NR 602 Week 8 Final Exam – All Possible Question

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ACOG guidelines regarding well women exams

  1. What is the ASCCP recommended management for an ASCUS (atypical squamous cells of undetermined significance) pap result with a positive high-risk HPV 16 cotest in a 26-year-old woman without a history of abnormal pap smears?
  2. A well-woman visit for an adolescent should include which of the following?

ACOG Pap smear guidelines

  1. A Bethesda system Pap smear report that reads LSIL is most consistent with which classification?
  2. A single Pap smear reading of ASCUS in a patient negative for HPV infection should have what as follow-up?
  3. A female patient is 35 years old. She has never had an abnormal PAP smear and has had regular screening since age 18. If she has a normal PAP smear with HPV testing today, when should she have the next cervical cancer screening?
  4. A young sexually active client at the family planning clinic is advised to have a Papanicolaou (Pap) smear. She has never had a Pap smear before. What should the nurse include in the explanation of this procedure?
  5. Lab results on your 26-year-old patient show a negative Pap smear with a positive human papillomavirus (HPV) screen. Which procedure will be required next?
  6. Which of the following is not part of the criteria for an older woman to cease having any future Pap tests performed?

Amenorrhea (Primary and Secondary)

  1. You are evaluating a 17-year-old Emily who presented with amenorrhea and normal secondary sex characteristics. The purpose of the progesterone challenge is to ascertain the presence of?
  2. A 17-year-old female patient presents with amenorrhea for 4 months she did experience menarche at age 15 but had not had a menstrual cycle since. On physical examination, it is noticed that she has normal secondary sexual characteristics. The nurse practitioner will consider a progesterone challenge to determine the presence of adequate
  3. A teenage patient presents with amenorrhea and moral secondary sex characteristics. A progesterone challenge is ordered. The purpose is to determine the presence of ____________?
  4. A 16year old girl who comes to your office with a history of secondary amenorrhea. She experienced menarche at age 10, regular cycles for 2 years. She has not menstruated now for 4 years. In your initial consideration of differential diagnoses, what is the most frequent etiology of this problem:
  5. 18yo female c/o secondary amenorrhea. On exam, there is normal secondary sex characteristics and normal genitalia. Pregnancy is ruled out. What would necessitate further eval?
  6. Primary amenorrhea is best described as:
  7. A nurse practitioner is caring for a woman with primary and secondary amenorrhea. The pelvic exam was normal. Which of the following may be the cause if etiology originates in the hypothalamus?

American Cancer Society recommendations

  1. A nurse practitioner is participating in a women’s health fair. When educating the women about risk factors for breast cancer, which of the following statements is incorrect?
  2. When educating women about breast cancer risk factors, which statement is incorrect?
  3. A woman with lobular carcinoma in situ has a relative risk of developing invasive breast cancer of

Androgen insensitivity/resistance syndrome

Changes in hormonal regulation during menopause result in the gradual cessation of menstruation. From which gland is Androstenedione secreted?

ASCUS/HSIL results from Paper Test Report

  1. A Pap smear result of atypical squamous cells of undetermined significance—rule out high-grade squamous intraepithelial lesion (ASCUS r/o HGSIL) will require which procedure next?
  2. A Pap smear result of atypical squamous cells of undetermined significance (ASCUS) will require which procedure next?

