Grand Canyon University > Nursing > NRS 433V/ NRS433V: female-reproductive-sys1

Female-reproductive-sys

A 34-year-old woman comes to the clinic because of left lower quadrant pain for the last 4 months. The pain is intermittent and seems to worsen during her periods. She has no significant past medical history and does not take any medications. She is sexually active with 1 partner and they use condoms for birth control. She has never been pregnant and has regular menstrual periods. Her last menstrual period was 17 days ago. Physical examination and vital signs are normal. Pelvic examination reveals mild tenderness in the mid and left side of the pelvis. There is no vaginal discharge or bleeding and the cervical os is closed. The most appropriate next step is to

  A. order a CT scan of the pelvis

  B. order ultrasonography of the pelvis

  C. prescribe nonsteroidal antiinflammatory medications for menstrual cramps

  D. prescribe oral contraceptives

  E. schedule a diagnostic laparoscopy

A 26-year-old woman, gravida 1, with insulin-dependent diabetes mellitus comes to the office at 33-weeks gestation, reporting decreased fetal movement for 1 day. She is found to have poor glucose control, with serial blood sugar levels greater than 150 mg/dL. The fetal heart rate on the nipple stimulation test is non-reactive. The baseline rate is 140/min, and late decelerations are observed in the first 30 minutes of the test with each contraction. The next step in management is

  A. a biophysical profile (BPP)

  B. delivery

  C. a nonstress test (NST)

  D. a contraction stress test (CST)

  E. a repeat nipple stimulation in 24 hours

You are the doctor on call in the well baby nursery at the community hospital. One of the nurses calls you to ask about one of your patients. The baby is now 30 hours old and was born full term via vaginal delivery to a healthy 28-year-old mother. There were no complications at the delivery and the baby has been feeding well. The nurse is concerned that the baby looks "yellow". You ask her to send for a bilirubin level. A few hours later she calls to tell you that the total bilirubin level has come back at 18 mg/dL with a direct bilirubin level of 0.6 mg/dL. The parents are now concerned about the baby's discoloration. The most appropriate next step is to

  A. reassure the mother that this is completely normal and no additional studies or treatment are indicated

  B. repeat the bilirubin level immediately as the result must be a lab error

  C. start phototherapy and repeat the bilirubin level in 6 hours

  D. transfer to the nearest neonatal intensive care unit for an exchange transfusion

  E. wait 6 hours and repeat the bilirubin level

A 31-year-old woman comes to the emergency department because of heavy vaginal bleeding. She is 10-weeks pregnant, by her last menstrual period and has been getting routine prenatal care. She has been in good health and her pregnancy has been uneventful, until the heavy bleeding started the night before. She reports having to change a pad every hour and thinks she may even have passed blood clots. She has no significant past medical history and her only medication is a daily prenatal vitamin. She denies alcohol, cigarette, or drug use. Vitals are normal. Pelvic examination reveals an open cervical os and blood in the vaginal vault. Ultrasonography of the pelvis demonstrates a single endometrial canal containing echogenic material. The uterus is homogeneous and there is no evidence for an intrauterine pregnancy. The factor most likely contributing to this patient's spontaneous abortion is

  A. a bicornuate uterus

  B. a chromosome abnormality of the fetus

  C. hypothyroidism

  D. an incompetent cervix

  E. a submucosal leiomyoma

A 33-year-old woman comes to the office for a periodic health maintenance examination. She has no specific complaints. Her last menstrual period began 10 days earlier. Physical examination is unremarkable. Pelvic examination reveals a mobile mass in the left adnexa and an ultrasound shows that is it is a 4 cm unilocular, homogeneous, fluid-filled mass. The most appropriate next step is to

  A. aspirate the mass under ultrasound guidance

  B. order serum α-fetoprotein and human chorionic gonadotropin levels

  C. order serum CA-125 concentration

  D. prescribe oral contraceptive pills

  E. repeat the examination in 2-3 months

  F. schedule a laparoscopy

A 28-year-old gravida 3, para 2 woman comes to the clinic for prenatal care at 11-weeks gestation. Her medical and surgical history are unremarkable, although she relates a social history significant for alcohol consumption. She drinks 1-2 glasses of wine with lunch and 3-4 glasses of wine with and after dinner on most nights. Given her history, her fetus is at greatest risk for

