NU 631 EXAMINATION QUESTIONS AND VERIFIED
ANSWERS
28. The cytology (Pap smear) result for a 21-year-old sexually active student whose partner
uses condoms inconsistently shows a large amount of inflammation. Which of the following
is the best follow-up?
A) Call the patient and tell her that she needs to return to the clinic for chlamydia and
gonorrhea testing
B) Treat the patient with metronidazole vaginal cream over the phone
C) Call the patient and tell her she will need a repeat Pap smear in 6 months
D) Advise her to use a Betadine douche at H (half strength) × 3 days - 28. A) Call the patient and
tell her that she needs to return to the clinic for chlamydia and
gonorrhea testing The patient may have cervicitis and needs to be screened for gonorrhea
and chlamydia infection.
29. While performing a Pap smear on a postmenopausal patient, several areas of flat white,
irregularly shaped lesions are found on the patient's labia. The skin lesions look thin and
atrophic. The patient reports that the lesions are itchy and have been present for several
years. Which condition is best described?
A) Chronic scabies infection
B) Lichen sclerosus
C) Chronic candidal vaginitis
D) A physiological variant found in some older women - 29. B) Lichen sclerosis Lichen sclerosus is
more common in older women. It is a long-term
chronic condition that affects the vulva and/or anal area in women. The lesions appear
as small white spots early in the disease and grow into bigger patches. Itching is very
common; however, other symptoms include discomfort, bleeding from skin tears, and
blisters. A skin biopsy allows for differentiation from other dermatological conditions.
33. Human papillomavirus (HPV) infection of the larynx has been associated with:
A) Laryngeal cancer
,B) Esophageal stricture
C) Cervical cancer
D) Metaplasia of the squamous cells - 33. A) Laryngeal cancer Human papillomavirus (HPV)
exposure is a risk factor in laryngeal
cancer. HPV DNA transforms the moist membranes of epithelial cells (cervix, anus,
mouth, and throat). The juvenile type is related to vertical transmission and the adult
type to orogenital contact. HPV subtype 16 accounts for the majority of oral tumors,
oropharynx cancers, and laryngeal cases.
42. A 22-year-old sexually active woman is complaining of amenorrhea and new-onset
bloody vaginal spotting. On examination, her left adnexa is tender and cervical motion
tenderness is positive. Which test should the nurse practitioner order initially?
A) Flat plate of the abdomen
B) Complete blood count (CBC) with white cell differential
C) Urine pregnancy test
D) Pelvic ultrasound - C) Urine pregnancy test
114. During a breast exam of a 30-year-old nulliparous woman, the nurse practitioner palpates
several rubbery mobile areas of breast tissue. They are slightly tender to palpation.
Both breasts have symmetrical findings. There are no skin changes or any nipple discharge.
The patient is expecting her menstrual period in 5 days. Which of the following
would you recommend?
A) Referral to a gynecologist for further evaluation
B) Advise the patient to return 1 week after her period so her breasts can be rechecked
C) Advise the patient to return in 6 months to have her breasts rechecked
D) Schedule the patient for a mammogram - 114. B) Advise the patient to return 1 week after her
period so her breasts can be
rechecked Symptoms of fibrocystic breast disease include cyclic tenderness with
prominent breast tissue that is present in both breasts. The symptoms are worse about 1
week before menses. A few days after menses starts, the bloating and breast tenderness
resolve. Symptoms are caused by elevated hormone levels (progesterone). Fibrocystic
,disease is differentiated from breast cancer by the lack of a dominant mass or other
symptoms such as peau d'orange, dimpling, retraction, or eczema-like rash on the nipples
and areola.
123. You are checking a 75-year-old woman's breast during an annual gynecological exam.
The left nipple and areola are scaly and reddened. The patient denies pain or pruritus.
She has noticed this scaliness on her left nipple for the past 8 months. Her dermatologist
gave her a potent topical steroid, which she used twice a day for 1 month. The patient
never went back for the follow-up. She still has the rash and wants an evaluation. Which
of the following is the best intervention for this patient?
A) Prescribe another potent topical steroid and tell the patient to use it twice a day for
4 weeks
B) Order a mammogram and refer the patient to a breast surgeon
C) Advise the patient to stop using soap on her breasts when she bathes to avoid drying
up the skin on her areolae and nipples
D) Order a sonogram of the breast and fine-needle biopsy of the breast - 123. B) Order a
mammogram and refer the patient to a breast surgeon A scaly, reddened
rash on the breast that does not resolve after a few weeks of medical treatment may
indicate breast cancer. She should have a mammogram performed and see a breast surgeon
for evaluation and treatment. Paget's disease of the breast is a rare type of cancer
involving the skin of the nipple and, usually, the areola. It may be misdiagnosed at first
because its early symptoms are similar to those caused by some benign skin conditions.
