CHAMBERLAIN NR 602 FINAL EXAM PRACTICE BANK — 2026
Primary Care of the Childbearing & Childrearing Family
,TABLE OF CONTENTS
Section
Practice Exam Set 1
Practice Exam Set 2
Practice Exam Set 3
PRACTICE EXAM SET 1
Question 1
During an urgent pediatric visit, a 9-month-old infant has episodic severe crying, draws the knees toward the abdomen, becomes temporarily
comfortable between episodes, and passes a stool containing blood and mucus. Which diagnosis should the FNP prioritize?
A. Viral gastroenteritis
B. Hirschsprung disease
C. Intussusception
D. Infantile colic
Correct Answer: C. Intussusception
Rationale:
Intussusception occurs when one segment of bowel telescopes into another, producing intermittent bowel obstruction and ischemia. Classic
findings include sudden episodic abdominal pain, drawing the knees toward the abdomen, periods of apparent wellness between attacks,
vomiting, and blood/mucus or “currant-jelly” stool. A sausage-shaped abdominal mass may also occur.
Why the others are less appropriate:
• A: Gastroenteritis generally causes persistent vomiting/diarrhea rather than stereotyped paroxysmal pain.
• B: Hirschsprung disease more commonly presents with chronic constipation, abdominal distention, and delayed passage of meconium.
• D: Colic occurs in younger infants and is not associated with bloody stool or intestinal obstruction.
Clinical Pearl: A child with suspected intussusception requires urgent diagnostic evaluation, commonly with abdominal ultrasonography.
Exam Strategy: Intermittent severe pain + knees to chest + bloody/mucous stool should immediately suggest intussusception.
Question 2
A 6-year-old with vomiting and diarrhea is assessed in the office. The following findings are documented:
Finding Result
Heart rate 132/min
Oral mucosa Dry
Tears Decreased
Capillary refill 3 seconds
Urine output Decreased
Mental status Irritable
Which interpretation is most appropriate?
A. Normal physiologic response
B. Clinically significant dehydration requiring prompt fluid assessment and replacement
C. Isolated electrolyte deficiency without dehydration
D. Fluid overload caused by gastrointestinal illness
Correct Answer: B
Rationale:
Tachycardia, dry mucous membranes, reduced tears, delayed capillary refill, decreased urine output, and behavioral change collectively indicate
clinically important dehydration. Severity must be assessed rapidly and oral versus IV rehydration determined from perfusion, mental status, and
ability to tolerate fluids.
Why the others are less appropriate:
• A: Multiple abnormal perfusion and hydration findings are present.
, • C: Electrolyte abnormalities may coexist, but the clinical picture demonstrates volume depletion.
• D: Fluid overload causes findings such as edema, crackles, or excessive weight gain rather than dry mucous membranes.
Clinical Pearl: In children, urine output, capillary refill, heart rate, mucous membranes, tears, and mental status are particularly useful hydration
indicators.
Question 3
A parent reports that a 10-year-old boy suddenly developed intense unilateral scrotal pain while playing outside. Examination reveals a high-
riding tender testicle with marked swelling and absent cremasteric reflex. What is the priority action?
A. Obtain a routine urinalysis and reassess tomorrow
B. Begin oral antibiotics for epididymitis
C. Recommend bed rest and scrotal elevation
D. Arrange immediate emergency/urologic evaluation for testicular torsion
Correct Answer: D
Rationale:
Testicular torsion represents twisting of the spermatic cord and interruption of testicular blood flow. Sudden severe unilateral pain,
nausea/vomiting, a high-riding testis, and absent cremasteric reflex are major warning findings. It is a time-sensitive surgical emergency.
Why the others are less appropriate:
• A: Delaying management risks testicular ischemia and loss.
• B: Epididymitis is generally less abrupt and frequently associated with urinary or infectious symptoms.
• C: Conservative therapy is inappropriate when torsion is suspected.
Clinical Pearl: Do not allow imaging or routine outpatient testing to create an unnecessary delay when clinical suspicion for torsion is high.
Question 4
An FNP reviews this growth pattern:
BMI-FOR-AGE PERCENTILE
100 |
95 | ●──●
90 | ●───
85 | ●───
75 | ●───
50 | ●──●───
+------------------------------
Age 5 6 7 8 9 10 years
Which finding is most concerning?
A. The child has remained at the same BMI percentile
B. The BMI decreased after age 5
C. The child's BMI trajectory has crossed progressively upward into a high percentile range
D. BMI percentile cannot be used in children
Correct Answer: C
Rationale:
Longitudinal growth trajectory is often more informative than a single measurement. Progressive upward crossing of BMI percentile bands signals
increasing adiposity and warrants assessment of diet, activity, sleep, family history, blood pressure, and metabolic risk.
Why the others are less appropriate:
• A: The graph demonstrates substantial upward movement.
