09-17-2010, 09:22 PM
9. A 16-year-old girl comes to the clinic because of a 2-week history of nausea and vomiting in
the morning before schooI. The nausea comes on as soon as she wakes up, and is
generally relieved after she "throws her guts up." She attends school and is able to function
at her evening job as a pharmacy clerk. She denies any weight loss. She is sexually active
with "many," different partners and does not use any form of contraception. She also admits
to injection drug use. She is unsure of the exact date of her last menstrual period, but thinks
that it was about 3-4 weeks ago. Her chart indicates that she has received the following
vaccinations: IPV, MMR, and DaPT. Her blood pressure is 120/80 mm Hg and pulse is
65/min. Physical examination is normaI. A pregnancy test is positive. You tell her that she is
pregnant and she tells you that she is going to keep the baby and has no plans to decrease
her sexual activity or drug use. She agrees to undergo HIV testing in addition to routine
tests. Laboratory studies show:
VDRL -ve
HbsAg -ve
Anti-HBs -ve
HIV -ve
A. admit her to the hospital for the treatment of hyperemesis gravidarum
B. advise her to use oral contraception pills to prevent future pregnancies
C. have her write a statement about her plans to continue unsafe sexual activity and drug
use and place it in her chart
D. recommend the hepatitis B vaccine
E. tell her that she must discontinue her drug use if you are going to continue to treat her
the morning before schooI. The nausea comes on as soon as she wakes up, and is
generally relieved after she "throws her guts up." She attends school and is able to function
at her evening job as a pharmacy clerk. She denies any weight loss. She is sexually active
with "many," different partners and does not use any form of contraception. She also admits
to injection drug use. She is unsure of the exact date of her last menstrual period, but thinks
that it was about 3-4 weeks ago. Her chart indicates that she has received the following
vaccinations: IPV, MMR, and DaPT. Her blood pressure is 120/80 mm Hg and pulse is
65/min. Physical examination is normaI. A pregnancy test is positive. You tell her that she is
pregnant and she tells you that she is going to keep the baby and has no plans to decrease
her sexual activity or drug use. She agrees to undergo HIV testing in addition to routine
tests. Laboratory studies show:
VDRL -ve
HbsAg -ve
Anti-HBs -ve
HIV -ve
A. admit her to the hospital for the treatment of hyperemesis gravidarum
B. advise her to use oral contraception pills to prevent future pregnancies
C. have her write a statement about her plans to continue unsafe sexual activity and drug
use and place it in her chart
D. recommend the hepatitis B vaccine
E. tell her that she must discontinue her drug use if you are going to continue to treat her