****Please write a rationale for correct answers written below: 1)Which of the f

****Please write a rationale for correct answers written below:
1)Which of the following is a cause of primary amenorrhea?
A. Turner syndrome
B. Hypothyroidism
C. Menopause
D. Obesity
Solution: A
Turner syndrome
Turner syndrome is a cause of primary amenorrhea. Menopause, hypothyroidism, and obesity (or extreme weight loss) can cause secondary amenorrhea, which is defined as the cessation of regular menses for 3 months or cessation of irregular menses for 6 months.
2)A 22-year-old presents for her annual gynecological exam and testing. The Pap smear result shows ASC-US. Which of the following is the best management for this patient?
A. Check for high-risk HPV
B. Repeat Pap in 12 months
C. Refer patient for colposcopy
D. Refer patient for endometrial biopsy
Solution: B
Repeat Pap in 12 months
The appropriate follow-up for a 22-year-old with a Pap smear result of ASC-US is to perform a repeat Pap smear in 12 months. HPV testing is not recommended for this age group with ASC-US. A colposcopy is not recommended for ASC-US, as most cases clear spontaneously in young women. An endometrial biopsy is not appropriate follow-up for ASC-US, since it does not involve the endometrium.
3)Which of the following statements is true regarding a threatened abortion?
A. Vaginal bleeding and cramping are present, but the cervix remains closed
B. Vaginal bleeding and cramping are present along with a dilated cervix
C. The fetus and placenta are both expelled
D. The products of conception and the placenta remain inside the uterus along with a dilated cervix
Solution: A
Vaginal bleeding and cramping are present, but the cervix remains closed
Threatened abortion is defined as vaginal bleeding and cramping without the presence of cervical dilation.
4)A multigravida who is at 28 weeks’ gestation has a fundal height of 29 cm. Which of the following is the best recommendation for this patient?
A. Advise the mother that her pregnancy is progressing well
B. Order an ultrasound of the uterus
C. Refer her to an obstetrician for an amniocentesis
D. Recommend bed rest with bathroom privileges
Solution: A
Advise the mother that her pregnancy is progressing well
Between 20 and 35 weeks, the fundal height is equal to the number of weeks of gestation plus or minus 2 cm. Fundal height is measured as the distance between the pubic bone and the uterine fundus. For example, a woman who is at 30 weeks’ gestation who has a fundal height of 29 cm is within normalimits. But if the fundal height is 27 cm (3 cm difference), it is abnormal. Next step is to order a fetal ultrasound.
5)All of the following have been classified as nationally notifiable diseases by the Centers for Disease Control and Prevention, except:
A. Herpes simplex infections
B. Pertussis
C. Anthrax
D. Lyme disease
Solution: A
Herpes simplex infections
According to the CDC, herpes simplex infections are not classified as a notifiable disease. Pertussis, anthrax, and Lyme disease are notifiable diseases. To report a disease, contact your local county health department.
6)A 14-year-old female adolescent is worried that she has not started to menstruate like most of her friends. During the gynecological examination, the NP tells the mother, who is in the room with the patient, that her daughter is starting Tanner stage II. What are the physical exam findings during this stage?
A. Breast buds and some straight pubic hair
B. Fully developed breasts and curly pubic hair
C. Breast tissue with the areola on a separate mound with curly pubic hair
D. No breast tissue and no pubic hair
Solution: A
Breast buds and some straight pubic hair
Tanner stage II in females is noted for breast and papilla elevated as a small mound and increased areola diameter (breast buds). Tanner II pubic hair for females is sparse, lightly pigmented straight hair along the medial border of the labia.
7)Three days after delivering a healthy baby girl, a mother calls the office with concerns that her daughter’s vagina is swollen with a small amount of bleeding. The nurse practitioner will:
A. Refer the patient to ED
B. Instruct the mother to bring the newborn into the office for evaluation
C. Reassure the mother that this is normal
D. Instruct the mother to cleanse the newborn’s genitals with soap and warm water
Solution: C
Reassure the mother that this is normal.
At approximately 2 to 3 days of age, a newborn female may have bleeding from the vagina, and the labia may be swollen. This is normal and caused by withdrawal of hormone exposure in the womb. There is no need for evaluation in the office or ED unless the bleeding does not stop or increases in amount. Though it is important to gently cleanse the genitals, there is no need to use soap, which can irritate the vaginal muco
8)During a breast exam of a 30-year-old nulliparous woman, the nurse practitioner palpates several rubbery mobile areas of breast tissue. They are slightly tender to palpation. Both breasts have symmetric findings. There are no skin changes or nipple discharge. The patient is expecting her menstrual period in 5 days. The nurse practitioner will:
srRefer the patient to a gynecologist for further evaluation
A. Advise the patient to return 1 week after her period so her breasts can be rechecked
B. Advise the patient to return in 6 months to have her breasts rechecked
C. Schedule the patient for a mammogram
Solution: B
Advise the patient to return 1 week after her period so her breasts can be rechecked.