Most patients with Paget's disease of the breast also have one or more tumors inside the
same breast, either ductal carcinoma in situ or invasive breast cancer.
161. You are reviewing a Pap smear result for a 25-year-old woman. Which of the following
cells should be obtained in a Pap smear sample to be classified as a satisfactory specimen?
A) Clue cells and endometrial cells
B) Vaginal cells and cervical cells
C) Squamous epithelial cells and endocervical cells
, D) Leukocytes and RBCs - 161. C) Squamous epithelial cells and endocervical cells An optimal Pap
smear sample
contains sufficient mature and metaplastic squamous cells to indicate adequate sampling
from the transformation zone and sufficient endocervical cells to indicate that the
upper limit of the transformation zone was sampled, and to provide a sample for screening
for adenocarcinoma and its precursors.
208. Women with a history of pelvic inflammatory disease (PID) have an increased risk for all
of the following complications except:
A) Ectopic pregnancy
B) Scarring of the fallopian tubes
C) Infertility
D) Ovarian cysts - 208. D) Ovarian cysts Women with a history of pelvic inflammatory disease (PID)
have a
higher risk of ectopic pregnancy, scarring of the fallopian tubes, and infertility due to the
scarring of the fallopian tube(s).
262. A 65-year-old woman's bone density result shows severe demineralization of cortical bone.
All of the following pharmacological agents are useful in treating this condition except:
A) Raloxifene (Evista)
B) Calcitonin (Miacalcin)
C) Medroxyprogesterone (Depo-Provera)
D) Calcium with vitamin D - 262. C) Medroxyprogesterone (Depo-Provera) Long-term use (>3
years) of medroxyprogesterone
(Depo-Provera) increases risk of bone loss. Avoid with osteopenia, osteoporosis,
long-term amenorrhea, or in underweight women with anorexia. First-line treatment
of osteoporosis is the biphosphanates. Lifestyle measures are weight-bearing exercises
and adequate calcium and vitamin D intake.
297. The most common cause of cancer deaths for women in the United States is:
A) Breast cancer
B) Lung cancer
C) Colon cancer
ANSWERS
28. The cytology (Pap smear) result for a 21-year-old sexually active student whose partner
uses condoms inconsistently shows a large amount of inflammation. Which of the following
is the best follow-up?
A) Call the patient and tell her that she needs to return to the clinic for chlamydia and
gonorrhea testing
B) Treat the patient with metronidazole vaginal cream over the phone
C) Call the patient and tell her she will need a repeat Pap smear in 6 months
D) Advise her to use a Betadine douche at H (half strength) × 3 days - 28. A) Call the patient and
tell her that she needs to return to the clinic for chlamydia and
gonorrhea testing The patient may have cervicitis and needs to be screened for gonorrhea
and chlamydia infection.
29. While performing a Pap smear on a postmenopausal patient, several areas of flat white,
irregularly shaped lesions are found on the patient's labia. The skin lesions look thin and
atrophic. The patient reports that the lesions are itchy and have been present for several
years. Which condition is best described?
A) Chronic scabies infection
B) Lichen sclerosus
C) Chronic candidal vaginitis
D) A physiological variant found in some older women - 29. B) Lichen sclerosis Lichen sclerosus is
more common in older women. It is a long-term
chronic condition that affects the vulva and/or anal area in women. The lesions appear
as small white spots early in the disease and grow into bigger patches. Itching is very
common; however, other symptoms include discomfort, bleeding from skin tears, and
blisters. A skin biopsy allows for differentiation from other dermatological conditions.
33. Human papillomavirus (HPV) infection of the larynx has been associated with:
A) Laryngeal cancer
,B) Esophageal stricture
C) Cervical cancer
D) Metaplasia of the squamous cells - 33. A) Laryngeal cancer Human papillomavirus (HPV)
exposure is a risk factor in laryngeal
cancer. HPV DNA transforms the moist membranes of epithelial cells (cervix, anus,
mouth, and throat). The juvenile type is related to vertical transmission and the adult
type to orogenital contact. HPV subtype 16 accounts for the majority of oral tumors,
oropharynx cancers, and laryngeal cases.
42. A 22-year-old sexually active woman is complaining of amenorrhea and new-onset
bloody vaginal spotting. On examination, her left adnexa is tender and cervical motion
tenderness is positive. Which test should the nurse practitioner order initially?
