Download NURS 660 Exam 1: Questions and Complete Solutions (2025) and more Exams Advanced Education in PDF only on Docsity!
NURS 660 EXAM 1 QUESTIONS WITH COMPLETE
SOLUTIONS GUARANTEED PASS BRAND NEW 2025
What is the most important differential to rule out in postmenopausal bleeding? Cancer (especially endometrial) An average cycle is how many days? 28 days Range 21-35 days/3-5 weeks How long does an average cycle last and how much blood is typically lost? 4 - 6 days 30 mL (not typically measured, upper limit of normal 6-80) Amenorrhea is defined as Absence of menses >6 months If <6 months, this is just irregular menstrual bleeding and not actual amenorrhea Define oligomenorrhea Bleeding at an interval >35 days Define menorrhagia Excessive or prolonged menstural bleeding occurring at regular intervals
80 cc or >7 days Define polymenorrhea Bleeding at an interval <21 days Differentiate between ovulatory and anovulatory bleeding.
Ovulatory bleeding is cyclic bleeding accompanied by cyclic signs of ovulation (tender breasts, cramping, pain) aka typical menstrual bleeding Anovulatory bleeding is unpredictable, non-cyclic bleeding that is variable in flow and duration. There are no signs of ovulation. What age groups are anovulatory bleeding not uncommon in? Perimenopausal Pre-teen What are some differentials to consider with pregnancy related AUB? Spontaneous abortion, ectopic pregnancy, placental previa (not attached to the fundus), placenta abruptio (detaching, emergency), trophoblastic disease, childbirth complications What are some medications that can cause irregular bleeding? Herbals? Anticoagulants, SSRIs/antipsychotics (especially Lexapro), corticosteroids, hormonal medications, IUD, tamoxifen Also some herbals like ginseng, gingko, soy, black cohosh Tamoxifen has what effects on estrogen? Blocks estrogen at the breast but has a positive effect on uterus which can increase endometrial cancer risk and therefore create AUB Name some systemic diseases that can cause AUB. thyroid disease (both hypo and hyper) PCOS Coagulopathies Hepatic disease Pituitary adenoma Hypothalamic suppression (common in athletes due to low adipose)
For a patient who is having chronic or less severe ANOVULATORY AUB, what would the pharmacologic management be? OCPs can help by increasing the predictability of cycles as well as decreasing blood loss per cycle Provera is cyclic progesterone which can help manage flow or jump start cycles to get back on track What is the use for the medication Provera? By taking 5-10 mg daily for 5-10 days you can manage your flow OR jump start your cycle to get back on track (bleeding should start within a week after taking) Synthetic progesterone For a patient who is having chronic or less severe OVULATORY AUB, what would the pharmacologic management be? Basically what you would think of to treat a bad period: NSAIDs before/during cycle to decrease prostaglandins and hopefully reduce cycle If patient wants to try a progesterone IUD like Mirena to decrease cycles/stop cycles A woman with postmenopausal bleeding comes to your office. She has been taking hormone therapy. What is something you want to know to help determine cancer risk? How long she has been on the therapy AUB cannot be diagnosed until the bleeding has been present for 6 months to 1 year IF she's been on it >6 months (or if she were to not be on hormonal therapy) --> r/o endometrial cancer What is the initial workup for postmenopausal bleeding?
Transvaginal US can be done BUT Endometrial biopsy is more specific/sensitive so should probably just go straight to that What endometrial stripe would be concerning in a postmenopausal woman? Why? What is the next step?