• B: BMI is increasing, not decreasing.
• D: BMI-for-age percentiles are routinely used for children age 2 years and older.
Clinical Pearl: Always assess growth trajectory, not merely the child's latest percentile.
Question 5
,While interviewing the parents of an 8-year-old with suspected ADHD, the FNP learns that inattentive behavior occurs at home but teachers
describe excellent attention, organization, and behavior at school. Which conclusion is most appropriate?
A. ADHD is confirmed because symptoms occur at home
B. Additional assessment is required because ADHD symptoms should cause impairment in more than one setting
C. Medication should be started immediately
D. The teacher's observations should be disregarded
Correct Answer: B
Rationale:
ADHD assessment requires evidence of a persistent pattern of developmentally inappropriate inattention and/or hyperactivity-impulsivity producing
impairment. Symptoms should occur in multiple settings, making information from parents, teachers, and other caregivers important.
Why the others are less appropriate:
• A: A single environment is insufficient for typical diagnostic criteria.
• C: Treatment should follow an adequate diagnostic assessment.
• D: School information is particularly valuable because academic and social demands may reveal functional impairment.
Exam Strategy: ADHD question → think multiple settings + functional impairment + developmental appropriateness.
Question 6
During an adolescent wellness visit, a 15-year-old screens positive for depression and quietly states, “Sometimes I think everyone would be
better off without me.” What should the FNP do first?
A. Tell the adolescent to exercise more frequently
B. Schedule reassessment in 6 months
C. Immediately prescribe an antidepressant without further questioning
D. Conduct a direct suicide-risk assessment, including current thoughts, plan, intent, means, and protective factors
Correct Answer: D
Rationale:
Any expression suggesting suicidal ideation requires prompt, direct safety assessment. Asking clearly about suicidal thoughts does not create
suicidal behavior; it helps determine immediate risk and the appropriate level of intervention.
Why the others are less appropriate:
• A: Lifestyle measures do not replace suicide-risk evaluation.
• B: Waiting could endanger the patient.
• C: Medication decisions follow safety evaluation and diagnostic assessment.
Clinical Pearl: When suicide is possible, safety outranks diagnostic refinement.
Question 7
A 27-year-old reports irregular menstruation, acne, increased facial hair, and difficulty becoming pregnant. Laboratory testing excludes pregnancy,
thyroid disease, and hyperprolactinemia.
Clinical pattern
│
├── Irregular ovulation
│
├── Hyperandrogenic signs
│
└── Metabolic risk
│
▼
??????????????
Which disorder best completes the diagram?
A. Primary ovarian insufficiency
B. Endometriosis
C. Polycystic ovary syndrome
D. Premenstrual dysphoric disorder
,Correct Answer: C. Polycystic ovary syndrome
Rationale:
PCOS commonly involves ovulatory dysfunction and clinical or biochemical hyperandrogenism, after appropriate exclusion of alternative disorders.
Patients may present with irregular menses, infertility, acne, hirsutism, obesity, and metabolic abnormalities.
Why the others are less appropriate:
• A: Primary ovarian insufficiency is characterized by impaired ovarian function rather than androgen excess.
• B: Endometriosis predominantly presents with pelvic pain, dysmenorrhea, and sometimes infertility.
• D: PMDD consists of cyclical mood and physical symptoms associated with the luteal phase.
Question 8
A 33-year-old describes severe cramping pelvic pain beginning shortly before menstruation. The discomfort has progressively worsened during
the last several years and is now accompanied by deep dyspareunia. Which finding most strongly suggests secondary rather than primary
dysmenorrhea?
A. Cramping during menstruation
B. Symptoms beginning around menses
C. Progressive pain accompanied by deep dyspareunia
D. Improvement with NSAIDs
Correct Answer: C
Rationale:
Primary dysmenorrhea typically begins during adolescence after ovulatory cycles become established and has no underlying pelvic pathology. New,
progressively worsening pain, dyspareunia, abnormal bleeding, infertility, or abnormal examination findings should raise suspicion for secondary
causes such as endometriosis or adenomyosis.
Clinical Pearl: “Pain that changes its character over time” is an important secondary-dysmenorrhea clue.
Question 9
A patient presents with vaginal symptoms:
Characteristic Finding
Discharge Thin, homogeneous
Vaginal odor Fishy
Vaginal pH Elevated
Vulvar inflammation Minimal
Microscopy Clue cells
Which diagnosis is most likely?
A. Vulvovaginal candidiasis
B. Bacterial vaginosis
C. Genital herpes
D. Atrophic vaginitis
Correct Answer: B. Bacterial vaginosis
Rationale:
A thin homogeneous discharge, characteristic amine/fishy odor, elevated vaginal pH, and clue cells are classic findings associated with bacterial
vaginosis.
Why the others are less appropriate:
• A: Candidiasis generally causes intense pruritus and thick discharge and usually maintains a normal vaginal pH.
