Download APEA 3P EXAM PREP- WOMEN'S HEALTH|2025-2026|ACTUAL EXAM QUESTIONS WITH VERIFIED ANSWERS|A+ and more Exams Nursing in PDF only on Docsity!
APEA 3P EXAM PREP- WOMEN'S HEALTH| 2025 -
2026 |ACTUAL EXAM QUESTIONS WITH VERIFIED
ANSWERS|A+ RATED
Three of the following interventions are appropriately used to prevent osteoporosis after menopause. Which one is NOT? Avoidance of corticosteroids Performance of weight-bearing activities for 40 mins at least 5 days/week Estrogen replacement therapy Adequate calcium & vitamin D intake C. Prevention of osteoporosis may be optimized by elimination of risk factors and engaging in interventions that maximize bone density. Good nutrition from infancy throughout adulthood is a major component of good bone health. Others include engaging in weight-bearing exercises, adequate intake of calcium and vitamin D, smoking cessation, limiting alcohol consumption to moderate amounts, and avoidance when possible of medications that may decrease bone density (corticosteroids, anticonvulsants). Osteoporosis occurs at accelerated rates in women who are post-menopausal. The lack of estrogen can produce rapid bone loss due to bone resorption. Estrogen replacement is not used to prevent or treat osteoporosis. A patient who is scheduled for pelvic exam with PAP smear should be advised to avoid douching, sexual intercourse, and tampon use before her exam. For how long should she be advised to avoid these activities for optimal evaluation? 24 hours 48 hours 36 hours 1
week B. The general recommendation is to avoid these activities and any vaginal medication for 48 hours prior to the PAP smear. Douching and tampon use can remove superficial cells, which are the ones collected and used as representative samples on PAP smear. Sexual intercourse should be avoided because there can be specimen contamination by the male partner. With vaginal medications or creams, either can serve as a barrier to epithelial cell sampling. When collecting cervical cells for a PAP smear, when are the endocervical cells typically collected? After the ectocervical specimen with a broom After the ectocervical specimen with a brush Before the ectocervical specimen with a broom Before the ectocervical specimen with a brush B. Ectocervical specimens are collected first to minimize any bleeding that can occur when the endocervical cells are sampled. The brush is considered a superior tool for the collection of endocervical specimens because it produces the highest yield of endocervical cells, and thus, is a good reflection of the health of the cervix. Alternatively, a cervical broom can be used to collect endocervical cells and ectocervical cells simultaneously. It is rotated for 5 turns before the samples are placed on the slide. This may be used in pregnant women. A 16 - year-old female is diagnosed with primary dysmenorrhea. She has taken over- the- counter ibuprofen in 800-mg increments every 8 hours during menses for the past 3 months, with minimal relief of symptoms. What intervention will provide greatest relief of dysmenorrhea symptoms?
with sexually transmitted diseases. The patient is at very high risk of developing pelvic inflammatory disease (PID) when there is an implanted foreign body. An example of this is an intrauterine device (IUD). The risk is also increased with a diaphragm, but, because it is not implanted for long periods at a time, the risk of PID is less than with an IUD. The first step in evaluating a breast lump is: history and physical exam. mammogram. ultrasound. Incorrect MRI. A. Although most patients will need further work-up of a breast mass, historical information is critically important in directing the health care provider to the next step. Historical information that should be ascertained is the location of the lump, how and when it was first noticed, whether there is nipple discharge, and whether it changes in size related to menses. Other historical information is the patient’s personal and family history of breast cancer and/or history of breast biopsies. A patient who takes oral contraceptive pills is at increased risk of: gallbladder disease. depression. hypothyroidi sm. varicose veins. A. One of the major components of gallstones is estrogen. A patient with underlying gallbladder disease should not take oral contraceptives (OC) since they will increase estrogen exposure and theoretically, formation of gallstones. Depression, hypothyroidism and varicose veins are not increased
by use of oral contraceptives. A 14 - year-old female has never menstruated. She and her mother are concerned. What is most important for the NP to assess? Stature Tanner stage Anemia Family history of amenorrhea B. Tanner staging, or sexual maturity ratings, are predictable changes that occur with puberty. These should be assessed. In females, breasts and pubic hair signify specific pubertal changes that constitute maturation. These are not age specific, but at 14 years, a Tanner Stage 3 or more would be characteristic of expected maturation. Menses should follow soon. After a vaginal exam, a patient received a prescription for metronidazole 500 mg twice daily for 7 days. What was her likely diagnosis? Bacterial vaginosis Syphilis Chlamydia Gonorrhea A. Bacterial vaginosis can be treated with metronidazole orally. The most effective dose is 500 mg twice daily for 7 days. This is generally well tolerated as long as the patient avoids alcohol. Alcohol in the presence of metronidazole can produce a disulfiram reaction. Another medication
A 54 - year-old female presents with a small to moderate amount of vaginal bleeding of recent onset. She has been postmenopausal for approximately 2 years. What diagnosis is least likely? Endometrial carcinoma Ovarian cancer Endometrial hyperplasia Uterine polyps B. Ovarian cancer may present as an adnexal mass, pelvic or abdominal symptoms and a variety of others. Postmenopausal bleeding (PMB) is an uncommon presentation of ovarian cancer, but can present this way. In women with PMB, likely causes of uterine pathology should be evaluated before considering ovarian pathology. In early menopause, the most common etiology is atrophy of the endometrium or vaginal mucosa. This patient has been postmenopausal for approximately 2 years. Other common causes of PMB are polyps, fibroids, and endometrial hyperplasia. Athletic amenorrhea increases the risk of: osteoporosis. an eating disorder. covert hypothyroidism. breast cancer. A. Athletic amenorrhea is a secondary cause of amenorrhea that is observed in females who engage in excessive amounts of exercise. Excessive exercise can produce significant loss of body fat. Since
