Deck 2: Gynecology

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?

A)Total hysterectomy
B)Subtotal hysterectomy
C)Hysteroscopic polypectomy
D)Dilatation and curettage

Answer 1

Hysteroscopic polypectomy

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?

A)Doppler ultrasound
B)Computed tomography
C)Pelvic ultrasound
D)Magnetic resonance imaging

Answer 2

Pelvic ultrasound

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?

A)The client had her first menstrual period at age 12.
B)The client's menstrual cycle is 34 days, on the average.
C)The client's menstrual blood loss per period is about 100 mL.
D)The client's average duration of menstrual flow is 7 days.

Answer 3

The client's menstrual blood loss per period is about 100 mL.

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:

A)Oligomenorrhea
B)Menorrhagia
C)Metrorrhagia
D)Menometrorrhagia

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?

A)Inform the client that a repeat Pap smear should be done in three months.
B)Inform the client that she needs to have a Pap smear in two years.
C)Perform colposcopy.
D)Inform the client that she needs to have a Pap smear after a year.

Question 6

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

A)A 30-year-old Chinese American who has a BMI of 30 and smokes 2 packs of cigarettes a day.
B)A 43-year-old Caucasian who has a BMI of 32 and smokes 2 packs of cigarettes daily.
C)A 25-year-old Black American who has a BMI of 32; cigarette smoking is denied.
D)A 25-year-old of Meditteranean descent who has a BMI of 30; cigarette smoking is denied.

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?

A)Administer heparin.
B)Administer oxygen at 6L/min.
C)Increase fluid intake.
D)Prepare to administer platelet replacement.

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:

A)Neisseria gonorrhoeae
B)Treponema pallidium
C)HSV-1
D)HSV-2

Question 9

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

A)Infertility
B)Pelvic inflammatory disease
C)Having a child infected with conjunctivitis
D)Having a child with developmental problems

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?

A)Avoid rubbing the sores.
B)Wear loose underwear made of cotton.
C)Apply hydrogen peroxide solution on sores.
D)Use cool and wet compresses for relief.

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?

A)Women who are infected with human immunodeficiency virus.
B)Women with endometrial polyps.
C)Women with ovarian cancer.
D)Women with colorectal cancer.

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?

A)Normal value of hemoglobin level.
B)Increased hemoglobin values.
C)Decreased hematocrit concentration.
D)Hyperthermia

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?

A)Women infected with Treponema pallidum.
B)Women with a history of genitalia herpes.
C)Women who are on oral contraceptives.
D)Women who have plans of conceiving within the next year.

Question 14

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

A)A client who regularly douches.
B)A client diagnosed with Addison's disease.
C)A client who is 8 weeks pregnant.
D)A client who is sexually active.

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?

A)Thin and grayish white vaginal discharge with a fishy odor.
B)Purulent vaginal discharge.
C)Greenish-gray, frothy vaginal discharge.
D)Thick, white vaginal discharge with severe perineal itching.

Question 16

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

A)Candida albicans.
B)Trichomonas.
C)Gardnerella vaginalis.
D)Treponema pallidum.

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?

A)A woman who engages in unprotected sex.
B)A woman on steroid therapy.
C)A woman who wears tampons during menstruation.
D)A woman with a history of genital herpes.

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:

A)"I can engage in vaginal intercourse after a week."
B)"I will avoid tub baths for a week."
C)"I should use tampons instead of sanitary pads."
D)"I need to be on bed rest for a week"

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:

A)A client diagnosed with genital herpes.
B)A client diagnosed with chlamydia.
C)A client diagnosed with bacterial vaginosis.
D)A client with hepatitis B.

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:

A)Primary syphilis
B)Secondary syphilis
C)Tertiary syphilis
D)Latent syphilis

Question 21

A client with a history of syphilis presents with ataxia. Further assessment reveals diminished deep tendon reflexes, proprioception and pain sensation. The nurse determines that the client has neurosyphilis. Which of the following statements is true about the client's condition?

A)The client is in the secondary stage of syphilis.
B)The client is not infectious.
C)The signs of primary syphilis most likely occurred about 2 years ago.
D)The client is not treatable.

Question 22

A female client comes to the clinic complaining of pain in the pelvic area. The client tells the nurse midwife that she feels a vague sense of bladder fullness after voiding. Constant sensation to void is also reported. The client is diagnosed with cystitis. Which of the following instructions given by the nurse midwife is the most appropriate for the client?

A)Wear underwear made of nylon.
B)Douche at least twice a month.
C)Increase intake of cranberry juice.
D)Relieve the discomfort with tub baths.

Question 23

A client complains of urinary frequency and pain in the external urethral orifice at the start of voiding. The nurse midwife suspects that the client is most likely experiencing:

A)Cystitis.
B)Pyelonephritis.
C)Urethritis.
D)Ureteritis.

Question 24

A nurse midwife is teaching a group of women about Norplant as a contraceptive method. Norplant is contraindicated for which of the following women?

