NR 602 FINAL EXAM Q&A LATEST
UPDATE WITH RATIONALES
Question 1
A 28-year-old female presents for her first prenatal visit. Her obstetric history
reveals: a birth at 39 weeks (child is alive), a miscarriage at 10 weeks, and a
delivery of twins at 34 weeks (both are alive). She is currently 8 weeks
pregnant. What is her correct GTPAL status?
A) G4, T1, P1, A1, L3
B) G4, T1, P2, A1, L3
C) G3, T2, P1, A1, L2
D) G4, T2, P1, A1, L3
VERIFIED ANSWER: A) G4, T1, P1, A1, L3
EXPLANATION: Gravida (G) is 4 (2 past deliveries + 1 miscarriage +
current pregnancy). Term (T) is 1 (the 39-week delivery). Preterm (P) is 1 (the
34-week twin delivery counts as one preterm event). Abortion (A) is 1 (the 10-
week miscarriage). Living (L) is 3 (the individual term child plus the twins).
Question 2
, During a routine wellness exam of a 68-year-old female, the nurse practitioner
notes a raised, irregular, ulcerated lesion on the left labium majus. The patient
reports a 2-year history of chronic vulvar itching that she treated with over-the-
counter hydrocortisone cream. What is the most appropriate next step?
A) Prescribe a high-potency topical steroid cream for lichen sclerosus.
B) Perform a punch biopsy of the lesion.
C) Treat empirically for a herpes simplex virus outbreak.
D) Reassure the patient it is a normal senile angioma.
VERIFIED ANSWER: B) Perform a punch biopsy of the lesion.
EXPLANATION: A new, irregular, or ulcerated vulvar lesion in a
postmenopausal woman presenting with a history of chronic pruritus is highly
suspicious for vulvar carcinoma. A punch biopsy is mandatory to establish a
definitive histological diagnosis before initiating any treatment.
Question 3
A 4-year-old child is brought to the clinic for a well-child checkup. Which
developmental milestone should the nurse practitioner expect the child to have
achieved by this age?
A) Tying shoelaces independently.
B) Hopping on one foot and copying a cross.
C) Printing their first and last name.
D) Drawing a person with at least 10 body parts.
VERIFIED ANSWER: B) Hopping on one foot and copying a cross.
EXPLANATION: At 4 years of age, typical gross motor skills include
hopping on one foot, while fine motor/adaptive skills include copying a cross
or a square. Tying shoes, printing names, and drawing complex people (10+
parts) are typically achieved around age 5 or older.
Question 4
, A 24-year-old patient complains of a malodorous, frothy, yellow-green vaginal
discharge accompanied by vulvar irritation and dyspareunia. On pelvic
examination, the nurse practitioner notes diffuse petechiae on the cervix. Which
of the following is the first-line treatment for this condition?
A) Oral Azithromycin 1g in a single dose
B) Intramuscular Ceftriaxone 500mg in a single dose
C) Oral Metronidazole 500mg twice daily for 7 days
D) Topical Clindamycin cream 2% for 7 days
VERIFIED ANSWER: C) Oral Metronidazole 500mg twice daily for 7 days
EXPLANATION: The clinical presentation describes Trichomoniasis, classic
for its frothy green discharge and "strawberry cervix" (petechiae). Current
CDC guidelines recommend oral Metronidazole 500 mg twice daily for 7 days
for women to ensure a high cure rate. Sexual partners must also be treated
simultaneously.
Question 5
An 18-month-old child is brought in for a regular visit. The parent notes that the
child does not point to objects of interest, avoids direct eye contact, and does
not respond consistently to their name. Which standardized screening
instrument should the clinician administer at this visit?
A) PHQ-A
B) M-CHAT-R/F
C) ASQ-3
D) CRAFFT
VERIFIED ANSWER: B) M-CHAT-R/F
EXPLANATION: The Modified Checklist for Autism in Toddlers, Revised
with Follow-Up (M-CHAT-R/F) is specifically validated and recommended
for administration at the 18- and 24-month well-child visits to screen for
, Autism Spectrum Disorder (ASD). The symptoms described (lack of joint
attention, poor eye contact) indicate an immediate need for this screening.
Question 6
A 23-year-old female presents requesting contraception. She has a history of
severe migraines with aura. Which of the following contraceptive methods is
contraindicated for this patient?
A) Copper Intrauterine Device (Paragard)
B) Levonorgestrel-releasing Intrauterine System (Mirena)
C) Combined Oral Contraceptive Pill (Ethinyl Estradiol/Norgestimate)
D) Progestin-only subdermal implant (Nexplanon)
VERIFIED ANSWER: C) Combined Oral Contraceptive Pill (Ethinyl
Estradiol/Norgestimate)
EXPLANATION: Estrogen-containing contraceptives are strictly
contraindicated in patients who experience migraines with aura due to a
significantly increased synergistic risk of ischemic stroke. Progestin-only
methods and non-hormonal copper IUDs do not carry this risk and are safe
alternatives.
Question 7
A pregnant patient at 36 weeks gestation presents with a sudden onset of
constant, severe abdominal pain and dark red vaginal bleeding. Her uterus feels
rigid and is highly tender to palpation. Fetal monitoring reveals prolonged
decelerations. Which condition is most likely?