• C: Genital herpes typically causes painful vesicles or ulcers.
• D: Atrophic changes are associated primarily with estrogen deficiency.
Quick Differentiation Table
Disorder Typical Discharge pH Hallmark
BV Thin, homogeneous >4.5 Clue cells/fishy odor
Candida Thick/curdy Usually ≤4.5 Intense itching
,Disorder Typical Discharge pH Hallmark
Trichomoniasis Often frothy >4.5 Motile trichomonads when seen
Question 10
At an initial prenatal visit, a patient asks which vaccines are generally avoided during pregnancy because they contain live attenuated organisms.
Which response is correct?
A. Inactivated influenza vaccine
B. Tdap vaccine
C. COVID-19 vaccine
D. MMR vaccine
Correct Answer: D. MMR vaccine
Rationale:
Live attenuated vaccines such as MMR are generally contraindicated during pregnancy. Inactivated vaccines and specifically recommended maternal
vaccines are handled differently according to current immunization guidance.
Why the others are less appropriate:
• A: Inactivated influenza vaccination is recommended during pregnancy when appropriate.
• B: Tdap is specifically recommended during each pregnancy according to timing recommendations.
• C: COVID-19 vaccination is not a live vaccine.
Exam Strategy: Pregnancy + “live vaccine” → think MMR and varicella.
QUESTION 11
A 4-year-old girl is brought to the clinic for fever, urinary frequency, dysuria, and new daytime urinary accidents. Urinalysis shows positive
leukocyte esterase, positive nitrites, and pyuria. Which diagnosis should the FNP consider most likely?
A. Vulvovaginitis
B. Nephrotic syndrome
C. Urinary tract infection
D. Diabetes insipidus
Correct Answer: C. Urinary tract infection
Rationale
The combination of fever, dysuria, urinary frequency, new incontinence, pyuria, leukocyte esterase, and nitrites strongly supports bacterial
urinary tract infection. Nitrites suggest the presence of nitrate-reducing gram-negative organisms, with Escherichia coli being the most common
pediatric pathogen.
Why the Other Options Are Less Appropriate
• A. Vulvovaginitis: May cause irritation and dysuria but does not typically produce nitrites and significant pyuria.
• B. Nephrotic syndrome: Characteristically produces proteinuria, edema, hypoalbuminemia, and hyperlipidemia.
• D. Diabetes insipidus: Causes polyuria and polydipsia without urinary inflammation.
Clinical Pearl
New urinary accidents in a previously toilet-trained child can be a clue to UTI, constipation, diabetes, or psychosocial stress.
Exam Strategy
When the stem gives nitrites + leukocyte esterase + pyuria, prioritize UTI unless another diagnosis clearly explains the findings.
QUESTION 12
A 7-year-old boy presents with facial puffiness noticed after waking. His parent reports that his urine has recently appeared “very foamy.”
Case Exhibit
Finding Result
Blood pressure 104/66 mmHg
Periorbital edema Present
Lower-extremity edema Present
Urinalysis protein 4+
,Finding Result
Urinalysis blood Negative
Serum albumin Low
Serum cholesterol Elevated
Which diagnosis best explains this presentation?
A. Acute cystitis
B. Nephrotic syndrome
C. Diabetes mellitus
D. Acute appendicitis
Correct Answer: B. Nephrotic syndrome
Rationale
The classic pattern of nephrotic syndrome includes:
GLOMERULAR PROTEIN LOSS
│
▼
Massive proteinuria
│
▼
Hypoalbuminemia
│
▼
↓ Plasma oncotic pressure
│
▼
EDEMA
│
└──────────────► Hyperlipidemia
Heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia strongly indicate nephrotic syndrome.
Why the Other Options Are Less Appropriate
• A: Cystitis causes dysuria, frequency, urgency, and possibly hematuria—not profound proteinuria and edema.
• C: Diabetes mellitus may cause glucosuria, polyuria, and weight loss.
• D: Appendicitis does not produce generalized edema or massive proteinuria.
Clinical Pearl
Periorbital edema in the morning is a classic early observation in children with nephrotic syndrome.
QUESTION 13
During a sports physical, the parent of a 13-year-old reports excessive thirst, frequent nighttime urination, increased appetite, and an
unexplained 5-kg weight loss over 6 weeks. Which immediate office test is most appropriate?
A. Serum calcium
B. Lipid profile
C. TSH level
D. Blood glucose measurement
Correct Answer: D. Blood glucose measurement
Rationale
Polyuria, polydipsia, polyphagia, and unexplained weight loss are classic symptoms of diabetes mellitus, particularly type 1 diabetes in a child or
adolescent. Blood glucose should be assessed promptly.