5mm is concerning for potential endometrial cancer and requires biopsy Postmenopausal women should not have estrogen production which therefore means they should have a thin stripe Biopsy is next step to evaluate for endometrial cancer Your postmenopausal patient's transvaginal US was normal but their AUB persists with no explanation. What is the next step? Continue the workup and do not rule out endometrial cancer. May need D&C, hyersteroscopy w/ biopsy What is the gold standard for endometrial cancer diagnosis? D&C Describe the differences between a D&C and biopsy for endometrial cancer diagnosis. D&C is gold standard BUT requires anesthesia/sedation and is a scheduled procedure. Biopsy can be performed in the office with no sedation BUT is not the gold standard because you can biopsy the wrong spot or miss the cancer and have a false reassuring result. How many months does pelvic pain need to be present to be considered chronic? 6 months What is the most common missed contributor to pelvic pain? IBS
What is a goal of pharmacologic treatment for endometriosis? decrease cycles less cycles --> less pain for woman Danazol is used for what? What are some side effects? Suppresses LH and FSH which can in turn stop periods Essentially a weak androgen Can have side effects like weight gain, masculinizations, vocal changes (can be permanent) When choosing an OCP for a patient with endometriosis, what do you want to consider regarding estrogen content? Choose OCPs with the least estrogenic effects with maximum endrogenic effects This will minimize the building of the lining Describes the uses and side effects of progestins for endometriosis. Can be taken long term for pain control unlike GnRH-A and are relatively inexpensive BUT can cause AUB, weight gain, amenorrhea (Which is not always the goal) How do GNRH-A work for endometriosis? How long can you use? What is "add back therapy"? GnRH-A initially stimulate FSH/LH release and down-regulates GnRH receptors to cause a pseudomenopause (so much stimulation that the anterior pituitary 'ignores' GnRH) Add back therapy is taking estrogen with it as well which can lengthen the amount of time patients can be on it. Should be a low dose estrogen Without add back: 6 months With add back: 1 year
What is the main factor to consider when deciding how long someone can be on Orlissa? Pain with sex: 6 months max No pain with sex: 24 months Reason: if pain with sex, higher dosage (BID) A patient with endometriosis is having new, sharp pain over her RLQ. What might you suspect? Appendicitis Very common as tissue often lands on appendix and causes inflammation The core cause of PCOS is what body system? endocrine, not gynecological Stein-Leventhal syndrome includes what triad of symptoms Amenorrhea, obesity, hirsutism Name the 4 requirements for PCOS diagnosis
- Ovarian/menstrual dysfunction
- Clinical/biochemical evidence of increased androgens
- Ultrasound showing polycystic ovaries
- Insulin resistance/metabolic syndrome What assessments in a teen with delayed onset or irregular menses would make you suspicious for PCOS? This as well as significant acne, hirsutism, other signs of masculinity Which hormone is more of the issue with PCOS? FSH or LH? LH They typically do not have issues with folicles being stimulated (will see several developed on US) but do not have a strong enough LH surge to trigger ovulation
Decreased HDL < Elevated BP fasting glu > The risk of a PCOS patient taking oral ovulation meds is what? Hyperstimulation --> multiple gestation pregnancy What is the reason for why PCOS women have high incidence of pregnancy loss? Insulin resistance suppresses glycodelin which is required for maintaining pregnancy What medication should be prescribed to PCOS women to take during the 1st trimester of pregnancy? Metformin Reduces risk of pregnancy loss when taken in the 1st trimester only What are some skin manifestations you may see in a PCOS patient? acanthosis nigricans due to hyperinsulinemia acne, hirsutism, and alopecia due to hyperandrogenism In order to assess a patient with PCOS's risk for heart disease, what are some labs/values that need to be monitored? OGTT for glucose (DM?) BP (hypertension?) Lipid profile (dyslipidemia?) Describe the benefit of spironolactone in treating PCOS. It is a diuretic that can decrease BP but also has the extra benefit of decreasing testosterone so they may see a benefit in features like acne Why would Yaz be a good option for a PCOS patient? What is the medication's benefit?
