NSG 6330 Final Exam Study Guide Graded A+

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How is HIV transmitted - ANSWER Vertical transmission from a mother to her baby, blood transfusion, or exchange of any blood products Question : HIV risk factors are all of these except: Unpro ... tected sex or trauma with sexual activity or multiple partners IV drug use, including shared syringes Exchange of saliva - ANSWER Exchange of saliva Whether you order diagnostic testing or refer the patient to an HIV-specific facility, laboratory confirmation for documentation for appropriate care rendered. The test confirming HIV infection is _____________. HIV-1/2 Ag/Ab combination immunoassay enzyme-linked immunosorbent HIV RNA CD4+ lymphocyte count quantitative plasma HIV RNA - ANSWER HIV-1/2 Ag/Ab combination immunoassay Treatment, although not curative, is critical for the best outcome possible. One important principle of antiretroviral therapy is: Therapy should be started when symptoms first appear. Monotherapy is recommended. Response to drug therapy is monitored by HIV RNA levels. Response to drug therapy is monitored with CD4+ counts. - ANSWER Response to drug therapy is monitored by HIV RNA levels. The HIV is positive, and the chest X-ray reflects bilateral infiltrates. The radiologist telephones you with a diagnosis of pneumonia. Further evaluation and report are sent to you with a diagnosis of pneumocystis pneumonia. What stage is this HIV presentation? Acute HIV infection Early-stage infection AIDS Symptomatic but likely to begin a latency period - ANSWER AIDS Women often tend to reschedule a well-woman visit, but they don't do so often with a problem such as pelvic pain. This symptom can present as an acute, or chronic, insult. When a woman presents with pelvic pain, the term can encompass many possibilities. Differentiating acute from chronic assists with narrowing down the possibilities but nonetheless can originate from more than one system as a referred pain or discomfort. The focus here will be of reproductive/pelvic origin. As you know, the most common cause of pelvic pain can be noted as endometriosis. But you also know that the most acute causes of pelvic pain are probably: Salpingo-oophoritis (fallopian tube/ovary) secondary to PID Gynecologic malignancy Adhesions Myomata uteri - ANSWER Salpingo-oophoritis (fallopian tube/ovary) A twenty-five-year-old presents with a report of a very tender area just near her introitus and to the left of her perineum. Very painful sex is how she knew "something wasn't right." She showered and when washing, she felt a "pea-sized" painful lump on the left side of her "bottom." She tells you she looked at it with a mirror and it was very small, but now it is the size of a ping-pong ball and getting worse. When you inspect her external genitalia, you are amazed at the size and appearance of the "lump." You note what appears to be an abscess on the left medial side of the labia minora, and there is some edema extending into the perineum. Your diagnosis for this presentation is: Lipoma Dermoid cyst Bartholin's cyst Skene's duct cyst - ANSWER Bartholin's cyst Bartholin's Cyst - ANSWER If a Bartholin duct gets blocked, fluid builds up in the gland. The blocked gland is called a Bartholin gland cyst You explain to this young woman what this "lump" is and let her know you will be referring her to a gynecologist you consult with regularly. You explain to her the likely treatment as follows: She will need to take sitz baths three times per day and a broad-spectrum antibiotic. This is likely a fatty tumor and will need to be surgically removed. A possible incision might be necessary and a catheter placed for two to four weeks to allow for drainage and appropriate healing. This is a folliculitis that has become infected and needs a needle aspiration and broad-spectrum antibiotic treatment. - ANSWER A possible incision might be necessary and a catheter placed for two to four weeks to allow for drainage and appropriate healing. You are at the office and a thirty-year-old woman presents with an abrupt onset of pain when attempting to urinate. She is also complaining of frequency and urgency and thinks she may have seen some blood as well.You take her history and she tells you she had sex three days ago with her long-term significant other, but she realized she left her diaphragm in until today when these symptoms occurred. Her BP is unremarkable, pulse is 90, temperature is 99, no costovertebral angle tenderness (CVAT), and is experiencing slight suprapubic discomfort. You review her urine dip and you note 2+ blood, +nitrates, +leukocyte esterase. You send the urine for a microscopic and culture and sensitivity but your management plan is: Pending the culture and sensitivities, you will treat accordingly. Advise her to drink cranberry juice and you will give her a pain medication. Provide broad spectrum antibiotic while waiting for culture and sensitivity lab to return for specific microbe. Refer to a urologist. - ANSWER Provide broad spectrum antibiotic while waiting for culture and sensitivity lab to return for specific microbe. The diagnosis of stress incontinence can be confirmed by __________. your suspected etiology the woman's symptom history to date urodynamic evaluation pelvic muscle