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
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)
,2
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
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
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, peaud'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.
,3
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.
Assessment findings: discrete, painless, firm or rubbery mass with well-defined borders, freely mobile,
changes in size may occur with pregnancy or menstrual cycle, Lesions >5 cm are considered giant fibroadenomas,
no nipple discharge.,
Dx studies: mammography, US to differentiate fluid-filled cyst from solid mass, fine needle aspiration
biopsy, open biopsy
Intraductal Papilloma: benign tumor within the ductal system of the breast, one of the heterogeneous
group of lesions encompassed by the term benign breast disease (BBD), seen in females 30-50 years,
Risk factors are multiple papillomas which increases the risk for breast cancer.
Assessment findings: smooth small mass that may or may not be palpable, typically retro-areolar, bloody
or serous nipple discharge, usually unilateral unless multiple ducts involved.
Dx studies: mammography, US (mores sensitive), MRI, Galactography (Ductography), fine needle or core
biopsy.
A nurse practitioner is participating in a women’s health fair. When educating the women about risk factors for
breast cancer, which of the following statements is incorrect?
Fibrocystic breast disease
When educating women about breast cancer risk factors, which statement is incorrect?
Fibrocystic breast disease
A woman with lobular carcinoma in situ has a relative risk of developing invasive breast cancer of
8.0
Androgen insensitivity/resistance syndromeInability of body to respond properly to male sex hormone, produced
during pregnancy
Sx- genetic make up is male but physical traits of woman
Vagina but no cervix, inguinal hernia w/ testes, normal female breasts, testes in abd or other place of body
Changes in hormonal regulation during menopause result in the gradual cessation of menstruation. From which
gland is Androstenedione secreted?
Adrenals
ASCUS/HSIL results from Paper Test Report
A Pap smear result of atypical squamous cells of undetermined significance—rule out high-grade squamous
intraepithelial lesion (ASCUS r/o HGSIL) will require which procedure next?
Colposcopy
A Pap smear result of atypical squamous cells of undetermined significance (ASCUS) will require which procedure
next?
Follow up pap smear
Bartholin glands and cysts-Obstruction of the main duct of Bartholin’s gland results in retention of secretions and
cystic dilation. Can be a secondary infection that can result in recurrent abscess formation. Results in a Fluctuant,
tender mass that is usually palpable. Common in women greater than 60. Can be the cause of tight fitting
undergarments resulting in chronic inflammation or STDs.
, 4
Symptoms-pain, tenderness, dyspareunia, and even difficulty in walking with adducted thighs.
Assessment finding: firm labia mass or cyst, erythema, induration, edema of labia minora, low grade fever,
possible purulent drainage. Diagnostic studies: not usually indicated unless other infection is suspected, C&S and
C&S for STD, most causative organism is aerobic E.coli.
Treatment-warm baths, Augmentin for E.coli and Strep infections, For staph or MRSA infections consider
Clindamycin. Re-evaluate in 7-10 days. Primary treatment is drainage of the infected cyst or abscess through
marsupialization and insertion of a WORD catheter.
Questions
A 25-year-old presents with a report of a very tender area just near her introitus and to the left of her
perineum. Very painful sex is how she knew "something wasn't right." She showered and when washing, she felt a
"pea-sized" painful lump on the left side of her "bottom." She tells you she looked at it with a mirror and it was very
small, but now it is the size of a ping-pong ball and getting worse.
When you inspect her external genitalia, you are amazed at the size and appearance of the "lump."
You note what appears to be an abscess on the left medial side of the labia minora, and there is some edema
extending into the perineum. Your diagnosis for this presentation is:
Bartholin’s cyst
You explain to this young woman what this "lump" is and let her know you will be referring her to a gynecologist
you consult with regularly. You explain to her the likely treatment as follows:
A possible incision might be necessary and a catheter placed for two to four weeks to allow
for drainage and appropriate healing.
A client at the women's health clinic complains of swelling of the labia and throbbing pain in the labial area after
sexual intercourse. For what condition does the nurse anticipate the client will be treated?
Bartholinitis
25yo female c/o tender area near her introitus and to the L of her perineum. Very painful sex was first sign. Initially
bump was very small, but now is ping-pong ball size. On exam, abscess is present on L medial side of labia minora
and there's edema extending into perineum. What is dx?
Bartholin’s cyst
Which of the following choices represents a disorder of the reproductive tract that causes pain, erythema,
dyspareunia, and a perineal mass?
Bartholin’s cyst
A nurse practitioner instructor is reviewing the anatomy of the external genitalia. At the opening of the vagina are
the Bartholin's glands. Which of the following describes the function of these glands?
Production of alkaline secretions for sperm viability
BMI
BMI Weight Status
Below 18.5 Underweight
18.5 – 24.9 Normal or Healthy Weight
25.0 – 29.9 Overweight
30.0 and Above Obese
CDC recommendations regarding STDs and PID• Routine annual screening of all sexually active females aged
25 years or younger for Chlamydia trachomatis and gonorrhea
• If infected, retest for chlamydia and gonorrhea 3 months after treatment (to check for reinfection, not for
test-of-cure)
• Annual testing for syphilis, chlamydia, and gonorrhea in persons with Hiv infection
• Minors do not need parental consent if the clinic visit is related to testing or treating STDs and birth
control; no state requires parental consent for STD care
Men Who Have Sex With Men (MSM)
