NR 509 Final Exam Q&A with Complete Solution (Latest 2021/2022)100% Verified Suspicious breast mass Correct Answer- -A mobile mass that becomes fixed when the arm relaxes is attached to the ribs and intercostal muscles;
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NR 509 Final Exam Q&A with Complete Solution (Latest 2021/2022)100% Verified Suspicious breast mass Correct Answer- -A mobile mass that becomes fixed when the arm relaxes is attached to the ribs and intercostal muscles; if fixed when the hand is pressed against the hip, it is attached to the pectoral fascia.
-Hard irregular poorly circumscribed nodules, fixed to the skin or underlying tissues, strongly suggest cancer
Risk for Breast cancer Correct Answer- --*Age*
-family history of breast/ovarian CA
- inherited genetic mutations,
-personal history of breast cancer
- high levels of endogenous hormones
- breast tissue density
- proliferative lesions with atypia on breast biopsy, - duration of unopposed estrogen exposure related to early menarche
-age of first full-term pregnancy
- late menopause.
- breastfeeding for less than 1 year,
- postmenopausal obesity
-cigarette smoking, alcohol ingestion,
- physical inactivity, and type of contraception.
Characteristics of a breast cyst Correct Answer- Soft to firm, round, mobile, often tender.
The best way to examine the lateral portion of the breast Correct Answer- -Have pt roll onto the opposite hip
-place her hand on her forehead.
- keep shoulders pressed against the bed
-palpate in the axilla, moving in a straight line down to the bra line, then move the fingers medially and palpate in a vertical strip up the chest to the clavicle. Continue in vertical overlapping strips until you reach the nipple
Bacterial Vaginosis (BV) Correct Answer- -Caused by overgrowth of anaerobic bacteria (often from sex)
- Discharge: Gray or white, thin, homogenous, malodorous, coats the vaginal walls, usually not profuse, may be minimal
- Fishy/musty genital odor
-Normal vulva and vaginal mucosa
-Scan saline wet mount for clue cells (epithelial cells with stippled borders); sniff for fishy odor after applying KOH ("whiff test"); test the vaginal secretions for pH > 4.5
Candidal Vaginitis Correct Answer- -Cause: Candida albicans, a yeast (normal overgrowth of vaginal flora); many factors predispose, including antibiotic therapy
-Discharge: white and curdy, may be thin but usually thick, not as profuse as trichomonal infection, not malodorous
- vaginal soreness, pruritus, pain on urination, dyspareunia (painful intercourse)
-The vulva and surrounding skin are inflamed and sometimes swollen to a variable extent; the vaginal mucosa is reddened, with white tenacious patches of discharge; the mucosa may bleed when these patches are scraped off; in mild cases, the mucosa looks normal
-Scan potassium hydroxide (KOH) preparation for the branching hyphae of Candida
Trichomonal Vaginitis Correct Answer- -Trichomonas vaginalis, a protozoan; often but not always acquired sexually
- Discharge:Yellowish green or gray, possibly frothy; often profuse and pooled in the vaginal fornix; may be malodorous
-Pruritus (though not usually as severe as with Candida
infection); pain on urination (from skin inflammation or possibly urethritis); dyspareunia
-Vestibule and labia minora may be erythematous; the vaginal mucosa may be diffusely reddened, with small red granular spots or petechiae in the posterior fornix; in mild cases, the mucosa looks normal
- Scan saline wet mount for trichomonads
Syphillis Correct Answer- This ulcerated papule with an indurated edge usually appears after 3 to 6 weeks of incubating infection from the spirochete Treponema pallidum. These lesions may resemble a carcinoma or crusted cold sore. Similar primary lesions are common in the pharynx, anus, and vagina but may escape detection since they are painless, nonsuppurative, and usually heal spontaneously in 3 to 6 weeks. Wear gloves during palpation since these chancres are infectious.
s/s of epididymitis Correct Answer- Acute: swollen, and notably tender, making it difficult to distinguish from the testis. The scrotum may be reddened and the vas deferens inflamed.
Chronic: firm enlargement of the epididymis, which is sometimes tender, with thickening or beading of the vas deferens.
Genital Warts (Condylomata Acuminata) Correct Answer- -Single or multiple papules or plaques of variable shapes; may be round, acuminate (pointed), or thin and slender. May be raised, flat, or cauliflower-like (verrucous).
-Causative organism: HPV, usually subtypes 6, 11; carcinogenic subtypes rare, approximately 5-10% of all anogenital warts. Incubation: weeks to months; infected contact may have no visible warts.
-Can arise on penis, scrotum, groin, thighs, anus; usually asymptomatic, occasionally cause itching and pain.
-May disappear without treatment.
Risk for prostate CA Correct Answer- Age, ethnicity, and family history are the strongest risk factors for prostate cancer.
s/s prostatitis Correct Answer- -fever
-frequency, urgency, dysuria, incomplete voiding,
-sometimes low back pain
- gland feels tender, swollen, "boggy," and warm
s/s BPH Correct Answer- - irritative (urgency, frequency, nocturia),
-obstructive (decreased stream, incomplete emptying, straining), or both,
- gland may be normal in size, or may feel symmetrically enlarged, smooth, and firm, though slightly elastic; there may be obliteration of the median sulcus and more notable protrusion into the rectal lumen.
Measuring a pregnant uterus Correct Answer- With a plastic or paper tape measure, locate the pubic symphysis and place the "zero" end of the tape measure where you can firmly feel that bone (Fig. 19-12). Then extend the tape measure to the very top of uterine fundus and note the number of centimeters measured.
s/s gestational HTN Correct Answer- systolic blood pressure (SBP) >140 mm Hg or diastolic blood pressure (DBP) >90 mm Hg first documented after 20 weeks, without proteinuria or preeclampsia, that resolves by 12 weeks postpartum.
s/s ectopic pregnancy Correct Answer- -Abdominal pain
-adnexal tenderness
-abnormal uterine bleeding
how a Bartholin gland infection presents Correct Answer- Causes of a Bartholin gland infection include trauma, gonococci, anaerobes like bacteroides and peptostreptococci, and C. trachomatis. Acutely, the gland appears as a tense, hot, very tender abscess. Look for pus emerging from the duct or erythema around the duct opening. Chronically, a nontender cyst is felt that may be large or small.
Bleeding between periods Correct Answer- Metrorrhagia
Vaccines safe in pregnancy Correct Answer- pneumococcal, meningococcal, and hepatitis B. Hepatitis A and B, meningococcal polysaccharide and conjugate, and pneumococcal polysaccharide vaccines can be given, if indicated.
-inactivated influenza
-Tdap
When to give the tetanus vaccine Correct Answer- All adults aged ≥19 years, including those aged ≥65 years: All adults aged ≥19 years who have not been vaccinated with Tdap should receive a single dose of Tdap regardless of the time interval since last receiving Td. After receiving Tdap, they should receive Td boosters at 10-year intervals. For adults aged ≥65 years, this will
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