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NSG 555 EXAM 4 STUDY GUIDE — WILKES UNIVERSITY
Nurse Practitioners in Primary Care II | 2026/2027
Update | Complete Solutions
PART A: WOMEN'S HEALTH, INFECTIOUS DISEASE & UROLOGY DRILL (Questions 1–12)
Question 1
A 48-year-old woman presents with irregular heavy menstrual bleeding lasting 10–14 days.
Her last Pap smear was normal 2 years ago. What is the most appropriate next step?
A. Start oral contraceptives immediately
B. Perform endometrial biopsy
C. Order pelvic ultrasound
D. Prescribe tranexamic acid and reassess in 3 months
Correct Answer: B. Perform endometrial biopsy
Rationale: Women ≥45 years with abnormal uterine bleeding (AUB) require endometrial
biopsy to exclude endometrial hyperplasia and carcinoma. This is a critical safety measure
before initiating hormonal management. The PALM-COEIN classification system guides AUB
evaluation, but endometrial sampling remains mandatory in this age group.
High-Yield Pearl: Age ≥45 + AUB = Endometrial biopsy FIRST. Never start hormonal therapy
without ruling out endometrial pathology in perimenopausal women with abnormal
bleeding.
Question 2
A 52-year-old woman with severe vasomotor symptoms requests hormone therapy. She had a
hysterectomy 5 years ago. Her family history is negative for breast cancer and CVD. What is
the most appropriate recommendation?
A. Combined estrogen/progestin therapy
B. Estrogen-only therapy
C. Low-dose vaginal estrogen only
D. Non-hormonal therapy (gabapentin)
, 2
Correct Answer: B. Estrogen-only therapy
Rationale: In women without a uterus, estrogen-only therapy is appropriate for vasomotor
symptoms. The Women's Health Initiative showed that estrogen-only therapy does not
increase breast cancer risk and may reduce it. Progestin is only needed if the uterus is intact
to prevent endometrial hyperplasia.
High-Yield Pearl: No uterus = No progestin needed. Estrogen-only therapy is safe for
vasomotor symptoms in hysterectomized women.
Question 3
A 38-year-old woman with premature ovarian failure (menopause before age 40) asks about
hormone therapy. She has no contraindications. What is the correct recommendation?
A. Hormone therapy is contraindicated before age 45
B. Hormone therapy recommended until average age of natural menopause (~51)
C. Hormone therapy only if symptoms are severe
D. Non-hormonal therapy preferred
Correct Answer: B. Hormone therapy recommended until average age of natural menopause
(~51)
Rationale: Premature menopause (<40 years) or early menopause (40–45 years) carries
increased risks for cardiovascular disease, osteoporosis, and cognitive decline. Hormone
therapy is recommended until the average age of natural menopause because the benefits
(bone protection, cardiovascular health) clearly outweigh risks when initiated early.
High-Yield Pearl: Premature menopause = HT until age 51. Early initiation provides
cardioprotection and bone preservation.
Question 4
A 28-year-old pregnant woman at 16 weeks gestation is diagnosed with chlamydia. What is
the appropriate treatment?
A. Doxycycline 100 mg BID × 7 days
B. Azithromycin 1 g PO single dose
C. Levofloxacin 500 mg daily × 7 days
D. Amoxicillin 500 mg TID × 7 days
, 3
Correct Answer: B. Azithromycin 1 g PO single dose
Rationale: Azithromycin is the treatment of choice for chlamydia in pregnancy. Doxycycline is
contraindicated in pregnancy (teratogenic—discolors teeth and affects bone growth).
Levofloxacin is also contraindicated (cartilage damage risk). Amoxicillin is an alternative but
azithromycin is preferred per CDC guidelines.
High-Yield Pearl: Pregnancy + Chlamydia = Azithromycin 1 g PO. Doxycycline and
fluoroquinolones are CONTRAINDICATED in pregnancy.
Question 5
A 25-year-old man is diagnosed with trichomoniasis. His female partner is asymptomatic.
What is the correct management for the partner?
A. No treatment needed if asymptomatic
B. Treat empirically with metronidazole 2 g PO single dose
C. Test and treat only if symptomatic
D. Treat with tinidazole 2 g PO single dose
Correct Answer: B. Treat empirically with metronidazole 2 g PO single dose
Rationale: Sexual partners of patients with trichomoniasis must be treated empirically,
regardless of symptoms, to prevent reinfection and ongoing transmission. The CDC
recommends treating all partners simultaneously. Both metronidazole and tinidazole are
effective; metronidazole is more commonly used.
High-Yield Pearl: Trichomoniasis = Treat ALL partners empirically. Reinfection is common if
partners are not treated.
