WILKES UNIVERSITY
Master of Science in Nursing (MSN)
NSG 554 Nurse Practitioners in Primary Care I
Academic Year: Exam 4 – Question Bank
Question 1
Which drugs decrease the efficacy of combined oral contraceptives?
Correct answer:
Phenytoin, phenobarbital, primidone, topiramate, carbamazepine, rifampin, St. John's
wort, and antiretroviral medications (ritonavir‑boosted protease inhibitors).
RATIONALE:
These drugs induce hepatic enzymes (CYP3A4) that increase the metabolism of estrogen and
progestin, reducing contraceptive efficacy. Patients taking these medications should use
additional or alternative contraception.
Question 2
What laboratory studies should be ordered for abnormal premenstrual bleeding?
Correct answer:
CBC, pregnancy test, thyroid tests. Vaginal and urine samples for PCR or culture to rule
out chlamydia.
RATIONALE:
Evaluation includes assessment for anemia (CBC), pregnancy, thyroid dysfunction, and
infection. Chlamydia is a common cause of bleeding in young women and should be excluded.
,Question 3
What are the signs and symptoms of chronic bacterial prostatitis?
Correct answer:
Irritative voiding symptoms (urethral pain, obstructive symptoms), low back and perineal
pain. Physical exam may be normal, or prostate may feel indurated or boggy. Post‑void
residual volume should be measured for retention.
RATIONALE:
Symptoms are often mild and fluctuate. The prostate may be normal on exam, unlike acute
prostatitis. Diagnosis relies on cultures of prostatic secretions after massage.
Question 4
What is hyperthyroidism (thyrotoxicosis) and its most common form?
Correct answer:
Clinical manifestations of elevated T4 or T3. The most common form is Graves' disease.
RATIONALE:
Thyrotoxicosis refers to the clinical syndrome of excess thyroid hormones. Graves' disease is an
autoimmune disorder that causes diffuse thyroid enlargement and hyperfunction. Other causes
include toxic adenoma, multinodular goiter, and thyroiditis.
Question 5
What are the single‑dose treatment options for vulvovaginal candidiasis?
Correct answer:
Miconazole 1200 mg vaginal suppository, tioconazole 6.5% cream 5 g vaginally,
extended‑release butoconazole 2% cream 5 g vaginally, or fluconazole 150 mg orally.
RATIONALE:
Single‑dose regimens offer convenience and high compliance. They are effective for
mild‑to‑moderate infection. Patients should be advised about local side effects (burning,
irritation).
, Question 6
What are the advantages of the progestin‑only minipill?
Correct answer:
Low dose of progestin and absence of estrogen makes it safe during lactation. May
increase milk flow. Good for patients who want minimal doses of hormones or women
over 35. Lacks cardiovascular risk. Can be used with sickle cell disease.
RATIONALE:
The minipill is preferred during breastfeeding and for women with contraindications to estrogen
(e.g., history of DVT, migraine with aura, hypertension). It does not affect coagulation and is
safe in sickle cell disease.
Question 7
What is the American Urological Association (AUA) symptom index?
Correct answer:
A tool for evaluating BPH symptoms, with scores from 0‑35; higher scores indicate
increasing severity.
RATIONALE:
The AUA‑SS (or IPSS) is a self‑administered questionnaire that quantifies symptom severity. It
helps guide treatment decisions and monitor response. It also includes a quality‑of‑life question.
Question 8
What is the prevalence and common causes of hypothyroidism?
Correct answer:
85% in women. May be due to failure or resection of the thyroid gland itself or deficiency
of pituitary TSH.
RATIONALE:
Hypothyroidism is more common in women. Primary hypothyroidism results from thyroid
gland dysfunction (e.g., Hashimoto's, iodine deficiency, surgical removal). Secondary
hypothyroidism occurs when the pituitary fails to produce sufficient TSH.
Master of Science in Nursing (MSN)
NSG 554 Nurse Practitioners in Primary Care I
Academic Year: Exam 4 – Question Bank
Question 1
Which drugs decrease the efficacy of combined oral contraceptives?
Correct answer:
Phenytoin, phenobarbital, primidone, topiramate, carbamazepine, rifampin, St. John's
wort, and antiretroviral medications (ritonavir‑boosted protease inhibitors).
RATIONALE:
These drugs induce hepatic enzymes (CYP3A4) that increase the metabolism of estrogen and
progestin, reducing contraceptive efficacy. Patients taking these medications should use
additional or alternative contraception.
Question 2
What laboratory studies should be ordered for abnormal premenstrual bleeding?
Correct answer:
CBC, pregnancy test, thyroid tests. Vaginal and urine samples for PCR or culture to rule
out chlamydia.
RATIONALE:
Evaluation includes assessment for anemia (CBC), pregnancy, thyroid dysfunction, and
infection. Chlamydia is a common cause of bleeding in young women and should be excluded.
,Question 3
What are the signs and symptoms of chronic bacterial prostatitis?
Correct answer:
Irritative voiding symptoms (urethral pain, obstructive symptoms), low back and perineal
pain. Physical exam may be normal, or prostate may feel indurated or boggy. Post‑void
residual volume should be measured for retention.
RATIONALE:
Symptoms are often mild and fluctuate. The prostate may be normal on exam, unlike acute
prostatitis. Diagnosis relies on cultures of prostatic secretions after massage.
Question 4
What is hyperthyroidism (thyrotoxicosis) and its most common form?
Correct answer:
Clinical manifestations of elevated T4 or T3. The most common form is Graves' disease.
RATIONALE:
Thyrotoxicosis refers to the clinical syndrome of excess thyroid hormones. Graves' disease is an
autoimmune disorder that causes diffuse thyroid enlargement and hyperfunction. Other causes
include toxic adenoma, multinodular goiter, and thyroiditis.
Question 5
What are the single‑dose treatment options for vulvovaginal candidiasis?
Correct answer:
Miconazole 1200 mg vaginal suppository, tioconazole 6.5% cream 5 g vaginally,
extended‑release butoconazole 2% cream 5 g vaginally, or fluconazole 150 mg orally.
RATIONALE:
Single‑dose regimens offer convenience and high compliance. They are effective for
mild‑to‑moderate infection. Patients should be advised about local side effects (burning,
irritation).
, Question 6
What are the advantages of the progestin‑only minipill?
Correct answer:
Low dose of progestin and absence of estrogen makes it safe during lactation. May
increase milk flow. Good for patients who want minimal doses of hormones or women
over 35. Lacks cardiovascular risk. Can be used with sickle cell disease.
RATIONALE:
The minipill is preferred during breastfeeding and for women with contraindications to estrogen
(e.g., history of DVT, migraine with aura, hypertension). It does not affect coagulation and is
safe in sickle cell disease.
Question 7
What is the American Urological Association (AUA) symptom index?
Correct answer:
A tool for evaluating BPH symptoms, with scores from 0‑35; higher scores indicate
increasing severity.
RATIONALE:
The AUA‑SS (or IPSS) is a self‑administered questionnaire that quantifies symptom severity. It
helps guide treatment decisions and monitor response. It also includes a quality‑of‑life question.
Question 8
What is the prevalence and common causes of hypothyroidism?
Correct answer:
85% in women. May be due to failure or resection of the thyroid gland itself or deficiency
of pituitary TSH.
RATIONALE:
Hypothyroidism is more common in women. Primary hypothyroidism results from thyroid
gland dysfunction (e.g., Hashimoto's, iodine deficiency, surgical removal). Secondary
hypothyroidism occurs when the pituitary fails to produce sufficient TSH.
