MID TERM OB REVIEW.MID TERM OB REVIEW., Exams of Nursing

Download MID TERM OB REVIEW.MID TERM OB REVIEW. and more Exams Nursing in PDF only on Docsity!

. 1.A twenty-one-year-old woman presents for her initial well-woman examination. She has never been sexually active and has a negative family history for gynecology problems. Personal history is negative for abuse, and she exercises regularly and eats a balanced diet. Menstrual history reveals that she experienced menarche at fourteen years of age, has a regular twenty- eight-day cycle, and denies dysmenorrhea. Which of the following would be included in her physical examination today? A. Stool for occult blood B. Baseline mammography C. Cultures for gonorrhea and chlamydia D. Pap smear . 2.Elba, a thirty-five-year-old woman, presents with a six-month history of hypermenorrhea, backache, and pelvic pressure. On examination, you discover twelve-week-size uterus with irregular contour. Which of the following does this represent? A. Cervical stenosis B. Missed abortion C. Uterine fibroid D. Fecal impaction . 3.A thirty-three-year-old woman presents to your clinic complaining of a dark brown, watery vaginal discharge and postcoital bleeding. There is a strong history of multiple unprotected sexual encounters. She has not been immunized for human papillomavirus (HPV). Which of the following examination findings would be suspicious for cervical cancer? A. Lymphadenopathy of the femoral area B. A soft, pink cervix with no ulceration C. An anteverted cervix with lateral displacement D. A very firm cervix with an ulcer . 4.A woman comes to the clinic with the chief complaint of disruption of urine flow. Which of the following is not a risk factor for pelvic floor relaxation? A. Obesity B. Menopause C. Vaginal delivery D. Cesarean section . 5.A patient is complaining of a milky nipple discharge. Galactorrhea is usually a finding with which other diagnosis? A. Cancer B. Miastalgia C. Hyperprolactinemia D. Fibroma

. 6.Nancy is an eleven-year-old presenting for an annual well-child visit. When reviewing the physiology of puberty, you recall that the initiation of puberty begins physiologically with the release of GnRH by the. A. Hypothalamus B. Adrenal gland C. Ovaries D. Pituitary gland . 7.The new ACOG Pap smear guidelines reflect a change in all of the following except. A. The age at which Pap smears are initiated B. The frequency of Pap smear screenings C. The follow-up to abnormal Pap smear results D. The endpoint for Pap smear testing . 8.Sally, a sixty-one-year-old Caucasian female, presents to your practice for a well-woman examination. She remarks that she feels like she is shrinking over the past year, despite keeping active and incorporating sources of calcium in her diet. Which of the following is not a risk factor for osteoporosis? A. Smoking B. History of maternal osteoporosis C. Excessive use of alcohol or caffeine D. Use of combined oral contraception

9. Malignant ovarian masses are very uncommon in young women. Which of the following information would be least helpful in the assessment, diagnosis, or management of pelvic malignancies in young women? A. Malignant germ cell tumors are the most common ovarian tumors in young women. B. Mutations in the breast cancer gene-1 (BRCA-1) are responsible for a small percentage of ovarian cancers in women. C. Oral contraceptives are effective in minimizing the risks of functional ovarian masses. D. The most common metastatic ovarian lesions in young women are lymphomas and leukemias. . 10.A fourteen-year-old patient is accompanied by her mother, who is concerned about irregular and infrequent periods. Her last menstrual period was two months ago. What would be the initial test performed? A. Urine HCG B. Serum beta HCG

C. Hemoglobin and hematocrit D. Chlamydia culture

. 11.Elizabeth, twenty-four years old, is pregnant, and you are educating her on common problems during the first trimester. Which of the following is abnormal and requires immediate attention? A. Nausea and vomiting (aka “morning sickness”) B. Fatigue and tiredness C. Back ache in the lumbar area D. Vaginal bleeding . 12.A young woman presents to your practice with vaginal itching and a white discharge. She denies sexual activity or douching. She has been in good health except for a recurrent strep throat. Pelvic examination reveals a tender vulvovaginal area with edema and white patches; no odor is detected. Which of the following is the most likely cause of this problem? A. Bacterial vaginosis B. Diabetes mellitus C. Allergy to personal hygiene product D. Candidiasis after antibiotic treatment

