Certified Solutions for Antibiotics Use in Pregnancy & Other Health Concerns, Exams of Nursing

Download Certified Solutions for Antibiotics Use in Pregnancy & Other Health Concerns and more Exams Nursing in PDF only on Docsity! Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions A 28-year-old woman at 22 weeks gestation has concerns regarding antibiotic use during pregnancy. She was just diagnosed with strep throat at an urgent care and was prescribed amoxicillin. Which of the following statements is true regarding antibiotic use during pregnancy? - Answer Amoxicillin is a preferred agent to use during pregnancy In addition to amoxicillin, antibiotics from the cephalosporin drug class are also considered safe in pregnancy. If a penicillin allergy is present and there is no history of an IgE-mediated response like anaphylaxis, it is appropriate to prescribe an antibiotic from the cephalosporin drug class. Emergency contraception should be considered when? - Answer If a patient misses two or more consecutive active pills in the first week of a cycle and if unprotected intercourse occurs during this timeframe, as ovulation is more likely to occur. A patient who is 38 weeks pregnant presents for her routine prenatal visit. She states she has had some painless bright red bleeding in the Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions last 24 hours accompanied by mild contractions. This has made her extremely nervous about the health of her fetus. Upon exam, her uterus is soft and nontender. Which of the following is the most likely diagnosis? - Answer Placenta previa Is the result of the placenta being in an unusual location, usually over or near the internal cervical opening (os). It is often characterized by bright red, painless bleeding with a soft, nontender uterus. This can lead to excessive bleeding in the antepartum, intrapartum, or postpartum period, thus placing the patient at high risk for preterm birth and maternal and fetal morbidity. Close monitoring throughout the duration of the pregnancy is required. Additionally, vaginal exams and sexual intercourse should be avoided. A 29-year-old patient presents for her annual wellness exam. She states she has had several sexual partners over the last year and uses condoms inconsistently. She states she intermittently feels vaginal itching. During her exam, the practitioner notes an erythematous cervix with tiny papillary hemorrhages. This finding is typically indicative of which of the following? - Answer Trichomoniasis Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions relieved with rest and acetaminophen, right upper quadrant pain, shortness of breath, and visual changes. Eclampsia, also known as status epilepticus, requires emergent delivery, regardless of the age of the fetus. A 32-year-old woman presents to the clinic to discuss contraception after the birth of her second child. Her medical history includes anxiety, depression, GERD, and systemic lupus erythematosus. Which of the following contraceptive options is the least appropriate for this patient? - Answer Norelgestromin-ethinylestradiol transdermal patch Estrogen-containing contraceptives, such as the norelgestromin- ethinylestradiol transdermal patch, are not recommended for patients with systemic lupus erythematosus (SLE) due to associated increased risk for cardiovascular disease and thromboembolism. Estrogen is contraindicated in patients with antiphospholipid syndrome, which is an autoimmune disorder that causes a significantly increased risk of thromboembolism and is often associated with SLE. Immunosuppressive, anticoagulant, and anticonvulsant medications commonly used in SLE also interact with estrogen.Contraception is an Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions essential aspect of care for patients with SLE, as the peak incidence occurs in the female population of reproductive age. Several medications for this condition are teratogenic, such as methotrexate, and pregnancy should be avoided while taking these. Long-acting reversible contraceptives, such as intrauterine devices, are the preferred choice of contraception for patients with SLE, as they do not contain estrogen and have high rates of efficacy. Emergency contraception is an option for patients with SLE. SLE does not affect fertility, but patients should be advised to pursue pregnancy when the disease is stable with low activity due to risk of pregnancy complications. A nurse practitioner is teaching a student how to perform a cervical pap smear. Which of the following statements would be the most appropriate to include in pre-procedure teaching? - Answer "It is critical to obtain an adequate sample with cells from the transformation zone" he pap smear is an important screening tool for cervical cancer. It detects precancerous or cancerous cells of the cervix by collecting cells for cytology or HPV testing. A cervical pap smear is obtained during a Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions speculum exam by using a spatula, brush, or broom to sample both the ectocervix and endocervix. The area known as the transformation zone is the most common place for abnormal cells to develop in the cervix. The transformation zone consists of squamous epithelial cells and endocervical cells. Obtaining an adequate sample from this zone is critical , as otherwise possible precancerous or cancerous cells may be inadvertently missed. The presence or absence of cells from the transformation zone will be noted on the cytology report. Bacterial or candidal infections, patient age, parity, and pregnancy are all factors that may impact the presence of endocervical or transformation zone cells on a specimen. The nurse practitioner is reviewing Pap smear results for a 21-year-old patient. The report notes that there are atypical squamous cells and cannot exclude high-grade squamous intraepithelial cells. Which of the following is the best plan of action for this patient? - Answer the patient should be referred for a colposcopy When cytology results return as atypical squamous cells that cannot exclude high-grade intraepithelial changes, regardless of age, the Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions first pregnancy, the risk of occurrence with future pregnancies increases 93 times. Severe placental abruption is defined as complications in the mother (disseminated intravascular coagulation, shock, organ failure, or death) or fetus (growth restriction, non reassuring fetal status, or death). Treatment includes fetal heart rate monitoring, maternal hemodynamic monitoring, lab monitoring for disseminated intravascular coagulation, and intravenous fluids and blood products, if needed. A 26-year-old woman presents to the clinic wanting the copper IUD placed. The patient says she has not had intercourse in the last 10 days and does not have any symptoms of an infection. What should the nurse practitioner do first? - Answer a urine pregnancy test should be ordered first Although this patient states that she has not had sexual intercourse in the past week, there is still a chance that she could be pregnant, so a urine pregnancy test should be ordered first. If there are any unknowns, the patient should be provided an hCG quantitative blood test to confirm a negative pregnancy. Placing an IUD in a patient with Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions an unknown pregnancy status can lead to fetal demise or other abnormalities. The copper IUD is a flexible plastic and copper-based T- shaped device that is inserted into the uterus to prevent pregnancy. This type of IUD does not contain hormones. An IUD works by creating a mechanical barrier to implantation, thereby