Ob Exam 1 Review

Front 1

Patient with has been trying to get pregnant without success. She asks the nurse, "What should I do?" what does the nurse tell her to do?

Back 1

- Keep a record of her basal body temp and menstrual cycles for 6 months

- To determine the dates of ovulation, a woman takes her oral temperature before rising each day and records it on a chart for 3-4 months

- Ovulation causes an abrupt fall and then a rise in body temperature (basal body temperature {BBT})

Front 2

A woman worried about infertility wants to keep a record of her temperature, when should the nurse advise her to take her daily temp?

Back 2

- In the morning
- To determine the dates of ovulation, a woman takes her oral temperature before rising each day and records it on a chart for 3-4 months
- Ovulation causes an abrupt fall and then a rise in body temperature (basal body temperature {BBT})

Front 3

A 18 year old male comes into the clinic with genital herpes, what type of lesions will you see?

Back 3

- genital herpes - has lesions called vesicles

- Pimples progress to papules, vesicles, and finally crusts in 1-3 weeks

Front 4

When should a male do a TSE?

Back 4

- right after a warm shower
- age 13 or 14 perform monthly
- after a bath or shower because warm water relaxes the scrotal sac
- Do not touch the scrotum with cold hands, that may stimulate the cremasteric reflex, which causes the scrotum to contract
- Testicle should feel rubbery and smooth
- Instruct client to palpate the testicle between the thumb and first finger progressing along the posterior surface of the epididymis
- Check inguinal and femoral areas for bulges which may indicate a hernia
- Epididymis is on top and behind the testicle
- Notify a healthcare provider if any small, painless lumps are palpated or if the testicle is enlarged

Front 5

What symptoms would a female with fibroid tumor c/o?

Back 5

- Complaints of heavy menstrual flow (menorrhagia)
- S/S – Abnormal vaginal bleeding, menorrhagia, pelvic heaviness and pressure, urinary retention, constipation
- Most common type of benign uterine tumor is the fibroid tumor (myoma)
- Range in size
- Grow slowly and arise from muscle cells
- Believed to result from hormonal influences due to shrinkage after menopause

Front 6

What is the position for a cervical exam?

Back 6

- Lithotomy position

Front 7

What would you tell your female patient to do to prevent toxic shock syndrome (TSS)?

Back 7

- To prevent toxic shock syndrome - change tampon's frequently (at least every 4 hours)
- If any of the S/S occur, remove the tampon and call the physician immediately
- Change tampons frequently, failure to remove may result in infection
- Use Tampons intermittently
- Insert tampon carefully to avoid abrasions
- Wash hands thoroughly before and after tampon insertion
- A serious condition associated with the use of tampons, particularly those with plastic inserters
- A bacterial toxin, Staphylococcus aureus, is believed to be the cause
- S/S – fever of 102 degrees F or greater, vomiting, diarrhea, drop in B/P, weakness, dizziness, peeling red rash, decreased Hgb, decreased urine output

Front 8

What are some complications that can arise from a mastectomy post-op that relate to immobility?

Back 8

- Bleeding, hoemans sign, pneumonia, lymphedema
- you want them to turn, cough and take deep breaths (to prevent DVT), Incentive Spirometer
- Postoperative exercises to prevent lymphedema if lymph node surgery is done
- Elevate affected arm for several days

Front 9

What would u tell a patient with Syphilis?

Back 9

- With STD's patient's need to be taught about the "ping pong effect" (getting the STD again from the still infected partner)

Front 10

What do you tell a patient who has come in for a pelvic exam?

Back 10

- tell them to relax, and to empty bladder
- The client needs to empty the bladder prior to the examination
- Encourage the client to breathe deeply to minimize discomfort

Front 11

Patient comes into the ER and complains of abnormal bleeding/spotting, what would you suspect?

Back 11

- suspect cervical cancer (especially if there is bleeding after intercourse)

- S/S of cervical cancer – Bleeding that does not occur in the early stages such as spotting between periods or after intercourse

Front 12

If a patient has a vasectomy, how long should he use protection during sex to prevent pregnancy?

Back 12

- wait 6 weeks post vasectomy to prevent pregnancy chances
- It may take up to 6 weeks after a vasectomy for the semen to be totally free of sperm
- Sperm count is taken 6 weeks to 2 months after the procedure
- Alternative birth control measures must be used until sperm counts remain at zero for 6 weeks
- Sperm counts should be taken after 6 months and then yearly to assess surgical effectiveness

Front 13

What complication can arise immediately (post-op) after a woman has abdominal surgery?