13. You are researching preliminary evidence-based sources about breast cancer risk factors. Which of the following would you find is not one for the disease? A. First full-term pregnancy after thirty-five years of age B. Late menopause after fifty-four years C. History of maternal breast cancer D. Fibrocystic breast disease . A nurse practitioner is educating a high school class about sexual education. Teaching should include that protective factors against repeat adolescent pregnancy include all of the following except: A. Use of effective contraception B. Participation in specialized adolescent parent program C. Continued sexual relationship with the same partner D. Continued school attendance . A mother presents to the clinic with her female child who she is concerned about because her breasts are developing “when she is so young.” When performing the initial assessment, it is important to recall that precocious puberty is present if.

A. Delay in any of the Tanner stages takes longer than two years between stages B. The adolescent has had sexual relations before menarche C. Puberty starts before eight years of age in a female D. The growth spurt in a female occurs after puberty is complete

. You are starting Ella, a twenty-one-year-old, on Ortho Tri-Cyclen, a combined oral contraceptive. Which of the following would not be included in your instructions and advice? A. Try to take the pill at the same time every day. If you miss one day, double up the next day. B. You need to use backup protection consistently for the first month to avoid pregnancy. C. Breakthrough bleeding may occur in the first few cycles. Please do not stop taking the pill due to this. If you are uncomfortable with this, come in for a follow-up appointment to discuss other options. D. Oral contraceptives offer protection against breast cancer for as long as you are using them. . The National Osteoporosis Foundation has screening guidelines for DEXA scans. Which of the following women would be most in need of bone mineral density testing? A. A fifty-four-year-old postmenopausal woman receiving hormone replacement therapy (HRT) B. A fifty-year-old woman who is having irregular menstrual cycles C. A fifty-one-year-old woman with systemic lupus erythematosus (SLE) on long- term corticosteroid therapy D. A forty-nine-year-old Caucasian woman who smokes and has an excessive alcohol intake . Lucinda, thirty-two years old, presents to your clinic with the complaint of missed periods for two months, nausea, breast tenderness, and frequent urination. She had an intrauterine device (IUD) placed five months ago. On examination, you find the following: Cervix—positive for Chadwick’s sign; IUD strings protruding from cervical os; uterus—nontender, enlarged; adnexa — nontender, no masses, and no cervical motion tenderness. The most probable diagnosis is . A. Uterine fibroid B. Dislodged IUD C. Pregnancy D. Urinary tract infection . Lakeisha, seventeen years old, is seeing her regular nurse practitioner for a sports physical. While participating in a psychosocial screen, Lakeisha volunteers that she “hasn’t had sex yet.” What is the best initial response to Lakeisha’s statement? A. Congratulate her for abstaining and move on to another topic. B. Clarify which behaviors are included in Lakeisha’s definition of “having sex.” C. Demonstrate condom use and give Lakeisha some condoms for future partners

D. Lakeisha to be screened for STIs.

. In caring for a menopausal client who has had a total hysterectomy, the nurse practitioner would include which of the following options? A. Estrogen alone B. Estrogen and progestin C. Progestin and testosterone D. Testosterone alone . A twenty-one-year-old woman presents to your family planning clinic seeking emergency contraception. She had unprotected sex last night and is not currently on any contraception. Her last menstrual period was two weeks ago, and she denies recent sexual intercourse. Which of the following is not an emergency contraception modality? A. Combined oral contraceptive using the Yuzpe protocol B. Progesterone-only contraceptive using Plan B protocol C. Mechanical agents using an intrauterine device (IUD) protocol D. RU-486—mifepristone protocol . A nurse practitioner is educating a woman who has a colposcopy ordered. Which of the following most accurately describes a colposcopy? A. A procedure that visualizes the vaginal, vulvar, or cervical epithelium with magnification to identify abnormal areas that may need to be biopsied B. A procedure to visualize the uterine cavity through a small, fiber-optic scope introduced through the cervix C. A procedure to remove a sample of endometrial tissue with a curette or an aspiration tool for biopsy D. A procedure to visualize the abdominal and pelvic cavity by fiber-optic endoscope via a sub umbilical incision . Jackie is a fifteen-year-old African American female who resides in a housing plan. You realize that barriers exist in providing preventive services to adolescents that include all of the following except: A. Reluctance of adolescents to seek care B. Concept that adolescents are “healthy” and don’t need services C. Concerns about lack of confidentiality D. Availability of guidelines for preventive care . A thirty-nine-year-old female has not had menses for over six months and has a negative pregnancy test. Which of the following characteristics puts her at risk for an early menopause?

