NRNP 6552
NRNP 6552 – Advanced Nurse Practice in
Reproductive Health Care: Comprehensive
200-Question Examination with Clinical Case
Scenarios and Evidence-Based Rationales
================================================================================
NRNP 6552
ADVANCED NURSE PRACTICE
IN REPRODUCTIVE HEALTH CARE
COMPREHENSIVE EXAM
200 QUESTIONS
================================================================================
DOCUMENT INFORMATION
--------------------------------------------------------------------------------
File Type: Examination Assessment Tool
Version: 1.0
Date: September 2026
Total Questions: 200
Question Types: Multiple-Choice, Clinical Case Scenarios
Target Audience: Graduate Nursing Students / Nurse Practitioners
Course Code: NRNP 6552
Status: Final
================================================================================
FORMAT LEGEND
================================================================================
Page 1 of 101
, NRNP 6552
QUESTION : Blue - Complete exam question with options (A-D)
ANSWER : Red - Correct answer with letter and full text
RATIONALE : Purple - Detailed explanation of the correct answer
================================================================================
EXAM INSTRUCTIONS
================================================================================
1. Read each question carefully.
2. Select the BEST answer among the options provided.
3. Each question is worth 1 point (Total: 200 points).
4. Review the rationale section after answering to reinforce learning.
5. Questions are based on evidence-based guidelines (ACOG, WHO, CDC, USPSTF).
================================================================================
BEGIN EXAM
================================================================================
Page 2 of 101
, NRNP 6552
NRNP 6552 – Advanced Nurse Practice in Reproductive Health Care
Comprehensive Exam
QUESTION 1
QUESTION:
A 28-year-old woman presents for a routine well-woman examination. She is asymptomatic and has
no significant medical history. During the breast examination, you palpate a firm, rubbery, well-
circumscribed, mobile mass in the upper outer quadrant of her right breast. The mass is nontender
and approximately 2 cm in diameter. There are no skin changes, nipple discharge, or axillary
lymphadenopathy. What is the most appropriate next step in management for this patient?
A. Order a diagnostic mammogram and ultrasound immediately.
B. Reassure the patient and schedule a follow-up visit in 6 months.
C. Perform a fine-needle aspiration biopsy in the office.
D. Refer the patient for an excisional biopsy.
ANSWER:
A. Order a diagnostic mammogram and ultrasound immediately.
RATIONALE:
This patient presents with a classic description of a fibroadenoma—firm, rubbery, well-
circumscribed, mobile, and nontender—which is the most common benign breast tumor in women
of reproductive age. However, the American College of Radiology (ACR) and American College of
Obstetricians and Gynecologists (ACOG) guidelines recommend diagnostic imaging (mammogram
and targeted ultrasound) for any new, dominant, or persistent breast mass in women over age 25 to
evaluate the lesion and establish a baseline. While the characteristics suggest benign pathology,
imaging is necessary to confirm the nature of the mass and determine the need for biopsy.
Reassurance without imaging (Option B) is inappropriate for a new palpable mass. Fine-needle
aspiration (Option C) or excisional biopsy (Option D) may be indicated if imaging reveals suspicious
findings, but imaging should be the first step.
QUESTION 2
QUESTION:
A 32-year-old G2P1 woman at 10 weeks gestation presents with complaints of mild, intermittent
vaginal spotting over the past 2 days. She reports no abdominal pain, cramping, or passage of tissue.
Her vital signs are stable. Pelvic examination reveals a closed cervix with no active bleeding.
Transvaginal ultrasound shows an intrauterine pregnancy with a fetal heartbeat and a small
subchorionic hematoma. What is the most appropriate management for this patient?
A. Hospital admission for observation and bed rest.
B. Administration of Rho(D) immune globulin if Rh-negative and continued monitoring.
C. Immediate surgical evacuation of the pregnancy.
D. Prescription of oral progesterone supplementation.
Page 3 of 101
, NRNP 6552
ANSWER:
B. Administration of Rho(D) immune globulin if Rh-negative and continued monitoring.
RATIONALE:
This patient presents with a threatened abortion, characterized by vaginal bleeding in the first
trimester with a closed cervix and a viable intrauterine pregnancy. The presence of a subchorionic
hematoma is a common finding and often resolves spontaneously. Management involves
reassurance, monitoring for signs of worsening bleeding or miscarriage, and administration of
Rho(D) immune globulin (RhoGAM) at 28 weeks and within 72 hours of any bleeding episode if the
patient is Rh-negative to prevent Rh isoimmunization. Hospital admission (Option A) is not routinely
required for a threatened abortion unless the patient is hemodynamically unstable or has heavy
bleeding. Surgical evacuation (Option C) is indicated for incomplete or inevitable abortion, not
threatened abortion. Progesterone supplementation (Option D) is not routinely recommended for
threatened abortion and remains controversial.
