1
NR 602 FINAL EXAM STUDY GUIDE
ACOG guidelines regarding well women exams- age specific screening, laboratory
tests, evaluation and counseling and immunizations
Ages 13-18:
Ages 19-39:
Ages 40-65:
Ages 65 and older:
What is the ASCCP recommended management for an ASCUS (atypical squamous
cells of undetermined significance) pap result with a positive high-risk HPV 16
cotest in a 26-year-old woman without a history of abnormal pap smears?
Colposcopy
A well-woman visit for an adolescent should include which of the following?
A general health history focusing on reproductive and sexual health
concerns (menses, gynecologic, and pregnancy related) and psychosocial
(family related, peer related, emotional, and physical as well as related
to abuse, drug use, and alcohol use) concerns
Physical exam, screening tests, and immunizations as indicated by the
health history and gynecologic considerations for an external-only
inspection of the genitalia
ACOG Pap smear guidelines- starts at age 21 and is done every three years. Age
30 and older doe a pap and HPV every five years if co test is done, if just pap then
do every 3 years. Can stop at age 65 if a negative history for 1o years or if the
patient has had a hysterectomy with no history of cervical cancer.
A Bethesda system Pap smear report that reads LSIL is most consistent with which
classification?
CIN 1
A single Pap smear reading of ASCUS in a patient negative for HPV infection
should have what as follow-up?
Routine screening
A female patient is 35 years old. She has never had an abnormal PAP smear and
has had regular screening since age 18. If she has a normal PAP smear with HPV
testing today, when should she have the next cervical cancer screening?
5 years
A young sexually active client at the family planning clinic is advised to have a
Papanicolaou (Pap) smear. She has never had a Pap smear before. What should the
nurse include in the explanation of this procedure?
The Pap smear can detect cancer of the cervix
, 2
Lab results on your 26-year-old patient show a negative Pap smear with a positive
human papillomavirus (HPV) screen. Which procedure will be required next?
Repeat Pap and HPV screen
Which of the following is not part of the criteria for an older woman to cease
having any future Pap tests performed?
Over 55 years of age
Amenorrhea (Primary and Secondary)
Primary and Secondary Amenorrhea
Primary amenorrhea: No menarche by the age of 15 years (with or without
development of secondary sexual characteristics). Half of cases are caused by
chromosomal disorders (50%) such as Turner syndrome.
Puberty is delayed if there is no breast development by age 13
years, absence of pubic hair at age 14 years, and no menarche
by age 15 years.
Secondary amenorrhea: No menses for three cycles, or 6 months if
previously had menses. Most common cause is ).
Secondary Amenorrhea Associated With Exercise and Underweight
Excessive exercise and/or sports participation have a higher incidence of
amenorrhea (and infertility) due to relative caloric deficiency
"Female athlete triad"; anorexia nervosa/restrictive eating, amenorrhea, and
osteoporosis
Labs
Pregnancy test (serum human chorionic gonadotropin [hCG])
Serum prolactin level (rule out prolactinoma-induced amenorrhea)
Serum TSH; also follicle-stimulating hormone (FSH) and luteinizing
hormone (LH; rule out premature ovarian failure)
If amenorrhea for more than 6 months, measure bone density
Treatment Plan
Educate about increasing caloric intake and decreasing exercise
Prescribe calcium with vitamin D 1,200 to 1,500 mg daily and vitamin
E 400 IU daily
Complications
Osteopenia/osteoporosis (stress fractures)
Myocardial atrophy, arrhythmia (sudden death), bradycardia,
hypotension
Hypoglycemia, dehydration, electrolytes
Lanugo (fine downy hair), telogen effluvium (hair loss), xerosis (dry
skin), infertility
Low body mass index (BMI), cachexia, anemia, respiratory failure
,3
You are evaluating a 17-year-old Emily who presented with amenorrhea and
normal secondary sex characteristics. The purpose of the progesterone challenge is
to ascertain the presence of?