Symptom Pattern
Insulin deficiency
, │
▼
Hyperglycemia
/ \
▼ ▼
Glucosuria Cellular fuel
│ deficiency
▼ │
Osmotic diuresis ▼
│ Weight loss
▼
Polyuria
│
▼
Dehydration
│
▼
Polydipsia
Why the Other Options Are Less Appropriate
• A: Hypercalcemia can cause polyuria but does not best explain the complete symptom cluster.
• B: Lipid testing does not address the immediate diagnostic concern.
• C: Hyperthyroidism can cause weight loss but usually does not cause marked polyuria and polydipsia.
Clinical Pearl
A child with suspected diabetes plus vomiting, abdominal pain, dehydration, deep respirations, or altered mental status must be evaluated
urgently for diabetic ketoacidosis.
QUESTION 14
A 14-year-old with type 1 diabetes arrives with vomiting and abdominal pain.
Parameter Result
Glucose 386 mg/dL
Respiratory rate 30/min, deep
Serum bicarbonate 12 mEq/L
Urine ketones Large
Mental status Drowsy
Which complication should the FNP suspect?
A. Hypoglycemia
B. Hyperosmolar state without ketosis
C. Diabetic ketoacidosis
D. Diabetes insipidus
Correct Answer: C. Diabetic ketoacidosis
Rationale
The combination of hyperglycemia, ketonuria, metabolic acidosis, vomiting, dehydration, abdominal pain, and deep respirations is strongly
characteristic of diabetic ketoacidosis.
Deep, rapid respiratory effort represents compensation for metabolic acidosis and is commonly called Kussmaul respiration.
Word-Safe Trend Graph
DKA METABOLIC PATTERN
,Glucose
High | ●
| ●
| ●
| ●
Low |________________________________
Clinical deterioration →
Bicarbonate
High | ●
| ●
| ●
| ●
Low | ●
|________________________________
Clinical deterioration →
As the metabolic disorder worsens, glucose and ketone burden rise while bicarbonate falls.
Clinical Pearl
Suspected pediatric DKA requires emergency-level management, not routine outpatient treatment.
QUESTION 15
At an adolescent visit, a 16-year-old requests reliable contraception. She has no contraindications to hormonal contraception and says, “I know I
will forget to take a pill every day.” Which counseling approach is most appropriate?
A. State that IUDs cannot be used in adolescents
B. Recommend abstinence as the only medically acceptable option
C. Discuss all appropriate methods, including implants and IUDs, using shared decision-making
D. Prescribe combined oral contraceptives despite her concern about adherence
Correct Answer: C
Rationale
Long-acting reversible contraception, including contraceptive implants and IUDs, can be safe and highly effective choices for adolescents.
Counseling should be patient-centered, noncoercive, and should present appropriate reversible options so that the patient can choose according to
preferences and clinical eligibility. ACOG notes that LARC methods have high efficacy and continuation and are safe options for adolescents.
Why the Other Options Are Less Appropriate
• A: Adolescence itself is not a contraindication to an IUD.
• B: Counseling should not coercively restrict the adolescent to one behavioral choice.
• D: A method requiring daily adherence may not align with this patient's stated needs.
Clinical Pearl
Patient preference is central. Highly effective contraception should be offered, not imposed.
Exam Strategy
When contraception questions emphasize poor adherence, think about methods that minimize user-dependent dosing.
QUESTION 16
A 19-year-old presents with lower abdominal pain. Findings include:
Assessment Finding
Temperature 38.2°C
Lower abdominal pain Present
Abnormal vaginal discharge Present
, Assessment Finding
Cervical motion tenderness Present
Uterine tenderness Present
Pregnancy test Negative
Which diagnosis is the priority consideration?
A. Uncomplicated bacterial vaginosis
B. Pelvic inflammatory disease
C. Primary dysmenorrhea
D. Vulvovaginal candidiasis
Correct Answer: B. Pelvic inflammatory disease
Rationale
Pelvic inflammatory disease should be strongly considered in a sexually active patient with pelvic or lower abdominal pain when examination
demonstrates cervical motion, uterine, or adnexal tenderness, particularly when supporting inflammatory findings are present.
PID is clinically important because delayed treatment increases risks including chronic pelvic pain, tubal infertility, and ectopic pregnancy.
Sketch
ASCENDING REPRODUCTIVE TRACT INFECTION
Vagina
│
▼
Cervix
│
▼
Uterus
/ \
▼ ▼
Fallopian tubes
│
▼
Pelvic inflammation
│
┌───┴───────────┐
▼ ▼
Scarring Abscess
│
▼
Infertility /
ectopic risk
Why the Other Options Are Less Appropriate
• A: BV may coexist but does not by itself explain cervical motion and uterine tenderness.
• C: Primary dysmenorrhea does not cause fever or inflammatory pelvic examination findings.
• D: Candidiasis usually causes intense pruritus and vulvovaginal irritation.
Clinical Pearl
PID is often diagnosed clinically; waiting for every laboratory result can unnecessarily delay treatment when suspicion is sufficient.