A. Obesity (BMI 30) B. Current smoker C. Early menarche D. Nulliparity

. Tanisha is a twenty-two-year-old woman who presents with extreme irritability and mood swings, bloating, constipation, fluid retention, and headache. She tearfully tells you, “This happens every month in my cycle. I get like a crazy woman, lashing out at everyone. I’m afraid I’ll lose my job if I can’t stop this. Sometimes, it’s so bad. I just want to quit living. I need help!” Tanisha’s symptoms are typical of what disorder? A. Depression B. Premenstrual syndrome (PMS) C. Bipolar disorder D. Premenstrual dysphoric disorder (PMDD) . According to Neinstein, all stages of adolescent psychosocial development revolve around issues with independence/dependence, body image concerns, peer group involvement, and identity development. During which stage are eating disorders most likely to surface? A. Early adolescence (ten to thirteen years) B. Middle adolescence (fourteen to sixteen years) C. Older adolescence (seventeen to twenty-one years) D. All of the above . A postmenopausal patient is prescribed hormonal therapy (HT). The nurse practitioner recalls that HT is indicated for the management of. A. Lipid changes B. Hot flashes C. Memory loss D. Obesity . Luz is a fifteen-year-old girl who comes to your office stating, “I have not had my period for two months now.” She experienced menarche at ten years of age, with regular cycles for the past two years. In your initial consideration of a differential diagnoses, what is the most likely etiology of this problem? A. Disordered eating B. Pregnancy C. Anovulatory cycles D. Stress

. Anna, twenty-five years old, presents with dysmenorrhea. She states that her sister and mother have endometriosis; so, she would like to be evaluated for it. Which if the following is consistent with a diagnosis of endometriosis? A. Erythema and edema of the vulva B. Postcoital bleeding with malodorous discharge C. Pelvic pain and dyspareunia D. Frequent diarrhea and amenorrhea . You are evaluating seventeen-year-old Emily who presented with amenorrhea and normal secondary sex characteristics. The purpose of the progesterone challenge is to ascertain the presence of. A. Prolactin B. Adequate body fat C. Endogenous estrogen D. Thyroxine . During a pelvic exam on a seventy-year-old, the nurse practitioner notices the position of the cervix at the introitus. The diagnosis is most likely. A. Cystocele B. Rectocele C. Urethral prolapse D. Uterine prolapse . The nurse practitioner is prescribing an oral contraception to Sally. She is concerned about having one that has “two hormones” as the active ingredients. You instruct her that adding progestin to estrogen therapy will decrease the risk of. A. Breast cancer B. Withdrawal bleeding C. Endometrial cancer D. Osteoporosis . Sheryl, a twelve-year-old, complains of a vaginal discharge for the past eight to nine months. She tells you her underpants are frequently wet. When she wipes after urinating, there is “white stuff” on the tissue. Sheryl denies urinary problems, genital itching, or odor. She also denies sexual activity. Her menses has not yet started, but she reports that she “started to develop” her breasts a little past age ten. Her vaginal discharge is most likely a result of. A. Fungal infection B. Chlamydia infection C. Retained foreign body D. Physiologic leukorrhea

