NR 602 Final Exam Study Guide with Q & A (New, 2024) : Chamberlain College of Nursing, Exercises of Nursing

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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

6. 18yo female c/o secondary amenorrhea. On exam, there is normal secondary sex

characteristics and normal genitalia. Pregnancy is ruled out. What would necessitate further eval? a. Elevated blood cholesterol levels b. Androgen deficiency c. Galactorrhea d. Hirsutism c

7 .24yo female is dx'd w/primary dysmenorrhea. Which med would be used as first-line to help

control symptoms? a. Antianxiety meds b. Progesterone-only contraception c. Oral steroids d. NSAIDs d

8 .Primary amenorrhea is best described as:

a. Cessation of menstruation x6mo b. Failure of menstruation to occur by 17ho c. Failure of menstruation to occur by 13yo d. Cessation of menstruation x6mo after menarche c

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

Which of the following are of a reproductive and pelvic origin? a. Salpingo-oophoritis (fallopian tube/ovary) secondary to PID b. Gynecologic malignancy c. Adhesions d. Myomata uteri a 25yo female c/o tender area near her introitus and to the L of her perineum. Very painful sex was first sign. Initially bump was very small, but now is ping-pong ball size. On exam, abscess is present on L medial side of labia minora and there's edema extending into perineum. What is dx? a. Lipoma b. Dermoid cyst c. Bartholin's cyst d. Skene's duct cyst c 49yo female c/o dark, watery brown vaginal discharge. Which best describes what might be seen on physical exam in pt's with cervical cancer? a. Ulcerated firm cervix b. Vague lower abd pain c. Enlarged tender femoral lymph nodes d. Soft, still shaped cervix

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 occurs with greatest frequency and severity in the: a. Late luteal phase b. Midfollicular phase c. Proliferative phase d. Early luteal phase a Which is not a common cause of irregular menstrual bleeding? a. Endocrine disorders b. Stress c. Anovulation d. Anatomical abnormality c What is considered the primary etiology of primary dysmenorrhea? a. Ovarian cysts b. Prostaglandin production c. Endometriosis d. Adenomyosis b 28yo female c/o breast tenderness, fatigue, abd bloating, fluid retention, irritability 1wk before her menses onset. What is most important info to obtain from this pt to determine if the pt has

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.

PALM:

Polyps Adenomyosis Leiomyoma Malignancy Name 5 non-structural abnormalities that are causes of dysfunctional uterine bleeding. COEIN: Coagulopathy Ovulatory disorders Endometrial Iatrogenic Not classified What is abnormal/dysfunctional uterine bleeding? Acute or chronic bleeding from uterine corpus; abnormal in regularity, volume, frequency, or duration; occurs in pregnancy absence. What is acute DUB? Episode of sufficient quantity to require immediate intervention to prevent further blood loss What is chronic DUB? Present for the majority of the last 6mo What is the most common benign tumor of the genital tract? Leiomyomas? (Hollier CPG p. 772) Name some risk factors for DUB.

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.

-If hx indicates: thyroid panel -Endometrial bx What are some diagnostic imaging studies for DUB? -TVUS: first-line if imaging needed -Saline infusion sonohysterography (helpful for leiomyoma) -Hysteroscopy (can be used for guided endometrial bx) -MRI What are some diagnostic studies for polyps in DUB? -TVUS -Saline infusion sonography -Hysteroscopy What are some diagnostic studies for adenomyosis in DUB? TVUS or MRI What are some diagnostic studies for leiomyomas in DUB? TVUS What are some diagnostic studies for malignancy in DUB? Bx/pathology What are some diagnostic studies for coagulopathies in DUB? Labs What are some surgical options for DUB? -Varies depending on dx, age, fertility status/desire -If bleeding severe/pregn. related: D&C or hysterectomy in extreme cases -Hysteroscopic removal of polyps

-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

What is the average age of menarche for Caucasians? 12.6y What is average age of menarche for African-Americans? 12.1y What is average age of menarche for Latinas? 12.2y What does higher BMI in childhood result in regarding puberty? Earlier onset Timing and progression of puberty are related to... Environmental factors, including: -Socioeconomic conditions -Nutrition -Access to preventive healthcare At what average age do secondary sexual development occur? 9y Menarche usually occurs w/in ______________ after thelarche (breast buds). 2-3y When should dx/referral be made for primary amenorrhea? -Any adolescent w/out menarche by 15yo -Any adolescent w/out menarche 3y after thelarche What are some things that can cause menstrual irregularities? -Disturbances in normal hormone release -Significant wt loss

