NR 509 Final Exam Questions with Answers

NR 509 Final Exam Questions with Answers Suspicious breast mass - ANSWER- -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 - ANSWER- --*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 - ANSWER- Soft to firm, round, mobile, often tender. The best way to examine the lateral portion of the breast - ANSWER- -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) - ANSWER- -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 - ANSWER- -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 - ANSWER- -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 Syphillis - ANSWER- This ulcerated papule with an indurated edge usually appears after 3 to 6 weeks of incubating infection from the spirochete Treponema pallidum. These lesions may resemble a carcinoma or crusted cold sore. Similar primary lesions are common in the pharynx, anus, and vagina but may escape detection since they are painless, nonsuppurative, and usually heal spontaneously in 3 to 6 weeks. Wear gloves during palpation since these chancres are infectious. s/s of epididymitis - ANSWER- Acute: swollen, and notably tender, making it difficult to distinguish from the testis. The scrotum may be reddened and the vas deferens inflamed. Chronic: firm enlargement of the epididymis, which is sometimes tender, with thickening or beading of the vas deferens. Genital Warts (Condylomata Acuminata) - ANSWER- -Single or multiple papules or plaques of variable shapes; may be round, acuminate (pointed), or thin and slender. May be raised, flat, or cauliflower-like (verrucous). -Causative organism: HPV, usually subtypes 6, 11; carcinogenic subtypes rare, approximately 5-10% of all anogenital warts. Incubation: weeks to months; infected contact may have no visible warts. -Can arise on penis, scrotum, groin, thighs, anus; usually asymptomatic, occasionally cause itching and pain. -May disappear without treatment. Risk for prostate CA - ANSWER- Age, ethnicity, and family history are the strongest risk factors for prostate cancer. s/s prostatitis - ANSWER- -fever -frequency, urgency, dysuria, incomplete voiding, -sometimes low back pain - gland feels tender, swollen, "boggy," and warm s/s BPH - ANSWER- - irritative (urgency, frequency, nocturia), -obstructive (decreased stream, incomplete emptying, straining), or both, - gland may be normal in size, or may feel symmetrically enlarged, smooth, and firm, though slightly elastic; there may be obliteration of the median sulcus and more notable protrusion into the rectal lumen. Measuring a pregnant uterus - ANSWER- With a plastic or paper tape measure, locate the pubic symphysis and place the "zero" end of the tape measure where you can firmly feel that bone (Fig. 19-12). Then extend the tape measure to the very top of uterine fundus and note the number of centimeters measured. s/s gestational HTN - ANSWER- systolic blood pressure (SBP) 140 mm Hg or diastolic blood pressure (DBP) 90 mm Hg first documented after 20 weeks, without proteinuria or preeclampsia, that resolves by 12 weeks postpartum. s/s ectopic pregnancy - ANSWER- -Abdominal pain -adnexal tenderness -abnormal uterine bleeding how a Bartholin gland infection presents - ANSWER- Causes of a Bartholin gland infection include trauma, gonococci, anaerobes like bacteroides and peptostreptococci, and C. trachomatis. Acutely, the gland appears as a tense, hot, very tender abscess. Look for pus emerging from the duct or erythema around the duct ope