Chapter 24 Workbook

Question 1

Folds of tissue that surround the urethral and vaginal openings

Answer 1

Labia

Question 2

The narrowest portion of the uterus; opens to the vagina

Answer 2

Cervix

Question 3

A disease causing lower abdominal and back pain, nausea, fever, pain during intercourse, and/or bleeding between menstrual cycles

Answer 3

Pelvic inflammatory disease (PID)

Question 4

The area of skin between the vagina and the anus

Answer 4

Perineum

Question 5

Connect(s) each ovary with the uterus

Answer 5

Fallopian tubes

Question 6

The primary female reproductive organ(s), produce(s) an ovum, or an egg

Answer 6

Ovaries

Question 7

The outermost cavity of a woman’s reproductive system; forms the lower part of the birth canal

Answer 7

Vagina

Question 8

A condition in which bacteria can grow and multiply rapidly in the reproductive tract, mouth, throat, eyes, and anus

Answer 8

Gonorrhea

Question 9

A condition in which normal bacteria is replaced by an overgrowth of other bacterial forms

Answer 9

Bacterial vaginosis

Question 10

A muscular organ where the fetus grows

Answer 10

Uterus

Question 11

Infection of the uterus, ovaries, and fallopian tubes

Answer 11

Chlamydia

Question 12

Possible causes of vaginal bleeding include all of the following EXCEPT:
A. ectopic pregnancy
B. cervical polyps
C. vaginal trauma
D. peptic ulcer

Answer 12

A. ectopic pregnancy

Question 13

Painful urination associated with burning and a yellowish discharge is associated with:
A. chlamydia
B. gonorrhea
C. endometriosis
D. syphilis

Answer 13

B. gonorrhea

Question 14

Which of the following statements is FALSE regarding the assessment and treatment of a woman who was the victim of sexual assault?
A. You may be called to testify in court regarding the incident.
B. You should question the victim thoroughly about the assaulter in case the police missed any details.
C. The patient should be given the option of being treated by a female responder.
D. The patient should be discouraged from urinating or changing her clothes prior to examination at the hospital.

Answer 14

B. You should question the victim thoroughly about the assaulter in case the police missed any details.

Question 15

The onset of menstruation usually occurs between the ages of:
A. 8 and 10 years
B. 11 and 16 years
C. 16 and 18 years
D. 17 and 20 years

Answer 15

B. 11 and 16 years

Question 16

What is the most common presenting sign or symptom of PID?
A. Vaginal discharge
B. Fever
C. Nausea and vomiting
D. Lower abdominal pain

Answer 16

D. Lower abdominal pain

Question 17

In rare cases, ________ causes arthritis that may be accompanied by skin lesions and inflammation of the eyes and urethra.
A. chlamydia
B. gonorrhea
C. PID
D. vaginal bleeding

Answer 17

A. chlamydia

Question 18

Left untreated, ________ can lead to premature birth or low birth weight in pregnant women.
A. chlamydia
B. gonorrhea
C. bacterial vaginosis
D. vaginal bleeding

Answer 18

C. bacterial vaginosis

Question 19

If a patient with vaginal bleeding presents with a rapid pulse and pale or cool skin, you should:
A. attempt to locate the source of bleeding and correct it
B. place the patient in a supine position
C. consider this to be a normal sign in a menstruating woman
D. inquire about recent problems with urination

Answer 19

B. place the patient in a supine position

Question 20

When taking a history on a patient experiencing a gynecologic emergency, you should consider asking all of the following EXCEPT:
A. Are you taking birth control?
B. When was your last menstrual period?
C. How many sexual partners have you had in the past?
D. Do you have any history of sexually transmitted diseases?

Answer 20

C. How many sexual partners have you had in the past?

Question 21

A shuffling gait with diffuse lower abdominal pain may indicate which of the following conditions?
A. Pelvic inflammatory disease
B. Bacterial vaginosis
C. Chlamydia
D. Gonorrhea

Answer 21

A. Pelvic inflammatory disease

Question 22

EMTs treating a victim of a sexual assault may not only be dealing with medical issues but with ________ issues as well.
A. psychological
B. physiological
C. educational
D. sociological

Answer 22

A. psychological

Question 23

When performing a physical exam on a victim of sexual assault, you should:
A. always expose and evaluate the patient’s vaginal area
B. allow multiple people to observe the examination in case you have to testify
C. limit your examination to a brief survey for life-threatening injuries
D. place the patient’s clothes into a plastic evidence bag

Answer 23

C. limit your examination to a brief survey for life-threatening injuries

Question 24

Rape is considered to be a ______ diagnosis, not a medical diagnosis.
A. psychological
B. surgical
C. sociological
D. legal

Answer 24

D. legal

Question 25

Often the most important intervention for a sexual assault patient is ______ and transport to a facility with a staff specially trained to deal with this scenario. A. comforting reassurance B. excellent assessment skills C. bandaging skills D. promising legal justice

