Download NURS 682 Exam I LATEST SPRING 2025 EXAM GRADED A+ WITH ANSWERS 100% Advanced Practice and more Exams Nursing in PDF only on Docsity!
What is the recommended screening tool for breast cancer? Mammography Modifiable risk factors for breast cancer: Overweight Low physical activity Poor nutrition Tobacco use Non-Modifiable risk factors for breast cancer: Family history Breast tissue density Proliferative lesions w atypic on breast biopsy Early menarche Age of 1st full-term pregnancy Late menopause Age of female
NURS 682 Exam I LATEST SPRING 2025
EXAM GRADED A+ WITH ANSWERS 100%
Advanced Practice Nursing Family Health
VERIFIED ANSWERS 100%
For women over 20 years of age, clinical breast exams (CBE's) should be carried out: Every 1-3 years For women over 40 years of age, CBE's should be carried out: Annually (40- 49 years of age) Most OB-Gyn's follow this rule For women under the age of 40 y/o and over 75 y/o, the following risk factors would warrant further testing than normal: BRCA 1, BRCA 2 (Would suggest a mammogram for women <40 y/o and >75 y/o) For women between 50 and 74 years of age, CBE's should be carried out: Bi-annually WITH mammography. If the guidelines are carried out differently, this decision will be made by: The physician AND the patient. Self-breast exams Are no longer indicated. HOWEVER, 15% of masses are missed by mammography. This is where SBE's can fill the gap and should still be recommended and educated to the patient. Cervical cancer screenings (PAP Smears), in women younger than 21 y/o:
Year. Insurance still covers the procedure annually. Why do women YOUNGER than 21 y/o, no longer require cervical cancer screenings? It used to be under 18 y/o but research showed that under 21, the HPV cleared on its own. Most HPV interventions are invasive and the immune system does it's job. Abnormal PAP smear results can be: ASC-US CIN-I CIN-II CIN-III If a female presents with an abnormal PAP of ASC-US: Have the patient follow-up in 1 year for another PAP. Anything other than this results, requires REFERRAL. In women, 65 years of age or older, bone density screening should occur: No more frequently than every 2 years (The DXA scan has radiation). For bone density testing, the is the preferred test. The GOLD STANDARD** DXA Scan
In women who are postmenopausal but YOUNGER than 65 years of age, must have the following risk factors to be screened: Increased risk for osteoporosis as defined by: Formal risk scoring Hx of fragility fracture Weight <127 lbs Smoker Alcoholism RA Family history Is there any FORMAL bone density testing for males? Nope Diagnosis criteria for Osteoporosis (in terms of T-Scores): Normal - T-score greater than or equal to - 1. Osteopenia - T-score < - 1.0 to - >2. Osteoporosis - less than or equal to - 2. Treatment for Osteoporosis: Bisphosphonate Zoledronic acid Raloxifene HRT
How long is the trial period for HRT, after counseling? 3 months FOLLOWED BY annual review. Common adverse effects of HRT: Bleeding Headache Breast tenderness Mood symptoms Bloating Contraindications of HRT: History of breast cancer CHD A previous venous thromboembolic event or stroke Active liver disease Unexplained vaginal bleeding High-risk endometrial cancer Transient ischemic attack Lupus REFER these patients NEVER give HRT to a patient with a history of: ANY TYPE of clotting disorder!! (Stroke, TIA, ect.)
Progesterone ONLY contraception is NOT as effective as combination, therefore healthcare providers must educate on the following: Take your BC at the same time everyday. Do not miss a single dose. Always use back-up contraception. Can cause breakthrough bleeding or spotting. Progesterone ONLY contraception is best for: Breast feeding mothers (Minipills) Combination contraception contains: Progesterone and estrogen. Before Nexplanon is prescribed, patients should try: Depovera. Copper IUD's contraception is best for: Basically anyone, at any age, regardless of contraindications for other contraceptives. What are the 3 different forms of EMERGENCY contraception?
prescription only WILL INTERRUPT A CURRENT PREGNANCY Which of the 3 types of emergency contraception interrupt a pregnancy, if it already exists? Copper IUD Progesterone receptor modulator Presenting signs and symptoms of Endometriosis: 20% of women with chronic pelvic pain and 30 - 40% of women with infertility have endometriosis however definitively diagnosed via surgery. Hallmark is cyclic pelvic pain prior to menses peaking 1 - 2 days prior to onset then subsiding prior to onset. How is endometriosis diagnosed? Requires direct visualization by laparoscopy or laparotomy. Classic lesions: blue-black ("raspberry") or dark brown ("powder-burned") appearance Ovaries may have endometriomas (characteristic "chocolate cysts"). How is endometriosis treated? NSAIDs
Cyclic or continuous combination OC's Progestins (Menstrual suppression) Adenomyosis is diagnosed with: MRI (Pelvic US can work and is often RX d/t MRI cost). This is where endometrial-like tissue grows into the muscle of your uterus. What is an NP's treatment plan for Adenomyosis? Order an abdominal-pelvic US and REFER to OB-Gyn. Adenomyosis vs. Endometriosis The difference between these conditions is where the tissue grows. Adenomyosis: Endometrial-like tissue grows into the muscle of your uterus. Endometriosis: Endometrial-like tissue grows outside your uterus in places like your ovaries or fallopian tubes. What is Primary Amenorrhea? Absence of menses by age 15 w/normal growth and secondary sexual characteristics- causes include congenital and chromosomal abnormalities, hormonal abnormality, hypothalamic- pituitary disorders, and secondary causes occurring prior to menarche- prevalence in US 1 - 2% What is Secondary Amenorrhea? Absence of menses for 3 months in women with previously regular cycles or 6 months in women with previously irregular cycles (most often caused by pregnancy).
