NURS 6615 MIDTERM EXAM
1. An adult client's last menstrual period was 2 months ago. She has had a Mirena IUD in place for the past 4 months. She is c/o nausea, fatigue, breast tenderness, and abdominal bloating. Physical exam reveals the following: abdomen: WNL, Pelvic: positive Chadwick's sign, string protruding from cervical os; uterus enlarged and nontender. What is most likely the diagnosis?
2. 65-year-old reports to office with intermittent vaginal bleeding over the last 2 months. LMP was more than 10 years ago. Last pap was WNL. She is not taking HRT. What is the most appropriate response of the nurse practitioner at this time?
Answer. The nurse should schedule endometrial biopsy
3. A middle-aged female presents with abnormal uterine bleeding, as well as elevated FSH and LH levels. What is the most likely cause for these findings?
Answer. The most likely cause is onset of climacteric
4. A young client comes to the office complaining of vaginal bleeding. The client states that she has used 5 tampons in the last hours. She admits to sexual activity and takes OCs. On further Professional assignment writing help "NURS 6615 Midterm Exam" Meet the team that makes it all possible questioning, she states that she was started her last pack of pills a few weeks late. The nurse practitioner should:-
Answer. The nurse should perform a stat urine pregnancy test
5. Evaluation of abnormal uterine bleeding initially involves a detailed history, PE, and labs. Which of the following are examples of the most inclusive list of nongynecological problems that may cause abnormal uterine bleeding?
Answer. Abnormal uterine bleeding hypothyroidism, liver disease, bleeding disorders, and eating disorders
6. A 24-year-old woman presents for amenorrhea for 2 monthly cycles. She has been training for a marathon at the gym daily. After ruling out pregnancy, the next most important test would be:-
Answer. The important test should be TSH (Thyroid stimulating hormone)
7. An endometrial biopsy should be seriously considered in the assessment of abnormal bleeding in all of the following except:-
Answer. Adolescents with irregular menstrual cycles
8. What is not a risk factor for breast cancer?
Answer, Fibrocystic breast disease is not a risk factor for breast cancer.
9. Which would be considered clearly an abnormal finding on a 75-year-old client?
Answer. Palpable ovaries
10. A 21-year-old virgin female presents for her first well-woman exam. Her family and personal history are negative for any significant disease. Her menses are regular with only mild dysmenorrhea. Her visit today should include:-
Answer. Pap smear
11. On a speculum exam, describe the presentation of cervical polyps:
Answer. Moist, red, and glandular Professional assignment writing help "NURS 6615 Midterm Exam" Meet the team that makes it all possible
12. Women who have HPV and smoke cigarettes have a higher risk of vulvar cancer, true or false?
13. The endometrial cycle is often described in 3 phases which are?
Answer. Proliferative, secretory and menstrual
14. Which of the following infections would be reported with the initial Pap smear results?
15. Standard guidelines in the preventive care of women include:
Answer. Routine pap smears beginning by 3 years post-coitarche or by age 21
16. Which of the following HPV serotypes is most strongly associated with cervical cancer?
Answer. HPV (Human papillomavirus) 16
17. Normal menstrual bleeding occurs from a decrease in:
Answer. Menstrual bleeding occurs from a decrease of progesterone
18. The Bethesda system equivalent for a Class III, moderate dysplasia pap smear is:
Answer. High-grade squamous intraepithelial lesion
19. To promote client comfort before performing a pelvic examination a pelvic examination, the nurse practitioner first:
Answer. The nurse should ask the client to empty her bladder
20. The current American Cancer Society guidelines recommend mammogram screening begin at age:
Answer. 40 years
21. In collecting specimens for chlamydia and gonorrhea testing, where is the most appropriate place to collect the swab?
Answer. Inside the cervical os
22. The nurse practitioner is reviewing the lab results of an 18 y/o recently screened for her annual pap smear. Her classification is HGSIL (high grade squamous intraepithelial lesion); endocervical cells; adequate screen, HPV 16 positive. You ask the client to come in to review her results and tell her which of the following: Professional assignment writing help "NURS 6615 Midterm Exam" Meet the team that makes it all possible
Answer. Your pap smear shows abnormal tissue that needs further evaluation. Please schedule appointment for a colposcopy as soon as possible.