. You are seeing twelve-year-old Sonya for a well-adolescent checkup. She is accompanied by her mother who agrees to having you see Sonya alone but wants to talk with you at the end. After examining Sonya and assuring her of confidentiality, you meet with her mother briefly. Sonya’s mother states, “I don’t know how to say this, but I am so worried that my daughter is homosexual. She spends so much time with her girlfriends, and they are the focus of her entire life.” From your understanding of normal adolescent stages and development, how would you respond to her concern? A. Advise Sonya’s mother that same-sex close friendships are normal at this age. B. Offer to refer Sonya’s mother to a counselor who is experienced with gay teens. C. Caution the mother that you can’t disclose any information that Sonya has told you. D. Explain that Sonya is old enough to decide her own sexual identity and to “let go.”

35. Thalia is a fifteen-year-old who is referred to your women’s health practice by her school counselor. She has macromastia and has been teased and ridiculed by her classmates at school. Which of the following would be the first step in dealing with this problem? A. Encourage Thalia to wear loose clothing and a bra with strong support. B. Refer Thalia to a therapist for counseling and support, including antibullying. C. Meet with Thalia and her parents to discuss options, including breast reduction surgery. D. Assess Thalia’s Tanner staging for breasts and date of menarche. = Frankie is concerned that she has an ultrasound ordered after the results of her mammogram of been reviewed by the nurse practitioner. You emphasize that the primary role of a breast ultrasound is to. A. Screen for breast cancer B. Definitively diagnose breast cancer C. Determine if a breast lesion is cystic or solid D. Locate small lesions before surgery . A twenty-five-year-old pregnant client presents with the complaint of headaches that are confined to the base of the head and upper neck; she denies visual changes, photophobia, or nausea. The most likely diagnosis is which type of headache? A. Common migraine B. Classic migraine C. Tension D. Withdrawal

. Cara is in the clinic for what you have diagnosed as dysfunctional uterine bleeding (DUB). She is concerned about why this is happening to her. You recall which of the following is the most common cause of DUB? A. Endocrine disorders B. Stress C. Anovulation D. Anatomical abnormality . Natasha is an eleven-year-old girl brought to your office for an annual well-child visit. When discussing the onset of puberty with Natasha and her mother, you would emphasize which of the following? A. Pubic hair develops before breast buds. B. Breast development delayed beyond twelve years of age may be considered pathological. C. The average age of menarche is twelve years. D. It usually takes about three-and-half years to go from breast buds to menarche. . A twenty-one-year-old woman comes into your practice seeking birth control. She has only recently become sexually active and has consistently used condoms for safe sex. Your history reveals that she does not use tampons during her menses and has very little knowledge about female reproductive anatomy. Based on this information, which of the following birth control choices would be least likely to meet her needs for contraceptive management? A. Combined oral contraceptive (COC) “The pill” B. Depo-Provera C. Ortho Evra patch D. NuvaRing . Seventeen-year-old Stella presents with the chief complaint of unilateral breast tenderness and swelling. Which of the following would be the least likely etiology for this problem? A. Breast cancer B. Mastitis C. Fibrocystic breast D. Fibroadenoma . The most effective interventions available to women’s healthcare providers for reducing the incidence and severity of the leading causes of death and disability in this group are. A. Screening tests B. Immunizations C. Chemoprophylaxis

D. Lifestyle changes

. LaShonda, thirty-four years old, is undergoing fertility treatments to become pregnant. Her period was three weeks late and heavier than normal. She thinks that she had an early miscarriage and wants confirmation. Which of the following tests would be most accurate to do this? A. Home pregnancy test B. Pelvic ultrasound C. Quantitative beta-HCG subunit D. Serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels . You are interviewing a teen with suspected substance abuse. Which of the following screening tools would give you the most specific information regarding substance abuse in teens? A. GAPS B. CAGE C. CRAFFT D. HEADSS . You are working in a women’s health practice and decide to incorporate brief preconception counseling into every visit. Which of the following would not be included in brief preconception counseling? A. Maternal assessment B. Risk screening C. Immunizations D. Medication management . A patient is being rechecked after having a total hysterectomy performed and is having multiple problems since. Which of the following is/are early symptom(s) of estrogen withdrawal? A. Vaginal lubrication B. Chills C. Sleep disturbances D. Myalgias . In prescribing hormone replacement therapy (HRT) for a menopausal woman, which of the following does not accurately reflect current best practices for HRT? A. The use of HRT should be an individualized decision with discussion of risks and benefits. B. Use the lowest possible dosage of HRT to achieve symptom alleviation. C. Use HRT for the shortest time possible to achieve symptom alleviation. D. Use combination therapy only in a woman with a history of prior breast cancer.

