |achy |cramping |pa |in |in |her |lower |abdomen
lasting |2 |or |3 |hours |that |occurs |between |her |menstrual |periods |each |month. |
The |adolescent |is |not |sexually |active. |What |is |the |treatment |for |this |condition? |- |correct |
answer |Prostaglandin |inhibitor |analgesics |and |a |heating |pad
Rationale |-This |is |signs |of |normal |period |and |the |1st |line |treatment |is |Prostoglandin |and |
heating |pad.
A |schoolage |female |has |had |vulvovaginitis |for |2 |months. |All |cultures |and |tests |.are |negative, |
but |the |symptoms |persist |after |treatment |with |both |topical |antibiotics |and |oral |amoxicillin. |
What |is |the |next |course |of |action |to |treat |this |condition? |- |correct |answer |Estrogen |cream |at |
bedtime |for |2 |to |3 |weeks
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precise detailed answers
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A |16yearold |sexually |active |female |has |a |fever, |bilateral |lower |abdominal
pain,and |malaise. |A |speculum |and |bimanual |exam |reveals |adnexal |tenderness.
The |urinalysis |is |normal |and |cervical |cultures |are |pending. |What |medications |will |the |primary |
care |pediatric |nurse |practitioner |prescribe |for |this |patient? |- |correct |answer |PID- |she |is |
Sexually |active+Adnexal |Tenderness |and |negative |for |UTI. |
Ceftriaxone, |doxycycline, |and |metronidazole |
Rational- |This |is |PID |the |treatment |is |Ceftriaxone |250 |mg |IM |plus |Doxyclicline |100 |mg |BID |for |
14 |days |plus |with |or |without |Metronidazole |500 |mg |PO |bid |for |14 |days.
4. |A |sexually |active |adolescent |female |tests |positive |for |N. |gonorrhea |
and |Chalmydia. |She |tells |the |primary |care |pediatric |nurse |practitioner |that |she |
wants |to |be |treated |today |since |she |is |moving |out |of |town |the |next |day. |What |will |the |nurse |
practitioner |order?What |is |the |treatment |for |her |- |correct |answer |Ceftriaxone |250 |mg |IM |and |
azithromycin |1 |g |PO |one |time |each
Rational- |Remember |the |G |in |Gonorehea |for |or |Ceftriaxone |and |Chlamydia |you |can |give |either
|Doxycycline |100 |mg |for |7 |days |or |Azithromycin |1 |g |PO |x1 |because |she |is |moving |she |are |
giving |this |combination.
A |14yearold |female |has |menometrorrhagia |with |moderate |increase |in |menstrual |flow |and |
irregular |periods. |Her |hemoglobin |is |13.1 |g/dL. |How |will |this |be |managed? |- |correct |answer |
Iron |supplementation |and |prostaglandin |inhibitors
Rationale: |Her |hemoglobin |level |is |at |13.1 |and |the |normal |range |for |this |age |group |is |11.9-15. |
It |is |better |to |give |Iron |because |of |the |bleeding |and |for |pain |reliefe |Prostoglandins |such |as |
Ibuprofen.
,An |adolescent |female |has |heavy |periods |that |are |also |irregular. |The |physical |exam |is |normal. |A
|complete |blood |count |reveals |a |hemoglobin |of |8.9 |g/dL. |What |test |will |the |primary |care |
pediatric |nurse |practitioner |order |next? |- |correct |answer |Coagulation |studies
Rational-The |normal |Hemoglobin |range |is |11.9-13.1 |and |she |is |outside |the |range. |We |need |to |
look |for |reasons |of |this.
An |adolescent |female |has |periods |every |30 |days |that |are |consistently |
heavy |and |last |from |5 |to |8 |days. |What |is |her |diagnosis? |- |correct |answer |Menorrhagia- |
Rationale- |The |diagnosis |for |this |is |periods |lasting |longer |than |7 |days. |Hers |are |lasting |8 |days. |
She |is |consistant |with |when |her |periods |start |so |it |won't |be |menometrorrhagia |because |that |
is |irregular |periods.
A |16yearold |female |has |not |had |a |menstrual |period |yet |and |is |concerned. |She
denies |sexual |activity. |An |exam |reveals |an |adult |sexual |maturity |rating. |
Which |laboratory |test |will |the |primary |care |pediatric |nurse |practitioner |order |initially? |- |
correct |answer |Pregnancy |Test
Rationale- |All |people |lie |and |the |number |one |reason |for |Ammenorrhea |is |pregnancy. |After |I |
rule |out |that |then |I |can |look |at |other |things |such |as |nutrition, |is |she |an |athlete |and |is |it |
Primary |Amenorrhea |which |is |failure |to |have |a |period |for |3 |years |or |creast |development |or |by
|age |15. |or |Secondary |Anemia |which |is |no |menstrual |periods |for |3 |months |or |absent |of |period
|for |6 |months |for |those |on |irregular |periods.
A |16yearold |female |reports |breast |tenderness |and |a |"lump." |The |primary |care |pediatric |nurse |
practitioner |palpates |a |small |fluidfilled |mass |in |her |right |breast. |- |correct |answer |Order |an |
Ultra |Sound |of |Breast
Rationale- |First |thing |you |always |do |is |order |an |ultra |sound |first |to |determine |reason. |Most |
girls |this |age |do |not |have |breast |cancer.
, A |15yearold |n |female |has |a |positive |pregnancy |test |and |asks |the |primary |care
pediatric |nurse |practitioner |not |to |tell |her |parents. |She |is |tearful |and |says |she |isn't |sure |she |
wants |to |keep |the |baby. |What |will |the |nurse |practitioner |do |first? |- |correct |answer |Determine |
the |state |mandated |reporting |laws. |
Rationale- |Each |state |has |different |laws |on |reporting |to |parents |about |STIs |and |Pregnancy.
A |17yearold |sexually |active |female |who |began |having |periods |at |age |14 |reports |having |
moderate |to |severe |dull |lower |abdominal |pain |associated |
predominantly |with |periods |but |that |occurs |at |other |times |as |well. |The |history |reveals |a |
recent |onset |of |these |symptoms. |A |pregnancy |test |is |negative. |Which |course |of |action |is |most |
important? |- |correct |answer |Perform |a |full |diagnostic |workup |to |evaluate |potential |causes. |
Rationale- |This |is |not |normal |and |needs |more |workup |to |determine |the |reason |for |it. |She |is |
sexually |active |so |this |raises |more |concerns |for |other |things |that |might |be |going |on |such |as |
PID |or |an |STI
A |16yearold |female |reports |dull, |achy |cramping |pa |in |in |her |lower |abdomen
lasting |2 |or |3 |hours |that |occurs |between |her |menstrual |periods |each |month. |
The |adolescent |is |not |sexually |active. |What |is |the |treatment |for |this |condition? |- |correct |
answer |Prostaglandin |inhibitor |analgesics |and |a |heating |pad
Rationale |-This |is |signs |of |normal |period |and |the |1st |line |treatment |is |Prostoglandin |and |
heating |pad.
A |schoolage |female |has |had |vulvovaginitis |for |2 |months. |All |cultures |and |tests |.are |negative, |
but |the |symptoms |persist |after |treatment |with |both |topical |antibiotics |and |oral |amoxicillin. |
What |is |the |next |course |of |action |to |treat |this |condition? |- |correct |answer |Estrogen |cream |at |
bedtime |for |2 |to |3 |weeks
