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FNP Family Nurse Practitioner Exam Prep

Category - Women's Health Nurse Practitioner

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A 37-year-old female comes to see you and reports severe labial pain. She tells you the pain began a few days ago and has worsened steadily.

On exam, vital signs show blood pressure 120/75, pulse 75, temperature 98.6, respiratory rate 20, and oxygen saturation of 99% on room air. The patient appears well. Examination of the labia reveals a 3 cm fluctuant mass on the right side.

What is the best next step in management?

  1. Administer cephalexin plus metronidazole and discharge with return precautions
  2. Placement of a Word catheter and discharge with return precautions
  3. Administer ceftriaxone, metronidazole and azithromycin and discharge with return precautions
  4. Ultrasound of the mass
  5. Culture, administer vancomycin IV, and admit to hospital
Explanation
Answer: B - This patient presents with symptoms of a Bartholin gland abscess, namely a painful fluctuant mass on the labia. In patients who present with signs and symptoms consistent with a Bartholin gland abscess, incision and drainage and placement of a Word catheter is recommended.

Treatment with antibiotics alone is not sufficient; the abscess must be incised and drained. Ultrasound has no diagnostic utility in this context. Admission to the hospital and IV vancomycin are reserved for severe soft tissue infections.
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