. A Pap smear result of atypical squamous cells of undetermined significance—rule out high- grade squamous intraepithelial lesion (ASCUS r/o HGSIL) will require which procedure next? A. Cold knife cone (CKC) B. Follow-up Pap smear C. Colposcopy D. Loop electro-excision procedure (LEEP) . Lenore, fifty-five years old, comes in for evaluation of a breast mass. Which of the following is not usually linked with carcinoma of the breast? A. Scaly lesions like eczema on one areola and nipple B. Peau d’orange dimpling of skin over breast C. Unilateral retraction and deviation of nipple D. Well-circumscribed, rubbery, and tender lesion . You are completing a pelvic exam on thirty-two-year-old Nancy. You detect a left adnexal mass on the bimanual exam. With an adnexal mass, the practitioner must always suspect until proven otherwise. A. Pelvic inflammatory disease (PID) B. Malignancy C. Pregnancy D. Polycystic ovary disease . A thirty-two-year-old woman presents to your practice with a complaint of postcoital bleeding. Which of the following must be included in the assessment of this patient? A. Papanicolaou smear B. Uterine biopsy C. Intrauterine device (IUD) string assessment D. Palpation of thyroid . A woman comes to the clinic with the chief complaint of disruption of urine flow. Which of the following is not a risk factor for pelvic floor relaxation? A. Obesity B. Menopause C. Vaginal delivery D. Cesarean section

. A mother presents to the clinic with her female child who she is concerned about because her breasts are developing “when she is so young.” When performing the initial assessment, it is important to recall that precocious puberty is present if. A. Delay in any of the Tanner stages takes longer than two years between stages B. The adolescent has had sexual relations before menarche C. Puberty starts before eight years of age in a female D. The growth spurt in a female occurs after puberty is complete . Abby, twenty years old, presents with pelvic pain. Which of the following is not a first- line diagnostic test for evaluation of pelvic pain? A. Pregnancy test B. CBC with differential C. CT of pelvis D. Urinalysis . A thirty-three-year-old woman presents to your clinic complaining of a dark brown, watery vaginal discharge and postcoital bleeding. There is a strong history of multiple unprotected sexual encounters. She has not been immunized for human papillomavirus (HPV). Which of the following examination findings would be suspicious for cervical cancer? A. Lymphadenopathy of the femoral area B. A soft, pink cervix with no ulcerations C. An anteverted cervix with lateral displacement D. A very firm cervix with an ulcer

54. A nurse practitioner is completing a history on a woman who has been diagnosed with primary amenorrhea. Which of the following would not be a significant past medical history for this diagnosis? A. Turner’s syndrome B. Kallmann syndrome C. Stein-Leventhal syndrome D. Pure gonadal dysgenesis . A twenty-one-year-old woman comes into your practice seeking birth control. She has only recently become sexually active and has consistently used condoms for safe sex. Your history reveals that she does not use tampons during her menses and has very little knowledge about female reproductive anatomy. Based on this information, which of the following birth control choices would be least likely to meet her needs for contraceptive management? A. Combined oral contraceptive (COC) pill B. Depo-Provera C. Ortho Evra patch