ultrasound, endometrial biopsy, etc.depending on pattern of bleeding, history, and patient characteristics AUB in all women OLDER than 45 years old should: Always have endometrial biopsy to R/O benign endometrial hyperplasia and cancer. Everyone who has AUB should be tested for: STI's. Risk factors for STI's include: Being sexually active female, obesity, increasing age, anatomic or neurologic abnormalities, DM, and sickle cell. More common in females than males. UTI presenting signs and symptoms: Dysuria, increased frequency, urgency. How to diagnose a UTI: U/A-looking for nitrates, leukocyte esterase, hematuria, and leukocytes. If positive, consider culture. If a patient presents with fever and CVA tenderness consider:
Pyelonephritis. How to treat a UTI: Sulfamethoxazole, nitrofurantoin, or fluoroquinolone for 3 - 7 days, Ampicillin or cephalexin may be used but have increased resistance. STI's can often cause: UTI's. If the patient with a UTI is symptomatic, always get a: Urine Culture and TREAT UTI's in pregnancy can cause: Spontaneous abortion. The only time a symptomatic UTI patient does not need a culture: If insurance will not approve of one without a UA. 80%-85% of UTI's are caused by which bacteria? E. Coli (lots of resistance to drugs)
How to diagnose Genital Herpes: Viral culture is gold standard but less sensitive in reoccurring episodes or healing lesions. Nucleic Acid Amplification Testing with polymerase chain reaction test primary method for testing. How to treat Genital Herpes: Primary episode: Acyclovir, famciclovir, or valacyclovir for 7- 10 days (dosage depends on drug); Recurrent lesions- acyclovir400mg TID or 800 mg BID for 5 days- for frequent reoccurrence may treat prophylactic. HPV Condyloma acuminata or genital warts. How is HPV prevented? Vaccine - Gardasil Use of condoms to prevent transmission. How is HPV treated? Local excision, cryotherapy, topical trichloroacetic acid, topical 25% podophyllin, and 5- fluorouracil cream usually repeated weekly by healthcare provider or imiquimod or podofilox by patient at home.
Bacterial Vaginosis Caused by bacterial shift in the vagina-likely polymicrobial. Gardnerella vaginalis is common on culture. Risk factors include: new or multiple sex partners, douching, antibiotic use, female sex partners, and smoking. May cause preterm labor in pregnant female How does Bacterial Vaginosis present? Thin, white, homogenous, non-irritating VD often with fishy amine odor. How is Bacterial Vaginosis diagnosed? Amsel criteria (3 of 4 present) Amine odor with addition of 10% KOH (positive whiff test), pH > 4.5, >20% clue cells ,thin white homogenous VD coating vaginal walls. How to treat Bacterial Vaginosis: Metronidazole 500 mg BID for 7 days, avoid alcohol or clindamycin if allergic. Yeast Infection Candidiasis causes approximately 30% of vaginitis; Candida albicans implicated in 80 - 90% of cases; increased risk with antibiotic use, DM, immunosuppression.
How is Trichomonas treated? Metronidazole 500 mg 2x/day for 7 days or tinidazole 2 gm po X 1 dose for women, treat all partners, no intercourse for 7 days post treatment (may use metronidazole 2 gm orally in a single dose in men). Neisseria Gonorrhoeae Second leading STI Multiple risk factors including: Low socioeconomic status, urban residence, nonwhite and non-Asian race/ethnicity, early age of first sexual activity, illicit drug use, unmarried, and history of STI. Condoms, diaphragms, and spermicides decrease risk. More likely to transmit from male to female as opposed female to male. May infect anal canal, urethra, and oropharynx Screening recommended for all women <25 years and older women with risk factors since approximately 50% of women are asymptomatic. How is Neisseria Gonorrhoeae treated? Ceftriaxone 500 or 1000 mg (weight based) IM and doxycycline (ONLY IF chlamydia not ruled out). Chlamydia Trachomatis Most prevalent bacterial STI
Increased risk in females age 15 - 24 years, those with early sexual activity, and greater number of partners Screen with NAAT testing. How is Chlamydia Trachomatis treated? Doxycycline 100 mg orally 2x/day for 7 days (may use azithromycin 1 gm orally in a single dose if concerned with compliance). What is the most common serious complication of STI's? Pelvic Inflammatory Disease (PID) and risk increases with number of PID episodes. Infertility and Ectopic Pregnancy Which age group has the highest incidence rate of PID? 15 - 25 year old females. (With increased risk in non-white and non-Asian ethnicity, multiple partners, recent history of douching, prior PID, and smoking) How does PID present? Abdominal/pelvic pain, VD, abnormal odor, abnormal bleeding, gastrointestinal disturbances, and urinary tract symptoms. Fever occurs in approximately 20%
