1
NRNP 6552 FINAL EXAM VERSION B 2026/2027 | Women's
Health Primary Care | A Grade Complete Exam | Walden
University | Pass Guaranteed - A+ Graded
Section 1: Gynecologic Disorders & Reproductive Endocrinology
(Questions 1-25)
Question 1
A 32-year-old G1P0 presents with cyclic pelvic pain, dysmenorrhea, and dyspareunia
for 3 years. Transvaginal ultrasound reveals a 3.5 cm endometrioma on the left ovary.
She desires fertility preservation. Which is the most appropriate first-line medical
management?
A. Combined oral contraceptives continuously for 6 months
B. Depot medroxyprogesterone acetate 150 mg IM every 3 months
C. Gonadotropin-releasing hormone (GnRH) agonist with add-back therapy
D. Aromatase inhibitor with progestin add-back
Correct Answer: A
Rationale: Combined oral contraceptives used continuously are first-line medical
therapy for endometriosis-related pain, especially in patients desiring fertility
preservation, as they suppress ovulation and endometrial proliferation. GnRH agonists
(C) are second-line due to bone density concerns. DMPA (B) causes prolonged
anovulation and is less ideal for fertility preservation. Aromatase inhibitors (D) are
reserved for refractory cases.
Question 2
A 28-year-old presents with oligomenorrhea, hirsutism, and acne. Laboratory studies
show total testosterone 85 ng/dL (elevated), DHEAS 280 mcg/dL (normal), LH:FSH
,2
ratio 2.8:1, and fasting glucose 110 mg/dL. Pelvic ultrasound shows 18 follicles per
ovary. Which diagnostic criterion is NOT required for the Rotterdam diagnosis of PCOS?
A. Oligo- or anovulation
B. Clinical or biochemical hyperandrogenism
C. Polycystic ovarian morphology on ultrasound
D. Exclusion of other causes of hyperandrogenism
Correct Answer: D
Rationale: The Rotterdam criteria require TWO of three: oligo/anovulation (A),
hyperandrogenism (B), or polycystic ovarian morphology (C). Exclusion of other causes
(D) is essential clinical practice but is not one of the three diagnostic criteria
themselves—it is a prerequisite step before applying Rotterdam.
Question 3
A 35-year-old G2P2 with heavy menstrual bleeding (HMB) has a uterus measuring 14
weeks on bimanual exam. MRI confirms multiple intramural and submucosal fibroids
with the largest measuring 8 cm. She declines hysterectomy and has completed
childbearing. Which intervention offers the best balance of symptom relief and uterine
preservation?
A. Uterine artery embolization (UAE)
B. Myomectomy
C. Magnetic resonance-guided focused ultrasound surgery (MRgFUS)
D. Gonadotropin-releasing hormone (GnRH) agonist therapy alone
Correct Answer: A
Rationale: UAE is highly effective for HMB with multiple fibroids and offers durable
symptom relief with uterine preservation in patients who have completed childbearing.
Myomectomy (B) is preferred for fertility preservation. MRgFUS (C) has limited efficacy
for large or multiple fibroids. GnRH agonists alone (D) provide only temporary relief
and are not definitive therapy.
,3
Question 4
A 42-year-old presents with progressively worsening dysmenorrhea, menorrhagia, and
a diffusely enlarged, tender, "boggy" uterus on exam. Transvaginal ultrasound shows a
globular uterus with indistinct endometrial-myometrial junction and small myometrial
cysts. What is the most likely diagnosis?
A. Uterine leiomyomatosis
B. Adenomyosis
C. Endometrial hyperplasia
D. Chronic endometritis
Correct Answer: B
Rationale: Adenomyosis presents with dysmenorrhea, menorrhagia, and a tender,
diffusely enlarged "boggy" uterus. Ultrasound findings of indistinct endometrial-
myometrial junction and myometrial cysts are pathognomonic. Leiomyomas (A)
typically present as discrete, well-circumscribed masses. Endometrial hyperplasia (C)
does not cause uterine enlargement. Chronic endometritis (D) causes intermenstrual
bleeding but not diffuse uterine enlargement.
Question 5
A 29-year-old with known endometriosis has failed continuous OCPs and a 3-month
trial of norethindrone acetate 10 mg daily. She reports severe pelvic pain affecting
quality of life and work attendance. Which next-step therapy is most appropriate?