estrogen is produced by the body’s fat tissue, there is a subsequent loss in the ability to produce adequate amounts of estrogen. When this occurs, infertility, vaginal and breast atrophy, and osteopenia are very likely. A 28-year-old female presents with a slightly tender 1.5-cm lump in her right breast. She noticed it 2 days ago. She has no associated lymphadenopathy and there is no nipple discharge. How should she be managed? Mammogram Ultrasound and mammogram Re-examination after her next menses Clinical exam only C. Women who are younger than age 35 years and who have no associated suspicious findings of breast cancer should delay imaging studies until re-examination 3 - 10 days after the last menstrual period to determine whether the lump changes in size or becomes nonpalpable. If there are associated suspicious findings on exam, such as palpable nodes, a large lump (>2.0 cm), or nipple discharge, diagnostic evaluation should not be delayed. If management involved a return visit for re- examination after menses, and the lump is unchanged, ultrasound is certainly advised. Mammogram may not yield good information in a 28 - year-old because of the density of the breast tissue. Baseline mammogram may be advised, and direction from a radiologist or breast surgeon could be sought. A definitive diagnosis of osteoporosis can be made when: an X-ray indicates fragility fractures. bone mineral density is 2.5 standard deviations below the mean. T- score greater than 2.5.
infections. pneumonia. B. The hallmark finding in a patient with bacterial vaginosis (BV) is clue cells on microscopic exam. Clue cells are epithelial cells with adherent bacteria. The most common clinical feature is an unpleasant, “fishy” smelling discharge that is more noticeable after sexual intercourse. BV can produce a cervicitis. It is a risk factor for HIV acquisition and transmission. Metronidazole is most commonly used for initial therapy. The usual oral regimen is 500 mg twice daily for 7 days. Alcohol should be avoided. A 50-year-old female believes that she is menopausal. She complains of hot flashes and has not had menses in 12 months. Which of the following test results would be expected during menopause? Increased thyroid-stimulating hormone Decreased follicle- stimulating hormone Hypoestrogenemia Increased follicle-stimulating hormone D. Follicle-stimulating hormone (FSH) begins to rise during menopausal transition. This stage of menopause begins with variation in menstrual cycle length and ends 12 months after the final menses. If the patient is older than 45 years and menstrual cycle dysfunction has been ruled out, menopause should be considered. Possibly the best approach to diagnosing menopause is to ask and observe clinical manifestations. An elevated FSH is not necessary to make a diagnosis of menopause, but it is commonly done in clinical practice. Diagnosis entails a review of her symptoms. Specifically, changes in bleeding patterns, hot flashes, sleep disturbances, and genitourinary symptoms are characteristic of menopause. By definition, cessation of menses for 12 months constitutes menopause. “Hot flashes” that occur during menopause are thought to
be related to: low estrogen levels. low progesterone levels. fluctuating progesterone levels. fluctuating estrogen levels. D. Low estrogen levels alone do not produce hot flashes. Female first graders are known to have low estrogen levels but do not have hot flashes. The fluctuation in estrogen levels produces vasomotor symptoms referred to as “hot flashes.” An initial pharmacologic approach to a patient who is diagnosed with primary dysmenorrhea could be: combination acetaminophen and NSAIDs. acetaminophen. NSAIDs at the time symptoms begin or onset of menses. NSAIDs prior to the onset of menses. C. Pain associated with dysmenorrhea is likely due to prostaglandins, which can cause prolonged contraction of the uterus. This produces uterine ischemia, sometimes termed uterine angina. NSAIDs (nonsteroidal anti- inflammatory drugs) are prostaglandin synthesis inhibitors. These are usually started at the onset of menses or onset of symptoms and continued for 2 - 3 days depending on the symptom pattern of the patient. There is no demonstrated increase in efficacy when acetaminophen is added or given alone. The recommended time to initiate screening for cervical cancer in
masses. MRI is not used unless a history of breast cancer is present. Mammography has the potential to evaluate the presence of a mass, but it is not adequate in assessing whether it is fluid-filled or not. A 32 - year-old female presents to your clinic for her annual GYN exam. A 1cm soft, non- tender, round mass is found at the 4 o’clock position at the posterior vaginal introitus. What is the most likely diagnosis? Nabothian cyst Mesonephric cyst Bartholin duct cyst Bartholin gland abscess C. A Bartholin duct cyst is formed from an accumulation of secretions produced by the Bartholin's gland. The duct dilates and cysts are formed at the four and eight o'clock positions on each side of the vaginal orifice. Larger cysts (greater than 1cm) may produce discomfort, but most Bartholin duct cysts (1cm or less) are typically asymptomatic. Nabothian and mesonephric cysts are present on the cervix, not in the area of the introitus. Obstruction of the duct may result in abscess which causes severe pain, swelling, and can interfere with walking, sitting and sexual intercourse. It appears as a swollen, warm, and tender mass that is usually located in the lower medial labia majora. A patient asks the NP’s advice about an herb to help with her hot flashes. The NP knows these: are safe to use in all patients. may be contraindicated in patients with history of breast cancer. substances have a mild estrogenic effect and will halt hot flashes. help prevent osteoporosis. B.
