PRAC 6552
PRAC 6552: Advanced Nurse Practice in Reproductive
Health Care Practicum – Comprehensive 200-Question
Summative Examination with detailed rationale
covering Antepartum, Intrapartum, Postpartum,
Gynecologic, Contraceptive, STI, Infertility,
Menopause, and Oncologic Care
PRAC 6552 – Advanced Nurse Practice in Reproductive Health Care Practicum
Comprehensive Examination
QUESTION 1
QUESTION:
A 24-year-old nulliparous female presents with complaints of heavy menstrual bleeding lasting 8
days each cycle, requiring frequent pad changes. Her hemoglobin is 10.2 g/dL. What is the most
appropriate initial diagnostic step?
A. Pelvic ultrasound
B. Endometrial biopsy
C. Comprehensive history and pelvic examination
D. Hysteroscopy
ANSWER:
C. Comprehensive history and pelvic examination
RATIONALE:
A thorough history and pelvic exam are the initial steps to assess for causes like fibroids or
endometriosis per ACOG guidelines . While pelvic ultrasound may be indicated based on findings, it
should not precede the comprehensive history and examination. Endometrial biopsy and
hysteroscopy are invasive and not first-line diagnostic tools for initial evaluation of heavy menstrual
bleeding.
QUESTION 2
QUESTION:
A 28-year-old female requests contraception and expresses concern about hormonal side effects.
Which non-hormonal contraceptive option is most effective?
A. Male condoms
B. Copper intrauterine device (IUD)
Page 1 of 83
, PRAC 6552
C. Diaphragm
D. Cervical cap
ANSWER:
B. Copper intrauterine device (IUD)
RATIONALE:
The copper IUD provides over 99% efficacy and is hormone-free per CDC contraception guidelines .
Male condoms have a typical-use failure rate of approximately 13-18%, while diaphragms and
cervical caps have higher failure rates (12-18% and 20-30%, respectively). The copper IUD is the most
effective non-hormonal reversible contraceptive method available.
QUESTION 3
QUESTION:
A 35-year-old female with a history of irregular menses presents with a positive urine pregnancy
test. What is the appropriate next step in management?
A. Ultrasound only
B. Quantitative hCG and pelvic exam
C. Progesterone level
D. Pap smear
ANSWER:
B. Quantitative hCG and pelvic exam
RATIONALE:
Quantitative hCG and exam confirm pregnancy viability per ACOG guidelines . A single ultrasound
without appropriate clinical correlation may be premature. Progesterone levels alone do not provide
comprehensive pregnancy assessment. A Pap smear is not indicated for initial pregnancy
confirmation and should not delay appropriate evaluation.
QUESTION 4
QUESTION:
A 25-year-old sexually active female reports a malodorous vaginal discharge with a "fishy" odor. On
examination, thin, gray-white discharge is noted adhering to the vaginal walls. What is the most
likely diagnosis?
A. Vulvovaginal candidiasis
B. Bacterial vaginosis
C. Trichomoniasis
D. Chlamydia
ANSWER:
B. Bacterial vaginosis
RATIONALE:
Malodorous discharge with a fishy odor suggests bacterial vaginosis per CDC STI guidelines .
Page 2 of 83
, PRAC 6552
Candidiasis typically presents with thick, white, curd-like discharge and pruritus. Trichomoniasis
usually presents with a frothy, yellow-green discharge. Chlamydia often presents with mucopurulent
discharge or may be asymptomatic. The presence of clue cells on wet mount would confirm the
diagnosis.
QUESTION 5
QUESTION:
A 30-year-old female with a history of gonorrhea infection 18 months ago asks about recommended
screening practices. According to CDC guidelines, what screening is recommended?
A. Annual Pap smear only
B. Annual chlamydia and gonorrhea testing for at-risk women
C. HPV testing only
D. HIV screening only
ANSWER:
B. Annual chlamydia and gonorrhea testing for at-risk women
RATIONALE:
Annual testing is recommended for sexually active women with risk factors per CDC guidelines .
Women with a history of gonorrhea are considered at increased risk and should undergo annual
screening. Pap smear and HPV testing are cervical cancer screening tools, not STI screening tests.
While HIV screening is recommended for all individuals aged 13-64, it does not replace gonorrhea
and chlamydia testing.
QUESTION 6
QUESTION:
A 27-year-old female with severe dysmenorrhea has had no relief with NSAIDs. She does not desire
pregnancy at this time. What is the most appropriate next step in management?
