NURS 6615 Midterm
Terms in this set (50)
A 75 year old female presents with skin changes to her left breast. These include redness, skin thickening, and
swelling. Your chief differential diagnosis for this patient would include:
Inflammatory breast carcinoma
Which statement is true regarding a clinical breast exam:
The ability to palpate the breasts, examine the lymph nodes, and inspection are all
important findings in a clinical breast exam.
Which of the following is NOT a risk factor for the development of cervical cancer?
October is breast cancer awareness month
Lately, Tani never knows when her partner will erupt and start beating her. Which phase of the
cycle of violence is this?
As a nurse practitioner, your priorities with a victim of intimate violence include:
providing a safe place to talk
knowing local resources
recognizing escalating signs of violence
Which of the following HPVserotypes is most strongly associated with cervical cancer?
Risk factors associated with endometrial cancer include all of the following except:
In which of the following patients is the use of HPV vaccine not currently recommended?
An 11 year old male, An 18 year old female
All of the following have been identified as risk factors for vulvar cancer except:
The American Cancer Society recommends annual mammography screening begin at what age:
At what age does a female need her first pap smear?
At age 21, unless there is significant concern in the past medical history or upon physical examination of the cervix
Potential causes of abnormal uterine bleeding before menarche include:
sexual abuse, malignancy, trauma
What is the first consideration of abnormal uterine bleeding in women of reproductive age?
A 19 year old female comes to you with the primary complaint of dysmenorrhea. Which of the following questions is least important to ascertain in her history?
Do you have first degree relatives with breast cancer?
When trying to narrow down the etiology of secondary amenorrhea in your 28 year old female patient, which of the following would most likely NOT be the cause of her amenorrhea?
A 16 year old female presents to you becuase she thinks 'she is not normal'. Her periods have
never started, but otherwise she has no physical complaints. She has never been sexually active. Based on the history you have obtained so far, her likely diagnosis is:
All of the following therapies are routinely used in the treatment of PMS except:
Surgical removal of the ovaries
A female patient complains of intermittently feeling a strange bulge in her vagina along with occasional episodes of urinary incontinence. Which of the following statements about her condition is most accurate?
Her symptoms are suggestive of a cystocele causing bladder prolapse through a defect in her anterior vaginal wall.
A 46 year old women presents with very heavy menses and no other symptoms. She denies menopausal symptoms. Her cycles are 21 days apart, lasting 7 days. On exam you palpate a firm, irregularly enlarged uterus. In discussing her condition you advise her that fibroids are:
the most common benign tumor of the female genital tract
The definitive diagnosis of uterine fibroids is typically made by:
The gold standard test to diagnose endometriosis is:
Laparoscopy with biopsy
A 42 year old smoker presents for her annual exam where you notice a firm lump in her external labia. She states she was exposed to HPV in the past, but is unsure if it was a high-risk strain. The primary condition to rule out with this patient would be:
Justice presents to the clinic with chronic pelvic pain. She has had several visits over the years for the same problem but it is worse now. The NP knows adhesions are a common noncyclic gyn cause of chronic pelvic pain. The NP would expect to find what in this patient?
Dyspareunia, Lower abdominal or pelvic pain that occurs or increases when the peritoneum is stretched, decreased motility of the pelvic organs
Chronic pelvic pain is defined as:
Defined as a pelvic pain lasting greater than 6 months with or without intervals of relief
A 41 year old African-American female presents to your clinic with complaints of 7 days of
heavy menstrual bleeding every 30-32 days. She is using super absorbency tampons and a pad to control bleeding. By definition, she is experiencing:
A 40 year old presents to your office with dull, aching pelvic pain intermittently for two years. You know that potential gynecological causes of chronic pelvic pain include all of the following except:
Your fellow practitioner explains that she ordered a CBC and hematology consult for an adolescent pt who presented today with severe menstrual bleeding and frequent bruising. With these tests, you are considering which of the following in your differential diagnosis?
A patient presents with abnormal uterine bleeding and complaint of excess hair growth. Your
physical exam shows elevated BMI and acanthosis nigricans skin changes. What is the most likely diagnosis
Polycystic ovarian syndrome
Which of the following tests is the most appropriate for an initial pre-menopausal dysfunctional uterine bleeding (DUB) workup?
