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NR 509 FINAL EXAM WITH 100%
CORRECT ANSWERS 2025 GRADED
A+
Suspicious breast mass correct answers >> -A mobile mass that becomes fixed when the arm relaxes is attached to the ribs and intercostal muscles; if fixed when the hand is pressed against the hip, it is attached to the pectoral fascia. -Hard irregular poorly circumscribed nodules, fixed to the skin or underlying tissues, strongly suggest cancer Risk for Breast cancer correct answers >> --Age -family history of breast/ovarian CA
- inherited genetic mutations, -personal history of breast cancer
- high levels of endogenous hormones
- breast tissue density
- proliferative lesions with atypia on breast biopsy, - duration of unopposed estrogen exposure related to early menarche -age of first full-term pregnancy
- late menopause.
- breastfeeding for less than 1 year,
- postmenopausal obesity -cigarette smoking, alcohol ingestion,
- physical inactivity, and type of contraception. Characteristics of a breast cyst correct answers >> Soft to firm, round, mobile, often tender. The best way to examine the lateral portion of the breast correct answers >> -Have pt roll onto the opposite hip -place her hand on her forehead.
- keep shoulders pressed against the bed -palpate in the axilla, moving in a straight line down to the bra line, then move the fingers medially and palpate in a vertical strip up the chest to the clavicle. Continue in vertical overlapping strips until you reach the nipple Bacterial Vaginosis (BV) correct answers >> -Caused by overgrowth of anaerobic bacteria (often from sex)
- Discharge: Gray or white, thin, homogenous, malodorous, coats the vaginal walls, usually not profuse, may be minimal
- Discharge:Yellowish green or gray, possibly frothy; often profuse and pooled in the vaginal fornix; may be malodorous -Pruritus (though not usually as severe as with Candida infection); pain on urination (from skin inflammation or possibly urethritis); dyspareunia -Vestibule and labia minora may be erythematous; the vaginal mucosa may be diffusely reddened, with small red granular spots or petechiae in the posterior fornix; in mild cases, the mucosa looks normal
- Scan saline wet mount for trichomonads Syphillis correct answers >> This ulcerated papule with an indurated edge usually appears after 3 to 6 weeks of incubating infection from the spirochete Treponema pallidum. These lesions may resemble a carcinoma or crusted cold sore. Similar primary lesions are common in the pharynx, anus, and vagina but may escape detection since they are painless, nonsuppurative, and usually heal spontaneously in 3 to 6 weeks. Wear gloves during palpation since these chancres are infectious. s/s of epididymitis correct answers >> Acute: swollen, and notably tender, making it difficult to distinguish from the
testis. The scrotum may be reddened and the vas deferens inflamed. Chronic: firm enlargement of the epididymis, which is sometimes tender, with thickening or beading of the vas deferens. Genital Warts (Condylomata Acuminata) correct answers >> -Single or multiple papules or plaques of variable shapes; may be round, acuminate (pointed), or thin and slender. May be raised, flat, or cauliflower-like (verrucous). -Causative organism: HPV, usually subtypes 6, 11; carcinogenic subtypes rare, approximately 5-10% of all anogenital warts. Incubation: weeks to months; infected contact may have no visible warts. -Can arise on penis, scrotum, groin, thighs, anus; usually asymptomatic, occasionally cause itching and pain. -May disappear without treatment. Risk for prostate CA correct answers >> Age, ethnicity, and family history are the strongest risk factors for prostate cancer. s/s prostatitis correct answers >> -fever
proteinuria or preeclampsia, that resolves by 12 weeks postpartum. s/s ectopic pregnancy correct answers >> -Abdominal pain -adnexal tenderness -abnormal uterine bleeding how a Bartholin gland infection presents correct answers
Causes of a Bartholin gland infection include trauma, gonococci, anaerobes like bacteroides and peptostreptococci, and C. trachomatis. Acutely, the gland appears as a tense, hot, very tender abscess. Look for pus emerging from the duct or erythema around the duct opening. Chronically, a nontender cyst is felt that may be large or small. Bleeding between periods correct answers >> Metrorrhagia Vaccines safe in pregnancy correct answers >> pneumococcal, meningococcal, and hepatitis B. Hepatitis A and B, meningococcal polysaccharide and conjugate, and pneumococcal polysaccharide vaccines can be given, if indicated.
-inactivated influenza -Tdap When to give the tetanus vaccine correct answers >> All adults aged ≥19 years, including those aged ≥65 years: All adults aged ≥19 years who have not been vaccinated with Tdap should receive a single dose of Tdap regardless of the time interval since last receiving Td. After receiving Tdap, they should receive Td boosters at 10-year intervals. For adults aged ≥65 years, this will reduce the likelihood of transmission to infants aged <12 months. HPV vaccine correct answers >> -The quadrivalent vaccine prevents infection from HPV sub-types 16 and 18, as well as 6 and 11, which cause 90% of genital warts (prevents cervical ca also) -The bivalent vaccine prevents infection from subtypes 16 and
Tanner staging of breast development correct answers >> 1: preadolescent- elevation of nipple only 2: Breast bud stage: elevation of breast and nipple as a small mound; enlargement of areolar diameter
(external) pain with defecation and sitting, tender, swollen, bluish, ovoid mass is visible at the anal margin. -P- on the stalk, or mucosal surface, soft, difficult to feel often -C- firm, nodular, rolled edge Erectile dysfunction correct answers >> In a 47 yo male, it is most often psychologic and not testosterone related. s/s of proctitis correct answers >> Anorectal pain, itching, tenesmus, or discharge or bleeding from infection or rectal abscess suggest proctitis. -anal fissures Forms of urinary incontinence correct answers >> -Stress: Increased abdominal pressure causes bladder pressure to exceed urethral resistance—there is poor urethral sphincter tone or poor support of bladder neck.