evaluation - ANSWER the woman's symptom history to date Anticholinergic medications are a type of treatment for which type of incontinence? Urge incontinence Stress incontinence Vulvodynia Vestibulitis - ANSWER Urge incontinence Treatment for stress incontinence can include: Student Answer: Pelvic muscle exercises/kegel floor exercises Biofeedback Weight loss if obese All of the above - ANSWER All of the above A well-woman visit for an adolescent should include which of the following? A general health history and physical examination, including a breast examination, pelvic with Pap smear, screening tests, counseling, immunizations, risk factors, and patient concerns A general health history focusing on reproductive and sexual health concerns (menses, gynecologic, and pregnancy related) and psychosocial (family related, peer related, emotional, and physical as well as related to abuse, drug use, and alcohol use) concerns Physical exam, screening tests, and immunizations as indicated by the health history and gynecologic considerations for an external-only inspection of the genitalia Both b and c - ANSWER Both b and c A myriad of influencing factors can affect adolescent women in a positive or negative way. As an advanced practice nurse, you will need to be cognizant of such influences and address them from a health promotion/prevention lens. Today, Marie, a sixteen-year-old woman, arrives for a well-woman visit, hoping to begin birth control since "all her friends are using it." After a thorough history, you note that Marie resides in a community with very high risk factors. These include poverty, violence, and lack of recreational facilities. She tells you that she "hangs out" at a convenience store near the apartment complex she lives at with her mother. "All the group hangs there," she reports proudly. She shares that she has been menstruating for two years now although she has irregular cycles. She also lets you know that she has had coitus only one time and that he "pulled out." She does not want to get pregnant, and this is why she is here today. What is your management plan for Marie today? (Select those that apply.) You will assess all predisposing factors that lead to premarital sex and the negative consequences, tell Marie to be careful, and prescribe birth-control pills. One by one, you will plan to carefully address the risks (red flags) in Marie's history. Your goal will be to clarify and address misconceptions, as well as share valuable sex education in a sensitive, nonjudgmental way. You will let her know you are her advocate and are very protective of her health. Without preaching, you want her to be aware of the negative possibilities of premarital, unprotected sexual activities. You will also share a clear understanding of the risk of STIs with Marie. After processing all of the history Marie has shared, you will write a referral for psychiatric evaluation and tell her she needs ongoing counseling for her behavior at such a young age and she likely needs to learn to cope within her environment (home and community). Your goal is to include healthy sexual-health decision making, including decisions regarding abstinence, birth-control efficacy and choice, and condom use. Depending on the need, you may include a referral to an effective program for teens (for example, a program that deals with STI prevention and or a family-based intervention program if available). - ANSWER CORRECT You will assess all predisposing factors that lead to premarital sex and the negative consequences, tell Marie to be careful, and prescribe birth-control pills. CORRECT One by one, you will plan to carefully address the risks (red flags) in Marie's history. Your goal will be to clarify and address misconceptions, as well as share valuable sex education in a sensitive, nonjudgmental way. You will let her know you are her advocate and are very protective of her health. Without preaching, you want her to be aware of the negative possibilities of premarital, unprotected sexual activities. You will also share a clear understanding of the risk of STIs with Marie. CORRECT After processing all of the history Marie has shared, you will write a referral for psychiatric evaluation and tell her she needs ongoing counseling for her behavior at such a young age and she likely needs to learn to cope within her environment (home and community). Abnormal uterine bleeding (AUB) has multiple causes. When a woman presents and reports menstrual irregularity with amenorrhea, which is the most common cause of amenorrhea? Ectopic pregnancy Adenomyosis Coagulopathy Anovulation - ANSWER Anovulation Anovulation - ANSWER when the ovaries do not release an oocyte during a menstrual cycle. Therefore, ovulation does not take place. However, a woman who does not ovulate at each menstrual cycle is not necessarily going through menopause. Chronic anovulation is a common cause of infertility. The most common cause of chronic pelvic pain for women in the prime of their reproductive years is: PID Fibroids Endometriosis Endometritis - ANSWER Endometriosis Polycystic ovaries predispose women to a higher incidence of: Adrenal tumors Ovarian cancer Endometrial cancer Endometriosis - ANSWER Endometrial cancer A definitive diagnosis of endometriosis cannot be made until