NU 545 Exam 3 Questions and Answers
Question 1.
Know all STIS: pathophysiology, etiology, clinical manifestations, diagnostic tests,
treatment, and complications. How is each transmitted during pregnancy to the fetus?
Know the different stages of syphilis; what organism causes each STI and is it viral,
bacterial etc.? Do you treat both partners and why? What age group has the greatest risk
of STIs and why? What causes cervical cancer
Correct Answer: FOUR STAGES OF SYPHILLIS Primary Syphilis (incubation period
ranges from 12 days to 12 weeks average of three weeks): Local bacterial
invasion: multiplies in epithelium and produces a granulomatous tissue
(chancre) at the site > Consider syphilis with any open lesion Chancre (eroded,
painless, firm and indurated ulcer <2cm in diameter) Some microorganisms
drain with lymph into adjacent lymph nodes. Cell-mediated and humoral immune
responses are stimulated within the nodes and at the site of the chancre. o If
left untreated, heals in 2-8 weeks, disappears with no scar Secondary Syphilis
(usually 6 weeks after first appearance of chancre - may overlap with primary
stage): Systemic > blood borne bacteria is spread to all major organ systems.
Followed by a period during which the immune system is able to suppress
infection. Even without treatment, spontaneous resolution of the skin lesions
occurs > individual enters latent stage of infection (relapses may occur for
several years) Typically, this stage presents with low-grade fever, malaise, sore
throat, hoarseness, anorexia, generalized adenopathy, headache, joint paint,
lymphadenopathy, pruritus, and skin or mucous membrane lesions or rashes
(e.g., condylomata lata). Women > appear in perineum, vulva, inner thigh, anal
area & groin Men > inner thigh and anal area
Question 2.
Correct Answer: Latent Syphilis (may be as short as 1 year or as long as a
lifetime): Subdivided into early and late stages even though no criteria to
delineate one from the other. Silent infection: medical history and serologic
studies show that syphilis is present, but the individual has no clinical
manifestations Transmission of infection is possible during both late and early
latent stages Tertiary Syphilis rare as antibiotics cure syphilis: Most severe
stage, involving significant morbidity and mortality (non-infectious disease)
Destructive skin, bone, and soft skin lesions called gummas develop, which
result from a severe hypersensitivity reaction to the microorganism.
Cardiovascular complications > aneurysms, heart valve insufficiencies, and
heart failure. CNS > possible manifestations of neurosyphilis may develop (this
may occur at any stage of syphilis infection). EVALUATION Early diagnosis
depends on darkfield microcopy of specimen from infected site. If initial result
negative, test is repeated on 2 successive days 2 categories of serologic testing
exist: 1. nontreponemal antigen > show presence of reagin (a group of
antibodies present in syphilis) in serum > provide indirect evidence of infection
a. VDRL antigen /RPR test - Yield positive results in >50% individuals with
,primary & 100% in secondary > useful in screening/assessing treatment
response > high rates of false positives 2. treponemal antibody a. done if VDRL
antigen (RPR test is positive) b. used to assess for antibody response to T.
pallidum c. include enzyme immunoassays (EIAs) FTA-AB test & TP-PA assay
During latent phase - patients can have positive serologic evidence, but
confirmation must include presence of treponemata in cerebrospinal fluid to
confirm.
Question 3.
Correct Answer: Preferred treatment for all stages is parenteral injection of
benzathine PCN G. - no other types of penicillin are effective TREATMENT: If <1
year infected > 1 IM dose is appropriate If >1 year infected; asymptomatic and
assumed to be in late stage > treatment is 3 weekly injections Penicillin is okay
for pregnant women (prevent vertical transmission to baby) Non-pregnant
women who are allergic to PCN receive Doxycycline 100mg BID x14 days
Pregnant women with PCN allergy should be desensitized then treated with PCN
G since tetracycline causes permanent, lifelong discoloration of fetus teeth.
Repeated assessment of VDRL and RPR titers = determine effectiveness of
treatment > titers should decrease 4-fold Sexual partners are examined and
treated and use of condoms recommended until treatment If infants require
treatment, PCN is drug of choice. Infants are given serologic tests for syphilis
every 2-3 months until test becomes nonreactive or titer has decreased 4-fold.