Back 13

- DVT (look to prevent thrombophlebitis post op)

Front 14

What does a pan hysterectomy include?

Back 14

- Total hysterectomy (pan hysterectomy) – Removal of entire uterus and cervix

Front 15

What is a subtotal hysterectomy?

Back 15

- Removal of the uterine body and fundus, leaving the cervix

Front 16

What is a salpingectomy?

Back 16

- Removal of an oviduct

Front 17

What is a pan hysterosalpingectomy?

Back 17

- Removal of the uterus, cervix, and oviducts

Front 18

What is a Pan hysterosalpingo-oopherectomy?

Back 18

- Removal of the uterus, cervix, oviducts, and ovaries

Front 19

A woman with heavy bleeding with period and complaining of fatigue, why?

Back 19

- Anemia (lack of Iron)
- lack of o2 to the tissues make the patient pale and tired

Front 20

What is one of the S/S of rectocele?

Back 20

-S/S of a rectocele - patient would have hemorrhoids
- S/S – Backache, fatigue, heaviness in the pelvic region, bowel difficulties, incontinence, flatus, hemorrhoids, and alternating constipation and diarrhea

Front 21

What should a female patient avoid to prevent harsher PMS symptoms?

Back 21

- avoid caffeine to prevent exacerbations of symptoms

- Low salt diet for 1-2 weeks during the premenstrual cycle

- Medications to increase excretion of sodium: HCTZ, HydroDiuril, Esidrix

- Increased protein and decreased sugar intake

- Elimination of allergens, omission of caffeine

- Positive stress management, support groups

- Active exercise, anti-anxiety medications if symptoms are severe

Front 22

Vesicovaginal fistula, what are the s/s?

Back 22

- S/S urine leaking into vaginal area
- Vesicovaginal – Between bladder and vagina
- Ureterovaginal or Vesicovaginal fistulas will leak urine into the vagina

Front 23

What is Toxic Shock Syndrome (TSS)?

Back 23

- To prevent toxic shock syndrome - change tampon's frequently (at least every 4 hours)
- If any of the S/S occur, remove the tampon and call the physician immediately

- Change tampons frequently, failure to remove may result in infection

- Use Tampons intermittently

- Insert tampon carefully to avoid abrasions

- Wash hands thoroughly before and after tampon insertion

- A serious condition associated with the use of tampons, particularly those with plastic inserters

- A bacterial toxin, Staphylococcus aureus, is believed to be the cause

- S/S – fever of 102 degrees F or greater, vomiting, diarrhea, drop in B/P, weakness, dizziness, peeling red rash, decreased Hgb, decreased urine output

Front 24

What can be a long term complication of PID (Pelvic Inflammatory Disease)?

Back 24

- sterility (infertility)

- Untreated PID can lead to: chronicity and sterility due to blockage of the oviducts with scar tissue

Front 25

What is the test for Benign prostatic hyperplasia (BPH)?

Back 25

- BPH test = PSA with DRE

- Prostate specific antigen (PSA) – a glycoprotein found in prostate gland tissue that is elevated in prostatitis, BPH, and adenocarcinoma (0-4 ng/mL)

- DX – DRE, urodynamic testing, endoscopy, PSA, ultrasound

Front 26

What is the position for a DRE exam?

Back 26

- modified standing

Front 27

What cause of Orchitis?

Back 27

- post puberty mumps
- Orchitis – inflammation of the testes that may result from infection or injury
- Causes – Mumps after puberty (may result in sterility)
- S/S – Pain and swelling in the scrotum, sometimes urethral irritation
- Tx – Scrotal support, ice bag to the scrotum (do not apply heat)

Front 28

If patient has painful swollen scrotum (possible caused from orchitis), what would you suggest they wear?

Back 28

- Patient with orchitis - wear underwear that supports the scrotum

Front 29

What is the most important thing to look for when doing a cone biopsy (Coniztion)?

Back 29

- Post cone biopsy - watch for excessive bleeding
- There may be some bleeding during and delayed bleeding after the procedure

Front 30

What causes fibrocystic breasts (Chronic Cystic Mastitis)?

Back 30

- caffine adds to fibrocystic breasts

- Caffeine aggravates cyst formation: coffee, tea, chocolate, and cola drinks

Front 31

What would a patient complain of after laparoscopic surgery?

Back 31

- shoulder pain from abdominal laparoscopy

- Shoulder pain may occur due to gas trapped in the abdomen under the diaphragm

- Severe pain may indicate hemorrhage

Front 32

Post uterine surgery, what do we watch for?

