NURS8024 FINAL EXAM
@ what point in pregnancy should you screen for GDM? - ANS-ALL pregnant women
between 24-28 weeks gestation
\10week uterus - ANS-may be able to begin to palpate the uterus at this point, usually still
within pelvic girdle
\12week uterus - ANS-@ the level of the symphysis pubis; grapefruit
\16 year old presents with CC of mass in her R breast- it is not painful, is 3-cm, movable,
and rubbery. her mom had just instructed her on how to perform SBE's so she's not sure
how long it has been there. What is the most likely diagnosis? - ANS-fibroadenoma (MC type
of breast mass in adolescents and young women)
\16week uterus - ANS-1/2 way between symphysis pubis and umbilicus
\18 year old presents to the office who has never had a menses, she is a senior in
highschool, her sisters had periods starting at age 13; no weight gain/loss, exercises 20
minutes/day, born w/ one kidney, vitals stable, ht 5'4", wt 122lbs, tanner stage IV breasts,
axillary and pubic hair. normal external genitalia. What is the most likely diagnosis? -
ANS-primary amenorrhea
\2 national organizations that provide guidelines for WHNP practice and education? -
ANS-american association of colleges of nursing (AACN)
national organization of NP faculties (NONPF)
\20 year old presents w/ CC of painful menstruation, menarche age 12 (28 day cycles),
lasting 5-6 days, heavy 3 days then tapers. Pain with cramps 8-9/10. she sometimes misses
school because of this. not sexually active. pelvic exam WNL. you diagnose her with
dysmenorrhea...how to you explain to her the patho of why she is having pain? - ANS-the
pain is caused by prostaglandins being released which are causing your uterus to contract =
pain
\20week uterus - ANS-@ umbilicus
\21 year old woman presents for her well woman exam- what are the recommendations for
her pap? - ANS-ages 21-29 pap test alone every 3 years
\22 year old G1P0 at 28 weeks presents with CC of intermittent and pelvic pressure for the
last 4 hours; no dysuria, vag bld, or LOF. no N/V, she drinks 8-9 glasses of water/day. no
pregnancy issues up to this point. vitals stable. FH- 28cm, FHT 144. longitudinal lie, cephalic
presentation. urine dip negative, you place her on the monitor and she is contracting every
3-5 minutes. what is the management plan - ANS-admit to l&d
spec exam for cervix, membranes, fFN swab
poss betamethasone, tocolytics, mag sulfate
\22 year old presents to the office with CC of rash on her back:
rash has been there for the past 4 years
the rash comes/goes, periods where skin is clear
rash is reddened with several silver-white patches that are thick, scaly, and flaky...what is the
diagnosis - ANS-psoriasis
\24 year old presents to the office with c/o:
cough that started 3 mos ago
cough is nonproductive, worse after exercise
she is sedentary- just started exercise program
,chest feels "tight" and breathing gets harder after exercising
runs out of breath earlier, coughs a lot
NO FEVER, SPUTUM, CONGESTION, H/A's, WEIGHT LOSS
she does not smoke
her lungs- bilateral wheezing, and prolonged expiratory phase; CXR is normal..whats the
diagnosis - ANS-asthma
\24 year old presents to your office with CC of a "mole"; hx reveals she goes to the beach
often and enjoys sunbathing.
