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NUR 6551 Week3 SOAP Note – Gynecologic Health
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NUR 6551 Week3 SOAP Note – Gynecologic Health: Select a patient that you examined as a nurse practitioner student during the last three weeks of clinical on OB/GYN Issue. With this patient in mind, address the following in a SOAP Note 1 OR 2 PAGES :
Subjective: What details did the patient provide regarding her personal and medical history?
Objective: What observations did you make during the physical assessment?
NUR 6551 Week3 SOAP – Gynecologic Health
Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters for this patient , as well as a rationale for this treatment and management plan. NUR 6551 Week 3 SOAP – Gynecologic Health.
Very Important: Reflection notes: What would you do differently in a similar patient evaluation?
Reference
Gagan, M. J. (2009). The SOAP format enhances communication. Kai Tiaki Nursing New Zealand, 15(5), 15.
Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery & Women’s health (4th ed.). Burlington, MA: Jones & Bartlett Publishers.
Chapter 6, “Care of the Well Woman Across the Life Span” ,“Care of the Woman Interested in Barrier Methods of Birth Control” (pp. 275–278)
Chapter 7, “Care of the Woman with Reproductive Health Problems”
“Care of the Woman with Dysmenorrhea” (pp. 366–368)
“Care of the Woman with Premenstrual Symptoms, Syndrome (PMS), or Dysphoric Disorder (PMDD)” (pp. 414–418)
NUR 6551 Week3 SOAP Note – Gynecologic Health
Assignment Details
For this Assignment, you are going to write a paper explaining how you developed your theory through the four stages (theorizing, syntax, theory testing, and evaluation). Your paper must be 3 to 5 pages, not including the title and reference pages.
To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Resources.
Assignment Requirements
Before finalizing your work, you should:
- Minimum requirement of at least 5 sources of support
- be sure to read the Assignment description carefully (as displayed above);
- consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary; and
- utilize spelling and grammar check to minimize errors.
NURS 6551 Mid Term Exam
How can liver and renal diseases result in abnormal uterine bleeding (AUB)?
a. They cause an imbalance in platelet aggregation.
b. They result in an inability to adequately clear estrogen from the body.
c. They cause thyroid dysfunction, which leads to bleeding abnormalities.
d. They result in elevated prolactin levels, which lead to bleeding abnormalities.
What is now thought to be the most important causative agent in cervical cancer?
a. PCOS
b. Vulvar cancer
c. Herpes simplex
d. HPV
An initial or primary genital herpes infection characteristically lasts about:
a. 1 week
b. 3 weeks
c. 1 month
d. 6 weeks
Which contraceptive methods have inherent failure rates?
a. None
b. Some
c. All
d. All except sterilization
Why do adolescents have the highest risk of developing pelvic inflammatory disease (PID)?
a. They have the highest risk for bacterial vaginosis.
b. They are the least at risk for developing other STIs.
c. They are the most sexually active.
d. They have decreased immunity to infectious organisms.
Exercise-induced amenorrhea is probably due to the combination of low body fat and decreased secretion of:
a. Estrogen
b. Prolactin
c. Progesterone
d. GnRH
What can result from an imbalance in the vaginal flora?
a. Herpes simplex virus
b. Human papillomavirus
c. Chlamydia
d. Bacterial vaginosis
The most effective means of obtaining the history of abuse is to use a communication model that:
a. Avoids having the patient’s children present during the discussion
b. Signals someone is interested and that the woman is not alone
c. Emphasizes the belief that violence is not acceptable, no matter what the batterer might have said to the patient
d. Allows the patient to talk without interruption and with time to relate, emphasize, and repeat her full story
What is the most common STI in the United States?
a. Gonorrhea
b. Chlamydia
c. Syphilis
d. Herpes simplex virus
Progestin-only pills (POPs):
a. Have no possible side effects
b. Suppress ovulation as reliably as COCs
c. May be taken earlier or later than prescribed
d. In combination with lactation are nearly 100% effective
According to the World Health Organization (WHO), the presence of a disease state:
a. Necessitates prompt medical attention
b. Excludes a person from being considered healthy
c. Does not exclude a person from being considered healthy
d. Classifies a person as in poor health
Which of the following might be a sign of hyperandrogenism?