Bartholin glands and cysts

  1. A 25-year-old presents with a report of a very tender area just near her introitus and to the left of her perineum. Very painful sex is how she knew “something wasn’t right.” She showered and when washing, she felt a “pea-sized” painful lump on the left side of her “bottom.” She tells you she looked at it with a mirror and it was very small, but now it is the size of a ping-pong ball and getting worse.
    When you inspect her external genitalia, you are amazed at the size and appearance of the “lump.”
    You note what appears to be an abscess on the left medial side of the labia minora, and there is some edema extending into the perineum. Your diagnosis for this presentation is:
  2. You explain to this young woman what this “lump” is and let her know you will be referring her to a gynecologist you consult with regularly. You explain to her the likely treatment as follows:
  3. A client at the women’s health clinic complains of swelling of the labia and throbbing pain in the labial area after sexual intercourse. For what condition does the nurse anticipate the client will be treated?
  4. 25yo female c/o tender area near her introitus and to the L of her perineum. Very painful sex was first sign. Initially bump was very small, but now is ping-pong ball size. On exam, abscess is present on L medial side of labia minora and there’s edema extending into perineum. What is dx?
  5. Which of the following choices represents a disorder of the reproductive tract that causes pain, erythema, dyspareunia, and a perineal mass?
  6. A nurse practitioner instructor is reviewing the anatomy of the external genitalia. At the opening of the vagina are the Bartholin’s glands. Which of the following describes the function of these glands?
  7. A 23-year-old women presents to your practice with a chief complaint of postcoital bleeding. Which of the following would NOT be included in the initial assessment of this patient?
  8. a nurse practitioner is educating a woman who has a colposcopy ordered. Which of the following most accurately describes a colposcopy?
  9. A 33-year-old women presents to your clinic complaining of a dark brown watery vaginal discharge and postcoital bleeding. There is a strong history of multiple unprotected sexual encounters. Which of the following findings on examination would be suspicious for cervical cancer?
  10. A 23-year-old woman comes to the clinic for a Pap smear. After the examination, the client confides that her mother died of endometrial cancer 1 year ago and says that she is afraid that she will die of the same cancer. Which risk factor stated by the client after an education session on risk factors indicates that further teaching is needed?
  11. The frequency for cervical screening depends on the patient and her age. What is the longest recommended time interval between cervical screens for patients who are 65 years-old or younger?
  12. What is the leading cause of death from a gynecologic malignancy in American women?

Cervix/Uterus examination

  1. A 49-year-old female patient presents with a chief complaint of dark, watery brown vaginal discharge. Part of the differential diagnosis includes that of cervical cancer. Which of the following best describes what might be visualized?
  2. A nurse practitioner is completing a speculum exam on a female patient. Which of the following findings world be considered a normal surface characteristic of the cervix?
  3. In collection of a specimen for a PAP smear, how is the endocervical specimen collected?

Cimetidine/Condyloma acuminate

  1. Treatment options for patients with condyloma acuminatum include:
  2. Which of the following best describes lesions associated with condyloma acuminatum?
  3. Treatment options for patients with condyloma acuminatum include all of the following except:
  4. All of the following findings are associated with secondary stage of an infection by the organism Treponema pallidum except :
  5. Patient education for condylomataacuminata should include all the following except:
  6. Jenna was evaluated and diagnosed with condyloma acuminatum. Treatment options for Jenna will include all of the following except:

Condyloma lata

  1. Which condyloma do we see insyphilis?
  2. the cytology (Pap smear) result for a 21-year-old sexually active student whose partner uses condoms inconsistently shows a large amount of inflammation. Which of the following is the best follow-up?
  3. A college freshman who is using oral contraceptives calls the nurse practitioner’s office asking for advice. She forgot to take her pills 2 days in a row during the second week of the pill cycle and wants to know what to do. What is the best advice?
  4. A 17-year-old high school student is considering her birth control options. She wants to know more about Seasonale. Which of the following statements is false?
  5. A 35-year-old smoker is being evaluated for birth control choices. The patient has a history of pelvic inflammatory disease (PID) along with an embolic episode after her last pregnancy. Which of the following methods of birth control would you recommend?
  6. A 20-year-old woman visiting the clinic says that she wishes to begin using depot medroxyprogesterone acetate (Depo-Provera) as a form of birth control. What important information should the nurse include when teaching the client about Depo-Provera?
  7. A woman questions the nurse about the effectiveness of oral contraceptives. What most important factor about the effectiveness of oral contraceptives should be included in the reply to this question?
  8. A female client who has been sexually active for 5 years is found to have gonorrhea. The client is upset and asks the nurse, “What can I do to keep from getting another infection in the future?” Which statement by the client indicates that the teaching by the nurse was effective?
  9. Contraceptives that contain estrogen-like and/or progesterone-like compounds are prepared in a variety of forms. Which contraceptives should the nurse tell clients have a hormonal component?
  10. A client seeking advice about contraception asks a nurse about how an intrauterine device (IUD) prevents pregnancy. How should the nurse respond?
  11. A nurse is teaching a group of women about the side effects of different types of contraceptives. What frequent side effect associated with the use of an intrauterine device (IUD) should the nurse discuss during the teaching session?
  12. A nurse is teaching a female client about the side effects of estrogen in an oral contraceptive. Which common side effect identified by the client indicates to the nurse that the teaching was effective?
  13. A nurse is counseling a female client with type 1 diabetes who requests contraceptive information. What contraceptive method should the nurse recommend?
  14. What instruction should a nurse include when teaching about the correct use of a female condom?
  15. A client asks the nurse about the use of an intrauterine device (IUD) for contraception. What information should the nurse include in the response?
  16. A 16-year-old client has a steady boyfriend with whom she is having sexual relations. She asks the nurse how she can protect herself from contracting HIV. What should the nurse advise her to do?
  17. Which form of birth control presents the highest risk to a female patient if she is exposed to a sexually transmitted disease (STD)?
  18. What choice below has no precautions for oral contraceptive pill use?
  19. A 21-year-old woman comes into your practice seeking birth control. She has only recently become sexually active and has consistently used condoms for safe sex. Your history reveals that she does not use tampons during her menses and has very little knowledge about female reproductive anatomy. Based on this information, which of the following birth control choices would be least likely to meet her needs for contraceptive management?

