1
NRNP 6552 MIDTERM EXAM 2026/2027 | Advanced Nurse
Practice in Reproductive Health Care | All 100 Questions &
Correct Answers | Pass Guaranteed - A+ Graded
[Section 1: Reproductive Anatomy, Physiology & HPO Axis Regulation (Q1-15)]
Q1. A 24-year-old patient presents with secondary amenorrhea. Laboratory studies
reveal low estradiol, low FSH, and low LH. Which hypothalamic-pituitary-ovarian axis
level is most likely disrupted?
A. Ovarian failure
B. Hypothalamic or pituitary dysfunction
C. Uterine outflow obstruction
D. Thyroid dysfunction
B. Hypothalamic or pituitary dysfunction [CORRECT]
Rationale: Low estradiol with concurrently low FSH and LH indicates
hypogonadotropic hypogonadism, localizing the defect to the hypothalamus or
pituitary. Ovarian failure would present with high FSH/LH (hypergonadotropic);
uterine obstruction and thyroid dysfunction would not typically suppress all three
hormones.
Correct Answer: B
Q2. During the late follicular phase, which hormonal event triggers the LH surge
required for ovulation?
A. Sustained low estradiol levels
B. Rising progesterone levels
,2
C. High estradiol levels exerting positive feedback on GnRH
D. High prolactin levels
C. High estradiol levels exerting positive feedback on GnRH [CORRECT]
Rationale: The LH surge is triggered by sustained high estradiol levels (>200 pg/mL for
~48 hours) exerting positive feedback on the hypothalamus and anterior pituitary,
stimulating GnRH pulsatility and LH release. Low estradiol maintains negative feedback;
progesterone rises post-ovulation; prolactin suppresses ovulation.
Correct Answer: C
Q3. A patient is in the luteal phase of her menstrual cycle. Which endometrial
histological feature is characteristic of this phase under progesterone influence?
A. Thin, atrophic endometrium with straight glands
B. Thick endometrium with coiled glands and decidualized stroma
C. Proliferative glands with pseudostratified epithelium
D. Breakdown and shedding of the functionalis layer
B. Thick endometrium with coiled glands and decidualized stroma [CORRECT]
Rationale: The luteal phase is characterized by progesterone-dominated secretory
transformation: coiled (saw-tooth) glands, glycogen-rich secretions, edematous stroma,
and decidualization. The proliferative phase shows straight glands with
pseudostratified epithelium; menses involves breakdown and shedding; atrophic
endometrium occurs with estrogen deficiency.
Correct Answer: B
Q4. The corpus luteum produces which hormone that maintains the endometrium
during the luteal phase and, if pregnancy occurs, supports the endometrium until
placental takeover?
,3
A. Estrogen
B. Progesterone
C. Human chorionic gonadotropin (hCG)
D. Inhibin A
B. Progesterone [CORRECT]
Rationale: The corpus luteum produces progesterone, which maintains secretory
endometrium for implantation. If pregnancy occurs, hCG from the trophoblast rescues
the corpus luteum to continue progesterone production until the placenta assumes
steroidogenesis at 8-10 weeks. Estrogen is also produced but progesterone is the
dominant luteal hormone.
Correct Answer: B
Q5. A 32-year-old patient with anorexia nervosa presents with amenorrhea. Her FSH is
2.1 mIU/mL, LH is 1.8 mIU/mL, and estradiol is 18 pg/mL. Which mechanism best
explains her hypothalamic amenorrhea?
A. Primary ovarian failure
B. Suppression of GnRH pulsatility due to low leptin and stress
C. Pituitary adenoma compressing gonadotrophs
D. Autoimmune oophoritis
B. Suppression of GnRH pulsatility due to low leptin and stress [CORRECT]
Rationale: Functional hypothalamic amenorrhea results from suppressed GnRH
pulsatility due to low leptin (from low body fat), corticotropin-releasing hormone stress
response, and energy deficit. Low FSH/LH with low estradiol confirms hypothalamic
suppression, not ovarian failure (high FSH/LH) or pituitary mass (would show other
hormonal deficits).
Correct Answer: B
, 4
Q6. During the menstrual cycle, which phase is characterized by a fixed duration of
approximately 14 days?
A. Early follicular phase
B. Late follicular phase
C. Luteal phase
D. Menstrual phase
C. Luteal phase [CORRECT]
Rationale: The luteal phase has a relatively fixed duration of approximately 14 days
(range 12-16 days), determined by the lifespan of the corpus luteum. The follicular
phase is highly variable (10-20+ days), accounting for cycle length variation. The
menstrual phase typically lasts 3-7 days.
Correct Answer: C
Q7. A patient with polycystic ovary syndrome has elevated LH and normal FSH. Which
feedback mechanism is most likely disrupted, resulting in this altered gonadotropin
ratio?
A. Increased negative feedback from progesterone
B. Increased pulse frequency of GnRH favoring LH over FSH secretion
C. Decreased inhibin B production from ovaries
D. Excessive positive feedback from estradiol
B. Increased pulse frequency of GnRH favoring LH over FSH secretion [CORRECT]
Rationale: In PCOS, increased GnRH pulse frequency (due to reduced progesterone and
allopregnanolone feedback) favors LH secretion over FSH, as LH-producing
gonadotrophs are more responsive to rapid GnRH pulsatility. This results in the
characteristic LH:FSH ratio >2:1. Decreased inhibin B contributes but is secondary;
progesterone is low, not increased.