A. Laparoscopic excision of endometriosis with ovarian preservation
B. GnRH agonist (leuprolide) with norethindrone acetate add-back
C. Danazol 200 mg twice daily
D. Hysterectomy with bilateral salpingo-oophorectomy
Correct Answer: B
Rationale: GnRH agonist with add-back therapy is indicated for moderate-to-severe
endometriosis refractory to first-line hormonal therapy. Add-back (low-dose progestin
± estrogen) mitigates bone loss and vasomotor symptoms. Laparoscopic excision (A) is
reasonable but hormonal therapy should be exhausted first in this age group. Danazol
, 4
(C) has significant androgenic side effects and is rarely used. Hysterectomy with BSO
(D) is excessive for a 29-year-old desiring fertility.
Question 6
A 26-year-old with PCOS presents for preconception counseling. Her BMI is 34 kg/m²,
fasting glucose is 108 mg/dL, and she has irregular cycles. Which intervention should be
prioritized to optimize pregnancy outcomes?
A. Immediate clomiphene citrate ovulation induction
B. Metformin 500 mg twice daily with lifestyle modification
C. Letrozole 2.5 mg daily for 5 days starting cycle day 3
D. Weight loss of at least 10% body weight before conception
Correct Answer: D
Rationale: Weight loss of 5-10% improves insulin sensitivity, restores ovulation in 30-
60% of women with PCOS, and reduces risks of GDM and preeclampsia. While
metformin (B) and ovulation induction agents (A, C) are useful, lifestyle modification
and weight loss are the foundational first steps for preconception optimization in obese
PCOS patients.
Question 7
A 38-year-old G0 presents with secondary amenorrhea for 8 months. FSH is 65
mIU/mL, LH is 48 mIU/mL, and estradiol is 18 pg/mL. She reports hot flashes and
vaginal dryness. Karyotype is 46,XX. What is the most likely diagnosis?
A. Polycystic ovary syndrome
B. Premature ovarian insufficiency
C. Hypothalamic amenorrhea
D. Pituitary microadenoma
Correct Answer: B
NRNP 6552 FINAL EXAM VERSION B 2026/2027 | Women's
Health Primary Care | A Grade Complete Exam | Walden
University | Pass Guaranteed - A+ Graded
Section 1: Gynecologic Disorders & Reproductive Endocrinology
(Questions 1-25)
Question 1
A 32-year-old G1P0 presents with cyclic pelvic pain, dysmenorrhea, and dyspareunia
for 3 years. Transvaginal ultrasound reveals a 3.5 cm endometrioma on the left ovary.
She desires fertility preservation. Which is the most appropriate first-line medical
management?
A. Combined oral contraceptives continuously for 6 months
B. Depot medroxyprogesterone acetate 150 mg IM every 3 months
C. Gonadotropin-releasing hormone (GnRH) agonist with add-back therapy
D. Aromatase inhibitor with progestin add-back
Correct Answer: A
Rationale: Combined oral contraceptives used continuously are first-line medical
therapy for endometriosis-related pain, especially in patients desiring fertility
preservation, as they suppress ovulation and endometrial proliferation. GnRH agonists
(C) are second-line due to bone density concerns. DMPA (B) causes prolonged
anovulation and is less ideal for fertility preservation. Aromatase inhibitors (D) are
reserved for refractory cases.
Question 2
A 28-year-old presents with oligomenorrhea, hirsutism, and acne. Laboratory studies
show total testosterone 85 ng/dL (elevated), DHEAS 280 mcg/dL (normal), LH:FSH
,2
ratio 2.8:1, and fasting glucose 110 mg/dL. Pelvic ultrasound shows 18 follicles per
ovary. Which diagnostic criterion is NOT required for the Rotterdam diagnosis of PCOS?
A. Oligo- or anovulation
B. Clinical or biochemical hyperandrogenism
C. Polycystic ovarian morphology on ultrasound
D. Exclusion of other causes of hyperandrogenism
Correct Answer: D
Rationale: The Rotterdam criteria require TWO of three: oligo/anovulation (A),
hyperandrogenism (B), or polycystic ovarian morphology (C). Exclusion of other causes
(D) is essential clinical practice but is not one of the three diagnostic criteria
themselves—it is a prerequisite step before applying Rotterdam.
