NURS8024 FINAL EXAM 2024-2025. All Exam Questions and Correct, Detailed Answers. Graded A+, Exams of Nursing

Download NURS8024 FINAL EXAM 2024-2025. All Exam Questions and Correct, Detailed Answers. Graded A+ and more Exams Nursing in PDF only on Docsity! NURS8024 FINAL EXAM 2024-2025. All Exam Questions and Correct, Detailed Answers. Graded A+ @ what point in pregnancy should you screen for GDM? - ANSALL pregnant women between 24-28 weeks gestation 10week uterus - ANSmay be able to begin to palpate the uterus at this point, usually still within pelvic girdle 12week uterus - ANS@ the level of the symphysis pubis; grapefruit 16 year old presents with CC of mass in her R breast- it is not painful, is 3-cm, movable, rubbery. her mom had just instructed her on how to perform SBE's so she's not sure how long it has been there. what is the most likely diagnosis? - ANSfibroadenoma (MC type of breast mass in adolescents and young women) 16week uterus - ANS1/2 way between symphysis pubis and umbilicus 18 year old presents to the office who has never had a menses, she is a senior in highschool, her sisters had periods starting at age 13; no weight gain/loss, exercises 20 minutes/day, born w/ one kidney, vitals stable, ht 5'4", wt 122lbs, tanner stage IV breasts, axillary and pubic hair. normal external genitalia. what is the most likely diagnosis? - ANSprimary amenorrhea 2 national organizations that provide guidelines for WHNP practice and education? - ANSamerican association of colleges of nursing (AACN) national organization of NP faculties (NONPF) 20 year old presents w/ CC of painful menstruation, menarche age 12 (28 day cycles), lasting 5-6 days, heavy 3 days then tapers. Pain with cramps 8-9/10. she sometimes misses school because of this. not sexually active. pelvic exam WNL. you diagnose her with dysmenorrhea...how to you explain to her the patho of why she is having pain? - ANSthe pain is caused by prostaglandins being released which are causing your uterus to contract = pain 20week uterus - ANS@ umbilicus 21 year old woman presents for her well woman exam- what are the recommendations for her pap? - ANSages 21-29 pap test alone every 3 years 22 year old G1P0 at 28 weeks presents with CC of intermittent and pelvic pressure for the last 4 hours; no dysuria, vag bld, or LOF. no N/V, she drinks 8-9 glasses of water/day. no pregnancy issues up to this point. vitals stable. FH- 28cm, FHT 144. longitudinal lie, cephalic presentation. urine dip negative, you place her on the monitor and she is contracting every 3-5 minutes. what is the management plan - ANSadmit to l&d spec exam for cervix, membranes, fFN swab poss betamethasone, tocolytics, mag sulfate 22 year old presents to the office with CC of rash on her back: rash has been there for the past 4 years the rash comes/goes, periods where skin is clear rash is reddened with several silver-white patches that are thick, scaly, and flaky...what is the diagnosis - ANSpsoriasis 24 year old presents to the office with c/o: cough that started 3 mos ago cough is nonproductive, worse after exercise she is sedentary- just started exercise program chest feels "tight" and breathing gets harder after exercising runs out of breath earlier, coughs a lot NO FEVER, SPUTUM, CONGESTION, H/A's, WEIGHT LOSS she does not smoke her lungs- bilateral wheezing, and prolonged expiratory phase; CXR is normal..whats the diagnosis - ANSasthma 24 year old presents to your office with CC of a "mole"; hx reveals she goes to the beach often and enjoys sunbathing. the mole is asymmetric, border is irregular, color is mottled, diameter is greater than tip of a pencil, it is elevated...what is the most likely diagnosis - ANSmelanoma 26 year old presents with: dark abdominal/facial hair (male pattern) 10 lbs weight gain acne periods every 40 to 82 days slight clitoromegaly (excess androgen) 8cm adnexal mass what is the diagnosis? - ANSPCOS 27 year old G2 P1 presents to your office for her new antenatal visit; she had routine labs drawn 4 days ago; you note her C&S shows 100,000 cfus/ml of E.Coli...what is the incidence of asymptomatic bacteriuria in pregnancy? - ANS4-7% 27 year old G2 P1 presents to your office for her new antenatal visit; she had routine labs drawn 4 days ago; you note her C&S shows 100,000 cfus/ml of E.Coli...what is 2- recommended age for HPV vaccine is 11-12, and ***prior to sex*** 3- the vaccine has dropped HPV cancers/warts by 81% 4- most common SE's = injection site reactions (red/swell), sore arm A 30-year-old presents with CC of dry, scaly lesion rash on her right arm (anterior elbow area), sometimes with intense itching and burning for the last 2 years; sometimes this rash oozes. What is the diagnosis - ANSeczema (atopic dermatitis) because of vesiculation/weeping of lesions, and itching a client calls you 2 days PP and states her breasts are very firm and tender...you determine she is experiencing engorgement. what is your management for her? - ANScontinued breastfeeding breast massage cold compresses frequent milk removal/hand expression/pumping anti-inflammatories chilled cabbage leaves **correct latch and suckling*** a woman is diagnosed with endometrial hyperplasia, what is the significance of this finding? - ANSthis is a condition in which the lining of the uterus is abnormally thickened, could mean endometrial cancer a woman presents with CC of spontaneous "bloody" nipple discharge from her R breast for the past 3 months...what are the possible diagnoses? - ANSintraductal papilloma* breast cancer A woman who is pregnant for the second time, and received Rhogam after her last birth...education wise. which pregnancy is Rh- incompatibility most concerning in... - ANSthe SECOND one (doesn't cause issues in the first pregnancy- she isn't sensitized then) abscessed Bartholin's cyst- what is the treatment? first line antibiotic is? - ANS-warm compress, ATB's, I&D, insertion ward catheter, marsupialization -trimethoprim 160 mg/sulfamethoxazole 800mg (Bactrim) absolute contraindications of COC's - ANSbreast cancer history of DVT/PE active liver disease pregnancy, while relative contraindications include smoking, age over 35, hypertension, breastfeeding ACOG recommends what regarding mammography: - ANSevery 1-2 years beginning at age ***40 years. If you have not started screening in your 40s, you should start having mammography no later than age 50 years. Screening should continue until at least age 75 years. adding KOH to a slide...will show you... - ANSpseudohyphae ADH and oxytocin are secreted by - ANSposterior pituitary all major organ systems are formed during the embryonic stage, except.... - ANSfetal LUNGS American cancer society recommendations for mammography: - ANSWomen 45 to 54 should get mammograms every year. Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. anti-HTN should be started when for new-onset pre-e in pregnancy... - ANSsystolic of 160 or > diastolic of 110 or > are tension headaches triggered by physical activity? - ANSNO ASB in pregnancy...does it need a test of cure? - ANSYES asymmetrical growth restriction - ANSlarge head compared to the body asymmetric growth is more commonly due to extrinsic influences that affect the fetus later in gestation, such as preeclampsia, chronic hypertension, and uterine anomalies Average age of perimenopause - ANS45-55 Benefits of an IUD (progesterone only) - ANSdecreased menses/pain or amenorrhea reversible used for those that can't take CHC's can be used in breastfeeding and immediately PP benefits of using a progesterone only pill - ANSsafe in those who cannot have estrogen can be used w/ breastfeeding black-box warning in pregnancy - ANSisotretinoin (accutane), ACE/ARB's BRCA 1 - ANSnormally acts of restrain growth of cells in the breast when mutated, predisposes to breast cancer increases risk of breast ca by 55-65% increases risk of ovarian ca by 39% BRCA2 - ANSprovides instructions for making a protein that acts as a tumor suppressor; Most BRCA2 gene mutations lead to the production of an abnormally small, nonfunctional