the mole is asymmetric, border is irregular, color is mottled, diameter is greater than tip of a
pencil, it is elevated...what is the most likely diagnosis - ANS-melanoma
\26 year old presents with:
dark abdominal/facial hair (male pattern)
10 lbs weight gain
acne
periods every 40 to 82 days
slight clitoromegaly (excess androgen)
8cm adnexal mass
what is the diagnosis? - ANS-PCOS
\27 year old G2 P1 presents to your office for her new antenatal visit; she had routine labs
drawn 4 days ago; you note her C&S shows 100,000 cfus/ml of E.Coli...what is the incidence
of asymptomatic bacteriuria in pregnancy? - ANS-4-7%
\27 year old G2 P1 presents to your office for her new antenatal visit; she had routine labs
drawn 4 days ago; you note her C&S shows 100,000 cfus/ml of E.Coli...what is your
management plan? - ANS-she needs ATB's at this point...anything of 100,000 colonies or >
requires treatment
Amoxicillin (PCN-beta lactams)
Keflex (cephalosporin)
Macrobid/Bactrim used cautiously
\32 weeker was seen at her 30 week appointment and assessment was WNL- at today's
appt however:
weight gain- 4lbs since 28 weeks
fundal hegiht- 35cm
presentation- cephalic/floating
vital signs and FHT- WNL
what is the most likely diagnosis? and whats your plan? - ANS-because she is only 32
weeks, measuring 35 weeks...most likely dx = polyhydramnios
mgmt- send for US to see if AFI >24cm, or deepest vertical pocket >8cm
then refer
\32 year old, G1P1 and 33 yr old husband have hx of infertility for the past 2 years- has been
tracking BBT, no STI hx, tubes patent, normal uterus, semen analysis normal...whats the
most likely diagnosis? - ANS-secondary infertility
unexplained infertility
\40 year old presents with CC of heavier than normal menses, several years ago she was
told she had an enlarged uterus. uterus fundus is palpable between symphysis pubis and
,umbilicus. there is an irregular midline mass approx 18 weeks in size, moves in conjunction
with the cervix. what is the most likely diagnosis.... - ANS-leiomyoma (fibroid)
\40 year old, 9 weeks pregnant
lower abd cramping and vaginal bleeding
pain 9/10
passed clot size of a golf ball- after that cramping stopped but began again an hour ago
vitals are stable
pelvic exam reveals normal genitalia
cervix is slightly dilated, nontender
what is the most likely diagnosis - ANS-spontaneous abortion
\40week uterus - ANS-weight about 1100g w/ a 5L volume
@ xiphisternum
\42 year old presents for her well woman exam- what are the recommendations for her pap?
- ANS-ages 30-65
pap test alone every 3
hpv alone every 5
pap/hpv every 5
\45 yr old, G55005 (gravida 5, term 5, preterm 0, aborted 0, living 5) presents with concern
about her menstrual cycle for the last 6 months, husband reports her being grouchy...how do
you approach this visit EDUCATION: - ANS-AUB is common as a woman approaches
menopause
begin health promoting activities early (exercise)
weight bearing exercises, yoga, strength
diet (high in iron/calcium)
smoking cessation if a smoker
regular wellness exams
\45 yr old, G55005 (gravida 5, term 5, preterm 0, aborted 0, living 5) presents with concern
about her menstrual cycle for the last 6 months, husband reports her being grouchy...how do
you approach this visit TESTING: - ANS-TVUS, CBC for anemia, TSH
\45 yr old, G55005 (gravida 5, term 5, preterm 0, aborted 0, living 5) presents with concern
about her menstrual cycle for the last 6 months, husband reports her being grouchy...how do
you approach this visit TREATMENT: - ANS-black cohosh, primrose oil
mirena for therapeutic amenorrhea
COC's depending on hx
\5 basic factors to consider in clients with infertility: what are they? - ANS-1- ovulatory
2- uterine/tubal
3- male factor
4- cervical
5- peritoneal (i.e. endometriosis)
\55 year old woman presents with CC stating that with her monthly SBE's, she has noted a
change in her R breast- last mammo was 2 years ago, there is no nipple discharge or pain.
on exam you note a 2-cm, mobile, non-tender mass, in the RUQ of the breast.
what is your mgmt plan? - ANS-mgmt: she needs a diagnostic mammo w/ or w/out US (she
is >30)
remember- most breast cancers occur in the RUQ of the breast
, \8week uterus - ANS-still within pelvic girdle
cannot be palpated
navel orange
\a 14 year old and her mother present to the office inquiring about HPV vaccine...what does
the education entail? - ANS-1- the vaccine helps prevent against new HPV strains; it does
NOT treat already existing ones.