An individual has syphilis, secondary stage. What will the nurse typically find
upon assessment? Low grade fever, malaise, and sore throat. Typically, this
stage (secondary) presents with variable systemic symptoms, including
low-grade fever, malaise, sore throat, hoarseness, anorexia, generalized
adenopathy, headache, joint pain, and skin or mucous membrane lesions or
rashes.
Question 4.
Correct Answer: Age Group with Highest Risk of STDs Each year in the United
States, 19 million individuals contract a sexually transmitted infection; half of
those infected are younger than 25 years of age. Partly because of risk-taking
behavior (unprotected intercourse or selection of high-risk partners),
adolescents have the greatest risk for STI exposure and infection. In addition,
adolescent women may have a physiologically increased susceptibility to
infections of cervical immaturity. Is prevalent in ALL socioeconomic and racial or
ethnic groups. CDC does not require that all STI's be reported, so most private
MD's don't but health Departments do. Thus, the reasoning it appears urban &
lower income population. Etiology may be bacterial, viral, protozoal, parasitic,
or fungal Cause of Cervical Cancer It is now known that infection with
persistent, high-risk serotypes of HPV is necessary for the development of
cervical or anal cancer. More than 120 different types of HPV have been
identified. More than 40 serotypes are unique to the stratified squamous
epitheliums of the genital area. These are divided into serotypes that have a
high risk of causing cervical cancer and low-risk serotypes, which are associated
,with benign genital lesions or warts. High-risk types 16 and 18 are the most
common, causing up to 70% of anogenital cancers. Low-risk subtypes can
coexist with the high-risk types, but do not cause cancer. Most cases occur in
post-menopausal women ages 50-60 with mortality of African American women
twice as high. Fortunately, most cases of HP are transient and resolve on their
own within 2 years. Persistence of the virus, immune response, and the
presence of cofactors, including smoking and hormonal contraceptive exposure,
may play a role in the development of cervical dysplasia and cancer following
HPV exposure.
Question 5.
Understand the different uterine tumor types.
Correct Answer: Leiomyomas (myomas or uterine fibroids) Benign smooth
muscle tumors in the myometrium The most common benign tumors of the
uterus (affecting as many as 70-80% of all women) Most remain small,
asymptomatic, and clinically insignificant Prevalence increases in women age
30-50, but decreases with menopause Cause: unknown; size appears to be
related to estrogen, progesterone, growth factors, angiogenesis, and apoptosis
Location: occur in the fundus of the uterus in multiples, or singly throughout
Classification: subserous, submucous, or intramural (according to their location
within various layers of the uterine wall) Clinical manifestations: abnormal
uterine bleeding, pain, pressure on nearby structure May distort uterine cavity
and increases uterine surface area which can explain increased bleeding
Evaluation: bimanual examination > uterine enlargement and irregular,
nontender nodularity of the uterus; confirm diagnosis with pelvic sonography or
MRI Treatment: dependent on symptoms, tumor size, age, reproductive status,
overall health, women's preference
Question 6.
What is PCOS and what does it cause? Clinical manifestations? Treatment? Causes?
Pathophysiology?
Correct Answer: Most common cause of anovulation and ovulatory dysfunction;
leading cause of infertility in the U.S. Associated with metabolic dysfunction >
dyslipidemia, insulin resistance, and obesity Defined at least two of the
following features: irregular ovulation elevated levels of androgen (ex:
testosterone) appearance of polycystic ovaries on ultrasound—polycystic
ovaries do not have to be present (their presence alone does not establish the
diagnosis) Pathophysiology of PCOS: strong genetic component suspected
Hyperandrogenic state is a cardinal feature Glucose intolerance/insulin
resistance run parallel to and markedly aggravate the hyperandrogenic state >
, severity of s/s of PCOS Clinical manifestations of PCOS: usually appear within 2
years of puberty (may present after a variable period of normal menstruation
function and possibly pregnancy) Goals of Treatment: reversing s/s of androgen
excess instituting cyclic menstruation restoring fertility ameliorating any
associated metabolic or endocrine or both disturbances Treatment of PCOS:
First-line > combined oral contraceptives for management of s/s and to
establish regular menses Overweight or obese women > lifestyle modifications
(regular exercise and weight loss) Women with insulin resistance, or those
women who do not respond to contraceptive therapy > insulin sensitizer
Metformin If oral contraceptives are not used and pregnancy is not desired >
progesterone therapy is recommended to oppose estrogen's effects on the
endometrium (means to initiate monthly withdrawal bleeding)
Question 7.