Answer 25

A. comforting reassurance

Question 26

Your ______ is the best tool to gain the patient’s confidence to seek medical help. A. confidence B. content knowledge C. compassion D. empathy

Answer 26

C. compassion

Question 27

You are called to the scene of a possible assault. On arrival, you are directed by police to a dark room, where you find a 22-year-old woman who says she was sexually assaulted by a coworker this afternoon. Your first course of action should be to: A. determine whether the patient is physically injured B. establish the exact events of what took place C. allow the patient to use the restroom D. let the police question the patient before conducting a primary assessment

Answer 27

A. determine whether the patient is physically injured

Question 28

You are called to the scene of a possible assault. On arrival, you are directed by police to a dark room, where you find a 22-year-old woman who says she was sexually assaulted by a coworker this afternoon. The second course of action involves the psychological care of the patient. You should avoid: A. making attempts to get a female EMT to examine the patient B. examination of the vaginal canal, even if active bleeding is taking place C. attempting to gather information to assist the police D. granting the patient’s wishes for refusing care and transport

Answer 28

C. attempting to gather information to assist the police

Question 29

You are called to the scene of a possible assault. On arrival, you are directed by police to a dark room, where you find a 22-year-old woman who says she was sexually assaulted by a coworker this afternoon. The patient tells you that she would really like to be transported to the hospital but refuses a physical examination. You should: A. explain to her that she cannot be transported without a physical exam B. have the police take the patient into custody in order to legally force a physical exam C. explain to her that this is a criminal case and that she must be examined D. follow your system’s policy and respect the patient’s wishes without judgment

Answer 29

D. follow your system’s policy and respect the patient’s wishes without judgment

Question 30

True/False Chlamydial infection of the cervix can spread to the rectum, leading to rectal pain, discharge, or bleeding.

Answer 30

True

Question 31

True/False If gonorrhea is not treated, the bacteria may enter the bloodstream and spread to other parts of the body, including the brain.

Answer 31

True

Question 32

True/False Because menstrual bleeding is a monthly occurrence, it is not necessary to assess for other causes of vaginal bleeding.

Answer 32

False

Question 33

True/False Obtaining an accurate and detailed patient assessment is critical when dealing with gynecologic issues.

Answer 33

True

Question 34

True/False Most cases of gynecologic emergencies are not life threatening.

Answer 34

True

Question 35

True/False Gynecologic emergencies are typically not embarrassing for women.

Answer 35

False

Question 36

True/False When taking a history of a woman with a gynecologic complaint, you should inquire about the possibility of pregnancy and exposure to sexually transmitted diseases.

Answer 36

True

Question 37

True/False Most presentations of tachycardia and hypotension are related to anxiety.

Answer 37

False

Question 38

True/False Any report of syncope in a woman complaining of vaginal bleeding is considered significant.

Answer 38

True

Question 39

True/False It is acceptable to place dressings into the vaginal canal to stop significant bleeding.

Answer 39

False

Question 40

True/False When examining a female, you should limit the number of people involved.

Answer 40

True

Question 41

True/False Gynecologic emergencies can occur at any age during a woman’s lifetime.

Answer 41

True

Question 42

True/False Injuries to the external genitals are typically not painful due to the very sparse nerve supply.

Answer 42

False

Question 43

True/False When completing documentation of a sexual assault incident, adding your personal thoughts can help with the investigation.

Answer 43

False

Question 44

True/False Determining the cause of vaginal bleeding should be of less importance than treating for shock and transporting the patient to an appropriate facility.

Answer 44

True

Question 45

The __________ are located on each side of the lower abdomen and produce the ovum, or egg.

Answer 45

ovaries

Question 46

When a female reaches __________, she begins to ovulate and experience menstruation.

Answer 46

puberty

Question 47

__________ __________ __________ is an infection of the upper female reproductive organs.

Answer 47

Pelvic inflammatory disease

Question 48

__________ __________ can be very messy, sometimes involving large amounts of blood and bodily fluids.

Answer 48

Gynecologic emergencies

Question 49

__________ __________ and __________ __________ are two conditions that can cause vaginal bleeding in women who do not appear to be pregnant and who may not realize they are pregnant.

Answer 49

Ectopic pregnancy, spontaneous abortion

Question 50

Make sure to use __________ __________ when attempting to control vaginal bleeding.

Answer 50

external pads

Question 51

__________ __________ can cause significant blood loss and lead to hypovolemia.

Answer 51

Vaginal bleeding

Question 52

You will need to work together with __________ __________ when dealing with a victim of sexual assault.

Answer 52

law enforcement

Question 53

Symptoms of __________ appear approximately 2 to 10 days after exposure.

Answer 53

gonorrhea

Question 54

Women will continue to experience menstruation until they reach __________.