D. NuvaRing

. A Pap smear result of atypical squamous cells of undetermined significance—rule out high- grade squamous intraepithelial lesion (ASCUS r/o HGSIL) will require which procedure next? A. Cold knife cone (CKC) B. Follow-up Pap smear C. Colposcopy D. Loop electro-excision procedure (LEEP) . Iris is a thirty-two-year-old married woman with three children. She comes in for information on using the copper T intrauterine device (IUD) for contraception. Which of the following would be a contraindication to using this appliance? A. Nulliparity B. Heart disease C. Prior ectopic pregnancy D. History of multiple births . Leticia, seventeen years old, has just been diagnosed with primary dysmenorrhea. Which of the following is responsible for the pain in this condition? A. Shedding of uterine lining B. Prostaglandin release and synthesis C. Endometriosis D. Pelvic-floor muscle dysfunction . Cara is in the clinic for what you have diagnosed as dysfunctional uterine bleeding (DUB). She is concerned about why this is happening to her. You recall which of the following is the most common cause of DUB? A. Endocrine disorders B. Stress C. Anovulation D. Anatomical abnormality . In caring for a menopausal client who has had a total hysterectomy, the nurse practitioner would include which of the following options? A. Estrogen alone B. Estrogen and progestin C. Progestin and testosterone D. Testosterone alone

. A patient is complaining of a milky nipple discharge. Galactorrhea is usually a finding with which other diagnosis? A. Cancer B. Mastalgia C. Hyperprolactinemia D. Fibroma . Lauren, twenty-three years old, presents to your office with a complaint of severe menstrual cramps for four months since she quit using an oral contraceptive. Your tentative diagnosis is primary dysmenorrhea. What would be the first-line treatment for this condition? A. Acetaminophen B. Naproxen C. Ergotamine D. Elavil . The new ACOG Pap smear guidelines reflect a change in all of the following except. A. The age at which Pap smears are initiated B. The frequency of Pap smear screenings C. The follow-up to abnormal Pap smear results D. The endpoint for Pap smear testing . Lakeisha, seventeen years old, is seeing her regular nurse practitioner for a sports physical. While participating in a psychosocial screen, Lakeisha volunteers that she “hasn’t had sex yet.” What is the best initial response to Lakeisha’s statement? A. Congratulate her for abstaining and move on to another topic. B. Clarify which behaviors are included in Lakeisha’s definition of “having sex.” C. Demonstrate condom use and give Lakeisha some condoms for future partners. D. Encourage Lakeisha to be screened for STIs. . Elba, a thirty-five-year-old woman, presents with a six-month history of hypermenorrhea, backache, and pelvic pressure. On examination, you discover twelve-week-size uterus with irregular contour. Which of the following does this represent? A. Cervical stenosis B. Missed abortion C. Uterine fibroid D. Fecal impaction

. You are counseling eleven-year-old Amanda and her mother about human papillomavirus (HPV) vaccine, Gardasil. Amanda is Tanner stage IV at this visit. In counseling this family, you tell them that HPV vaccine. A. Is a series of two doses, four months apart B. Will protect Amanda from all strains of HPV C. Can cause syncope in some children D. Is not indicated in her age group as she is not yet sexually active . You are seeing a twenty-two-year-old pregnant woman for routing antepartum care. She discloses that she forgets to take her prenatal vitamins. Which of the following would not be part of your counseling and education? A. Try putting them next to your toothbrush and taking them at night when you brush before going to bed. B. Using an OTC stool softener and drinking plenty of water can help with constipation. C. You can just take a regular multivitamin in place of the prenatal. D. Prenatal vitamins are specially formulated to prevent anemia in you and your baby. . A sixty-year-old woman has presented with the chief complaint of bleeding after intercourse. Which of the following is not associated with postcoital bleeding or spotting in a postmenopausal woman? A. Cervical cancer B. Endometrial cancer C. Atrophic vaginitis D. Polycystic ovary syndrome (PCOS) . A woman presents to the office seeking the birth control measure that is 100% effective. When counseling a woman on effectiveness of these methods, which of the following fulfills this requirement? A. Implanon B. Combined oral contraceptive C. Abstinence D. Intrauterine device (IUD) . You are speaking to a women’s group in the community about mammography screening. What important information would you include in this presentation? A. Mammograms are only indicated for breast pain or nipple retraction. B. All women of childbearing age should have an annual mammogram. C. All sexually active women should have an annual mammogram.

