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Question: When palpating the cervix during the bimanual exam, cervical motion tenderness (chandelier sign) is noted. This tenderness could be suggestive of: retroversion of the uterus.pelvic inflammatory disease. Correctvulvar lesions. IncorrectBartholin gland infection. Explanation: Cervical motion tenderness, also known as Chandelier's sign, and/or adnexal tenderness, suggest pelvic inflammatory disease, ectopic pregnancy, or appendicitis. Question: In a female diagnosed with a first-degree uterine prolapse, the cervix: is located in its normal position. has slipped but is well within the vagina. Correctis located in the introitus.and vagina are outside the introitus. Explanation: Uterine prolapse occurs in progressive stages. The uterus becomes retroverted
Chamberlain College of NursingNURSING NR 509APEA
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and descends down the vaginal canal to the exterior. In first-degree prolapse, the cervix is still well within the vagina. In second- degree prolapse, it is at the introitus. In third-degree prolapse (procidentia), the cervix and vagina are outside the introitus. Question: Daughters of women who took Diethylstilbestrol (DES) during pregnancy are at a high risk for developing all of the following abnormalities except: columnar epithelium covering most or all of the cervix.a slit- like cervical os. Correctvaginal adenosis.a circular collar or ridge of tissue between the cervix and the vagina. Explanation: Daughters of women who took Diethylstilbestrol (DES) during pregnancy are at greatly increased risk for several abnormalities: columnar epithelium that covers most or all of the cervix vaginal adenosis, and a circular collar or ridge of tissue, of varying shapes, between the cervix and vagina. The slit-like cervical os is a normal variation. Question: A female patient presents with a profuse, yellowish, green vaginal discharge that is malodorous. This vaginal discharge is most consistent with:
Chamberlain College of NursingNURSING NR 509APEA
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common causes are situational and psychosocial in origin. Therefore, obtaining a comprehensive sexual history is of utmost importance. Question: Chronic pelvic pain refers to pain that does not respond to therapy and: lasts more than 3 months. Incorrectlasts more than 6 months. Correctlasts more than 9 months.lasts more than 12 months. Explanation: According to the International Pelvic Pain Society, chronic pelvic pain refers to pain that lasts more than 6 months without response to treatment. Question: In female patients with dyspareunia, superficial pain is most likely related to all of the following except: local inflammation.atrophic vaginitis. Incorrectpressure on a normal ovary. Correctinadequate lubrication. Explanation: In females, dyspareunia, or painful intercourse, can occur at the vaginal opening,
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occurring at the start of intercourse, or when the partner is pushing deeper. It is important to differentiate the pain to determine the etiology. Superficial pain suggests local inflammation, atrophic vaginitis, or inadequate lubrication. Deeper pain may be from pelvic disorders or pressure on a normal ovary. Question: If urethritis or inflammation of the paraurethral glands is suspected in a female patient, the index finger should be inserted into the vagina and: milk the urethra gently from the outside inward.milk the urethra gently from the inside outward. Correctmassage the urethral meatus with the other hand.massage the pelvic floor muscles in a clockwise fashion. Explanation: If urethritis or inflammation of the paraurethral glands is suspected, the examiner should insert the index finger into the vagina and milk the urethra gently from inside outward. Note any discharge from or about the urethral meatus. If present, it should be cultured. Question: Upon examination of the vagina, a swollen red ring is noted around the urethral opening. This finding is most consistent with a:
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pain, increased abdominal size, and urinary tract symptoms. An ovarian cyst tends to be smooth and compressible and if uncomplicated, nontender. A right tubal pregnancy does not typically present with an ovarian lesion. A tubo-ovarian abscess is difficult to palpate and typically presents with severe pain and purulent vaginal discharge. Question: Indications for performing a rectovaginal exam include all of the following except to: palpate a retroverted uterus.assess pelvic pathology.assess an inguinal hernia. Correctscreen for colorectal cancer in women over 50. Explanation: The rectovaginal examination has three primary purposes: to palpate a retroverted uterus, the uterosacral ligaments, cul-de-sac, and adnexa; to screen for colorectal cancer in women 50 years or older; and to assess for pelvic pathology. It is not indicated for assessing or palpating inguinal hernias. Question: Examination of a female patient's right breast reveals a retraction of the nipple and areola. This finding is consistent with:
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breast cancer. Correctmastitis.Paget's disease of the breast.fibrocystic breast disease. Explanation: Retraction of the nipple and areola are suggestive of an underlying tumor. Mastitis is an inflammation of the breast tissue. Paget's disease is an uncommon form of breast cancer that starts with a scaly, eczema- like lesion that may weep, crust, or erode. Fibrocystic breast disease findings include lumps, thickening and swelling in the breast tissue, and becomes prominent immediately before onset of menses. Question: To assess pelvic floor muscle strength during the bimanual vaginal exam, have the patient squeeze around the inserted fingers for as long as possible. To consider full strength, snug compression should last for: 1 seconds.2 seconds.3 seconds. Correctat lease 5 seconds. Incorrect Explanation: To assess pelvic floor muscle strength during the bimanual vaginal exam, have the patient squeeze around the inserted fingers for as long as possible. To consider full strength, snug compression should last for 3 or more seconds.