Endogenous estrogen
A 17-year-old female patient presents with amenorrhea for 4 months she did
experience menarche at age 15 but had not had a menstrual cycle since. On
physical examination, it is noticed that she has normal secondary sexual
characteristics. The nurse practitioner will consider a progesterone challenge to
determine the presence of adequate
Endogenous estrogen
A teenage patient presents with amenorrhea and moral secondary sex
characteristics. A progesterone challenge is ordered. The purpose is to determine
the presence of ____________?
Endogenous estrogen
A 16year old girl who comes to your office with a history of secondary
amenorrhea. She experienced menarche at age 10, regular cycles for 2 years. She
has not menstruated now for 4 years. In your initial consideration of differential
diagnoses, what is the most frequent etiology of this problem:
Eating disorder
18yo female c/o secondary amenorrhea. On exam, there is normal secondary sex
characteristics and normal genitalia. Pregnancy is ruled out. What would
necessitate further eval?
Galactorrhea
Primary amenorrhea is best described as:
Failure to menstruation to occur by 13 yr
A nurse practitioner is caring for a woman with primary and secondary
amenorrhea. The pelvic exam was normal. Which of the following may be the
cause if etiology originates in the hypothalamus?
Sheehan’s syndrome
American Cancer Society recommendations
Mammography remains the single best screening procedure for the early
detection of breast cancer. The majority of breast cancers in the United States are
detected as a result of an abnormal screening study
A positive family history of breast cancer is recognized as a risk factor for
the subsequent development of breast cancer. With the discovery of 2 major breast
cancer predisposition genes, BRCA1 (17q21) and BRCA2 (13q12-13), there has
been increasing interest in genetic testing. Mutations in these 2 genes are
associated with an elevated risk for breast cancer, as well as ovarian, colon,
prostate, and pancreatic cancers.
Brest Cancer
, 4
Breast cancer is the main cause of death for women between the ages of 40 and 59
breast cancer is the most common cancer among women of all ethnic groups,
although the incidence of the disease is highest among white patients. Inherited
genes BRCA1 and BRCA2 gene mutations, Fibrocystic changes of the breast and
other nonproliferative breast lesions are not associated with an increased risk of
breast cancer. Clinical staging is based on the TNM (tumor, node, metastasis)
system of the International Union Against Cancer. Most patients with palpable
breast cancers present with painless masses in the breast, most of which are
discovered by the patient herself physical examination should be carried out with
the patient sitting, arms at sides and then overhead.
Symptoms- Early findings are a Single, nontender, firm to hard mass with
ill-defined margins; mammographic abnormalities and no palpable mass. Late
findings are Skin or nipple retraction; axillary lymphadenopathy; breast
enlargement, redness, edema, brawny induration, peau d'orange, pain, fixation of
mass to skin or chest wall. Late late findings Ulceration; supraclavicular
lymphadenopathy; edema of arm; bone, lung, liver, brain, or other distant
metastases.
Reccomendations: After completion of treatment a patient should undergo a
physical examination every 4 months for the first 2 years, then every 6 months
until year 5, and annually thereafter. A mammogram should be obtained annually
for all patients and no less than 6 months after the completion of radiation therapy
Breast Disorders
Fibrocystic breast: Benign breast disease
S/S occur 2 weeks before the onset of mensus (luteal phase) and they’re
worst right before the menstrual cycle. Resolves after menses start, often seen in
women in their 30’s. On assessment the breast lumps are tender and feel rubbery,
are mobile to touch.
Tx: stop caffeine intake, take vitamin E and evening primrose capsules
daily, Spironolactone for swelling and pain, wear bras with good support, referral
needed if dominant mass, skin changes, fixed mass. Mastoplasia is thickening of
the breast tissue in a rope like manner that predominates during the menstrual
cycle. There is NO increased risk of breast malignancy with presence of simple
cysts. Breast malignancy presenting as complicated cysts is rare. Complex cysts
may increase risk of breast malignancy.
Fibroadenoma-benign breast lesion. Common benign tumor for females
between the ages of 15-40 years, but can occur in women of any age.
Risk factors: multiple fibroademomas associated with rare cancer sydromes
like Maffucci syndrome, Cowden syndrome, and Carney complex, early ETOH
consumption.