Answer 54

menopause

Question 55

Answer 55

Female Reproductive System A. Uterine (fallopian) tube B. Uterus C. Ovary D. Cervix E. Vagina

Question 56

Answer 56

External Genitalia A. Labia minora B. Labia majora C. Urethra D. Vaginal orifice E. Perineum F. Anus

Question 57

Short Answer When performing your scene size-up, what questions should you ask yourself when dealing with a gynecologic emergency?

Answer 57

Where or in what position is the patient found? What is the condition of the residence? Clean, filthy, or wrecked? Is there evidence of a fight? Are alcohol, tobacco products, or drug paraphernalia present? Are there pictures of loved ones? Is there a noticeable absence of pictures? Does the patient live alone or with other people?

Question 58

Short Answer List at least five signs and symptoms commonly found with a gonorrhea infection.

Answer 58

1. Painful urination 2. Burning or itching 3. Yellowish or bloody discharge associated with a foul odor 4. Blood associated with vaginal intercourse 5. Cramping and abdominal pain 6. Nausea and vomiting 7. Bleeding between menstrual periods

Question 59

Short Answer Explain the general treatment strategies for vaginal bleeding.

Answer 59

Use external pads to control bleeding. Keep the patient warm, place her in a supine position, and provide her with supplemental oxygen, even if she is not experiencing any difficulty breathing. Provide prompt transport to the hospital, and reassess her vital signs every 5 minutes.

Question 60

Ambulance Calls The following case scenarios provide an opportunity to explore the concerns associated with patient management and to enhance critical-thinking skills. Read each scenario and answer each question to the best of your ability. You are dispatched to a local college campus for a 21-year-old woman with abdominal pain. The dispatcher tells you that the patient has lower abdominal pain, fever, nausea, and vomiting. When you arrive on the campus, you are directed by campus police to the health center. There you find your patient lying supine on a bed. The patient tells you that she has had lower abdominal pain and a fever for the past 24 hours. She describes the pain as “achy” and says it gets worse with walking. She believes she has a “stomach virus” due to the fever and vomiting. Your partner obtains vital signs as you continue with your assessment. After finishing your SAMPLE history, you casually ask if she has had any other recent illnesses or if she has any other complaints. The patient says, “Well, since you mentioned it, I’ve been having some rather foul vaginal discharge lately. But I just thought it would go away.” The patient denies pregnancy because she just finished her menstrual period last week. What is the likely cause of this patient’s condition, and how is it treated?

Answer 60

The patient is most likely suffering from pelvic inflammatory disease (PID). A patient with PID will complain of abdominal pain. The pain is typically described as “achy” and can be worse with walking. Other symptoms include vaginal discharge, fever and chills, and pain or burning on urination. Prehospital treatment is limited to supportive care, and nonemergency transport is usually recommended. Place the patient in a position of comfort and monitor vital signs. Consider oxygen (if appropriate). Keep in mind that although this condition is typically not an emergency, these patients require monitoring for any signs of deterioration.

Question 61

Ambulance Calls You are dispatched to an apartment complex at 538 N. 10th Street, Apartment 4-C, for an assault. You look at your watch and note the time as 2101. On the way to the unit, your partner remarks, “Six hundred and eighty-ninth call for the year so far. No doubt we’ll hit 700 before the end of the night.” You make note of this incident number at 011689 and mark responding 2 minutes after dispatch. The additional information states this is for a 32-year-old woman who was sexually assaulted. You arrive on scene 8 minutes after the initial dispatch and notice the apartment is very well kept and is not cluttered. The police lead you to the back bedroom, where you find your patient sitting up on the side of the bed, speaking to the investigator. The patient appears alert, and you notice bleeding from the nose along with bruises to the patient’s face. The patient tells you that she was raped by a maintenance worker at the apartment complex. She complains of pain to the nose, face, and groin. The patient says she is not sure whether she wants to go to the hospital, but she definitely wants to take a shower and change her clothes. Explain the key issues to consider when treating a victim of sexual assault.

Answer 61

The first issue is the medical treatment of the patient. You should assess and treat life threats and inquire about pain. The second issue focuses on the psychological care of the patient. Many women report feeling violated when subjected to interrogation, so do not cross-examine the patient or pass judgment on her during the assessment. Take the patient’s history, and limit any physical examination to a brief survey for life-threatening injuries. Keep in mind that this patient has been through a traumatic experience, and your compassion for her will help to gain the patient’s confidence. Limit the number of people involved in the assessment/examination process to protect the patient’s privacy and dignity. Remember that you are at a crime scene. Do not cut through any clothing or throw away anything from the scene. Place bloodstained articles in a separate paper bag. You should gently persuade the patient to refrain from cleaning herself, urinating, changing clothes, moving her bowels, or rinsing her mouth because this could potentially destroy evidence. When documenting this incident, keep the report concise and record only what the patient stated in her own words. Use quotation marks to indicate that you are reporting the patient’s version of the events. Refrain from inserting your own opinion into the documentation. Record all of your observations during the physical exam, including the patient’s emotional state, the condition of her clothing, obvious injuries, and so forth.