NSG 554 Exam 4 – Nurse Practitioners in Primary Care I | 85
Actual Questions and Answers + Expert Rationales | 2026/27
Updates | 100% correct
1. Most Common Breast Problem in Primary Care
• A) Mastalgia or mastodynia (breast pain)
• B) Galactorrhea
• C) Fibroadenoma
• D) Breast cancer
Correct Answer: A) Mastalgia or mastodynia (breast pain)
Expert Rationale: Mastalgia (breast pain) is the most common breast-related complaint
in primary care. It can be cyclical (related to hormonal changes during the menstrual
cycle) or non-cyclical. Cyclical mastalgia is most common in premenopausal women and
typically resolves with menopause. Non-cyclical mastalgia may be associated with
trauma, infection, or referred pain from underlying chest wall structures.
2. Galactorrhea: Definition and Associated Conditions
• A) Milky breast discharge associated with pituitary adenoma or hypothyroidism
• B) Bloody breast discharge associated with breast cancer
• C) Purulent breast discharge associated with mastitis
• D) Clear discharge associated with ductal ectasia
Correct Answer: A) Milky breast discharge associated with pituitary adenoma or
hypothyroidism
Expert Rationale: Galactorrhea is a milky breast discharge unrelated to pregnancy or
breastfeeding. It is associated with hyperprolactinemia, which can be caused by pituitary
adenomas (prolactinomas), hypothyroidism, medications (antipsychotics,
antidepressants), or chest wall stimulation. Workup includes prolactin level, TSH, and
MRI of the pituitary if indicated.
,3. Chronic Pelvic Pain: Definition
• A) Continuous or episodic non-menstrual pain of at least 6 months at or below
the umbilicus
• B) Pain lasting less than 3 months
• C) Pain associated only with menstruation
• D) Acute pain requiring emergency intervention
Correct Answer: A) Continuous or episodic non-menstrual pain of at least 6 months at
or below the umbilicus
Expert Rationale: Chronic pelvic pain (CPP) is defined as non-cyclical, non-menstrual
pain lasting at least 6 months and located below the umbilicus. It interrupts normal
activities and may involve multiple organ systems (GI, urologic, gynecologic,
musculoskeletal, neurologic). The cause is often multifactorial .
4. Chronic Pelvic Pain: Risk Factors
• A) History of physical/sexual abuse, pelvic inflammatory disease, endometriosis,
interstitial cystitis, irritable bowel syndrome, musculoskeletal disorders,
postsurgical pain
• B) Only endometriosis
• C) Only interstitial cystitis
• D) No known risk factors
Correct Answer: A) History of physical/sexual abuse, pelvic inflammatory disease,
endometriosis, interstitial cystitis, irritable bowel syndrome, musculoskeletal disorders,
postsurgical pain
Expert Rationale: CPP is associated with a history of physical or sexual abuse, pelvic
inflammatory disease, endometriosis, interstitial cystitis, irritable bowel syndrome,
musculoskeletal disorders, and postsurgical pain. The multifactorial nature of CPP
requires a comprehensive biopsychosocial approach to management .
,5. Chronic Pelvic Pain: Diagnostics
• A) Detailed abdominal, pelvic, and back examination; vaginal/cervical cultures,
UA, urine culture, CBC, pregnancy test, ESR; transvaginal/renal ultrasound,
laparoscopy, CT, or MRI
• B) Only pelvic ultrasound
• C) Only laboratory testing
• D) Only physical examination
Correct Answer: A) Detailed abdominal, pelvic, and back examination; vaginal/cervical
cultures, UA, urine culture, CBC, pregnancy test, ESR; transvaginal/renal ultrasound,
laparoscopy, CT, or MRI
Expert Rationale: The diagnostic workup for CPP is comprehensive and includes a
detailed physical examination, laboratory testing (cultures, CBC, ESR, pregnancy test),
and imaging (transvaginal ultrasound, CT, MRI). Laparoscopy may be considered in
selected cases to evaluate for endometriosis or adhesions .
