Question 1

A 45-year-old female client comes to the facility due to vaginal bleeding in between menses lasting 1 to 2 days. The client's usual menstrual cycle is 30 days. Her menstrual flow usually lasts between 3 and 4 days. A sonohysterogram is performed, and an endometrial polyp is found. The nurse midwife expects which treatment following the diagnosis?

Accepted Answer

Hysteroscopic polypectomy as is the main treatment for endometrial polyps. This procedure involves surgical removal of the polyp with hysteroscopic guidance. Hysterectomy is not considered for the client. Dilatation and curettage is not usually done as a single treatment. It is usually an adjunct procedure to hyesterocopy and polypectomy. Performing D&C without hysteroscopy increases the chances of missing the polyp.

Question 2

A 25-year-old female client comes to the facility complaining of abrupt and severe lower abdominal pain, which radiates to the lower back and thighs. The client says the pain usually lasts for 20 minutes, resolves and then comes back again. The pain has started 12 hours before the consult. The client also reports vomiting, excessive sweating and constipation. Assessment findings include fever, tachycardia and tenderness over the lower abdominal region, with greater pain reported on the side. Urine human chorionic gonadotropin test is negative. Which of the following diagnostic tests is ordered for further evaluation and diagnosis?

Accepted Answer

Pelvic ultrasound is ordered for further evaluation and diagnosis. Based on the history and signs and symptoms, the client is likely experiencing ovarian torsion, or twisting of the ovary. This condition is also known as adnexal torsion. A pelvic ultrasound is the diagnostic tool of choice as it can accurately and easily evaluate adnexal masses. A Doppler ultrasound may be used to help determine if the blood flow is impaired. A computed tomography or magnetic resonance imaging is not definitive when evaluating adnexal masses. Ovarian torsion is manifested by extreme, abrupt lower abdominal pain. It is caused by the existence of another disease or by a congenital abnormality. Ovarian torsion commonly occurs in females in their mid-twenties and postmenopausal women.

Question 3

A 23-year-old female client who has never been pregnant comes to the clinic due to an irregularity in her menstrual periods. The nurse midwife obtains the client's history and performs a thorough physical assessment. Which of the following details in client's history is not considered normal and should be further evaluated?

Accepted Answer

The client's menstrual blood loss per period, which is about 100 mL, is not considered normal and should be further evaluated. On average, menstrual blood loss per period is between 60 and 80 mL. Blood loss greater than 80 mL is called menorrhagia, and it may be due to an imbalance between the estrogen and the progesterone. Menarche, or the onset of the first menstrual period, commonly occurs between 12 and 13 years. Menstrual cycles usually last between 21 and 35 days. The duration of menstrual flow is normally between 3 and 7 days.

Question 4

An 18-year-old G0P0 female client tells a nurse midwife that she usually soaks a maxi sanitary pad in less than three hours every time she gets her period. Large clots are also passed. The client's menstrual cycle lasts 30 days and her average duration of menstrual flow is 5 days. The client also informs the nurse that she usually experiences vaginal bleeding in between periods. The flow usually lasts for 2 days, and the amount of blood loss is the same as that of the blood loss during her regular menstrual period. Based on the history, the nurse midwife determines that the client has:

Accepted Answer

The client has menometrorrhagia. Menometrorrhagia is excessive uterine bleeding, both during regular menstrual periods and in-between vaginal bleeding. Oligomenorrhea is the presence of fewer than eight menstrual cycles per year, or menstrual cycles that last for more than 35 days. Menorrhagia is heavy bleeding during a regular period or prolonged menstrual flow. Metrorrhagia is the occurrence of vaginal bleeding in between periods.

Question 5

A 25-year-old female client comes to the clinic for a Pap smear. The result of the test reveals a low grade squamous intraepithelial lesion or LSIL. Which of the following is the next action of the nurse midwife?

