NR 509 Final Exam All answers verified correct and graded already.

NR 509 Final Exam Suspicious breast mass - ANS -A mobile mass that becomes fixed when the arm relaxes is attached to the ribs and intercostal muscles; if fixed when the hand is pressed against the hip, it is attached to the pectoral fascia. -Hard irregular poorly circumscribed nodules, fixed to the skin or underlying tissues, strongly suggest cancer Risk for Breast cancer - ANS --*Age* -family history of breast/ovarian CA - inherited genetic mutations, -personal history of breast cancer - high levels of endogenous hormones - breast tissue density - proliferative lesions with atypia on breast biopsy, - duration of unopposed estrogen exposure related to early menarche -age of first full-term pregnancy - late menopause. - breastfeeding for less than 1 year, - postmenopausal obesity -cigarette smoking, alcohol ingestion, - physical inactivity, and type of contraception. Characteristics of a breast cyst - ANS Soft to firm, round, mobile, often tender. The best way to examine the lateral portion of the breast - ANS -Have pt roll onto the opposite hip -place her hand on her forehead. - keep shoulders pressed against the bed -palpate in the axilla, moving in a straight line down to the bra line, then move the fingers medially and palpate in a vertical strip up the chest to the clavicle. Continue in vertical overlapping strips until you reach the nipple Bacterial Vaginosis (BV) - ANS -Caused by overgrowth of anaerobic bacteria (often from sex) - Discharge: Gray or white, thin, homogenous, malodorous, coats the vaginal walls, usually not profuse, may be minimal - Fishy/musty genital odor -Normal vulva and vaginal mucosa -Scan saline wet mount for clue cells (epithelial cells with stippled borders); sniff for fishy odor after applying KOH ("whiff test"); test the vaginal secretions for pH > 4.5 Candidal Vaginitis - ANS -Cause: Candida albicans, a yeast (normal overgrowth of vaginal flora); many factors predispose, including antibiotic therapy -Discharge: white and curdy, may be thin but usually thick, not as profuse as trichomonal infection, not malodorous - vaginal soreness, pruritus, pain on urination, dyspareunia (painful intercourse) -The vulva and surrounding skin are inflamed and sometimes swollen to a variable extent; the vaginal mucosa is reddened, with white tenacious patches of discharge; the mucosa may bleed when these patches are scraped off; in mild cases, the mucosa looks normal -Scan potassium hydroxide (KOH) preparation for the branching hyphae of Candida Trichomonal Vaginitis - ANS -Trichomonas vaginalis, a protozoan; often but not always acquired sexually - Discharge:Yellowish green or gray, possibly frothy; often profuse and pooled in the vaginal fornix; may be malodorous -Pruritus (though not usually as severe as with Candida infection); pain on urination (from skin inflammation or possibly urethritis); dyspareunia -Vestibule and labia minora may be erythematous; the vaginal mucosa may be diffusely reddened, with small red granular spots or petechiae in the posterior fornix; in mild cases, the mucosa looks normal - Scan saline wet mount for trichomonads