NSG 554 EXAM 4 V3 NURSE PRACTITIONERS IN
PRIMARY CARE I 2026: COMPREHENSIVE Q&A WITH
RATIONALES
SECTION 1: REPRODUCTIVE HEALTH – GYNECOLOGICAL DISORDERS
1. An adolescent female reports a mass on her genitalia which is becoming increasingly
painful. On examination, the provider notes an erythematous, edematous, tender mass
lateral to the vestibule without discharge. It is determined that the patient has a Bartholin
gland abscess. What will the provider do initially?
A. Obtain a consultation for biopsy of the lesion
B. Perform a speculum examination of the vagina
C. Prescribe a broad-spectrum antibiotic
D. Refer the patient for an incision and drainage and culture
Answer: C
Rationale: Empirical administration of antibiotics, if done early, can be helpful in treating a
Bartholin gland abscess. Biopsy is performed if the mass is suspected as being cancerous.
Speculum examination is deferred until pain is relieved to avoid causing the patient
additional discomfort. Incision and drainage has risks and often results in recurrence, so it
is not the initial approach .
2. A patient has undergone surgical incision and drainage of a Bartholin's cyst with
insertion of a drain. What is an important aspect of care for this patient?
,A. Administration of antibiotics
B. Education about long-term dyspareunia
C. Teaching about reproductive sequelae
D. Weekly follow-up monitoring
Answer: D
Rationale: Patients with surgical incision and drainage who have a drain inserted should be
monitored weekly to ensure proper healing and to assess for complications. If adequately
treated, long-term function should be normal, so education about dyspareunia and
reproductive sequelae is not typically necessary unless complications develop. Antibiotics
are not routinely required post-procedure .
3. A female patient identified as having the BRCA mutation asks which intervention will
reduce the risk of breast cancer the most. What will the provider tell her?
A. Breast magnetic resonance imaging (MRI)
B. Clinical breast examination every 6 months
C. Early childbearing and breastfeeding
D. Prophylactic mastectomy
Answer: D
Rationale: Although all the options help to reduce breast cancer risk, patients with BRCA
mutation are at extremely high risk and will benefit most from prophylactic mastectomy
and oophorectomy. MRI can help detect invasive cancers earlier but does not reduce the
risk of developing cancer. Clinical breast examinations and lifestyle factors provide more
modest risk reduction .
,4. A postmenopausal woman reports unilateral breast pain that she describes as sharp and
burning and localized to one area. A breast examination reveals no dimpling, discharge, or
masses. Which diagnostic test will the provider order?
A. Bilateral mammography
B. Focused ultrasound
C. Hormone levels
D. Needle biopsy
Answer: A
Rationale: Bilateral mammography is usually performed in postmenopausal women with
noncyclic breast pain, although the likelihood of abnormal findings is low. Focused
ultrasound may be performed in addition to mammography if indicated. Hormone levels
are generally normal in this presentation. Needle biopsy is performed if a suspicious mass
is identified .
5. A woman who has just weaned her infant from breastfeeding develops signs of mastitis
and is treated with antibiotics. At a follow-up visit, the provider notes marked breast edema
and erythema of the affected breast. What will the provider do next?
A. Consult with a surgeon for incision and drainage of the breast
B. Counsel the patient to apply warm compresses
C. Prescribe antibiotics to treat MRSA infection
D. Refer the patient for an immediate biopsy
Answer: D
Rationale: Patients treated for mastitis who do not respond to antibiotics and who have
persistent erythema and edema are likely to have inflammatory breast carcinoma and
should be referred for a biopsy immediately. MRSA infection is possible, but these
, symptoms are severe, and the patient needs immediate evaluation. Warm compresses and
surgical intervention would delay necessary diagnostic procedures .
6. A woman diagnosed with chronic pelvic pain most likely has a gynecological cause for
her symptoms. Which treatment will the provider recommend initially?
A. Counseling and support
B. Hysterectomy
C. Neurostimulation
D. Oral contraceptives
Answer: D
Rationale: Oral contraceptives may be helpful for chronic pelvic pain and are a good initial
choice, particularly if a gynecological cause is suspected. Counseling and support are
necessary throughout management but do not directly help with symptom relief.
Hysterectomy may be indicated if there are more severe structural problems but does not
always alleviate symptoms. Neurostimulation is used when neuropathic pain is present .
7. Which underlying causes are related to chronic pelvic pain in women? (Select all that
apply.)
