NR 509 Final Exam Test Question and Answers
Know that in a 47-year-old man ED is usually ___________ rather than testosterone
Answer: psychologic
Erectile dysfunction may be from psychogenic causes, especially if
Answer: early morning erection is preserved.it may also reflect decreased testosterone, decreased blood
flow in the hypogastric arterial system, impaired neural innervation, and diabetes
When performing a breast exam, know what abnormal masses should do when the arm
Answer: may be fixed to skin or underlying tissues (may cause dimpling of skin or retraction when arms
are lifted over head or hands are pressed against hips)
Fibro adenoma and cysts mobility
Answer: very mobile/mobile
Know that a high proportion of breast masses are noted during ________
Answer: BSE
Breast stage 1
Answer: preadolescent- elevation of nipple only
Breast stage 2
Answer: breast bud stage- elevation of breast and nipple as a small mound; enlargement of areolar
diameter
breast stage 3
Answer: further enlargement of elevation of breast and areola, with no separation of their contours
breast stage 4
Answer: projection of areola and nipple to form a secondary mound above the level of breast
breast stage 5
Answer: mature stage- projection of nipple only; areola has receded to general contour of the breast
(although in some individuals the areola continues to form a secondary mound)
Know where pain is located with pancreatitis: acute
Answer: epigastric, may radiation straight to the back of other areas of the abdomen; 20% with severe
sequelae of organ failure
Know where pain is located with pancreatitis: chronic
Answer: epigastric, radiating to back
Know how hepatitis A is transmitted
Answer: Transmitted through fecal-oral route. Fecal shedding followed by poor handwashing
contaminates water and foods leading to infection of household and sexual contacts
,Stress incontinence
Answer: the urethral sphincter is weakened so that transient increases in intra-abdominal pressure raise
the bladder pressure to levels that exceed urethral resistance. Causes include childbirth and surgery,
postmenopausal atrophy of the mucosa, and urethral infection. May follow prostate surgery in men.
urge incontinence
Answer: detrusor contractions are stronger than normal and overcome the normal urethral resistance.
The bladder is typically small. Mechanisms: Decreased cortical inhibition of detrusor contractions from
stroke, brain tumor, dementia, and lesions of the spinal cord above sacral level. Also hyperexcitability of
sensory pathways ie: bladder infections, tumors, and fecal impaction. Deconditioning of voiding reflexes
ie: frequent voluntary voiding at low bladder volumes.
overflow incontinence
Answer: detrusor contractions are insufficient to overcome urethral resistance, causing urinary
retention. The bladder is typically flaccid and large, even after an effort to void. Mechanisms:
obstruction of the bladder outlet ie: BPH or tumor. Weakness of the detrusor muscle associated with
peripheral nerve disease at S2-4 level. Impaired bladder sensation that interrupts the reflex arc ie:
diabetic neuropathy.
functional incontinence
Answer: the patient is functionally able to reach the toilet in time because of impaired health or
environmental conditions. Mechanism: problems in mobility resulting from weakness, arthritis, poor
vision, or other conditions. Also environmental factors such as an unfamiliar setting, distant bathroom
facilities, bed rails, or physical restraints.
Incontinence secondary to medications
Answer: drugs may contribute to any type of incontinence listed. Ex: sedatives, tranquilizers,
anticholinergics, sympathetic blockers, and potent diuretics
Know where lymph nodes should be with strep
Answer: Strep throat streptococcal pharyngitis, bacterial infection that may cause a sore, scratchy
throat· Common childhood infection has a classic presentation of erythema of the posterior pharynx and
palatal petechiae· Enlarged swollen cervical lymph nodes -> superficial cervical lymph nodes.Superficial
cervical -> superficial to the sternocleidomastoid
What vaccines are safe during pregnancy
Answer: tdap, flu, Pneumococcal, meningococcal, Hepatitis B, rho gam*NOT MMR, polio, or varicella
Know what to be concerned about if you note an irregular rectal mass
Answer: · Any masses with irregular borders suspicious for rectal cancer.A tender purulent reddened
mass with fever or chills suggests an anal abscess. Abscesses tunneling to the skin surface from the anus
or rectum may form a clogged or draining ano-rectal fistula. Fistulas may ooze blood, pus, or feculent
mucus. Consider colonoscopy or sigmoidoscopy for better visualization.
Know what HPV Vac protects against
Answer: · Prevents infection from HPV subtypes 16, 18, 6 & 11 which cause 90 % of genital warts
· The bivalent vaccine prevents infection from subtypes 16 and 18.