Cystocele

  1. Cystocele is best defined as
  2. While a speculum is retracting the posterior vaginal wall, a 51-year-old patient is asked to strain down. There is a bulge from the anterior vaginal wall. This is most likely
  3. The situation where the bladder forces the anterior vaginal wall down and out is termed
  4. Which of the following is an effect of estrogen deficiency on paravaginal tissue?
  5. A woman is admitted for repair of cystocele and rectocele. She has nine living children. In taking her health history, which of the following would the nurse expect to find?

Dysmenorrhea

  1. Which of the following substances is responsible for the symptoms of dysmenorrhea?
  2. the first line treatment of severe menstrual cramps that having been occurring for 4 months in a patient with primary dysmenorrhea includes which of the following?
  3. A 40-year-old female presents with an abnormal menstrual cycle with menorrhagia and intermenstrual bleeding. The nurse practitioner suspects the patient may have dysfunctional uterine bleeding (DUB) and orders tests for follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels. Both of these lab values are elevated. What is the most likely cause of DUB in this patient?
  4. A patient who a nurse practitioner is seeing for the first time has the past medical history of primary dysmenorrhea. She recalls that which of the following is considered as the primary etiology?
  5. Dysfunctional uterine bleeding (DUB). She is concerned about why this is happening to her. You recall which of the following is the most common cause of DUB?
  6. Sylvia is 44-year-old women with dysfunctional uterine bleeding (DUB) and is unable to use oral contraceptives. Which of the following medications can be used for management of DUB?
  7. a 24-year-old female patient has been diagnosed with primary dysmenorrhea. Which of the following medications would be would be used as a first line to help control her symptoms?
  8. A nurse practitioner is teaching an undergraduate course in women’s health. A student asks about the etiology of the pain that occurs with primary dysmenorrhea. Which of the following response is correct?
  9. Anna, 25-year-old, presents with dysmenorrhea. She states that her sister and mother have endometriosis, so she would like to be evaluated for it. Which of the following is consistent with a diagnosis of endometriosis?
  10. Which is not a common cause of irregular menstrual bleeding?
  11. Which of the following is a “classic” symptom of endometriosis?
  12. A 16-year-old female is diagnosed with primary dysmenorrhea. She has taken over the counter ibuprofen in 800 mg increments every 8 hours during menses for the past 3 months with minimal relief of symptoms. What intervention will provide greatest relief of dysmenorrhea symptoms?
  13. A woman visits the clinic because she has dysmenorrhea. What goal should the nurse identify for this client?
  14. This is defined as “cramping pain in the lower abdomen occurring just before or during menstruation in the absence of other diseases.”

Gravida/Para

  1. After treatment for a bladder infection, a client asks whether there is anything she can do to prevent cystitis in the future. What is the best response by the nurse?
  2. A patient has been diagnosed with interstitial cystitis. The nurse practitioner remembers that this is best defined as _____.
  3. The nurse practitioner is examining a 29-year-old female with a3 day history of dysuria and urinary frequency. On examination, the patient is positive for suprapubic tenderness and negative for costovertebral angle (CVA) tenderness. This most likely represents which of the following?
  4. A twenty-five-year-old patient presents with urinary frequency and urgency. These symptoms have been occurring for three days without fever. A patient with interstitial cystitis would most likely describe their symptoms as _______.