A. Oral contraceptives (combined)
B. Progestin-only contraceptives
C. Hysterectomy
D. Laparoscopic uterine nerve ablation
ANSWER:
A. Oral contraceptives (combined)
RATIONALE:
Combined OCPs are effective for refractory dysmenorrhea per ACOG guidelines . They reduce
prostaglandin synthesis and endometrial thickness, decreasing menstrual pain. Progestin-only
methods may be less effective for dysmenorrhea. Hysterectomy is an irreversible surgical option
reserved for severe cases refractory to medical management. Laparoscopic uterine nerve ablation
has limited long-term efficacy data.
Page 3 of 83
, PRAC 6552
QUESTION 7
QUESTION:
A 33-year-old female with a history of HPV infection requests cervical cancer screening. What is the
recommended screening test for a woman in this age group (30-65 years)?
A. Pap smear alone
B. Co-testing with Pap smear and HPV DNA testing
C. Colposcopy
D. HPV DNA test only
ANSWER:
B. Co-testing with Pap smear and HPV DNA testing
RATIONALE:
Co-testing is standard for women aged 30-65 per ACOG guidelines . Pap smear alone is acceptable
but co-testing provides superior sensitivity for detecting cervical dysplasia. Colposcopy is a
diagnostic procedure, not a screening test. HPV DNA testing alone without cytology is not the
recommended standard for screening in this age group.
QUESTION 8
QUESTION:
A 29-year-old female is diagnosed with pelvic inflammatory disease (PID). She reports fever, bilateral
lower abdominal pain, and cervical motion tenderness. What is the recommended treatment
regimen?
A. Metronidazole alone
B. Ceftriaxone plus doxycycline
C. Azithromycin alone
D. Penicillin alone
ANSWER:
B. Ceftriaxone plus doxycycline
RATIONALE:
Combination therapy covers common pathogens (Neisseria gonorrhoeae, Chlamydia trachomatis,
and anaerobic organisms) per CDC guidelines . Metronidazole alone does not cover the primary
organisms responsible for PID. Azithromycin alone has limited coverage for gonorrhea. Penicillin is
not effective against many of the organisms involved in PID due to resistance patterns.
QUESTION 9
QUESTION:
A 24-year-old female with a history of three recurrent urinary tract infections (UTIs) in the past year
asks about prevention strategies. What is the most evidence-based prophylactic option?
A. Cranberry juice daily
B. Low-dose nitrofurantoin prophylaxis
Page 4 of 83
PRAC 6552: Advanced Nurse Practice in Reproductive
Health Care Practicum – Comprehensive 200-Question
Summative Examination with detailed rationale
covering Antepartum, Intrapartum, Postpartum,
Gynecologic, Contraceptive, STI, Infertility,
Menopause, and Oncologic Care
PRAC 6552 – Advanced Nurse Practice in Reproductive Health Care Practicum
Comprehensive Examination
QUESTION 1
QUESTION:
A 24-year-old nulliparous female presents with complaints of heavy menstrual bleeding lasting 8
days each cycle, requiring frequent pad changes. Her hemoglobin is 10.2 g/dL. What is the most
appropriate initial diagnostic step?
A. Pelvic ultrasound
B. Endometrial biopsy
C. Comprehensive history and pelvic examination
D. Hysteroscopy
ANSWER:
C. Comprehensive history and pelvic examination
RATIONALE:
A thorough history and pelvic exam are the initial steps to assess for causes like fibroids or
endometriosis per ACOG guidelines . While pelvic ultrasound may be indicated based on findings, it
should not precede the comprehensive history and examination. Endometrial biopsy and
hysteroscopy are invasive and not first-line diagnostic tools for initial evaluation of heavy menstrual
bleeding.
QUESTION 2
QUESTION:
A 28-year-old female requests contraception and expresses concern about hormonal side effects.
Which non-hormonal contraceptive option is most effective?
A. Male condoms
B. Copper intrauterine device (IUD)
Page 1 of 83
, PRAC 6552
C. Diaphragm
D. Cervical cap
ANSWER:
B. Copper intrauterine device (IUD)
RATIONALE:
The copper IUD provides over 99% efficacy and is hormone-free per CDC contraception guidelines .
Male condoms have a typical-use failure rate of approximately 13-18%, while diaphragms and
cervical caps have higher failure rates (12-18% and 20-30%, respectively). The copper IUD is the most
effective non-hormonal reversible contraceptive method available.
QUESTION 3
QUESTION:
A 35-year-old female with a history of irregular menses presents with a positive urine pregnancy
test. What is the appropriate next step in management?