Question 6
A 30-year-old man is diagnosed with gonorrhea. He weighs 75 kg. What is the appropriate
treatment per current CDC guidelines?
A. Ceftriaxone 250 mg IM single dose
B. Ceftriaxone 500 mg IM + azithromycin 1 g PO
C. Ceftriaxone 1 g IM single dose
D. Cefixime 400 mg PO single dose
Correct Answer: B. Ceftriaxone 500 mg IM + azithromycin 1 g PO
, 4
Rationale: Current CDC guidelines recommend dual therapy for gonorrhea: ceftriaxone 500
mg IM (1 g if weight ≥150 kg) PLUS azithromycin 1 g PO. Dual therapy addresses potential
cephalosporin resistance and covers possible chlamydia co-infection. For patients weighing
<150 kg, 500 mg ceftriaxone is sufficient.
High-Yield Pearl: Gonorrhea = Dual therapy (Ceftriaxone + Azithromycin). Weight ≥150 kg
requires 1 g ceftriaxone.
Question 7
A 68-year-old man presents with bothersome lower urinary tract symptoms (LUTS) due to
BPH. He has a 35 cc prostate on exam. What is the most appropriate initial therapy?
A. Tamsulosin 0.4 mg daily
B. Finasteride 5 mg daily
C. Watchful waiting
D. Surgical referral
Correct Answer: A. Tamsulosin 0.4 mg daily
Rationale: Alpha-blockers (tamsulosin, doxazosin) provide rapid symptom relief (days to
weeks) and are first-line for bothersome LUTS. 5-alpha reductase inhibitors (finasteride,
dutasteride) reduce prostate size but take 6–12 months to work. For a 35 cc prostate with
bothersome symptoms, an alpha-blocker is the best initial choice.
High-Yield Pearl: Bothersome LUTS = Alpha-blocker FIRST. Rapid relief; 5-ARIs take 6–12
months.
Question 8
A 72-year-old man with BPH has a 45 cc prostate and moderate LUTS. He is at risk for disease
progression. What is the most effective long-term management?
A. Alpha-blocker alone
B. 5-alpha reductase inhibitor alone
C. Combination therapy (alpha-blocker + 5-ARI)
D. Transurethral resection of the prostate (TURP)
Correct Answer: C. Combination therapy (alpha-blocker + 5-ARI)
NSG 555 EXAM 4 STUDY GUIDE — WILKES UNIVERSITY
Nurse Practitioners in Primary Care II | 2026/2027
Update | Complete Solutions
PART A: WOMEN'S HEALTH, INFECTIOUS DISEASE & UROLOGY DRILL (Questions 1–12)
Question 1
A 48-year-old woman presents with irregular heavy menstrual bleeding lasting 10–14 days.
Her last Pap smear was normal 2 years ago. What is the most appropriate next step?
A. Start oral contraceptives immediately
B. Perform endometrial biopsy
C. Order pelvic ultrasound
D. Prescribe tranexamic acid and reassess in 3 months
Correct Answer: B. Perform endometrial biopsy
Rationale: Women ≥45 years with abnormal uterine bleeding (AUB) require endometrial
biopsy to exclude endometrial hyperplasia and carcinoma. This is a critical safety measure
before initiating hormonal management. The PALM-COEIN classification system guides AUB
evaluation, but endometrial sampling remains mandatory in this age group.
High-Yield Pearl: Age ≥45 + AUB = Endometrial biopsy FIRST. Never start hormonal therapy
without ruling out endometrial pathology in perimenopausal women with abnormal
bleeding.
Question 2
A 52-year-old woman with severe vasomotor symptoms requests hormone therapy. She had a
hysterectomy 5 years ago. Her family history is negative for breast cancer and CVD. What is
the most appropriate recommendation?
A. Combined estrogen/progestin therapy
B. Estrogen-only therapy
C. Low-dose vaginal estrogen only
D. Non-hormonal therapy (gabapentin)
, 2
Correct Answer: B. Estrogen-only therapy
Rationale: In women without a uterus, estrogen-only therapy is appropriate for vasomotor
symptoms. The Women's Health Initiative showed that estrogen-only therapy does not
increase breast cancer risk and may reduce it. Progestin is only needed if the uterus is intact
to prevent endometrial hyperplasia.
High-Yield Pearl: No uterus = No progestin needed. Estrogen-only therapy is safe for
vasomotor symptoms in hysterectomized women.
Question 3
A 38-year-old woman with premature ovarian failure (menopause before age 40) asks about
hormone therapy. She has no contraindications. What is the correct recommendation?