Yaz is a birth control that contains spironolactone. BC: controls estrogen and progestin and controls uterine lining, gives ovaries a rest Spironolactone: diuretic with anti-testosterone effects Name two medications that are typically used to treat males but have offlabel use for PCOS. Antiandrogen: flutamide (usually used for prostate cancer) Alpha reductase inhibitors: finasteride (usually used for BPH) When is surgical therapy an option for PCOS patients? What are some of the surgeries available? Surgery is last resort after all other options have been exhausted: nutrition referral, weight management, medications Can do a wedge resection (not favored d/t scar tissue), ovarian drilling (cauterization of portion of ovaries, mixed reviews, better results in younger patients with a normal BMI), or bariatric surgery to decrease adipose tissue and therefore decrease insulin What is the underlying pathophysiological reason for basically all of PCOS's manifestations? hyperinsulinemia!!! endocrine problem Hyperinsulinemia --> low SHGB, high androgens, disordered LH/FSH --> hyperandrogenism and anovulation --> PCOS What is the largest non-pharmacological treatment that a PCOS patient can do that will help restore ovulation/ovarian function? lose weight (even a little) How long should baby blues last to be truly considered baby blues?
basically every time you see them preconception visit, prenatal intake and subsequent visits, postpartum exams, f/u visits, sick care or in ER, early intervention home visits, family planning visits, mother's visits for episodic care Describe the screening tool for PPD most commonly used and what score means what. Edinburgh Postnatal Depression Scale 0 - 8: low risk 9 - 11: additional f/u required (every 1-2 weeks until stable) 12+: immediate intervention, disregard reason for visit and focus on PPD A patient sitting in front of you is concerning to you for PPD. When you give her the Edinburgh Postnatal Depression scale, she only scores a 2. What should your next step be? These tools are just screening and should not be substituted for professional judgment. Investigate further, follow up frequently (or intervene now depending on how concerned you are). Do not use the screening tool as the end all be all. What is Zulresso? Black box warning? The only FDA approved medication for treatment of PPD However, is given scheduled IV and is restricted to only certain centers BBW: excessive sedation and sudden loss of consciousness What symptoms shown by a woman suffering from PPD is out of the FNP's scope of practice and should be referred immediately to psych? Psychosis-hallucinations, delusions Suicidal/homicidal ideations
Differentiate between an unintended and intended pregnancy. Intended: desired at the time they occurred or were wanted sooner than they occurred Unintended: either one that occurred when a woman wanted to become pregnant in the future but not currently OR occurred when she did not ever want to be pregnant Name the 3 options currently available for emergency contraception.
- Copper IUD
- Ella
- Plan b Name the window of use for the 3 types of emergency contraception After unprotected or inadequately protected intercourse:
- Copper IUD: 5 days
- Ella: 5 days 3: Plan B is technically 5 days but efficacy decreases after 3 Describe the BMI restrictions for emergency contraceptions. If using Ella, less effective if BMI > If using Plan B, less effective if BMI >25 and likely ineffective if BMI > Describe the MOA of Ella and Plan B. These pills essentially are just progestin (ella is a progestin agonist while plan b is straight up progestin) and therefore delay or inhibit ovulation. They do NOT harm an existing pregnancy (because progestin is actually beneficial for pregnancy) but will stop the sperm and egg from meeting by not allowing release of egg due to hormonal changes (shutting off GnRH feedback loop) Ella can also alter endometrial thickness if taken after to ovulation Name some common side effects of emergency contraception pills.
What is the best prevention for vulvar cancer? to not get HPV so avoiding exposure (vaccine, smaller amounts of partners), not smoking (prolongs HPV) Your patient was treated for vulvar cancer 2 years ago and is here for her annual exam. You notice a lesion on her labia. What is the most likely cause? Reoccurrence Very common for reoccurrence of vulvar cancer w/i first 2 years, need to refer back to gyn onc patient needs to make sure she is having regular follow up during the initial 3 years post diagnosis Are condoms 100% effective in prevention of HPV? No spread by skin to skin genital contact (so could be the area not covered by penis) What is the most significant risk factor for development of invasive cervical cancer? Persistent infection with a high risk (esp. 16 and 18) HPV strain NOT the transient infections that clear up (patients will have a lot of anxiety) What is the latency period between HPV exposure and the development of cervical cancer? around 10-12 years coincides well with pap schedule What does SIL and CIN stand for and what (in general) are these terms describing?