version of the BRCA2 . As a result, less of this protein is available to help repair damaged DNA or fix mutations that occur in other genes Breast Abscess Treatment - ANSdrain with incision and drainage (I&D) or aspiration continue to breastfeed unless abscess drainage is close to where baby latches can occur any time within the first year PP (most often 2 mos pp) tearful, anger, mood swings, lack of interest in baby, sleep disturbances, guilt/shame, feeling isolated, hopeless, loss of interest/pleasure in things, feelings of harming self/baby requires SSRI's, CBT - ANSpostpartum depression can occur any time within the first year PP (most often 4 weeks PP) hallucinations delusions cant communicate rapid mood changes paranoia hyperactivity disorganized thoughts requires inpatient/mental health tx - ANSpostpartum psychosis can the mini pill/progestin only pill be given in the immediate PP period? - ANSyes- no evidence to show that bleeding, involution, or lactogenesis is affected by POP's- can be given immediately PP. can you use imiquimod in pregnancy? - ANSNO - but can use TCA Category A drugs and pregnancy - ANSStudies indicate no risk to the human fetus. Safe for mother and baby (ex: MV/ synthroid) Category B drugs (pregnancy) - ANSStudies indicate no risk to an animal fetus; information for humans is not available (ex: Tylenol, Amoxicillin, Metformin) Category C drugs and pregnancy - ANSAdverse effects reported in the animal fetus; information for humans not available- benefits MAY outweigh risks (ex: oxytocin, Zoloft) Category D drugs and pregnancy - ANSPossible fetal risk in humans has been reported- benefits MAY outweigh risks (ex: NSAID's, losartan, lisinopril, paxil) Category X pregnancy - ANSAnimal or human studies have shown fetal abnormalities or toxicity, and the RISK outweighs the benefits (ex: ergotamine, atorvastatin, methotrexate, thalidomide, accutane) d/t a low level of von willebrand substance, or improperly functioning VWD substance, that results in the inability to clot or a prolonged clotting time - ANSVon Willebrand's Disease define a corpus luteal cyst.... - ANSwhen the follicle releases the egg, it begins producing E/P for conception, sometimes fluid accumulates inside this cyst usually no treatment needed, disappear w/in 3 cycles define a follicular cyst.... - ANSsimple ovarian cyst that occurs when dominant follicle fails to "rupture" or release an egg usually asymptomatic goes away on its own in 6-8 weeks define a hemorrhagic cyst.... - ANSsac that forms on the ovary and fills with blood typically no treatment needed if the cyst is >10 cm, can be drained or removed define endometriosis - ANSendometrial glands and stroma found OUTSIDE the uterus Define intimate partner violence - ANSA pattern of coercive, exploitive, & violent tactics, used by one intimate partner against another, in order to establish & maintain power, control, & dominance define leiomyomata uteri - ANSaka uterine fibroid- benign growth that grows from the smooth muscle of the uterus Define menopause - ANScessation of menstruation for 12 months Define perimenopause - ANSperiod b/t beginning of menopausal sxs/changes until 12 months after LMP (irregular menstrual cycles are common during this time*) define sexual assualt - ANSunwanted sexual contact that is forced upon an individual; umbrella term for any sexual act that is attempted or committed against someone who has not given their consent Diagnosis of SLE - ANS- High titer ANA plus at least 4 physical manifestations (ex: malar rash, renal disease, arthritis) Diagnostic testing is subjective/objective... - ANSobjective do you have to wait after stopping OCP before trying to get pregnant? - ANSmedically, NO, but it might be easier to track cycles if you've had a few off of the pill does BPP or NST have a better predictive value of fetal well-being? - ANSBPP (per Maus) does chorionic villi sampling detect NTDs? - ANSNO does nexplanon contain estrogen? - ANSNO remember, only COC's, patch, ring do! does pain usually dissipate after a bowel movement in someone with IBS? - ANSyes... does the partner of someone with trichomoniasis need treated? - ANSYES - need TOC in 3 months as well Drugs with a high potential to cause psychological or physical dependence and abuse are called ____. however some do have medical use. - ANSschedule II (methadone/morphine) drugs with a moderate to low potential for abuse and physical and psychological dependence - ANSschedule III (codeine) Drugs with low potential for abuse and low risk of dependence - ANSschedule IV (phenobarbital) drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. - ANSschedule V (cough preparations; Robitussin) Drugs with NO currently accepted medical use and a high potential for abuse - ANSschedule I (heroin) education about a diaphragm - ANSinsert just prior to or up to 2 hours before sex leave in place for 6 hours after sex education for a patient using the nuvaring for birth control... - ANSinsert ring for 3 weeks, remove for bleed, insert new ring 7 days later EDUCATION for a patient using the transdermal patch for birth control... - ANSskin irritation can occur at application site rotate site (butt, belly, back, upper arm) apply new patch on same day each week for 3 weeks, then no patch for 4th week for bleed education for a patient with chlamydia: - ANSBOTH partners need treated! abstain from sex for 7 days after treatment is complete untreated can lead to PID TOC 4 weeks after treatment if pregnant TOC 3 months after treatment if not pregnant high rate of reinfection* education for a patient with syphilis? - ANSClinical and serologic evaluation should be performed at 6 and 12 months after treatment* partners need treated if sex <90 days before diagnosis education for a patient with trichomoniasis? - ANSDO NOT DRINK ALCOHOL DURING TREATMENT (can experience a disulfiram-like reaction- abd pain, N/V, HA) sex partners need treated too! TOC is rec 3 months after completion of tx education for patient with gonorrhea - ANSboth partners need treated! TOC 7-14 days ONLY if throat infection untreated can cause PID (infertility, ectopic's, pain) education for PID: - ANStest partners from the last 60 days for STI and treat presumptively for N. gonorrhoeae and C. trachomatis education for someone who is starting depo and wants to know how it can affect fertility? - ANScan take anywhere from 15-49 weeks for fertility to return education regarding pre-conception...women should start... - ANStaking a PNV that contains folic acid*** education when someone is taking flagyl... - ANSavoid etoh educational point when a patient is taking iron...what should they take it with? - ANScitrus (orange juice, Vit C) effectiveness of COC's - ANSTypical use: 8-9% Estradiol - ANSmost common type in women of reproductive age Estriol - ANSestrogen of pregnancy estrogen is released by the ovary in response to... - ANSfsh Estrogen is secreted by the - ANSovaries Estrogen-containing oral contraceptives are recommended in breastfeeding women; true or false - ANSFALSE- not recommended, have been shown to decrease the quantity and duration of BFeeding. Estrone - ANSMost common estrogen after menopause example of collaboration level management of care - ANSjoint communication and decision-making between healthcare professionals that are working towards mutual goals of patient care GnRH is secreted by - ANShypothalamus and triggers release of FSH and LH headache that is: -more common in women -caused by VASCULAR CHANGES (regional hypoperfusion) -triggers=hormones, stress, lighting, noise -has a prodrome, AURA, H/A, postdrome - ANSmigraine w/ aura health care services by clinicians who are accountable for addressing a large majority of personal health care needs; developing a sustained partnership with patients, and practicing in the context of family and community - ANSprimary care health history is (CC, HPI, ROS- +/-)subjective/objective... - ANSsubjective hepatic metabolism of drugs in pregnancy increases AND decreases; t or f - ANStrue! high