A. Hormone therapy is contraindicated before age 45
B. Hormone therapy recommended until average age of natural menopause (~51)
C. Hormone therapy only if symptoms are severe
D. Non-hormonal therapy preferred
Correct Answer: B. Hormone therapy recommended until average age of natural menopause
(~51)
Rationale: Premature menopause (<40 years) or early menopause (40–45 years) carries
increased risks for cardiovascular disease, osteoporosis, and cognitive decline. Hormone
therapy is recommended until the average age of natural menopause because the benefits
(bone protection, cardiovascular health) clearly outweigh risks when initiated early.
High-Yield Pearl: Premature menopause = HT until age 51. Early initiation provides
cardioprotection and bone preservation.
Question 4
A 28-year-old pregnant woman at 16 weeks gestation is diagnosed with chlamydia. What is
the appropriate treatment?
A. Doxycycline 100 mg BID × 7 days
B. Azithromycin 1 g PO single dose
C. Levofloxacin 500 mg daily × 7 days
D. Amoxicillin 500 mg TID × 7 days
, 3
Correct Answer: B. Azithromycin 1 g PO single dose
Rationale: Azithromycin is the treatment of choice for chlamydia in pregnancy. Doxycycline is
contraindicated in pregnancy (teratogenic—discolors teeth and affects bone growth).
Levofloxacin is also contraindicated (cartilage damage risk). Amoxicillin is an alternative but
azithromycin is preferred per CDC guidelines.
High-Yield Pearl: Pregnancy + Chlamydia = Azithromycin 1 g PO. Doxycycline and
fluoroquinolones are CONTRAINDICATED in pregnancy.
Question 5
A 25-year-old man is diagnosed with trichomoniasis. His female partner is asymptomatic.
What is the correct management for the partner?
A. No treatment needed if asymptomatic
B. Treat empirically with metronidazole 2 g PO single dose
C. Test and treat only if symptomatic
D. Treat with tinidazole 2 g PO single dose
Correct Answer: B. Treat empirically with metronidazole 2 g PO single dose
Rationale: Sexual partners of patients with trichomoniasis must be treated empirically,
regardless of symptoms, to prevent reinfection and ongoing transmission. The CDC
recommends treating all partners simultaneously. Both metronidazole and tinidazole are
effective; metronidazole is more commonly used.
High-Yield Pearl: Trichomoniasis = Treat ALL partners empirically. Reinfection is common if
partners are not treated.
Question 6
A 30-year-old man is diagnosed with gonorrhea. He weighs 75 kg. What is the appropriate
treatment per current CDC guidelines?
A. Ceftriaxone 250 mg IM single dose
B. Ceftriaxone 500 mg IM + azithromycin 1 g PO
C. Ceftriaxone 1 g IM single dose
D. Cefixime 400 mg PO single dose
Correct Answer: B. Ceftriaxone 500 mg IM + azithromycin 1 g PO
, 4
Rationale: Current CDC guidelines recommend dual therapy for gonorrhea: ceftriaxone 500
mg IM (1 g if weight ≥150 kg) PLUS azithromycin 1 g PO. Dual therapy addresses potential
cephalosporin resistance and covers possible chlamydia co-infection. For patients weighing
<150 kg, 500 mg ceftriaxone is sufficient.
High-Yield Pearl: Gonorrhea = Dual therapy (Ceftriaxone + Azithromycin). Weight ≥150 kg
requires 1 g ceftriaxone.
Question 7
A 68-year-old man presents with bothersome lower urinary tract symptoms (LUTS) due to
BPH. He has a 35 cc prostate on exam. What is the most appropriate initial therapy?
A. Tamsulosin 0.4 mg daily
B. Finasteride 5 mg daily
C. Watchful waiting
D. Surgical referral
Correct Answer: A. Tamsulosin 0.4 mg daily
Rationale: Alpha-blockers (tamsulosin, doxazosin) provide rapid symptom relief (days to
weeks) and are first-line for bothersome LUTS. 5-alpha reductase inhibitors (finasteride,
dutasteride) reduce prostate size but take 6–12 months to work. For a 35 cc prostate with
bothersome symptoms, an alpha-blocker is the best initial choice.
High-Yield Pearl: Bothersome LUTS = Alpha-blocker FIRST. Rapid relief; 5-ARIs take 6–12
months.
Question 8
A 72-year-old man with BPH has a 45 cc prostate and moderate LUTS. He is at risk for disease
progression. What is the most effective long-term management?
A. Alpha-blocker alone
B. 5-alpha reductase inhibitor alone
C. Combination therapy (alpha-blocker + 5-ARI)
D. Transurethral resection of the prostate (TURP)
Correct Answer: C. Combination therapy (alpha-blocker + 5-ARI)