D. Mammography should be accompanied by a clinical breast exam.

. A twenty-four-year-old woman in your practice has been trying to conceive. She comes in for a pregnancy test, and it is positive. LMP was five weeks ago. She is prone to migraines and has used Imitrex (sumatriptan) with good success. She asks you about what to do if she has a migraine during pregnancy. Which of the following would be an inappropriate intervention as part of your counseling? A. Triptans are contraindicated during pregnancy. B. Substitute ibuprofen at the onset of a headache; it is safe and effective. C. Migraines often occur less frequently during pregnancy due to hormonal changes. D. Nonpharmacological measures such as pressure points or lying down in a quiet environment for a brief rest at the onset of headache can help. . A postmenopausal patient is prescribed hormonal therapy (HT). The nurse practitioner recalls that HT is indicated for the management of. A. Lipid changes B. Hot flashes C. Memory loss D. Obesity . A prescription is being written by the nurse practitioner for birth control pills. When completing patient education, which of the following would be an accurate statement about oral contraceptive use? A. It is unnecessary to double up on missed pills for combined oral contraception. B. Oral contraceptives do not provide protection against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). C. Most women will not notice a change in their periods once they go on the pill. D. The pill provides added protection against cervical and uterine cancer. . Which of the following is true regarding education of a forty-two-year-old woman diagnosed with uterine myoma? A. Myomas usually resolve with menopause. B. Myomas will become larger with the withdrawal of estrogen. C. Hysterectomy is the treatment of choice. D. Myomas are never responsible for uterine bleeding. . Anna, twenty-five years old, presents with dysmenorrhea. She states that her sister and mother have endometriosis; so, she would like to be evaluated for it. Which if the following is consistent with a diagnosis of endometriosis?

A. Erythema and edema of the vulva B. Postcoital bleeding with malodorous discharge C. Pelvic pain and dyspareunia D. Frequent diarrhea and amenorrhea

. Suzanne, a forty-six-year-old client, reports shortened menstrual cycles for one year. The most likely diagnosis is. A. Anovulatory bleeding B. Menopause C. Perimenopause D. Breakthrough bleeding . Elisabeth comes for a consultation. She has been in a committed relationship for five years now and wants to become pregnant. She is seeking information on the menstrual cycle and her “fertile period.” Her cycle is twenty-eight days and regular. She and her partner have used condoms consistently to avoid pregnancy. Which of the following would be most valuable to her initially? A. The viability period for sperm is twenty-four hours. B. Ovulation occurs on day 14 +/– 2 days, before the next period. C. Taking her temperature daily will tell her when she is fertile. D. Cervical mucus evaluation can be used to determine fertility. . A patient is being rechecked after having a total hysterectomy performed and is having multiple problems since. Which of the following is/are early symptom(s) of estrogen withdrawal? A. Vaginal lubrication B. Chills C. Sleep disturbances D. Myalgias . A female patient has been diagnosed with polycystic ovary syndrome (PCOS) and weighs 250 pounds. In addition to obesity, PCOS is associated with which of the following clinical manifestations? A. Excessive menstrual flow B. Dry, flaking skin C. Infertility D. Hair loss

. You are completing a pelvic exam on thirty-two-year-old Nancy. You detect a left adnexal mass on the bimanual exam. With an adnexal mass, the practitioner must always suspect until proven otherwise. A. Pelvic inflammatory disease (PID) B. Malignancy C. Pregnancy D. Polycystic ovary disease . The nurse practitioner is completing a follow-up visit on a woman who was previously prescribed hormonal therapy (HT), which she has not taken for the last month. The primary reason the patient discontinued HT is. A. Weight gain B. Vaginal bleeding C. Breast tenderness D. Mood changes . The nurse practitioner is prescribing an oral contraception to Sally. She is concerned about having one that has “two hormones” as the active ingredients. You instruct her that adding progestin to estrogen therapy will decrease the risk of. A. Breast cancer B. Withdrawal bleeding C. Endometrial cancer D. Osteoporosis