What is the difference between primary and secondary amenorrhea?
Correct Answer: Primary amenorrhea: Failure of menarche and the absence of
menstruation by age 13 years, without the development of secondary sex
characteristics, or by age 15 regardless of the presence of secondary sex
characteristics. It differs from delayed puberty in that most cases of delayed
puberty require on reassurance, but when the diagnosis of primary amenorrhea
is reached, a thorough evaluation is needed. Secondary amenorrhea: The
absence of regular menses for 3 months or irregular menses for 6 months in
women who have previously menstruated. Pregnancy is the most common
condition to exclude before further evaluation. Common causes (after
pregnancy): thyroid disorders, hyperprolactinemia, HPO interruption secondary
to excessive exercise, stress, weight loss and polycystic ovary syndrome
(PCOS). Compartment II: Disorders which involve the ovary and are often linked
with genetic abnormalities. These include gonadal dysgenesis (Turner
Syndrome) or androgen insensitivity syndrome (AIS).
Question 8.
What are the signs of puberty in girls and boys? What delays puberty?
Correct Answer: Puberty is the onset of sexual maturation and differs from
adolescence. Adolescence is the stage of human development between
childhood and adulthood. GIRLS: begins at about 8-9 years of age with thelarche
(breast development, one of the first signs of puberty in girls) BOYS: begins at
about 11 years of age occurs with increased weight and body mass index
Influences on timing: genetics, environment, ethnicity, general health, and
nutrition Reproductive maturation involves the hypothalamic pituitary-gonadal
(HPG) axis, the CNS, and the endocrine system A sequential series of hormonal
events promotes sexual maturation as puberty approaches About 1 year before
puberty in girls > increase in frequency and amplitude of nocturnal pulses of
gonadotropin secretion, LH, and FSH, and an increased response in the pituitary
to GnRH > stimulates gonadal maturation (gonadarche) with estradiol secretion
in girls and testosterone secretion in boys o Estradiol causes breast
development (thelarche), maturation of the reproductive organs, (vagina,
uterus, ovaries) and fat deposit in hips in girls. o Estrogen and increased
Question 1.
Know all STIS: pathophysiology, etiology, clinical manifestations, diagnostic tests,
treatment, and complications. How is each transmitted during pregnancy to the fetus?
Know the different stages of syphilis; what organism causes each STI and is it viral,
bacterial etc.? Do you treat both partners and why? What age group has the greatest risk
of STIs and why? What causes cervical cancer
Correct Answer: FOUR STAGES OF SYPHILLIS Primary Syphilis (incubation period
ranges from 12 days to 12 weeks average of three weeks): Local bacterial
invasion: multiplies in epithelium and produces a granulomatous tissue
(chancre) at the site > Consider syphilis with any open lesion Chancre (eroded,
painless, firm and indurated ulcer <2cm in diameter) Some microorganisms
drain with lymph into adjacent lymph nodes. Cell-mediated and humoral immune
responses are stimulated within the nodes and at the site of the chancre. o If
left untreated, heals in 2-8 weeks, disappears with no scar Secondary Syphilis
(usually 6 weeks after first appearance of chancre - may overlap with primary
stage): Systemic > blood borne bacteria is spread to all major organ systems.
Followed by a period during which the immune system is able to suppress
infection. Even without treatment, spontaneous resolution of the skin lesions
occurs > individual enters latent stage of infection (relapses may occur for
several years) Typically, this stage presents with low-grade fever, malaise, sore
throat, hoarseness, anorexia, generalized adenopathy, headache, joint paint,
lymphadenopathy, pruritus, and skin or mucous membrane lesions or rashes
(e.g., condylomata lata). Women > appear in perineum, vulva, inner thigh, anal
area & groin Men > inner thigh and anal area
Question 2.
Correct Answer: Latent Syphilis (may be as short as 1 year or as long as a
lifetime): Subdivided into early and late stages even though no criteria to
delineate one from the other. Silent infection: medical history and serologic
studies show that syphilis is present, but the individual has no clinical
manifestations Transmission of infection is possible during both late and early
latent stages Tertiary Syphilis rare as antibiotics cure syphilis: Most severe
stage, involving significant morbidity and mortality (non-infectious disease)
Destructive skin, bone, and soft skin lesions called gummas develop, which
result from a severe hypersensitivity reaction to the microorganism.
