Women's Health Care Nurse Practitioner Examination – Rationale Samples

Question

A 69 year old woman weighing 240 pounds reports a burning sensation in her feet especially at night and numbness and difficulty in walking. The nurse practitioner should refer her for

  • Doppler ultrasound
  • glucose screening
  • nerve conduction studies

Rationale

This patient's age, weight and symptoms are consistent with Type II diabetes. Her neuropathy is probably due to the fact that she has had undiagnosed diabetes for some time. While the other tests may have merit, the first evaluation should be glucose screening.

Question

A woman presents with a cold abscess type lesion of the skin with a necrotic center and obliteration of small vessels. She had been treated for syphilis several years ago but never continued with follow up therapy. The nurse practitioner should recognize that the presenting symptom is consistent with

  • reinfection of primary syphilis
  • tertiary syphilis
  • treatment failure

Rationale

The manifestation that the patient presented with is consistent with tertiary syphilis. This can be a devastating disease affecting the central nervous system and musculoskeletal system. A gumma similar to a cold abscess with a necrotic center and obliteration of small vessels is a common symptom of tertiary syphilis. Other effects include optic atrophy, tabes dorsalis, generalized paresis and aortic aneurysm. This is not a sign of reinfection of primary syphilis because the patient never went through follow up. The treatment was probably incomplete to treat the earlier stages of the disease and disease progressed.