preventing the sperm and egg from joining. It is one of the most effective forms of birth control at 99%. A pelvic exam must first be performed. Then, a tenaculum is used to hold the cervix in place while the uterus is checked for length with a uterine sound or hysterometer. The IUD is then placed through the opening of the cervix into the uterus, and the plastic strings are cut to length. A 28-year-old woman is requesting long-acting reversible contraception and would like information regarding the side effects of nonhormonal choices. Which of the following are common side effects associated with the copper intrauterine device? - Answer The most common side effects associated with copper intrauterine devices (IUDs) are heavy menstrual bleeding and menstrual pain Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions Complications of all IUDs are uncommon and include uterine perforation, device expulsion, and ectopic pregnancy in the rare event of IUD failure. Both hormonal and nonhormonal IUDs can be used in female adults and adolescents, regardless of parity history. There are few contraindications for using an IUD, and they should be routinely offered to most women. IUDs and dermal implants are the two long- acting reversible contraceptive methods available, and they are both effective with a < 1% failure rate. Dermal implants and several types of IUDs have a hormonal component. The only nonhormonal IUD available in the United States is the copper IUD. It is T-shaped, and the arms and stem are wrapped with copper wire. The copper IUD's primary mechanism of action is preventing fertilization by inhibiting sperm migration and viability. It does not interrupt a pregnancy. It remains in place and is effective for 10 continuous years. A woman at 26 weeks gestation was recently diagnosed with placenta previa after she experienced vaginal bleeding after having intercourse. What is the best education to give her, to reinforce instructions given by the obstetric team, in regard to her new diagnosis? - Answer Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions The nurse practitioner is performing a chart review of a new patient who has presented to the clinic for erectile dysfunction. Which of the following comorbidities is not listed as contraindication for the use of (Viagra)? - Answer muscular dystrophy Sildenafil (Viagra) has been shown in studies to potentially reduce respiratory muscle weakness and lung fibrosis. Therefore, patients with muscular dystrophy can use sildenafil (Viagra). Muscular dystrophy causes extensive muscle fiber atrophy resulting in weakness of multiple muscle systems. This loss of strength can lead to difficulty moving and performing everyday tasks. Phosphodiesterase type 5 (PDE5) inhibitors reduce the weakness of the diaphragm muscle and enhance its ability to contract, leading to easier breathing. Contraindications to ED meds: - Answer Cardiac conditions are almost always contraindicated in the use of PDE5 inhibitors due to the risk of interaction with any dosage formulation of nitrate. A patient who had a myocardial infarction in the last year will most likely have been prescribed nitrates for chest pain. It is contraindicated in male patients with multiple myeloma because of the increased risk of priapism. PDE5 Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions inhibitors can lead to further visual side effects and damage to the retina in pigmentary retinopathy A 19-year-old patient presents to the clinic with nausea, fatigue, and amenorrhea for 2 weeks. She states that she cannot be pregnant as she has been on birth control and only forgets to take it occasionally. The nurse practitioner decides to run a urine human chorionic gonadotropin pregnancy test, which is positive. The nurse practitioner understands that this is a: - Answer A positive pregnancy test is an example of a probable sign of pregnancy This is considered probable as false positives can occur. Other probable signs of pregnancy include cervical changes or softening of the cervix, mild uterine cramping, or Braxton Hicks contractions. Positive signs of pregnancy: - Answer Objective findings from the nurse practitioner such as auscultation of fetal heart tones, palpation of fetal movement, or ultrasound confirmation. Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions A 40-year-old woman presents to the office to discuss contraception options. She reports she was recently diagnosed with breast cancer and does not want to become pregnant at this time. Which of the following types of contraception is the most appropriate for the nurse practitioner to recommend to the patient? - Answer A copper intrauterine device (IUD) Hormonal contraception is not recommended for patients with a current breast cancer diagnosis or a history of breast cancer. A copper intrauterine device (IUD) is the most appropriate type of contraception for the nurse practitioner to recommend to this patient, as it is an effective and nonhormonal option. The nurse practitioner should reasonably exclude pregnancy prior to initiating contraception in female patients. Routine Pap smears are advised, as warranted. A copper IUD is inserted at any time during the menstrual cycle and is approved for use for up to 10 years. The efficacy of a copper IUD is comparable to surgical sterilization. It may cause heavier menstrual bleeding and spotting in between periods, so it should not be recommended to patients who experience difficulty with these symptoms. Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions than three consecutive months without a period. If polycystic ovary syndrome is suspected, which symptom is least likely to be observed in this patient? - Answer Symptoms such as vaginal itching or vaginal irritation are not commonly associated with polycystic ovary syndrome (PCOS) PCOS: - Answer Is an endocrine disorder with an unknown etiology. Approximately 5-10% of reproductive-age patients are diagnosed with this disorder. The Rotterdam criteria identify hyperandrogenism, ovulatory dysfunction, and polycystic ovaries as the key diagnostic features of the disorder. At least two of these features must be present to meet diagnostic criteria. Common symptoms of PCOS include irregular menses and presentations associated with hyperandrogenism, which include acne, hair loss, and hirsutism. Mood changes, such as depression and anxiety, may also be present. Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions The etonogestrel (Nexplanon) implant - Answer This is the best contraception method for this patient. Migraines with aura are not a contraindication for etonogestrel (Nexplanon), and fertility is returned quickly after removal. Any combined contraceptive that has both estrogen and progesterone may worsen migraines with aura and can pose risks such as blood clots and certain cancers, especially in patients over age 35 and those who smoke. A thorough individual health history is essential to choosing a contraceptive method. Medroxyprogesterone acetate (Depo Provera) can cause a delay in fertility anywhere from 15- 49 months after the last injection and would be inappropriate for a patient trying to conceive in 1 year. Medroxyprogesterone acetate (Depo Provera) is the only temporary contraceptive method that can cause a marked delay in fertility. The other methods all have a quick return to fertility, with the implantable devices (arm implant and IUDs) being immediate upon removal. An 80-year-old woman with a recent history of low-trauma fracture presents to the clinic to review recent DXA scan results. Her T-score value is −1.9, and her 10-year FRAX score is 13%. Which of the following is the best next step in