NU 661 / NU661 Primary Care Childbearing Woman
Final Exam Actual 2024/2025 with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
SECTION 1: REPRODUCTIVE HEALTH & GYNECOLOGY (14
Questions)
Q1: A 24-year-old patient presents with a 7-day history of thin, gray, malodorous
vaginal discharge with a positive "whiff" test. The vaginal pH is 5.2. Which organism
is most likely responsible?
A. Candida albicans
B. Trichomonas vaginalis
C. Gardnerella vaginalis [CORRECT]
D. Neisseria gonorrhoeae
Correct Answer: C
Rationale: Correct because bacterial vaginosis is characterized by thin gray
discharge, a fishy odor, positive whiff test, and elevated vaginal pH > 4.5, with
Gardnerella vaginalis being the predominant anaerobic organism involved.
Q2: A 32-year-old patient reports cyclic pelvic pain that worsens during menses and
dyspareunia. Transvaginal ultrasound reveals a 4-cm endometrioma on the left
ovary. Which statement about endometriosis is most accurate?
A. It is caused by ascending bacterial infection from the vagina
,B. It involves ectopic endometrial tissue responding to hormonal changes
[CORRECT]
C. It is a premalignant condition that always progresses to ovarian cancer
D. It is best treated with long-term antibiotic therapy
Correct Answer: B
Rationale: Correct because endometriosis is defined by the presence of endometrial
glands and stroma outside the uterine cavity that respond to cyclic hormonal
stimulation, causing inflammation, pain, and adhesions.
Q3: A 19-year-old patient presents with vulvar pruritus, erythema, and thick, white,
"cottage cheese-like" vaginal discharge. The vaginal pH is 4.0. Which treatment is
first-line?
A. Oral metronidazole 500 mg BID for 7 days
B. Intravaginal clotrimazole 200 mg suppository for 3 days [CORRECT]
C. Oral azithromycin 1 g single dose
D. Intravaginal boric acid 600 mg daily for 14 days
Correct Answer: B
Rationale: Correct because the presentation is classic for vulvovaginal candidiasis
(thick white discharge, pruritus, normal acidic pH), and intravaginal azole therapy
such as clotrimazole is first-line for uncomplicated infection.
Q4: A 28-year-old patient with regular 28-day cycles reports intermenstrual bleeding
and postcoital spotting. Cervical cytology shows high-grade squamous intraepithelial
lesion (HSIL). What is the next appropriate step?
,A. Repeat Pap smear in 6 months
B. Immediate loop electrosurgical excision procedure (LEEP)
C. Colposcopy with directed biopsy [CORRECT]
D. Observation with annual cytology
Correct Answer: C
Rationale: Correct because HSIL (CIN 2/3) requires colposcopic examination with
directed biopsy to confirm the diagnosis and guide definitive management; cytology
alone is insufficient for treatment planning.
Q5: A 35-year-old patient reports heavy menstrual bleeding (HMB) with cycles every
24–26 days lasting 8–9 days. Laboratory studies show microcytic anemia. Pelvic
ultrasound reveals a normal uterus and ovaries. What is the most likely diagnosis?
A. Uterine fibroids
B. Adenomyosis
C. Anovulatory abnormal uterine bleeding (AUB) [CORRECT]
D. Endometrial hyperplasia
Correct Answer: C
Rationale: Correct because a structurally normal uterus with heavy, frequent,
prolonged bleeding in a reproductive-age patient is most consistent with anovulatory
abnormal uterine bleeding due to unopposed estrogen causing endometrial
proliferation.
Q6: A 45-year-old patient presents with a unilateral, tender breast mass that
fluctuates in size with her menstrual cycle. Ultrasound reveals a well-circumscribed,
, anechoic lesion with posterior acoustic enhancement. What is the most likely
diagnosis?
A. Invasive ductal carcinoma
B. Fibroadenoma
C. Simple breast cyst [CORRECT]
D. Breast abscess
Correct Answer: C
Rationale: Correct because a simple breast cyst presents as a well-circumscribed,
anechoic lesion with posterior acoustic enhancement on ultrasound, often with
cyclic size changes related to hormonal fluctuations.
Q7: A 26-year-old patient reports severe dysmenorrhea unresponsive to NSAIDs.
Pelvic exam is normal. The nurse practitioner suspects primary dysmenorrhea. What
is the first-line pharmacologic treatment?
A. Oral contraceptive pills [CORRECT]
B. High-dose prednisone
C. Tricyclic antidepressants
D. Long-term opioid therapy
Correct Answer: A
Rationale: Correct because combined oral contraceptives suppress ovulation and
reduce prostaglandin production, which is the underlying mechanism of primary
dysmenorrhea; they are first-line when NSAIDs are ineffective.