Question 3
A 35-year-old G2P2 with heavy menstrual bleeding (HMB) has a uterus measuring 14
weeks on bimanual exam. MRI confirms multiple intramural and submucosal fibroids
with the largest measuring 8 cm. She declines hysterectomy and has completed
childbearing. Which intervention offers the best balance of symptom relief and uterine
preservation?
A. Uterine artery embolization (UAE)
B. Myomectomy
C. Magnetic resonance-guided focused ultrasound surgery (MRgFUS)
D. Gonadotropin-releasing hormone (GnRH) agonist therapy alone
Correct Answer: A
Rationale: UAE is highly effective for HMB with multiple fibroids and offers durable
symptom relief with uterine preservation in patients who have completed childbearing.
Myomectomy (B) is preferred for fertility preservation. MRgFUS (C) has limited efficacy
for large or multiple fibroids. GnRH agonists alone (D) provide only temporary relief
and are not definitive therapy.
,3
Question 4
A 42-year-old presents with progressively worsening dysmenorrhea, menorrhagia, and
a diffusely enlarged, tender, "boggy" uterus on exam. Transvaginal ultrasound shows a
globular uterus with indistinct endometrial-myometrial junction and small myometrial
cysts. What is the most likely diagnosis?
A. Uterine leiomyomatosis
B. Adenomyosis
C. Endometrial hyperplasia
D. Chronic endometritis
Correct Answer: B
Rationale: Adenomyosis presents with dysmenorrhea, menorrhagia, and a tender,
diffusely enlarged "boggy" uterus. Ultrasound findings of indistinct endometrial-
myometrial junction and myometrial cysts are pathognomonic. Leiomyomas (A)
typically present as discrete, well-circumscribed masses. Endometrial hyperplasia (C)
does not cause uterine enlargement. Chronic endometritis (D) causes intermenstrual
bleeding but not diffuse uterine enlargement.
Question 5
A 29-year-old with known endometriosis has failed continuous OCPs and a 3-month
trial of norethindrone acetate 10 mg daily. She reports severe pelvic pain affecting
quality of life and work attendance. Which next-step therapy is most appropriate?
A. Laparoscopic excision of endometriosis with ovarian preservation
B. GnRH agonist (leuprolide) with norethindrone acetate add-back
C. Danazol 200 mg twice daily
D. Hysterectomy with bilateral salpingo-oophorectomy
Correct Answer: B
Rationale: GnRH agonist with add-back therapy is indicated for moderate-to-severe
endometriosis refractory to first-line hormonal therapy. Add-back (low-dose progestin
± estrogen) mitigates bone loss and vasomotor symptoms. Laparoscopic excision (A) is
reasonable but hormonal therapy should be exhausted first in this age group. Danazol
, 4
(C) has significant androgenic side effects and is rarely used. Hysterectomy with BSO
(D) is excessive for a 29-year-old desiring fertility.
Question 6
A 26-year-old with PCOS presents for preconception counseling. Her BMI is 34 kg/m²,
fasting glucose is 108 mg/dL, and she has irregular cycles. Which intervention should be
prioritized to optimize pregnancy outcomes?
A. Immediate clomiphene citrate ovulation induction
B. Metformin 500 mg twice daily with lifestyle modification
C. Letrozole 2.5 mg daily for 5 days starting cycle day 3
D. Weight loss of at least 10% body weight before conception
Correct Answer: D
Rationale: Weight loss of 5-10% improves insulin sensitivity, restores ovulation in 30-
60% of women with PCOS, and reduces risks of GDM and preeclampsia. While
metformin (B) and ovulation induction agents (A, C) are useful, lifestyle modification
and weight loss are the foundational first steps for preconception optimization in obese
PCOS patients.
Question 7
A 38-year-old G0 presents with secondary amenorrhea for 8 months. FSH is 65
mIU/mL, LH is 48 mIU/mL, and estradiol is 18 pg/mL. She reports hot flashes and
vaginal dryness. Karyotype is 46,XX. What is the most likely diagnosis?
A. Polycystic ovary syndrome
B. Premature ovarian insufficiency
C. Hypothalamic amenorrhea
D. Pituitary microadenoma
Correct Answer: B