23. Which of the following is NOT a risk factor for the development of cervical cancer?
Answer. Virginal status
24. 21 y/o female client is seen for her annual gyn exam. She is sexually active, rarely uses condoms for STD prevention and has multiple sex partners. She smokes one ppd., admits to sedentary lifestyle, eats 2 meals per day, most often at fast food restaurants. Her exam is negative for any abnormality. Her family and person history are negative for major disease. There are no menstrual abnormalities, her LMP was 1 week ago. The nurse practitioner has done her Pap smear. Which intervention is the least appropriate for this client at this time?
Answer. Lab testing: glucose, cardiac risk profile, and TSH
25. The NP knows the majority of breast cancers occur in which area of the breast?
Answer. Majority of breast cancers occurs upper outer quadrant
26. A patient is dx with HPV. He cannot understand how he got it. Both he and his partner claim monogamy. Which of the following is most important to elicit from his history?
Answer. Number of previous partners
27. A 69-year-old woman presented w/abnormal vaginal bleeding and has now been dx with endometrial cancer. She returns to you because she doesn't understand how this could happen when her pap smear was normal 6 months ago. What is your best response?
Answer. Pap smears are not useful in determining uterine cancer in most cases
28. What finding is considered a normal surface characteristic of the cervix?
Answer. Small, yellow, raised area on cervix
29. Which of the following is not Professional assignment writing help "NURS 6615 Midterm Exam" Meet the team that makes it all possible considered a treatment approach for PMS?
Answer. Oral contraception
30. All of the following are true regarding the proliferative phase of the endometrial cycle except?
Answer. During this phase, prostaglandins initiate contractions of the uterine smooth muscle and sloughing of the degraded endometrial tissue
31. If a female has abnormal uterine bleeding, what tests must be obtained?
Answer. Pregnancy (HCG), CBC, TSH, Gonorrhea and chlamydia
32. What condition is a benign, chronic, progressive disease of the skin characterized by inflammation, epithelial thinning and distinctive dermal changes that may occur on the trunk, neck, forearms, axillae and under the breasts as well as on the vulva?
Answer. Lichen sclerosis
33. A 40-year-old woman presents in clinic with complaint of dull aching pelvic pain that has been ongoing for the past 2 years. You know that potential gyn causes of pelvic pain include all of the following except?
Answer. Multiple pregnancies
34. Which of the following is characteristic of a normal cervix?
Answer. Cervix is round and should move 2-4 cm without discomfort
35. An 18-year-old female comes to you complaining of dysmenorrhea. All of the following are important initial questions to ask except?
Answer. Do you have first degree relatives with breast cancer?
36. When a patient presents with symptoms of ovulatory dysfunctional uterine bleeding the clinician should?
Answer. Check quantitative HCG, iron, and TSH levels, perform a pelvic, speculum and bimanual exam, obtain detailed menarche and menstrual hx.
37. When trying to narrow down the etiology of secondary amenorrhea in your 28 year old patient, which of the following would most likely NOT be the cause?
Answer. A body % 30 percent fat.
38. All of the following management techniques can be used for polycystic ovary syndrome except:
39. The first consideration in women of childbearing age who Professional assignment writing help "NURS 6615 Midterm Exam" Meet the team that makes it all possible presents with abnormal uterine bleeding is:
40. The proliferative phase of the endometrial cycle coincides with what phase of the ovarian cycle?
Answer. Follicular phase
41. Risk factors associated with endometrial cancer include all of the following except:
Answer. Early menopause (before age 50)
42. What is the initial medical tx for a client who presents with severe bleeding from a raw and denuded endometrium?
Answer. High dose estrogen
43. All are considered diff dx for abnormal uterine bleeding except:
Answer. Excessive weight gain
44. A 21-year-old female is dx with trich. You prescribe metronidazole 2 grams in single dose. What further education should be provided?
