2024 ADVANCED NURSING NSG
6001 EXAM WITH CORRECT
ANSWERS
Steps of Pelvic Exam - CORRECT-ANSWERS1) observation and Speculum
exam
2) Bimanual exam
3) recto-vaginal exam (includes DRE)
Clinical of HSV - CORRECT-ANSWERSFirst there is a prodromal tingling or
pruritus of the genital region.
-systemic - fever, myalgia, malaise, can have meningitis, encephalitis, or
hepatitis
local- clusters of small, painful blisters that ulcerate and crust outside of
mucous membranes
- itching, dysuria, vaginal discharge, inguinal adenopathy, bleeding from
cervicitis
- new lesions form for about 10 days after initial infection, but can last up to
3 weeks
- shedding of virus can last 2-10 days, most contagious when blisters are
present.
Diagnosis of HSV - CORRECT-ANSWERS- Viral isolation culture- the culture
often fails to find the virus even when its present
- Herpes virus antigen detection test: cells from fresh sores on microscope
slide, looks for antigens on surface of cells infected with HSV
- Direct detection of HSV DNA by polymerase chain reaction (PCR): used to
establish the presence of HSV and determine the type of HSV you have
Serology: IgM antibodies indicate a recent infection; IgGantibodies indicate a
previous infection
management of HSV - CORRECT-ANSWERSrelieve symptoms, heal lesions,
reduce frequency of episodes, reduce viral transmission, patient support and
counseling
- antiviral therapy: Acyclovir (Zovirax), Valacyclovir(Valtrex), and Famciclovir
(Famvir)
bacterial vaginosis - CORRECT-ANSWERSUnpleasant "fishy smelling" grayish
white discharge
, -white thick coating on vaginal walls
- itching and inflammation are uncommon
-vaginal pH is greater than 4.5
- positive Wiff test
- Clue cells on wet mount (vaginal epithelia cells coated with bacteria) (most
reliable protector of BV
Tx: may resolve spontaneously, treat if symptomatic.
Metronidazole, Metronidazole gel, or clindamycin cream
- Refrain from intercourse or use condoms consistently during tx
Candida vulvovaginitis - CORRECT-ANSWERSClinical: Vulvar/vaginal pruitis,
vaginal soreness/irritation, dyspareunia, burning with voiding, white, clumpy
discharge.
Wet mount: pH 4-4.5 (normal)
- yeast buds or spores or hyphae on wet mount
tx: most uncomplicated infections improve with therapy within 2 days, sever
infections may require up to 14 days
- OTC anti yeast vaginal agents (Butoconazole, coltrimazole, moconazole);
Prescription anti yeast vaginal agents: (Terconazole o.4%/0.8%,
Butoconazole 2% cream)
Oral antifungals: Fluconazole 150 mg tablet (Diflucan)- do not use in
pregnancy
Trichomoniasis Vaginitis - CORRECT-ANSWERSClinical: range from
asymptomatic infection to severe, acute inflammatory disease
- diffuse, thin malodorous greenish-yellow frothy purulent discharge, vulval
irritation, dysuria, dyspareunia and pruritus are common, erythema of vagina
walls and cervix (strawberry cervix)
wet mount: Elevated pH, can increase leukocytes
Tx: Metronidazole 2 grams orally X 1 dose. Tinidazole 2 grams orally X 1
dose
-treat sexual partners
- re-screen at 3 months following infection if patient remains sexually active
epididymitis - CORRECT-ANSWERSInflammation of the epidermis
risks: multiple sex partners, unprotected sex, anal intercourse, prostate
cancer, BPH, prolonged sitting, vasectomy
most common cause of scrotal pain in post pubertal males
- gradual onset of unilateral testicular pain and tenderness
-dysuria, urethral discharge, pain with ejaculation, fever, nausea, vomiting,
scrotum tender on palpitation, redness and or pain.
