NSG 6330 FINAL EXAM

NSG 6330 Final EXAM Study Guide QUESTIONS AND ANSWERS How is HIV transmitted? Vertical transmission from a mother to her baby, blood transfusion, or exchange of any blood products HIV risk factors are all of these except: Unprotected sex or trauma with sexual activity or multiple partners IV drug use, including shared syringes 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 Treatment, although not curative, is critical for the best outcome possible. One important principle of antiretroviral therapy is: 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? 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) 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: Bartholin's 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. A possible incision might be necessary and a catheter placed for two to four weeks to allow for drainage and appropriate healing. Bartholin's Cyst If a Bartholin duct gets blocked, fluid builds up in the gland. The blocked gland is called a Bartholin gland cyst 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: 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 __________. the woman's symptom history to date Anticholinergic medications are a type of treatment for which type of incontinence? Urge incontinence Treatment for stress incontinence can include: All of the above A well-woman visit for an adolescent should include which of the following? Both b and c (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 externalonly inspection of the genitalia) 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.) 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? Anovulation Anovulation - 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: Endometriosis Polycystic ovaries predispose women to a higher incidence of: Endometrial cancer A definitive diagnosis of endometriosis cannot be made until which of these is completed? 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 _________. 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? 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? Pap smear Which of the following characteristics is not associated with psychosocial development problems in adolescence? 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 _____. 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 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? 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? Anovulation Anovulation - 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? 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? Cesarean section The nurse practitioner understands that premenstrual syndrome (PMS) occurs with greatest frequency and severity in the ___________. 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? NuvaRing A pregnant client in your practice is experiencing nausea and vomiting in her first trimester. Which of the following would you suggest to alleviate the problem? Eating small meals at frequent intervals, avoiding spicy or fatty foods Natasha is an eleven-year-old girl brought to your office for an annual wellchild visit. When discussing the onset of puberty with Natasha and her mother, you would emphasize which of the following? The average age of menarche is twelve years. Suzanne, a forty-six-year-old client, reports shortened menstrual cycles for one year. The most likely diagnosis is __________. Perimenopause Maria, fifty-two years old, comes in for her annual well-woman examination. LMP was fourteen months ago. You would document this as ____________. Menopause Strategies to protect teenagers from risks include all of the following except _________. pairing young adolescents with middle adolescents In caring for a menopausal client who has had a total hysterectomy, the nurse practitioner would include which of the following options? Estrogen alone Alicia lived in foster care for several years before being placed in a new city. She is in tenth grade. Which of the following aspects of her life protect her from risk? A female teacher with whom she can talk about her problems Elizabeth, twenty-four years old, is pregnant, and you are educating her on common problems during the first trimester. Which of the following is abnormal and requires immediate attention? Vaginal bleeding Beth, a sixty-two-year-old woman, is seen for a follow-up discussion of DEXA scan result of minus 1.5 standard deviation (SD) at the hip. Her PMH includes a recent myocardial infarction and a fractured wrist at fifty-eight years of age. Which of the following would not be an option for her? Continuous conjugated estrogen 0.625 mg and medroxyprogesterone acetate (MPA) 2.5 mg (Prempro) p.o. daily A woman has been diagnosed with polycystic ovary syndrome (PCOS). Management of PCOS includes all of the following except ___________. daily basal insulin to reduce blood sugar A nurse practitioner is educating a woman who has a colposcopy ordered. Which of the following most accurately describes a colposcopy? A procedure that visualizes the vaginal, vulvar, or cervical epithelium with magnification to identify abnormal areas that may need to be biopsied Lakeisha, seventeen years old, is seeing her regular nurse practitioner for a sports physical. While participating in a psychosocial screen, Lakeisha volunteers that she "hasn't had sex yet." What is the best initial response to Lakeisha's statement? Clarify which behaviors are included in Lakeisha's definition of "having sex." A fourteen-year-old patient is accompanied by her mother, who is concerned about irregular and infrequent periods. Her last menstrual period was two months ago. What would be the initial test performed? Urine HCG Lenore, fifty-five years old, comes in for evaluation of a breast mass. Which of the following is not usually linked with carcinoma of the breast? Well-circumscribed, rubbery, and tender lesion Frankie is concerned that she has an ultrasound ordered after the results of her mammogram of been reviewed by the nurse practitioner. You emphasize that the primary role of a breast ultrasound is to _____. determine if a breast lesion is cystic or solid A patient is complaining of a milky nipple discharge. Galactorrhea is usually a finding with which other diagnosis? Hyperprolactinemia The nurse practitioner is completing a follow-up visit on a woman who was previously prescribed hormonal therapy (HT), which she has not taken for the last month. The primary reason the patient discontinued HT is _________. vaginal bleeding