Answer. Do not drink ETOH for 48 hours after treatment, trich may cause labia minora edema and tenderness; your partner needs to be treated and avoid sex until tx is completed
45. Which of the following factors place women at increased risk for breast cancer?
Answer. hx of previous bx that revealed atypical hyperplasia
46. What are the phases of the ovarian cycle?
Answer. Follicular, ovulatory and luteal
47. What are the phases of the endometrial cycle?
Answer. Proliferative, secretory and menstruation
48. What is not considered a non-gynecological cause of abnormal uterine bleeding?
49. What is most freq symptom of uterine fibroids?
Answer. Increased bleeding at menses
50. All of the following are nongyn causes of abnormal uterine bleeding except:
51. A patient comes to clinic complaining of mood swings, depression, anxiety, bloating, and breast tenderness that occurs in the second half of her menstrual cycle. The most likely dx is?
52. A middle-aged woman, in the climateric stage of her life, presents with pelvic pain. What is the least likely cause of her pain?
Answer. Uterine fibroids
53. Wet prep is used to test for?
54. The following are signs and symptoms of cervical cancer except?
Answer. GI upset
55. Progestin therapy is preferred tx for all of the following except:
Answer. Acute uterine bleeding
56. Management goals for treating abnormal uterine bleeding include all of the following except:
Answer. Episodes of acute hemorrhage should be managed by a NP
57. Which of the following is not a biochemical feature of PCOS? Professional assignment writing help "NURS 6615 Midterm Exam" Meet the team that makes it all possible
Answer. Markedly elevated serum total testosterone levels
58. A 60-year-old woman whose LMP was more than 5 years ago presents with intermittent uterine bleeding over the past few months. You know that:
Answer. She is experiencing post-menopausal bleeding which is strongly suggestive of endometrial cancer
59. Cyclic mastalgia typically begins in the ___ phase and subsides with ____?
Answer. Luteal, menses
60. When considering the physiology of the menstrual cycle, we know that all are true except?
Answer. The follicular cycle consists of 3 phases: maturation, expulsion and endometrial phases
61. When cervical mucus is applied to a clean, dry slide, a non-frond like appearance indicates?
Answer. Ovulation has occurred
62. Your fellow practitioner explains that she has ordered a CBC and hematology consult for an adolescent pt who presented today with severe menstrual bleeding and frequent bruising. The practitioner is most likely trying to identify or rule out?
Answer. Inherited coagulopathy
63. The most common psychological illness accompanying PMS and PMDD is
64. 30-year-old presents as a new patient for routine screening checkup and to discuss OC use. Se confides that her mother died this year of breast cancer and maternal gm died at age 58 from ovarian cancer. She is worried that she may develop cancer. You acknowledge her concerns and review the known risk factors for breast cancer. All of the following except:
65. A contraindication for HRT would be:
Answer. hx of nontraumatic DVT
66. 13-year-old female in clinic c/o heavy menstrual bleeding this month. The NP learns from the hx that pt's first menses was four months ago. The practitioner realizes that:
Answer. it is not unusual for her periods to be irregular and it would be wise to perform pelvic exam and get an ultrasound
67. 28-year-old presents to clinic c/o bleeding. She is concerned because it is not time for her period. In what order would the NP work up this pt to determine a presumed dx of dysfunctional uterine bleeding?
Answer. Rule out pregnancy, rule out iatrogenic causes, rule out systemic disorders, rule out pathology of genital tract, presumed dysfunctional bleeding
68. Current USPSTF guidelines assigns an "A" recommendation to screening for cervical cancer for all of the following except:
Answer. 65-year-old with hx of previous cytologically normal screens who is not at increased risk for cervical cancer
69. When evaluating dysfunctional uterine bleeding in women of childbearing age, it is important to understand the risk factors for endometrial cancer. These risk factors include all of the following except:
70. What factor is considered Professional assignment writing help "NURS 6615 Midterm Exam" Meet the team that makes it all possible high risk for breast cancer?
Answer. Genetic mutation in BRCA-1 and BRCA-2 genes
71. 65-year-old comes to gynecologist for her annual exam. Her friend was recently dx with ovarian cancer and she wants to be tested. Which of the following would be the most appropriate screening for ovarian cancer?Answer. No screening at all
72. You are performing an exam on a 45 y/o female. Which of the following screening recommendation does not apply to this patient?