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Explanation: Retroversion of the uterus refers to a tilting backward of the entire uterus, including both body and cervix. It is a common variant occurring in approximately 20% of women. A backward angulation of the uterus in relation to its cervix is referred to as a retroflexion of the uterus. When the cervix is located at the introitus, and the uterus is in the vaginal canal, this is consistent with a third- degree uterine prolapse. Question: Upon examination of the vagina, the entire anterior vaginal wall, together with the bladder and urethra create a bulge. This condition is most consistent with a: prolapse of the urethral mucosa.urethral caruncle.cystocele.cystourethrocele. Correct Explanation: When the entire anterior vaginal wall, together with the bladder and urethra, is involved in the bulge, a cystourethrocele is present. A cystocele is a bulge of the upper two-thirds of the anterior vaginal wall and the bladder above it. It results from weakened supporting tissues. A prolapsed urethral mucosa
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forms a swollen red ring around the urethral meatus. A urethral caruncle is a small, red, benign tumor visible at the posterior part of the urethral meatus. Question: Urethritis in a female patient may arise from all of the following organisms except: Neisseria gonorrhoeae.Herpes simplex. IncorrectChlamydia trachomatis.Campylobacter. Correct Explanation: Urethritis may arise from infection with Chlamydia trachomatis or Neisseria gonorrhoeae, Streptococcus, E. coli, and Herpes simplex virus. Campylobacter is associated with bacterial infections of the GI tract and commonly produce diarrhea. Question: To palpate the uterus during a bimanual exam, the examiner would lubricate the index and middle fingers of one hand and insert them into the vagina. The other hand would be placed on the abdomen: near the symphysis pubis while pressing downward and elevating the cervix and uterus with the other hand.about midway between the umbilicus and symphysis
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an ovarian cyst.metastatic tissue in the rectouterine pouch. Correctrectal polyp. Incorrectcarcinoma of the rectum. Explanation: Widespread peritoneal metastases from any source may develop in the area of the peritoneal reflection anterior to the rectum. A firm to hard nodular rectal “shelf” may be just palpable with the tip of the examining finger. In a woman, this shelf of metastatic tissue develops in the rectouterine pouch, behind the cervix and the uterus. Rectal polyps and carcinoma of the rectum, if palpable, are typically located in the lower section of the rectum. To palpate the ovaries, a bimanual pelvic examination would be more appropriate. Question: A twenty-year-old female complains of a milky discharge bilaterally from her breasts. This suggests: a normal finding in women in their early twenties.pregnancy or elevated prolactin level. Correctbreast disease.breast cancer. Explanation:
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Galactorrhea, a milky breast discharge usually observed bilaterally, is suggestive of pregnancy or elevated prolactin level. It's presence bilaterally is not characteristic of breast disease or breast cancer. It is not normally present in twenty-year-olds. Question: A woman complains of infrequent menses with intervals greater than 35 days. This condition is termed: oligomenorrhea. Correctpolymenorrhea.metrorrhagia.menorrhagia. Incorrect Explanation: Oligomenorrhea is infrequent bleeding with menses occurring at greater than 35- day intervals, or 4-9 menstrual cycles per year. Polymenorrhea occurs when there are fewer than 21-day intervals between menses. Menorrhagia refers to excessive or prolonged menstrual flow occurring at regular intervals. Metrorrhagia refers to intermenstrual bleeding. Question: The most common cause of acute pelvic pain in women is: ruptured ovarian cysts.appendicitis.pelvic inflammatory disease. Correctmittelschmerz.
