Download NR 602 Final Exam Study Guide with Q & A (New, 2024) : Chamberlain College of Nursing and more Exercises Nursing in PDF only on Docsity!
NR 602 Final Exam Study Guide
(With Q & Answers)
1.Which one best describes lesions associated with condyloma acuminatum?
a. Verruciform
b. Plaque-like
c. Vesicular
d. Bullous
2. 39yo female has completed course of amox for strep throat. LMP was 2wks ago, says it was
normal. On exam, there's erythema of extern. genitalia w/small amount of white discharge. Micro wet prep reveals few clue cells, but many budding hyphae. No WBCs. Which one would be the most appropriate treatment? a. Metronidazole 500mg BID x7 days b. OTC hydrocortisone 1% cream TID c. Fluconazole tabs 150mg x1 dose d. Erythromycin 500mg TID x10 days
c
3 .Which one best describes lesions associated with condyloma acuminatum?
a. Verruciform
b. Plaque-like c. Vesicular d. Bullous a
4. 39yo female has completed course of amox for strep throat. LMP was 2wks ago, says it was
normal. On exam, there's erythema of extern. genitalia w/small amount of white discharge. Micro wet prep reveals few clue cells, but many budding hyphae. No WBCs. Which one would be the most appropriate treatment? a. Metronidazole 500mg BID x7 days b. OTC hydrocortisone 1% cream TID c. Fluconazole tabs 150mg x1 dose d. Erythromycin 500mg TID x10 days c
5 .Woman c/o vaginal itching, white discharge. She is in good health except for recent abx for
strep throat. Pelvic reveals tender vulvovaginal area w/edema and nonmalodorous white patches. Which is the most likely cause? a. Bacterial vaginosis b. Trichomonas c. Lactobacillus overgrowth d. Candidiasis d
9. 25yo female c/o vaginal irritation and discharge. On exam, cervix is easily friable and
erythematous. No adnexal tenderness. Wet prep reveals mobile protozoa on NS slide. This most likely represents: a. Trichomonas b. Mucopurulent cervicitis c. Bacterial vaginosis d. Gonorrhea a
10 .16yo female has h/o secondary amenorrhea. Menarche at 10yo, regular cycles x2yrs, has not
menstruated x4yrs. What is most frequent etiology of this problem? a. Eating disorder b. Pregnancy c. Anovulatory cycles d. Stress a
11 .Woman is experiencing vaginal discharge. Wet mount with KOH would be used to confirm:
a. Herpes simplex b. Gonorrhea c. Candidiasis d. Chlamydia
c Treatment options for condyloma acuminatum include: a. Imiquimod (Aldera) b. Azithromycin c. Acyclovir d. Metronidazole a 25yo postmenopausal female c/o pain in upper outer quadrant of L breast x1mo. Best course of action would be: a. Reassure pt that pain is often not presenting symptom of breast cancer. b. Teach pt breast self-exam. c. Order labs as most likely this is secondary to hormonal fluctuation d. Perform breast exam and order mammo d PID typically presents with all of the following except: a. Dysuria b. Leukopenia c. Cervical motion tenderness d. Abd pain b
a 22yo female c/o pelvic pain. Exam reveals cervical motion and uterine tenderness. Which supports PID dx? a. Temp <100F b. Absence of WBCs in vag fluid c. Mucopurulent vag discharge d. Lab documentation of cervical infection w/E. coli c When educating pt about rationale for getting mammo, which statement is false? a. Mammo is cost-effective method to screen for breast cancer b. Mammo detects all breast cancers c. Mammo should be accompanied by breast exam d. Negative mammo should not delay biopsy of clinically suspicious mass b When educating women about breast cancer risk factors, which statement is incorrect? a. Pregnancy after 35yo b. Late menopause after 57yo c. Fibrocystic breast dz d. H/o maternal breast cancer c
Which of the following statements is accurate regarding the usefulness of mammo in screening and detection of breast cancer? a. Mammo shouldn't be done if there is any breast pain or nipple retraction b. All women >40yo should have mammo on annual basis c. Mammo should be done annually for all women of child-bearing age d. Mammos should be performed annually after initial pregnancy, especially if women doesn't breastfeed b Which would be considered normal surface characteristic of the cervix during a speculum exam? a. Small, yellow, raised around area on cervix b. Friable, bleeding tissue opening of the cervical os c. Red patch areas w/occasional white spots d. Irregular, granular surface w/red patches a What is the most common cause of dysfunctional uterine bleeding? a. Endocrine disorders b. Stress c. Anovulation d. Anatomical abnormality c
PMS?
a. Severity of symptoms b. Occurrence of symptoms in menstrual cycle c. Frequency and number of symptoms over past 4mo b 35yo woman c/o 6mo h/o hypermenorrhea, backache, pelvic pressure. On exam, you discover 12wk size uterus w/irregular contour. What does this represent? a. Uterine cancer b. Dysfunctional uterine bleeding c. Uterine fibroid d. Fecal impaction c Female c/o vaginal itching and white discharge. Denies sexual activity or douching. In good health except for recurrent strep throat. Pelvic reveals tender vulvovag area w/edema and white patches. No odor. What is the most likely cause? a. Bacterial vaginosis b. DM c. Allergy to personal hygiene product d. Candidiasis after abx treatment d
32yo woman c/o postcoital bleeding. Which would not be included in the initial assessment? a. Pap smear b. Uterine biopsy c. Pelvic ultrasound d. CBC w/diff b What phase of menstrual cycle begins with menses cessation and ends w/ovulation? a. Ovulatory phase b. Follicular phase c. Proliferative phase d. Luteal phase b What phase of menstrual cycle begins with ovulation and ends w/menstruation? a. Ovulatory phase b. Follicular phase c. Proliferative phase d. Luteal phase c Name 4 structural abnormalities that are causes of dysfunctional uterine bleeding.
