NURS 620 Adult Gerontology Health Care 1
Exam 4 Prep Test
250 Questions with Correct Answers
and Detailed Rationales
Latest Exam 4 | Graded A+
1. Darcy is to undergo a core-needle biopsy for a suspicious breast mass. This procedure
includes:
A. A 21- or 22-gauge needle that is used to aspirate cells from the lesion for analysis
B. Removal of a large core of tissue from the lesion for histological evaluation usually a
large gauge cutting needle
C. Removal of a wedge of tissue for examination
D. Removal of the entire lesion
Correct Answer: B
Rationale: A core-needle biopsy uses a large-gauge cutting needle (typically 14-gauge or
larger) to remove a cylindrical core of tissue from the suspicious lesion. This provides a
histological sample that preserves tissue architecture, allowing for definitive diagnosis
including assessment of invasion, grade, and receptor status. Option A describes fine-
needle aspiration (FNA), which only obtains cells for cytological analysis. Option C
describes an incisional biopsy (wedge biopsy), and Option D describes an excisional biopsy
where the entire lesion is removed.
2. Which of the following is a contraindication to using the copper intrauterine device
(IUD)?
A. History of ectopic pregnancy
B. Nulliparity
[1]
,C. Treated cervical dysplasia
D. Heart Disease
Correct Answer: D
Rationale: Heart disease, particularly valvular heart disease or conditions that predispose
to endocarditis, is a contraindication to copper IUD use due to the risk of bacteremia during
insertion. While a history of ectopic pregnancy, nulliparity, and treated cervical dysplasia
are not absolute contraindications, they require careful consideration. The copper IUD is
actually effective for emergency contraception and long-term use in nulliparous women.
Wilson's disease and current pelvic infection are also contraindications, but heart disease is
the correct answer among the options provided.
3. Joy has been breastfeeding and has developed puerperal mastitis. You tell her:
A. "Using cool compresses to the affected breast before pumping will increase milk
expression"
B. "Continue breastfeeding the baby to avoid milk stasis"
C. "Continue doing your normal activities during the acute phase to keep things flowing"
D. "Do not massage the breast"
Correct Answer: B
Rationale: Continuing to breastfeed or pump from the affected breast is essential in
managing puerperal mastitis. Emptying the breast helps prevent milk stasis, which is a key
factor in the development and progression of mastitis. Warm compresses before feeding
and gentle massage can help with milk flow (not cool compresses before pumping, which is
more appropriate for engorgement). Rest and adequate hydration are important during the
acute phase, not continuing normal activities. The milk from the affected breast is safe for
the infant, and stopping breastfeeding can worsen the condition and lead to abscess
formation.
[2]
,4. A 17-year-old female asks to start Depo-Provera injections as her method of birth
control. She discloses she has had four sexual partners in the past year. Her last menstrual
period was 12 days ago, and she had unprotected sex 3 days ago. The appropriate
management for this patient would be to:
A. Administer the injection today
B. Advise her to use another method for now and return with her next menses
C. Give the injection after a negative pregnancy test and tell her to use a condom for the
next 7 days
D. Give her injection and tell her to use a barrier method for 7 days
Correct Answer: B
Rationale: Depo-Provera should ideally be initiated within the first 5 days of the menstrual
cycle to ensure immediate contraceptive coverage. Since this patient had unprotected
intercourse 3 days ago and is now on day 12 of her cycle, she may already be pregnant or at
risk for pregnancy. Administering Depo-Provera today would not provide emergency
contraception. She should be advised to use another method for now (such as condoms)
and return for the injection with her next menses, at which time a pregnancy test should be
performed. Emergency contraception (Plan B or ella) should be offered if within the
appropriate time frame (72 hours for Plan B, 120 hours for ella).