,· Recommended for prevention of cervical, vulvar, and vaginal cancers and precancers in females as well
as anal cancer, precancers, and genital warts in both female and males
· Vaccinated women should still get cervical cancer screening because vaccines do not prevent all HPV
subtypes
· Condoms do not eliminate the risk of cervical HPV infection
Recommended for those with compromised immune systems including HIV
Know what a 3-year-old can do in regard to jumping and balancing
Answer: · Climbs well, runs easily· Pedals a tricycle· Walks up and down stairs, one foot on each step
Know where to place measuring tape when measuring uterus in a pregnant patient
Answer: · Measure the fundal height if gestational age is >20 weeks
- fundus should reach the umbilicus
· Place tape measure on pubic symphysis and place the "zero" end of the tape measure when you can
firmly feel that bone.
· Extend the tape measure to the very top of uterine fundus and note the number of cm measured.
Subject to error between 16-36 weeks
· Number should roughly equal the number of weeks of gestation
If fundal height is >4cm than expected -multiple gestation, large fetus, extra amniotic fluid, uterine
leiomyoma
If fundal height is < 4cm than expected - low-level amniotic fluid, missed abortion, intrauterine growth
retardation, or fetal anomaly
The _______ _______ occupies most of the anterior cardiac surface
Answer: right ventricle
Know what bleeding between periods is called
Answer: Abnormal uterine bleeding, Intermenstrual bleeding
Know types of vaginosis
Answer: Trichomonal vaginitis, Candidal Vaginitis, Bacterial vaginosis
miliaria rubra
Answer: Scattered vesicles on an erythematous base, usually on the face and trunk, result from
obstruction of the sweat gland ducts; disappears spontaneously within weeks
Know the characteristics of a breast cyst
Answer: Usually soft to firm, round, mobile and often tender. Most common between the ages of 25-50
Know the signs of peritonitis
Answer: When tender area is palpated for guarding, early voluntary guarding may be replaced by
involuntary muscular rigidity and signs of peritoneal inflammation. There may also be RLQ pain on quick
withdrawal or deferred rebound tenderness.
Know where pain is with diverticulitis
Answer: LLQ
Know what position to have pt in to listen for mitral stenosis
, Answer: Left lateral decubitus
Know what to ask in regards to cardiovascular review of systems (pick the one that belongs)
Answer: Know what to ask in regards to cardiovascular review of systems (pick the one that belongs)
Know how a bartholin's gland infection presents
Answer: Acutely, the gland appears as a tense, hot, very tender abscess. Possible labial swelling. Look for
pus emerging from the duct or erythema around the duct opening. Chronically, a nontender cyst is felt
that may be large or small.
Know where pain is with appendicitis
Answer: RLQ pain or pain that migrates from the periumbilical region, combined with abdominal wall
rigidity on palpation is suspicious for appendicitis
Know how syphilis presents genitally
Answer: Female: syphilitic chancre- firm, painless ulcer from primary syphilis, forms approx. 21 days
after exposure to Treponema pallidum. It may remain hidden and undetected in the vagina and heals
regardless of treatment in 3-6 weeks.
Secondary syphilis (Condyloma lantum)- large raised, round or oval, flat-topped gray or white lesions
point to condylomata lata. These are contagious and, along with rash and mucus membrane sores in the
mouth, vagina, or anus are manifestations of secondary syphilis.
Male: Primary syphilis: small red papule that becomes a chancre, a painless erosion up to 2 cm in
diameter. Base of chancre is clean, red, smooth, and glistening; borders are raised and indurated.
Chancre heals within 3-8 weeks.
Know the signs of proctitis
Answer: Anorectal pain, itching, tenesmus, or discharge or bleeding from infection or rectal abscess
suggest proctitis.
Know what causes dark, bloody emesis
Answer: Hematemesis may accompany esophageal or gastric varices, Mallory-Weiss tears, or peptic
ulcer disease.
Know what causes an S3 heart sound
Answer: In children and young adults, a third heart sound (S3) may arise from rapid deceleration of the
column of blood against the ventricular wall. In an older adult, an S3 usually indicates a pathologic
change in ventricular compliance.
Know the signs of thrombophlebitis
Answer: Local swelling, redness, warmth, and a subcutaneous cord signal superficial thrombophlebitis
(an emerging risk factor for DVT).
Know what chalazion is
Answer: A subacute nontender, usually painless nodule caused by a blocked meibomian gland. May
become acutely inflamed, but unlike a stye, usually points inside the lid rather than on the lid margin.
