D120 2026 PRACTICE SOLUTION EXAM
QUESTIONS GRADED A+
● A young woman presents with complaints of irritation in the vaginal
area. This is the first time this has occurred. On exam, the cervix is
inflamed and friable. Flagellated protozoa are seen on the wet mount.
What is the most likely diagnosis? Answer: trichomoniasis;
Flagellated protozoan confirms the diagnosis of trichomoniasis.
● A 21-year-old female patient presents for her first well-woman exam.
She has never been sexually active. Her family history and past medical
history are negative for any gynecologic diseases. Her menses occur
every 28 days, lasting 5 days, with a relatively moderate flow and no
significant dysmenorrhea. Her physical exam should include which
tests? Answer: Pap smear;
The recommended age for females to begin screening pap smears is at
the age of 21, regardless of sexual activity history. STD screening is not
necessary as the patient is not sexually active. Hemoccult and
mammogram are not recommended for this age group of patient.
● A young adult patient presents with a history of vaginal itching and
heavy white discharge. The patient denies a history of sexual activity.
On exam, the FNP finds a red, edematous vulva and white patches on
the vaginal walls. The discharge has no odor. What finding would the
FNP suspect in the patient's history? Answer: recent antibiotic use;
,Almost half of all vaginal infections are caused by candida. The majority
of women who develop this infection have recently taken antibiotics.
● A 46-year-old female patient is being seen in the clinic by the FNP.
She was last seen 2 weeks ago for an upper respiratory tract infection
and was treated with amoxicillin 250mg PO TID x 10days. She
completed her medication last week, but now complains of vaginal
itching and thick white discharge. She states that she has never
experienced such intense itching. She is in a mutually monogamous
relationship. Her LMP was 2 weeks ago. Her partner had a vasectomy.
Wet mount shows negative whiff test, rare clue cells, positive
lactobacilli, positive hyphae, positive spores, few WBCs, and no
trichomonads. She is leaving tomorrow for a week long cruise. She is
not taking any medications and has no known drug allergies. The FNP
should prescribe which of the following? Answer: fluconazole 150mg 1
tab PO x1 dose;
Fluconazole is approved for a single-dose oral treatment of
uncomplicated vulvovaginal candidiasis. It is the most convenient
treatment for this patient who will is unlikely to be compliant with
vaginal creams given the upcoming travel.
● A 25-year-old patient presents with complaints of malodorous vaginal
discharge, which is white and watery. She douches with vinegar and
water every 2 weeks. She uses a diaphragm for contraception and has
been sexually active with her boyfriend for two years, using condoms
for STD prevention. Her LMP was 1 week ago, and there are no noted
changes in her normal menstrual pattern. Her wet mount shows a
positive whiff test, clue cells too numerous to count, no lactobacilli, no
,hyphae, no spores. What is the diagnosis and treatment for this patient?
Answer: bacterial vaginosis: metronidazole vaginal gel 1 applicator HS
x 5 days.;
Metronidazole vaginal gel is the treatment of choice for bacterial
vaginosis in the non-pregnant female. The presence of clue cells, and the
associated malodorous discharge and absence of lactobacilli are markers
for the diagnosis of bacterial vaginosis.
● A 41-year-old patient is seen for her 6-week postpartum exam by the
FNP. She is breastfeeding without difficulty and plans to continue for a
year. She wants to begin using contraception and plans no further
pregnancies. Which of the following is not an appropriate choice for this
patient? Answer: Combination OC;
Combination OCs are not recommended for breastfeeding mothers
because of the effect of estrogen on milk supply. Progestin only OCs,
IUDs, and Depo-Provera are acceptable methods of contraception for
breastfeeding mothers.
● Which two patients should have a Pap smear test performed by the
FNP? Answer: Based on USPSTF guidelines, pap smear tests should be
performed on female patients aged 21 and older, regardless of sexual
activity.
● What finding is considered a normal surface characteristic of the
cervix? Answer: Small, yellow, raised round area on the cervix.;
A nabothian cyst is a small, white or yellow, raised round area on the
cervix and is considered to be a normal variant.
, ● The FNP is reviewing the lab results of a 28-year-old patient recently
seen for a pap smear. Classification is high-grade squamous
intraepithelial lesion, endocervical cells seen, and adequate smear. The
FNP phones the patient and tells her which of the following? Answer:
Your pap smear shows abnormal tissue that needs to be evaluated. Please
schedule an appointment for a colposcopy.;
The pap smear is a screening test for cervical cancer and precancerous
states. The diagnostic test needed to confirm the diagnosis of a high-
grade lesion is a colposcopy with guided biopsies.
● The FNP is reviewing the lab results of a 61-year-old patient recently
seen for a pap smear. Results are: atrophic changes, scent endocervical
cells, and adequate smear. She has been treated for breast cancer with
mastectomy and tamoxifen. She has never received hormone
replacement therapy. What is appropriate for the FNP to tell the patient?
Answer: Your pap smear is normal but shows some mild thinning of the
tissue. This is to be expected in someone who is postmenopausal and not
on hormones. It does not pose a threat to your health. Please return to the
office in 1 year for your annual exam or sooner if needed.;
Atrophic changes on the cervix of a postmenopausal woman are to be
expected, as is the paucity of endocervical cells. Because of her past
medical history, she is not a candidate for HRT, and the pap smear
results are not abnormal.