2- recommended age for HPV vaccine is 11-12, and ***prior to sex***
3- the vaccine has dropped HPV cancers/warts by 81%
4- most common SE's = injection site reactions (red/swell), sore arm
\A 30-year-old presents with CC of dry, scaly lesion rash on her right arm (anterior elbow
area), sometimes with intense itching and burning for the last 2 years; sometimes this rash
oozes. What is the diagnosis - ANS-eczema (atopic dermatitis)
because of vesiculation/weeping of lesions, and itching
\a client calls you 2 days PP and states her breasts are very firm and tender...you determine
she is experiencing engorgement. what is your management for her? - ANS-continued
breastfeeding
breast massage
cold compresses
frequent milk removal/hand expression/pumping
anti-inflammatories
chilled cabbage leaves
**correct latch and suckling***
\a woman is diagnosed with endometrial hyperplasia, what is the significance of this finding?
- ANS-this is a condition in which the lining of the uterus is abnormally thickened, could
mean endometrial cancer
\a woman presents with CC of spontaneous "bloody" nipple discharge from her R breast for
the past 3 months...what are the possible diagnoses? - ANS-intraductal papilloma*
breast cancer
\A woman who is pregnant for the second time, and received Rhogam after her last
birth...education wise. which pregnancy is Rh- incompatibility most concerning in... -
ANS-the SECOND one (doesn't cause issues in the first pregnancy- she isn't sensitized
then)
\abscessed Bartholin's cyst- what is the treatment? first line antibiotic is? - ANS--warm
compress, ATB's, I&D, insertion ward catheter, marsupialization
-trimethoprim 160 mg/sulfamethoxazole 800mg (Bactrim)
\absolute contraindications of COC's - ANS-breast cancer
history of DVT/PE
active liver disease
pregnancy,
while relative contraindications include smoking, age over 35, hypertension, breastfeeding
\ACOG recommends what regarding mammography: - ANS-every 1-2 years beginning at
age ***40 years.
If you have not started screening in your 40s, you should start having mammography no
later than age 50 years. Screening should continue until at least age 75 years.
\adding KOH to a slide...will show you... - ANS-pseudohyphae
\ADH and oxytocin are secreted by - ANS-posterior pituitary
@ what point in pregnancy should you screen for GDM? - ANS-ALL pregnant women
between 24-28 weeks gestation
\10week uterus - ANS-may be able to begin to palpate the uterus at this point, usually still
within pelvic girdle
\12week uterus - ANS-@ the level of the symphysis pubis; grapefruit
\16 year old presents with CC of mass in her R breast- it is not painful, is 3-cm, movable,
and rubbery. her mom had just instructed her on how to perform SBE's so she's not sure
how long it has been there. What is the most likely diagnosis? - ANS-fibroadenoma (MC type
of breast mass in adolescents and young women)
\16week uterus - ANS-1/2 way between symphysis pubis and umbilicus
\18 year old presents to the office who has never had a menses, she is a senior in
highschool, her sisters had periods starting at age 13; no weight gain/loss, exercises 20
minutes/day, born w/ one kidney, vitals stable, ht 5'4", wt 122lbs, tanner stage IV breasts,
axillary and pubic hair. normal external genitalia. What is the most likely diagnosis? -
ANS-primary amenorrhea
\2 national organizations that provide guidelines for WHNP practice and education? -
ANS-american association of colleges of nursing (AACN)
national organization of NP faculties (NONPF)
\20 year old presents w/ CC of painful menstruation, menarche age 12 (28 day cycles),
lasting 5-6 days, heavy 3 days then tapers. Pain with cramps 8-9/10. she sometimes misses
school because of this. not sexually active. pelvic exam WNL. you diagnose her with
dysmenorrhea...how to you explain to her the patho of why she is having pain? - ANS-the
pain is caused by prostaglandins being released which are causing your uterus to contract =
pain
\20week uterus - ANS-@ umbilicus