Lichen sclerosus

  1. A 65-year-old female presents for a health maintenance examination. She complains of a vulvar itching due to what she calls “recurrent yeast infections,” and her symptoms have worsened over the last few months. She is sexually active with her husband and has experienced dyspareunia with penetration lately. She always uses a water-based lubricant with intercourse. On examination, you find complete loss of the borders of the labia minora, constriction of the vaginal outlet, and several thin white plaques (like parchment paper) on the vulva. There is no other skin or mucosal involvement.
  2. A 65-year-old patient is diagnosed with lichen sclerosus. The woman asks the nurse what this really means. What is the nurse’s best response?

Lichen simplex chronicus

  1. The appearance of lichen simplex chronicus is best described as
  2. A patient ask why she needs a breast ultrasound when she already has had a mammogram. Which of the following would be the best response of the use?
  3. A 55-year-old female patient presents with pain in the upper outer quadrant of her left breast for over 1month now. The best course of action would be to _________.
  4. A 24-year-old female presents to the practice with a painless 2 cm, lobular mass in the right breast that is freely mobile and firm. This has noted on self-breast examination, and she reports it has been unchanged for the past 3 months. The best course of action by the nurse practitioner would be to __________.
  5. When educating a patient about the rationale for obtaining a mammogram, which of the following statements is false?
  6. A 55-year-old women presents to the clinic for evaluation of a breast mass. Which of the following is not a typical presenting sign of breast cancer?
  7. During a breast exam of a 30-year-old nulliparous female, the nurse practitioner palpates several rubbery mobile areas of the breast tissue. They are slightly tender to palpation. Both breasts have symmetrical findings. There are no skin changes or any nipple discharge. The patient is expecting her menstrual period in 5 days. Which of the following would you recommend?
  8. Which of the following statements is accurate regarding the usefulness of mammo in screening and detection of breast cancer?
  9. A 45-year-old woman has an abnormal screening mammogram. The next step in management should be
  10. What recommendation should be made to a 70-year-old female regarding mammograms?

Metronidazole

  1. A nurse is caring for a client who has contracted a trichomonal infection. Which oral drug should the nurse anticipate that the health care provider will most likely prescribe?
  2. An important part of patient education for the patient with bacterial vaginosis who is receiving a prescription for oral Metronidazole is:
  3. For the patient with chronic bacterial vaginosis, the nurse practitioner will prescribe:

Molluscum contagiosum

  1. The differential diagnosis for genital ulceration includes all of the following except :
  2. When molluscum contagiosum is found on the genital area of children, which of the following is the best explanation?
  3. Tina is evaluated and diagnosed with Molluscum Contagiosum. The nurse practitioner understands that clinical presentation of this disease is characterized by:

Nabothian Glands

  1. Small, pale yellow, raised, and rounded areas are visualized on the surface of the cervix. You should:

PCOS

  1. Elevated triglyceride levels, low HDL levels, and elevated LDL levels are associated with
  2. A 34-year-old woman comes to see you in the office complaining of facial and abdominal hair growth and severe acne. She tells you that although her sister also has some facial hair, her worsening changes are dramatic as compared with family members. Which of the following is the most likely explanation for her symptoms?
  3. The blood test result most consistent with supporting the diagnosis of PCOS is
  4. An adolescent female has had normal menses for almost 2 years. She has not had menses in 3 months. She is diagnosed with polycystic ovarian syndrome (PCOS). What else is a common finding?
  5. A woman has been diagnosed with polycystic ovary syndrome (PCOS). Management of PCOS includes all of the following except ___________.
  6. A nurse practitioner is reviewing the chart of a woman who has findings consistent with polycystic ovary syndrome (PCOS).The diagnostic criteria for PCOS include all of the following except:
  7. A nurse practitioner is reviewing the signs of polycystic ovary syndrome (PCOS) for a differential diagnosis for a female patient. Which of the following would be a positive finding?