QUESTION 3
QUESTION:
A 45-year-old woman presents with complaints of heavy, prolonged menstrual bleeding for the past
6 months. She reports soaking through pads every 1-2 hours and passing large clots. Her hemoglobin
is 9.2 g/dL and hematocrit is 28%. Pelvic ultrasound reveals a 3 cm submucosal fibroid. Which of the
following is the most appropriate initial medical management option for this patient?
A. Oral contraceptive pills
B. Tranexamic acid
C. Gonadotropin-releasing hormone (GnRH) agonists
D. Progestin-releasing intrauterine device (IUD)
ANSWER:
D. Progestin-releasing intrauterine device (IUD)
RATIONALE:
The progestin-releasing IUD (levonorgestrel-releasing intrauterine system, LNg-IUS) is highly
effective for managing heavy menstrual bleeding (HMB) and is considered first-line therapy for
women with HMB, including those with submucosal fibroids, as long as the uterine cavity is not
significantly distorted. It reduces menstrual blood loss by up to 90% within 3-6 months and has a
favorable side effect profile compared to systemic therapies. Oral contraceptive pills (Option A) can
reduce bleeding but are less targeted than the LNg-IUS and may have more systemic side effects.
Tranexamic acid (Option B) reduces bleeding but does not address the underlying fibroid. GnRH
agonists (Option C) are effective but are used for short-term treatment (3-6 months) due to
significant side effects and are not considered initial medical management for chronic use.
QUESTION 4
QUESTION:
A 19-year-old woman presents to the clinic with complaints of secondary amenorrhea. She reports
having regular menstrual cycles since menarche at age 12 but has not had a period in 4 months. She
Page 4 of 101
NRNP 6552 – Advanced Nurse Practice in
Reproductive Health Care: Comprehensive
200-Question Examination with Clinical Case
Scenarios and Evidence-Based Rationales
================================================================================
NRNP 6552
ADVANCED NURSE PRACTICE
IN REPRODUCTIVE HEALTH CARE
COMPREHENSIVE EXAM
200 QUESTIONS
================================================================================
DOCUMENT INFORMATION
--------------------------------------------------------------------------------
File Type: Examination Assessment Tool
Version: 1.0
Date: September 2026
Total Questions: 200
Question Types: Multiple-Choice, Clinical Case Scenarios
Target Audience: Graduate Nursing Students / Nurse Practitioners
Course Code: NRNP 6552
Status: Final
================================================================================
FORMAT LEGEND
================================================================================
Page 1 of 101
, NRNP 6552
QUESTION : Blue - Complete exam question with options (A-D)
ANSWER : Red - Correct answer with letter and full text
RATIONALE : Purple - Detailed explanation of the correct answer
================================================================================
EXAM INSTRUCTIONS
================================================================================
1. Read each question carefully.
2. Select the BEST answer among the options provided.
3. Each question is worth 1 point (Total: 200 points).
4. Review the rationale section after answering to reinforce learning.
5. Questions are based on evidence-based guidelines (ACOG, WHO, CDC, USPSTF).
================================================================================
BEGIN EXAM
================================================================================
Page 2 of 101
, NRNP 6552
NRNP 6552 – Advanced Nurse Practice in Reproductive Health Care
Comprehensive Exam
QUESTION 1
QUESTION:
A 28-year-old woman presents for a routine well-woman examination. She is asymptomatic and has
no significant medical history. During the breast examination, you palpate a firm, rubbery, well-
circumscribed, mobile mass in the upper outer quadrant of her right breast. The mass is nontender
and approximately 2 cm in diameter. There are no skin changes, nipple discharge, or axillary
lymphadenopathy. What is the most appropriate next step in management for this patient?