Symptoms of fibrocystic breast disease include cyclic tenderness with prominent breast tissue that is present in both breasts. The symptoms are worse about 1 week before menses. A few days after menses starts, the bloating and breast tenderness resolve. Symptoms are caused by elevated hormone levels (progesterone). Fibrocystic disease is differentiated from breast cancer by the lack of a dominant mass or other symptoms such as peau d’orange, dimpling, retraction, or eczema-like rash on the nipples and areolae.
9)A 20-year-old college athlete presents with weight loss and amenorrhea for 6 months. She had a period 7 months ago and denies sexual activity. The patient’s body mass index (BMI) has decreased to 16.4, her pulse is 52 beats/min and weak, and her blood pressure is 84/54 mmHg. What will the nurse practitioner assess next?Fingerstick glucose
A. Exercise routine
B. Eating habits
C. Medication use
Solution: A
Fingerstick glucose.
Assessing blood glucose level on this patient is a priority, as hypoglycemia is a complication from secondary amenorrhea. Exercise, eating habits, and medication use would be assessed to determine differential diagnosis, after the glucose test is administered.
10)A female patient experiencing frequent urinary tract infections (UTIs) and vaginal infections is being seen in the office for the third time in 7 months with complaints of urinary burning and frequency, vaginal discharge, and severe itching. The nurse practitioner orders testing for which possible underlying condition?
A. Diabetes insipidus
B. Anemia
C. Helicobacter pylori infection
D. Diabetes mellitus
Solution: D
Diabetes mellitus.
Persistent urinary and vaginal infections may indicate underlying glucose metabolism disorders and diabetes mellitus. Diabetes insipidus is a rare metabolic disorder affecting fluid balance (excessive fluid intake and urination) in the body and would not be screened for with the symptomatology of this case. H. pylori is a bacterial infection of the digestive tract and would not manifest as vaginal discharge or itching. Anemia is not a possible underlying cause for frequent UTIs or vaginal infections.
11)A 35-year-old primigravida who is at 18 weeks’ gestation is expecting twins. What would you expect her alpha-fetoprotein (AFP) values to be?
11)Normal
A. Higher than normal
B. Lower than normal
C. None of the above
Solution: B
Higher than normal.
AFP is produced in the fetal and maternal liver. Higher levels of AFP are commonly seen in multiple gestations because of the growing liver in each fetus, which cumulatively lead to higher AFP levels.
12)Puberty begins during which Tanner stage?
A. Tanner stage I
B. Tanner stage II
C. Tanner stage III
D. Tanner stage IV
Solution: B
Tanner stage II.
Puberty is defined as the period in life when secondary sexual characteristics begin to develop, identified as Tanner stage II for boys and girls.
13)A sexually active adult female presents to the clinic complaining of genital ulcers. Upon examination, white wartlike papules are found in the inguinal area and a maculopapular rash is noted on the palms and soles of the feet. The nurse practitioner will order:
A. Gram stain
B. Rapid plasma reagin test
C. Nucleic acid amplification test (NAAT)
D. HIV-1/HIV-2 antibody and P24 antigen test
Solution: B
Rapid plasma reagin test.
These wartlike lesions (condylomata lata) and rash on palms and soles of feet indicate a probable syphilis infection. Two types of syphilis serologic tests (treponemal and nontreponemal tests) are needed to diagnose syphilis. Step 1—Order screening test (nontreponemal tests): rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL). If reactive, order confirmatory test. Step 2—Order confirmatory test (treponemal tests): fl uorescent treponemal antibody absorption (FTA-ABS), microhemagglutination test for antibodies to Treponema pallidum (MHA-TP). A Gram stain to look for gram-negative diplococci in clusters is not typically used in primary care. It is useful in diagnosing gonorrhea. NAATs are highly sensitive tests for both gonorrhea and chlamydia. HIV-1/ HIV-2 antibody and P24 antigen tests (combination assay) are ordered for suspected infection with HIV.
14) A 30-year-old primigravida is diagnosed with a possible threatened abortion. The result of the urine pregnancy test is positive. Which of the following statements is true regarding a threatened abortion?
A. Vaginal bleeding and cramping are present, but the cervix remains closed
B. Vaginal bleeding and cramping are present along with a dilated cervix
C. The fetus and placenta are both expelled
D. The products of conception and the placenta remain inside the uterus along with a dilated cervix
Solution: A
Vaginal bleeding and cramping are present, but the cervix remains closed.
Threatened abortion is defined as vaginal bleeding and cramping without the presence of cervical dilation.
15) Which of the following would you expect to find on a wet-mount slide of a patient diagnosed with bacterial vaginosis?
A. Tzanck cells
B. A large number of leukocytes and squamous epithelial cells
C. A large number of squamous epithelial cells whose surfaces and edges are coated with large numbers of bacteria along with a few leukocytes
D. Epithelial cells and a small amount of blood
Solution: C
A large number of squamous epithelial cells whose surfaces and edges are coated with large numbers of bacteria along with a few leukocytes.
Diagnosis of bacterial vaginosis includes three of four Amsel criteria: (1) white, thick adherent discharge; (2) pH >4.5; (3) positive whiff test (amineodor mixed with 10% potassium hydroxide [KOH]); (4) clue cells >20% on a wet mount (epithelial cells dotted with large numbers of bacteria that obscure cell borders)