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When preparing to perform a pelvic exam in an older female, vaginal atrophy is noted. Due to this finding, the speculum: should not be used.should be a larger size. Incorrectshould be a smaller size. Correctshould be completely dry. Explanation: Performing a pelvic exam in an older woman, the nurse practitioner should separate the labia, press downward on the introitus to relax the levator muscles, and gently insert the speculum after moistening it with warm water or a water- soluble lubricant. If there is severe vaginal atrophy, a gaping introitus, or an introital stricture from estrogen loss, the size of the speculum may need to be adjusted to a smaller size. Question: Upon examination of the cervix, a yellow drainage is visible around the cervical os. This finding is most likely suggestive of: candidal vaginitis.cervical polyp.carcinoma of the cervix.mucopurulent cervicitis. Correct
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Explanation: Mucopurulent cervicitis produces purulent, yellow drainage from the cervical os, usually from Chlamydia trachomatis, Neisseria gonorrhoeae, or herpes infection. Candidal vaginitis produces a white and curd- like, thin discharge from the vagina and does not originate from the cervix. Typically a cervical polyp does not produce a cervical discharge. Carcinoma of the cervix begins in an area of metaplasia and usually does not produce a mucopurulent cervical discharge. Question: When examining the cervix, a bright, red, soft and fragile lesion is noted on the cervical surface. This finding is consistent with: a retention cyst.an epidermoid cyst.a syphilitic chancre. Incorrecta cervical polyp. Correct Explanation: A cervical polyp usually arises from the endocervical canal, becoming visible when it protrudes through the cervical os. It is bright red, soft, and fragile. A small, firm, round cystic nodule in the labia suggests an epidermoid cyst. A retention cyst appears as a translucent nodule on the cervical surface. A small, firm, round cystic nodule in the labia suggests an epidermoid cyst. A syphilitic chancre appears as a firm, painless ulcer and suggests the chancre of primary syphilis. Question: During examination of the vagina, a bulge in the upper two-thirds of the anterior
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is next in frequency. Question: A female patient presents with a gray, thin, malodorous (fishy) vaginal discharge. These symptoms are most consistent with: candidal vaginitis.bacterial vaginosis CorrectTrichomonal vaginitis.gonorrhea. Explanation: The discharge associated with bacterial vaginosis can be gray or white, thin, malodorous, and not usually profuse. The odor is usually fishy. Trichomonas vaginalis causes trichomonal vaginitis. Presenting symptoms include a profuse, yellowish, green vaginal discharge that is malodorous. Candidal vaginitis produces a white and curd-like thin discharge that is rarely malodorous. The discharge associated with gonorrhea is usually thick and bloody. Question: When performing a bimanual vaginal exam, a smooth and rather compressible non-tender lesion is palpated over the right ovary. This finding is most consistent with: ovarian cancer.an ovarian cyst. Correcta right tubal pregnancy.a tubo-ovarian abscess. Explanation:
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An ovarian cyst tends to be smooth and compressible and if uncomplicated, nontender. Ovarian tumors appear more solid and often nodular. A right tubal pregnancy does not typically present with an ovarian lesion. A tubo-ovarian abscess is difficult to palpate and typically presents with severe pain and purulent vaginal discharge. Question: When performing the bimanual vaginal exam, a nodule on the anterior uterine surface could suggest a (an): ovarian cyst.myoma. Correctpregnancy.pelvic inflammatory disease. Explanation: When performing the bimanual vaginal exam, the pelvic fingers can feel the anterior surface of the uterus, and the abdominal hand can feel part of the posterior surface. A nodule palpated on either the anterior or posterior uterine surfaces could suggest a myoma. Question: Cessation of the menses for 12 months is termed: oligomenorrhea.menopause. Correctmenorrhagia.metrorrhagia.
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