management? - Answer The nurse practitioner Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions should prescribe alendronate (Fosamax) and recommend lifestyle interventions Alendronate is a type of bisphosphonate drug, which is considered first- line treatment for this condition. Typical dosing is 70 mg orally once weekly. Patients should be advised to take the medication first thing in the morning with water and at least 30 minutes prior to the first meal, and they must stay upright for at least 30 minutes after eating to reduce the risk of esophageal side effects. A 28-year-old woman presents to the clinic today with a swollen, erythematous right breast. She states that this began in the last few days, and her pain increases every time she tries to breastfeed. You suspect a possible diagnosis of acute mastitis and decide to treat her with antibiotics. Her medical history includes generalized anxiety disorder, lupus, and exercise-induced asthma. She also reports having shortness of breath and facial swelling after taking amoxicillin- clavulanate (Augmentin) as a child. Which of the following antibiotics would be appropriate to prescribe for this condition? - Answer Clindamycin (Cleocin) Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions support group that includes weekly (or bi-weekly) in person breast feeding clinics. If the infant has a thrush infection, this should be treated. A 20-year-old woman presents to your office for evaluation. She states she would like to be tested for all possible sexually transmitted infections, as she is sexually active and is unsure of her last partner's status. Which of the following would be an inappropriate test to order? - Answer Reflex HPV DNA testing Due to her age, this patient does not need HPV testing. This is because younger female patients typically clear the infection so quickly that it usually does not progress to any further abnormalities. Current guidelines recommend beginning cervical cancer screening with cytology alone at age 21, and routine HPV testing should begin at age 25 and be performed every 5 years for patients at high risk. A pregnant patient is interested in getting the copper T intrauterine device (IUD) for contraception after delivery and would like to learn Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions more information about this method. Which of the following statements is most appropriate to tell the patient? - Answer After delivery, it can be placed within the first 48 hours after birth After that window, a patient should wait until 4-6 weeks postpartum to decrease the risk of expulsion. The IUD is the most commonly used reversible, long-acting contraception method. The copper T IUD is a hormone-free intrauterine device A 23-year-old man presents to the office with concerns of yellow/green penile discharge and pain with urination. The patient reports a poor hydration status, multiple new sexual partners over the past year, and occasional use of condoms. The vital signs are as follows: weight 180 lbs, blood pressure 120/60 mm Hg, pulse 68 bpm, and temperature 98.4°F orally. A nucleic acid amplification test is positive for gonorrhea and negative for chlamydia. What is the best treatment plan for this patient? - Answer The CDC recently updated the treatment guidelines for gonorrhea and chlamydia. For individuals weighing < 150 kg, gonorrhea infections are to be treated with a single intramuscular dose of ceftriaxone (Rocephin) 500 mg Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions For individuals weighing ≥ 150 kg, 1 g ceftriaxone intramuscular in a single dose should be administered. A patient who is appropriately treated does not require a test of cure. Specific to chlamydia, for individuals weighing <150 kg, chlamydia (confirmed or suspected) should be treated with doxycycline 100 mg orally twice daily for 7 days. A 35-year-old woman presents for preconception counseling. She reports having one child 3 years ago, who was born with spina bifida. She is asking how to prevent this in future pregnancies. Which of the following statements is the most appropriate education for the patient? - Answer High-dose folic acid supplementation of 4,000 mcg daily This is recommended for patients with prior children with neural tube defects. Neural tube defects are one of the most common congenital abnormalities in the United States. Women who have had a prior child with neural tube defects are 10 times as likely to have another child with neural tube defects. Folic acid supplementation of 400 mcg to 800 Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions lot of vaginal dryness recently. Her last menstrual period was approximately 23 months ago. Which is the most important action for the practitioner to take? - Answer Any episode of postmenopausal bleeding warrants further assessment, so this patient should be promptly referred to gynecology While this patient's bleeding may be due to vaginal atrophy, the main concern is that endometrial cancer may be the cause. Further diagnostic tests would likely include a pelvic ultrasound, an endometrial biopsy, and dilation and curettage to rule out cancer or other pathologies, such as endometrial hyperplasia or polyps. Hyperplasia is considered a precursor to endometrial cancer, while polyps are generally benign. A 24-year-old woman presents for her routine Pap smear. Her last Pap smear was performed 3 years ago and resulted with normal findings. Upon cervical exam, you notice an erythematous cervix with some purulent discharge around the cervical os. She states she has been having unprotected sex with more than one partner and was last tested Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions for sexually transmitted infections a couple of years ago. Based on this information and these clinical findings, what would be the priority test to order today? - Answer Nucleic acid amplification testing Nucleic acid amplification testing on vaginal swabs (preferred for female patients) or urine (preferred for male patients) is the recommended screening test for chlamydia, gonorrhea, and trichomoniasis. These sexually transmitted infections (STIs) commonly present with no symptoms, which is why cervical exams are so valuable. Female patients may experience vaginal discharge, intermenstrual bleeding, and postcoital bleeding. Male patients sometimes experience urethritis but can also transmit infection with no symptoms. On cervical exam, the practitioner may see classic findings of cervicitis, including mucopurulent endocervical discharge, friability, and ectropion. A 40-year-old woman presents to the clinic and wants to discuss her family history of breast cancer. She reports that her mother died at the age of 51 from breast cancer and wants to know what her treatment options are should she develop breast cancer herself. What is the best Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions way for the nurse practitioner to respond to these concerns? - Answer It is important to address questions and concerns, so stating a lumpectomy with radiation therapy is an option if the breast cancer is caught early Is an appropriate response to directly address the patient's question. If caught early, the breast cancer has likely not metastasized, and removing the tumor with a lumpectomy followed by targeted radiation therapy to the area to eliminate any remaining tumor cells can significantly decrease the risk of recurrence. Breast Cancer: - Answer Is the leading cancer diagnosis worldwide, and early detection is key to survival. Nurse practitioners use risk assessment tools to place patients into categories (average, moderate, and high risk). Patients with a hereditary