PID

  1. An 18-year-old waitress is diagnosed with pelvic inflammatory disease (PID). The cervical Gen-Probe result is positive for Neisseria gonorrhoeaeand negative for Chlamydia trachomatis. All of the following statements are true regarding the management of this patient except:
  2. Women often tend to reschedule a well woman visit but they don’t do so often with a problem such as pelvic pain. This symptom can present as an acute or chronic, insult. When a woman presents with pelvic pain, the term can encompass many possibilities. Differentiating acute from chronic assists with narrowing down the possibilities but nonetheless can originate from more than one system as a referred pain or discomfort. Which of the following choices are of a reproductive and pelvic origin?
  3. Women with PID typically present with all of the follow except:
  4. 22yo female c/o pelvic pain. Exam reveals cervical motion and uterine tenderness. Which supports PID dx?
  5. women with a history of pelvic inflammatory disease (PID) have an increased risk for all of the following except:
  6. The nurse practitioner understands that a complication of gonoccocal and chlamydial genitourinary infection in women include which of the following:

Pyelonephritis

  1. Complications of gonococcal and chlamydial genitourinary infection in women include all of the following except:

Rectocele

  1. Rectocele is best defined as

Skene’s glands

  1. A nurse is describing the Skene glands, explaining that these glands would be found at which location?
  2. Which of the following findings indicates a possible gonococcal infection?

STDs

  1. Patients who are diagnosed with gonorrhea should also be treated for which of the following infections?
  2. Which of the following is the best method to diagnose a vaginal trichomonas infection?
  3. A 30-year-old woman who is sexually active complains of a large amount of milk-like vaginal discharge for several weeks. A microscopy slide reveals a large number of cells that have blurred margins. Very few white blood cells are seen. The vaginal pH is at 6.0. What is most likely?
  4. A 25-year-old woman complains of dysuria, severe vaginal pruritus, and a malodorous vaginal discharge. Pelvic examination reveals a strawberry-colored cervix and frothy yellow discharge. Microscopic examination of the discharge reveals mobile organisms that have flagella. The correct pharmacological therapy for the condition is:
  5. A patient diagnosed with bacterial vaginosis should be advised that her sexual partner:
  6. All of the following are infections that affect mostly the labia and vagina except:
  7. A 25-year-old obese female with type 2 diabetes mellitus presents to your office with a complaint of vaginal itching and burning for 2 weeks. She has tried douching with an OTC cream with no relief. Physical examination, the vulva is deep red with some thick white adherent material. Which of the following conditions would be most likely cause of her symptoms?
  8. A young woman presents to your practice with vaginal itching and white discharge. She denies sexual activity or douching. She has been in good health except for a recurrent strep throat. Pelvic examination reveals a tender vulvovaginal area with edema and white patches, no odor is detected. Which of the following is the most likely cause of this problem?
  9. A patient has symptoms consistent with chlamydia. Which laboratory test gold standard? In the diagnosis?
  10. A woman presents to your practice with vaginal itching and a white discharge. She has been in good health except for recent treatment for strep throat. Pelvic examination reveals a tender vulvovaginal area with edema and non-malodorous white patches. Which of the following is most likely cause of this problem?
  11. A 39-year-old female has just completed a course of amoxicillin for treatment of streptococcal pharyngitis. Her LMP was 2 weeks ago and reports that it was normal for her. On physical examination, there is some erythema of the eternal genitalia with a small amount of white discharge. The macroscopic wet prep examination revels few clue cells but an abundance of budding hyphae. There are no WBC’s present. considering the differential diagnoses and results of the microscopic examination, which of the following would be the most appropriate.
  12. A 24-year-old female presents to the office with a complaint of vaginal itching in addition to thick mucoid discharge. She also has some mild urinary discomfort. The wet mount preparation using potassium hydroxide. (KOH) reveals a negative whiff test and few clue cells. There was no trichomonas visualized but the WBCs were too numerous to count. Which of the following would be the most likely diagnosis in the patient?
  13. The patient has been diagnosed with trichomoniasis. Which of the following medications would be the best options?
  14. 25yo female c/o vaginal irritation and discharge. On exam, cervix is easily friable and erythematous. No adnexal tenderness. Wet prep reveals mobile protozoa on NS slide. This most likely represents:
  15. Woman is experiencing vaginal discharge. Wet mount with KOH would be used to confirm:
  16. A 21-year-old female presents with three 0.5 cm human papilloma virus (HPV) lesions on her vulva. An appropriate treatment option for this patient would be:
  17. A 25-year-old woman comes to the clinic complaining of increased vaginal discharge, milky gray in color with a “fishy” odor that both she and her husband have noticed. A wet smear is performed and the presence of “clue cells” confirmed. Which type of infection does the nurse suspect?
  18. A nurse in the family planning clinic reviews the health history of a sexually active 16-year-old girl whose chief concern is a thick, burning discharge accompanied by a burning sensation and lower abdominal pain. After an examination the girl is informed that she may have a sexually transmitted infection (STI) that requires treatment. The adolescent is concerned that her parents will discover that she has been sexually active and asks the nurse whether her parents will be contacted. The nurse explains that her parents will:
  19. A woman visits the clinic for an annual physical examination, and herpes genitalis is diagnosed. The client asks how the disease can be diagnosed without any tests. How should the nurse reply?
  20. The clinic nurse is planning care for a client found to have Chlamydia. Which treatment should the nurse plan to implement?
  21. The clinical syndrome resulting from replacement of normal vaginal flora with anaerobic bacteria is: 
  22. A patient has symptoms consistent with Chlamydia. Which laboratory test would aid in the diagnosis?
  23. A 19-year-old sexually active female presents to your urgent care center with a foul smelling vaginal discharge. She has noted the discharge for about 3 days. On examination, she is in no acute distress, and her vital signs are normal. Her pelvic examination is remarkable for mild vaginal erythema and a frothy gray discharge. You note a malodorous discharge and suspect Trichomonas (bacterial vaginosis can also be malodorous, of course, with a fishy smell). A wet prep confirms your diagnosis.