A) Placenta previa
B) Placental abruption
UPDATE WITH RATIONALES
Question 1
A 28-year-old female presents for her first prenatal visit. Her obstetric history
reveals: a birth at 39 weeks (child is alive), a miscarriage at 10 weeks, and a
delivery of twins at 34 weeks (both are alive). She is currently 8 weeks
pregnant. What is her correct GTPAL status?
A) G4, T1, P1, A1, L3
B) G4, T1, P2, A1, L3
C) G3, T2, P1, A1, L2
D) G4, T2, P1, A1, L3
VERIFIED ANSWER: A) G4, T1, P1, A1, L3
EXPLANATION: Gravida (G) is 4 (2 past deliveries + 1 miscarriage +
current pregnancy). Term (T) is 1 (the 39-week delivery). Preterm (P) is 1 (the
34-week twin delivery counts as one preterm event). Abortion (A) is 1 (the 10-
week miscarriage). Living (L) is 3 (the individual term child plus the twins).
Question 2
, During a routine wellness exam of a 68-year-old female, the nurse practitioner
notes a raised, irregular, ulcerated lesion on the left labium majus. The patient
reports a 2-year history of chronic vulvar itching that she treated with over-the-
counter hydrocortisone cream. What is the most appropriate next step?
A) Prescribe a high-potency topical steroid cream for lichen sclerosus.
B) Perform a punch biopsy of the lesion.
C) Treat empirically for a herpes simplex virus outbreak.
D) Reassure the patient it is a normal senile angioma.
VERIFIED ANSWER: B) Perform a punch biopsy of the lesion.
EXPLANATION: A new, irregular, or ulcerated vulvar lesion in a
postmenopausal woman presenting with a history of chronic pruritus is highly
suspicious for vulvar carcinoma. A punch biopsy is mandatory to establish a
definitive histological diagnosis before initiating any treatment.
Question 3
A 4-year-old child is brought to the clinic for a well-child checkup. Which
developmental milestone should the nurse practitioner expect the child to have
achieved by this age?
A) Tying shoelaces independently.
B) Hopping on one foot and copying a cross.
C) Printing their first and last name.
D) Drawing a person with at least 10 body parts.
VERIFIED ANSWER: B) Hopping on one foot and copying a cross.
EXPLANATION: At 4 years of age, typical gross motor skills include
hopping on one foot, while fine motor/adaptive skills include copying a cross
or a square. Tying shoes, printing names, and drawing complex people (10+
parts) are typically achieved around age 5 or older.
Question 4
, A 24-year-old patient complains of a malodorous, frothy, yellow-green vaginal
discharge accompanied by vulvar irritation and dyspareunia. On pelvic
examination, the nurse practitioner notes diffuse petechiae on the cervix. Which
of the following is the first-line treatment for this condition?
A) Oral Azithromycin 1g in a single dose
B) Intramuscular Ceftriaxone 500mg in a single dose
C) Oral Metronidazole 500mg twice daily for 7 days
D) Topical Clindamycin cream 2% for 7 days
VERIFIED ANSWER: C) Oral Metronidazole 500mg twice daily for 7 days
EXPLANATION: The clinical presentation describes Trichomoniasis, classic
for its frothy green discharge and "strawberry cervix" (petechiae). Current
CDC guidelines recommend oral Metronidazole 500 mg twice daily for 7 days
for women to ensure a high cure rate. Sexual partners must also be treated
simultaneously.
Question 5
An 18-month-old child is brought in for a regular visit. The parent notes that the
child does not point to objects of interest, avoids direct eye contact, and does
not respond consistently to their name. Which standardized screening
instrument should the clinician administer at this visit?
A) PHQ-A
B) M-CHAT-R/F
C) ASQ-3
D) CRAFFT
VERIFIED ANSWER: B) M-CHAT-R/F
EXPLANATION: The Modified Checklist for Autism in Toddlers, Revised
with Follow-Up (M-CHAT-R/F) is specifically validated and recommended
for administration at the 18- and 24-month well-child visits to screen for
, Autism Spectrum Disorder (ASD). The symptoms described (lack of joint
attention, poor eye contact) indicate an immediate need for this screening.
Question 6
A 23-year-old female presents requesting contraception. She has a history of
severe migraines with aura. Which of the following contraceptive methods is
contraindicated for this patient?
A) Copper Intrauterine Device (Paragard)
B) Levonorgestrel-releasing Intrauterine System (Mirena)
C) Combined Oral Contraceptive Pill (Ethinyl Estradiol/Norgestimate)
D) Progestin-only subdermal implant (Nexplanon)
VERIFIED ANSWER: C) Combined Oral Contraceptive Pill (Ethinyl
Estradiol/Norgestimate)
EXPLANATION: Estrogen-containing contraceptives are strictly
contraindicated in patients who experience migraines with aura due to a
significantly increased synergistic risk of ischemic stroke. Progestin-only
methods and non-hormonal copper IUDs do not carry this risk and are safe
alternatives.
Question 7
A pregnant patient at 36 weeks gestation presents with a sudden onset of
constant, severe abdominal pain and dark red vaginal bleeding. Her uterus feels
rigid and is highly tender to palpation. Fetal monitoring reveals prolonged
decelerations. Which condition is most likely?
A) Placenta previa
B) Placental abruption