breast cancer risk without genetic testing fall into a moderate risk category and should be encouraged to consider genetic testing when possible. For those who have a moderate and high risk, professional breast exams should be completed every 6 to 12 months, with mammograms and MRIs completed yearly. Surveillance should start 10 years before the age that Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions following is a complication of hyperglycemia during pregnancy? - Answer Preeclampsia a complication of untreated gestational diabetes and hyperglycemia. Gestational diabetes can affect both the pregnant person and the infant in multiple ways. Infants born to pregnant people with uncontrolled gestational diabetes can develop macrosomia and be large for gestational age at birth. As a result, shoulder dystocia and cesarean sections are also a risk for patients with untreated gestational diabetes. A long-term risk for pregnant people with gestational diabetes is developing type 2 diabetes later in life.Lifestyle modification is the mainstay of treatment for gestational diabetes. Many pregnant people manage this condition with diet and exercise alone. Insulin is the first- line treatment if glycemic control does not occur with lifestyle modification. Metformin and glyburide (Diabeta) are second-line treatments and are not FDA approved for gestational diabetes. A 36-year-old woman presents to the office for a routine physical and gynecological exam. She asks to discuss contraception. Her physical Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions exam is without abnormalities. Which of the following aspects of the patient's history is considered a contraindication to combined oral contraceptive use? - Answer A patient who is currently 18 days postpartum should not be prescribed combined oral contraceptive pills because this is considered a hypercoagulable state and supplemental estrogen intake can increase the risk of blood clots. Safer alternatives for patients < 30 days postpartum are progestin-only pills, medroxyprogesterone acetate (Depo-Provera), or a progestin-only implantable device.Other contraindications for combined oral contraceptive use are: age over 35 and current tobacco use; history of current breast cancer; breast cancer in the last 5 years; history of migraine with aura; personal history of blood clots, hypertension, liver cirrhosis, or diabetic neuropathy; history of stroke; history of lupus; anticonvulsant use; treatment with lamotrigine (Lamictal) and fosamprenavir for HIV pre-exposure prophylaxis. The nurse practitioner measures a fundal height of 35 cm on a patient who is 37 weeks gestation. What action should the nurse practitioner Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions take in response to this information? - Answer A patient who is 37 weeks gestation should have a fundal height that ranges between 35-39 cm. This is a normal finding, so she should follow up at her next routine prenatal visit as scheduled A 53-year-old woman presents with a breast lump she discovered during a self-breast exam. Which of the following physical exam findings is most likely associated with the risk for breast cancer? - Answer fixed, nontender, irregular-shaped singular mass Some characteristics of a breast mass may help distinguish between benign and malignant lesions, even though a clinical breast exam has low predictive power for detecting whether a breast tumor is cancerous. The typical features of a malignant breast mass are a fixed, nontender, irregular-shaped singular mass that is heterogeneous in texture. For patients who present with a palpable breast lump, a detailed history and a thorough clinical breast exam will guide the nurse practitioner's level of concern and assist in determining the next step in management. The first step of a clinical breast exam should be a visual assessment while the patient is seated with their hands on their Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions patient should be tested for parvovirus B19 antibodies to assess immunity status Fifth disease, or erythema infectiosum, is a common viral illness that is caused by parvovirus B19. Rarely, an acute infection during pregnancy can cause fetal outcomes such as spontaneous abortion, fetal nonimmune hydrops fetalis, and fetal loss. An exposed pregnant patient should be tested for parvovirus B19 antibodies to assess immunity status as soon as possible after exposure. Both B19-specific IgM and IgG should be ordered. IgM reflects recent infection, and IgG indicates past infection and immunity. Pregnant patients exposed to parvovirus B19 should be monitored for potential fetal infection if they are positive for IgM, regardless of the IgG status. Exposed pregnant patients who are negative for IgM and IgG are susceptible to parvovirus B19 infection and should have parvovirus B19 levels repeated in 4 weeks. The practitioner is reviewing the Pap smear results for a 30-year-old patient. The report is positive for HPV and atypical squamous cells of Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions undetermined significance. What is the best plan of action for this patient? - Answer referral for a colposcopy In a patient 30 years of age or older, cytology results of atypical squamous cells of undetermined significance (ASC-US) with positive HPV testing warrant referral for a colposcopy for further evaluation. This is the recommendation regardless of HPV subtype. If the patient had a Pap smear that was positive for ASC-US but negative for HPV, repeat Pap screening in 1 year would be recommended. Patients in this age group with a Pap smear negative for ASC-US but positive for HPV types 16 or 18 are also referred for colposcopy. A young female patient of reproductive age presents with severe abdominal pain and abnormal vaginal bleeding. Which of the following signs and symptoms is not associated with ruptured ectopic pregnancy? - Answer Both clonus (involuntary muscle contractions of the hands, ankle, or jaw, for example) and proteinuria are typically seen in patients with severe preeclampsia, not with an ectopic pregnancy Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions Ectopic pregnancy: - Answer One that occurs anywhere outside of the uterus, whether it be the fallopian tube, ovary, cervix, or abdominal cavity. The risk of rupture is greatest when the fertilized egg implants in the fallopian tube and continues to grow, exceeding the size of the area. This can lead to heavy bleeding inside the abdomen and peritonitis and can become life threatening. Typical treatment for an ectopic pregnancy without unstable bleeding usually entails administering methotrexate, which stops the embryo's cells from growing and dividing, eventually ending the pregnancy. In patients who are experiencing heavy bleeding, emergency surgery may be performed to prevent long-term complications. The Cullen sign, a bluish discoloration around the umbilicus, may present due to intra-abdominal bleeding associated with an etopic pregnancy. A heart rate of 139 bpm suggests tachycardia and is likely to be seen in a ruptured ectopic pregnancy due to fluid volume loss. In addition, a positive Blumberg sign, pain that occurs after palpation of the abdomen is released, is possible in a ruptured ectopic pregnancy, as it can cause peritonitis. Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions hormone, and luteinizing hormone to prevent ovulation. Common early side effects include breast tenderness, nausea, breakthrough bleeding, and headaches, though these often resolve within a few months. COCs are contraindicated for patients with a history of migraines with aura due to an increased risk of stroke. COCs are also associated with an increased risk of venous thromboembolism and hypertension in patients of reproductive age. An adult woman nearing menopause asks the nurse practitioner about exercises she can do to help prevent "brittle bones" in the future. Which of the following exercises should the patient not be advised to consider? - Answer Swimming is not considered a weight-bearing exercise, which is recommended for the prevention of osteoporosis. There are several lifestyle interventions women can adopt to help reduce their risk of osteoporosis as they age. Such measures include adequate nutrition, exercise, smoking cessation, and avoidance of heavy alcohol use. Women are recommended to engage in at least 30 minutes of weight-bearing exercise most days of the week. Exercises Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions that increase muscle strength and promote balance are also important for reducing fall risk. Exercise to reduce risk of Osteoporosis? - Answer Dancing, hiking, and jumping rope are all examples of weight-bearing exercises and should be included in education about reducing one's risk for osteoporosis. The nurse practitioner is starting a 20-year-old patient on ethinyl estradiol and drospirenone (Loryna), a combined oral contraceptive pill. She asks about the side effects she should watch for. Which of the following would be an inappropriate response? - Answer An inappropriate response would be lightening of the skin around the buccal orifice. Combined oral contraceptive pills are not associated with this side effect. Possible side effects of combined oral contraceptives include nausea, breast swelling or tenderness, and bleeding between periods. Oral contraceptives may also trigger melasma, which causes irregular dark patches of skin to develop on the face. Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions Bleeding or spotting between periods during the first few months is a common side effect of oral contraceptive pills. Dark patches of skin on the face may develop due to the estrogen component of the pills. An increase in breast size is another possible side effect. A 32-year-old woman presents to the clinic and reports that she was raped the night prior. Which of the following actions should the nurse practitioner initiate? - Answer refer the patient to the nearest emergency department If a patient discloses a sexual assault, and the assault occurred within the past 5 days, the nurse practitioner is expected to promptly refer the patient to the nearest emergency department. This will ensure that standardized protocol is followed when collecting evidence and reporting information to the proper authorities. This is essential to support the patient's potential desire for legal pursuits. The presentation of a patient who has been raped is immensely varied. Some patients may not initially report an assault, or they may not report it at all. Some patients may choose to report this to their nurse Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions Cervical cancer screening should be performed for women between the ages of 21 and 65 with cytology every 3 years. For women aged 30 to 65, screening is performed with cytology and human papillomavirus (HPV) testing every 5 years. The US Preventive Services Task Force (USPSTF) recommends against routinely co testing with cytology and HPV for women younger than 30 years old. If a Pap shows positive atypical squamous cells of undetermined significance (ASC-US), HPV testing should be ordered. After the age of 65, screening can be discontinued if there is adequate prior screening. A colposcopy should be performed if there are AS-CUS or squamous intraepithelial lesions on cytology. A Pap smear should be repeated in 1 year if a Pap smear is positive for AS-CUS and HPV is negative. A Pap smear can be repeated in 3 years with cervical cytology alone. The practitioner is examining the results of a wet mount for a patient suspected to have a vulvovaginal candidiasis infection. Which of the Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions following findings on a wet mount would support this diagnosis? - Answer pseudohyphae Vulvovaginal candidiasis, commonly referred to as a yeast infection, is one of the most common causes of vaginal irritation and discharge. It can be identified by the presence of pseudohyphae, spores, and bud cells on a wet mount. Patients often describe a chunky white vaginal discharge and intense itching. Overgrowth of squamous epithelial cells? - Answer would be seen on a Pap smear rather than a wet mount and could be a sign of infection, including HPV. A 27-year-old patient is at the office requesting recommendations for an obstetrician because she would like to get pregnant within the next few months. While reviewing the patient's vaccination records, the nurse practitioner notices that she has had only one dose of the MMR vaccine at 19 years old. Knowing that the patient is trying to become pregnant, what must the nurse practitioner tell her regarding the MMR Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions vaccine? - Answer She must avoid getting pregnant for at least 4 weeks following vaccination The MMR vaccine, a live attenuated virus vaccine, should be given to patients who do not have evidence of immunity to measles, mumps, and rubella, including documentation of completion of MMR vaccination and laboratory evidence of immunity. The MMR vaccine should only be given to nonpregnant patients. If a person is planning to become pregnant and is not vaccinated, they must avoid getting pregnant for at least 4 weeks following vaccination A lactating patient presents to the clinic for a visit as her symptoms of mastitis have not improved after completion of susceptible antibiotics per culture sensitivity. She states she has not had any further fevers, but her breast is still extremely painful, erythematous, and edematous. Which of the following is the best course of action for this patient? - Answer Patients treated for mastitis who do not experience total resolution of their symptoms after recommended therapeutic treatment should be referred for a breast ultrasound and possible mammogram Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions (indicating the presence of bacteria), clue cells (epithelial cells covered by adherent gram-negative rods), or a vaginal pH > 4.5. This bacterial infection is not contagious and can be treated with oral metronidazole (Flagyl), vaginal metronidazole (Metrogel Vaginal), or clindamycin (Cleocin-T) cream.It is important to instruct patients to avoid douches, as use is known to raise vaginal pH > 4.5 and create a favorable environment for this type of infection. A normal vaginal pH is ≤ 4.5. A 46-year-old woman presents to the office for her annual gynecological well-visit. She tells the nurse practitioner a friend of hers was recently diagnosed with breast cancer. She does not have any family history of breast cancer, but her father had skin and colon cancers. She is concerned and would like recommendations for cancer screening tests. Which of the following is the most appropriate recommendation for this patient? - Answer The American College of Obstetricians and Gynecologists recommend annual mammograms starting at age 40 For women at average risk of breast cancer, screening mammography is recommended every 1-2 years. Patients should start having Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions mammography no later than age 50 years. Screening should continue until at least age 75 years. A 20-year-old woman presents for contraceptive counseling. After talking to her friends, she believes the contraceptive patch will be her best