5. Beth is breastfeeding her 3-month-old infant with no supplementation. She says she has
heard she cannot get pregnant during this time. What do you tell her:
A. "It's highly likely that you may become pregnant, so you should use another method of
birth control"
B. "Yes, you are safe as long as you breastfeed"
C. "For the first 6 months, if you breastfeed and have very little supplementation, your
chances are less than 2% that you will get pregnant"
D. "You're more at risk for getting pregnant now because of your fluctuating hormone
levels"
Correct Answer: C
[3]
, Rationale: The lactational amenorrhea method (LAM) is an effective form of contraception
when specific criteria are met. For LAM to be effective, the woman must be exclusively
breastfeeding (or nearly exclusively), the infant must be less than 6 months old, and the
mother must be amenorrheic. When these conditions are met, the pregnancy rate is less
than 2%, which is comparable to hormonal contraceptives. Option A overstates the risk
when criteria are met. Option B is incorrect because it suggests absolute safety without
conditions. Option D is incorrect as breastfeeding typically suppresses ovulation through
elevated prolactin levels.
6. Mrs. Williams would like to schedule an appointment to bring her 18-year-old daughter
in for her first gynecological exam and Pap smear. The most appropriate reply would
include:
A. "I would be happy to see your daughter and complete her gynecological exam and Pap
smear"
B. "Your daughter does not need a gynecological exam and Pap at this time"
C. "Your daughter only needs a gynecological exam and Pap smear when she becomes
sexually active"
D. "I would be happy to see your daughter and complete her gynecological exam, however,
she does not need a Pap smear until the age of 21"
Correct Answer: D
Rationale: Current American College of Obstetricians and Gynecologists (ACOG) and U.S.
Preventive Services Task Force (USPSTF) guidelines recommend that cervical cancer
screening (Pap smear) begin at age 21, regardless of sexual history. However, a
gynecological exam can be performed earlier if there are specific concerns or if the patient
desires contraception. Option A is incorrect because a Pap smear is not indicated at age 18.
Option B is incorrect because the daughter may benefit from a gynecological exam for other
reasons. Option C is incorrect because screening is recommended at age 21 regardless of
sexual activity.
7. Candidiasis is more common in:
[4]
Exam 4 Prep Test
250 Questions with Correct Answers
and Detailed Rationales
Latest Exam 4 | Graded A+
1. Darcy is to undergo a core-needle biopsy for a suspicious breast mass. This procedure
includes:
A. A 21- or 22-gauge needle that is used to aspirate cells from the lesion for analysis
B. Removal of a large core of tissue from the lesion for histological evaluation usually a
large gauge cutting needle
C. Removal of a wedge of tissue for examination
D. Removal of the entire lesion
Correct Answer: B
Rationale: A core-needle biopsy uses a large-gauge cutting needle (typically 14-gauge or
larger) to remove a cylindrical core of tissue from the suspicious lesion. This provides a
histological sample that preserves tissue architecture, allowing for definitive diagnosis
including assessment of invasion, grade, and receptor status. Option A describes fine-
needle aspiration (FNA), which only obtains cells for cytological analysis. Option C
describes an incisional biopsy (wedge biopsy), and Option D describes an excisional biopsy
where the entire lesion is removed.
2. Which of the following is a contraindication to using the copper intrauterine device
(IUD)?
A. History of ectopic pregnancy
B. Nulliparity
[1]
,C. Treated cervical dysplasia
D. Heart Disease
Correct Answer: D
Rationale: Heart disease, particularly valvular heart disease or conditions that predispose
to endocarditis, is a contraindication to copper IUD use due to the risk of bacteremia during
insertion. While a history of ectopic pregnancy, nulliparity, and treated cervical dysplasia
are not absolute contraindications, they require careful consideration. The copper IUD is
actually effective for emergency contraception and long-term use in nulliparous women.
Wilson's disease and current pelvic infection are also contraindications, but heart disease is
the correct answer among the options provided.