-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

Prominent hormones: progesterone Description: endometrium thickens in prep for implantation What are some common menstrual abnormalities? Prolonged interval Excessive flow What are some menstrual conditions that may require eval? -Absence of cycle 3y after thelarche -Absence of cycle by 13yo w/out signs of pubertal development -Absence of menses by 15yo -New onset irregularity -Cycles closer than 21 days or farther apart than 45 days -Menses >7 days -Menses needing pad/tampon change q1-2h -Painful menses What is a Bartholin's gland cyst/abscess? Obstruction of one or both Bartholin glands, resulting in pus that forms lump/abscess. Where are Bartholin glands located? Bilat to opening of vagina What are typical characteristics of Bartholin's gland cyst/abscess? 1-3cm, unilat What is etiology for Bartholin's gland cyst/abscess?

-Most common >60yo -Mechanical irritation from tight fitting undergarments resulting in chronic inflammation -STDs What are some risk factors for Bartholin's gland cyst/abscess? -Vulvovaginal infection -Poor perineal hygiene What are some assessment findings of Bartholin's gland cyst/abscess? -Firm labia mass/cyst -Erythema -Induration -Labia minora edema -Low grade fever -Possible purulent drainage What are some diff dx for Bartholin's gland cyst/abscess? -Sebaceous cyst -Malignancy/tumor What are some diagnostic studies for Bartholin's gland cyst/abscess? -Usually none unless other infection suspected -C/S of cyst contents -Cx for STD, esp. gonorrhea & chlamydia What is the most common causative organism of Bartholin's gland cyst/abscess? Aerobic bacteria E. coli What are some preventive measures for Bartholin's gland cyst/abscess?

-Loose breathable garments -Good perineal hygiene -Early treatment What are some nonpharm treatment options for Bartholin's gland cyst/abscess? -None needed if only 1-2mm & asymptomatic -Exclude possible carcinoma if >40yo -Local moist heat -Warm sitz baths/tepid water soak 3-4 times/day -I&D w/Word cath of fluctuant abscess if refractory to initial treatment (no sex until cath removed) -Possible marsupialization (permanent surgical opening allowing drainage) What is the goal of treatment for Bartholin's gland cyst/abscess? To facilitate drainage of cyst contents What are some pharm options for Bartholin's gland cyst/abscess? -If high risk/recurrent: Augmentin for E. coli/Strep, clinda for Staph (incl. MRSA) -Treat for any STD -NSAIDs When is consultation/referral recommended for Bartholin's gland cyst/abscess? Surgical or gyn consult if large cyst or unresponsive to treatment What are follow up recommendations for Bartholin's gland cyst/abscess? Re-eval in 7-10days What is expected course of Bartholin's gland cyst/abscess?

-Complete resolution w/appropriate treatment -1 of 10 will recur What are possible complications of Bartholin's gland cyst/abscess? Cellulitis What is description of breast cancer? -Malignant breast tumors -Primarily female, but can be in males -Stratified into 1 of 5 subtypes based on histopathological characteristics (Luminal A/B/B-like, HER2 positive, Triple Negative) Presence of _________________ and _____________________ gene mutations are associated with lifetime risk of breast ca from 45-60%. BRCA 1, BRCA 2 What cancer is the most frequently diagnosed in females? Breast Which ethnic group is more likely to develop breast ca? Caucasians What are some risk factors for breast ca? -Increasing age -Dense breast tissue -Prolonged estrogen exposure (menarche <12yo, 1st term pregn >35yo, nulliparity, never breastfeeding, contraceptives w/exogenous hormones, menopause >55yo, postmenopausal hormone therapy) -Fam h/o breast ca (esp. 1st degree relative)

-Personal h/o breast ca -H/o benign breast dz (nonproliferative = slight risk, proliferative = high risk) -Obesity in postmenopause -Inherited gene mutations -High dose radiation exposure to chest area at <20yo ->3 ETOH drinks/day -Emerging/unclear risk factors (tobacco, phys. inactivity, high fat diet, night shift) What are some assessment findings in breast ca? -Painless, firm, fixed mass (most common symptom; no changes in mass w/menstruation) -Nipple discharge that's not breast milk -Skin/nipple changes (dimpling, skin ulceration, lymphedema, nipple retraction, scaly nipple lesion or eczematous rash i.e. Paget's) -Increased vascular pattern of breast -Significant asymmetry of breasts -Axillary, supraclavicular, infraclavicular lymph node enlargement -Late findings: wt loss, anorexia, bone pain, anemia What are some diff dx for breast ca? -Breast cysts -Fibroadenoma -Sclerosing adenosis -Intraductal papilloma -Hyperplasia