NSG 3500 Exam 2 | NSG 3500 Maternal Health |
Questions and Answers with Rationales
2026/2027 Update
QUESTION 1 A nurse is caring for a client experiencing dysfunctional uterine
bleeding (DUB) due to anovulation. Which physiological mechanism is primarily
responsible for the irregular and heavy bleeding associated with this condition?
A. Continuous high levels of progesterone suppressing endometrial growth
B. Unopposed estrogen stimulation leading to a thickened, fragile endometrium
that sloughs irregularly
C. Premature degeneration of the corpus luteum
D. Excessive release of oxytocin from the posterior pituitary
CORRECT ANSWER: B
RATIONALE: Anovulatory cycles lack corpus luteum formation and progesterone
production. This leaves estrogen to stimulate the endometrium unopposed,
causing it to become overly thick, fragile, and prone to irregular, unpredictable
shedding and heavy bleeding.
QUESTION 2 A client is diagnosed with primary dysmenorrhea. Which
pharmacological agent should the nurse anticipate the primary healthcare
provider prescribing as first-line therapy?
A. Oral anticoagulant therapy
B. Prostaglandin synthetase inhibitors (Nonsteroidal anti-inflammatory drugs,
such as ibuprofen)
C. Selective serotonin reuptake inhibitors
D. Systemic corticosteroid therapy
CORRECT ANSWER: B
,RATIONALE: Primary dysmenorrhea is caused by excessive intrauterine
production of prostaglandins during menses, leading to uterine ischemia and
painful contractions. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit
prostaglandin synthesis and are the first-line medical treatment.
QUESTION 3 A nurse is providing education to a female adolescent diagnosed
with premenstrual dysphoric disorder (PMDD). Which symptom helps
differentiate PMDD from standard premenstrual syndrome (PMS)?
A. Mild breast tenderness and bloating occurring 3 days prior to menses
B. Severe mood disturbance, marked irritability, depression, and anxiety that
significantly interfere with daily functioning and work
C. Mild fatigue relieved adequately by normal sleep
D. Occasional mild headache occurring on the first day of menses
CORRECT ANSWER: B
RATIONALE: While PMS involves mild physical and emotional symptoms, PMDD is
a more severe, disabling psychiatric and somatic condition marked by prominent
affective symptoms (depressed mood, severe irritability, anxiety) that disrupt
interpersonal relationships and occupational functioning.
QUESTION 4 A nurse is reviewing the medical record of a client with
endometriosis. Which classic symptom should the nurse expect the client to
report?
A. Secondary dysmenorrhea, deep dyspareunia, and pelvic pain
B. Painless, heavy vaginal bleeding with irregular intervals
C. Complete absence of menstrual cycles (amenorrhea)
D. Unilateral right lower quadrant pain accompanied by shoulder referral
CORRECT ANSWER: A
RATIONALE: Endometriosis involves the presence of functional endometrial tissue
outside the uterine cavity. Classic clinical manifestations include secondary
progressive dysmenorrhea, deep dyspareunia (painful intercourse), pelvic pain,
and infertility.
,QUESTION 5 A client with endometriosis is prescribed leuprolide acetate (a
gonadotropin-releasing hormone agonist). What is the primary mechanism of
action of this medication in treating endometriosis?
A. To stimulate rapid estrogen production and thicken the endometrium
B. To suppress the hypothalamic-pituitary-ovarian axis, creating a hypoestrogenic
state that causes ectopic endometrial implants to atrophy
C. To act as a direct systemic vasoconstrictor
D. To inhibit prostaglandin synthesis in the renal tubules
CORRECT ANSWER: B
RATIONALE: GnRH agonists suppress gonadotropin secretion, leading to
temporary medical menopause (low estrogen levels), which causes the abnormal
endometrial tissue implants to regress and shrink.
QUESTION 6 A nurse is providing contraceptive counseling to a client who
requests a reversible method with a high efficacy rate that can also help reduce
heavy menstrual bleeding and dysmenorrhea. Which intrauterine device (IUD)
meets these criteria?