A) Flat plate of the abdomen
B) Complete blood count (CBC) with white cell differential
C) Urine pregnancy test
D) Pelvic ultrasound - C) Urine pregnancy test
114. During a breast exam of a 30-year-old nulliparous woman, the nurse practitioner palpates
several rubbery mobile areas of breast tissue. They are slightly tender to palpation.
Both breasts have symmetrical findings. There are no skin changes or any nipple discharge.
The patient is expecting her menstrual period in 5 days. Which of the following
would you recommend?
A) Referral to a gynecologist for further evaluation
B) Advise the patient to return 1 week after her period so her breasts can be rechecked
C) Advise the patient to return in 6 months to have her breasts rechecked
D) Schedule the patient for a mammogram - 114. B) Advise the patient to return 1 week after her
period so her breasts can be
rechecked Symptoms of fibrocystic breast disease include cyclic tenderness with
prominent breast tissue that is present in both breasts. The symptoms are worse about 1
week before menses. A few days after menses starts, the bloating and breast tenderness
resolve. Symptoms are caused by elevated hormone levels (progesterone). Fibrocystic
,disease is differentiated from breast cancer by the lack of a dominant mass or other
symptoms such as peau d'orange, dimpling, retraction, or eczema-like rash on the nipples
and areola.
123. You are checking a 75-year-old woman's breast during an annual gynecological exam.
The left nipple and areola are scaly and reddened. The patient denies pain or pruritus.
She has noticed this scaliness on her left nipple for the past 8 months. Her dermatologist
gave her a potent topical steroid, which she used twice a day for 1 month. The patient
never went back for the follow-up. She still has the rash and wants an evaluation. Which
of the following is the best intervention for this patient?
A) Prescribe another potent topical steroid and tell the patient to use it twice a day for
4 weeks
B) Order a mammogram and refer the patient to a breast surgeon
C) Advise the patient to stop using soap on her breasts when she bathes to avoid drying
up the skin on her areolae and nipples
D) Order a sonogram of the breast and fine-needle biopsy of the breast - 123. B) Order a
mammogram and refer the patient to a breast surgeon A scaly, reddened
rash on the breast that does not resolve after a few weeks of medical treatment may
indicate breast cancer. She should have a mammogram performed and see a breast surgeon
for evaluation and treatment. Paget's disease of the breast is a rare type of cancer
involving the skin of the nipple and, usually, the areola. It may be misdiagnosed at first
because its early symptoms are similar to those caused by some benign skin conditions.
Most patients with Paget's disease of the breast also have one or more tumors inside the
same breast, either ductal carcinoma in situ or invasive breast cancer.
161. You are reviewing a Pap smear result for a 25-year-old woman. Which of the following
cells should be obtained in a Pap smear sample to be classified as a satisfactory specimen?
A) Clue cells and endometrial cells
B) Vaginal cells and cervical cells
C) Squamous epithelial cells and endocervical cells
, D) Leukocytes and RBCs - 161. C) Squamous epithelial cells and endocervical cells An optimal Pap
smear sample
contains sufficient mature and metaplastic squamous cells to indicate adequate sampling
from the transformation zone and sufficient endocervical cells to indicate that the
upper limit of the transformation zone was sampled, and to provide a sample for screening
for adenocarcinoma and its precursors.
208. Women with a history of pelvic inflammatory disease (PID) have an increased risk for all
of the following complications except:
A) Ectopic pregnancy
B) Scarring of the fallopian tubes
C) Infertility
D) Ovarian cysts - 208. D) Ovarian cysts Women with a history of pelvic inflammatory disease (PID)
have a
higher risk of ectopic pregnancy, scarring of the fallopian tubes, and infertility due to the
scarring of the fallopian tube(s).
262. A 65-year-old woman's bone density result shows severe demineralization of cortical bone.
All of the following pharmacological agents are useful in treating this condition except:
A) Raloxifene (Evista)
B) Calcitonin (Miacalcin)
C) Medroxyprogesterone (Depo-Provera)
D) Calcium with vitamin D - 262. C) Medroxyprogesterone (Depo-Provera) Long-term use (>3
years) of medroxyprogesterone
(Depo-Provera) increases risk of bone loss. Avoid with osteopenia, osteoporosis,
long-term amenorrhea, or in underweight women with anorexia. First-line treatment
of osteoporosis is the biphosphanates. Lifestyle measures are weight-bearing exercises
and adequate calcium and vitamin D intake.
297. The most common cause of cancer deaths for women in the United States is:
A) Breast cancer
B) Lung cancer
C) Colon cancer