6. Chronic Pelvic Pain: Management
• A) NSAIDs, TCAs, anticonvulsants, neurostimulation, laparoscopy
• B) Only NSAIDs
• C) Only hormonal therapy
• D) Only surgical intervention
Correct Answer: A) NSAIDs, TCAs, anticonvulsants, neurostimulation, laparoscopy
Expert Rationale: Management of CPP is multimodal and may include NSAIDs, tricyclic
antidepressants, anticonvulsants, neurostimulation, and laparoscopic intervention when
indicated. Counseling and support are necessary throughout management but do not
directly provide symptom relief .
7. Abnormal Uterine Bleeding: Definition
• A) Bleeding from the uterine corpus that is abnormal in duration, volume,
frequency, or regularity
, • B) Bleeding associated only with menopause
• C) Bleeding that occurs only during pregnancy
• D) Bleeding that is always heavy
Correct Answer: A) Bleeding from the uterine corpus that is abnormal in duration,
volume, frequency, or regularity
Expert Rationale: Abnormal uterine bleeding (AUB) is defined as bleeding from the
uterine corpus that deviates from normal in duration, volume, frequency, or regularity.
Chronic AUB has been present for the majority of the past 6 months. Acute AUB is an
episode of heavy bleeding that requires immediate intervention .
8. AUB: Initial Diagnostics
• A) Serum hCG, TSH, cervical cultures
• B) Liver function tests and testosterone levels
• C) Only transvaginal ultrasound
• D) Only endometrial biopsy
Correct Answer: A) Serum hCG, TSH, cervical cultures
Expert Rationale: Initial diagnostic tests for AUB include serum human chorionic
gonadotropin (hCG) to rule out pregnancy, thyroid-stimulating hormone (TSH) to
evaluate for thyroid dysfunction, and cervical cultures to rule out infection. Liver function
tests and testosterone levels are considered more advanced tests .
9. AUB: Causes (PALM-COEIN Classification)
• A) Polyp, adenomyosis, leiomyoma, malignancy, ovulatory disorders (PCOS,
hypothyroid, hyperprolactin), endometrial, iatrogenic, not otherwise classified
• B) Only fibroids and polyps
• C) Only hormonal causes
• D) Only malignancy
Correct Answer: A) Polyp, adenomyosis, leiomyoma, malignancy, ovulatory disorders
(PCOS, hypothyroid, hyperprolactin), endometrial, iatrogenic, not otherwise classified
Actual Questions and Answers + Expert Rationales | 2026/27
Updates | 100% correct
1. Most Common Breast Problem in Primary Care
• A) Mastalgia or mastodynia (breast pain)
• B) Galactorrhea
• C) Fibroadenoma
• D) Breast cancer
Correct Answer: A) Mastalgia or mastodynia (breast pain)
Expert Rationale: Mastalgia (breast pain) is the most common breast-related complaint
in primary care. It can be cyclical (related to hormonal changes during the menstrual
cycle) or non-cyclical. Cyclical mastalgia is most common in premenopausal women and
typically resolves with menopause. Non-cyclical mastalgia may be associated with
trauma, infection, or referred pain from underlying chest wall structures.
2. Galactorrhea: Definition and Associated Conditions
• A) Milky breast discharge associated with pituitary adenoma or hypothyroidism
• B) Bloody breast discharge associated with breast cancer
• C) Purulent breast discharge associated with mastitis
• D) Clear discharge associated with ductal ectasia
Correct Answer: A) Milky breast discharge associated with pituitary adenoma or
hypothyroidism
Expert Rationale: Galactorrhea is a milky breast discharge unrelated to pregnancy or
breastfeeding. It is associated with hyperprolactinemia, which can be caused by pituitary
adenomas (prolactinomas), hypothyroidism, medications (antipsychotics,
antidepressants), or chest wall stimulation. Workup includes prolactin level, TSH, and
MRI of the pituitary if indicated.
,3. Chronic Pelvic Pain: Definition
• A) Continuous or episodic non-menstrual pain of at least 6 months at or below
the umbilicus
• B) Pain lasting less than 3 months
• C) Pain associated only with menstruation
• D) Acute pain requiring emergency intervention
Correct Answer: A) Continuous or episodic non-menstrual pain of at least 6 months at
or below the umbilicus
Expert Rationale: Chronic pelvic pain (CPP) is defined as non-cyclical, non-menstrual
pain lasting at least 6 months and located below the umbilicus. It interrupts normal
activities and may involve multiple organ systems (GI, urologic, gynecologic,
musculoskeletal, neurologic). The cause is often multifactorial .