Cardiovascular complications > aneurysms, heart valve insufficiencies, and
heart failure. CNS > possible manifestations of neurosyphilis may develop (this
may occur at any stage of syphilis infection). EVALUATION Early diagnosis
depends on darkfield microcopy of specimen from infected site. If initial result
negative, test is repeated on 2 successive days 2 categories of serologic testing
exist: 1. nontreponemal antigen > show presence of reagin (a group of
antibodies present in syphilis) in serum > provide indirect evidence of infection
a. VDRL antigen /RPR test - Yield positive results in >50% individuals with
,primary & 100% in secondary > useful in screening/assessing treatment
response > high rates of false positives 2. treponemal antibody a. done if VDRL
antigen (RPR test is positive) b. used to assess for antibody response to T.
pallidum c. include enzyme immunoassays (EIAs) FTA-AB test & TP-PA assay
During latent phase - patients can have positive serologic evidence, but
confirmation must include presence of treponemata in cerebrospinal fluid to
confirm.
Question 3.
Correct Answer: Preferred treatment for all stages is parenteral injection of
benzathine PCN G. - no other types of penicillin are effective TREATMENT: If <1
year infected > 1 IM dose is appropriate If >1 year infected; asymptomatic and
assumed to be in late stage > treatment is 3 weekly injections Penicillin is okay
for pregnant women (prevent vertical transmission to baby) Non-pregnant
women who are allergic to PCN receive Doxycycline 100mg BID x14 days
Pregnant women with PCN allergy should be desensitized then treated with PCN
G since tetracycline causes permanent, lifelong discoloration of fetus teeth.
Repeated assessment of VDRL and RPR titers = determine effectiveness of
treatment > titers should decrease 4-fold Sexual partners are examined and
treated and use of condoms recommended until treatment If infants require
treatment, PCN is drug of choice. Infants are given serologic tests for syphilis
every 2-3 months until test becomes nonreactive or titer has decreased 4-fold.
An individual has syphilis, secondary stage. What will the nurse typically find
upon assessment? Low grade fever, malaise, and sore throat. Typically, this
stage (secondary) presents with variable systemic symptoms, including
low-grade fever, malaise, sore throat, hoarseness, anorexia, generalized
adenopathy, headache, joint pain, and skin or mucous membrane lesions or
rashes.
Question 4.
Correct Answer: Age Group with Highest Risk of STDs Each year in the United
States, 19 million individuals contract a sexually transmitted infection; half of
those infected are younger than 25 years of age. Partly because of risk-taking
behavior (unprotected intercourse or selection of high-risk partners),
adolescents have the greatest risk for STI exposure and infection. In addition,
adolescent women may have a physiologically increased susceptibility to
infections of cervical immaturity. Is prevalent in ALL socioeconomic and racial or
ethnic groups. CDC does not require that all STI's be reported, so most private
MD's don't but health Departments do. Thus, the reasoning it appears urban &
lower income population. Etiology may be bacterial, viral, protozoal, parasitic,
or fungal Cause of Cervical Cancer It is now known that infection with
persistent, high-risk serotypes of HPV is necessary for the development of
cervical or anal cancer. More than 120 different types of HPV have been
identified. More than 40 serotypes are unique to the stratified squamous
epitheliums of the genital area. These are divided into serotypes that have a
high risk of causing cervical cancer and low-risk serotypes, which are associated
,with benign genital lesions or warts. High-risk types 16 and 18 are the most
common, causing up to 70% of anogenital cancers. Low-risk subtypes can
coexist with the high-risk types, but do not cause cancer. Most cases occur in
post-menopausal women ages 50-60 with mortality of African American women
twice as high. Fortunately, most cases of HP are transient and resolve on their
own within 2 years. Persistence of the virus, immune response, and the
presence of cofactors, including smoking and hormonal contraceptive exposure,
may play a role in the development of cervical dysplasia and cancer following
HPV exposure.
Question 5.
Understand the different uterine tumor types.