Accepted Answer

The next action of the nurse midwife is to inform the client that she needs to have a Pap smear after a year. A squamous intraepithelial lesion, or LSIL, indicates early changes in the size and shape of the cells found on the surface of the cervix. This finding is also called mild dysplasia, indicating that the abnormal, non-cancerous cells can be cancerous after some time. When a Pap smear reveals atypical squamous cells, the client should have another Pap smear in three months. Women with normal test results are scheduled for another Pap smear in two years. Colposcopy is ordered for clients with mild dysplasia. This test uses a device that is placed at the entrance of the vagina to examine the cervix closer.

Question 6

Which of the following female clients has the greatest risk for uterine fibroids?

Accepted Answer

The 25-year-old Black American who has a BMI of 32 and denies cigarette smoking has the greatest risk for uterine fibroids. The risk factors for uterine fibroids include: obesity, pregnancy, race (Black women are more likely to have fibroids) and heredity. Research has revealed that smoking is associated with low occurrence of uterine fibroids. This is most likely due to the lowering effect of smoking on the bioavailability of estrogen.

Question 7

A nurse midwife is caring for a female client who recently had an induced abortion through suction curettage. After the procedure, the client develops disseminated intravascular coagulation. The client's platelet count is 35,000 platelets/µL. Which of the following is the nurse midwife's priority action when caring for the client?

Accepted Answer

The priority action of the nurse is to administer heparin. Disseminated intravascular coagulation is a condition in which small blood clots form throughout the blood stream. Increased clotting depletes the platelets and clotting factors that control bleeding, which may result in excessive bleeding. Heparin increases anti-thrombin III activity and prevents the conversion of fibrinogen to fibrin. Oxygen may be administered at 2-3L/min. Platelet replacement may be necessary when the client's platelet count decreases to less than 20,000 platelets/µL.

Question 8

A nurse midwife initiates therapy for an infection in a female client. The client is instructed to return a week later for a repeat culture so that the nurse midwife can monitor the effectiveness of the medication in eliminating the causative agent of the infection. The client is most likely infected with:

Accepted Answer

The client is most likely infected with Neisseria gonorrhoeae. N. gonorrhoeae is a bacterium that can be treated and eliminated by antibiotic therapy. Clients with gonorrhea are usually prescribed penicillin, and a repeat culture verifies whether or not the causative agent has been eliminated. Treponema pallidum is the causative agent for syphilus. It is a bacterium that is treated with antibiotics; however, the response to therapy is determined by a dark microscopy test. HSV 1 and 2 are viruses. They are not curable. HSV 1 and 2 are managed by supportive therapy.

Question 9

A client is diagnosed with chlamydia infection. Which of the following is not a risk of untreated chlamydia?

Accepted Answer

Complications of untreated chlamydia infection include infertility, pelvic inflammatory disease, having a child with conjunctivitis, respiratory infection in neonates and cystitis in women. Developmental problems are not associated with chlamydia infections.

Question 10

A client complains of a crop of sores in the genitalia, flu-like symptoms and swollen glands. The client is diagnosed with herpes. Which of the following instructions is the least appropriate for the client?

Accepted Answer

The least appropriate instruction is to apply hydrogen peroxide solution on sores. The client must be instructed to avoid rubbing the sores, as rubbing can cause skin trauma and spread the infection. Wearing loose underwear made of cotton prevents moisture and avoids irritating the lesions. Cool and wet compresses can be used to alleviate the itch.

Question 11

A nurse midwife is teaching a group of women about the importance of performing breast self-examination every month. The nurse midwife is most concerned about increasing the awareness of its importance in which group of women?

Accepted Answer

Research shows that women with ovarian cancer are at risk of developing breast cancer. Breast self-examination may detect cancerous tumors, resulting in early treatment and better prognosis. The other options are not correct.

Question 12

A nurse midwife is assessing a client who visits for a follow up examination after an abdominal hysterectomy. The nurse midwife determines that the client has a hematoma. Which of the following findings supports the diagnosis?

Accepted Answer

A decrease in hematocrit concentration suggests hematoma. Hematoma is a delayed complication of abdominal hysterectomy. An increase in body temperature and a decrease in hemoglobin level are also indicative of this complication.

Question 13

The nurse midwife is creating a teaching plan for a program that encourages women to have their regular Pap smear. Which of the following groups of women is the nurse midwife's priority?