QUESTION 17
Primary Care of the Childbearing & Childrearing Family
,TABLE OF CONTENTS
Section
Practice Exam Set 1
Practice Exam Set 2
Practice Exam Set 3
PRACTICE EXAM SET 1
Question 1
During an urgent pediatric visit, a 9-month-old infant has episodic severe crying, draws the knees toward the abdomen, becomes temporarily
comfortable between episodes, and passes a stool containing blood and mucus. Which diagnosis should the FNP prioritize?
A. Viral gastroenteritis
B. Hirschsprung disease
C. Intussusception
D. Infantile colic
Correct Answer: C. Intussusception
Rationale:
Intussusception occurs when one segment of bowel telescopes into another, producing intermittent bowel obstruction and ischemia. Classic
findings include sudden episodic abdominal pain, drawing the knees toward the abdomen, periods of apparent wellness between attacks,
vomiting, and blood/mucus or “currant-jelly” stool. A sausage-shaped abdominal mass may also occur.
Why the others are less appropriate:
• A: Gastroenteritis generally causes persistent vomiting/diarrhea rather than stereotyped paroxysmal pain.
• B: Hirschsprung disease more commonly presents with chronic constipation, abdominal distention, and delayed passage of meconium.
• D: Colic occurs in younger infants and is not associated with bloody stool or intestinal obstruction.
Clinical Pearl: A child with suspected intussusception requires urgent diagnostic evaluation, commonly with abdominal ultrasonography.
Exam Strategy: Intermittent severe pain + knees to chest + bloody/mucous stool should immediately suggest intussusception.
Question 2
A 6-year-old with vomiting and diarrhea is assessed in the office. The following findings are documented:
Finding Result
Heart rate 132/min
Oral mucosa Dry
Tears Decreased
Capillary refill 3 seconds
Urine output Decreased
Mental status Irritable
Which interpretation is most appropriate?
A. Normal physiologic response
B. Clinically significant dehydration requiring prompt fluid assessment and replacement
C. Isolated electrolyte deficiency without dehydration
D. Fluid overload caused by gastrointestinal illness
Correct Answer: B
Rationale:
Tachycardia, dry mucous membranes, reduced tears, delayed capillary refill, decreased urine output, and behavioral change collectively indicate
clinically important dehydration. Severity must be assessed rapidly and oral versus IV rehydration determined from perfusion, mental status, and
ability to tolerate fluids.
Why the others are less appropriate:
• A: Multiple abnormal perfusion and hydration findings are present.
, • C: Electrolyte abnormalities may coexist, but the clinical picture demonstrates volume depletion.
• D: Fluid overload causes findings such as edema, crackles, or excessive weight gain rather than dry mucous membranes.
Clinical Pearl: In children, urine output, capillary refill, heart rate, mucous membranes, tears, and mental status are particularly useful hydration
indicators.
Question 3
A parent reports that a 10-year-old boy suddenly developed intense unilateral scrotal pain while playing outside. Examination reveals a high-
riding tender testicle with marked swelling and absent cremasteric reflex. What is the priority action?
A. Obtain a routine urinalysis and reassess tomorrow
B. Begin oral antibiotics for epididymitis
C. Recommend bed rest and scrotal elevation
D. Arrange immediate emergency/urologic evaluation for testicular torsion
Correct Answer: D
Rationale:
Testicular torsion represents twisting of the spermatic cord and interruption of testicular blood flow. Sudden severe unilateral pain,
nausea/vomiting, a high-riding testis, and absent cremasteric reflex are major warning findings. It is a time-sensitive surgical emergency.
Why the others are less appropriate:
• A: Delaying management risks testicular ischemia and loss.
• B: Epididymitis is generally less abrupt and frequently associated with urinary or infectious symptoms.
• C: Conservative therapy is inappropriate when torsion is suspected.
Clinical Pearl: Do not allow imaging or routine outpatient testing to create an unnecessary delay when clinical suspicion for torsion is high.
Question 4
An FNP reviews this growth pattern:
BMI-FOR-AGE PERCENTILE
100 |
95 | ●──●
90 | ●───
85 | ●───
75 | ●───
50 | ●──●───
+------------------------------
Age 5 6 7 8 9 10 years
Which finding is most concerning?
A. The child has remained at the same BMI percentile
B. The BMI decreased after age 5
C. The child's BMI trajectory has crossed progressively upward into a high percentile range
D. BMI percentile cannot be used in children
Correct Answer: C
Rationale:
Longitudinal growth trajectory is often more informative than a single measurement. Progressive upward crossing of BMI percentile bands signals
increasing adiposity and warrants assessment of diet, activity, sleep, family history, blood pressure, and metabolic risk.
Why the others are less appropriate:
• A: The graph demonstrates substantial upward movement.
• B: BMI is increasing, not decreasing.