Correct Answer: Leiomyomas (myomas or uterine fibroids) Benign smooth
muscle tumors in the myometrium The most common benign tumors of the
uterus (affecting as many as 70-80% of all women) Most remain small,
asymptomatic, and clinically insignificant Prevalence increases in women age
30-50, but decreases with menopause Cause: unknown; size appears to be
related to estrogen, progesterone, growth factors, angiogenesis, and apoptosis
Location: occur in the fundus of the uterus in multiples, or singly throughout
Classification: subserous, submucous, or intramural (according to their location
within various layers of the uterine wall) Clinical manifestations: abnormal
uterine bleeding, pain, pressure on nearby structure May distort uterine cavity
and increases uterine surface area which can explain increased bleeding
Evaluation: bimanual examination > uterine enlargement and irregular,
nontender nodularity of the uterus; confirm diagnosis with pelvic sonography or
MRI Treatment: dependent on symptoms, tumor size, age, reproductive status,
overall health, women's preference
Question 6.
What is PCOS and what does it cause? Clinical manifestations? Treatment? Causes?
Pathophysiology?
Correct Answer: Most common cause of anovulation and ovulatory dysfunction;
leading cause of infertility in the U.S. Associated with metabolic dysfunction >
dyslipidemia, insulin resistance, and obesity Defined at least two of the
following features: irregular ovulation elevated levels of androgen (ex:
testosterone) appearance of polycystic ovaries on ultrasound—polycystic
ovaries do not have to be present (their presence alone does not establish the
diagnosis) Pathophysiology of PCOS: strong genetic component suspected
Hyperandrogenic state is a cardinal feature Glucose intolerance/insulin
resistance run parallel to and markedly aggravate the hyperandrogenic state >
, severity of s/s of PCOS Clinical manifestations of PCOS: usually appear within 2
years of puberty (may present after a variable period of normal menstruation
function and possibly pregnancy) Goals of Treatment: reversing s/s of androgen
excess instituting cyclic menstruation restoring fertility ameliorating any
associated metabolic or endocrine or both disturbances Treatment of PCOS:
First-line > combined oral contraceptives for management of s/s and to
establish regular menses Overweight or obese women > lifestyle modifications
(regular exercise and weight loss) Women with insulin resistance, or those
women who do not respond to contraceptive therapy > insulin sensitizer
Metformin If oral contraceptives are not used and pregnancy is not desired >
progesterone therapy is recommended to oppose estrogen's effects on the
endometrium (means to initiate monthly withdrawal bleeding)
Question 7.
What is the difference between primary and secondary amenorrhea?
Correct Answer: Primary amenorrhea: Failure of menarche and the absence of
menstruation by age 13 years, without the development of secondary sex
characteristics, or by age 15 regardless of the presence of secondary sex
characteristics. It differs from delayed puberty in that most cases of delayed
puberty require on reassurance, but when the diagnosis of primary amenorrhea
is reached, a thorough evaluation is needed. Secondary amenorrhea: The
absence of regular menses for 3 months or irregular menses for 6 months in
women who have previously menstruated. Pregnancy is the most common
condition to exclude before further evaluation. Common causes (after
pregnancy): thyroid disorders, hyperprolactinemia, HPO interruption secondary
to excessive exercise, stress, weight loss and polycystic ovary syndrome
(PCOS). Compartment II: Disorders which involve the ovary and are often linked
with genetic abnormalities. These include gonadal dysgenesis (Turner
Syndrome) or androgen insensitivity syndrome (AIS).
Question 8.
What are the signs of puberty in girls and boys? What delays puberty?
Correct Answer: Puberty is the onset of sexual maturation and differs from
adolescence. Adolescence is the stage of human development between
childhood and adulthood. GIRLS: begins at about 8-9 years of age with thelarche
(breast development, one of the first signs of puberty in girls) BOYS: begins at
about 11 years of age occurs with increased weight and body mass index
Influences on timing: genetics, environment, ethnicity, general health, and
nutrition Reproductive maturation involves the hypothalamic pituitary-gonadal
(HPG) axis, the CNS, and the endocrine system A sequential series of hormonal
events promotes sexual maturation as puberty approaches About 1 year before
puberty in girls > increase in frequency and amplitude of nocturnal pulses of
gonadotropin secretion, LH, and FSH, and an increased response in the pituitary
to GnRH > stimulates gonadal maturation (gonadarche) with estradiol secretion
in girls and testosterone secretion in boys o Estradiol causes breast
development (thelarche), maturation of the reproductive organs, (vagina,
uterus, ovaries) and fat deposit in hips in girls. o Estrogen and increased