Stein-Leventhal Syndrome

  1. The Stein-Leventhal syndrome is characterized by each of the following except

Turner’s syndrome

  1. Which of the following is NOT a characteristic of Turner syndrome?
  2. Which of the following statements is NOT true about Turner syndrome?
  3. Which of the following is common treatment for individuals with Turner syndrome?
  4. Does the X chromosome more commonly come from the mother or father in girls with Turner syndrome?

USPSTF recommendations regarding breast exams

Uterine Prolapse

  1. During a pelvic exam on a seventy-year-old, the nurse practitioner notices the position of the cervix at the introitus. The diagnosis is most likely _____.
  2. Uterine prolapse is caused by a relaxation of the ?

UTI

  1. In women, most urinary tract infections occur through:
  2. A woman with a lower urinary tract infection is least likely to experience which of the following symptoms?
  3. Approximately what percent of women will suffer a urinary tract infection at some point in their lives?
  4. Urinary tract infections are commonly seen in primary care. A 25-year-old female presents with a new onset of dysuria and suprapubic pain for the last twenty-four hours. The examination reveals only mild tenderness without any peritoneal signs on the lower abdomen. A urinalysis reveals the presence of WBCs. The urine is sent for a culture and sensitivity. In addition to Escherichia colione might typically expect to see the presence of which bacterium?

Vulvar carcinoma/ Pelvic mass

  1. What percent of vulvar carcinomas are of the squamous cell type?
  2. Paget disease of the vulva may be associated with carcinoma of the
  3. In patients with vulvar carcinoma, what is the most common presenting complaint?
  4. The spread of squamous cell carcinoma of the vulva is best characterized by which of the following?
  5. What is the recommended procedure for the evaluation of a chronic vulvar ulcer?
  6. The most common cause of the delay in diagnosing vulva carcinoma is the
  7. 35yo woman c/o 6mo h/o hypermenorrhea, backache, pelvic pressure. On exam, you discover 12wk size uterus w/irregular contour. What does this represent?
  8. You are completing a pelvic exam on 32-year-old Nancy. You detect a left adnexal mass on the bimanual exam. With an adnexal mass, the practitioner must always suspect ________ until proven otherwise.
  9. A 28-year-old happily married woman presents with new-onset insertional dysparenunia. The most likely diagnosis is
  10. All of the following medications may be used for neuropathic pain management of vulvodynia, except:
  11. The nurse practitioner understands that which of the following lab tests is appropriate for the patient who presents with symptoms of dysesthetic vulvodynia?
  12. A 14-year-old is brought to the clinic by her mother. The mother explains to the nurse that her daughter has just started using tampons but is not yet sexually active. The mother states “I am very concerned because my daughter is having a lot of stabbing pain and burning.” What might the nurse suspect is the problem with the 14-year-old?

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