levels of estrogen stimulate this hormone... - ANSLH how accurate is NIPT testing? - ANS99% detection rate for down syndrome (0.5% false +) how do most people describe a tension headache? - ANS"like a band around my head" how do we know its an asthma diagnosis and not URI, pneumonia, TB, etc. - ANSURI- congested, runny nose, sore throat PNA- fever, fatigue, weight loss, green/yellow sputum, crackles, + CXR TB- blood tinged sputum, weight loss, night sweats, + CXR how do we perform CVAT - ANSplacing a hand over the patients flank, and hit your hand with the fist of the other hand...assess for pain how do we treat lichen simplex chronicus? - ANSavoid irritants topical xylocaine, antihistamines CBT how do you manage a partial expulsion of an IUD - ANSremove old one, insert new, start doxy @ current visit how do you report an adverse drug reaction or event? - ANScall FDA directly, use the FDA adverse reporting system (FAERS)- they collect reports on ADE's, ADR's, quality issues, usage errors, and therapeutic failures. NP's can submit reports through the MedWatch website. How does emergency contraception work? and is it breastfeeding safe? - ANSprevents ovulation yes - it is BF safe how does the babies blood communicate with blood from mom. - ANStrophoblasts How does tranexamic acid work? - ANSInhibits fibrinolysis by forming a reversible complex that displaces plasminogen from fibrin (increases clotting) How effective are condoms? - ANS85-98% ^ very high when used correctly however, tier 3 of effectiveness how effective are IUD's/ParaGard's - ANS99% How is a punch biopsy performed? - ANSexplain procedure cleanse area w/ solution lidocaine w/epi wait 3 minutes bx help perpendicular to the skin sample lifted w/ tissue forceps/released w/ scissors place in medium sites <4mm don't need closure review hygiene precautions how is bacterial vaginosis diagnosed? - ANS3 out 4 findings: AMSELS CRITERIA thing white discharge positive Whiff test (fishy odor) pH > 4.5 clue cells on wet mount How is lichen sclerosis diagnosed? - ANSvulvar biopsy How is psoriasis managed? - ANSneeds referral topical Vitamin D analogues corticosteroids phototherapy methotrexate How is trichomoniasis diagnosed? - ANS-saline wet mount of vaginal discharge - motile trichomonads - pH >5 - "strawberry cervix" How is urge incontinence treated? - ANSAnticholinergics (Oxybutynin, Tolterodine) Surgery as last resort How is vulvovaginal candidiasis diagnosed? - ANSwet mount - will see presence of budding yeast, pseudohyphae ph normal how long can ParaGard be used for - ANS10 years how long is an NST predictive of fetal well-being? - ANSin general, FHR b/t 110- 160bpm, moderate variability, accelerations, and no decels demonstrates a very low likelihood of adverse outcomes within 1 week of a reactive NST. how long should a woman wait after childbirth to initiate COMBINED hormonal contraceptive? - pill/patch/ring - ANSthese should be avoided in the first 21 days PP** (42 days for someone @ high risk for VTE) how many veins and how many arteries are in the umbilical cord - ANS2 arteries 1 vein vein- o2 artery- no o2 ^^different from normal how much calcium is recommended (dietary or supplemented) for a menopausal/perimenopausal woman? - ANS1200mg/day -adequate Vit D -weight bearing -fall prevention -stop smoking -limit ETOH how will the WHNP diagnose a generalized anxiety disorder? - ANSusing the GAD-7*** 1- nervous/anxious/on edge 2- not sleeping, can't control worrying 3- worrying too much 4- trouble relaxing 5- being restless/can't sit still 6- becoming easily annoyed/irritable 7- feeling afraid something bad will happen score of 5 = mild score of 10= moderate score of 15= severe how will the WHNP screen women for depression in a primary care setting? - ANSPHQ- 2 (the easiest tool in primary care setting) increased blood flow to the skin in pregnancy results in an increase or decrease in drug absorption - ANSincrease (TD, IN, IV, epidural, SQ) increased ventilation in pregnancy results in an increase or decrease in drug uptake - ANSincrease incubation period for gonorrhea - ANS1-14 days incubation period for syphilis - ANS10-90 days (avg 21) -- point of this: person won't present immediately after high-risk sexual encounter incubation period of chlamydia - ANS7-21 days incubation period of condyloma acuminata - ANS2 weeks-8 months (avg 2-3 mos) incubation period of herpes - ANS2-12 days incubation period of HIV - ANS2wks-6mos after contact w/ virus incubation period of trichomoniasis - ANS5-28 days independence; capacity for making decisions, judgement, knowledge, and self- determination. ex: clinical decision making - ANSautonomy infected Bartholin's cyst- often the causative organism is... - ANSE.Coli integration of clinical expertise with the best available clinical evidence from research; is the "conscientious, explicit, and judicious use of theory-derived, research-based information in making decisions about care delivery to patients and in consideration of individual needs and preferences. - ANSevidence-based practice is a migraine with aura bilateral or unilateral? - ANSunilateral (one sided) is a patient is on a COC and is experiencing bleeding/spotting after scheduled bleeding...increase the... - ANSestrogen is endometriosis managed? - ANSThe primary goal of medical treatment for endometriosis is to halt the growth and activity of endometriosis lesions (d/t estrogen) and ovulation suppression GnRH agonists Danazol COC's Progestin surgery (removal of implants, hyster, ablations) is the HPV vaccine recommended for those >26 years old? - ANSNO is the levonorgestrol IUD/mirena safe for breastfeeding and can it be inserted in the immediate PP period? - ANSyes & yes- however, runs high risk of expulsion when inserted immediately after birth. is the nexplanon safe for breastfeeding and can it be inserted in the immediate PP period? - ANSyes & yes is the paraguard IUD safe for breastfeeding? can it be inserted immediated PP? - ANSyes & yes- however, runs high risk of expulsion when inserted immediately after birth. it is determined a 55 year old woman is experiencing dyspareunia due to vaginal dryness; she is not on any medications. what is your management plan? - ANSvaginal estrogen vaginal lubricant w/ every encounter shifting of positions/hips during sex itch-scratch cycle - ANSLichen simplex chronicus JNC 8 criteria for HTN diagnosis in those <60 without DM/CKD... - ANS>140/>90 (initiate therapy) JNC 8 criteria for HTN diagnosis in those age 60+ withOUT DM/CKD... - ANS>150/>90 (initiate therapy) JNC 8 criteria for HTN diagnosis in those WITH DM/CKD (all ages)... - ANS>140/>90 labs for gallbladder workup - ANSCBC, AST/ALT, amylase/lipase, US lactogenesis III - ANS*ongoing milk synthesis in response to milk removal "supply and demand" lactogenesis IV - ANSbreast involution, removal of milk decreases, the process of decreased milk production by apoptosis of the milk-making epithelial cells lactogenesis stage I - ANSBeginning at approximately 16 to 18 weeks of pregnancy. Onset of colostrum mainly controlled by progesterone (prolactin, HPL, GH, insulin like GF) lactogenesis stage II - ANS***copious milk production, usually 2-4 days PP d/t the rapid decline of progesterone after placental delivery Latent syphilis symptoms - ANS-No outward symptoms (only evidence is positive serologic test) leading cause of death ages 11-24 - ANSunintentional injury leading cause of death ages 25-45 - ANSunintentional injury leading cause of death ages 45-65 - ANScancer/malignant neoplasm leading cause of death ages 65 years and beyond - ANSheart disease Leopold's Maneuvers - ANSPalpation to determine presentation and position of the fetus and aid in location of fetal heart sounds. LH and FSH are secreted from - ANSanterior pituitary LH is progesterone/estrogen dominent - ANSprogesterone (think about what happens with LH surge..ovulation, pregnancy, need progesterone to sustain) LH:FSH ratio in PCOS - ANS3:1 Lochia alba - ANSWhite, cream-colored, or light yellow vaginal