SIL: squamous intraepithelial lesions CIN: cervical intraepithelial lesions these are terms on a pap smear that refer to premalignant changes (can regress, progress, or persist) Your pap smear comes back with an ASCUS reading. What does this mean? What are some reasons it could say this? ASC-US: atypical squamous cells of undetermined significance Basically, they appear abnormal but unsure why. This could be for many reasons: HPV infection, symptom of benign growth, low hormonal levels. Requires more testing to definitively decide. Per the guidelines, how do you manage treatment for a woman whose pap smear comes back ASC-US? If >24 years, it is recommended to do HPV reflex testing. If that's positive, proceed with a colposcopy. Technically the guidelines say you can also wait 1 year but this is not preferred. If <24 years, it's recommended to not do any further testing and repeat pap in 1 year and go from there. If negative again, repeat again in 1 year from there and then can go back to routine if still negative. If positive at either the 1st 1 year f/u or the 2nd 1st year f/u, colpo. How should you manage an "unsatisfactory" cytology per the guidelines? Repeat cytology in 2-4 months If already known HPV positive, can progress to colpo immediately. What does LSIL mean on a cytology report? What could cause this? Low-grade squamous intraepithelial lesion (often CIN 1 or 2) Could be an HPV transient infection Per the guidelines, how do you manage a cytology report of LSIL?
Atypical squamous cells Cannot rule out HSIL (worse than ASC-US) May be precursor to cancer if not treated Describe the three types of endometrial cancer.
- Estrogen dependent (80%), due to exogenous or endogenous excess estrogen
- Spontaneous neoplasm development (10%), often seen in multiparous normal weight women
- Familial endometrial cancer, hereditary and often seen with Lynch syndrome Risk factors for endometrial cancer Estrogen therapy (esp unbalanced), Tamoxifen, early menarche, late menopause, inferility, nulliparity, obesity, chronic anovulation, diabetes, high fat diet, ovarian cancer, PCOS essentially anything that increases estrogen exposure What is the #1 symptom of endometrial cancer? Abnormal uterine bleeding ESPECIALLY in postmenopausal women Your patient is concerned they have endometrial cancer because they have had some irregular bleeding. On exam, you find an irregularly shaped uterus. What is your top differential? More likely fibroids as cancer rarely changes the size or contour of the uterus A pap smear comes back with AGUS. What are you worried about? AGUS (atypical glandular cells) is a concern that the patient may have endometrial cancer. They need referral and biopsy.
What other cancers or syndromes require close monitoring for endometrial cancer? breast, ovarian, or Lynch syndrome Name a significant risk factor for ovarian cancer. advanced age (average age of diagnosis is 63) Name the early symptoms of ovarian cancer and why these contribute to the high mortality rate. Vague symptoms early in the disease process: abdominal bloating, discomfort, difficulty eating, early satiety So vague they are often missed A woman >50 is having bloating, abdominal discomfort. Per the text, what is the number of days per month of having these symptoms that would most concern you for ovarian cancer? 12 days a month for 12 months very concerning for ovarian cancer Describe some of the late symptoms of ovarian cancer. Anorexia, N/V, ascites, ABD or back pain, abd mass, pleural effusion Describe the use of CA-125 in ovarian cancer. Not helpful for initial diagnosis, not sensitive enough Can be helpful in monitoring their status though once ovarian cancer has been CONFIRMED NOT screening What can help reduce risk of ovarian cancer? Inhibiting ovulation (OCP usage, pregnancy, breast feeding) What might the treatment for ovarian cancer include?
