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 muscle
...
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 trichomonadsSyphillis 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 reduce the likelihood of transmission to
infants aged <12 months.HPV vaccine Correct Answer- -The quadrivalent vaccine prevents infection from HPV sub-types 16 and
18, as well as 6 and 11, which cause 90% of genital warts (prevents cervical ca also)
-The bivalent vaccine prevents infection from subtypes 16 and 18.
Tanner staging of breast development Correct Answer- 1: preadolescent- elevation of nipple only
2: Breast bud stage: elevation of breast and nipple as a small mound; enlargement of areolar diameter
3: Further enlargement of elevation of breast and areola, with no separation of their contours
4: Projection of areola and nipple to form a secondary mound above the level of breast
5: Mature stage: projection of nipple only; areola has receded to general contour of the breast (although
in some normal individuals the areola continues to form a secondary mound)
Breast masses Correct Answer- Most often found by women during self examination
Irregular rectal mass Correct Answer- Masses with irregular borders are suspicious for rectal cancer
s/s rectal prolapse Correct Answer- On straining for a bowel movement, the rectal mucosa, with or
without its muscular wall, may prolapse through the anus, appearing as a doughnut or rosette of red
tissue. A prolapse involving only mucosa is relatively small and shows radiating folds, as illustrated.
When the entire bowel wall is involved, the prolapse is larger and covered by concentrically circular
folds.
Hemorrhoids vs polyps vs CA Correct Answer- -H-(internal-prolapsed)reddish, moist, protruding masses,
(external) pain with defecation and sitting, tender, swollen, bluish, ovoid mass is visible at the anal
margin.
-P- on the stalk, or mucosal surface, soft, difficult to feel often
-C- firm, nodular, rolled edge
Erectile dysfunction Correct Answer- In a 47 yo male, it is most often psychologic and not testo
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