Correct Answer: B
NRNP 6552 MIDTERM EXAM 2026/2027 | Advanced Nurse
Practice in Reproductive Health Care | All 100 Questions &
Correct Answers | Pass Guaranteed - A+ Graded
[Section 1: Reproductive Anatomy, Physiology & HPO Axis Regulation (Q1-15)]
Q1. A 24-year-old patient presents with secondary amenorrhea. Laboratory studies
reveal low estradiol, low FSH, and low LH. Which hypothalamic-pituitary-ovarian axis
level is most likely disrupted?
A. Ovarian failure
B. Hypothalamic or pituitary dysfunction
C. Uterine outflow obstruction
D. Thyroid dysfunction
B. Hypothalamic or pituitary dysfunction [CORRECT]
Rationale: Low estradiol with concurrently low FSH and LH indicates
hypogonadotropic hypogonadism, localizing the defect to the hypothalamus or
pituitary. Ovarian failure would present with high FSH/LH (hypergonadotropic);
uterine obstruction and thyroid dysfunction would not typically suppress all three
hormones.
Correct Answer: B
Q2. During the late follicular phase, which hormonal event triggers the LH surge
required for ovulation?
A. Sustained low estradiol levels
B. Rising progesterone levels
,2
C. High estradiol levels exerting positive feedback on GnRH
D. High prolactin levels
C. High estradiol levels exerting positive feedback on GnRH [CORRECT]
Rationale: The LH surge is triggered by sustained high estradiol levels (>200 pg/mL for
~48 hours) exerting positive feedback on the hypothalamus and anterior pituitary,
stimulating GnRH pulsatility and LH release. Low estradiol maintains negative feedback;
progesterone rises post-ovulation; prolactin suppresses ovulation.
Correct Answer: C
Q3. A patient is in the luteal phase of her menstrual cycle. Which endometrial
histological feature is characteristic of this phase under progesterone influence?
A. Thin, atrophic endometrium with straight glands
B. Thick endometrium with coiled glands and decidualized stroma
C. Proliferative glands with pseudostratified epithelium
D. Breakdown and shedding of the functionalis layer
B. Thick endometrium with coiled glands and decidualized stroma [CORRECT]
Rationale: The luteal phase is characterized by progesterone-dominated secretory
transformation: coiled (saw-tooth) glands, glycogen-rich secretions, edematous stroma,
and decidualization. The proliferative phase shows straight glands with
pseudostratified epithelium; menses involves breakdown and shedding; atrophic
endometrium occurs with estrogen deficiency.
Correct Answer: B
Q4. The corpus luteum produces which hormone that maintains the endometrium
during the luteal phase and, if pregnancy occurs, supports the endometrium until
placental takeover?
,3
A. Estrogen
B. Progesterone
C. Human chorionic gonadotropin (hCG)
D. Inhibin A
B. Progesterone [CORRECT]
Rationale: The corpus luteum produces progesterone, which maintains secretory
endometrium for implantation. If pregnancy occurs, hCG from the trophoblast rescues
the corpus luteum to continue progesterone production until the placenta assumes
steroidogenesis at 8-10 weeks. Estrogen is also produced but progesterone is the
dominant luteal hormone.
Correct Answer: B
Q5. A 32-year-old patient with anorexia nervosa presents with amenorrhea. Her FSH is
2.1 mIU/mL, LH is 1.8 mIU/mL, and estradiol is 18 pg/mL. Which mechanism best
explains her hypothalamic amenorrhea?
A. Primary ovarian failure
B. Suppression of GnRH pulsatility due to low leptin and stress
C. Pituitary adenoma compressing gonadotrophs
D. Autoimmune oophoritis
B. Suppression of GnRH pulsatility due to low leptin and stress [CORRECT]
Rationale: Functional hypothalamic amenorrhea results from suppressed GnRH
pulsatility due to low leptin (from low body fat), corticotropin-releasing hormone stress
response, and energy deficit. Low FSH/LH with low estradiol confirms hypothalamic
suppression, not ovarian failure (high FSH/LH) or pituitary mass (would show other
hormonal deficits).
Correct Answer: B
, 4
Q6. During the menstrual cycle, which phase is characterized by a fixed duration of
approximately 14 days?
A. Early follicular phase
B. Late follicular phase
C. Luteal phase
D. Menstrual phase
C. Luteal phase [CORRECT]
Rationale: The luteal phase has a relatively fixed duration of approximately 14 days
(range 12-16 days), determined by the lifespan of the corpus luteum. The follicular
phase is highly variable (10-20+ days), accounting for cycle length variation. The
menstrual phase typically lasts 3-7 days.
Correct Answer: C
Q7. A patient with polycystic ovary syndrome has elevated LH and normal FSH. Which
feedback mechanism is most likely disrupted, resulting in this altered gonadotropin
ratio?
A. Increased negative feedback from progesterone
B. Increased pulse frequency of GnRH favoring LH over FSH secretion
C. Decreased inhibin B production from ovaries
D. Excessive positive feedback from estradiol
B. Increased pulse frequency of GnRH favoring LH over FSH secretion [CORRECT]
Rationale: In PCOS, increased GnRH pulse frequency (due to reduced progesterone and
allopregnanolone feedback) favors LH secretion over FSH, as LH-producing
gonadotrophs are more responsive to rapid GnRH pulsatility. This results in the
characteristic LH:FSH ratio >2:1. Decreased inhibin B contributes but is secondary;
progesterone is low, not increased.
Correct Answer: B
