NSG 6330 Final Study Guide with 100% correct answers

How is HIV transmitted 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: Unprotected sex or trauma with sexual activity or multiple partners IV drug use, including shared syringes Exchange of saliva 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 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. 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 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 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 Bartholin's cyst 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 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. 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. 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 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 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 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 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). 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 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: PID Fibroids Endometriosis Endometritis Endometriosis Polycystic ovaries predispose women to a higher incidence of: Adrenal tumors Ovarian cancer Endometrial cancer Endometriosis Endometrial cancer A definitive diagnosis of endometriosis cannot be made until which of these is completed? CT scan Transvaginal ultrasound Exploratory laparoscopy MRI 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 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. 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 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 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 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 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 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 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? 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. 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 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 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 Depo-Provera Ortho Evra patch NuvaRing 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? Avoiding all carbonated beverages, including sodas and seltzer water Eating small meals at frequent intervals, avoiding spicy or fatty foods Avoiding eating the first thing on awakening in the morning Taking additional iron and prenatal vitamins 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 well-child visit. When discussing the onset of puberty with Natasha and her mother, you would emphasize which of the following? Pubic hair develops before breast buds. Breast development delayed beyond twelve years of age may be considered pathological. The average age of menarche is twelve years. It usually takes about three-and-half years to go from breast buds to menarche. 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 __________. anovulatory bleeding menopause perimenopause breakthrough bleeding perimenopause Maria, fifty-two years old, comes in for her annual well-woman examination. LMP was fourteen months ago. You would document this as ____________. secondary amenorrhea menopause perimenopause primary ovarian failure menopause Strategies to protect teenagers from risks include all of the following except _________. involving them in community activities for a worthy cause encouraging them to participate in teambuilding sports pairing young adolescents with middle adolescents involving them in school-related activities 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 Estrogen and progestin Progestin and testosterone Testosterone alone 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? Her recent move to a new city and school Occasional alcohol use while at parties Friendships with two teen girls who have "been around the foster care system" A female teacher with whom she can talk about her problems 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? Nausea and vomiting (aka "morning sickness") Fatigue and tiredness Back ache in the lumbar area Vaginal bleeding 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 Counseling on smoking cessation and alcohol consumption Ibandronate (Boniva) 150 mg p.o. once monthly in the a.m. Encouraging weight-bearing exercises and increased calcium intake 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 ___________. oral contraceptives to establish a regular menstrual cycle a planned program of regular exercise consult with dietician for weight management daily basal insulin to reduce blood sugar 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 A procedure to visualize the uterine cavity through a small, fiber-optic scope introduced through the cervix A procedure to remove a sample of endometrial tissue with a curette or an aspiration tool for biopsy A procedure to visualize the abdominal and pelvic cavity by fiber-optic endoscope via a subumbilical incision 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? Congratulate her for abstaining and move on to another topic. Clarify which behaviors are included in Lakeisha's definition of "having sex." Demonstrate condom use and give Lakeisha some condoms for future partners. Encourage Lakeisha to be screened for STIs. Clarify which behaviors are included in Lakeisha's definition of "having sex."