NR 509 Final Exam (Answered) 2022/2023
Know that in a 47-year-old man ED is usually ___________ rather than testosterone
psychologic
Erectile dysfunction may be from psychogenic causes, especially if
early morning erection is preserved.
it may also reflect decreased testosterone, decreased b...
nr 509 final exam answered 20222023 know that in a 47 year old man ed is usually rather than testosterone psychologic erectile dysfunction may be from psychogenic causes
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NR 509 Final Exam (Answered)
2022/2023
Know that in a 47-year-old man ED is usually ___________ rather than
testosterone
psychologic
Erectile dysfunction may be from psychogenic causes, especially if
early morning erection is preserved.
it may also reflect decreased testosterone, decreased blood flow in the hypogastric
arterial system, impaired neural innervation, and diabetes
When performing a breast exam, know what abnormal masses should do when
the arm
may be fixed to skin or underlying tissues (may cause dimpling of skin or retraction
when arms are lifted over head or hands are pressed against hips)
Fibroadenoma and cysts mobility
very mobile/mobile
Know that a high proportion of breast masses are noted during ________
BSE
Breast stage 1
preadolescent- elevation of nipple only
Breast stage 2
breast bud stage- elevation of breast and nipple as a small mound; enlargement of
areolar diameter
breast stage 3
further enlargement of elevation of breast and areola, with no separation of their
contours
breast stage 4
projection of areola and nipple to form a secondary mound above the level of breast
breast stage 5
mature stage- projection of nipple only; areola has receded to general contour of the
breast (although in some individuals the areola continues to form a secondary mound)
Know where pain is located with pancreatitis: acute
epigastric, may radiation straight to the back of other areas of the abdomen; 20% with
severe sequelae of organ failure
Know where pain is located with pancreatitis: chronic
epigastric, radiating to back
Know how hepatitis A is transmitted
Transmitted through fecal-oral route. Fecal shedding followed by poor handwashing
contaminates water and foods leading to infection of household and sexual contacts
Stress incontinence
the urethral sphincter is weakened so that transient increases in intra-abdominal
pressure raise the bladder pressure to levels that exceed urethral resistance. Causes
include childbirth and surgery, postmenopausal atrophy of the mucosa, and urethral
infection. May follow prostate surgery in men.
, urge incontinence
detrusor contractions are stronger than normal and overcome the normal urethral
resistance. The bladder is typically small. Mechanisms: Decreased cortical inhibition of
detrusor contractions from stroke, brain tumor, dementia, and lesions of the spinal cord
above sacral level. Also hyperexcitability of sensory pathways ie: bladder infections,
tumors, and fecal impaction. Deconditioning of voiding reflexes ie: frequent voluntary
voiding at low bladder volumes.
overflow incontinence
detrusor contractions are insufficient to overcome urethral resistance, causing urinary
retention. The bladder is typically flaccid and large, even after an effort to void.
Mechanisms: obstruction of the bladder outlet ie: BPH or tumor. Weakness of the
detrusor muscle associated with peripheral nerve disease at S2-4 level. Impaired
bladder sensation that interrupts the reflex arc ie: diabetic neuropathy.
functional incontinence
the patient is functionally able to reach the toilet in time because of impaired health or
environmental conditions. Mechanism: problems in mobility resulting from weakness,
arthritis, poor vision, or other conditions. Also environmental factors such as an
unfamiliar setting, distant bathroom facilities, bed rails, or physical restraints.
Incontinence secondary to medications
drugs may contribute to any type of incontinence listed. Ex: sedatives, tranquilizers,
anticholinergics, sympathetic blockers, and potent diuretics
Know where lymph nodes should be with strep
· Strep throat àstreptococcal pharyngitis, bacterial infection that may cause a sore,
scratchy throat
· Common childhood infection has a classic presentation of erythema of the posterior
pharynx and palatal petechiae
· Enlarged swollen cervical lymph nodes -> superficial cervical lymph nodes
Superficial cervical -> superficial to the sternocleidomastoid
What vaccines are safe during pregnancy
tdap, flu, Pneumococcal, meningococcal, Hepatitis B, rho gam
*NOT MMR, polio, or varicella
Know what to be concerned about if you note an irregular rectal mass
· Any masses with irregular borders suspicious for rectal cancer
A tender purulent reddened mass with fever or chills suggests an anal abscess.
Abscesses tunneling to the skin surface from the anus or rectum may form a clogged or
draining ano-rectal fistula. Fistulas may ooze blood, pus, or feculent mucus. Consider
anoscopy or sigmoidoscopy for better visualization.
Know what HPV Vac protects against
· Prevents infection from HPV subtypes 16, 18, 6 & 11 which cause 90 % of genital
warts
· The bivalent vaccine prevents infection from subtypes 16 and 18.
· Recommended for prevention of cervical, vulvar, and vaginal cancers and precancers
in females as well as anal cancer, precancers, and genital warts in both female and
males
· Vaccinated women should still get cervical cancer screening because vaccines do not
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