NR 602 FINAL EXAM STUDY GUIDE
ACOG guidelines regarding well women exams- age specific screening, laboratory
tests, evaluation and counseling and immunizations
Ages 13-18:
Ages 19-39:
Ages 40-65:
Ages 65 and older:
What is the ASCCP recommended management for an ASCUS (atypical squamous
cells of undetermined significance) pap result with a positive high-risk HPV 16
cotest in a 26-year-old woman without a history of abnormal pap smears?
Colposcopy
A well-woman visit for an adolescent should include which of the following?
A general health history focusing on reproductive and sexual health
concerns (menses, gynecologic, and pregnancy related) and psychosocial
(family related, peer related, emotional, and physical as well as related
to abuse, drug use, and alcohol use) concerns
Physical exam, screening tests, and immunizations as indicated by the
health history and gynecologic considerations for an external-only
inspection of the genitalia
ACOG Pap smear guidelines- starts at age 21 and is done every three years. Age
30 and older doe a pap and HPV every five years if co test is done, if just pap then
do every 3 years. Can stop at age 65 if a negative history for 1o years or if the
patient has had a hysterectomy with no history of cervical cancer.
A Bethesda system Pap smear report that reads LSIL is most consistent with which
classification?
CIN 1
A single Pap smear reading of ASCUS in a patient negative for HPV infection
should have what as follow-up?
Routine screening
A female patient is 35 years old. She has never had an abnormal PAP smear and
has had regular screening since age 18. If she has a normal PAP smear with HPV
testing today, when should she have the next cervical cancer screening?
5 years
A young sexually active client at the family planning clinic is advised to have a
Papanicolaou (Pap) smear. She has never had a Pap smear before. What should the
nurse include in the explanation of this procedure?
The Pap smear can detect cancer of the cervix
, 2
Lab results on your 26-year-old patient show a negative Pap smear with a positive
human papillomavirus (HPV) screen. Which procedure will be required next?
Repeat Pap and HPV screen
Which of the following is not part of the criteria for an older woman to cease
having any future Pap tests performed?
Over 55 years of age
Amenorrhea (Primary and Secondary)
Primary and Secondary Amenorrhea
Primary amenorrhea: No menarche by the age of 15 years (with or without
development of secondary sexual characteristics). Half of cases are caused by
chromosomal disorders (50%) such as Turner syndrome.
Puberty is delayed if there is no breast development by age 13
years, absence of pubic hair at age 14 years, and no menarche
by age 15 years.
Secondary amenorrhea: No menses for three cycles, or 6 months if
previously had menses. Most common cause is ).
Secondary Amenorrhea Associated With Exercise and Underweight
Excessive exercise and/or sports participation have a higher incidence of
amenorrhea (and infertility) due to relative caloric deficiency
"Female athlete triad"; anorexia nervosa/restrictive eating, amenorrhea, and
osteoporosis
Labs
Pregnancy test (serum human chorionic gonadotropin [hCG])
Serum prolactin level (rule out prolactinoma-induced amenorrhea)
Serum TSH; also follicle-stimulating hormone (FSH) and luteinizing
hormone (LH; rule out premature ovarian failure)
If amenorrhea for more than 6 months, measure bone density
Treatment Plan
Educate about increasing caloric intake and decreasing exercise
Prescribe calcium with vitamin D 1,200 to 1,500 mg daily and vitamin
E 400 IU daily
Complications
Osteopenia/osteoporosis (stress fractures)
Myocardial atrophy, arrhythmia (sudden death), bradycardia,
hypotension
Hypoglycemia, dehydration, electrolytes
Lanugo (fine downy hair), telogen effluvium (hair loss), xerosis (dry
skin), infertility
Low body mass index (BMI), cachexia, anemia, respiratory failure
,3
You are evaluating a 17-year-old Emily who presented with amenorrhea and
normal secondary sex characteristics. The purpose of the progesterone challenge is
to ascertain the presence of?