\21 year old woman presents for her well woman exam- what are the recommendations for
her pap? - ANS-ages 21-29 pap test alone every 3 years
\22 year old G1P0 at 28 weeks presents with CC of intermittent and pelvic pressure for the
last 4 hours; no dysuria, vag bld, or LOF. no N/V, she drinks 8-9 glasses of water/day. no
pregnancy issues up to this point. vitals stable. FH- 28cm, FHT 144. longitudinal lie, cephalic
presentation. urine dip negative, you place her on the monitor and she is contracting every
3-5 minutes. what is the management plan - ANS-admit to l&d
spec exam for cervix, membranes, fFN swab
poss betamethasone, tocolytics, mag sulfate
\22 year old presents to the office with CC of rash on her back:
rash has been there for the past 4 years
the rash comes/goes, periods where skin is clear
rash is reddened with several silver-white patches that are thick, scaly, and flaky...what is the
diagnosis - ANS-psoriasis
\24 year old presents to the office with c/o:
cough that started 3 mos ago
cough is nonproductive, worse after exercise
she is sedentary- just started exercise program
,chest feels "tight" and breathing gets harder after exercising
runs out of breath earlier, coughs a lot
NO FEVER, SPUTUM, CONGESTION, H/A's, WEIGHT LOSS
she does not smoke
her lungs- bilateral wheezing, and prolonged expiratory phase; CXR is normal..whats the
diagnosis - ANS-asthma
\24 year old presents to your office with CC of a "mole"; hx reveals she goes to the beach
often and enjoys sunbathing.
the mole is asymmetric, border is irregular, color is mottled, diameter is greater than tip of a
pencil, it is elevated...what is the most likely diagnosis - ANS-melanoma
\26 year old presents with:
dark abdominal/facial hair (male pattern)
10 lbs weight gain
acne
periods every 40 to 82 days
slight clitoromegaly (excess androgen)
8cm adnexal mass
what is the diagnosis? - ANS-PCOS
\27 year old G2 P1 presents to your office for her new antenatal visit; she had routine labs
drawn 4 days ago; you note her C&S shows 100,000 cfus/ml of E.Coli...what is the incidence
of asymptomatic bacteriuria in pregnancy? - ANS-4-7%
\27 year old G2 P1 presents to your office for her new antenatal visit; she had routine labs
drawn 4 days ago; you note her C&S shows 100,000 cfus/ml of E.Coli...what is your
management plan? - ANS-she needs ATB's at this point...anything of 100,000 colonies or >
requires treatment
Amoxicillin (PCN-beta lactams)
Keflex (cephalosporin)
Macrobid/Bactrim used cautiously
\32 weeker was seen at her 30 week appointment and assessment was WNL- at today's
appt however:
weight gain- 4lbs since 28 weeks
fundal hegiht- 35cm
presentation- cephalic/floating
vital signs and FHT- WNL
what is the most likely diagnosis? and whats your plan? - ANS-because she is only 32
weeks, measuring 35 weeks...most likely dx = polyhydramnios
mgmt- send for US to see if AFI >24cm, or deepest vertical pocket >8cm
then refer
\32 year old, G1P1 and 33 yr old husband have hx of infertility for the past 2 years- has been
tracking BBT, no STI hx, tubes patent, normal uterus, semen analysis normal...whats the
most likely diagnosis? - ANS-secondary infertility
unexplained infertility
\40 year old presents with CC of heavier than normal menses, several years ago she was
told she had an enlarged uterus. uterus fundus is palpable between symphysis pubis and
,umbilicus. there is an irregular midline mass approx 18 weeks in size, moves in conjunction
with the cervix. what is the most likely diagnosis.... - ANS-leiomyoma (fibroid)
\40 year old, 9 weeks pregnant
lower abd cramping and vaginal bleeding
pain 9/10
passed clot size of a golf ball- after that cramping stopped but began again an hour ago
vitals are stable
pelvic exam reveals normal genitalia
cervix is slightly dilated, nontender
what is the most likely diagnosis - ANS-spontaneous abortion
\40week uterus - ANS-weight about 1100g w/ a 5L volume
@ xiphisternum
\42 year old presents for her well woman exam- what are the recommendations for her pap?