choice because taking a daily pill is difficult for her to remember. She requests a prescription for the levonorgestrel-ethinyl estradiol transdermal system (Twirla patch). Which of the following medical conditions would be a contraindication to this method of contraception? - Answer SLE and positive antiphospholipid antibodies The levonorgestrel-ethinyl estradiol transdermal system (Twirla patch) is a combined hormonal contraceptive containing estrogen and progestin. Patients with systemic lupus erythematosus (SLE) have an increased risk of arterial and venous thrombosis and myocardial infarction, and the presence of antiphospholipids antibodies further increases the risk. Combined hormonal contraception is contraindicated Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions A 26-year-old woman was previously seen for a routine Pap smear and received a result of atypical squamous cells of undetermined significance. How should the nurse practitioner explain this finding to the patient? - Answer If a Pap shows positive atypical squamous cells of undetermined significance (AS-CUS), HPV testing should be ordered as the next step in management. A 37-year-old man reports dysuria, urinary frequency, painful ejaculation, fever, and malaise. Upon a digital rectal exam, the nurse practitioner notes a tender, warm, enlarged, and boggy prostate. Which of the following is the most likely diagnosis? - Answer A tender, warm, enlarged, and boggy prostate indicates prostatitis Acute prostatitis is an infection of the prostate gland. Patients present with acute onset of dysuria, urinary frequency, urinary urgency, painful ejaculation, hematospermia, or painful defecation. Systemic symptoms such as fever, chills, malaise, myalgia, and nausea are also common. Men may also report pain at the tip of the penis and obstructive urinary symptoms such as a weak stream, hesitancy, and straining to urinate. The physical exam should include an abdominal, genital, and digital Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions confirmation. During pregnancy, at 28 weeks of gestation, patients who are D negative and have a negative anti-D antibody screen are administered RhoGAM. RhoGAM is an anti-D immune globulin administered intramuscularly at 28 weeks of gestation to Rh negative mothers. RhoGAM prevents isoimmunization by suppressing the pregnant patient's immune response and subsequent antibody formation if exposed to Rh-positive red blood cells. If the baby is Rh positive at birth, a second dose of RhoGAM will be administered within 72 hours of delivery. Long-term, Rh negative pregnant patients will receive RhoGAM during every pregnancy unless already sensitized. A 25-year-old woman presents to the clinic for preconception counseling. The patient asks about folic acid and why it is so important for patients of childbearing age to take it. Which of the following teaching statements would be the most appropriate? - Answer Folic acid supplementation during pregnancy reduces the incidence of neural tube defects in the fetus A 32-year-old woman who is 28 weeks pregnant presents today for her prenatal checkup. She asks if she needs the Tdap vaccine today, as she Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions received it a year and a half ago during her last pregnancy. What is the most appropriate response from the nurse practitioner? - Answer A Tdap booster is recommended in every pregnancy without regard to when the last booster was administered to provide passive immunity to the fetus Infants typically receive their first dose of the DTaP vaccine at 2 months of age. They will need an additional two doses, given at 4 and 6 months of age, to build full immunity. The mother typically receives their Tdap vaccine during the third trimester of pregnancy between weeks 27 and 36 weeks, which is protective for the fetus and newborn.Live vaccinations are contraindicated during pregnancy. These include the varicella vaccine, intranasal influenza vaccine, and measles-mumps- rubella vaccine. Intramuscular influenza is routinely recommended in pregnancy. It is recommended that patients have all other scheduled vaccinations prior to pregnancy, but most vaccinations can be given during pregnancy if applicable. A 19-year-old patient presents with concerns of milky discharge from both breasts for 2 days. She is extremely worried as her great aunt was Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions recently diagnosed with breast cancer. While the nurse practitioner is aware that this is generally a benign condition, which of the following lab levels would be advisable to check at today's visit? - Answer A prolactin level This patient is exhibiting galactorrhea, which typically presents as bilateral milky nipple discharge involving multiple ducts. Most often, nipple discharge is of benign origin. Galactorrhea can be caused by hyperprolactinemia, so it is advisable to check a prolactin level for this patient. Hyperprolactinemia can occur due to medications such as certain antipsychotics or antidepressants, pituitary tumors, or endocrine abnormalities. If the prolactin level is found to be elevated in the absence of taking a medication known to cause hyperprolactinemia, an MRI of the pituitary gland is warranted along with referral to an endocrinologist. A 32-year-old patient presents to the clinic to discuss contraception options. Which of the following items in the patient's history would warrant further investigation prior to prescribing her ethinyl estradiol, norethindrone acetate, and ferrous fumarate combination (Lo-Loestrin Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions Patients who experience menopausal symptoms such as hot flashes, mood lability, and sleep disturbances may be candidates for menopausal hormone therapy (MHT). However, the risk of cardiovascular events, such as myocardial infarction or a cerebrovascular event, is higher in older patients than in their younger counterparts. Initiation of MHT is not recommended for patients over the age of 60. These patients may be candidates for nonhormonal pharmacologic management. A 30-year-old woman presents with a possible vaginal infection. When looking at the wet mount, the nurse practitioner sees that there is movement on the slide via flagella. What infection does the nurse practitioner believe the patient has based on these wet mount findings? - Answer A wet mount that shows mobile trichomonads that move via flagella is indicative of trichomoniasis Trichomoniasis is a parasitic sexually transmitted infection requiring antibiotic treatment. A common drug used is metronidazole (Flagyl) by mouth or intravaginally. The partner(s) of the infected person also need to be treated. Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions A nurse practitioner is assessing a patient with vaginal irritation and foul odor. While analyzing the wet mount, the nurse practitioner identifies cells that appear fuzzy and without sharp edges. Given these findings, which of the following statements should be incorporated into patient teaching? - Answer The wet mount shows clue cells, which are diagnostic for bacterial vaginosis. The first-line treatment for bacterial vaginosis is metronidazole (Flagyl), which can cause a disulfiram-like reaction if alcohol is consumed while taking this or for several days after. It is important to not drink alcohol while taking this medication and for 3 days after completion A 27-year-old man presents to the office for a follow-up on a sexually transmitted infection screening after recent intercourse with a new partner. The nucleic acid amplification test result is positive for chlamydia. What would be the best treatment option for this patient? - Answer doxycycline (Vibramycin) 100 mg PO twice daily for 7 days An 18-year-old man presents to the clinic for evaluation of bilateral swelling and pain in the scrotum. He lives in a college dormitory and Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions reports he is not sexually active. He has not received any childhood vaccines. The exam is significant for a fever of 41ºC, severe testicular pain, and swelling and erythema of the scrotum. Which of the following diagnoses should be prioritized on the differential diagnosis? - Answer Mumps orchitis Is associated with fever, testicular and scrotal pain, as well as erythema and edema. Among male patients with mumps, 20-30% develop orchitis, polyarthritis, or thyroiditis in addition to parotid gland swelling. Risk factors for developing mumps are living in a crowded environment such as a dormitory, traveling globally, and being unvaccinated against mumps. Treatment is supportive and includes NSAIDs and ibuprofen for pain and fever. Ice packs and scrotal elevation may help relieve symptoms of orchitis. A 23-year-old woman presents to the clinic today with concern over a recent mobile lump she felt in her right breast. She states one is starting to form in her left breast as well. She has no significant past medical history but does report a lot of stress at her new job. Which of Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions within range with dietary and lifestyle changes alone, medication should be considered. The American Cancer Society's cervical cancer screening guidelines are relied upon by nurse practitioners. Which of the following statements is incorrect regarding human papillomavirus (HPV) screening and Pap smears? - Answer Pap smears have a higher sensitivity than HPV tests According to the American Cancer Society, HPV testing is more sensitive and specific compared to the Pap smear. The HPV test is a screening measure that detects infection by high-risk types of HPV. It can be conducted alone or with the Pap test, which is also known as a cotest. There are various recommendations for screening the average-risk patient, depending on age and medical history. These guidelines have recently been updated to avoid screening patients under the age of 21, regardless of sexual activity. The guidelines have also changed from annual screening to every 3-5 years depending on age and medical history. Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions A patient who is 32 weeks pregnant presents to your office after having abnormal lab results at her yearly physical. Her lab results are TSH 0.02 mIU/L, T3 500 ng/dL, and T4 15 ug/dL. Which of the following therapies is indicated? - Answer methimazole (Tapazole) Hyperthyroidism is diagnosed when TSH values are below 0.05 mU/L (normal 0.5-5 mIU/L) and T3 and T4 are elevated. During pregnancy, T3 and total T4 concentrations often exceed 1.5 times the upper limit of normal for nonpregnant patients. Treatment options for hyperthyroidism include radioactive iodine, propylthiouracil (PTU), methimazole (Tapazole), and in some cases, a thyroidectomy. For the first trimester of pregnancy, the medication of choice is PTU, but in the second and third trimesters of pregnancy, it is safe to switch patients to methimazole (Tapazole) instead. A 19-year-old man presents to the clinic with heaviness and painless swelling on the right side of his scrotum that has persisted for 3 weeks. An in-office ultrasound shows a solid mass present on the right testicle. Which of the following is the most likely next step in management? - Answer refer the patient for tumor markers Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions The primary differential diagnosis for a patient with a firm, fixed, painless testicular mass is testicular cancer. Since an ultrasound already confirmed a solid mass, the next step in management is to refer the patient for tumor markers, as nurse practitioners will use these levels for staging, prognosis, and a baseline measurement for comparing levels throughout treatment. Testicular cancer can occur in young adults, and new cases in the United States are on the rise in patients aged 20 to 34 years old When a testicular mass is found, the first course of action is an ultrasound to determine the consistency of the mass to rule out other possible diagnoses such as a hydrocele or epididymitis. When a solid mass suspicious for malignancy is visualized, the patient is referred to a specialist, and further testing is completed, including tumor markers and additional imaging to evaluate for staging and metastasis. A discussion about sperm preservation should be had with the patient prior to surgical intervention, especially if the patient is at risk for infertility. Then, a radical orchiectomy is often performed. The only way to definitively diagnose testicular cancer is by examining the histology of tissue obtained from a radical orchiectomy. A biopsy of the mass before removal of the testicle can increase the risk of metastasis into inguinal lymph nodes, and thus it is not performed. Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions symptoms develop, it occurs within 10 days of contact in women and 2- 5 days in men. Clinical manifestations of gonorrhea in women include dysuria, vaginal pruritus, intermenstrual bleeding, mild lower abdominal pain, dyspareunia, and thin, purulent, and mildly odorous leukorrhea. This may progress to pelvic inflammatory disease (PID) in some women. Symptoms of PID include lower abdominal pain, mucopurulent urethral discharge, vaginal discharge, cervical motion tenderness, dysuria, adnexal tenderness, fever, chills, nausea, and vomiting. Clinical manifestations of gonorrhea in men include burning on urination and serous penile discharge that can progress to purulent, blood-tinged discharge. Gonorrhea is treated with antibiotics. A 33-year-old patient who is newly pregnant presents to the clinic. She asks the nurse practitioner questions regarding which vaccines she can receive during her pregnancy. Which vaccine would not be safe to receive during her pregnancy? - Answer Intranasal influenza It is recommended that pregnant patients receive all necessary scheduled vaccines prior to pregnancy. During pregnancy, it is safe for mothers to receive most vaccines except those that are live vaccines. Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions Intranasal influenza is thus not safe for this patient to receive. Other live vaccines include smallpox, yellow fever, varicella, and measles- mumps-rubella vaccines. Vaccinations protect the fetus and mother from complications and mortality from preventable diseases. Immunizations can provide passive immunity to the fetus. The Tdap and injectable influenza vaccination are routinely recommended for all pregnant patients. There is no evidence of harm to the fetus with inactivated vaccinations. A 29-year-old patient who is pregnant at 20 weeks of gestation presents to the clinic for a routine prenatal checkup. Which of the following locations is associated with appropriate fetal growth and development at 20 weeks of gestation? - Answer At 20 weeks gestation, the fundal height should be at the level of the umbilicus This can be off by 1-2 cm and still be within normal limits.During pregnancy, the uterus remains in the pelvis until approximately 12 weeks gestation, when it becomes large enough to palpate over the abdomen just above the symphysis pubis. Fundal height measurement is part of a routine prenatal assessment and can assist the nurse Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions practitioner in estimating the due date and detecting fetal growth abnormalities, such as small or large for gestational age. If the fundal height is off by more than 2 cm, the patient should undergo an ultrasound. A female patient presents to the clinic for evaluation due to reports of vaginal burning and irritation. The nurse practitioner performs a wet mount and observes clusters of budding yeast and pseudohyphae via the microscope. Which of the following would be the most appropriate treatment option for this patient? - Answer The treatment of choice for uncomplicated yeast infections is a one-time 150 mg oral dose of fluconazole (Diflucan) Vulvovaginal candidiasis, commonly referred to as a yeast infection, is one of the most common causes of vaginal irritation and discharge. It can be identified by pseudohyphae and clusters of budding yeast under microscopic observation. Patients commonly describe symptoms of chunky white vaginal discharge and intense itching or burning. Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions The area on the upper outer quadrant of the left breast is erythematous, warm, and painful to palpation. Which of the following is the most appropriate next step in management? - Answer Dicloxacillin 500 mg four times a day for 10 to 14 days is a first-line treatment for mastitis. Lactational mastitis typically occurs in the first 12 weeks of breastfeeding and causes a breast to become painful, swollen, red, and warm. The clinical presentation can range in severity from painful inflammation to systemic symptoms such as fever and flu-like symptoms. Mastitis is a clinical diagnosis, and breast milk cultures are not routinely done It is also important to advise the patient to continue frequent breastfeedings to ensure complete emptying of the breasts during the treatment. When milk remains in the breast, milk stasis can increase the risk of recurrence. A delayed or skipped feeding causing milk stasis can be enough to trigger mastitis in some patients. Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions A patient who is 36 weeks pregnant presents with vaginal bleeding, a hard stomach, and painful contractions. Which of the following is the priority action? - Answer Placental abruption is an emergent complication of pregnancy where the placenta separates from the uterus before birth due to ruptured maternal blood vessels When this occurs, it puts the placenta's blood supply, and thus the pregnancy, at high risk. This patient needs to be evaluated as soon as possible in the emergency department. Clinical findings often include abrupt onset vaginal bleeding, abdominal pain, a hard stomach, uterine contractions, uterine tenderness, and a non reassuring fetal heart rate. A 20-year-old woman has green vaginal discharge and vaginal irritation. She also reports postcoital bleeding. A speculum exam reveals vaginal erythema, cervical petechiae, and frothy green discharge. Which of the following is the best test to confirm the diagnosis? - Answer a nucleic acid amplification test (NAAT) Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions Trichomoniasis is a sexually transmitted infection caused by the protozoan parasite Trichomonas vaginalis. Typical symptoms are a yellow or green malodorous vaginal discharge, pruritus, irritation, dysuria, and postcoital bleeding. Speculum exam findings include a frothy green discharge, a pH that usually exceeds 6.0, and cervical petechiae, known as a strawberry cervix. In the past, wet-mount microscopy was the preferred diagnostic test for the diagnosis of trichomoniasis. Due to the limited sensitivity of wet-mount microscopy, the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists both recommend a nucleic acid amplification test (NAAT) as the preferred test to diagnose trichomoniasis in women who are symptomatic or at high risk. These tests can be performed on vaginal, cervical, or urine specimens. Testing vaginal discharge with pH and wet-mount microscopy is still appropriate, but a NAAT should be used in conjunction with a negative wet mount in women who are symptomatic or at high risk. However, the presence of motile trichomonads on a wet mount is diagnostic of trichomoniasis. On saline wet-mount microscopy, trichomonads appear as pear-shaped motile protozoa with flagella and a jerking and spinning motion. Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions hyperprolactinemia, which may develop secondary to medications, pituitary tumors, endocrine disorders, or other medical conditions. Evaluation of milky nonbloody nipple discharge includes a patient history, a clinical breast exam, and a pregnancy test. If the pregnancy test is negative, a galactorrhea workup should be performed. The initial workup includes a measurement of thyroid-stimulating hormone and serum prolactin levels and a review of the patient's medications to identify medications that are associated with galactorrhea. A patient is approaching her second trimester and has concerns regarding future testing. She would like to know when she will be tested for gestational diabetes. During which time frame can the patient anticipate being tested for gestational diabetes? - Answer Screening for gestational diabetes takes place between 24 and 28 weeks A 30-year-old woman presents to the clinic with a 6-week history of amenorrhea and believes that she may be pregnant. Which of the following best describes amenorrhea as a sign or symptom of Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions pregnancy? - Answer Amenorrhea is a presumptive symptom of pregnancy because it is a physical sign that suggests a patient of menstruating age may be pregnant, but the pregnancy has not yet been confirmed. Other presumptive symptoms may include changes to the breasts, pigmentary changes to the skin, nausea, urinary frequency, constipation, and fatigue. A 53-year-old woman presents to the clinic with an interest in discussing hormone replacement therapy for menopausal symptoms. Which of the following elements of the patient's health history makes her a candidate for hormone replacement therapy? - Answer Smoking Smoking is not advised while taking hormone replacement therapy, but it is not a contraindication. The decision to initiate hormone replacement therapy is highly individualized, and the decision should be made in collaboration with the patient, as there is no perfect risk to benefit ratio for initiating therapy. Hormone replacement therapy is Qbank- Women’s & Mens health All chapters well Reviwed Questions with certified solutions often used as a broad term to describe any hormone supplementation. The Food and Drug Administration uses the term hormone therapy to describe only combination estrogen-progestogen. Hormone therapy is the most effective treatment for vasomotor symptoms (e.g., hot flashes, night sweats), genitourinary syndrome of menopause (e.g., loss of vaginal elasticity), and prevention of fracture and bone loss. Estrogen therapy alone is appropriate for patients who have had a hysterectomy, but progesterone is required if the patient still has a uterus. Unopposed estrogen administration in patients with a uterus increases the risk of endometrial cancer. Low-dose, topical estrogen therapy may be indicated for patients with vaginal dryness, recurrent urinary tract infections, or dyspareunia. A woman who is 28 weeks pregnant was diagnosed with gestational diabetes mellitus at today's visit after completing her oral glucose tolerance test. She reports that she has a fear of needles and would hate to have to give herself insulin injections multiple times a day. Which of the following is true regarding the treatment of gestational diabetes? - Answer The first-line treatment for gestational diabetes mellitus is lifestyle modifications