Obstetric Nursing| uWise OBGYN Quiz
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A 36-year-old woman requests prenatal diagnosis. She is healthy and
excited about finally getting pregnant. She is interested in genetic
counseling and asks about the advantages of chorionic villus sampling
versus amniocentesis. Which of the following is true when chorionic villus
sampling is compared to amniocentesis?
A. Reduced post-procedure loss rate
B. Performed earlier
C. More likely to obtain an adequate sample
D. Lower rate of procedure related birth defects
E. Performed in is immunized pregnancies
Verified Answer -B
Chorionic villus sampling (CVS) is a prenatal test that can detect genetic
and chromosomal abnormalities of a fetus. The loss rate with
amniocentesis is quoted as 0.5% vs. ~1 to 3% for chorionic villus
sampling. CVS is performed between 10 and 12 weeks gestation, while
amniocentesis is performed after 15 weeks. Early CVS (<10 weeks
gestation) is associated with an increase in rare limb abnormalities. It is
more likely that a CVS will involve multiple attempts - a failure to obtain
an adequate sample of cells and the woman requiring a repeat test later
on - when compared with amniocentesis. Pregnancies complicated by
isoimmunization can be followed by serial assessment of the amniotic
fluid for bilirubin.
,A 36-year-old G2P2 woman presents with irregular vaginal bleeding. Six
weeks ago, she had her first Depo-Provera injection and now she has
unpredictable bleeding. She is concerned by these symptoms. She has a
history of hypertension but is currently on no medications. Vital signs
reveal: blood pressure 130/90; weight 188 pounds; height 5 feet 5 inches;
BMI 31.4kg/m2. Which of the following is the most appropriate next step
in the management of this patient?
A. Reassurance
B. Begin oral contraceptives
C. Begin estrogen
D. Insert etonogestrel implant (Implanon)
E. Perform an endometrial biopsy
Verified Answer -A
The patient should be reassured since initially after Depo-Provera
injection there may be unpredictable bleeding. This usually resolves in 2-3
months. In general, after oone year of using Depo-Provera, nearly 50% of
users have amenorrhea.
A 23-year-old G0 woman with last menstrual period 14 days ago presents
to the office because she had unprotected intercourse the night before. She
does not desire pregnancy at this time and is requesting contraception. She
has no medical problems and is not taking any medications. In addition to
offering her counseling and testing for sexually transmitted infections,
which of the following is the most appropriate next step in the
management of this patient?
A. Observe for two weeks to establish if pregnancy occurred before
initiating treatment
B. Begin oral contraceptives now
C. Begin oral contraceptives after her next normal menstrual period
,D. Provide emergency contraception, and return after next menstrual
period
E. Provide emergency contraception, then begin oral contraceptives
immediately
Verified Answer -E
Emergency contraceptive pills are not an abortifacient, and they have not
been shown to cause any teratogenic effect if inadvertently administered
during pregnancy. They are more effective the sooner they are taken after
unprotected intercourse, and it is recommended that they be started within
72 hours, and no later than 120 hours. Plan B, the levonorgestrel pills, can
be taken in one or two doses and cause few side effects. Emergency
contraceptive pills may be used anytime during a woman's cycle, but may
impact the next cycle, which can be earlier or later with bleeding ranging
from light, to normal, to heavy.
A 35-year-old G3P3 woman requests contraception. Her youngest child is
seven years old. Her periods have been regular since she discontinued
breastfeeding five years ago. Her past medical history includes depression
that is controlled with antidepressants, and a history of deep venous
thrombosis. She denies smoking or alcohol use. In the past, oral
contraceptive pills have caused her to have severe gastrointestinal upset.
What in her history makes her an ideal candidate for progestin-only pills?
A. Depression
B. Smoking history
C. Severe nausea on combined oral contraceptives
D. Lactation history
E. Deep venous thrombosis
Verified Answer -E
, Ideal candidates for progestin-only pills include women who have
contraindications to using combined oral contraceptives (estrogen and
progestin containing). Contraindications to estrogen include a history of
thromboembolic disease, women who are lactating, women over age 35
who smoke or women who develop severe nausea with combined oral
contraceptive pills. Progestins should be used with caution in women with
a history of depression.
A 24-year-old G1P1 woman comes to the office requesting contraception.
Her past medical history is unremarkable, except for a family history of
ovarian cancer. She denies alcohol, smoking and recreational drug use.
She is in a monogamous relationship. She wants to decrease her risk of
gynecological cancer. Of the following, what is the best method of
contraception for this patient?
A. Female condoms
B. Male condoms
C. Copper containing intrauterine device
D. Progesterone containing intrauterine device
E. Combined oral contraceptives
Verified Answer -E
Oral contraceptives will decrease a woman's risk of developing ovarian
and endometrial cancer. The earlier, higher dose oral contraceptive pills
have been linked to a slight increase in breast cancer, but not the most
recent lower dose pills. Women who use oral contraceptive pills have a
slightly higher risk of developing cervical intraepithelial neoplasia, but
their risk of developing PID, endometriosis, benign breast changes and
ectopic pregnancy are reduced. Both hypertension and thromboembolic
disorders can be a potential side effect from using oral contraceptive pills.
Condoms and intrauterine devices will not lower her risk of ovarian
cancer.
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