73. 15-year-old female presents to the clinic worried because other girls her age have started their menstruation, and she has not. She has no physical complaints, no past medical history and is not sexually active. Her most likely diagnosis would be:
Answer. Primary amenorrhea
74. 26-year-old woman presents to the clinic with concerns of trying to become pregnant for several months. During history and physical she indicates that she has been extremely stressed and has a long history of bulimia. What is the most likely cause of anovulation?
Answer. Hypothalamic suppression
75. Based on symptoms, including homogenous white discharge with "fishy" odor, pH > 4.5, clue cells on microscopic exam and positive "whiff" test...First line recommended treatment would more than likely include:
Answer. Metronidazole 500 mg bid x 7 days
76. In which of the following patients would the HPV vaccine be contraindicated?
Answer. 27-year-old female
77. Which of these women does not need to receive mammogram screening?
Answer. 34-year-old dx with fibrocystic breast disease
78. 34-year-old AA woman presents to your clinic with a history of heavy menstrual bleeding occurring every 30-32 days. She states that she has to wear both a super absorbency tampon and a pad. She is most likely experiencing:
79. Polycystic ovarian syndrome should be considered in the patient who is:
Answer. 40-year-old obese, never been pregnant, and has been dx with type 2 diabetes
80. Characterized by depressed or labile mood, anxiety, irritability, anger and other symptoms that are severe enough to interfere with occupational and social functioning. It occurs exclusively during the two weeks preceding menses.
81. Upon a pelvic examination, the NP attempts to place the speculum in the vaginal vault. She notes the patient has involuntary muscle contraction in the uterine wall and appears frightened. She is mostly suffering from?
Answer. This disorder is called vaginismus
82. Which of the following findings requires referral for further evaluation of abnormal vaginal bleeding?
Answer. Ultrasound shows ovarian tumor
83. Polycystic ovarian syndrome exhibits all of the following symptoms, which one is the most accurate?
Answer. Hirsutism, alopecia, acne, virilization, menstrual irregularity and infertility, polycystic ovaries, obesity, insulin resistance and metabolic syndrome
84. Primary dysmenorrhea can be caused by Professional assignment writing help "NURS 6615 Midterm Exam" Meet the team that makes it all possible endometriosis, tumors, ovarian cysts, or PID.
85. All of the following are characteristics of BV except:
Answer. Postcoital bleeding
86. Most common benign vulvar dermatoses
Answer. Primary irritant and allergic dermatitis, lichen sclerosis, lichen planus, squamous cell hyperplasia and psoriasis
87. Most common presenting symptom of lichen sclerosis
Answer. Vulvar pruritis.
88. Physical finding associated with lichen sclerosis
Answer. classic figure 8 formation that surrounds vulva and perianal area
89. What is the presenting symptom of lichen planus?
Answer. Irritating vaginal discharge
90. Three major classifications for vulvar LP
Answer. Papulosquamous, erosive and hypertrophic
91. Vaginal involvement is more likely for which: lichen planus or lichen sclerosis?
Answer. Lichen planus
92. Usually begins as a benign disorder that causes vaginal pruritis but over time progresses to this; usually occurs prior to menopause; women think they have chronic yeast infections
Answer. Squamous cell hyperplasia
93. Erythema is more common and scaling is finer Professional assignment writing help "NURS 6615 Midterm Exam" Meet the team that makes it all possible with thick plaque seldomly seen :-
Answer. Vulvar psoriasis
94. Mucus collection and creates a smooth, often shiny bulge on this cyst; usually requires no treatment
Answer. Nabothian cyst
95. These polyps appear moist, red and glandular; can become malignant if infected with HPV
Answer. Cervical polyp
96. Most common symptoms of endometriosis
Answer. Pelvic pain, dysmenorrhea, dyspareunia, abnormal menstrual bleeding, and infertility
97. Most common finding on physical exam of patient with endometriosis
Answer. Pain with palpation of posterior fornix during bimanual exam
98. When is surgery indicated for endometriosis?
Answer. For severe or debilitating symptoms that have not been controlled with medical therapy
99. Main treatment for adolescents with endometriosis?
Answer. NSAIDs and OCs