● An adult patients LMP was 2 months ago. She has had and IUD in
place for the last 4 months. She is complaining of nausea, fatigue, breast
QUESTIONS GRADED A+
● A young woman presents with complaints of irritation in the vaginal
area. This is the first time this has occurred. On exam, the cervix is
inflamed and friable. Flagellated protozoa are seen on the wet mount.
What is the most likely diagnosis? Answer: trichomoniasis;
Flagellated protozoan confirms the diagnosis of trichomoniasis.
● A 21-year-old female patient presents for her first well-woman exam.
She has never been sexually active. Her family history and past medical
history are negative for any gynecologic diseases. Her menses occur
every 28 days, lasting 5 days, with a relatively moderate flow and no
significant dysmenorrhea. Her physical exam should include which
tests? Answer: Pap smear;
The recommended age for females to begin screening pap smears is at
the age of 21, regardless of sexual activity history. STD screening is not
necessary as the patient is not sexually active. Hemoccult and
mammogram are not recommended for this age group of patient.
● A young adult patient presents with a history of vaginal itching and
heavy white discharge. The patient denies a history of sexual activity.
On exam, the FNP finds a red, edematous vulva and white patches on
the vaginal walls. The discharge has no odor. What finding would the
FNP suspect in the patient's history? Answer: recent antibiotic use;
,Almost half of all vaginal infections are caused by candida. The majority
of women who develop this infection have recently taken antibiotics.
● A 46-year-old female patient is being seen in the clinic by the FNP.
She was last seen 2 weeks ago for an upper respiratory tract infection
and was treated with amoxicillin 250mg PO TID x 10days. She
completed her medication last week, but now complains of vaginal
itching and thick white discharge. She states that she has never
experienced such intense itching. She is in a mutually monogamous
relationship. Her LMP was 2 weeks ago. Her partner had a vasectomy.
Wet mount shows negative whiff test, rare clue cells, positive
lactobacilli, positive hyphae, positive spores, few WBCs, and no
trichomonads. She is leaving tomorrow for a week long cruise. She is
not taking any medications and has no known drug allergies. The FNP
should prescribe which of the following? Answer: fluconazole 150mg 1
tab PO x1 dose;
Fluconazole is approved for a single-dose oral treatment of
uncomplicated vulvovaginal candidiasis. It is the most convenient
treatment for this patient who will is unlikely to be compliant with
vaginal creams given the upcoming travel.
● A 25-year-old patient presents with complaints of malodorous vaginal
discharge, which is white and watery. She douches with vinegar and
water every 2 weeks. She uses a diaphragm for contraception and has
been sexually active with her boyfriend for two years, using condoms
for STD prevention. Her LMP was 1 week ago, and there are no noted
changes in her normal menstrual pattern. Her wet mount shows a
positive whiff test, clue cells too numerous to count, no lactobacilli, no
,hyphae, no spores. What is the diagnosis and treatment for this patient?
Answer: bacterial vaginosis: metronidazole vaginal gel 1 applicator HS
x 5 days.;
Metronidazole vaginal gel is the treatment of choice for bacterial
vaginosis in the non-pregnant female. The presence of clue cells, and the
associated malodorous discharge and absence of lactobacilli are markers
for the diagnosis of bacterial vaginosis.
● A 41-year-old patient is seen for her 6-week postpartum exam by the
FNP. She is breastfeeding without difficulty and plans to continue for a
year. She wants to begin using contraception and plans no further
pregnancies. Which of the following is not an appropriate choice for this
patient? Answer: Combination OC;
Combination OCs are not recommended for breastfeeding mothers
because of the effect of estrogen on milk supply. Progestin only OCs,
IUDs, and Depo-Provera are acceptable methods of contraception for
breastfeeding mothers.
● Which two patients should have a Pap smear test performed by the
FNP? Answer: Based on USPSTF guidelines, pap smear tests should be
performed on female patients aged 21 and older, regardless of sexual
activity.
● What finding is considered a normal surface characteristic of the
cervix? Answer: Small, yellow, raised round area on the cervix.;
A nabothian cyst is a small, white or yellow, raised round area on the
cervix and is considered to be a normal variant.
, ● The FNP is reviewing the lab results of a 28-year-old patient recently
seen for a pap smear. Classification is high-grade squamous
intraepithelial lesion, endocervical cells seen, and adequate smear. The
FNP phones the patient and tells her which of the following? Answer:
Your pap smear shows abnormal tissue that needs to be evaluated. Please
schedule an appointment for a colposcopy.;
The pap smear is a screening test for cervical cancer and precancerous
states. The diagnostic test needed to confirm the diagnosis of a high-
grade lesion is a colposcopy with guided biopsies.
● The FNP is reviewing the lab results of a 61-year-old patient recently
seen for a pap smear. Results are: atrophic changes, scent endocervical
cells, and adequate smear. She has been treated for breast cancer with
mastectomy and tamoxifen. She has never received hormone
replacement therapy. What is appropriate for the FNP to tell the patient?
Answer: Your pap smear is normal but shows some mild thinning of the
tissue. This is to be expected in someone who is postmenopausal and not
on hormones. It does not pose a threat to your health. Please return to the
office in 1 year for your annual exam or sooner if needed.;
Atrophic changes on the cervix of a postmenopausal woman are to be
expected, as is the paucity of endocervical cells. Because of her past
medical history, she is not a candidate for HRT, and the pap smear
results are not abnormal.
● An adult patients LMP was 2 months ago. She has had and IUD in
place for the last 4 months. She is complaining of nausea, fatigue, breast