a. Irritable bowel syndrome
b. Decreased sebum secretion in the skin
c. Decreased muscle mass
d. Acne associated with menstrual dysfunction
Surgical abortion represents an option for women who desire termination of pregnancy beyond:
a. 8 weeks’ gestation
b. 12 weeks’ gestation
c. 4 weeks’ gestation
d. 15 weeks’ gestation
How can weight loss specifically control symptoms of polycystic ovary syndrome (PCOS)?
a. It decreases SHBG.
b. It increases insulin resistance.
c. It decreases androgen levels.
d. It increases estrogen levels.
Why is acknowledging the oppression of women more difficult within Western societies?
a. The multiplicity of minority groups complicates the issue.
b. The availability of health care makes acknowledgment more difficult.
c. The diversity of the news media clouds the issue.
d. Affluence and increased opportunities mask oppression.
How does vaginosis differ from vaginitis?
a. It must be treated with metronidazole.
b. The discharge does not contain white blood cells.
c. The discharge does not have an odor.
d. It causes itching and/or burning.
What area of injury prevention is a focus of the USPSTF’s guidelines for counseling all healthy, asymptomatic women?
a. Motor vehicle accidents
b. Falls
c. Domestic violence
d. All of the above
What approach does Healthy People 2020 use to achieve its goals and objectives?
a. Social determinants of health
b. Evidence-based determinants of health
c. Quality-of-life determinants of health
d. Longevity promotion determinants of health
Approximately what percentage of women with bacterial vaginosis are asymptomatic?
a. 25%
b. 40%
c. 75%
d. 50%
The genetic counselor has a significant role in the care of women because BRCA1 and BRCA2 genetic mutations account for 5 to 10 percent of all _______ cancer cases.
a. Breast
b. Ovarian
c. Uterine
d. Pancreatic
Which organism causes 90% of vulvovaginal candidiasis episodes in women?
a. Candida tropicalis
b. Candida albicans
c. Candida glabrata
d. Candida krusei
What term refers to the period from about 7 to 10 days before menstrual flow begins until the first or second day of menstrual flow?
a. Amenorrhea
b. Premenstrual
c. Dysmenorrhea
d. Perimenstrual
The ParaGard IUD is impregnated with copper and is effective for:
a. 15 years
b. 3 years
c. 5 years
d. 10 years
What is the danger of giving estrogen replacement therapy (ERT) to menopausal women with an intact uterus?
a. A higher risk of heart disease
b. An increased likelihood of blood clots
c. An increased likelihood of osteoporosis
d. A higher risk of endometrial cancer
Although barrier contraception methods are less effective in preventing pregnancy than more modern methods, interest in them is on the rise because they:
a. Can help protect against STIs, including HIV
b. Are coitus dependent and require planning
c. Are nonallergenic and male controlled
d. Involve the use of hormones
A risk factor that could lead to endometrial cancer is:
a. Early menopause
b. Late menopause
c. High blood pressure
d. Cervical cancer
Of the two intrauterine contraceptive devices currently available in the United States only one provides a local delivery of protestin. It is the:
a. Combined contraceptive patch (Ortho Evra)
b. Copper IUD (T380A, ParaGard)
c. LNG-IUS (Mirena)
d. Dalkon Shield
Approximately what percentage of vulvar cancers occur in women older than the age of 50?
a. 50%
b. 70%
c. 85%
d. 60%
What is the best definition of abnormal uterine bleeding (AUB)?
a. Uterine bleeding for which no pelvic pathology is found
b. Uterine bleeding that is irregular during a woman’s menstrual cycle
c. Uterine bleeding that is irregular in amount or frequency
d. Uterine bleeding that is related to systemic conditions
The most common benign breast masses are:
a. Galactoceles
b. Hamartomas
c. Fibroadenomas and cysts
d. Lipomas and phyllodes tumors
Which cancer has the highest mortality rate of all gynecological cancers?
a. Vulvar cancer
b. Endometrial cancer
c. Cervical cancer
d. Ovarian cancer
Vulvovaginal candidiasis accounts for what percentage of all vaginal infections?