A. Copper-releasing IUD (ParaGard)
B. Levonorgestrel-releasing intrauterine system (Mirena or Liletta)
C. Diaphragm with spermicide
D. Cervical cap
CORRECT ANSWER: B
RATIONALE: Levonorgestrel-releasing intrauterine systems release local progestin,
which thins the endometrium, significantly reducing menstrual blood loss and
dysmenorrhea while providing highly effective long-acting contraception.
QUESTION 7 A nurse is screening a client for potential contraindications prior to
initiating combined hormonal oral contraceptive pills (COCs). Which finding
represents an absolute contraindication for COC use?
A. Mild essential hypertension controlled with lifestyle modifications
, B. Age under 35 years old
C. History of thromboembolic disorder, cerebrovascular accident, or estrogen-
dependent cancer
D. Mild seasonal allergies
CORRECT ANSWER: C
RATIONALE: Combined hormonal contraceptives increase the risk of blood
clotting and are strictly contraindicated in clients with a history of deep vein
thrombosis, pulmonary embolism, stroke, ischemic heart disease, or estrogen-
dependent tumors.
QUESTION 8 A client who has been prescribed combined oral contraceptive pills
calls the clinic reporting that she missed taking her pill for two consecutive days
during the second week of her pill pack. What instruction should the nurse
provide?
A. Take two pills immediately for two days and use an additional barrier method
of contraception for the next 7 days
B. Discontinue the entire pack and wait for menses to start
C. Take no action and continue the pack as originally scheduled
D. Double the dose for the entire remainder of the month
CORRECT ANSWER: A
RATIONALE: Missing two consecutive active pills requires taking two pills as soon
as remembered and two pills the next day, plus utilizing a backup barrier method
for 7 days to prevent unintended ovulation and pregnancy.
QUESTION 9 A nurse is teaching a client about barrier methods of birth control.
Which instruction regarding the use of a diaphragm is accurate?
A. The diaphragm should be removed immediately following intercourse without
waiting
B. The diaphragm must be left in place for at least 6 hours following coitus and
used in conjunction with spermicidal cream or jelly
Questions and Answers with Rationales
2026/2027 Update
QUESTION 1 A nurse is caring for a client experiencing dysfunctional uterine
bleeding (DUB) due to anovulation. Which physiological mechanism is primarily
responsible for the irregular and heavy bleeding associated with this condition?
A. Continuous high levels of progesterone suppressing endometrial growth
B. Unopposed estrogen stimulation leading to a thickened, fragile endometrium
that sloughs irregularly
C. Premature degeneration of the corpus luteum
D. Excessive release of oxytocin from the posterior pituitary
CORRECT ANSWER: B
RATIONALE: Anovulatory cycles lack corpus luteum formation and progesterone
production. This leaves estrogen to stimulate the endometrium unopposed,
causing it to become overly thick, fragile, and prone to irregular, unpredictable
shedding and heavy bleeding.
QUESTION 2 A client is diagnosed with primary dysmenorrhea. Which
pharmacological agent should the nurse anticipate the primary healthcare
provider prescribing as first-line therapy?
A. Oral anticoagulant therapy
B. Prostaglandin synthetase inhibitors (Nonsteroidal anti-inflammatory drugs,
such as ibuprofen)
C. Selective serotonin reuptake inhibitors
D. Systemic corticosteroid therapy
CORRECT ANSWER: B
,RATIONALE: Primary dysmenorrhea is caused by excessive intrauterine
production of prostaglandins during menses, leading to uterine ischemia and
painful contractions. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit
prostaglandin synthesis and are the first-line medical treatment.
QUESTION 3 A nurse is providing education to a female adolescent diagnosed
with premenstrual dysphoric disorder (PMDD). Which symptom helps
differentiate PMDD from standard premenstrual syndrome (PMS)?