A. Ultrasound only
B. Quantitative hCG and pelvic exam
C. Progesterone level
D. Pap smear
ANSWER:
B. Quantitative hCG and pelvic exam
RATIONALE:
Quantitative hCG and exam confirm pregnancy viability per ACOG guidelines . A single ultrasound
without appropriate clinical correlation may be premature. Progesterone levels alone do not provide
comprehensive pregnancy assessment. A Pap smear is not indicated for initial pregnancy
confirmation and should not delay appropriate evaluation.
QUESTION 4
QUESTION:
A 25-year-old sexually active female reports a malodorous vaginal discharge with a "fishy" odor. On
examination, thin, gray-white discharge is noted adhering to the vaginal walls. What is the most
likely diagnosis?
A. Vulvovaginal candidiasis
B. Bacterial vaginosis
C. Trichomoniasis
D. Chlamydia
ANSWER:
B. Bacterial vaginosis
RATIONALE:
Malodorous discharge with a fishy odor suggests bacterial vaginosis per CDC STI guidelines .
Page 2 of 83
, PRAC 6552
Candidiasis typically presents with thick, white, curd-like discharge and pruritus. Trichomoniasis
usually presents with a frothy, yellow-green discharge. Chlamydia often presents with mucopurulent
discharge or may be asymptomatic. The presence of clue cells on wet mount would confirm the
diagnosis.
QUESTION 5
QUESTION:
A 30-year-old female with a history of gonorrhea infection 18 months ago asks about recommended
screening practices. According to CDC guidelines, what screening is recommended?
A. Annual Pap smear only
B. Annual chlamydia and gonorrhea testing for at-risk women
C. HPV testing only
D. HIV screening only
ANSWER:
B. Annual chlamydia and gonorrhea testing for at-risk women
RATIONALE:
Annual testing is recommended for sexually active women with risk factors per CDC guidelines .
Women with a history of gonorrhea are considered at increased risk and should undergo annual
screening. Pap smear and HPV testing are cervical cancer screening tools, not STI screening tests.
While HIV screening is recommended for all individuals aged 13-64, it does not replace gonorrhea
and chlamydia testing.
QUESTION 6
QUESTION:
A 27-year-old female with severe dysmenorrhea has had no relief with NSAIDs. She does not desire
pregnancy at this time. What is the most appropriate next step in management?
A. Oral contraceptives (combined)
B. Progestin-only contraceptives
C. Hysterectomy
D. Laparoscopic uterine nerve ablation
ANSWER:
A. Oral contraceptives (combined)
RATIONALE:
Combined OCPs are effective for refractory dysmenorrhea per ACOG guidelines . They reduce
prostaglandin synthesis and endometrial thickness, decreasing menstrual pain. Progestin-only
methods may be less effective for dysmenorrhea. Hysterectomy is an irreversible surgical option
reserved for severe cases refractory to medical management. Laparoscopic uterine nerve ablation
has limited long-term efficacy data.
Page 3 of 83
, PRAC 6552
QUESTION 7
QUESTION:
A 33-year-old female with a history of HPV infection requests cervical cancer screening. What is the
recommended screening test for a woman in this age group (30-65 years)?
A. Pap smear alone
B. Co-testing with Pap smear and HPV DNA testing
C. Colposcopy
D. HPV DNA test only
ANSWER:
B. Co-testing with Pap smear and HPV DNA testing
RATIONALE:
Co-testing is standard for women aged 30-65 per ACOG guidelines . Pap smear alone is acceptable
but co-testing provides superior sensitivity for detecting cervical dysplasia. Colposcopy is a
diagnostic procedure, not a screening test. HPV DNA testing alone without cytology is not the
recommended standard for screening in this age group.
QUESTION 8
QUESTION:
A 29-year-old female is diagnosed with pelvic inflammatory disease (PID). She reports fever, bilateral
lower abdominal pain, and cervical motion tenderness. What is the recommended treatment
regimen?
A. Metronidazole alone
B. Ceftriaxone plus doxycycline
C. Azithromycin alone
D. Penicillin alone
ANSWER:
B. Ceftriaxone plus doxycycline
RATIONALE:
Combination therapy covers common pathogens (Neisseria gonorrhoeae, Chlamydia trachomatis,
and anaerobic organisms) per CDC guidelines . Metronidazole alone does not cover the primary
organisms responsible for PID. Azithromycin alone has limited coverage for gonorrhea. Penicillin is
not effective against many of the organisms involved in PID due to resistance patterns.
QUESTION 9
QUESTION:
A 24-year-old female with a history of three recurrent urinary tract infections (UTIs) in the past year
asks about prevention strategies. What is the most evidence-based prophylactic option?
A. Cranberry juice daily
B. Low-dose nitrofurantoin prophylaxis
Page 4 of 83