• D: BMI-for-age percentiles are routinely used for children age 2 years and older.
Clinical Pearl: Always assess growth trajectory, not merely the child's latest percentile.
Question 5
,While interviewing the parents of an 8-year-old with suspected ADHD, the FNP learns that inattentive behavior occurs at home but teachers
describe excellent attention, organization, and behavior at school. Which conclusion is most appropriate?
A. ADHD is confirmed because symptoms occur at home
B. Additional assessment is required because ADHD symptoms should cause impairment in more than one setting
C. Medication should be started immediately
D. The teacher's observations should be disregarded
Correct Answer: B
Rationale:
ADHD assessment requires evidence of a persistent pattern of developmentally inappropriate inattention and/or hyperactivity-impulsivity producing
impairment. Symptoms should occur in multiple settings, making information from parents, teachers, and other caregivers important.
Why the others are less appropriate:
• A: A single environment is insufficient for typical diagnostic criteria.
• C: Treatment should follow an adequate diagnostic assessment.
• D: School information is particularly valuable because academic and social demands may reveal functional impairment.
Exam Strategy: ADHD question → think multiple settings + functional impairment + developmental appropriateness.
Question 6
During an adolescent wellness visit, a 15-year-old screens positive for depression and quietly states, “Sometimes I think everyone would be
better off without me.” What should the FNP do first?
A. Tell the adolescent to exercise more frequently
B. Schedule reassessment in 6 months
C. Immediately prescribe an antidepressant without further questioning
D. Conduct a direct suicide-risk assessment, including current thoughts, plan, intent, means, and protective factors
Correct Answer: D
Rationale:
Any expression suggesting suicidal ideation requires prompt, direct safety assessment. Asking clearly about suicidal thoughts does not create
suicidal behavior; it helps determine immediate risk and the appropriate level of intervention.
Why the others are less appropriate:
• A: Lifestyle measures do not replace suicide-risk evaluation.
• B: Waiting could endanger the patient.
• C: Medication decisions follow safety evaluation and diagnostic assessment.
Clinical Pearl: When suicide is possible, safety outranks diagnostic refinement.
Question 7
A 27-year-old reports irregular menstruation, acne, increased facial hair, and difficulty becoming pregnant. Laboratory testing excludes pregnancy,
thyroid disease, and hyperprolactinemia.
Clinical pattern
│
├── Irregular ovulation
│
├── Hyperandrogenic signs
│
└── Metabolic risk
│
▼
??????????????
Which disorder best completes the diagram?
A. Primary ovarian insufficiency
B. Endometriosis
C. Polycystic ovary syndrome
D. Premenstrual dysphoric disorder
,Correct Answer: C. Polycystic ovary syndrome
Rationale:
PCOS commonly involves ovulatory dysfunction and clinical or biochemical hyperandrogenism, after appropriate exclusion of alternative disorders.
Patients may present with irregular menses, infertility, acne, hirsutism, obesity, and metabolic abnormalities.
Why the others are less appropriate:
• A: Primary ovarian insufficiency is characterized by impaired ovarian function rather than androgen excess.
• B: Endometriosis predominantly presents with pelvic pain, dysmenorrhea, and sometimes infertility.
• D: PMDD consists of cyclical mood and physical symptoms associated with the luteal phase.
Question 8
A 33-year-old describes severe cramping pelvic pain beginning shortly before menstruation. The discomfort has progressively worsened during
the last several years and is now accompanied by deep dyspareunia. Which finding most strongly suggests secondary rather than primary
dysmenorrhea?
A. Cramping during menstruation
B. Symptoms beginning around menses
C. Progressive pain accompanied by deep dyspareunia
D. Improvement with NSAIDs
Correct Answer: C
Rationale:
Primary dysmenorrhea typically begins during adolescence after ovulatory cycles become established and has no underlying pelvic pathology. New,
progressively worsening pain, dyspareunia, abnormal bleeding, infertility, or abnormal examination findings should raise suspicion for secondary
causes such as endometriosis or adenomyosis.
Clinical Pearl: “Pain that changes its character over time” is an important secondary-dysmenorrhea clue.
Question 9
A patient presents with vaginal symptoms:
Characteristic Finding
Discharge Thin, homogeneous
Vaginal odor Fishy
Vaginal pH Elevated
Vulvar inflammation Minimal
Microscopy Clue cells
Which diagnosis is most likely?
A. Vulvovaginal candidiasis
B. Bacterial vaginosis
C. Genital herpes
D. Atrophic vaginitis
Correct Answer: B. Bacterial vaginosis
Rationale:
A thin homogeneous discharge, characteristic amine/fishy odor, elevated vaginal pH, and clue cells are classic findings associated with bacterial
vaginosis.
Why the others are less appropriate:
• A: Candidiasis generally causes intense pruritus and thick discharge and usually maintains a normal vaginal pH.
