NURS 629 Women's Health Med Challenger All Questions With Answers. Maryville University

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NURS 629 Women's Health Med Challenger All Questions With Answers. Maryville University.Question 1 Edited: Jul 25, 2018 Report Question Although women may experience some "nuisance" type of side e... ffects while on oral contraceptives (OCPs), how long should they be encouraged to wait for resolution of these effects? 1 month 3 months 6 months Educational Objective Outline duration of side effects from OCPs Key Point Most minor side effects from OCPs resolve within 3 months. Explanation Most of the minor side effects of OCPs, including breakthrough bleeding, will resolve within 3 months if they are going to resolve at all. Women should therefore be encouraged to wait at least that long prior to discontinuing or changing contraception secondary to side effects. A follow-up visit after 2 to 3 months is recommended for women using oral contraceptives. At this time persisting side effects can be addressed and a new pill chosen if indicated. Blood pressure should be measured and instructions for management of missed pills reviewed. Reference: Zieman M. Overview of contraception. In: Basow DS, ed. UpToDate. Accessed September 12, 2012. Question 2 Edited: Sep 1, 2017 Report Question A 25-year-old patient presents with a urinary tract infection and was prescribed sulfamethoxazole/trimethoprim to treat the infection. She is concerned that the antibiotic will interfere with the effectiveness of her oral contraceptive pills. How should this patient be counseled regarding her use of antibiotics and oral contraceptive pills (OCPs)? Antibiotics are teratogenic and she should completely avoid sexual contact while taking them. She should use a back-up method of contraception while taking antibiotics. She should request a different antibiotic because sulfamethoxazole/trimethoprim may reduce the effectiveness of her OCP. She should use a back-up method of contraception until the onset of her next menses. Taking sulfamethoxazole/trimethoprim will not alter the effectiveness of her OCPs. Rifampin is the only proven antibiotic to decrease serum ethinyl estradiol and progestin levels in women taking OCPs. A nonhormonal contraceptive method is recommended in women prescribed rifampin, but not other antibiotics. Rifampin may also decrease the effectiveness of transdermal and vaginal ring contraception. Despite anecdotal reports of OCP failure, other antibiotics have not been shown to alter the pharmacokinetics of oral contraception. Therefore, in the case described, no back-up contraception is necessary. Reference: Martin KA, Barbieri RL. Overview of the use of estrogen-progestin contraceptives. In: Basow DS, ed. UpToDate. Accessed September 12, 2012. Question 3 Edited: Dec 18, 2018 Report Question A 30-year-old 32-weeks’ pregnant woman with pre-gestational diabetes reports vulvar itching, burning, and a whitish-thick discharge for the past 7 days. Exam demonstrates diffuse erythema of the vulva and vagina, with a thick white discharge adherent to the vaginal walls. No abnormal odor is noted. Pseudohyphae are noted on microscopy. Which of the following best describes her diagnosis? bacterial vaginosis vulvovaginal candidiasis trichomoniasis lichen simplex chronicus Educational Objective: Diagnose vulvovaginal candidiasis. Key Point: Suspect vulvovaginal candidiasis in a patient presenting with pruritus, erythema and white, thick, curd-like vaginal discharge. Diagnose with microscopy of wet mount. Explanation: The condition described is vulvovaginal candidiasis. Diagnosis is made by microscopy or culture. Treatment of vulvovaginal candidiasis includes oral fluconazole 150 mg in a single dose or topical antifungal preparations. In patients with complicated cases such as the one described, a second dose of fluconazole 150 mg given 3 days after the first increased the cure rate from 67% to 80%. Trichomoniasis is a sexually transmitted disease diagnosed by visualization of motile trichomonads on microscopy. Bacterial vaginosis does not typically affect the vulva and is characterized by a fishy odor, thin gray/green vaginal discharge, and clue cells on microscopy. Lichen simplex chronicus can be initiated by an underlying candida infection; however, it does not typically involve the vagina. There is no evidence that fluconazole poses a risk to the fetus at any stage of development. References: Norgaard M, Pedersen L, Gislum M, et al: Maternal use of fluconazole and risk of congenital malformations: a Danish population-based cohort study. J Antimicrob Chemother, 2008; 62: 172-176 Galask RP, Elas D. Vulvovaginitis. Precis: An Update in Obstetrics and Gynecology. Gynecology. Fourth Edition. 2011; 67-77. Chen TM. Differential diagnosis of vulvar lesions. Curso ENARM 2018. Published March 16, 2011. Accessed February 13, 2018. Vaginitis. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists. ACOG Compendium of Selected Publications 2008; 1314-1325. Aguin TJ, Sobel JD. Vulvovaginal candidiasis in pregnancy. Curr Infect Dis Rep. 2015; 17: 462 Question 4 Report Question A 60-year-old female presents for her annual gynecologic exam and Pap smear reporting pain with intercourse, vaginal dryness, and a thin gray discharge. She reports that she used to have bothersome hot flashes and night sweats; however, these resolved several years ago, and she feels physically well. On exam you note vulvar atrophy, paling of the vaginal mucosa with petechiae, and a friable cervix. Infectious causes are excluded. Microscopy demonstrates an absence of superficial epithelial cells, an increase in parabasal cells, and an increase in polymorphonuclear leukocytes. Which of the following is the best initial treatment strategy for this patient? [Show More]

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