A. 10–15%
B. 20–25%
C. 50–55%
D. 60–65%
Which type of counseling results in a statistically significant reduction in STIs?
a. Abstinence-only education
b. Counseling delivered in multiple individual or group sessions totaling more than 3 hours
c. Remote counseling via Internet or phone
d. Brief, individual sessions in the primary care setting
Which of the following is an ethical issue that is specifically associated with pre-implantation testing with ART?
a. Ownership of frozen embryos after the couple has divorced
b. A surrogate deciding she does not want to relinquish the infant
c. Genetic engineering and the ability to reject embryos affected by inherited disorders
d. The implantation of multiple embryos, which can create high risk for the embryos and the woman
What symptom is present in 80 to 90 percent of women with cervical cancer?
a. Abnormal vaginal bleeding
b. Abnormal vaginal discharge
c. Pelvic pain
d. Ectopic pregnancy
If a patient has not reported a sexual assault to law enforcement, all of the following clinician actions are important except:
a. Asking if reporting is something she wants to consider
b. Discussing any fears or concerns that she may have about reporting
c. Explaining that only some forced sexual contacts are reportable crimes
d. Telling her that women who report do better psychologically than those who do not
What test should be ordered for a woman who is experiencing abnormal uterine bleeding (AUB) as well as headaches and peripheral vision changes?
a. Thyroid-stimulating hormone test
b. Nucleic acid amplification test
c. Complete blood count
d. Prolactin level test
What had been a significant problem in medical research well into the 1990s?
a. The focus on randomized clinical trials over epidemiological investigations
b. The lack of representation of women in research trials
c. The lack of research related to gynecology
d. The focus on randomized clinical trials over observational research
What is the definitive diagnostic technique for vulvar dermatoses?
a. Pap test
b. Biopsy
c. Colposcopy
d. Physical exam
Where in the breast do most malignancies develop?
a. Upper inner quadrant
b. Upper outer quadrant
c. Lower outer quadrant
d. Lower inner quadrant
Approximately how many Americans will contract one or more sexually transmitted infections during their lifetime?
a. 50%
b. 25%
c. 40%
d. 60%
In the GTPAL system for recording pregnancy history, the “T†stands for:
a. Term births
b. Terminal pregnancies
c. Total number of pregnancies
d. Type of birth (spontaneous, assisted, or cesarean)
Both very young and elderly sexual assault victims:
a. Are addressed in most state mandatory reporting laws
b. never has any difficulty describing the incident and related symptoms
c. Require the same equipment for proper examination that others do
d. Have fewer injuries than victims of other age groups
What is one of the side effects of hormonal contraceptives?
a. Reduction in ovarian cancer risk
b. Increased menstrual blood loss
c. Increased risk of endometrial cancer
d. Heavier menstrual flow
Tubal sterilization for women who have completed their families is highly effective, but there are disadvantages such as:
a. Women are less likely to use condoms or return for health services.
b. There is a decreased risk of ovarian cancer and pelvic inflammatory disease.
c. There is a high likelihood of complications and side effects.
d. The surgery is not covered by insurance.
What is the current (2006) recommendation by the CDC regarding HIV testing?
a. Test all patients who report risk behaviors associated with HIV.
b. Test all patients unless they explicitly decline to be tested.
c. Test all patients.
d. Test only those patients who ask to be tested.