- Urge: urgency is followed by involuntary leakage due to uncontrolled detrusor contractions that overcome urethral resistance.
- Overflow: neurologic disorders or anatomic obstruction from pelvic organs or the prostate limit bladder emptying until the bladder becomes overdistended.
- Functional: patient is functionally unable to reach the toilet in time d/t impaired health or environmental conditions Hepatitis A transmission correct answers >> fecal-oral route how to distinguish between a jugular venous pulsation & carotid pulse correct answers >> -IJ:Rarely palpable Soft biphasic undulating quality, usually with two elevations and characteristic inward deflection (x descent) Pulsations eliminated by light pressure on the vein(s) just above the sternal end of the clavicle Height of pulsations changes with position, normally dropping as the patient becomes more upright Height of pulsations usually falls with inspiration -Carotid:Palpable. A more vigorous thrust with a single outward component Pulsations not eliminated by pressure on veins at sternal end of clavicle Height of pulsations unchanged by position Height of pulsations not affected by inspiration
- see how long it takes for color to return to feet (usually 10- seconds) S/S of a venous insufficiency ulcer correct answers >> - edema, reddish pigmentation and purpura, venous varicosities, the eczematous changes of stasis dermatitis (redness, scaling, and pruritus), and at times cyanosis of the foot when dependent. Gangrene is rare -Borders are irregular, flat, or slightly steep. Why venous insufficiency causes ulceration correct answers >> chronic obstruction and incompetent valves in the deep venous system What do you feel when palpating the chest correct answers
right ventricle What causes the S3 sound? correct answers >> -Children/young adults: rapid deceleration of the column of blood against the ventricular wall.
- Older adults: usually indicates a pathologic change in ventricular compliance.
What causes a split S2 correct answers >> During inspiration, the right heart filling time is increased, which increases right ventricular stroke volume and the duration of right ventricular ejection compared with the neighboring left ventricle. This delays the closure of the pulmonic valve, P2, splitting S2 into its two audible components. Listening for extra heart sounds (mitral stenosis) correct answers >> left lateral decubitus cardiovascular ROS correct answers >> SOB, syncope, edema, chest pain, orthopnea preservation correct answers >> persistent repetition of words or ideas pancreatitis pain correct answers >> Epigastric, may radiate straight to the back or other areas of the abdomen; 20% with severe sequelae of organ failure cricoid cartilage correct answers >>
Peritonitis s/s correct answers >> Early voluntary guarding may be replaced by involuntary muscular rigidity and signs of peritoneal inflammation. There may also be RLQ pain on quick withdrawal or deferred rebound tenderness. Diverticulitis pain correct answers >> -LLQ -cramping at first, then steady
- gradual onset
- tx: analgesia, bowel rest, abx
- sx: fever, constipation, n/v Appendicitis pain correct answers >> RLQ pain or pain that migrates from the periumbilical region, combined with abdominal wall rigidity on palpation If you feel an abdominal mass with palpation correct answers >> Ask the patient either to raise the head and shoulders or to strain down, thus tightening the abdominal muscles. Feel for the mass again. -intraabdominal mass is obscured by muscle contraction Abdomen assessment sequence correct answers >> Inspect, auscultate, and percuss the abdomen. Palpate lightly,
then deeply. Assess the liver and spleen by percussion and then palpation. Try to palpate the kidneys. Palpate the aorta and its pulsations. If you suspect kidney infection, percuss posteriorly over the costovertebral angles. Epigastric pain correct answers >> Epigastric pain occurs with GERD, pancreatitis, and perforated ulcers. RUQ and upper abdominal pain are common in cholecystitis and cholangitis Causes of dk. bloody emesis correct answers >> Hematemesis may accompany esophageal or gastric varices, Mallory-Weiss tears, or peptic ulcer disease. Chalazion correct answers >> A subacute nontender, usually painless nodule caused by a blocked meibomian gland. May become acutely inflamed but, unlike a stye, usually points inside the eyelid rather than on the lid margin. Onychomycosis correct answers >> fungal infection of the nail -Trichophyton rubrum (usually)
s/s of elder abuse correct answers >> abuse, neglect, exploitation, and abandonment. Functional syndromes correct answers >> -Co-occurrence rates for common functional syndromes such as irritable bowel syndrome, fibromyalgia, chronic fatigue, temporomandibular joint disorder, and multiple chemical sensitivity reach 30% to 90%, depending on the disorders compared -The prevalence of symptom overlap is high in the common functional syndromes namely, complaints of fatigue, sleep disturbance, musculoskeletal pain, headache, and gastrointestinal problems. -The common functional syndromes also overlap in rates of functional impairment, psychiatric comorbidity, and response to cognitive and antidepressant therapy. 8mo old child development correct answers >> -say dada/mama
- indicate wants -feeds self -sit -cant stand
Retracted TM with effusion correct answers >> looks like air bubbles
