APEA 3P EXAM PREP1–WOMEN’S HEALTH WITH VERIFIED QUESTIONS AND ANSWERS WITH RATIONALE
A 16-year-old female is diagnosed with primary dysmenorrhea.
... [Show More] She has taken over-the-counter ibuprofen in
800-mg increments every 8 hours during menses for the past 3 months, with minimal relief of symptoms.
What intervention will provide greatest relief of dysmenorrhea symptoms?
Flurbiprofen during menses
Combined oral contraceptives
Daily multivitamin with B12 supplementation
30 minutes of regular exercise daily
B.
NSAIDs and hormonal contraceptives represent the mainstay of pharmacologic treatment for dysmenorrhea.
NSAIDs produce an 80-86% response rate when used for dysmenorrhea. The general recommendation is that
when one agent (NSAIDs or hormonal contraceptives) does not produce relief of symptoms, the other agent
should be tried. Hence, the best choice is oral contraceptives. Both agents should be considered for women
who are symptomatic with one agent only.
A 22-year-old female states that she has multiple sexual partners and inconsistently uses barrier
protection. Which form of birth control should the nurse practitioner avoid prescribing in this patient?
Intrauterine device
Progestin-only pill
Diaphragm
Oral contraceptives
A.
Multiple sexual partners place the patient at increased risk for infection with sexually transmitted diseases.
The patient is at very high risk of developing pelvic inflammatory disease (PID) when there is an implanted
foreign body. An example of this is an intrauterine device (IUD). The risk is also increased with a diaphragm,
but, because it is not implanted for long periods at a time, the risk of PID is less than with an IUD.
Three of the following interventions are appropriately used to prevent osteoporosis after menopause. Which
one is NOT?
Avoidance of corticosteroids
Performance of weight-bearing activities for 40 mins at least 5 days/week
Estrogen replacement therapy
Adequate calcium & vitamin D intake
C.
Prevention of osteoporosis may be optimized by elimination of risk factors and engaging in interventions that
maximize bone density. Good nutrition from infancy throughout adulthood is a major component of good bone
health. Others include engaging in weight-bearing exercises, adequate intake of calcium and vitamin D,
smoking cessation, limiting alcohol consumption to moderate amounts, and avoidance when possible of
medications that may decrease bone density (corticosteroids, anticonvulsants). Osteoporosis occurs at
accelerated rates in women who are post-menopausal. The lack of estrogen can produce rapid bone loss
due to bone resorption. Estrogen replacement is not used to prevent or treat osteoporosis.
A patient who is scheduled for pelvic exam with PAP smear should be advised to avoid douching, sexual
intercourse, and tampon use before her exam. For how long should she be advised to avoid these activities
for optimal evaluation?
24 hours
48 hours
36 hours
1 week
B.
The general recommendation is to avoid these activities and any vaginal medication for 48 hours prior to the
PAP smear. Douching and tampon use can remove superficial cells, which are the ones collected and used
as representative samples on PAP smear. Sexual intercourse should be avoided because there can be
specimen contamination by the male partner. With vaginal medications or creams, either can serve as a
barrier to epithelial cell sampling.
When collecting cervical cells for a PAP smear, when are the endocervical cells typically collected?
After the ectocervical specimen with a broom
After the ectocervical specimen with a brush
Before the ectocervical specimen with a broom
Before the ectocervical specimen with a brush
B.
Ectocervical specimens are collected first to minimize any bleeding that can occur when the endocervical
cells are sampled. The brush is considered a superior tool for the collection of endocervical specimens
because it produces the highest yield of endocervical cells, and thus, is a good reflection of the health of the
cervix. Alternatively, a cervical broom can be used to collect endocervical cells and ectocervical cells
simultaneously. It is rotated for 5 turns before the samples are placed on the slide. This may be used in
pregnant women.
The first step in evaluating a breast lump is:
history and physical exam.
mammogram.
ultrasound. Incorrect
MRI.
A.
Although most patients will need further work-up of a breast mass, historical information is critically
important in directing the health care provider to the next step. Historical information that should be
ascertained is the location of the lump, how and when it was first noticed, whether there is nipple discharge,
and whether it changes in size related to menses. Other historical information is the patient’s personal and
family history of breast cancer and/or history of breast biopsies.
A patient who takes oral contraceptive pills is at increased risk of:
gallbladder disease.
depression.
hypothyroidism.
varicose veins.
A.
One of the major components of gallstones is estrogen. A patient with underlying gallbladder disease should
not take oral contraceptives (OC) since they will increase estrogen exposure and theoretically, formation of
gallstones. Depression, hypothyroidism and varicose veins are not increased by use of oral contraceptives.
A 14-year-old female has never menstruated. She and her mother are concerned. What is most important for
the NP to assess?
Stature
Tanner stage
Anemia
Family history of amenorrhea
B.
Tanner staging, or sexual maturity ratings, are predictable changes that occur with puberty. These should be
assessed. In females, breasts and pubic hair signify specific pubertal changes that constitute maturation.
These are not age specific, but at 14 years, a Tanner Stage 3 or more would be characteristic of expected
maturation. Menses should follow soon.
After a vaginal exam, a patient received a prescription for metronidazole 500 mg twice daily for 7 days. What
was her likely diagnosis?
Bacterial vaginosis
Syphilis
Chlamydia
Gonorrhea
A.
Bacterial vaginosis can be treated with metronidazole orally. The most effective dose is 500 mg twice daily
for 7 days. This is generally well tolerated as long as the patient avoids alcohol. Alcohol in the presence of
metronidazole can produce a disulfiram reaction. Another medication used to treat bacterial vaginosis is
tinidazole. It may provide more effective coverage if metronidazole fails because it has a longer half-life.
A 54-year-old female presents with a small to moderate amount of vaginal bleeding of recent onset. She has
been postmenopausal for approximately 2 years. What diagnosis is least likely?
Endometrial carcinoma
Ovarian cancer
Endometrial hyperplasia
Uterine polyps
B.
Ovarian cancer may present as an adnexal mass, pelvic or abdominal symptoms and a variety of others.
Postmenopausal bleeding (PMB) is an uncommon presentation of ovarian cancer, but can present this way.
In women with PMB, likely causes of uterine pathology should be evaluated before considering ovarian
pathology. In early menopause, the most common etiology is atrophy of the endometrium or vaginal mucosa.
This patient has been postmenopausal for approximately 2 years. Other common causes of PMB are polyps,
fibroids, and endometrial hyperplasia.
Athletic amenorrhea increases the risk of:
osteoporosis.
an eating disorder.
covert hypothyroidism.
breast cancer.
A.
Athletic amenorrhea is a secondary cause of amenorrhea that is observed in females who engage in
excessive amounts of exercise. Excessive exercise can produce significant loss of body fat. Since estrogen is
produced by the body’s fat tissue, there is a subsequent loss in the ability to produce adequate amounts of
estrogen. When this occurs, infertility, vaginal and breast atrophy, and osteopenia are very likely. [Show Less]