What is generally the cause of Bartholin’s cyst?
a. Complications from gonorrhea
b. Cystic fluid in Bartholin’s gland becomes infected
c. A fungal infection in Bartholin’s gland
d. Obstruction of a duct in Bartholin’s gland
Which of the following factors associated with increased risk for developing osteoporosis appears to be the best predictor of risk?
a. Smoking
b. Low body weight
c. Sedentary lifestyle
d. Family history
What is the definition of primary amenorrhea?
a. The cessation of menses for an interval of 6 months
b. The failure to begin menses by age 14
c. The cessation of menses due to outflow tract obstruction
d. The failure to begin menses by age 16
In respect to an evidentiary examination:
a. The patient may not withhold consent if the clinician is a mandated reporter.
b. The clinician is required to strictly follow local agency protocols, no others.
c. The time frame within which it must take place depends on local standards.
d. Maintaining the chain of custody of all evidence collected is recommended, not required.
QUESTION 1
1. Which of the following is a diagnostic label that is listed in the Diagnostic and Statistical Manual IV-TR?
2. 3. a. 4. Premenstrual dysphoric disorder
5. 6. b. 7. Premenstrual magnification
8. 9. c. 10. Dysmenorrhea
11. 12. d. 13. Premenstrual syndrome
1. About half of all pregnancies in the United States are unintended and occur most frequently in women who:
2. 3. a. 4. Are married or divorced
5. 6. b. 7. Have finished high school
8. 9. c. 10. Are between the ages of 18 and 24
11. 12. d. 13. Are members of the majority group
What is one factor that can reduce the risk for the development of ovarian cancer?
a. Multiple pregnancies
b. Transvaginal ultrasounds
c. Identification of recurrence
d. Weight loss
What percentage of toxic shock syndrome cases are related to menses?
a. 50%
b. 25%
c. 75%
d. 90%
Tubal sterilization for women who have completed their families is highly effective, but there are disadvantages such as:
a. Women are less likely to use condoms or return for health services.
b. There is a decreased risk of ovarian cancer and pelvic inflammatory disease.
c. There is a high likelihood of complications and side effects.
d. The surgery is not covered by insurance.
Women who report experiencing the most severe symptoms of PMS tend to be: In their late 40s
1. 2. a. 3. In their late 40s
4. 5. b. 6. In their early 20s
7. 8. c. 9. In their late teens
10. 11. d. 12. In their late 30s
What is the definition of primary amenorrhea?
a. The cessation of menses for an interval of 6 months
b. The failure to begin menses by age 14
c. The cessation of menses due to outflow tract obstruction
d. The failure to begin menses by age 16
How many stages does the Tanner scale use to stage sexual maturity?
a. 3 stages
b. 5 stages
c. 6 stages
d. 8 stages
Which contraceptive methods have inherent failure rates?
1. 2. a. 3. None
4. 5. b. 6. Some
7. 8. c. 9. All
10. 11. d. 12. All except sterilization
What is the most common type of menstrual dysfunction related to hyperandrogenism?
a. Painful menstruation
b. Absence of menses
c. Irregular bleeding
d. Early menopause
Combined oral contraceptives (COCs) are among the most extensively studied medications available. Which one of the following statements about their use has been found to be true?
a. Broad-spectrum antibiotics may enhance their efficacy.
b. They do not increase the risk of venous thromboembolism.
c. They decrease the relative risk of ovarian and endometrial cancers.
d. Among possible side effects are acne, hirsuitism, and benign breast conditions.
Many patients experiencing intimate partner violence (IPV) meet the criteria for diagnosing PTSD. Those criteria include all of the following except:
1. 2. a. 3. Experiencing a traumatic event
4. 5. b. 6. Reexperiencing the traumatic event
7. 8. c. 9. Numbness and avoidance
10. 11. d. 12. Hypovigilance
Which of the following is an ethical issue that is specifically associated with pre-implantation testing with ART?