Back 32

- Post uterine surgery to watch I & O's
- Document I&O’s
- Watch Urine output

Front 33

Post mastectomy, what is one of the treatments to prevent swelling (Lymphedema) for the arm on the operative side?

Back 33

- Post mastectomy - to prevent swelling on operative side – elevate affected arm
- Elevate affected arm for several days
- Lymphedema – most common cause is infection; monitor and report signs of infection
- Avoid taking blood pressure, giving injections, or drawing blood on the operative side

Front 34

What is the most important question to ask when screening for breast cancer?

Back 34

- Family history important in breast cancer screening

- Menarche prior to age 12

- Late menopause (after 50)

- Long or irregular menstrual cycles

- Women older than 40

- Hx of fibrocystic breast disease

- Hx of cancer of the other breast

- Hx of endometrial or ovarian cancer

- Women who have never had a baby (nulliparous)

- Women who had their first baby after the age of 30

- Women who have not breast fed

- Women on Antihypertensive therapy

- Radiation exposure before age 30

- Diet high in fat

- Obesity

- Alcohol and tobacco use

- Previous breast surgery (biopsy, implants)

- Estrogen replacement therapy for longer than 8 years

Front 35

For an ABDominal ultrasound, how would you want the bladder - Full or Empty?

Back 35

- full
- Do not void for several hours prior to a pelvic ultrasound

Front 36

What is the best way to prevent pregnancy?

Back 36

- Abstinence and then second is condoms to prevent pregnancy

Front 37

What is the most important aspect for care with a sexual assault patient?

Back 37

- Rape patient - crisis intervention, emotional support and preserve DNA evidence

- Provide emotional support (priority)

Front 38

What are the S/S for gonorrhea?

Back 38

- gonorrhea - foul smelling discharge
- A yellow-green purulent vaginal discharge

Front 39

Patient has gonorrhea, what else will you check for?

Back 39

- check for other STD's, REPORTABLE STD

- Individuals with gonorrhea should also be tested for other STD’s, including HIV

Front 40

At what age does a woman start getting mammograms?

Back 40

- at age 40 for people not deemed to be at familial risk

- Women > 40 years should have annual mammogram

Front 41

What do you assess for post TURP?

Back 41

- Monitor I&O (make sure the TURP is patent and make sure there are no blood clots)

- Monitor for catheter obstruction: bladder spasms and pain

Front 42

What is a patient with HPV (Genital Human Papillomavirus or Condylomata acumate) higher risk for?

Back 42

- higher risk of cervical cancer

- At least 10 of the HPV virus types can lead to development of cervical cancer

Front 43

What presents candida?

Back 43

- Presents with cottage cheese look
- Symptoms include: intense vulvar itching, inflammation and irritation, burning after urination, and a white, cottage cheese-like discharge

Front 44

What is the most prevalent surgery used for prostate enlargement?

Back 44

- TURP - most common prostate surgery

- Transurethral resection of the prostate

- Most common procedure, particularly for older men or those who are a poof surgical risk

- Surgeon removes prostate tissue through the urethra using a resectoscope

- No incision is necessary

- Recovery is shorter than other approaches

- Complications: hemorrhage, urinary incontinence, and ED

Front 45

Q1. What childhood infectious disease most significantly affects male fertility?

Q2. Couple trying to have a baby, what child hood disorder would you ask about?

Back 45

Q1.
- Mumps can cause infertility

Q2.
- Mumps

- Cryptorchidism, orchitis after mumps

Front 46

Is Gonorrhea a reportable disease?

Back 46

- Yes

Front 47

What can you teach a man with gonorrhea to do?

Back 47

Wear a condom and tell other sexual contacts to get treated

Front 48

Pt having a TURP and c/o pain, what do you do?

Back 48

- Assess the catheter for kinks

Front 49

Pt with a swollen scrotum, what can you do for him?

Back 49

Ice packs and scrotal support

Front 50

How often does a man do a TSE (Testicular Self Exam)?

Back 50

Monthly after a warm shower

Front 51

Gonorrhea is state mandated reporting

Back 51

Gonorrhea is state mandated reporting

Front 52

Vaccinate for mumps!!

Back 52

Vaccinate for mumps!!

Front 53

What STD is highest risk to develop cervical cancer?

Back 53

HPV

Front 54

What is used to monitor for prostate cancer?

Back 54

- PSA (normal levels are 0-4)

Front 55

What can you teach a pt with a vasectomy?

