FNP Family Nurse Practitioner Exam Prep

Category - Women's Health Nurse Practitioner

You are working at the local urgent care. A 32-year-old woman complains of abdominal pain and vaginal bleeding. The patient states the symptoms began several days ago and have rapidly worsened. The patient describes the bleeding as light spotting and reports that she has missed her usual menstrual period this month.

On exam, vital signs show blood pressure 110/70, pulse 65, temperature 98.6, respiratory rate 20, and oxygen saturation of 99% on room air. Blood is present in the vaginal vault, and cervical motion tenderness is present. Upon examination, the cervix has a blue coloration.

What is the best next step in management?

  1. Prescribe NSAIDs
  2. Quantitative serum beta hCG level
  3. Ultrasound of the abdomen and pelvis
  4. Admission and gynecologic surgery consult for emergent exploratory laparoscopy
  5. Dilatation and curettage
  6. Bedside urine pregnancy test (beta hCG)
Explanation

Answer: E - This female patient presents with classic symptoms of unruptured ectopic pregnancy, namely abdominal pain, vaginal bleeding or spotting in a woman with previous amenorrhea, cervical motion tenderness with blood present in the vaginal vault, and blue coloration to the cervix as in a normal pregnancy. For the presentation of classic clinical symptoms of unruptured ectopic pregnancy, the initial diagnostic test is a simple bedside urine pregnancy test.

If negative and clinical symptoms still suggest ectopic pregnancy, a quantitative serum beta bCG is obtained. If confirmed, then an ultrasound is performed to rule out intrauterine pregnancy and possibly locate ectopic pregnancy as well. If ultrasound cannot locate the ectopic pregnancy, a gynecologic surgery consult is recommended for exploratory laparoscopy. Dilatation and curettage are indicated to ascertain if intrauterine pregnancy exists and to terminate it if present.

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