A)A woman who is suspected of having breast cancer.
B)An adolescent who is sexually active.
C)A woman who is breastfeeding.
D)A woman in need of a reversible contraceptive method.

Question 25

A nurse midwife is teaching a 14-year-old girl about contraceptives. The client gave birth to a healthy baby girl three days ago. The nurse midwife is correct when she says that the most effective way to protect against conception is through:

A)Natural family planning.
B)Abstinence.
C)Oral contraception.
D)Surgical methods.

Question 26

A female client visits the clinic to learn more about her contraceptive options. The client is about to get married in less than a year and is a practicing Catholic. Which of the following contraceptive method is least likely to be appropriate for the client?

A)Basal body temperature method
B)Symptothermal method
C)Periodic abstinence
D)Spermicides

Question 27

A 15-year-old comes to the facility and asks the nurse midwife about her contraceptive options. Which of the following is the least appropriate method of contraception for this client?

A)Periodic abstinence
B)Subcutaneous implants
C)Oral contraceptives
D)Diaphragms

Question 28

A female client with an IUD comes to the facility after testing positive in the home pregnancy kit. Physical examination and laboratory tests are ordered to verify the pregnancy. After reviewing the test results, the nurse midwife determines that the client is 8 weeks pregnant. Which of the following is the next action of the nurse midwife?

A)Order a sonogram to rule out birth defects.
B)Notify a physician for removal of the IUD.
C)Inform the client that the IUD may be left in place without complications.
D)Prepare the client for a surgical abortion procedure.

Question 29

A diaphragm is initially fitted to a 23-year-old female client by the nurse midwife. Which of the following occurrences would not necessitate another fitting?

A)She goes through a dilatation and curettage.
B)She gains 20 pounds.
C)She gets pregnant.
D)She loses 10 pounds.

Question 30

The following female clients are contraindicated for diaphragm use except for:

A)A client with a history of toxic shock syndrome.
B)A client with allergy to rubber.
C)A client with umbilical hernia.
D)A client with recurrent UTI.

Question 31

A nurse midwife is creating a teaching plan for a female client who is scheduled for tubal ligation. Which of the following teachings should not be included in the plan?

A)Avoid unprotected coitus before the surgical procedure.
B)The procedure will not affect the menstrual cycle.
C)Coitus may be resumed 3 days after the procedure.
D)Occurrence of sharp shoulder pain necessitates immediate medical intervention.

Question 32

A couple visits the facility for a fertility assessment. A semen analysis is ordered. Which of the following suggests a likely fertility problem?
I.Sperm count = 15 million per milliliter of seminal fluid.
II.Sperm motility = 80%
III.Sperm progressive motility = 35%
IV.Ejaculation volume = 1.2 cc

A)I
B)I and IV
C)I, III and IV
D)All of above

Question 33

A nurse midwife is assessing the fertility of couples who have been trying to conceive for a period of time without success. Which of the following couples has primary infertility?

A)A couple engaging in unprotected sex for half a year. No previous conceptions are reported.
B)A couple engaging in unprotected sex for one year. A previous conception is reported.
C)A couple engaging in unprotected sex for one year. No previous conceptions are reported.
D)A couple engaging in unprotected sex for half a year. A previous conception is reported.

Question 34

A series of laboratory tests reveals that a male client's spermatozoa are immobilized by vaginal secretions due to an immunological factor. The following interventions are appropriate for the client except:

A)Administer clomiphene citrate to the male client.
B)Administer corticosteroids to the client's female partner.
C)Instruct the couple abstain from sex for the next 6 months.
D)Instruct the man to wear a condom for the next 6 months.

Question 35

A couple is considering artificial insemination after the man fails to respond to medications that intend to increase his sperm count. Which of the following statements about artificial insemination is false?

A)A donor's sperm can be used.
B)The sperm is instilled into the female reproductive tract one day after ovulation.
C)It involves selective termination of gestational sacs.
D)The sperm is instilled into the cervix or uterus.

Question 36

A couple is considering in vitro fertilization and embryo transfer after learning that the woman's fallopian tubes are blocked. Which of the following statements about in vitro fertilization and embryo transfer is/are true?
I.Embryo transfer involves insertion of one or more fertilized ova about 40 hours after fertilization.
II.After the pregnancy is implanted, the woman's prenatal care is the same as that for any pregnant woman.
III.In vitro fertilization involves fertilization of one or more mature oocytes removed from a woman's ovary in a controlled or laboratory environment.
IV.The procedure involves selective termination of gestational sacs.

A)I, II and III
B)I, III and IV
C)II, III and IV
D)All of the statements are true.

Question 37

Clomiphene citrate is prescribed to a woman to stimulate ovulation. Which of the following statements by the nurse midwife is the most appropriate for this client?

A)"If no results are obtained after the second course of clomiphene citrate therapy, the therapy will be discontinued."
B)"Blurring of vision is an expected side effect of the medication."
C)"Bruising or bleeding should be reported."
D)"Blood samples are obtained periodically."