Anovulation Hormone replacement anovulation Obesity Nulliparity
35yo DM Personal/fam h/o coagulation disorder Liver disorder Anticoagulant therapy/chemo What are some subjective findings for DUB? Heavy bleeding Bleeding >7 days Cycles closer than 21 days Pain Post-coital bleeding Passing clots/tissue Dizziness Hot flashes Temp intolerance Uterine/cervical tenderness What are some objective findings for DUB? Excessive bleeding on exam Hypotension
Tachycardia Diaphoresis Vag atrophy Mass Trauma Enlarged uterus/adnexa Hirsutism Thyromegaly Bruising Galactorrhea What are some diff dx's for DUB? PALM-COEIN Traumatic injury Pregnancy-related bleeding (ectopic, SAB, placenta previa/abruptio) What are some diagnostic lab studies for DUB? -*Serum hCG: always do first before examining pt of menstruating age w/vag bleeding -CBC -ABO/Rh if preg. suspected/severe bleeding -STD tests/wet prep -Cervical cytology -CMP (w/renal & liver panel) -Coags -If hx indicates: screen for bleeding disorders for DUB at menarche.
-Endometrial ablation -Hysterectomy -Traumatic repair What are some pharm options for DUB? -NSAIDs (cyclic DUB) -Antifibrinolytics (cyclic DUB) -Combined OCP, medroxyprogesterone acetate, levonorgestrel-releasing intrauterine systems (effective if agreeable to contraceptive effects) -Danazol/GnRH agonists (reduce DUB if med/surg treatments fail/contraindicated -Abx if infection/STD -Intravag estrogen for vag atrophy Which meds for DUB are contraindicated in pregnancy? -Ethinyl Estradiol (Estinyl): estrogen; risk of VTE; use w/progesterone if pt hasn't had hysterectomy. -Medroxyprogesterone Acetate (Provera): progesterone; risk of VTE; caution w/CVA, CA risk -Levonorgestrel-releasing intrauterine system (Mirena): combined hormone; risk of infection/migration; bleeding/cramping may occur x1-3mo -Danazol (Danocrine): androgen; risk of acne/wt gain/hirsutism; short-term use for refractory DUB Which meds for DUB are pregnancy cat C? -ibuprofen (Motrin), naprosyn (Aleve): NSAID; risk of gastric upset/ulcer; don't use w/other NSAIDs Which med for DUB is preg cat B?
Tranexamic acid (Lysteda): antifibrinolytic; risk of VTE; don't use w/hormones (risk of CVA/VTE) What are some consultation/referral recommendations for DUB? -Severity of acute DUB may warrant admission/consultation w/gyn -Hematology: coagulopathies -Endocrine: thyroid, hyperprolactinemia, PCOS findings -Surg/Gyn: polyps, adenomyosis, leiomyoma What are the follow up recommendations for DUB? -Depends on type, severity, course of treatment -Acute: 1-2wks to assess anemia prn -Combined OCPs require at least 21-day course to eval efficacy, though improvement seen by ~80% in 3 days What is the expected course of acute DUB? Once bleeding stabilized: transition to maintenance therapy prn What is expected course of chronic DUB? Treatment should progress until DUB controlled; may required more testing, dosage adjustments, referral for treatment options What are possible complications of DUB? -Anemia -Break through bleeding -VTE -Uterine artery embolization/polypectomy: maybe issues w/infertility -Premature ovarian failure secondary to hysterectomy
-Strenuous exercise -Substantial changes in sleep/eating habits -Severe stressors Most cycles range from ___________. 21-34 days When is woman's normal cycle length usually established? Around 6th gynecological yr, ~19-20yo What are the 2 cycles that occur simultaneously in the menstrual cycle? Ovarian and endometrial What cycle are follicular, ovulation, & luteal phases? Ovarian What phase is menstrual days 1-14 in ovarian cycle? Follicular Prominent hormones: FSH, estrogen Description: maturation of ovarian follicle What phase is menstrual day 14 in ovarian cycle? Ovulation Prominent hormones: LH Description: ovulation 36h after LH surge; increased basal body temp
What phase is menstrual days 15-28 in ovarian cycle? Luteal Prominent hormones: Progesterone, estrogen Description: follicle becomes corpus luteum What cycle are menses, proliferative, & secretory phases? Endometrial/ovarian What phase is menstrual days 1-5 (variable) in endometrial phase? Menses (part of proliferative phase) Prominent hormones: prostaglandin Description: endometrium sloughs if fertilization of ovum doesn't occur What phase is menstrual days 1-14 in endometrial phase? Proliferative Prominent hormones: estrogen Description: endometrium proliferates What phase is menstrual days 14-28 in endometrial phase? Secretory