which of these is completed? CT scan Transvaginal ultrasound Exploratory laparoscopy MRI - ANSWER Exploratory laparoscopy A woman has just stopped birth control pills in efforts to become pregnant. You recall that estrogen withdrawal reflects activity primarily from the _________. hypothalamus uterus ovary pituitary - ANSWER ovary A prescription is being written by the nurse practitioner for birth control pills. When completing patient education, which of the following would be an accurate statement about oral contraceptive use? It is unnecessary to double up on missed pills for combined oral contraception. Oral contraceptives do not provide protection against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). Most women will not notice a change in their periods once they go on the pill. The pill provides added protection against cervical and uterine cancer. - ANSWER Oral contraceptives do not provide protection against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). A twenty-one-year-old woman presents for her initial well-woman examination. She has never been sexually active and has a negative family history for gynecology problems. Personal history is negative for abuse, and she exercises regularly and eats a balanced diet. Menstrual history reveals that she experienced menarche at fourteen years of age, has a regular twenty-eight-day cycle, and denies dysmenorrhea. Which of the following would be included in her physical examination today? Stool for occult blood Baseline mammography Cultures for gonorrhea and chlamydia Pap smear - ANSWER Pap smear Which of the following characteristics is not associated with psychosocial development problems in adolescence? Being different than others or feeling different Late onset of pubertal sexual maturity Sexual identity as GLBTQ Having a disability or chronic health condition - ANSWER Late onset of pubertal sexual maturity During a pelvic exam on a seventy-year-old, the nurse practitioner notices the position of the cervix at the introitus. The diagnosis is most likely _____. cystocele rectocele urethral prolapse uterine prolapse - ANSWER uterine prolapse While participating in a woman's health fair, a parent comes to you with the concern of her daughter participating prematurely in sex. Which of the following factors is strongly associated with early onset of unwanted sexual activity? Dating a partner that is >3 years older than the teen Planning on attending college in the near future Poor academic performance in school Presence of strong religious convictions - ANSWER Dating a partner that is >3 years older than the teen Iris is a thirty-two-year-old married woman with three children. She comes in for information on using the copper T intrauterine device (IUD) for contraception. Which of the following would be a contraindication to using this appliance? Nulliparity Heart disease Prior ectopic pregnancy History of multiple births - ANSWER Heart disease Cara is in the clinic for what you have diagnosed as dysfunctional uterine bleeding (DUB). She is concerned about why this is happening to her. You recall which of the following is the most common cause of DUB? Endocrine disorders Stress Anovulation Anatomical abnormality - ANSWER Anovulation Anovulation - ANSWER when the ovaries do not release an oocyte during a menstrual cycle. Therefore, ovulation does not take place. However, a woman who does not ovulate at each menstrual cycle is not necessarily going through menopause. Chronic anovulation is a common cause of infertility. You are starting Ella, a twenty-one-year-old, on Ortho Tri-Cyclen, a combined oral contraceptive. Which of the following would not be included in your instructions and advice? Try to take the pill at the same time every day. If you miss one day, double up the next day. You need to use backup protection consistently for the first month to avoid pregnancy. Breakthrough bleeding may occur in the first few cycles. Please do not stop taking the pill due to this. If you are uncomfortable with this, come in for a follow-up appointment to discuss other options. Oral contraceptives offer protection against breast cancer for as long as you are using them. - ANSWER Oral contraceptives offer protection against breast cancer for as long as you are using them. A woman comes to the clinic with the chief complaint of disruption of urine flow. Which of the following is not a risk factor for pelvic floor relaxation? Obesity Menopause Vaginal delivery Cesarean section - ANSWER Cesarean section The nurse practitioner understands that premenstrual syndrome (PMS) occurs with greatest frequency and severity in the ___________. late luteal phase follicular phase proliferative phase ovulatory phase - ANSWER late luteal phase A twenty-one-year-old woman comes into your practice seeking birth control. She has only recently become sexually active and has consistently used condoms for safe sex. Your history reveals that she does not use tampons during her menses and has very little knowledge about female reproductive anatomy. Based on this information, which of the following birth control choices would be least likely to meet her needs for contraceptive management? Combined oral contraceptive (COC) pill [Show More]

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