A nurse is examining a 35-year-old female patient. During the health history, the nurse notices that she has had two term pregnancies, and both babies were delivered vaginally. During the internal examination, the nurse observes that the cervical os is a horizontal slit with some healed lacerations and that the cervix has some nabothian cysts that are small, smooth, and yellow. In addition, the nurse notices that the cervical surface is granular and red, especially around the os. Finally, the nurse notices the presence of stringy, opaque, odorless secretions. Which of these findings are abnormal?

Correct Answer: C

Rationale: The correct answer is C: The cervical surface is granular and red. This finding indicates inflammation or infection, as a healthy cervix should appear smooth and pink. The presence of granular and red surface could suggest cervicitis or another underlying issue that needs further evaluation or treatment. A: Nabothian cysts are present - This is a normal finding and does not indicate any abnormality or concern. B: The cervical os is a horizontal slit - This is a normal anatomical variation and does not indicate any abnormality. D: Stringy, opaque secretions are present - This can be a normal finding depending on the phase of the menstrual cycle and does not necessarily indicate an abnormality.

Correct Answer: B

Rationale: The correct answer is B: Severe nausea and vomiting. In an ectopic pregnancy, the fertilized egg implants outside the uterus, commonly in the fallopian tube. As the pregnancy progresses, the tube can rupture, leading to severe internal bleeding. This bleeding can irritate the abdominal lining, causing nausea and vomiting. Severe pain on one side of the lower abdomen (choice A) is also common but not the most common symptom. Pain with urination or bowel movements (choice C) and frequent urination (choice D) are not typical symptoms of ectopic pregnancy.

Correct Answer: B

Rationale: The correct answer is B: Refer the patient to a gynecologist for further evaluation. Given the characteristics of the mass (hard, irregular, fixed), it raises concerns for possible malignancy. Referring the patient to a gynecologist allows for a specialist to conduct a thorough evaluation, which may include additional imaging studies and biopsies to determine the nature of the mass. Monitoring the mass (choice A) without further evaluation may delay potential diagnosis and treatment. Obtaining a biopsy (choice C) without proper evaluation by a specialist may not be appropriate at this stage. Performing a pelvic ultrasound (choice D) can provide additional information but may not be sufficient for a definitive diagnosis of malignancy.

Correct Answer: C

Rationale: The correct answer is C: Trichomoniasis. A Pap smear can detect abnormal changes in the cervix caused by Trichomoniasis, which is a common STI. The test can identify the presence of the parasite Trichomonas vaginalis. The other choices, A: Chlamydia, B: Gonorrhea, and D: HPV, cannot be detected through a Pap smear as they require specific tests such as urine tests, swab tests, or blood tests. Chlamydia and Gonorrhea are bacterial infections, while HPV is a viral infection that can lead to cervical cancer but is not detectable through a Pap smear alone.

Correct Answer: C

Rationale: The glomeruli and Bowman's capsules are found in the renal cortex. The renal cortex is the outer layer of the kidney where the initial stages of urine formation occur. Glomeruli are clusters of capillaries responsible for filtering blood, while Bowman's capsules surround the glomeruli and collect the filtrate. The renal pelvis (A) is the innermost part of the kidney where urine collects before entering the ureter (B). Renal columns (D) are extensions of the renal cortex that project into the renal medulla. Therefore, the correct answer is C as it accurately locates the structures involved in urine filtration.