discharge that follows lochia serosa. Occurs when the amount of blood is decreased and the number of leukocytes is increased. Lochia rubra - ANSReddish or red-brown vaginal discharge that occurs immediately after childbirth; composed mostly of blood. Lochia serosa - ANSPinkish/brown, serosanguineous. Lasts day 4-10 postpartum macrocytic anemia - ANSMCV > 100, caused by vitamin B12 or folate deficiency or both. Other causes (alcoholism, poor nutrition, GI disorders and pregnancy. Vitamin B12 deficiency can result in serious neurological dysfunction. Folic acid deficiency causes ulcerations of the tongue and oral mucosa, and changes to skin, hair and fingernail pigmentation TX: Vitamin B12 (Cyanocobalamin) injections (1st line), folic acid (folate vitamin B9) uterine hypertrophy- 2 lbs placenta- 1.5 lbs only FDA approved medication for gestational diabetes - ANSinsulin order of fertilization... - ANSoocyte zygote morula blastocyst gastrula embryo fetus osteoarthritis causes what type of joint pain... - ANSunilateral (one sided), asymmetrical joint pain ovarian cycle consists of: - ANSfollicular phase, ovulation, luteal phase oxytocin causes milk... - ANSejection Oxytocin is responsible for - ANSmilk ejection (Oxytocin, milk Out) pain with RA causes AM pain and stiffness, and stiffness is worse after a long rest (vs. with OA where rest relieves pain) t or f - ANSTRUE PALM-COEIN - ANSP: Polyp A: Adenomyosis L: Leiomyoma M: Malignancy/hyperplasia C: Coagulopathy O: Ovulatory dysfunction E: Endometrial I: Iatrogenic N: Not yet classified palpating an ovary of a 64 year old woman is an normal finding; true or false - ANSFALSE- ovaries at this age should have diminished to the point of not being able to be felt; if they are, this needs further evaluated (as this is a sign of ovarian ca) pap results for a 32 year old read as follows" satisfactory, endocervical cells present ASCUS, HPV reflex + HPV 16 & 18. what is your management plan? - ANScolposcopy!! (d/t high risk HPV strains) patient has abdominal pain in the RUQ, N/V x 3 hours, no diarrhea. exam reveals normal bowel sounds, + murphy's sign whats the most likely diagnosis - ANScholecystitis patients with sickle cell disease in pregnancy...what do we need to watch for - ANSUTI's per acog & american academy of pediatrics, how long is breastfeeding recommended? - ANSexclusively breastfed for 6 months* then intro of complementary foods and continued breastfeeding to 1 year and beyond. person who has not carried a baby to 500g or 20 weeks - ANSnullipara possible reaction that may occur when treating for syphilis? - ANSJarisch-Herxheimer (H/A, myalgia, fever) pregnant patient is diagnosed with bacterial vaginosis - she does not have any symptoms however. what do you tell her? - ANSonly treat if she is @ risk for preterm delivery Presentation of basal cell carcinoma - ANSElevated nodule with central, ulcerated crater surrounded by dilated (telangiectatic) vessels; "pink pearl like papule" translucent Primary syphilis symptoms - ANSpainless chancre process by which a drug becomes available to body fluids/tissues? - ANSdistribution Process for certification maintenance for an NP - ANS-cert is valid for 3 years -complete continuing competency assessment at the beginning of your maintenance cycle -continuing education earned is based on your education plan after the assessment is completed maintain current/active, unencumbered licensure, update and upload licensure Progesterone is secreted by - ANScorpus luteum prolactin causes milk... - ANSproduction Prolactin is responsible for - ANSstimulating milk production (PROlactin, PROduction) Prolactin is secreted by - ANSanterior pituitary proliferation of endometrium (what hormone is dominant?) - ANSestrogen provision of services in a manner consistent with care as a another professional with similar training and experience faced with a similar situation would provide; sets minimum criteria for job proficiency (stated by medicare, joint commission) - ANSstandards of care pt presents to office with painful, reddened, R breast. NO c/o dysuria, uterine cramping, or abd pain. lochia has ceased. she has body aches and chills. fever of 101.4, HR 102bpm lungs clear, UA negative R breast is firm, warm, reddened, slight fissure on R nipple what is the diagnosis and mgmt plan - ANSmastitis dicloxacillin 500mg Q6H or Keflex 500 Q6H continue to breastfeed, rest, hydrate, take entire course of ATB's remaining TRUTHFUL w/ the patients regardless of any circumstances ex: telling the patient the truth, never lying, even if it may cause distress - ANSveracity removal of a drug from the body; primarily occurs in the kidneys, but can also occur through the skin, lungs, bile, sweat, breast milk, or feces - ANSexcretion rheumatoid arthritis occurs bilaterally or unilaterally & asymmetrical or symmetrical in wrists/fingers, hips, knees? - ANSBILATERALLY, SYMETRICALLY rheumatoid occurs in men more than women; t or f - ANSFALSE women > men risk factors for adenomyosis - ANSpatients who have recurrent D&C (suction of contents of the uterus) multiparity extended exposure to estrogen COC use risk factors for cervical polyps? - ANS> 4o years of age multigravida hx of STI's previous polyps risk factors for type II DM include: - ANSobesity sedentary lifestyle family h/o certain races (native Americans, Hispanics, blacks, Asians) high cholesterol d/t an LH surge Step 4 of Menstrual Cycle - ANSLuteal/Secretory (progesterone dominant) corpus luteum formed mucousy (secretions) Step 5 of Menstrual Cycle - ANSif pregnancy does not occur, after the Corpus Luteum breaks down, the progesterone and estrogen levels crash, the Endometrium breaks down and blood flows out of the vagina stress incontinence - ANSthe inability to control the voiding of urine under physical stress such as running, sneezing, laughing, or coughing study of drug concentration and the patients response; the study of a drug's EFFECT, including the duration and magnitude of the response in relation to the drug dosage, what the DRUG DOES to the body - ANSpharmacodynamics study of how different genes in the full genome determine drug behavior; identifies genes involved in drug metabolism and drug response - ANSpharmacogenomics symmetrical growth restriction - ANSboth head and body parts are small undernourished fetus genetic disorders heart disease maternal drug use/ETOH/tobacco symptoms < 14 days affects upwards of 80% of women short lived usually occurs in the first 7-10 days PP tearful, irritable, mood swings, fatigue, appetite changes - ANSpostpartum blues Symptoms of Gonorrhea - ANSdischarge and painful urination (often asymptomatic or mistaken for a UTI) Symptoms of PID include: - ANS· Lower abdominal pain · Pelvic organ tenderness · Inflammation of the genital tract · Fever · Abnormal uterine bleeding Symptoms of Trichomoniasis - ANSGreen, yellow, gray, frothy, vaginal discharge strawberry spots on cervix tension headaches are unilateral or bilateral? - ANSbilateral- mainly frontal or occipital area and/or cervical spine tertiary syphilis symptoms - ANSPainful swollen tumors (gummas) develop in liver, skin, bone, and/or cartilage; may cause serious tissue damage Worst case scenarios: ---Cardiovascular syphilis (fatal) ---Neurosyphilis (pain, blindness, dementia) The average age of menopause is about _____ years. - ANS51 the CDC's recommendations for STI treatment is an example of... - ANSstandards of care the cytotrophoblast is... - ANSchorionic villi...helps with implantation, gives rise to the synctiotrophoblast the exact etiology of rheumatoid arthritis is unknown; t or f *thought to be an autoimmune component/chronic inflammation - ANStrue (there may be a genetic predisposition or environmental factors like bacterial infections or asbestos) The female hormones—estrogen and progesterone—control the changes in the uterine lining. Estrogen builds up the uterine lining. Progesterone maintains and controls this growth. Estrogen without enough progesterone may cause the lining of the uterus to thicken. In