NURS 660 EXAM 1 QUESTIONS WITH COMPLETE
SOLUTIONS GUARANTEED PASS BRAND NEW 2025
What is the most important differential to rule out in postmenopausal
bleeding?
Cancer (especially endometrial)
An average cycle is how many days?
28 days
Range 21-35 days/3-5 weeks
How long does an average cycle last and how much blood is typically
lost?
4-6 days
30 mL (not typically measured, upper limit of normal 6-80)
Amenorrhea is defined as
Absence of menses >6 months
If <6 months, this is just irregular menstrual bleeding and not actual
amenorrhea
Define oligomenorrhea
Bleeding at an interval >35 days
Define menorrhagia
Excessive or prolonged menstural bleeding occurring at regular intervals
>80 cc or >7 days
Define polymenorrhea
Bleeding at an interval <21 days
Differentiate between ovulatory and anovulatory bleeding.
,Ovulatory bleeding is cyclic bleeding accompanied by cyclic signs of
ovulation (tender breasts, cramping, pain) aka typical menstrual bleeding
Anovulatory bleeding is unpredictable, non-cyclic bleeding that is variable
in flow and duration. There are no signs of ovulation.
What age groups are anovulatory bleeding not uncommon in?
Perimenopausal
Pre-teen
What are some differentials to consider with pregnancy related AUB?
Spontaneous abortion, ectopic pregnancy, placental previa (not attached to
the fundus), placenta abruptio (detaching, emergency), trophoblastic
disease, childbirth complications
What are some medications that can cause irregular bleeding?
Herbals?
Anticoagulants, SSRIs/antipsychotics (especially Lexapro), corticosteroids,
hormonal medications, IUD, tamoxifen
Also some herbals like ginseng, gingko, soy, black cohosh
Tamoxifen has what effects on estrogen?
Blocks estrogen at the breast but has a positive effect on uterus which can
increase endometrial cancer risk and therefore create AUB
Name some systemic diseases that can cause AUB.
thyroid disease (both hypo and hyper)
PCOS
Coagulopathies
Hepatic disease
Pituitary adenoma
Hypothalamic suppression (common in athletes due to low adipose)
,In a woman who is not menopausal, what needs to be ruled out before
investigating other causes of AUB?
pregnancy always
Why is it important to assess the size, contour, and tenderness of the
uterus when doing a physical exam for someone with AUB?
rule out ectopic pregnancy, fibroids that you may be able to palpate
What lab are you going to make sure to add for a woman who reports
she is reporting she is changing her pad or tampon multiple times in
an hour?
Bleeding studies: H/H, platelet count, PT, PTT
May want to consider factor VIII, von Willebrand factor antigen (referral)
A patient with AUB is also reporting nipple discharge. What is your
top differential and what lab do you want to order?
Prolactinoma
Order prolactin level
Who requires an endometrial biopsy if experiencing AUB?
All women over age 35 or with risk factors of endometrial cancer
What is the initial pharmacologic management of SEVERE AUB in
reproductive-age women?
High dose of estrogen during severe acute bleeding
Oral: 35 mcg 1-4x/day for 7 days and then daily
IV prn
What is something to consider when a patient is interested in
endometrial ablation as treatment for their AUB?
Fertility
Will not be able to have children after this procedure so it is not
recommended in the case that she wants to reproduce
, For a patient who is having chronic or less severe ANOVULATORY
AUB, what would the pharmacologic management be?
OCPs can help by increasing the predictability of cycles as well as
decreasing blood loss per cycle
Provera is cyclic progesterone which can help manage flow or jump start
cycles to get back on track
What is the use for the medication Provera?
By taking 5-10 mg daily for 5-10 days you can manage your flow OR jump
start your cycle to get back on track (bleeding should start within a week
after taking)
Synthetic progesterone
For a patient who is having chronic or less severe OVULATORY AUB,
what would the pharmacologic management be?
Basically what you would think of to treat a bad period: NSAIDs
before/during cycle to decrease prostaglandins and hopefully reduce cycle
If patient wants to try a progesterone IUD like Mirena to decrease
cycles/stop cycles
A woman with postmenopausal bleeding comes to your office. She
has been taking hormone therapy. What is something you want to
know to help determine cancer risk?
How long she has been on the therapy
AUB cannot be diagnosed until the bleeding has been present for 6 months
to 1 year
IF she's been on it >6 months (or if she were to not be on hormonal
therapy) --> r/o endometrial cancer
What is the initial workup for postmenopausal bleeding?