The herb that the patient is asking about is probably black cohosh, Actaearacemosa. It is a phytoestrogen. This means that it provides estrogen from a plant source. If estrogen is contraindicated in a patient, then it does not matter whether it comes from plants or is produced synthetically. There is a potential safety concern in using black cohosh in women with breast cancer or who are at high risk of breast cancer because of the estrogenic effects that are possible on the breasts. Black cohosh has not been shown in studies to help with hot flashes. A nurse practitioner identifies the following image during a microscopic exam of vaginal discharge. These are probably: bacteri a. sperm . hypha e. Candida albicans. C. Typically filamentous structures, hyphae are the mechanism that allows fungal growth. Yeast may look like uniform oval-shaped structures. These can range in size but are usually large and unicellular. Visualization of hyphae and yeast should prompt an immediate diagnosis of a fungal infection. Candida albicans is a specific fungus, often found in vaginal secretions. Since many fungi can produce hyphae and yeast, it is not possible to diagnose Candida albicans specifically. The frequency for cervical screening depends on the patient and her
simplex. B. Bacterial vaginosis (BV) results when normal vaginal flora such as Lactobacillus sp. are replaced with anaerobic bacteria like Prevotella, Mobiluncus or Gardnerella. This
is usually, but not always, associated with sexual activity. Women who have never been sexually active are less affected. A female patient is 35 years old. She has never had an abnormal PAP smear and has had regular periodic screening. If she has a normal PAP smear with HPV testing today, when should she have the next cervical cancer screening? 1 year 2 - 3 years 3 years 5 years D. The American Congress of Obstetricians and Gynecologists recommends screening for women over age 30 years no more frequently than every 5 years if both tests are negative. If she had been screened with PAP only, the recommendation for screening would be in 3 years. US Preventive Services Task Force recommends screening this patient in 5 years. Human papillomavirus (HPV) testing in combination with cervical cytology has been shown to be more sensitive than cytology alone. However, HPV is not recommended as a lone screening modality. A female should be told to take her oral contraceptive pill (OCP) at bedtime if she experiences: weight gain. headache s. nausea.
urinary tract infection. pelvic inflammatory disease C. The exact mechanism for increased urinary tract infections is unknown, but it is believed to be due to nonoxynol- 9 - induced changes in vaginal flora. Another consideration is the possible contamination that might accompany insertion before each episode of coitus. Care and cleaning of the diaphragm must take place, or that could be a contributor to increased bacteria. A 17-year-old presents with complaints of dysmenorrhea. Which finding below suggests that this is secondary dysmenorrhea? Normal pelvic exam Dysmenorrhea is not limited to menses Unpredictable menses Nausea with menses B. Primary dysmenorrhea has been attributed to prolonged uterine contractions that cause ischemia in the myometrium. Some females with secondary dysmenorrhea may have a normal pelvic exam, but they tend to have an enlarged, irregularly- shaped uterus or tender uterus on exam. Most secondary dysmenorrhea is due to endometriosis. On physical exam, patients with secondary dysmenorrhea can have displacement of the cervix, cervical stenosis, adnexal enlargement, or nodular and/or tender uterosacral ligaments. Infection should be strongly considered if she is sexually active. According to the American Cancer Society (ACS), what recommendation should be made to a 70 - year-old female regarding mammograms if she is considered low risk?
She no longer needs mammogram. She should have them annually until age 75 years. She should have them every three years. She should have them every 1 - 2 years as long as she has a reasonable life expectancy. D. Breast cancer is more prevalent in older women. In fact, 85% of breast cancer occurs in women after age 50 years. According to the latest recommendations from ACS (2015), it is appropriate to begin screening at ages 40 - 44 years, then annually. Age 55 or older may be screened every 2 years or as is considered clinically appropriate for the patient, but only if life expectancy is at least 10 years. A female patient who takes oral contraceptives has just completed her morning exercise routine. She complains of pain in her right calf. Her blood pressure and heart rate are normal. She is not short of breath. Her calf is red and warm to touch. What is NOT part of the differential diagnosis? Deep vein thrombosis Cellulitis Calf muscle strain Sciatica D. Sciatica can produce pain in the calf but it is not associated with redness or warmth. While it is not likely that someone who exercises regularly would have a DVT, this patient does take oral contraceptives. Therefore, DVT should always be part of the differential given the potential risks associated