most cases, endometrial hyperplasia can be treated with medication that is a form of the hormone progesterone. Taking progesterone will cause the lining to shed and prevent it from building up again. It often will cause vaginal bleeding. ^^ just an FYI - ANSFYI the lowest/highest dose of HT should be used... - ANSLOWEST the most common benign neoplasm of the cervix is... - ANSpolyp The movement of drug particles from the GI tract to body fluids by passive absorption, active absorption, or pinocytosis. - ANSabsorption The national organization of nurse practitioner faculties (NONPF) describes NINE core competencies...what are they - ANSscientific foundation leadership quality practice inquiry technology/information literacy policy health delivery system ethics independent practice the obligation not to harm or cause injury ex: stopping a medication that is causing harmful SE's - ANSnonmalifience the only TWO things that *decrease* in pregnancy and affect drug pharmacokinetics... - ANSintestinal motility/emptying plasma proteins the ovaries react to... - ANSFSH/LH The physical exam is subjective/objective... - ANSobjective the predominate site of biosynthesis of the sex hormones (estrogen, progesterone, and androgen) in a healthy, ovulating woman is the.... however, these hormones can be produced in lesser degree in the... - ANSovaries adrenal gland The process of drug absorption, distribution, metabolism, and excretion; the MOVEMENT of drugs within the body, what the BODY DOES to a drug - ANSpharmacokinetics the same woman we treated for ASB returns to the office @ 28 weeks...she has dysuria and suprapubic discomfort, she has had a fever and chills x24 hours. temp is 100.2 and she is +CVAT...what is the diagnosis and management plan - ANSpyelonephritis (fever, chills ,CVAT) IV ATB's until afebrile cephalosporin's, gentamycin, ampicillin the synctiotrophoblast is... - ANSthe epithelial covering of the highly vascular embryonic placental villi, which invades the wall of the uterus to establish ****nutrient circulation between the embryo and the mother**** the things that *increase* in pregnancy and affect drug pharmacokinetics.... - ANSventilation <3 output blood flow to skin gastric pH intestinal transport time plasma volume total body water body fat uterine blood flow this results from entrapment and compression of the median nerve and hand tendons, occurs in women > men; management through NSAIDS, wrist splints...surgery offers definitive treatment - ANScarpal tunnel syndrome this type of diabetes is d/t insulin deficiency/secretory effect & increased hepatic glucose production...lifestyle modification (exercise/diet), oral anti-DM's, sometimes insulin - ANSType II DM This type of diabetes typically begins in childhood, and is d/t beta cell destruction...there is a genetic component (especially w/ 1st degree relatives)...requires insulin - ANStype I DM this type of disorder results in lack of protection of oxidizing effects on RBC's- hemolysis occurs d/t illness, stress, and exposure to sulfa drugs or fava beans - ANSG6PD this type of headache has a CNS and PNS mechanism. CNS- hypersensitivity of trigeminal nerve PNS- contraction of jaw/neck muscles - ANStension this type of headache is: more common in MEN r/t release of histamine/serotonin - ANScluster headaches this type of headache is: often d/t menstrual cycle in childbearing aged women DOES NOT CAUSE vascular changes OR hypoperfusion lasts 4-72 hours is UNIlateral DOES NOT have aura occuring before onset - ANSmigraine W/OUT aura this type of hepatitis is: - *the MC blood-borne disease in the US - spread via blood/IV drug use - incubation: 2wks-6months - there IS NOT a vaccine - treatment- interferon/ribavirin (those with chronic infection can be cured w/ 8-12 wks of oral therapy) - ANSHepatitis C this type of hepatitis is: - spread via blood/sexual contact - incubation: 90 days - there IS a vaccine - treatment- if exposed give IG, chronic can use antiretroviral therapy - ANSHepatitis B this type of hepatitis is: - spread via fecal-oral route d/t poor hygiene or sanitation - incubation: 28 days - there IS a vaccine - treatment = mgmt of GI symptoms - ANSHepatitis A this type of vulvar dermatosis has the following presentation: severe itching (relieved by scratching) can have mild erythema to fissures, patches, excoriations ITCH SCRATCH ITCH CYCLE pubic hair may be gone from itching - ANSlichen simplex chronicus (three words, itch scratch itch) this vulvar dermatosis has the following presentation: itching, burning symmetrical depigmentation in FIGURE 8 pattern pale TISSUE PAPER skin loss of vulvar architecture - ANSlichen sclerosus this vulvar dermatosis has the following presentation: itching, chronic OR remitting white reticulation/striae/hyperpigmentation lesions can appear in oral cavity well demarcated erosions - ANSlichen planus Toxoplasmosis - ANSa parasite that is most commonly transmitted from pets to humans by contact with contaminated animal feces dont change the kitty litter when pregnant TPAL system - ANSterm, preterm, abortion, living transmission of HIV to fetus WITH ART - ANS< 1% transmission of HIV to fetus without ART - ANS15-45% treatment for a cervical polyp? - ANSobservation vs removal if she develops any irregular of postcoital bleeding, or has an atypical polyp - removal for histology is indicated. Treatment for UTI in a PREGNANT patient - ANSPCN (amoxicillin) - 500mg Q8H for 5-7 days OR 875mg Q12H for 5-7 days Augmentin (amoxicillin-clavunate) Cephalosporin (Keflex/Cephalexin)- 250-500mg Q6H for 5-7 days Treatment for UTI in non-pregnant patient - ANS1* Nitrofurantoin (macrobid) 100mg BID x5 days 2- Fosfomycin (monurol) 3g x1 3- Bactrim (TMP/SMX) 160/800 BID x3 days (IF resistance is <20%) turners syndrome...uterus/ovaries - ANSuterus present ovaries absent MC chromosomal abnormality in aborted fetuses types of lochia - ANSrubra, serosa, alba unity and mutuality; FAIR distribution of resources and care in healthcare ex: providing the same treatment options to two different patients - ANSjustice Unopposed estrogen use for women who have undergone hysterectomy and combined estrogen-progestin therapy for women with an intact uterus who need a progestin to prevent estrogen-associated endometrial hyperplasia - true or false in regards to HT for menopausal relief... - ANSTRUE if they have a uterus...need progesterone urge incontinence - ANSstate in which a person experiences involuntary passage of urine that occurs soon after a strong sense of urgency to void Use Nagele's rule to calculate the EDC for a woman whose first day of the LMP 10-11- 15 - ANS7/18/16 use of prescribing of a drug for conditions other than what it has been approved for by the FDA... - ANSoff-label use USPSTF Grade A recommendations. - ANSThe USPSTF recommends the service. There is high certainty that the net benefit is substantial USPSTF Grade B Recommendations. - ANSThe USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. USPSTF Grade C recommendations - ANSThe USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small. USPSTF grade D recommendations - ANSThe USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. USPSTF Grade I Recommendations - ANSThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. what are 3 etiologies of vulvodynia? - ANS- inflammation - hormonal - musculoskeletal what are Amsel's criteria to diagnose bacterial vaginosis? - ANSthin white d/c fishy odor (+whiff) clue cells ph >4.5 what are contraindications of breastfeeding - ANSHIV Illicit drug use Active herpetic breast lesions Active TB Galactosemia in infant (cannot have lactose) Chemo Active Varicella what are examples of teratogens? - ANSETOH drugs lead mercery thalidomide DES accutane Vit A tetracyclines ACE/ARB misoprostol what are possible causes of a puerperal fever? - ANSpyelo breast engorgement/mastitis dehydration URI believed to be caused by a bacterial infection of the upper genital tract after childbirth, the most common causative organism is the Beta hemolytic strep. What