Endogenous estrogen
A 17-year-old female patient presents with amenorrhea for 4 months she did
experience menarche at age 15 but had not had a menstrual cycle since. On
physical examination, it is noticed that she has normal secondary sexual
characteristics. The nurse practitioner will consider a progesterone challenge to
determine the presence of adequate
Endogenous estrogen
A teenage patient presents with amenorrhea and moral secondary sex
characteristics. A progesterone challenge is ordered. The purpose is to determine
the presence of ____________?
Endogenous estrogen
A 16year old girl who comes to your office with a history of secondary
amenorrhea. She experienced menarche at age 10, regular cycles for 2 years. She
has not menstruated now for 4 years. In your initial consideration of differential
diagnoses, what is the most frequent etiology of this problem:
Eating disorder
18yo female c/o secondary amenorrhea. On exam, there is normal secondary sex
characteristics and normal genitalia. Pregnancy is ruled out. What would
necessitate further eval?
Galactorrhea
Primary amenorrhea is best described as:
Failure to menstruation to occur by 13 yr
A nurse practitioner is caring for a woman with primary and secondary
amenorrhea. The pelvic exam was normal. Which of the following may be the
cause if etiology originates in the hypothalamus?
Sheehan’s syndrome
American Cancer Society recommendations
Mammography remains the single best screening procedure for the early
detection of breast cancer. The majority of breast cancers in the United States are
detected as a result of an abnormal screening study
A positive family history of breast cancer is recognized as a risk factor for
the subsequent development of breast cancer. With the discovery of 2 major breast
cancer predisposition genes, BRCA1 (17q21) and BRCA2 (13q12-13), there has
been increasing interest in genetic testing. Mutations in these 2 genes are
associated with an elevated risk for breast cancer, as well as ovarian, colon,
prostate, and pancreatic cancers.
Brest Cancer
, 4
Breast cancer is the main cause of death for women between the ages of 40 and 59
breast cancer is the most common cancer among women of all ethnic groups,
although the incidence of the disease is highest among white patients. Inherited
genes BRCA1 and BRCA2 gene mutations, Fibrocystic changes of the breast and
other nonproliferative breast lesions are not associated with an increased risk of
breast cancer. Clinical staging is based on the TNM (tumor, node, metastasis)
system of the International Union Against Cancer. Most patients with palpable
breast cancers present with painless masses in the breast, most of which are
discovered by the patient herself physical examination should be carried out with
the patient sitting, arms at sides and then overhead.
Symptoms- Early findings are a Single, nontender, firm to hard mass with
ill-defined margins; mammographic abnormalities and no palpable mass. Late
findings are Skin or nipple retraction; axillary lymphadenopathy; breast
enlargement, redness, edema, brawny induration, peau d'orange, pain, fixation of
mass to skin or chest wall. Late late findings Ulceration; supraclavicular
lymphadenopathy; edema of arm; bone, lung, liver, brain, or other distant
metastases.
Reccomendations: After completion of treatment a patient should undergo a
physical examination every 4 months for the first 2 years, then every 6 months
until year 5, and annually thereafter. A mammogram should be obtained annually
for all patients and no less than 6 months after the completion of radiation therapy
Breast Disorders
Fibrocystic breast: Benign breast disease
S/S occur 2 weeks before the onset of mensus (luteal phase) and they’re
worst right before the menstrual cycle. Resolves after menses start, often seen in
women in their 30’s. On assessment the breast lumps are tender and feel rubbery,
are mobile to touch.
Tx: stop caffeine intake, take vitamin E and evening primrose capsules
daily, Spironolactone for swelling and pain, wear bras with good support, referral
needed if dominant mass, skin changes, fixed mass. Mastoplasia is thickening of
the breast tissue in a rope like manner that predominates during the menstrual
cycle. There is NO increased risk of breast malignancy with presence of simple
cysts. Breast malignancy presenting as complicated cysts is rare. Complex cysts
may increase risk of breast malignancy.
Fibroadenoma-benign breast lesion. Common benign tumor for females
between the ages of 15-40 years, but can occur in women of any age.
Risk factors: multiple fibroademomas associated with rare cancer sydromes
like Maffucci syndrome, Cowden syndrome, and Carney complex, early ETOH
consumption.