A. Mild breast tenderness and bloating occurring 3 days prior to menses
B. Severe mood disturbance, marked irritability, depression, and anxiety that
significantly interfere with daily functioning and work
C. Mild fatigue relieved adequately by normal sleep
D. Occasional mild headache occurring on the first day of menses
CORRECT ANSWER: B
RATIONALE: While PMS involves mild physical and emotional symptoms, PMDD is
a more severe, disabling psychiatric and somatic condition marked by prominent
affective symptoms (depressed mood, severe irritability, anxiety) that disrupt
interpersonal relationships and occupational functioning.
QUESTION 4 A nurse is reviewing the medical record of a client with
endometriosis. Which classic symptom should the nurse expect the client to
report?
A. Secondary dysmenorrhea, deep dyspareunia, and pelvic pain
B. Painless, heavy vaginal bleeding with irregular intervals
C. Complete absence of menstrual cycles (amenorrhea)
D. Unilateral right lower quadrant pain accompanied by shoulder referral
CORRECT ANSWER: A
RATIONALE: Endometriosis involves the presence of functional endometrial tissue
outside the uterine cavity. Classic clinical manifestations include secondary
progressive dysmenorrhea, deep dyspareunia (painful intercourse), pelvic pain,
and infertility.
,QUESTION 5 A client with endometriosis is prescribed leuprolide acetate (a
gonadotropin-releasing hormone agonist). What is the primary mechanism of
action of this medication in treating endometriosis?
A. To stimulate rapid estrogen production and thicken the endometrium
B. To suppress the hypothalamic-pituitary-ovarian axis, creating a hypoestrogenic
state that causes ectopic endometrial implants to atrophy
C. To act as a direct systemic vasoconstrictor
D. To inhibit prostaglandin synthesis in the renal tubules
CORRECT ANSWER: B
RATIONALE: GnRH agonists suppress gonadotropin secretion, leading to
temporary medical menopause (low estrogen levels), which causes the abnormal
endometrial tissue implants to regress and shrink.
QUESTION 6 A nurse is providing contraceptive counseling to a client who
requests a reversible method with a high efficacy rate that can also help reduce
heavy menstrual bleeding and dysmenorrhea. Which intrauterine device (IUD)
meets these criteria?
A. Copper-releasing IUD (ParaGard)
B. Levonorgestrel-releasing intrauterine system (Mirena or Liletta)
C. Diaphragm with spermicide
D. Cervical cap
CORRECT ANSWER: B
RATIONALE: Levonorgestrel-releasing intrauterine systems release local progestin,
which thins the endometrium, significantly reducing menstrual blood loss and
dysmenorrhea while providing highly effective long-acting contraception.
QUESTION 7 A nurse is screening a client for potential contraindications prior to
initiating combined hormonal oral contraceptive pills (COCs). Which finding
represents an absolute contraindication for COC use?
A. Mild essential hypertension controlled with lifestyle modifications
, B. Age under 35 years old
C. History of thromboembolic disorder, cerebrovascular accident, or estrogen-
dependent cancer
D. Mild seasonal allergies
CORRECT ANSWER: C
RATIONALE: Combined hormonal contraceptives increase the risk of blood
clotting and are strictly contraindicated in clients with a history of deep vein
thrombosis, pulmonary embolism, stroke, ischemic heart disease, or estrogen-
dependent tumors.
QUESTION 8 A client who has been prescribed combined oral contraceptive pills
calls the clinic reporting that she missed taking her pill for two consecutive days
during the second week of her pill pack. What instruction should the nurse
provide?
A. Take two pills immediately for two days and use an additional barrier method
of contraception for the next 7 days
B. Discontinue the entire pack and wait for menses to start
C. Take no action and continue the pack as originally scheduled
D. Double the dose for the entire remainder of the month
CORRECT ANSWER: A
RATIONALE: Missing two consecutive active pills requires taking two pills as soon
as remembered and two pills the next day, plus utilizing a backup barrier method
for 7 days to prevent unintended ovulation and pregnancy.
QUESTION 9 A nurse is teaching a client about barrier methods of birth control.
Which instruction regarding the use of a diaphragm is accurate?
A. The diaphragm should be removed immediately following intercourse without
waiting
B. The diaphragm must be left in place for at least 6 hours following coitus and
used in conjunction with spermicidal cream or jelly