Back 55

Come back for check up because it will be six weeks before all sperm is gone out of system

Front 56

What is a panhysterectomy?

Back 56

Same thing as a total hysterectomy (removal of entire uterus and cervix)

Front 57

What might bleeding after sex indicate?

Back 57

Cancer

Front 58

S/S of toxic shock syndrome?

Back 58

- Fever of 102 and greater.
- Vomiting, diarrhea, drop in B/P, weakness, dizziness, peeling red rash, decreased Hgb, decreased urine output

Front 59

What do you teach a pt with a total mastectomy?

Back 59

- Elevate arm and assess lung sounds

Front 60

What is basal body temp?

Back 60

- Fertility Awareness Method. Take temp each morning for many months before rising to acquire your ovulation days (rhythm method)

Front 61

Pt comes in with smelly discharge, how do you test for gonorrhea or chlamydia?

Back 61

- Stained smear test and/or culture and sensitivity

Front 62

What is the long term effect of PID (Pelvic Inflammatory Disease)?

Back 62

Infertility/Sterility

Front 63

What do you tell a pt who is about to get a uterus ultrasound?

Back 63

- Dont void

Front 64

What is important to teach a pt who has genital herpes?

Back 64

- Tell partners

Front 65

How often does a woman do a SBE?

Back 65

- Monthly, usually a week after menstruation

Front 66

What age does a woman start to get mammograms?

Back 66

- At age 40, earlier if hereditary

Front 67

What should u avoid with fibrous breasts?

Back 67

- Avoid caffeine with fibrous breasts

Front 68

First sign of gonorrhea?

Back 68

- smell

Front 69

What is a colposcopy?

Back 69

- A lighted, magnifying speculum that is inserted into the vagina to view the vagina and cervix, pt will have slight bleeding and cramping

Front 70

Post op for D&C (Dilatation and Curettage)?

Back 70

Monitor voiding and urinary retention

Front 71

What is menorrhagia?

Back 71

excessive bleeding

Front 72

What is metrorrhagia?

Back 72

- bleeding between menstrual periods
- Metrorrhagia is uterine bleeding at irregular intervals, particularly between the expected menstrual periods

Front 73

S/E of menorrhagia?

Back 73

- may result in anemia
- Menorrhagia: Excessive uterine bleeding occurring at the expected intervals of the menstrual periods.

Front 74

S/E of metorrhagia?

Back 74

- May indicate cancer or retained placental tissue
- metorrhagia: Uterine bleeding at irregular intervals

Front 75

Expectations of menopause?

Back 75

-Hot flashes, perspiration, fatigue, vaginal dryness and atrophy, weight gain, skin dryness, sagging breasts and osteoporosis

Front 76

A fistula is an opening between two organs that normally do not open into one another

Back 76

A fistula is an opening between two organs that normally do not open into one another

Front 77

Ureterovaginal =

Back 77

between ureter and vagina

Front 78

Vesicovaginal =

Back 78

between bladder and vagina

Front 79

Rectovaginal =

Back 79

between rectum and vagina

Front 80

Sign of rectocele?

Back 80

Hemorrhoids

Front 81

Why does infertility happen with long term PID?

Back 81

- Scarring of the fallopian tubes (oviducts)

Front 82

What is a major symptom of a benign uteran tumor?

Back 82

- abnormal heavy bleeding

Front 83

What is important post op hysterectomy?

Back 83

DVT, use ted hose

Front 84

What is the fastest growing group to acquire HIV/AIDS?

Back 84

- WOMEN of color and heterosexual

Front 85

Dx of HIV/AIDS?

Back 85

- EIA and Western Blot

Front 86

S/S of chlamydia?

Back 86

- Gray white discharge with itching and burning

Front 87

Gonorrhea is a bacterial infection

Back 87

Gonorrhea is a bacterial infection

Front 88

Young adults have the highest incidence of gonorrhea

Back 88

Young adults have the highest incidence of gonorrhea

Front 89

What type of antibiotic for gonorrhea?

Back 89

Broad spectrum (Rocephin)

Front 90

Syphilis is a bacteria infection that is reportable to the public health dept. Lesions. Can be spread to a fetus. Many types of blood test to dx

Back 90

Syphilis is a bacteria infection that is reportable to the public health dept. Lesions. Can be spread to a fetus. Many types of blood test to dx

Front 91

Sentinel Node Biopsy?

Back 91

- The node that drains the area of the breast affected by the tumor is identified and removed
- If the node is cancer free, it is assumed that no cancer cells exist in the other nodes