are presumptive (possible) signs of pregnancy? - ANSSubjective signs perceived by the woman - Signs: amenorrhea, breast changes & tenderness, nausea - Symptoms: N/V, urinary freq, weight gain, fatigue, skin changes, maternal belief she is pregnancy What are probable signs of pregnancy? - ANSObjective signs - perceived by the health care provider + pregnancy test enlargement of abdomen/uterus Goodell, Hegar, Chadwick's , Pikacek's sign Braxton hicks/ctxs ballotment palpation of fetal outline what are the 4 components of drug distribution in a pregnant woman? - ANSdistribution absorption metabolism excretion (DAME) what are the 4 levels of management of care? - ANSindependent consultation referral collaboration what are the components of a biophysical profile? - ANSTest Baby, MAN! Tone (flexion or extension of an extremity) Breathing (30 sec in 30 min) Movement (3 in 30 min) Amniotic fluid volume (single pocket greater than 2 cm) Nonstress test (reactive) 8-10 is normal (2 present, 0 absent) what are the criteria for lactational amenorrhea? - ANSnursing an infant 6mos old or less exclusively breastfeeding (q4h during the day and q6h at night) menses has not returned what are the criteria for which you would start a woman on hormone therapy? - ANSvasomotor symptoms/GU symptoms women <60 or within 10 years of menopause onset (has best risk/benefit ratio) women >60 or >10 years of menopause onset (have MORE risk-CAD, stroke, VTE) what are the etiologies for oligohydramnios? - ANSuteroplacental insufficiency post-term pregnancy fetal kidney issue what are the etiologies for polyhydramnios? - ANSfetal GI NTD's macrosomia/maternal GDM multiple gestation What are the four APRN roles? - ANSNP CNM CNS CRNA what are the four factors that affect pharmacokinetics? - ANSdistribution absorption metabolism excretion (DAME) what are the guidelines for women with unknown GBS status according to the CDC? - ANSbasically treat prophylactically in the following women with unknown GBS: PPROM in labor before 37 weeks ROM for >18 hrs. temp of 100.4 or > if intramniotic infection is suspected known hx of GBS in previous pregnancy what are the indications for an endometrial biopsy? - ANS*postmenopausal bleeding *endometrial thickness >5 in postmenopausal women *those on tamoxifen therapy *Lynch syndrome those aged 30-45 who have not responded to medical treatment and have a negative beta those aged >45...EMB should be done BEFORE starting medication what are the most common symptoms of adenomyosis? - ANS*dysmenorrhea AUB pelvic pain/FULLNESS,boggy/tender what are the most common symptoms of cystitis (lower UTI)? - ANSdysuria malodorous urine frequency/urgency suprapubic pain/pressure what are the most common symptoms of pyelonephritis (upper UTI)? - ANSsame as cystitis but with N/V, FEVER, CVAT* what are the options for prevention of HIV? - ANSPrEP (pre exposure prophylaxis) PEP (post exposure prophylaxis) what are the parameters to diagnosis pre-htn? - ANSsystolic BP 120 to 139 mm Hg diastolic BP 80 to 89 mm Hg what are the symptoms of chlamydia? - ANSdysuria, itching, irritation of the genital area, discharge what are the symptoms of condyloma accuminata? - ANSSmall, skin-colored or gray spots in your genital area that are raised or flat. Several warts close together that are shaped like a cauliflower** HPV 6/11 what are the symptoms of lichen sclerosis? - ANSthin white patches "tissue paper skin" itchy painful what are the symptoms of vulvovaginal candidiasis? - ANSThick, curdy white vaginal discharge, itching, dysuria, dyspareunia what are the treatment options for GBS? - ANSPenicillin, IV Ampicillin, IV what are the USPSTF's 5 "A's" for prevention, screening, and mgmt of smoking cessation? - ANSAsk Advise Assess Assist Arrange what are the values for 3hr gtt - ANSFasting: 95 mg/dL 1-hour: 180 mg/dL 2-hours: 155 mg/dL 3-hours: 140 mg/dL Pregnant women with two or more elevated values are considered to have gestational diabetes mellitus (GDM), though even one elevated value increases certain risks. what can a breast US do - ANShelp you differentiate between a cystic mass vs. solid mass what disease causes itchy nipples? - ANSpaget's disease what do labs look like in HYPERthyroid - ANSLOW tsh HIGH t4 what do labs look like in HYPOthyroid - ANSHIGH tsh LOW t4 what does a quad screen measure? - ANS-maternal serum alpha-fetoprotein -unconjugated estriol -human chorionic gonadotropin -inhibin A What does a z-score represent for bone mineral density? - ANScompares the BMD of an age, sex, and ethnicity matched population. What does ACHES stand for in the adverse effects of taking OC? - ANSabd pain chest pain headaches eye problems swelling What does HIPAA stand for? - ANSHealth Insurance Portability and Accountability Act (1996) what does hormone therapy prevent? - ANSbone loss (decreases fracture risk) what does the acronym SIGECAPS stand for - ANSSleep Interest Guilt Energy Concentration Appetite Psychomotor Suicide What does the CAGE questionnaire stand for? - ANSCut down (Ever feel you need to cut down on ___) Annoyed with others' comments about your drinking? Guilty (about your use) Eye opener (need to use in AM to function) What does the corpus luteum secrete? - ANSprogesterone (this is what sustains a pregnancy) this acts as the "placenta" for the baby until the placenta actually takes over. What does the DASH diet stand for? - ANSDietary Approach to Stop Hypertension What does the T score represent? - ANSthe number of standard deviations that a patients bone mineral density is above or below the average BMD for young, gender matched healthy adult What drugs do NOT cross the placenta? - ANSHeparin Insulin Glyburide Oxytocin what form of contraceptive is not recommended for a perimenopausal woman who is having irregular menses? - ANSfertility based (unknown ovulation, risk of pregnancy greater d/t this) WHAT FORMS OF BIRTH CONTROL ARE COMBINATION (hormones estrogen/progestin)? - ANSPILL (except mini pill) PATCH RING What happens in the expiratory phase with asthma? - ANS*prolonged* expiratory phase what happens to FSH, LH, and estradiol in menopause - ANSincreased FSH, LH decrease estradiol what happens to hgb/hct in iron deficiency anemia? - ANSits LOW what happens to MCV in IDA? - ANSits LOW (MCV = cell size...in IDA the cell size is smaller...its a microcytic, hypochromic anemia) what happens to plasma proteins in a pregnant woman? - ANSthey DECREASE what happens to plasma volumes in a pregnant woman? - ANSthey INCREASE (hemodilution) what happens to reticulocyte count in IDA? - ANSits LOW what happens to TIBC in IDA? - ANSits HIGH (think there's a lot of room left on the cell for iron...because not a lot of iron is bound to it) what happens to total body fat in a pregnant woman? - ANSit INCREASES what happens to total body water in a pregnant woman? - ANSit INCREASES what hormone is dominant during the follicular/proliferative phases? - ANSestrogen what hormone is dominant during the luteal/secretory phases? - ANSprogesterone what hormone is response for milk ejection - ANSoxytocin what hormone is responsible for decreased smooth muscle tone in pregnancy? - ANSprogesterone what hormone is responsible for increased blood volume in pregnancy? - ANSprogesterone what is nuchal translucency w/PAPP-A and hcg testing? - ANSaka "first trimester screening" US done to measure nuchal fold thickness (more than 3mm of fluid = > risk for DS) 82-87% detection rate PAPP-A low, HcG high = increased risk of trisomy 21 What is oligohydramnios? What is the cut off? - ANStoo LITTLE amniotic fluid AFI<5cm on U/S what is PCOS? - ANSMultiple ovarian follicular cysts due to hormone imbalance Characterized by increased LH and low FSH (LH:FSH >2) Increased LH induces excess androgen production (from theca cells) resulting in hirsutism (excess hair in male distribution) Androgen converted to estrone in adipose tissue. Estrone feedback decreases FSH resulting in cystic degeneration of follicles. High levels of circulating estrone increase risk for endometrial