3. Joy has been breastfeeding and has developed puerperal mastitis. You tell her:
A. "Using cool compresses to the affected breast before pumping will increase milk
expression"
B. "Continue breastfeeding the baby to avoid milk stasis"
C. "Continue doing your normal activities during the acute phase to keep things flowing"
D. "Do not massage the breast"
Correct Answer: B
Rationale: Continuing to breastfeed or pump from the affected breast is essential in
managing puerperal mastitis. Emptying the breast helps prevent milk stasis, which is a key
factor in the development and progression of mastitis. Warm compresses before feeding
and gentle massage can help with milk flow (not cool compresses before pumping, which is
more appropriate for engorgement). Rest and adequate hydration are important during the
acute phase, not continuing normal activities. The milk from the affected breast is safe for
the infant, and stopping breastfeeding can worsen the condition and lead to abscess
formation.
[2]
,4. A 17-year-old female asks to start Depo-Provera injections as her method of birth
control. She discloses she has had four sexual partners in the past year. Her last menstrual
period was 12 days ago, and she had unprotected sex 3 days ago. The appropriate
management for this patient would be to:
A. Administer the injection today
B. Advise her to use another method for now and return with her next menses
C. Give the injection after a negative pregnancy test and tell her to use a condom for the
next 7 days
D. Give her injection and tell her to use a barrier method for 7 days
Correct Answer: B
Rationale: Depo-Provera should ideally be initiated within the first 5 days of the menstrual
cycle to ensure immediate contraceptive coverage. Since this patient had unprotected
intercourse 3 days ago and is now on day 12 of her cycle, she may already be pregnant or at
risk for pregnancy. Administering Depo-Provera today would not provide emergency
contraception. She should be advised to use another method for now (such as condoms)
and return for the injection with her next menses, at which time a pregnancy test should be
performed. Emergency contraception (Plan B or ella) should be offered if within the
appropriate time frame (72 hours for Plan B, 120 hours for ella).
5. Beth is breastfeeding her 3-month-old infant with no supplementation. She says she has
heard she cannot get pregnant during this time. What do you tell her:
A. "It's highly likely that you may become pregnant, so you should use another method of
birth control"
B. "Yes, you are safe as long as you breastfeed"
C. "For the first 6 months, if you breastfeed and have very little supplementation, your
chances are less than 2% that you will get pregnant"
D. "You're more at risk for getting pregnant now because of your fluctuating hormone
levels"
Correct Answer: C
[3]
, Rationale: The lactational amenorrhea method (LAM) is an effective form of contraception
when specific criteria are met. For LAM to be effective, the woman must be exclusively
breastfeeding (or nearly exclusively), the infant must be less than 6 months old, and the
mother must be amenorrheic. When these conditions are met, the pregnancy rate is less
than 2%, which is comparable to hormonal contraceptives. Option A overstates the risk
when criteria are met. Option B is incorrect because it suggests absolute safety without
conditions. Option D is incorrect as breastfeeding typically suppresses ovulation through
elevated prolactin levels.
6. Mrs. Williams would like to schedule an appointment to bring her 18-year-old daughter
in for her first gynecological exam and Pap smear. The most appropriate reply would
include:
A. "I would be happy to see your daughter and complete her gynecological exam and Pap
smear"
B. "Your daughter does not need a gynecological exam and Pap at this time"
C. "Your daughter only needs a gynecological exam and Pap smear when she becomes
sexually active"
D. "I would be happy to see your daughter and complete her gynecological exam, however,
she does not need a Pap smear until the age of 21"
Correct Answer: D
Rationale: Current American College of Obstetricians and Gynecologists (ACOG) and U.S.
Preventive Services Task Force (USPSTF) guidelines recommend that cervical cancer
screening (Pap smear) begin at age 21, regardless of sexual history. However, a
gynecological exam can be performed earlier if there are specific concerns or if the patient
desires contraception. Option A is incorrect because a Pap smear is not indicated at age 18.
Option B is incorrect because the daughter may benefit from a gynecological exam for other
reasons. Option C is incorrect because screening is recommended at age 21 regardless of
sexual activity.
7. Candidiasis is more common in:
[4]