- ANS-ages 30-65
pap test alone every 3
hpv alone every 5
pap/hpv every 5
\45 yr old, G55005 (gravida 5, term 5, preterm 0, aborted 0, living 5) presents with concern
about her menstrual cycle for the last 6 months, husband reports her being grouchy...how do
you approach this visit EDUCATION: - ANS-AUB is common as a woman approaches
menopause
begin health promoting activities early (exercise)
weight bearing exercises, yoga, strength
diet (high in iron/calcium)
smoking cessation if a smoker
regular wellness exams
\45 yr old, G55005 (gravida 5, term 5, preterm 0, aborted 0, living 5) presents with concern
about her menstrual cycle for the last 6 months, husband reports her being grouchy...how do
you approach this visit TESTING: - ANS-TVUS, CBC for anemia, TSH
\45 yr old, G55005 (gravida 5, term 5, preterm 0, aborted 0, living 5) presents with concern
about her menstrual cycle for the last 6 months, husband reports her being grouchy...how do
you approach this visit TREATMENT: - ANS-black cohosh, primrose oil
mirena for therapeutic amenorrhea
COC's depending on hx
\5 basic factors to consider in clients with infertility: what are they? - ANS-1- ovulatory
2- uterine/tubal
3- male factor
4- cervical
5- peritoneal (i.e. endometriosis)
\55 year old woman presents with CC stating that with her monthly SBE's, she has noted a
change in her R breast- last mammo was 2 years ago, there is no nipple discharge or pain.
on exam you note a 2-cm, mobile, non-tender mass, in the RUQ of the breast.
what is your mgmt plan? - ANS-mgmt: she needs a diagnostic mammo w/ or w/out US (she
is >30)
remember- most breast cancers occur in the RUQ of the breast
, \8week uterus - ANS-still within pelvic girdle
cannot be palpated
navel orange
\a 14 year old and her mother present to the office inquiring about HPV vaccine...what does
the education entail? - ANS-1- the vaccine helps prevent against new HPV strains; it does
NOT treat already existing ones.
2- recommended age for HPV vaccine is 11-12, and ***prior to sex***
3- the vaccine has dropped HPV cancers/warts by 81%
4- most common SE's = injection site reactions (red/swell), sore arm
\A 30-year-old presents with CC of dry, scaly lesion rash on her right arm (anterior elbow
area), sometimes with intense itching and burning for the last 2 years; sometimes this rash
oozes. What is the diagnosis - ANS-eczema (atopic dermatitis)
because of vesiculation/weeping of lesions, and itching
\a client calls you 2 days PP and states her breasts are very firm and tender...you determine
she is experiencing engorgement. what is your management for her? - ANS-continued
breastfeeding
breast massage
cold compresses
frequent milk removal/hand expression/pumping
anti-inflammatories
chilled cabbage leaves
**correct latch and suckling***
\a woman is diagnosed with endometrial hyperplasia, what is the significance of this finding?
- ANS-this is a condition in which the lining of the uterus is abnormally thickened, could
mean endometrial cancer
\a woman presents with CC of spontaneous "bloody" nipple discharge from her R breast for
the past 3 months...what are the possible diagnoses? - ANS-intraductal papilloma*
breast cancer
\A woman who is pregnant for the second time, and received Rhogam after her last
birth...education wise. which pregnancy is Rh- incompatibility most concerning in... -
ANS-the SECOND one (doesn't cause issues in the first pregnancy- she isn't sensitized
then)
\abscessed Bartholin's cyst- what is the treatment? first line antibiotic is? - ANS--warm
compress, ATB's, I&D, insertion ward catheter, marsupialization
-trimethoprim 160 mg/sulfamethoxazole 800mg (Bactrim)
\absolute contraindications of COC's - ANS-breast cancer
history of DVT/PE
active liver disease
pregnancy,
while relative contraindications include smoking, age over 35, hypertension, breastfeeding
\ACOG recommends what regarding mammography: - ANS-every 1-2 years beginning at
age ***40 years.
If you have not started screening in your 40s, you should start having mammography no
later than age 50 years. Screening should continue until at least age 75 years.
\adding KOH to a slide...will show you... - ANS-pseudohyphae
\ADH and oxytocin are secreted by - ANS-posterior pituitary