• C: Genital herpes typically causes painful vesicles or ulcers.
• D: Atrophic changes are associated primarily with estrogen deficiency.
Quick Differentiation Table
Disorder Typical Discharge pH Hallmark
BV Thin, homogeneous >4.5 Clue cells/fishy odor
Candida Thick/curdy Usually ≤4.5 Intense itching
,Disorder Typical Discharge pH Hallmark
Trichomoniasis Often frothy >4.5 Motile trichomonads when seen
Question 10
At an initial prenatal visit, a patient asks which vaccines are generally avoided during pregnancy because they contain live attenuated organisms.
Which response is correct?
A. Inactivated influenza vaccine
B. Tdap vaccine
C. COVID-19 vaccine
D. MMR vaccine
Correct Answer: D. MMR vaccine
Rationale:
Live attenuated vaccines such as MMR are generally contraindicated during pregnancy. Inactivated vaccines and specifically recommended maternal
vaccines are handled differently according to current immunization guidance.
Why the others are less appropriate:
• A: Inactivated influenza vaccination is recommended during pregnancy when appropriate.
• B: Tdap is specifically recommended during each pregnancy according to timing recommendations.
• C: COVID-19 vaccination is not a live vaccine.
Exam Strategy: Pregnancy + “live vaccine” → think MMR and varicella.
QUESTION 11
A 4-year-old girl is brought to the clinic for fever, urinary frequency, dysuria, and new daytime urinary accidents. Urinalysis shows positive
leukocyte esterase, positive nitrites, and pyuria. Which diagnosis should the FNP consider most likely?
A. Vulvovaginitis
B. Nephrotic syndrome
C. Urinary tract infection
D. Diabetes insipidus
Correct Answer: C. Urinary tract infection
Rationale
The combination of fever, dysuria, urinary frequency, new incontinence, pyuria, leukocyte esterase, and nitrites strongly supports bacterial
urinary tract infection. Nitrites suggest the presence of nitrate-reducing gram-negative organisms, with Escherichia coli being the most common
pediatric pathogen.
Why the Other Options Are Less Appropriate
• A. Vulvovaginitis: May cause irritation and dysuria but does not typically produce nitrites and significant pyuria.
• B. Nephrotic syndrome: Characteristically produces proteinuria, edema, hypoalbuminemia, and hyperlipidemia.
• D. Diabetes insipidus: Causes polyuria and polydipsia without urinary inflammation.
Clinical Pearl
New urinary accidents in a previously toilet-trained child can be a clue to UTI, constipation, diabetes, or psychosocial stress.
Exam Strategy
When the stem gives nitrites + leukocyte esterase + pyuria, prioritize UTI unless another diagnosis clearly explains the findings.
QUESTION 12
A 7-year-old boy presents with facial puffiness noticed after waking. His parent reports that his urine has recently appeared “very foamy.”
Case Exhibit
Finding Result
Blood pressure 104/66 mmHg
Periorbital edema Present
Lower-extremity edema Present
Urinalysis protein 4+
,Finding Result
Urinalysis blood Negative
Serum albumin Low
Serum cholesterol Elevated
Which diagnosis best explains this presentation?
A. Acute cystitis
B. Nephrotic syndrome
C. Diabetes mellitus
D. Acute appendicitis
Correct Answer: B. Nephrotic syndrome
Rationale
The classic pattern of nephrotic syndrome includes:
GLOMERULAR PROTEIN LOSS
│
▼
Massive proteinuria
│
▼
Hypoalbuminemia
│
▼
↓ Plasma oncotic pressure
│
▼
EDEMA
│
└──────────────► Hyperlipidemia
Heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia strongly indicate nephrotic syndrome.
Why the Other Options Are Less Appropriate
• A: Cystitis causes dysuria, frequency, urgency, and possibly hematuria—not profound proteinuria and edema.
• C: Diabetes mellitus may cause glucosuria, polyuria, and weight loss.
• D: Appendicitis does not produce generalized edema or massive proteinuria.
Clinical Pearl
Periorbital edema in the morning is a classic early observation in children with nephrotic syndrome.
QUESTION 13
During a sports physical, the parent of a 13-year-old reports excessive thirst, frequent nighttime urination, increased appetite, and an
unexplained 5-kg weight loss over 6 weeks. Which immediate office test is most appropriate?
A. Serum calcium
B. Lipid profile
C. TSH level
D. Blood glucose measurement
Correct Answer: D. Blood glucose measurement
Rationale
Polyuria, polydipsia, polyphagia, and unexplained weight loss are classic symptoms of diabetes mellitus, particularly type 1 diabetes in a child or
adolescent. Blood glucose should be assessed promptly.