carcinoma Presentation: obesity, infertility, oligomenorrhea, hirsutism, insulin resistance (type 2 DM) What is Piskacek's sign? - ANSa palpable lateral bulge or soft prominence at one of the locations where the uterine tube meets the uterus. what is polyhydramnios? what is the cut off? - ANStoo MUCH amniotic fluid AFI >24cm, or deepest vertical pocket >8cm on US What is precocious puberty? - ANSDefined as sexual development before age 9 in boys and before age 8 in girls. Occurs more frequently in girls what is prescriptive authority? - ANSThe ability and extent of NP's ability to prescribe medication; is dependent on state nurse practice act what is primary amenorrhea? - ANSnot having a menses before age 16 OR has not had menses w/in 3 months of thelarche (breasts) What is primary infertility? - ANSnever been pregnant what is produced by the corpus luteum - ANSprogesterone (in early pregnancy..until placenta takes over, an event called "luteal placental shift") what is secondary amenorrhea? - ANSAbsence of menses for 3 months in a woman who has previously menstruated. What is secondary infertility? - ANSDifficulty conceiving after having had a pregnancy, regardless of outcome. What is spinnbarkeit? - ANSthe stretching characteristics of mucus -stringy, elastic, stretchy -can be stretched b/t thumb and index finger What is teratology? - ANSThe study of birth defects / abnormal development what is the "all or nothing" phenomenon in pregnancy? - ANSexposure to something in utero either causes an effect (all/death), or does nothing at all. occurs before organogenesis/embryonic period...exposure to a teratogen at this point will either kill the embryo or it will survive. if it survives, no adverse effects occur. what is the #1 risk factor for tension headache? - ANSSTRESS what is the 1st line treatment for dysmenorrhea? - ANSNSAID's - begin 2 days prior to menses and continue to take for 2-3 days after menses starts. can also try pill,patch,ring, etc. - these usually decrease prostaglandin production and menses volume = less cramps. what is the 1st line treatment for tension headaches? - ANSNDAID's, tylenol, excedrin, naproxen what is the 1st line treatment of GERD? - ANSPPI's (proton pump inhibitors) -azole's what is the 2nd line treatment of GERD? - ANSh2 receptor antagonists -tidine's What is the all or nothing theory in pregnancy? - ANStakes place during pre- implantation phase when embryo is exposed to a teratogen(before organogenesis)where if the embryo is affected, it does. however, if the embryo survives, there are no adverse affects. what is the appropriate prescription for a 1 day PP woman who is Rh- and whose infant is Rh+; she is rubella non-immune as well. - ANSRhogam 300mcg x1 dose w/in 72 hours of birth MMR 0.5ml SQ x1 before d/c what is the appropriate testing for a UTI? - ANSurinalysis (looking for leuks/nitrites) then UC to determine causative organisms/and verify tx regimen what is the attachment and bonding theory - ANSmaternal adaptation to the pregnancy and attachment to the fetus is CRUICAL to survival and thriving of newborn and ongoing health of mother- proper attachment and bonding results in decreased anx/dep in mom during PP as well. it is the biological and critical period after birth (i.e. skin to skin) what is the best questionnaire to use for ETOH use in pregnancy? - ANSTACE (score of 2 or > = @ risk) what is the best treatment for adenomyosis? medication wise - ANSMirena IUD (levonorgestrel-releasing IUD) to reduce the thickness of the endometrium (the lining of the uterus) and also the endometrial cells which grow in the myometrium. -can have hyster, and use NSAID's as well what is the c-section rate in the US - ANS31.8% what is the CDC first line treatment for gonorrhea? - ANSCeftriaxone 500mg IM x 1 if cant r/o coinfection- doxy 100mg PO BID x7 days what is the CDC's first line treatment for chlamydia? - ANSdoxycycline 100mg BID x 7 days azithromycin 1g PO x1 dose what is the CDC's first line treatment for HIV? - ANSthere is NO cure ***antiretroviral treatment (to suppress viral load) want to keep tcell count >400-500 what is the correct term for the disease caused by hyperthyroid? - ANSgraves (aunt cindy) what is the correct term for the disease caused by hypothyroid? - ANShashimotos what is the criteria for administering steroids to facilitate maturation of fetal lungs? what medication is given (route/dose, etc)? - ANS**GIVEN IF B/T 24-34 WKS GESTATION AND @ RISK FOR PTB W/IN THE NEXT 7 DAYS** medication options: betamethasone (celestone), dexamethasone (decadron) Betamethasone: 12mg IM, 2 doses given 24 hrs apart Dexamethasone: 6mg, every 12 hrs for 4 doses what is the criteria for chronic HTN in pregnancy? - ANSHTN >140/90 before pregnancy or before 20 weeks gestation what is the first-line pharmacologic treatment for a 22 year old woman diagnosed with IDA? - ANSferrous sulfate, 325mg PO, 1-3x/day what is the gold standard for diagnosing endometriosis? - ANSlaparoscopy What is the gold standard in the evaluation of post menopausal bleeding/AUB? - ANShysteroscopy w/ targeted endometrial biopsy what is the health insurance portability and accountability act? - ANSfederal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge what is the incidence of gestational diabetes in the US - ANS2-10% of pregnancies what is the incidence of IPV in the US: - ANS> 1 in 3 women have experienced IPV what is the incidence of pre-eclampsia in the US - ANS1 in 25 pregnancies what is the incidence of sexual assault in the US - ANS1 in 3 women 1 in 6 men what is the incubation period for HPV? - ANS2-3 months (can range from 1-20 months for warts, and up to TEN YEARS for high-risk HPV to become cancer) what is the incubation period for PID? - ANSunknown (depends on causative agent usually) What is the life course perspective? - ANShealth of a person over their life, and how it determines overall health status mental, physical, and social health of an individual that determines their health trajectory what is the management of vulvodynia? - ANSreiterate to the pt it is NOT just "in her head" avoid irritants loose clothing, shower rather than bathe unscented soaps CBT pelvic floor therapy acupuncture what is the management plan for a patient with bloody nipple discharge? - ANSbreast exam mammo if over 30 US if under 30 possible referral for biopsy/excision what is the management plan for someone with asthma? specifically the 24 year old with exercise-induced asthma - ANSavoid triggers (exposure to cold air, etc.) PRN rapid acting b2 agonist (SABA) can include low-dose inhaled corticosteroid for daily control what is the MC endocrine disorder in reproductive-aged women? - ANSPCOS what is the MC type of skin cancer - ANSbasal cell carcinoma what is the mechanism of action for IUD's (mirena, liletta, kyleena, skyla) - ANSthickening of cervical mucus preventing passage of sperm into the uterus, inhibition of sperm capacitation or survival, and alteration of the endometrium what is the mgmt plan for the 16 year old with the breast mass (most likely fibroadenoma)? - ANSUS (best diagnostic tool for this age group...