CBC, pregnancy test, endocrine studies
A 22 year old client complains of severe dysmenorrhea and menorrhagia. Her gynecological exam is normal. What management protocol would be most preferred?
Assess for contraceptive interest, and suggest the use of oral contraceptives along with medications to assist with pain management
A 60 year old woman whose last menstrual period was more than 5 years ago presents with intermittent uterine bleeding for the past few months. You know that:
She is experiencing post menopausal bleeding which is strongly suggestive for endometrial cancer.
Primary amenorrhea is defined as:
Failure of menses to occur by age 16 regardless of sexual characteristics
A 38 year old woman comes into your clinic with pelvic pain and dyspareunia. On exam, you palpate a fixed uterus in the retroflexed position with pain noted when the posterior fornix is palpated. You suspect:
Which would be the most appropriate way to manage a pap results of satisfactory cytology with negative HPV screening on an 24 year old patient:
Repeat pap at next routine screening for age
A 65 year old woman reports to your office with intermittent vaginal bleeding over the last 2 months. Her LMP was more than 10 years ago. Her last pap smear was WNL. She is not taking any hormone replacement products. What is the most appropriate response of the nurse practitioner at this time?
Schedule endometrial biopsy
A young client comes to the office complaining of vaginal bleeding. The client states that she has used five tampons in the last 3 hours. She admits to sexual activity and takes OC's. On further questioning, she states that she started her last pack of pills a few weeks late. The nurse practitioner should:
Perform a stat urine pregnancy test
A 22-year-old married female presents with complaints of severe dysmenorrhea and menorrhagia. Her gynecologic exam is normal. Which managment protocol is preferred?
Assess for contraceptive interest, and combine with NSAID therapy
Pat presents to the clinic with psychological symptoms that escalate around the time of menstruation and subside after menses begin. Her symptoms include depression, irritability, tension, impatience, anxiety, anger, mood swings, and sometimes feels out of control or tearful. Her diagnosis is?
Perimenstrual mood discomfort
When using OLD CAARTS, the NP would include:
onset, location, duration, characteristics, alleviating/aggrevating, associated sxs, radiation, temporal, and severity.
Beth comes to the clinic with severe pelvic pain. She denies STI exposure, her LMP 2 wks ago, and is on OCPs. She states her pain is constant and started today rapidly. Her temp is 99.6. Her PE is positive for a tender abdomen with localized rebound tenderness in the left lower quadrant as well a large pelvic mass in the left lower quadrant. No labs are available. The NP suspects?
Jackie comes to the office with a low grade fever, and complaints of pelvic pain and vaginal discharge. The NP suspects PID. What would the NP expect to find on her PE and from her history?
Low grade fever, purulent vaginal discharge, positive CMT and pain that is achy that radiates to her back.
Lisa presents to the clinic with a low grade temperature, positive Psoas sign, and pain in the RLQ. She is nauseated and vomited once. She states she is worried she has PID because she has a new boyfriend. She denies vaginal discharge. The NP suspects?
Susan presents to the clinic with severe colicky pain in the suprapubic area, urinary frequency, and dysuria. She is bleeding vaginally today as well. The NP knows the following statement to be true in distinguishing gyn and nongyn causes of acute pelvic pain.
Ureteral lithiasis can mimic ectopic pregnancy
The NP knows the following is true of Vulvodynia when discussing it with a patient:
A vulvodynia is chronic vulvar pain without an identifiable cause
What is the best way to manage a pap for a 25 year old with ASCUS on cytology and neg HPV testing?
Repeat contesting in 3 years
What is the best management for a woman > 30 years old with LSIL with positive HPV?
Alice comes in to the clinic and is diagnosed with PID based upon her PE and history. The NP treats Alice with what combination of medications that would be most appropriate at this time despite not having specimen results:
Rocephin 250mg IM, Doxcyclin 100mg bid for 14 days, and Flagyl 500 mg bid for 14 days.
A patient presents with moderate abdominal pelvic pain that began suddenly. LMP 2 wks ago. Negative pregnancy test. VS 98, P120, R 20, B/P 90/48. PE positive for abdominal tenderness with rebound in LLQ. The NP suspects?
Hemorrhagic corpus luteum cyst
In a patient with ovarian remnant syndrome, the management is usually:
Initial treatment with Danazol or high dose progestins