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NURS 366 FINAL EXAM QUESTIONS AND CORRECT ANSWERS
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NURS 366 FINAL EXAM QUESTIONS AND CORRECT ANSWERSAssessment - factors that impact sexuality - ANSWER Describe client's definition of
sexuality
Physical changes: breast, genitalia, skin, hair. Menarche, menstruation,
fertility/ovulation/conception, contraception, pregnancy, perimenopause
Aging: hormones, vaginal changes, menopause (average age 51). Most common
concerns: decreased desire, vaginal dryness, lack of partner, difficulty with orgasm.
Average age 51. range 44-55, premature: 40
Comorbidities: remember these can affect sexual function - diabetes, stroke, HTN, MI,
surgical intervention/trauma/pelvic injury, medications, incontinence
Psycosocial: roles, relationships, orientation, gender identity, self concept, cultural
influence, values/cultural background, coping and stress tolerance
It is important to ask when first menstrual period was because that will tell you how
much estrogen they have been exposed to in their lifetime
Menopause - ANS Cycles tend to shorten with age. Bleeding will be heavier at the onset
and can last longer. Menopause is defined as no menstruation for 12 consecutive
months. These women are most at risk for unintended pregnancy because they are
having irregular periods.
Sexual history assessment - ANS Gender identity and orientation
Current/past partners
Last sexual activity
Types of sexual activity: oral, anal, genital, sex objects
Desire, arousal, orgasm: need to know about female sexual response - females may be
ignorant about this
Pain, bleeding, s/s infection
Force, coercion abuse
,Dysfunctional uterine bleeding is the #1 problem or reason for women's healthcare visits
in the US
Diseases which affect sexuality in women- ANSWER Breast disorders
Menstrual orders
Abnormal uterine bleeding
Obesity: can affect menstrual/hormone cycle. You can lose your periods and you have a
more difficult time with child-bearing. There is also psychosocial component. Obese
persons are made to feel asexual
Menopause
Pelvic inflammatory disease
Uterine disorders
Ovarian disorders
Vaginal and vulvar disorders
Eating disorders/body dysmorphic disorder
Pap tests- ANSWER Every 3 years for women ages 21-65, or every five years for women
ages 30-65 with HPV testing. NO HPV testing for women under the age of 30. NO
screening for women under the age of 21 or over the age of 65. NO screening for women
who have had a hysterectomy for reasons other than cancer
Mammograms screening - ANSWER Begin screening age 50, every two years for women
50-74, stop at 75
90% of breast masses are found to be benign
STIs screening - ANSWER Screen all women 24 and younger for gonorrhea and
chlamydia, and older women at risk. Screen all pregnant women for both. All for HIV. All
women 50 and older should be screened at least once for hepatitis C.
BRCA1 and 2 screening ANSWER Screen all women with a history of the following
,cancers: breast, ovarian, uterine cancers (offer screening)
No routine screening for ovarian cancer (same for prostate cancer)
Assessment of breast ANSWER Female: inspection, palpation, lump or mass = begin
palpation on unaffected side. Note location, size, shape, contour, consistency, mobility,
pain, tenderness, discharge, number of lumps or masses. Always start on unaffected
side
Male: similar to preadolescent girl. Contains few ducts surrounded by connective tissue.
Men also can get breast cancer
Assessment of female reproductive system - ANSWER Tubal ligation is the most
common birth control method in the US. Make sure you assess this.
Menstrual history - menarche, menopause, duration, flow
Sexual history - STI, pelvic infections, pap smear, HPV vaccine
Contraception
Obstetrical history (GPTAL)
Medical and surgical history (GYN): D&C, C-section, tubal ligation, cystocele/rectocele
repair, TAH-BSO, surgical abortion
Fibrocystic disease - ANSWER Most frequently occurring benign breast disease -
usually painful, which differentiates it from cancer
Most prevalent in women 35-50 years old - 50-80% of women
Usual mass location: upper outer quadrants of breast
Risk factors: premenstrual symptoms, nulliparity (never being pregnant), long menstrual
history, family history, diet, stress
Chocolate, fat, caffeine can exacerbate these changes. Often associated with
tenderness or pain, during the second phase of menstrual cycle. Assess for changing
masses, breast discharge, breast symmetry
Symptoms: premenstrual exacerbation, subsides post-menstrually, breast
tenderness/pain, mass is round, well-defined, and free mobility
, Can be caused by an ill-fitting bra because they cut off the lymph flow
Tx: well fitted bra, no underwire. Decrease/eliminate caffeine, decrease estrogen,
decrease sodium, fat and sugar intake. Medical: analgesics (NSAIDs), diuretics,
hormone therapy - progesterone androgen, anti-estrogen. Surgical - rare
Breast cancer - ANSWER Most commonly diagnosed cancer in the US. Second leading
cancer-cause of death in US women
Majority of women newly diagnosed in US with breast cancer have no evidence of
metastatic disease
Most newly diagnosed classified as either early stage or locally advanced (tumor >5cm,
axillary lymph node involvement, extension into chest wall, or inflammatory breast
cancer).
Staging system: This forms the basis of treatment options with receptor positivity
[oestrogen], progesterone human epidermal growth factor. Better to have a cancer that
is not receptive to hormones.
It is a treatment of choice for eligible women and evidence-based to have same or better
outcomes as mastectomy, but not an option for all women-large tumors, prior history,
persistently positive margins, pregnancy
Breast cancer therapeutic management - ANSWER Surgery: lumpectomy, mastectomy,
breast conservation, limited lymph node removal
Preoperative teaching: basic preop information, wound care, arm and hand care.
Should know tumor, node, metastasis classification because it affects prognosis and
treatment plan. Pain management, treatment decisions, self-concept, sexuality.
Postop care: assessment, intervention, teaching. Wound care, arm and hand elevation,
rehab exercises, s/s of lymphedema, neuropathy, reconstruction, avoiding lymphedema
and injury (exercises, taking BP, blood draws, constrictive clothing/jewelry, airplanes,
promoting circulation).
Nursing management after mastectomy: risk for bleeding, risk for infection, acute pain,
risk for ineffective breathing pattern, risk for disturbed body image, risk for ineffective
coping, and fatigue
Mastectomy post op care - ANSWER Frequent VS (T, BP, HR, RR, pulse ox)
Labs (HCT, Hgb, WBCs)
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