1. 2. a. 3. Ownership of frozen embryos after the couple has divorced
4. 5. b. 6. A surrogate deciding she does not want to relinquish the infant
7. 8. c. 9. Genetic engineering and the ability to reject embryos affected by inherited disorders
10. 11. d. 12. The implantation of multiple embryos, which can create high risk for the embryos and the woman
The ________ is probably the most widely used intimate partner violence (IPV) screen.
a. Three-question AAS (McFarlane et al., 1992)
b. Campbell’s Danger Assessment (2003)
c. Sheridan’s HARASS Instrument
d. Helton’s nine-question AAS
What is the term for the absence of menses for 3 to 6 months in a woman who has previously menstruated and is not pregnant, breastfeeding, or menopausal?
1. 2. a. 3. Primary amenorrhea
4. 5. b. 6. Initial dysmenorrhea
7. 8. c. 9. Secondary amenorrhea
10. 11. d. 12. Primary dysmenorrhea
Among women age 55 years and older:
a. Macromastia is the most common cause of breast masses.
b. Breast masses are presumed malignant until proven otherwise.
c. Most breast masses decrease in size over time and many resolve completely.
d. Diagnostic imaging of a breast mass and tissue sampling should be deferred.
Both very young and elderly sexual assault victims:
1. 2. a. 3. Are addressed in most state mandatory reporting laws
4. 5. b. 6. never has any difficulty describing the incident and related symptoms
7. 8. c. 9. Require the same equipment for proper examination that others do
10. 11. d. 12. Have fewer injuries than victims of other age groups
What is the major source of normal vaginal secretions?
a. Bartholin’s glands
b. Apocrine glands
c. Sebaceous glands
d. Cervical mucosa
Which one of the following statements about intimate partner violence (IPV) is false?
1. 2. a. 3. It refers to an escalating pattern of abuse.
4. 5. b. 6. It includes emotional abuse, such as disregarding what a woman wants.
7. 8. c. 9. It includes using physical force to make a woman engage in a sexual act against her will.
10. 11. d. 12. It refers to a current or former spouse or dating partner of the opposite sex, not someone of the same sex.
How is being overweight defined on the BMI table?
a. 18–29.9
b. 20–29.9
c. 25–29.9
d. 30 or greater
What has contributed to the decreased incidence of hepatitis B over the past 20 years?
1. 2. a. 3. The decrease in PID
4. 5. b. 6. The HBV vaccination
7. 8. c. 9. The increase in condom use
10. 11. d. 12. More precise screening methods
Which are the most common forms of hepatitis seen in women’s health practices?
a. A and B
b. A and D
c. B, C, and D
d. B and C
The factors that enable women to enjoy and control their sexual and reproductive lives, including a physical and emotional state of well-being and the quality of sexual and other close relationships, make up a woman’s:
1. 2. a. 3. Sexual health
4. 5. b. 6. Gender identity
7. 8. c. 9. Gender role behaviors
10. 11. d. 12. Psychosocial orientation
What test should be ordered for a woman who is experiencing abnormal uterine bleeding (AUB) as well as headaches and peripheral vision changes?
a. Thyroid-stimulating hormone test
b. Nucleic acid amplification test
c. Complete blood count
d. Prolactin level test
Surgical abortion represents an option for women who desire termination of pregnancy beyond:
1. 2. a. 3. 8 weeks’ gestation
4. 5. b. 6. 12 weeks’ gestation
7. 8. c. 9. 4 weeks’ gestation
10. 11. d. 12. 15 weeks’ gestation
What population of women should be screened for signs and symptoms of thyroid dysfunction?