Know what the lungs do with age
Know that in a 47-year-old man ED is usually ___________ rather than testosterone
Answer: psychologic
Erectile dysfunction may be from psychogenic causes, especially if
Answer: early morning erection is preserved.it may also reflect decreased testosterone, decreased blood
flow in the hypogastric arterial system, impaired neural innervation, and diabetes
When performing a breast exam, know what abnormal masses should do when the arm
Answer: may be fixed to skin or underlying tissues (may cause dimpling of skin or retraction when arms
are lifted over head or hands are pressed against hips)
Fibro adenoma and cysts mobility
Answer: very mobile/mobile
Know that a high proportion of breast masses are noted during ________
Answer: BSE
Breast stage 1
Answer: preadolescent- elevation of nipple only
Breast stage 2
Answer: breast bud stage- elevation of breast and nipple as a small mound; enlargement of areolar
diameter
breast stage 3
Answer: further enlargement of elevation of breast and areola, with no separation of their contours
breast stage 4
Answer: projection of areola and nipple to form a secondary mound above the level of breast
breast stage 5
Answer: mature stage- projection of nipple only; areola has receded to general contour of the breast
(although in some individuals the areola continues to form a secondary mound)
Know where pain is located with pancreatitis: acute
Answer: epigastric, may radiation straight to the back of other areas of the abdomen; 20% with severe
sequelae of organ failure
Know where pain is located with pancreatitis: chronic
Answer: epigastric, radiating to back
Know how hepatitis A is transmitted
Answer: Transmitted through fecal-oral route. Fecal shedding followed by poor handwashing
contaminates water and foods leading to infection of household and sexual contacts
,Stress incontinence
Answer: the urethral sphincter is weakened so that transient increases in intra-abdominal pressure raise
the bladder pressure to levels that exceed urethral resistance. Causes include childbirth and surgery,
postmenopausal atrophy of the mucosa, and urethral infection. May follow prostate surgery in men.
urge incontinence
Answer: detrusor contractions are stronger than normal and overcome the normal urethral resistance.
The bladder is typically small. Mechanisms: Decreased cortical inhibition of detrusor contractions from
stroke, brain tumor, dementia, and lesions of the spinal cord above sacral level. Also hyperexcitability of
sensory pathways ie: bladder infections, tumors, and fecal impaction. Deconditioning of voiding reflexes
ie: frequent voluntary voiding at low bladder volumes.
overflow incontinence
Answer: detrusor contractions are insufficient to overcome urethral resistance, causing urinary
retention. The bladder is typically flaccid and large, even after an effort to void. Mechanisms:
obstruction of the bladder outlet ie: BPH or tumor. Weakness of the detrusor muscle associated with
peripheral nerve disease at S2-4 level. Impaired bladder sensation that interrupts the reflex arc ie:
diabetic neuropathy.
functional incontinence
Answer: the patient is functionally able to reach the toilet in time because of impaired health or
environmental conditions. Mechanism: problems in mobility resulting from weakness, arthritis, poor
vision, or other conditions. Also environmental factors such as an unfamiliar setting, distant bathroom
facilities, bed rails, or physical restraints.
Incontinence secondary to medications
Answer: drugs may contribute to any type of incontinence listed. Ex: sedatives, tranquilizers,
anticholinergics, sympathetic blockers, and potent diuretics
Know where lymph nodes should be with strep
Answer: Strep throat streptococcal pharyngitis, bacterial infection that may cause a sore, scratchy
throat· Common childhood infection has a classic presentation of erythema of the posterior pharynx and
palatal petechiae· Enlarged swollen cervical lymph nodes -> superficial cervical lymph nodes.Superficial
cervical -> superficial to the sternocleidomastoid
What vaccines are safe during pregnancy
Answer: tdap, flu, Pneumococcal, meningococcal, Hepatitis B, rho gam*NOT MMR, polio, or varicella
Know what to be concerned about if you note an irregular rectal mass
Answer: · Any masses with irregular borders suspicious for rectal cancer.A tender purulent reddened
mass with fever or chills suggests an anal abscess. Abscesses tunneling to the skin surface from the anus
or rectum may form a clogged or draining ano-rectal fistula. Fistulas may ooze blood, pus, or feculent
mucus. Consider colonoscopy or sigmoidoscopy for better visualization.
Know what HPV Vac protects against
Answer: · Prevents infection from HPV subtypes 16, 18, 6 & 11 which cause 90 % of genital warts
· The bivalent vaccine prevents infection from subtypes 16 and 18.
