1|Page
NSG 554/ NSG554 EXAM 4: (NEW 2026/ 2027 UPDATE)
| QUESTIONS & ANSWERS| GRADE A| 100% CORRECT
(VERIFIED SOLUTIONS)- WILKES
1. A patient presents with abnormal uterine bleeding. The nurse recalls that the
PALM-COEIN classification system is used to categorize the causes. Which
conditions are included in the "PALM" component of this system?
A. Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic
B. Polyp, adenomyosis, leiomyoma, malignancy and hyperplasia
C. Polycystic ovaries, anovulation, luteal phase defect, menorrhagia
D. Pelvic inflammatory disease, adhesions, leiomyoma, metastasis
CORRECT ANSWER: B. Polyp, adenomyosis, leiomyoma, malignancy
and hyperplasia
Rationale: The PALM-COEIN classification system is used to categorize causes
of abnormal uterine bleeding. "PALM" refers to structural causes: Polyp,
Adenomyosis, Leiomyoma, and Malignancy and hyperplasia. "COEIN" refers to
non-structural causes: Coagulopathy, Ovulatory dysfunction, Endometrial,
Iatrogenic, and Not yet classified.
,2|Page
2. A patient with abnormal premenstrual bleeding is undergoing diagnostic
testing. Which laboratory studies should the nurse expect to be ordered?
A. Complete blood count, pregnancy test, and thyroid tests
B. Liver function tests and serum amylase
C. Cardiac enzymes and lipid profile
D. Hemoglobin A1C and urine culture
CORRECT ANSWER: A. Complete blood count, pregnancy test, and
thyroid tests
Rationale: Initial laboratory evaluation for abnormal premenstrual bleeding
typically includes a complete blood count (CBC) to assess for anemia, a pregnancy
test to rule out pregnancy-related causes, and thyroid function tests as thyroid
disorders can affect menstrual bleeding. Vaginal and urine samples for PCR or
culture may also be obtained to rule out chlamydia.
3. The nurse is assessing a patient with suspected vaginitis. Which statement
about normal vaginal pH is correct?
A. Normal vaginal pH is greater than 5.5
B. Normal vaginal pH is 4.5 or less
C. Normal vaginal pH is neutral (7.0)
D. Normal vaginal pH varies widely and is not clinically significant
CORRECT ANSWER: B. Normal vaginal pH is 4.5 or less
, 3|Page
Rationale: The normal pH of the vagina is 4.5 or less, maintained by lactobacilli
that produce lactic acid from glycogen. An elevated pH (>4.5) is often associated
with infections such as bacterial vaginosis or trichomoniasis.
4. A patient presents with vaginal irritation, pain, and malodorous discharge.
Which components should the nurse include in the history assessment for
suspected vaginitis?
A. Dietary intake and exercise patterns
B. Last menstrual period, sexual activity, and recent antibiotic use
C. Family history of breast cancer
D. Immunization history and travel abroad
CORRECT ANSWER: B. Last menstrual period, sexual activity, and
recent antibiotic use
Rationale: Assessment for vaginitis should include history of last menstrual period
(LMP), recent sexual activity, use of contraceptives, tampons, douches, recent
changes in medications or antibiotic use, and presence of burning, pain, pruritus, or
profuse discharge. These factors help identify potential causes.
5. During a speculum examination for suspected vaginitis, the nurse collects a
discharge sample. Which finding would suggest an infection caused by
trichomonads or bacterial vaginosis?
A. Vaginal pH less than 4.5
NSG 554/ NSG554 EXAM 4: (NEW 2026/ 2027 UPDATE)
| QUESTIONS & ANSWERS| GRADE A| 100% CORRECT
(VERIFIED SOLUTIONS)- WILKES
1. A patient presents with abnormal uterine bleeding. The nurse recalls that the
PALM-COEIN classification system is used to categorize the causes. Which
conditions are included in the "PALM" component of this system?
A. Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic
B. Polyp, adenomyosis, leiomyoma, malignancy and hyperplasia
C. Polycystic ovaries, anovulation, luteal phase defect, menorrhagia
D. Pelvic inflammatory disease, adhesions, leiomyoma, metastasis
CORRECT ANSWER: B. Polyp, adenomyosis, leiomyoma, malignancy
and hyperplasia
Rationale: The PALM-COEIN classification system is used to categorize causes
of abnormal uterine bleeding. "PALM" refers to structural causes: Polyp,
Adenomyosis, Leiomyoma, and Malignancy and hyperplasia. "COEIN" refers to
non-structural causes: Coagulopathy, Ovulatory dysfunction, Endometrial,
Iatrogenic, and Not yet classified.
,2|Page
2. A patient with abnormal premenstrual bleeding is undergoing diagnostic
testing. Which laboratory studies should the nurse expect to be ordered?
A. Complete blood count, pregnancy test, and thyroid tests
B. Liver function tests and serum amylase
C. Cardiac enzymes and lipid profile
D. Hemoglobin A1C and urine culture
CORRECT ANSWER: A. Complete blood count, pregnancy test, and
thyroid tests
Rationale: Initial laboratory evaluation for abnormal premenstrual bleeding
typically includes a complete blood count (CBC) to assess for anemia, a pregnancy
test to rule out pregnancy-related causes, and thyroid function tests as thyroid
disorders can affect menstrual bleeding. Vaginal and urine samples for PCR or
culture may also be obtained to rule out chlamydia.
3. The nurse is assessing a patient with suspected vaginitis. Which statement
about normal vaginal pH is correct?
A. Normal vaginal pH is greater than 5.5
B. Normal vaginal pH is 4.5 or less
C. Normal vaginal pH is neutral (7.0)
D. Normal vaginal pH varies widely and is not clinically significant
CORRECT ANSWER: B. Normal vaginal pH is 4.5 or less
, 3|Page
Rationale: The normal pH of the vagina is 4.5 or less, maintained by lactobacilli
that produce lactic acid from glycogen. An elevated pH (>4.5) is often associated
with infections such as bacterial vaginosis or trichomoniasis.
4. A patient presents with vaginal irritation, pain, and malodorous discharge.
Which components should the nurse include in the history assessment for
suspected vaginitis?
A. Dietary intake and exercise patterns
B. Last menstrual period, sexual activity, and recent antibiotic use
C. Family history of breast cancer
D. Immunization history and travel abroad
CORRECT ANSWER: B. Last menstrual period, sexual activity, and
recent antibiotic use
Rationale: Assessment for vaginitis should include history of last menstrual period
(LMP), recent sexual activity, use of contraceptives, tampons, douches, recent
changes in medications or antibiotic use, and presence of burning, pain, pruritus, or
profuse discharge. These factors help identify potential causes.
5. During a speculum examination for suspected vaginitis, the nurse collects a
discharge sample. Which finding would suggest an infection caused by
trichomonads or bacterial vaginosis?
A. Vaginal pH less than 4.5