1. 2. a. 3. All women
4. 5. b. 6. Older women
7. 8. c. 9. Older women, smokers, and women with diabetes
10. 11. d. 12. Older women, postpartum women, and women with Down syndrome
All of the following diagnostic testing and procedures are now infrequently performed in clinical practice except:
1. 2. a. 3. Hysterosalpingogram
4. 5. b. 6. Sperm penetration assay
7. 8. c. 9. The postcoital test (PCT)
10. 11. d. 12. Endometrial biopsy (EMB)
The most common site for endometrial implants found in other parts of the body is:
1. 2. a. 3. The appendix
4. 5. b. 6. The uterus
7. 8. c. 9. The ovaries
10. 11. d. 12. The fallopian tubes
Women who have had toxic shock syndrome should be instructed not to use tampons or:
a. Barrier contraception methods
b. Hormonal contraception methods
c. Intravaginal antibiotic cream
d. Oral antibiotics. NUR 6551 Week3 SOAP Note – Gynecologic Health
Cyclic mastalgia:
a. More likely causes unilateral, localized pain that is sharp or burning in nature
b. Has an increased risk of occurrence in women whose diets are low in fat
c. Occurs most frequently in women who are 18 to 30 years old
d. Is caused by hormonal changes associated with menstruation
The incidence of uterine fibroids:
1. 2. a. 3. Increases with age
4. 5. b. 6. Decreases with age
7. 8. c. 9. Is often caused by early menopause
10. 11. d. 12. Is related to the age of first menses
Patients presenting for STI treatment should be screened for HIV:
a. At each visit
b. At the end of treatment
c. At the beginning of treatment
d. Each year
1. What screening recommendation is similar across all groups for colorectal cancer?
2. 3. a. 4. Screening women age 76 to 85 based on risk factors
5. 6. b. 7. Screening only for those women at increased risk
8. 9. c. 10. Screening for all women starting at age 50
11. 12. d. 13. Against routine screening in adults age 76 and over
Approximately what percentage of vulvar cancers occur in women older than the age of 50?
a. 50%
b. 70%
c. 85%
d. 60%
Signs of endometrial or cervical cancer may present abnormal uterine bleeding, often as heavy, prolonged bleeding or:
1. 2. a. 3. Menometrorrhagia
4. 5. b. 6. Amenorrhea
7. 8. c. 9. Oligomenorrhea
10. 11. d. 12. Polymenorrhea
In the GTPAL system for recording pregnancy history, the “T†stands for:
a. Term births
b. Terminal pregnancies
c. Total number of pregnancies
d. Type of birth (spontaneous, assisted, or cesarean). NUR 6551 Week3 SOAP Note – Gynecologic Health
What is now thought to be the most important causative agent in cervical cancer?
a. PCOS
b. Vulvar cancer
c. Herpes simplex
d. HPV
The most common sites of metastatic spread of invasive breast cancer include all of the following except:
1. 2. a. 3. Bones
4. 5. b. 6. Lungs
7. 8. c. 9. Pituitary
10. 11. d. 12. Lymph nodes
Who should be screened regularly for STIs?
a. Women who have more than one sexual partner
b. Women over the age of 21
c. Women who are sexually active
d. Women over the age of 15
What is a common vasomotor symptom of menopause?
1. 2. a. 3. Blood clots
4. 5. b. 6. Night sweats
7. 8. c. 9. Osteoporosis
10. 11. d. 12. Hysterectomy
What is the best definition of abnormal uterine bleeding (AUB)?
a. Uterine bleeding for which no pelvic pathology is found
b. Uterine bleeding that is irregular during a woman’s menstrual cycle
c. Uterine bleeding that is irregular in amount or frequency
d. Uterine bleeding that is related to systemic conditions
What should be the clinician’s first objective after learning the chief reason the woman desires care?
a. To give the reason or problem a structural and chronological framework
b. To probe for any additional concerns missed
c. To take a family history related to the presenting concern
d. To gain insight into the woman’s cultural and social influences. NUR 6551 Week3 SOAP Note – Gynecologic Health
No risk factors other than age are identifiable in ______ of women with breast cancer.
a. 100%
b. 85%
c. 60%
d. 24%
The highest prevalence of human papillomavirus (HPV) is found among women ages:
a. 18–20
b. 20–24
c. 25–30
d. 30–35
Although barrier contraception methods are less effective in preventing pregnancy than more modern methods, interest in them is on the rise because they:
a. Can help protect against STIs, including HIV
b. Are coitus dependent and require planning
c. Are nonallergenic and male controlled
d. Involve the use of hormones. NUR 6551 Week3 SOAP Note – Gynecologic Health