,· Recommended for prevention of cervical, vulvar, and vaginal cancers and precancers in females as well
as anal cancer, precancers, and genital warts in both female and males
· Vaccinated women should still get cervical cancer screening because vaccines do not prevent all HPV
subtypes
· Condoms do not eliminate the risk of cervical HPV infection
Recommended for those with compromised immune systems including HIV
Know what a 3-year-old can do in regard to jumping and balancing
Answer: · Climbs well, runs easily· Pedals a tricycle· Walks up and down stairs, one foot on each step
Know where to place measuring tape when measuring uterus in a pregnant patient
Answer: · Measure the fundal height if gestational age is >20 weeks
- fundus should reach the umbilicus
· Place tape measure on pubic symphysis and place the "zero" end of the tape measure when you can
firmly feel that bone.
· Extend the tape measure to the very top of uterine fundus and note the number of cm measured.
Subject to error between 16-36 weeks
· Number should roughly equal the number of weeks of gestation
If fundal height is >4cm than expected -multiple gestation, large fetus, extra amniotic fluid, uterine
leiomyoma
If fundal height is < 4cm than expected - low-level amniotic fluid, missed abortion, intrauterine growth
retardation, or fetal anomaly
The _______ _______ occupies most of the anterior cardiac surface
Answer: right ventricle
Know what bleeding between periods is called
Answer: Abnormal uterine bleeding, Intermenstrual bleeding
Know types of vaginosis
Answer: Trichomonal vaginitis, Candidal Vaginitis, Bacterial vaginosis
miliaria rubra
Answer: Scattered vesicles on an erythematous base, usually on the face and trunk, result from
obstruction of the sweat gland ducts; disappears spontaneously within weeks
Know the characteristics of a breast cyst
Answer: Usually soft to firm, round, mobile and often tender. Most common between the ages of 25-50
Know the signs of peritonitis
Answer: When tender area is palpated for guarding, early voluntary guarding may be replaced by
involuntary muscular rigidity and signs of peritoneal inflammation. There may also be RLQ pain on quick
withdrawal or deferred rebound tenderness.
Know where pain is with diverticulitis
Answer: LLQ
Know what position to have pt in to listen for mitral stenosis
, Answer: Left lateral decubitus
Know what to ask in regards to cardiovascular review of systems (pick the one that belongs)
Answer: Know what to ask in regards to cardiovascular review of systems (pick the one that belongs)
Know how a bartholin's gland infection presents
Answer: Acutely, the gland appears as a tense, hot, very tender abscess. Possible labial swelling. Look for
pus emerging from the duct or erythema around the duct opening. Chronically, a nontender cyst is felt
that may be large or small.
Know where pain is with appendicitis
Answer: RLQ pain or pain that migrates from the periumbilical region, combined with abdominal wall
rigidity on palpation is suspicious for appendicitis
Know how syphilis presents genitally
Answer: Female: syphilitic chancre- firm, painless ulcer from primary syphilis, forms approx. 21 days
after exposure to Treponema pallidum. It may remain hidden and undetected in the vagina and heals
regardless of treatment in 3-6 weeks.
Secondary syphilis (Condyloma lantum)- large raised, round or oval, flat-topped gray or white lesions
point to condylomata lata. These are contagious and, along with rash and mucus membrane sores in the
mouth, vagina, or anus are manifestations of secondary syphilis.
Male: Primary syphilis: small red papule that becomes a chancre, a painless erosion up to 2 cm in
diameter. Base of chancre is clean, red, smooth, and glistening; borders are raised and indurated.
Chancre heals within 3-8 weeks.
Know the signs of proctitis
Answer: Anorectal pain, itching, tenesmus, or discharge or bleeding from infection or rectal abscess
suggest proctitis.
Know what causes dark, bloody emesis
Answer: Hematemesis may accompany esophageal or gastric varices, Mallory-Weiss tears, or peptic
ulcer disease.
Know what causes an S3 heart sound
Answer: In children and young adults, a third heart sound (S3) may arise from rapid deceleration of the
column of blood against the ventricular wall. In an older adult, an S3 usually indicates a pathologic
change in ventricular compliance.
Know the signs of thrombophlebitis
Answer: Local swelling, redness, warmth, and a subcutaneous cord signal superficial thrombophlebitis
(an emerging risk factor for DVT).
Know what chalazion is
Answer: A subacute nontender, usually painless nodule caused by a blocked meibomian gland. May
become acutely inflamed, but unlike a stye, usually points inside the lid rather than on the lid margin.
Know what the lungs do with age