A. Postural problems
B. Hepatitis
C. Interstitial cystitis
D. Physical abuse
E. Gastrointestinal disorders
Answer: A, C, D, E
PRIMARY CARE I 2026: COMPREHENSIVE Q&A WITH
RATIONALES
SECTION 1: REPRODUCTIVE HEALTH – GYNECOLOGICAL DISORDERS
1. An adolescent female reports a mass on her genitalia which is becoming increasingly
painful. On examination, the provider notes an erythematous, edematous, tender mass
lateral to the vestibule without discharge. It is determined that the patient has a Bartholin
gland abscess. What will the provider do initially?
A. Obtain a consultation for biopsy of the lesion
B. Perform a speculum examination of the vagina
C. Prescribe a broad-spectrum antibiotic
D. Refer the patient for an incision and drainage and culture
Answer: C
Rationale: Empirical administration of antibiotics, if done early, can be helpful in treating a
Bartholin gland abscess. Biopsy is performed if the mass is suspected as being cancerous.
Speculum examination is deferred until pain is relieved to avoid causing the patient
additional discomfort. Incision and drainage has risks and often results in recurrence, so it
is not the initial approach .
2. A patient has undergone surgical incision and drainage of a Bartholin's cyst with
insertion of a drain. What is an important aspect of care for this patient?
,A. Administration of antibiotics
B. Education about long-term dyspareunia
C. Teaching about reproductive sequelae
D. Weekly follow-up monitoring
Answer: D
Rationale: Patients with surgical incision and drainage who have a drain inserted should be
monitored weekly to ensure proper healing and to assess for complications. If adequately
treated, long-term function should be normal, so education about dyspareunia and
reproductive sequelae is not typically necessary unless complications develop. Antibiotics
are not routinely required post-procedure .
3. A female patient identified as having the BRCA mutation asks which intervention will
reduce the risk of breast cancer the most. What will the provider tell her?
A. Breast magnetic resonance imaging (MRI)
B. Clinical breast examination every 6 months
C. Early childbearing and breastfeeding
D. Prophylactic mastectomy
Answer: D
Rationale: Although all the options help to reduce breast cancer risk, patients with BRCA
mutation are at extremely high risk and will benefit most from prophylactic mastectomy
and oophorectomy. MRI can help detect invasive cancers earlier but does not reduce the
risk of developing cancer. Clinical breast examinations and lifestyle factors provide more
modest risk reduction .
,4. A postmenopausal woman reports unilateral breast pain that she describes as sharp and
burning and localized to one area. A breast examination reveals no dimpling, discharge, or
masses. Which diagnostic test will the provider order?
A. Bilateral mammography
B. Focused ultrasound
C. Hormone levels
D. Needle biopsy
Answer: A
Rationale: Bilateral mammography is usually performed in postmenopausal women with
noncyclic breast pain, although the likelihood of abnormal findings is low. Focused
ultrasound may be performed in addition to mammography if indicated. Hormone levels
are generally normal in this presentation. Needle biopsy is performed if a suspicious mass
is identified .
5. A woman who has just weaned her infant from breastfeeding develops signs of mastitis
and is treated with antibiotics. At a follow-up visit, the provider notes marked breast edema
and erythema of the affected breast. What will the provider do next?
A. Consult with a surgeon for incision and drainage of the breast
B. Counsel the patient to apply warm compresses
C. Prescribe antibiotics to treat MRSA infection
D. Refer the patient for an immediate biopsy
Answer: D
Rationale: Patients treated for mastitis who do not respond to antibiotics and who have
persistent erythema and edema are likely to have inflammatory breast carcinoma and
should be referred for a biopsy immediately. MRSA infection is possible, but these
, symptoms are severe, and the patient needs immediate evaluation. Warm compresses and
surgical intervention would delay necessary diagnostic procedures .
6. A woman diagnosed with chronic pelvic pain most likely has a gynecological cause for
her symptoms. Which treatment will the provider recommend initially?
A. Counseling and support
B. Hysterectomy
C. Neurostimulation
D. Oral contraceptives
Answer: D
Rationale: Oral contraceptives may be helpful for chronic pelvic pain and are a good initial
choice, particularly if a gynecological cause is suspected. Counseling and support are
necessary throughout management but do not directly help with symptom relief.
Hysterectomy may be indicated if there are more severe structural problems but does not
always alleviate symptoms. Neurostimulation is used when neuropathic pain is present .
7. Which underlying causes are related to chronic pelvic pain in women? (Select all that
apply.)
A. Postural problems
B. Hepatitis
C. Interstitial cystitis
D. Physical abuse
E. Gastrointestinal disorders
Answer: A, C, D, E
