Question 1

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?
A. Coagulation studies
B. Creactive protein
C. Thyroid function
D. Ultrasound of pelvis

Coagulation studies

Accepted Answer

Coagulation studies

Question 2

A 16&#173;year&#173;old female reports dull, achy cramping pain in her lower abdomen&#10;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?&#10;A. Abdominal ultrasound to rule out ovarian cyst&#10;B. Oral contraceptives to suppress ovulation&#10;C. Prostaglandin inhibitor analgesics and a heating pad&#10;D. Referral to a pediatric gynecologist

Accepted Answer

This type of pain is likely caused by ovulation or the release of an egg from the ovary. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be effective in relieving this type of pain by inhibiting the production of prostaglandins, which are chemicals in the body that cause inflammation and pain. A heating pad can also provide relief. An abdominal ultrasound or referral to a pediatric gynecologist may be considered if the pain is severe or if other symptoms are present. Oral contraceptives may be considered if the pain is related to the menstrual cycle, but they are not necessary in this case since the patient is not sexually active.

Question 3

A school&#173;age female has had vulvovaginitis for 2 months. All cultures and tests&#10;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?&#10;A. Estrogen cream at bedtime for 2 to 3 weeks&#10;B. Referral to a pediatric gynecologist for further evaluation&#10;C. Trimethoprim&#173;sulfamethoxazole daily for 1 to 2 months&#10;D. Workup for possible sexual abuse

Accepted Answer

Estrogen cream at bedtime for 2 to 3 weeks

Question 4

A 16&#173;year&#173;old sexually active female has a fever, bilateral lower abdominal pain,&#10;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?&#10;A. Azithromycin, doxycycline, and penicillin&#10;B. Cefotaxime, azithromycin, and penicillin&#10;C. Ceftriaxone, doxycycline, and metronidazole&#10;D. Doxycycline, penicillin, and metronidazole

Accepted Answer

The patient's symptoms are consistent with pelvic inflammatory disease (PID), which typically results from a sexually transmitted infection such as chlamydia or gonorrhea. The standard treatment for uncomplicated PID in adolescents is a combination of an injection of a third-generation cephalosporin (such as ceftriaxone) and oral antibiotics such as doxycycline and/or metronidazole. Azithromycin may also be used in place of doxycycline. Penicillin is not typically prescribed for PID.

Question 5

A 4&#173;year&#173;old female who has had two urinary tract infections has persistent&#10;dysuria and genital redness. The physical exam reveals a thin, flat membrane from the posterior fourchette almost to the clitoris. Which treatment is indicated?&#10;A. Application of A&D ointment&#10;B. Counseling about hygiene&#10;C. Reassurance and observation&#10;D. Use of estrogen&#173;containing cream

Accepted Answer

The thin, flat membrane is likely a result of labial adhesion, which can cause symptoms like dysuria and genital redness. Treatment with estrogen-containing cream can promote separation of the adhesion and improve symptoms. A&D ointment and counseling about hygiene may not address the underlying issue of labial adhesion. Reassurance and observation may not be sufficient if the symptoms persist.

Question 6

A 16&#173;year&#173;old female has not had a menstrual period yet and is concerned. She&#10;denies sexual activity. An exam reveals an adult sexual maturity rating. Which laboratory test will the primary care pediatric nurse practitioner order initially?&#10;A. Genetic test for Turner syndrome&#10;B. Pituitary hormone tests&#10;C. Pregnancy test&#10;D. Thyroid function tests

Accepted Answer

The initial test to order would be a pregnancy test to rule out pregnancy as a cause of missed periods, even if the patient denies sexual activity.

Question 7

The primary care pediatric nurse practitioner needs to assess a potential hymenal
tear in a prepubertal female who is apprehensive about the exam. Which approach will the nurse practitioner use?
A. Have the child sit froglegged on the parent's lap.
B. Place the child in the kneechest position on the exam table.
C. Put the child supine on the exam table with her feet in the stirrups.
D. Refer the child for a speculum exam under sedation.

Accepted Answer

The answer of The primary care pediatric nurse practitioner needs...