4. Chronic Pelvic Pain: Risk Factors
• A) History of physical/sexual abuse, pelvic inflammatory disease, endometriosis,
interstitial cystitis, irritable bowel syndrome, musculoskeletal disorders,
postsurgical pain
• B) Only endometriosis
• C) Only interstitial cystitis
• D) No known risk factors
Correct Answer: A) History of physical/sexual abuse, pelvic inflammatory disease,
endometriosis, interstitial cystitis, irritable bowel syndrome, musculoskeletal disorders,
postsurgical pain
Expert Rationale: CPP is associated with a history of physical or sexual abuse, pelvic
inflammatory disease, endometriosis, interstitial cystitis, irritable bowel syndrome,
musculoskeletal disorders, and postsurgical pain. The multifactorial nature of CPP
requires a comprehensive biopsychosocial approach to management .
,5. Chronic Pelvic Pain: Diagnostics
• A) Detailed abdominal, pelvic, and back examination; vaginal/cervical cultures,
UA, urine culture, CBC, pregnancy test, ESR; transvaginal/renal ultrasound,
laparoscopy, CT, or MRI
• B) Only pelvic ultrasound
• C) Only laboratory testing
• D) Only physical examination
Correct Answer: A) Detailed abdominal, pelvic, and back examination; vaginal/cervical
cultures, UA, urine culture, CBC, pregnancy test, ESR; transvaginal/renal ultrasound,
laparoscopy, CT, or MRI
Expert Rationale: The diagnostic workup for CPP is comprehensive and includes a
detailed physical examination, laboratory testing (cultures, CBC, ESR, pregnancy test),
and imaging (transvaginal ultrasound, CT, MRI). Laparoscopy may be considered in
selected cases to evaluate for endometriosis or adhesions .
6. Chronic Pelvic Pain: Management
• A) NSAIDs, TCAs, anticonvulsants, neurostimulation, laparoscopy
• B) Only NSAIDs
• C) Only hormonal therapy
• D) Only surgical intervention
Correct Answer: A) NSAIDs, TCAs, anticonvulsants, neurostimulation, laparoscopy
Expert Rationale: Management of CPP is multimodal and may include NSAIDs, tricyclic
antidepressants, anticonvulsants, neurostimulation, and laparoscopic intervention when
indicated. Counseling and support are necessary throughout management but do not
directly provide symptom relief .
7. Abnormal Uterine Bleeding: Definition
• A) Bleeding from the uterine corpus that is abnormal in duration, volume,
frequency, or regularity
, • B) Bleeding associated only with menopause
• C) Bleeding that occurs only during pregnancy
• D) Bleeding that is always heavy
Correct Answer: A) Bleeding from the uterine corpus that is abnormal in duration,
volume, frequency, or regularity
Expert Rationale: Abnormal uterine bleeding (AUB) is defined as bleeding from the
uterine corpus that deviates from normal in duration, volume, frequency, or regularity.
Chronic AUB has been present for the majority of the past 6 months. Acute AUB is an
episode of heavy bleeding that requires immediate intervention .
8. AUB: Initial Diagnostics
• A) Serum hCG, TSH, cervical cultures
• B) Liver function tests and testosterone levels
• C) Only transvaginal ultrasound
• D) Only endometrial biopsy
Correct Answer: A) Serum hCG, TSH, cervical cultures
Expert Rationale: Initial diagnostic tests for AUB include serum human chorionic
gonadotropin (hCG) to rule out pregnancy, thyroid-stimulating hormone (TSH) to
evaluate for thyroid dysfunction, and cervical cultures to rule out infection. Liver function
tests and testosterone levels are considered more advanced tests .
9. AUB: Causes (PALM-COEIN Classification)
• A) Polyp, adenomyosis, leiomyoma, malignancy, ovulatory disorders (PCOS,
hypothyroid, hyperprolactin), endometrial, iatrogenic, not otherwise classified
• B) Only fibroids and polyps
• C) Only hormonal causes
• D) Only malignancy
Correct Answer: A) Polyp, adenomyosis, leiomyoma, malignancy, ovulatory disorders
(PCOS, hypothyroid, hyperprolactin), endometrial, iatrogenic, not otherwise classified