Accepted Answer

Herpes simplex virus is associated with increased risk of cervical cancer, so it is important to encourage women who had or have genital herpes to have their regular Pap smear. A Pap smear can detect early changes in cells located in the cervix. The other options are not correct.

Question 14

Which of the following female clients has the least risk for candidiasis?

Accepted Answer

A client who is sexually active has the least risk for candidiasis. Candidiasis is mainly caused by an altered vaginal environment, normally acidic, that causes an overgrowth of bacteria from the Candida family. These bacteria are normally found in the vaginal environment, but if the pH of the vaginal environment is altered or if the good bacteria are overwhelmed by Candida, candidiasis may occur. It is not spread by sexual contact. Douches may eliminate the good bacteria, causing candidiasis. Clients who are on long term corticosteroid therapy, such as women with Addison's disease, are at risk for candidiasis. Pregnant women are also at risk because hormonal changes may alter the normal vaginal environment.

Question 15

A nurse midwife suspects that a 23-year-old female client has trichomoniasis. Which of the following findings is most suggestive of this infection?

Accepted Answer

Trichomoniasis is manifested by greenish-gray frothy vaginal discharge. Thin and grayish white vaginal discharge with a fishy odor suggests giardiasis. A purulent vaginal discharge most likely suggests gonorrhea. Thick, white vaginal discharge with severe perineal itching suggests candidiasis.

Question 16

A female client complains of thin and grayish-white vaginal discharge with a fishy odor. These symptoms are most likely caused by:

Accepted Answer

G. vaginalis bacteria cause thin, grayish discharge with a fishy odor. The client will most likely be diagnosed with bacterial vaginosis. C. albicans causes candidiasis. Trichomonas causes trichomoniasis. T. pallidum causes syphillis.

Question 17

A nurse midwife is teaching a group of clients about toxic shock syndrome. Which of the following women has the greatest risk of developing this condition?

Accepted Answer

Women who wear tampons during menstruation have the greatest risk for toxic shock syndrome. A tampon that is not changed for more than eight hours is a good breeding ground for bacterial growth. Toxic shock syndrome is caused by bacteria, specifically Staphylococcus aureus, that have entered the blood stream. Toxic shock syndrome is not sexually transmitted. Women on steroid therapy are also at risk for candidiasis, and women with a history of genital herpes may be.

Question 18

A client had a miscarriage and underwent a cervical dilatation and curettage procedure. Before discharge, the nurse midwife instructs the client about certain activities that have to be limited or avoided in the next few weeks. The nurse midwife determines that the health teaching has been successful if the client says:

Accepted Answer

The teaching has been successful if the client says that she will avoid tub baths for a week. The client may engage in vaginal intercourse after two weeks. Tampons have to be avoided for a week. The client may gradually increase her activities; bed rest is not necessary.

Question 19

A nurse midwife is assessing four female clients with signs and symptoms involving the reproductive system. All clients are engaging in heterosexual sexual relationships. The nurse midwife requires identification and treatment of sexual partners of all of the following clients except:

Accepted Answer

A client diagnosed with bacterial vaginosis is not required to identify her sexual partners for treatment. Engaging in unprotected sex increases the risk for bacterial vaginosis for women only, and it is believed that bacterial vaginosis can be transmitted between women. Therefore, only women who engage in sexual relationships with other women need to identify their sexual partners for treatment of bacterial vaginosis.

Question 20

A client presents with a painless, ulcerative crater that is within a papule in the vulva. The client says she had an unprotected sex with a new sexual partner three weeks ago. Dark field microscopy of lesions identifies Treponema pallidum. The client is most likely diagnosed with:

Accepted Answer

The client is most likely diagnosed with primary syphilis. Primary syphilis is manifested by a painless, ulcerative crater within a papule. The lesions are usually found on the vulva or cervix in females and on the glans penis in males. Secondary syphilis is manifested by a localized or diffused mucocutaneous rash and generalized, non-tender lymphadenopathy. Latent syphilis is usually detected through serological tests. Tertiary syphilis usually involves visceral organs.

Quiz 2: Gynecology