A female patient presents with grayish, odorous vaginal ...

[Engineer]

A female patient presents with grayish, odorous vaginal discharge. The primary care NP performs a gynecologic examination and notes vulvar and vaginal erythema. Testing of the discharge reveals a pH of 5.
 
  2 and a fishy odor when mixed with a solution of 10 potassium hydroxide. The NP should: a. order topical fluconazole.
  b. order metronidazole 500 mg twice daily for 7 days.
  c. withhold treatment until culture results are available.
  d. prescribe a clotrimazole vaginal suppository for 7 days.

Question 2

A patient takes rizatriptan (Maxalt) to abort migraine headaches but tells the primary care NP that the headaches have become more frequent since a promotion at work. The NP's initial response should be to:
 
  a. prescribe topiramate (Topamax).
  b. stress the importance of establishing new routines.
  c. help the patient identify stressors associated with the new role.
  d. add a combination NSAID, aspirin, and caffeine product to the regimen.

[Meganchabluk]

Answer to Question 1

B
This patient has classic symptoms of bacterial vaginosis. The treatment of choice is metronidazole. Fluconazole is used to treat fungal infections. Cultures are generally not helpful in the diagnosis of bacterial vaginosis. Clotrimazole is used to treat Candida infections.

Answer to Question 2

B
Prevention or reduction of episodes of migraine requires healthy regular daily habits. Regularity of habits, rather than just searching for triggers, is essential for enhancing the effectiveness of nonpharmacologic approaches. If the increase in migraine episodes remains chronic after nonpharmacologic measures are taken, topiramate may be used.