Question 8

A 14&#173;year&#173;old female has menometrorrhagia with moderate increase in menstrual flow and irregular periods. Her hemoglobin is 13.1 g/dL. How will this be managed?&#10;A. Iron supplementation and prostaglandin inhibitors&#10;B. One OCP twice daily for 3 to 4 days and then daily&#10;C. Progestin every day for 10 to 14 days&#10;D. Referral to a pediatric gynecologist for treatment

Accepted Answer

The patient has menometrorrhagia, which is excessive and prolonged menstrual bleeding. Iron supplementation is important to prevent anemia due to blood loss. Prostaglandin inhibitors can help reduce menstrual bleeding. Other options like OCP or progestin may be used in the future if the bleeding persists or worsens, but for now, iron supplementation and prostaglandin inhibitors are the best initial management. Referral to a pediatric gynecologist may be considered if the bleeding does not improve with initial management.

Question 9

The primary care pediatric nurse practitioner is prescribing contraception for an
adolescent who has not used birth control previously. The adolescent has a normal exam and has no family history of cardiovascular and peripheral vascular disease or diabetes. Which preparation is used initially?
A. A combination oral contraceptive pills (OCP) with 30 to 35 mcg of estrogen and low progestin
B. A combination OCP with low androgenic potency, such as OrthoCyclen
C. A progestinonly minipill oral contraceptive
D. A subdermal implant contraception, such as Implanon or Nexplanon

Accepted Answer

The answer of The primary care pediatric nurse practitioner is...

Question 10

An adolescent female tells the primary care pediatric nurse practitioner that she
had unprotected sexual intercourse 4 days prior and is worried she might become pregnant. What will the nurse practitioner do?
A. Prescribe ulipristal acetate (Ella).
B. Recommend levonorgestrel (Plan B One Step).
C. Start a combination OCP at regular doses.
D. Suggest using the less expensive After Pill preparation.

Accepted Answer

Ulipristal acetate (Ella) is effective up to 5 days after unprotected intercourse, making it the best option in this scenario.

Question 11

A 17&#173;year&#173;old sexually active female who began having periods at age 14 reports&#10;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?&#10;A. Perform a full diagnostic workup to evaluate potential causes.&#10;B. Prescribe a prostaglandin synthetase inhibitor.&#10;C. Start a 3&#173; to 6&#173;month trial of oral contraceptive pills.&#10;D. Suggest using transcutaneous electrical nerve stimulation.

Accepted Answer

The answer of A 17&#173;year&#173;old sexually active female who began...

Question 12

An adolescent female has periods every 30 days that are consistently heavy and last from 5 to 8 days. What is her diagnosis?
A. Menometrorrhagia
B. Menorrhagia
C. Metrorrhagia
D. Polymenorrhea

Accepted Answer

The answer of An adolescent female has periods every 30...

Question 13

A 16&#173;year&#173;old female reports breast tenderness and a &#34;lump.&#34; The primary care&#10;pediatric nurse practitioner palpates a small fluid&#173;filled mass in her right breast. A pregnancy test is negative. Which action is correct?&#10;A. Obtain a CBC to rule out infection.&#10;B. Order an ultrasound of the mass.&#10;C. Prescribe NSAIDs to treat her discomfort.&#10;D. Reassure her that the findings are normal.

Accepted Answer

The answer of A 16&#173;year&#173;old female reports breast tenderness and...

Question 14

A 15&#173;year&#173;old female has a positive pregnancy test and asks the primary care&#10;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?&#10;A. Determine the state&#173;mandated reporting laws.&#10;B. Encourage the adolescent to talk to her parents.&#10;C. Obtain a social work consult to discuss adoption options.&#10;D. Refer her to a prenatal care specialist for follow&#173;up.

Accepted Answer

The answer of A 15&#173;year&#173;old female has a positive pregnancy...

Question 15

A sexually active adolescent female tests positive for N. gonorrhoeae and
B. Ceftriaxone 250 mg IM and azithromycin 1 g PO one time each
C.
trachomatis. 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?
C. Doxycycline 100 mg PO bid for 7 days
D. Erythromycin base 500 mg PO qid for 7 days

Accepted Answer

The answer of A sexually active adolescent female tests positive...

Deck 36: Gynecologic Disorders