  A. a bowel obstruction

  B. a cardiac defect

  C. cleft lip and palate

  D. macrosomia

  E. tall stature

A 26-year-old African American woman walks into the emergency department where you are working. She is 37-weeks pregnant and is complaining of a severe headache for the past 24 hours. She also tells you that she has noticed that the vision in her right eye has been extremely blurry since she woke up this morning. She states that her pregnancy has been uneventful and that she receives prenatal care at the hospital clinic. The card she is carrying with her indicates that all prenatal tests were within normal limits. Three consecutive blood pressure readings 15 minutes apart are 156/102 mm Hg, 164/112 mm Hg, and 144/98 mm Hg. The nurse informs you that her bedside urine dipstick reveals 3+ proteinuria. On physical examination you find a mild systolic ejection murmur and 2+ pitting edema of her lower extremities. A sterile vaginal exam reveals a long and closed cervix. Tocodynomometer shows irregular uterine contractions every 8-10 minutes. The external fetal heart tracing is reassuring. The most appropriate next step in this patient's management is

  A. an emergent ophthalmology consult

  B. intravenous administration of magnesium sulfate and induction of labor

  C. intravenous administration of magnesium sulfate and a shot of intramuscular terbutaline to quiet her uterine contractions

  D. prolonged external fetal heart monitoring

  E. ultrasound examination of the fetus to evaluate amniotic fluid index and fetal well being

A 2-day-old female infant in the neonatal unit has a distended abdomen and has not passed meconium since birth. The child was delivered vaginally at term, but her birth was induced with magnesium sulfate, because the mother was diagnosed with preeclampsia. The infant's vital signs are: temperature 38.1 C (100.6 F), blood pressure 70/40 mm Hg, pulse 130/min, and respirations 22/min. Physical examination is significant for a distended abdomen. An abdominal x-ray demonstrates a "bubbly" bowel gas pattern on the left side of the abdomen. The next step in the management of this patient is

  A. bowel rest

  B. contrast enema

  C. intravenous fluids

  D. laparotomy

  E. an ultrasonography

A 22-year-old college student comes to the emergency department with a severe right lower quadrant pain. She says that the pain started approximately 6 hours ago and has progressively worsened. She has no significant medical problems and her only medication is oral contraceptive pills. She is sexually active with 1 partner, her boyfriend. Her last menstrual period was 2 weeks ago. Vital signs are: temperature 37.0 C (98.6 F), blood pressure 120/70 mm Hg, and pulse is 80/min. Abdominal examination is significant for focal tenderness in the right lower quadrant. Pelvic examination reveals exquisite tenderness in the right adnexa, a closed cervical os, and clear vaginal discharge. Laboratory studies show:

The most likely etiology of this patient's symptoms is

  A. acute appendicitis

  B. diverticulitis

  C. ovarian torsion

  D. a ruptured ectopic pregnancy

  E. a tuboovarian abscess

A 46-year-old woman comes to the office for a periodic health maintenance examination. She is married and has worked in the local library for 15 years. She states that she has no medical problems, runs 3 miles every other day, and feels generally well. She takes a multivitamin, as well as 1000 mg of calcium every day. She has never smoked cigarettes, and reports drinking wine with dinner when she goes to a restaurant. Her only surgery was a bilateral tubal ligation 10 years ago after her third child. When questioned about her menstrual periods, she said that she has experienced a 28-30 day cycle for years, with three days of bleeding. She does mention that for the past three months her periods have been different, with bleeding about every 15 days, lasting 2 days. A physical examination and a pelvic examination reveal no abnormal findings. The most important next step in this woman's care is to

  A. cycle her on a low-dose combination oral contraceptive pills and give her some extra iron

  B. determine FSH and LH levels

  C. send her for an ultrasound evaluation of her pelvic anatomy

  D. perform an office endometrial Pipelle biopsy

  E. perform a routine Pap smear and send her for a mammogram

A 16-year-old girl comes to the clinic because of a 2-week history of nausea and vomiting in the morning before school. The nausea comes on as soon as she wakes up, and is generally relieved after she "throws her guts up." She attends school and is able to function at her evening job as a pharmacy clerk. She denies any weight loss. She is sexually active with "many," different partners and does not use any form of contraception. She also admits to injection drug use. She is unsure of the exact date of her last menstrual period, but thinks that it was about 3-4 weeks ago. Her chart indicates that she has received the following vaccinations: IPV, MMR, and DaPT. Her blood pressure is 120/80 mm Hg and pulse is 65/min. Physical examination is normal. A pregnancy test is positive. You tell her that she is pregnant and she tells you that she is going to keep the baby and has no plans to decrease her sexual activity or drug use. She agrees to undergo HIV testing in addition to routine tests. Laboratory studies show:

At this time you should:

  A. admit her to the hospital for the treatment of hyperemesis gravidarum