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21) Signs of an ectopic pregnancy include all of the following, EXCEPT: A) missed, late, or unusually light menstrual period. B) syncope. C) fundal height at the level of the umbilicus. D) unilateral lower abdominal pain. 22) Your patient is an 18-year-old female who is alert and in moderate distress, complaining of abdominal pain and light-headedness. She describes a four-week history of worsening unilateral lower quadrant abdominal pain with onset of malaise, nausea andvomiting, this week.. Today, she is experiencing faintness and near-syncope with exertion. She denies pain or difficulty with urination. Her last menstrual period was two weeks ago. She is sexually active and uses oral contraceptives. Physical examination reveals marked tenderness and guarding with palpation of her abdomen. Her skin is cool and diaphoretic. HR = 121, BP = 90/58, RR = 18. The patient’s presentation is most consistent with: A) ectopic pregnancy. B) pelvic inflammatory disease. C) spontaneous abortion. D) pyelonephritis. 23) Complications associated with endometritis include all of the following, EXCEPT: A) sepsis. B) infertility. C) fibroid tumors. D) death. 24) A 26-year-old female is complaining of severe abdominal pain and heavy vaginal bleeding. She has used five sanitary napkins in the past hour. Her last menstrual period was six weeks ago, and she describes a history of irregular periods but never to this extent. Evaluation of her abdomen shows rebound tenderness and rigidity in the midline of the lower abdomen. Management should include: A) IV magnesium sulfate. B) IV oxytocin. C) SQ terbutaline. D)IV access and fluid infusion to maintain peripheral perfusion 25) Your patient is a 44-year-old female who is alert and in mild distress. She states that she had an acute onset of sharp, right lower quadrant abdominal pain last evening while having intercourse and that the pain has not subsided. She states the pain radiates to her lower back and rates it as a 5 on a scale of 1–10. Physical examination reveals tenderness with palpation to the lower right abdominal quadrant, and her skin is warm and dry. HR = 100, RR = 12, BP = 116/78. Her last menstrual period was three weeks ago, she had a tubal ligation ten years ago and she states she has several small fibroid tumors. Which of the following is the most likely diagnosis for this patient? A) Ectopic pregnancy B) Pelvic inflammatory disease C) Mittelschmerz D) Ruptured ovarian cyst 26) Endometritis is a complication LEAST likely to be associated with: A) ectopic pregnancy. B) elective abortion. C) childbirth. D) spontaneous abortion. 27) Your patient is a 20-year-old female victim of a sexual assault. Her roommate came home to their dorm room to find the patient curled up in bed crying, stating that she had just been raped “5 minutes ago.” Physical examination reveals no trauma or any other abnormal findings. HR = 100, BP = 130/78, RR = 20, SpO2 = 99%. The patient agrees to be transported to the ED, but would like to change her clothes and use the bathroom before she leaves. Which of the following is the most appropriate course of action? A) Ask that the patient place her clothing in a paper bag. B) Advise the patient that using the toilet, changing her clothing, brushing her hair and teeth, or washing any part of her body will destroy evidence. C) Allow the patient to do as she wishes to avoid subjecting her to additional emotional trauma. D) Ask that the patient place each article of clothing in a separate plastic bag. 28) The term used to describe how many times a women has been pregnant is: A) parity. B) gravida. C) menarche. D) para. 29) Which of the following is TRUE of the Fallopian tubes? A) This is the normal site of implantation of the blastocyst. B) This is the normal site of fertilization of the ovum. C) They secrete follicle-stimulating hormone and luteinizing hormone. D) They are strong suspensory ligaments that hold the uterus in place. 30) Which of the following is TRUE of mittelschmerz? A) It is typically located unilaterally in one of the upper abdominal quadrants. B) It is usually accompanied by heavy vaginal bleeding. C) It is associated with ovulation. D) It is a sign of ectopic pregnancy. 31) Your patient is a 36-year-old female who is alert and complaining of abdominal pain. She states that she is having her period and that this pain is “much different than the cramps I usually get.” She describes the pain as achy throughout her pelvis and lower abdomen. She says that this has occurred the past three menstrual cycles and that she has experienced dyspareunia and spotting over the same period. She is G2P2 and has no other significant gynecologic history. Physical examination reveals pain with palpation over her entire abdomen; her skin is warm and dry. HR = 84, BP = 124/76, RR = 12, SpO2 = 99%. Which of the following is the most likely diagnosis for this patient? A) Uterine fibroids B) Endometriosis C) Primary dysmenorrhea D) Polycystic ovary disease 32) Which of the following best explains why the use of an intrauterine device (IUD) increases the risk of developing pelvic inflammatory disease? A) The absorbent cotton string of the IUD acts as a wick for bacteria to enter the uterus. B) The use of a copper IUD weakens the user’s immune system. C) Women with an IUD are more likely than other women to have multiple sexual partners. D) An IUD may cause irritation of the endometrium, allowing microorganisms to invade the uterine wall. 33) Which of the following is NOT appropriate in the care of a victim of a sexual assault? A) Approach the patient calmly, in a professional manner. B) Touch the patient’s shoulder or pat her on the leg often to reassure her. C) Explain all procedures and ask for permission before beginning them. D) Be especially attentive to the victim’s modesty. 34) Cyclical bleeding occurs with endometriosis because the ectopic endometrial tissue responds to: A) increased FSH and LH levels. B) decreased estrogen and progesterone levels. C) decreased FSH and LH levels.

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