Final Exam Actual 2024/2025 with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
SECTION 1: REPRODUCTIVE HEALTH & GYNECOLOGY (14
Questions)
Q1: A 24-year-old patient presents with a 7-day history of thin, gray, malodorous
vaginal discharge with a positive "whiff" test. The vaginal pH is 5.2. Which organism
is most likely responsible?
A. Candida albicans
B. Trichomonas vaginalis
C. Gardnerella vaginalis [CORRECT]
D. Neisseria gonorrhoeae
Correct Answer: C
Rationale: Correct because bacterial vaginosis is characterized by thin gray
discharge, a fishy odor, positive whiff test, and elevated vaginal pH > 4.5, with
Gardnerella vaginalis being the predominant anaerobic organism involved.
Q2: A 32-year-old patient reports cyclic pelvic pain that worsens during menses and
dyspareunia. Transvaginal ultrasound reveals a 4-cm endometrioma on the left
ovary. Which statement about endometriosis is most accurate?
A. It is caused by ascending bacterial infection from the vagina
,B. It involves ectopic endometrial tissue responding to hormonal changes
[CORRECT]
C. It is a premalignant condition that always progresses to ovarian cancer
D. It is best treated with long-term antibiotic therapy
Correct Answer: B
Rationale: Correct because endometriosis is defined by the presence of endometrial
glands and stroma outside the uterine cavity that respond to cyclic hormonal
stimulation, causing inflammation, pain, and adhesions.
Q3: A 19-year-old patient presents with vulvar pruritus, erythema, and thick, white,
"cottage cheese-like" vaginal discharge. The vaginal pH is 4.0. Which treatment is
first-line?
A. Oral metronidazole 500 mg BID for 7 days
B. Intravaginal clotrimazole 200 mg suppository for 3 days [CORRECT]
C. Oral azithromycin 1 g single dose
D. Intravaginal boric acid 600 mg daily for 14 days
Correct Answer: B
Rationale: Correct because the presentation is classic for vulvovaginal candidiasis
(thick white discharge, pruritus, normal acidic pH), and intravaginal azole therapy
such as clotrimazole is first-line for uncomplicated infection.
Q4: A 28-year-old patient with regular 28-day cycles reports intermenstrual bleeding
and postcoital spotting. Cervical cytology shows high-grade squamous intraepithelial
lesion (HSIL). What is the next appropriate step?
,A. Repeat Pap smear in 6 months
B. Immediate loop electrosurgical excision procedure (LEEP)
C. Colposcopy with directed biopsy [CORRECT]
D. Observation with annual cytology
Correct Answer: C
Rationale: Correct because HSIL (CIN 2/3) requires colposcopic examination with
directed biopsy to confirm the diagnosis and guide definitive management; cytology
alone is insufficient for treatment planning.
Q5: A 35-year-old patient reports heavy menstrual bleeding (HMB) with cycles every
24–26 days lasting 8–9 days. Laboratory studies show microcytic anemia. Pelvic
ultrasound reveals a normal uterus and ovaries. What is the most likely diagnosis?
A. Uterine fibroids
B. Adenomyosis
C. Anovulatory abnormal uterine bleeding (AUB) [CORRECT]
D. Endometrial hyperplasia
Correct Answer: C
Rationale: Correct because a structurally normal uterus with heavy, frequent,
prolonged bleeding in a reproductive-age patient is most consistent with anovulatory
abnormal uterine bleeding due to unopposed estrogen causing endometrial
proliferation.
Q6: A 45-year-old patient presents with a unilateral, tender breast mass that
fluctuates in size with her menstrual cycle. Ultrasound reveals a well-circumscribed,
, anechoic lesion with posterior acoustic enhancement. What is the most likely
diagnosis?
A. Invasive ductal carcinoma
B. Fibroadenoma
C. Simple breast cyst [CORRECT]
D. Breast abscess
Correct Answer: C
Rationale: Correct because a simple breast cyst presents as a well-circumscribed,
anechoic lesion with posterior acoustic enhancement on ultrasound, often with
cyclic size changes related to hormonal fluctuations.
Q7: A 26-year-old patient reports severe dysmenorrhea unresponsive to NSAIDs.
Pelvic exam is normal. The nurse practitioner suspects primary dysmenorrhea. What
is the first-line pharmacologic treatment?
A. Oral contraceptive pills [CORRECT]
B. High-dose prednisone
C. Tricyclic antidepressants
D. Long-term opioid therapy
Correct Answer: A
Rationale: Correct because combined oral contraceptives suppress ovulation and
reduce prostaglandin production, which is the underlying mechanism of primary
dysmenorrhea; they are first-line when NSAIDs are ineffective.