<30) what is the most common bleeding disorder? - ANSvon Willebrand disease what is the most common neural tube defect? - ANSspina bifida what is the most common ovarian cyst? - ANSfollicular what is the most common side effect of an endometrial biopsy? - ANSuterine cramping (NSAID beforehand!) what is the most common type of headache? women > men - ANSTension headache what is the most important education for someone taking the mini pill/progesterone only pill - ANS***THEY MUST TAKE IT AT THE SAME TIME EVERY DAY* what is the most important piece of education regarding the progestin only pill? - ANS*MUST TAKE AT SAME TIME EVERY DAY* what is the most likely causative organisms of PID? - ANSN. gonorrhoeae and C. trachomatis what is the number one side effect of paragard? - ANSprolonged, heavy bleeding (this is why we always say we would never put these in women lol) What is the only cure for preeclampsia? - ANSdelivery of the placenta what is the only definitive treatment for cholecystitis... - ANSsurgery what is the order of LH surge and BBT? - ANSLH surge Ovulation Rise in BBT Thick mucus temp rises AFTER ovulation what is the order of the "-arche's" - ANSthelarche - boobs adrenarche/pubarche - pubic hair growth spurt menarche - menses what is the origin and significance of the mucous plug? - ANScreated by cervical secretions, seals the cervical canal as a protective barrier what is the overall US infant mortality rate? does it differ by ethnicity/race? - ANS5.6 deaths per 1000 live births Again, higher in black women, natives, hispanics what is the overall US preterm birth rate? does it differ by ethnicity/race? - ANSoverall 10.1% (is actually a decline from previous) Black women 14.1%...which is 50% > than white/hispanic what is the patho behind ostearthritis? - ANSdegeneration of articular cartilage and subchondral bone causing synovial inflammation (bone ends thicken and form bone spurs) what is the patho of pre-eclampsia? - ANSspiral artery What is the postcoital test? - ANS- after sex, checks cervical mucous for abundance and spinnbarkheit - looks at the sperm in the mucous for number and motility What is the postpartum period? - ANS6-8 weeks after delivery of the placenta to the involution and return of reproductive organs to their non-pregnant state- considered a time of "restoration" What is the preembryonic period? - ANS0-2 weeks what is the prevalence of obesity in the US - ANS68.8% of the US population 80% AA's, 78% Hispanics (compared to 60.3% of non-Hispanic White women) if only desires cycle control- can use COC's or IUD's what is the treatment of IBS? - ANSstress mgmt probiotics increase fiber antispasmodics (i.e. bentyl- for cramping) tricyclic antidepressants what is the universal carrier screening? - ANSblood work that indicates whether you carry a gene; can even be done before pregnancy! what is the USPSTF's recommendation for cervical cancer screening in women >65 (grade D)? - ANSrecommends AGAINST screening for cervical cancer in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. what is the USPSTF's recommendation for cervical cancer screening in women aged 21-65 (grade A)? - ANSevery 3 years with cervical cytology alone in women aged 21 to 29 years every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus testing alone, or every 5 years with HPV testing in combination with cytology in women aged 30 to 65 years what is the USPSTF's recommendation for cervical cancer screening in women who have had a hysterectomy (grade D)? - ANSrecommends AGAINST screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion ([CIN] grade 2 or 3) or cervical cancer. what is the USPSTF's recommendation for cervical cancer screening in women younger than 21 (grade D)? - ANSrecommends against it What is the USPSTF's recommendation regarding breast cancer screening for women aged 40-49 (grade I)? - ANSThe decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years. what is thought to be the cause of eczema? - ANSgenetics/environment- inherited predisposition towards skin hypersensitivities, these patients usually have dry skin that makes them vulnerable to irritants, have a lower itch threshold, and can be triggered by sweat, clothing, and season changes. what is thought to be the cause of psoriasis? - ANSauto-immune mediated; genetic component w/ environmental triggers, can be triggered by stress, trauma, infections, medications. What is Virchow's triad? - ANSStasis, hypercoagulability, endothelial damage what is vulvodynia? - ANSvulvar discomfort (usually burning) lasting @ least 3 months with no visible lesions or neuro dx can be made. what is your plan for the 40 year old who is going through an SAB? - remember she is actively bleeding/cramping - ANSmake sure hemodynamically stable know blood type, will need rhogam if Rh- check H&H TVUS quant hcg level (should be dropping appropriately) expectant mgmt- needs to watch for excessive bleeding (>1pad/hour), feeling faint/dizzy can be given what IUD can be used for emergency contraception - ANSParagard inserted w/in 5 days What IUD can be used for emergency contraception? - ANSParagard what lab tests are used to diagnose thyroid disease? - ANSTSH, T3, T4 what lab work needs done for a pregnant patient with HTN (most likely pre-e)? - ANSCBC CMP Uric acid 24 hr urine (proteinuria >300) Liver enzymes check for cerebral or visual symptoms check for pulmonary edema what labs need done at 15-20 weeks? - ANSQuad screen (MMS)- AFP, estriol, hcg, inhibin A what labs need done at 28 weeks? - ANS1hr gtt, cbc, rhogam if needed what labs need done at 36 weeks - ANSGBS culture repeat STI testing if needed what labs need done at initial prenatal visit - ANSCBC blood type HIV Hep B RPR Varicella Rubella GCCT Pap if needed UA/culture addition if needed: BG or a1C if indicated, HepC in high risk women, TSH, trich in HIV+, TB what level of ferritin is indicative of iron deficiency anemia in a non-pregnant, non- smoking woman ages 19-50? - ANSlevel <12 what medication for UTI is avoided at end of pregnancy and in patients with glucose-6- phosphate dehydrogenase deficiency d/t risk of hemolytic anemia in the newborn? - ANSnitrofurantoin what medication for UTI is avoided in the FIRST and THIRD trimester b/c it is a folate antagonist (1st trimester) and in those with g6pd (third trimester; hemolytic anemia) and in those with sulfa allergy? - ANSBactrim (TMP/SMX) what medications can be used for HTN in pregnancy - ANSlabetalol nifedipine CCB's what medications can be used for vulvodynia? - ANS-triptyline's -effexor -cymbalta what medications can be used to treat morning sickness - ANSDiclegis (FDA approved) Unisom/B6 what oral contraceptive is recommended for breastfeeding women? - ANSprogestin- only "mini pill" what phase does PMS occur in... - ANSluteal phase what phase goes with the follicular phase? - ANSproliferative (both have F's in them) what phase goes with the luteal phase? - ANSsecretory phase what questions does the PHQ-2 ask? - ANS1- do you find enjoyment in activities she usually enjoys? 2- do you feel down, depressed, or hopeless? what screening tool can be used for depression? - ANSPHQ which headache causes horner-like syndrome (hallmark sign of this type of HA: ptosis/miosis on affected side) - ANScluster which headache often exhibits tearing of the eyes, stuffy nose on same side as headache... - ANScluster which IUGR is more detrimental? - ANSsymmetric which medication decreases hepatic glucose production - ANSbiguanides (metformin) Which type of hepatitis can cause hepatocellular carcinoma? - ANSHep C Who Governs the scope of practice of WHNP? - ANS**established by the nurse practice act in the STATE which they are licensed/practice in who is at risk for melanoma? - ANSfair-skinned excessive, unprotected sun exposure large number of nevi family history increases risk 2-fold white males who is at risk for uterine fibroids? - ANSheredity exposure to estrogen black women obese women primiparous women MC in the decade prior to menopause who is most at risk for developing osteoarthritis? - ANSolder females (also repetitive joint stress/overuse) who is the certifying body we take the WHNP boards through? - ANSNCC (National Certification Corporation) who should not take combined birth control methods - ANSbreast ca smoker >15/day HTN hx or high risk for DVT/PE hx of stroke migraines w/aura liver issues who should not use a diaphragm? - ANSHIV- diaphragm can disrupt vaginal epithelium and make infection easier to pass on/get women with endometriosis often have estrogen/progesterone resistance? - ANSprogesterone you are seeing a 29 year old G2P1 for a return OB visit @ 26 weeks gestation; what items need assessed and screened at this visit. - ANS1hr gtt CBC rhogam is rh - Z scores of -2.0 or less is defined as... - ANS"below the expected range for age" zygote, morula, blastocyst...etc. whats the order - ANSzygote morula blastocyst gastrula embryo fetus (ZMBGEF)