A. Order a diagnostic mammogram and ultrasound immediately.
B. Reassure the patient and schedule a follow-up visit in 6 months.
C. Perform a fine-needle aspiration biopsy in the office.
D. Refer the patient for an excisional biopsy.
ANSWER:
A. Order a diagnostic mammogram and ultrasound immediately.
RATIONALE:
This patient presents with a classic description of a fibroadenoma—firm, rubbery, well-
circumscribed, mobile, and nontender—which is the most common benign breast tumor in women
of reproductive age. However, the American College of Radiology (ACR) and American College of
Obstetricians and Gynecologists (ACOG) guidelines recommend diagnostic imaging (mammogram
and targeted ultrasound) for any new, dominant, or persistent breast mass in women over age 25 to
evaluate the lesion and establish a baseline. While the characteristics suggest benign pathology,
imaging is necessary to confirm the nature of the mass and determine the need for biopsy.
Reassurance without imaging (Option B) is inappropriate for a new palpable mass. Fine-needle
aspiration (Option C) or excisional biopsy (Option D) may be indicated if imaging reveals suspicious
findings, but imaging should be the first step.
QUESTION 2
QUESTION:
A 32-year-old G2P1 woman at 10 weeks gestation presents with complaints of mild, intermittent
vaginal spotting over the past 2 days. She reports no abdominal pain, cramping, or passage of tissue.
Her vital signs are stable. Pelvic examination reveals a closed cervix with no active bleeding.
Transvaginal ultrasound shows an intrauterine pregnancy with a fetal heartbeat and a small
subchorionic hematoma. What is the most appropriate management for this patient?
A. Hospital admission for observation and bed rest.
B. Administration of Rho(D) immune globulin if Rh-negative and continued monitoring.
C. Immediate surgical evacuation of the pregnancy.
D. Prescription of oral progesterone supplementation.
Page 3 of 101
, NRNP 6552
ANSWER:
B. Administration of Rho(D) immune globulin if Rh-negative and continued monitoring.
RATIONALE:
This patient presents with a threatened abortion, characterized by vaginal bleeding in the first
trimester with a closed cervix and a viable intrauterine pregnancy. The presence of a subchorionic
hematoma is a common finding and often resolves spontaneously. Management involves
reassurance, monitoring for signs of worsening bleeding or miscarriage, and administration of
Rho(D) immune globulin (RhoGAM) at 28 weeks and within 72 hours of any bleeding episode if the
patient is Rh-negative to prevent Rh isoimmunization. Hospital admission (Option A) is not routinely
required for a threatened abortion unless the patient is hemodynamically unstable or has heavy
bleeding. Surgical evacuation (Option C) is indicated for incomplete or inevitable abortion, not
threatened abortion. Progesterone supplementation (Option D) is not routinely recommended for
threatened abortion and remains controversial.
QUESTION 3
QUESTION:
A 45-year-old woman presents with complaints of heavy, prolonged menstrual bleeding for the past
6 months. She reports soaking through pads every 1-2 hours and passing large clots. Her hemoglobin
is 9.2 g/dL and hematocrit is 28%. Pelvic ultrasound reveals a 3 cm submucosal fibroid. Which of the
following is the most appropriate initial medical management option for this patient?
A. Oral contraceptive pills
B. Tranexamic acid
C. Gonadotropin-releasing hormone (GnRH) agonists
D. Progestin-releasing intrauterine device (IUD)
ANSWER:
D. Progestin-releasing intrauterine device (IUD)
RATIONALE:
The progestin-releasing IUD (levonorgestrel-releasing intrauterine system, LNg-IUS) is highly
effective for managing heavy menstrual bleeding (HMB) and is considered first-line therapy for
women with HMB, including those with submucosal fibroids, as long as the uterine cavity is not
significantly distorted. It reduces menstrual blood loss by up to 90% within 3-6 months and has a
favorable side effect profile compared to systemic therapies. Oral contraceptive pills (Option A) can
reduce bleeding but are less targeted than the LNg-IUS and may have more systemic side effects.
Tranexamic acid (Option B) reduces bleeding but does not address the underlying fibroid. GnRH
agonists (Option C) are effective but are used for short-term treatment (3-6 months) due to
significant side effects and are not considered initial medical management for chronic use.
QUESTION 4
QUESTION:
A 19-year-old woman presents to the clinic with complaints of secondary amenorrhea. She reports
having regular menstrual cycles since menarche at age 12 but has not had a period in 4 months. She
Page 4 of 101