- Prehns sign- passive elevation of testes relieve pain, swollen and red within
24 hrs
Tx: abx based on urine culture, treat sexual partner, bed rest, scrotal
support/elevation, sitz bath, pain meds. ice packs
6001 EXAM WITH CORRECT
ANSWERS
Steps of Pelvic Exam - CORRECT-ANSWERS1) observation and Speculum
exam
2) Bimanual exam
3) recto-vaginal exam (includes DRE)
Clinical of HSV - CORRECT-ANSWERSFirst there is a prodromal tingling or
pruritus of the genital region.
-systemic - fever, myalgia, malaise, can have meningitis, encephalitis, or
hepatitis
local- clusters of small, painful blisters that ulcerate and crust outside of
mucous membranes
- itching, dysuria, vaginal discharge, inguinal adenopathy, bleeding from
cervicitis
- new lesions form for about 10 days after initial infection, but can last up to
3 weeks
- shedding of virus can last 2-10 days, most contagious when blisters are
present.
Diagnosis of HSV - CORRECT-ANSWERS- Viral isolation culture- the culture
often fails to find the virus even when its present
- Herpes virus antigen detection test: cells from fresh sores on microscope
slide, looks for antigens on surface of cells infected with HSV
- Direct detection of HSV DNA by polymerase chain reaction (PCR): used to
establish the presence of HSV and determine the type of HSV you have
Serology: IgM antibodies indicate a recent infection; IgGantibodies indicate a
previous infection
management of HSV - CORRECT-ANSWERSrelieve symptoms, heal lesions,
reduce frequency of episodes, reduce viral transmission, patient support and
counseling
- antiviral therapy: Acyclovir (Zovirax), Valacyclovir(Valtrex), and Famciclovir
(Famvir)
bacterial vaginosis - CORRECT-ANSWERSUnpleasant "fishy smelling" grayish
white discharge
, -white thick coating on vaginal walls
- itching and inflammation are uncommon
-vaginal pH is greater than 4.5
- positive Wiff test
- Clue cells on wet mount (vaginal epithelia cells coated with bacteria) (most
reliable protector of BV
Tx: may resolve spontaneously, treat if symptomatic.
Metronidazole, Metronidazole gel, or clindamycin cream
- Refrain from intercourse or use condoms consistently during tx
Candida vulvovaginitis - CORRECT-ANSWERSClinical: Vulvar/vaginal pruitis,
vaginal soreness/irritation, dyspareunia, burning with voiding, white, clumpy
discharge.
Wet mount: pH 4-4.5 (normal)
- yeast buds or spores or hyphae on wet mount
tx: most uncomplicated infections improve with therapy within 2 days, sever
infections may require up to 14 days
- OTC anti yeast vaginal agents (Butoconazole, coltrimazole, moconazole);
Prescription anti yeast vaginal agents: (Terconazole o.4%/0.8%,
Butoconazole 2% cream)
Oral antifungals: Fluconazole 150 mg tablet (Diflucan)- do not use in
pregnancy
Trichomoniasis Vaginitis - CORRECT-ANSWERSClinical: range from
asymptomatic infection to severe, acute inflammatory disease
- diffuse, thin malodorous greenish-yellow frothy purulent discharge, vulval
irritation, dysuria, dyspareunia and pruritus are common, erythema of vagina
walls and cervix (strawberry cervix)
wet mount: Elevated pH, can increase leukocytes
Tx: Metronidazole 2 grams orally X 1 dose. Tinidazole 2 grams orally X 1
dose
-treat sexual partners
- re-screen at 3 months following infection if patient remains sexually active
epididymitis - CORRECT-ANSWERSInflammation of the epidermis
risks: multiple sex partners, unprotected sex, anal intercourse, prostate
cancer, BPH, prolonged sitting, vasectomy
most common cause of scrotal pain in post pubertal males
- gradual onset of unilateral testicular pain and tenderness
-dysuria, urethral discharge, pain with ejaculation, fever, nausea, vomiting,
scrotum tender on palpitation, redness and or pain.
- Prehns sign- passive elevation of testes relieve pain, swollen and red within
24 hrs
Tx: abx based on urine culture, treat sexual partner, bed rest, scrotal
support/elevation, sitz bath, pain meds. ice packs