Symptom Pattern
Insulin deficiency
, │
▼
Hyperglycemia
/ \
▼ ▼
Glucosuria Cellular fuel
│ deficiency
▼ │
Osmotic diuresis ▼
│ Weight loss
▼
Polyuria
│
▼
Dehydration
│
▼
Polydipsia
Why the Other Options Are Less Appropriate
• A: Hypercalcemia can cause polyuria but does not best explain the complete symptom cluster.
• B: Lipid testing does not address the immediate diagnostic concern.
• C: Hyperthyroidism can cause weight loss but usually does not cause marked polyuria and polydipsia.
Clinical Pearl
A child with suspected diabetes plus vomiting, abdominal pain, dehydration, deep respirations, or altered mental status must be evaluated
urgently for diabetic ketoacidosis.
QUESTION 14
A 14-year-old with type 1 diabetes arrives with vomiting and abdominal pain.
Parameter Result
Glucose 386 mg/dL
Respiratory rate 30/min, deep
Serum bicarbonate 12 mEq/L
Urine ketones Large
Mental status Drowsy
Which complication should the FNP suspect?
A. Hypoglycemia
B. Hyperosmolar state without ketosis
C. Diabetic ketoacidosis
D. Diabetes insipidus
Correct Answer: C. Diabetic ketoacidosis
Rationale
The combination of hyperglycemia, ketonuria, metabolic acidosis, vomiting, dehydration, abdominal pain, and deep respirations is strongly
characteristic of diabetic ketoacidosis.
Deep, rapid respiratory effort represents compensation for metabolic acidosis and is commonly called Kussmaul respiration.
Word-Safe Trend Graph
DKA METABOLIC PATTERN
,Glucose
High | ●
| ●
| ●
| ●
Low |________________________________
Clinical deterioration →
Bicarbonate
High | ●
| ●
| ●
| ●
Low | ●
|________________________________
Clinical deterioration →
As the metabolic disorder worsens, glucose and ketone burden rise while bicarbonate falls.
Clinical Pearl
Suspected pediatric DKA requires emergency-level management, not routine outpatient treatment.
QUESTION 15
At an adolescent visit, a 16-year-old requests reliable contraception. She has no contraindications to hormonal contraception and says, “I know I
will forget to take a pill every day.” Which counseling approach is most appropriate?
A. State that IUDs cannot be used in adolescents
B. Recommend abstinence as the only medically acceptable option
C. Discuss all appropriate methods, including implants and IUDs, using shared decision-making
D. Prescribe combined oral contraceptives despite her concern about adherence
Correct Answer: C
Rationale
Long-acting reversible contraception, including contraceptive implants and IUDs, can be safe and highly effective choices for adolescents.
Counseling should be patient-centered, noncoercive, and should present appropriate reversible options so that the patient can choose according to
preferences and clinical eligibility. ACOG notes that LARC methods have high efficacy and continuation and are safe options for adolescents.
Why the Other Options Are Less Appropriate
• A: Adolescence itself is not a contraindication to an IUD.
• B: Counseling should not coercively restrict the adolescent to one behavioral choice.
• D: A method requiring daily adherence may not align with this patient's stated needs.
Clinical Pearl
Patient preference is central. Highly effective contraception should be offered, not imposed.
Exam Strategy
When contraception questions emphasize poor adherence, think about methods that minimize user-dependent dosing.
QUESTION 16
A 19-year-old presents with lower abdominal pain. Findings include:
Assessment Finding
Temperature 38.2°C
Lower abdominal pain Present
Abnormal vaginal discharge Present
, Assessment Finding
Cervical motion tenderness Present
Uterine tenderness Present
Pregnancy test Negative
Which diagnosis is the priority consideration?
A. Uncomplicated bacterial vaginosis
B. Pelvic inflammatory disease
C. Primary dysmenorrhea
D. Vulvovaginal candidiasis
Correct Answer: B. Pelvic inflammatory disease
Rationale
Pelvic inflammatory disease should be strongly considered in a sexually active patient with pelvic or lower abdominal pain when examination
demonstrates cervical motion, uterine, or adnexal tenderness, particularly when supporting inflammatory findings are present.
PID is clinically important because delayed treatment increases risks including chronic pelvic pain, tubal infertility, and ectopic pregnancy.
Sketch
ASCENDING REPRODUCTIVE TRACT INFECTION
Vagina
│
▼
Cervix
│
▼
Uterus
/ \
▼ ▼
Fallopian tubes
│
▼
Pelvic inflammation
│
┌───┴───────────┐
▼ ▼
Scarring Abscess
│
▼
Infertility /
ectopic risk
Why the Other Options Are Less Appropriate
• A: BV may coexist but does not by itself explain cervical motion and uterine tenderness.
• C: Primary dysmenorrhea does not cause fever or inflammatory pelvic examination findings.
• D: Candidiasis usually causes intense pruritus and vulvovaginal irritation.
Clinical Pearl
PID is often diagnosed clinically; waiting for every laboratory result can unnecessarily delay treatment when suspicion is sufficient.
QUESTION 17
