Family Nurse Practitioner Exam

What is the next step in management for a sexually active 20-year-old with abnormal Pap smear results indicating inflammation?

1. The NP needs to do cervical cultures to verify gonorrhea

2. Prescribe metronidazole vaginal cream for the patient over the phone

3. Call the patient and tell her she needs a repeat Pap smear in 6 months

4. Advise her to use a Betadine douche at bedtime x 3 days

The correct answer is: The NP needs to do cervical cultures to verify gonorrhea

The appropriate next step in management for a sexually active 20-year-old with an abnormal Pap smear indicating inflammation is to conduct cervical cultures to verify gonorrhea. Inflammation indicated by an abnormal Pap smear can often be due to infections such as sexually transmitted infections (STIs) like gonorrhea or chlamydia. Since these infections are common in sexually active young women, obtaining culture samples allows the clinician to identify the presence of these pathogens and guide appropriate treatment. This step is critical to ensure that if an STI is present, it can be promptly treated to prevent complications, such as pelvic inflammatory disease or infertility. Cervical cultures are an essential part of the evaluation process following abnormal Pap results, especially when inflammation suggests a potential infectious cause. This approach also helps to clarify the etiology of the inflammation beyond just the Pap test results. Managing the situation with just a repeat Pap smear in six months or prescribing treatment without verifying the infection does not adequately address the immediate concern regarding potential STIs, which could complicate the patient's health. Using douches, especially with Betadine, is not recommended as it can disrupt the normal vaginal flora and not address any underlying infectious issues.