SOLUTIONS GUARANTEED PASS BRAND NEW 2025
What is the most important differential to rule out in postmenopausal
bleeding?
Cancer (especially endometrial)
An average cycle is how many days?
28 days
Range 21-35 days/3-5 weeks
How long does an average cycle last and how much blood is typically
lost?
4-6 days
30 mL (not typically measured, upper limit of normal 6-80)
Amenorrhea is defined as
Absence of menses >6 months
If <6 months, this is just irregular menstrual bleeding and not actual
amenorrhea
Define oligomenorrhea
Bleeding at an interval >35 days
Define menorrhagia
Excessive or prolonged menstural bleeding occurring at regular intervals
>80 cc or >7 days
Define polymenorrhea
Bleeding at an interval <21 days
Differentiate between ovulatory and anovulatory bleeding.
,Ovulatory bleeding is cyclic bleeding accompanied by cyclic signs of
ovulation (tender breasts, cramping, pain) aka typical menstrual bleeding
Anovulatory bleeding is unpredictable, non-cyclic bleeding that is variable
in flow and duration. There are no signs of ovulation.
What age groups are anovulatory bleeding not uncommon in?
Perimenopausal
Pre-teen
What are some differentials to consider with pregnancy related AUB?
Spontaneous abortion, ectopic pregnancy, placental previa (not attached to
the fundus), placenta abruptio (detaching, emergency), trophoblastic
disease, childbirth complications
What are some medications that can cause irregular bleeding?
Herbals?
Anticoagulants, SSRIs/antipsychotics (especially Lexapro), corticosteroids,
hormonal medications, IUD, tamoxifen
Also some herbals like ginseng, gingko, soy, black cohosh
Tamoxifen has what effects on estrogen?
Blocks estrogen at the breast but has a positive effect on uterus which can
increase endometrial cancer risk and therefore create AUB
Name some systemic diseases that can cause AUB.
thyroid disease (both hypo and hyper)
PCOS
Coagulopathies
Hepatic disease
Pituitary adenoma
Hypothalamic suppression (common in athletes due to low adipose)
,In a woman who is not menopausal, what needs to be ruled out before
investigating other causes of AUB?
pregnancy always
Why is it important to assess the size, contour, and tenderness of the
uterus when doing a physical exam for someone with AUB?
rule out ectopic pregnancy, fibroids that you may be able to palpate
What lab are you going to make sure to add for a woman who reports
she is reporting she is changing her pad or tampon multiple times in
an hour?
Bleeding studies: H/H, platelet count, PT, PTT
May want to consider factor VIII, von Willebrand factor antigen (referral)
A patient with AUB is also reporting nipple discharge. What is your
top differential and what lab do you want to order?
Prolactinoma
Order prolactin level
Who requires an endometrial biopsy if experiencing AUB?
All women over age 35 or with risk factors of endometrial cancer
What is the initial pharmacologic management of SEVERE AUB in
reproductive-age women?
High dose of estrogen during severe acute bleeding
Oral: 35 mcg 1-4x/day for 7 days and then daily
IV prn
What is something to consider when a patient is interested in
endometrial ablation as treatment for their AUB?
Fertility
Will not be able to have children after this procedure so it is not
recommended in the case that she wants to reproduce
, For a patient who is having chronic or less severe ANOVULATORY
AUB, what would the pharmacologic management be?
OCPs can help by increasing the predictability of cycles as well as
decreasing blood loss per cycle
Provera is cyclic progesterone which can help manage flow or jump start
cycles to get back on track
What is the use for the medication Provera?
By taking 5-10 mg daily for 5-10 days you can manage your flow OR jump
start your cycle to get back on track (bleeding should start within a week
after taking)
Synthetic progesterone
For a patient who is having chronic or less severe OVULATORY AUB,
what would the pharmacologic management be?
Basically what you would think of to treat a bad period: NSAIDs
before/during cycle to decrease prostaglandins and hopefully reduce cycle
If patient wants to try a progesterone IUD like Mirena to decrease
cycles/stop cycles
A woman with postmenopausal bleeding comes to your office. She
has been taking hormone therapy. What is something you want to
know to help determine cancer risk?
How long she has been on the therapy
AUB cannot be diagnosed until the bleeding has been present for 6 months
to 1 year
IF she's been on it >6 months (or if she were to not be on hormonal
therapy) --> r/o endometrial cancer
What is the initial workup for postmenopausal bleeding?
