2025 NRNP 6552 MIDTERM EXAM: ADVANCED
NURSE PRACTICE IN REPRODUCTION
Walden University | 100 Questions & Answers
(Graded)
1. A 24-year-old nulligravida presents with cyclic pelvic pain, dyspareunia, and
tender nodularity along the uterosacral ligaments on bimanual exam. Which
initial imaging study is most appropriate to evaluate suspected endometriosis?
A. Transabdominal pelvic ultrasound
B. Transvaginal pelvic ultrasound
C. Pelvic MRI
D. CT abdomen/pelvis
Answer: B
Rationale: Transvaginal ultrasound is the 2025 first-line imaging modality for
endometriosis when performed by an experienced operator (ACOG 2024).
Transabdominal views lack resolution for superficial implants, while MRI is
reserved for equivocal cases or pre-surgical mapping. CT offers no soft-tissue
contrast for endometriotic lesions.
2. A 19-year-old G0 requests contraception. She has migraine with aura, BMI 32
kg/m², and smokes 10 cigarettes/day. Which method is absolutely
contraindicated?
A. Depot medroxyprogesterone acetate
B. Copper IUD
C. Combined oral contraceptives
D. Etonogestrel implant
Answer: C
Rationale: Combined hormonal contraceptives are WHO category 4 (absolute
contraindication) in migraine with aura due to increased ischemic stroke risk
(CDC MEC 2024). Smoking <35 y is category 3, but aura overrides age. DMPA,
implant, and copper IUD are safe.
3. When performing a speculum exam on a menarcheal 13-year-old, which blade
size and approach minimizes patient distress while visualizing the cervix?
A. Pedersen narrow, warmed, inserted at 30° downward angle
B. Graves medium, room temperature, horizontal insertion
C. Pedersen narrow, pre-soaked in lidocaine gel, 45° angle
D. Huffman narrow, chilled, posterior pressure
Answer: A
Rationale: Pedersen narrow blades fit most nulliparous adolescents; warming
pg. 1
, reduces vaginismus reflex (AAP 2025). Lidocaine gel is not evidence-based, and
chilled specula increase discomfort. Graves blades are too wide.
4. A 32-year-old G2P2 with 6-week amenorrhea presents with spotting and β-hCG
1,800 IU/L. Transvaginal ultrasound shows empty uterus with endometrial
thickness 8 mm, no adnexal masses, and free fluid in cul-de-sac. What is the next
best action?
A. Repeat β-hCG in 48 h
B. Immediate methotrexate
C. Uterine aspiration
D. Prescribe misoprostol
Answer: A
Rationale: β-hCG <3,500 IU/L with no intrauterine or ectopic visualization
requires serial β-hCG to determine viability or ectopic trend (ACOG 2023).
Methotrexate or aspiration is premature without established diagnosis.
5. Which screening strategy is recommended for Chlamydia trachomatis in a 17-
year-old sexually active female?
A. Annual cervical cytology only
B. Annual nucleic acid amplification test (NAAT) from urine or vaginal swab
C. Biannual NAAT if prior partner >5 years older
D. Only if symptomatic
Answer: B
Rationale: CDC 2025 STI guidelines recommend annual NAAT screening for all
sexually active women ≤24 y regardless of symptoms. Cervical cytology does not
detect chlamydia; age-based, not partner-age, determines frequency.
6. A 45-year-old woman reports 10 months of amenorrhea, hot flashes, and FSH 45
IU/L. She still uses combined oral contraceptives (COC). What is the most
appropriate guidance?
A. Stop COC now; diagnose menopause
B. Continue COC until age 50
C. Switch to menopausal hormone therapy
D. Repeat FSH in 6 weeks off COC
Answer: D
Rationale: COC suppresses FSH; accurate menopause diagnosis requires 12 mo
amenorrhea off hormonal contraception (NAMS 2024). Repeat FSH after 6-week
pill-free interval clarifies status.
7. A patient with PCOS desires pregnancy. Which medication is first-line for
ovulation induction per 2025 ACOG/ASRM guidelines?
A. Clomiphene citrate
B. Letrozole
C. Metformin alone
pg. 2
, D. Gonadotropins
Answer: B
Rationale: Letrozole has superior ovulation and live-birth rates vs clomiphene in
PCOS (ACOG 2024). Metformin alone is less effective; gonadotropins are second-
line.
8. A 28-year-old G1P0 at 10 weeks gestation asks about non-invasive prenatal
testing (NIPT). Which statement is correct?
A. Screens only for trisomy 21
B. Can determine fetal sex at 10 weeks
C. Requires chorionic villus sampling for confirmation
D. False-positive rate >10%
Answer: B
Rationale: Cell-free DNA detects fetal sex chromosomes by 9–10 weeks with
>99% accuracy (ACOG 2025). It screens common aneuploidies, has <0.15% false-
positive rate, and positive results need invasive testing.
9. Which vaccine is contraindicated in pregnancy?
A. Tdap
B. Influenza inactivated
C. MMR
D. COVID-19 mRNA
Answer: C
Rationale: MMR is live-attenuated and contraindicated due to theoretical fetal
risk (CDC 2025). Tdap, inactivated influenza, and COVID-19 vaccines are
recommended.
10. A 38-year-old woman with BRCA1 mutation completes childbearing. What is the
most effective risk-reducing strategy?
A. Annual MRI and mammography
B. Risk-reducing salpingo-oophorectomy by age 40
C. Tamoxifen chemoprevention
D. Bilateral mastectomy only
Answer: B
Rationale: BRCA1 carriers have 40–60% lifetime ovarian cancer risk; salpingo-
oophorectomy by 40 reduces risk 80% and breast cancer 50% (NCCN 2025).
Surveillance does not prevent disease.
11. A 21-year-old reports dysuria and intermenstrual bleeding. Cervical motion
tenderness is noted. NAAT positive for N. gonorrhoeae. Which regimen is
recommended for uncomplicated gonorrhea in 2025?
A. Ceftriaxone 500 mg IM ×1
B. Cefixime 400 mg PO ×1
C. Azithromycin 1 g PO ×1
pg. 3
NURSE PRACTICE IN REPRODUCTION
Walden University | 100 Questions & Answers
(Graded)
1. A 24-year-old nulligravida presents with cyclic pelvic pain, dyspareunia, and
tender nodularity along the uterosacral ligaments on bimanual exam. Which
initial imaging study is most appropriate to evaluate suspected endometriosis?
A. Transabdominal pelvic ultrasound
B. Transvaginal pelvic ultrasound
C. Pelvic MRI
D. CT abdomen/pelvis
Answer: B
Rationale: Transvaginal ultrasound is the 2025 first-line imaging modality for
endometriosis when performed by an experienced operator (ACOG 2024).
Transabdominal views lack resolution for superficial implants, while MRI is
reserved for equivocal cases or pre-surgical mapping. CT offers no soft-tissue
contrast for endometriotic lesions.
2. A 19-year-old G0 requests contraception. She has migraine with aura, BMI 32
kg/m², and smokes 10 cigarettes/day. Which method is absolutely
contraindicated?
A. Depot medroxyprogesterone acetate
B. Copper IUD
C. Combined oral contraceptives
D. Etonogestrel implant
Answer: C
Rationale: Combined hormonal contraceptives are WHO category 4 (absolute
contraindication) in migraine with aura due to increased ischemic stroke risk
(CDC MEC 2024). Smoking <35 y is category 3, but aura overrides age. DMPA,
implant, and copper IUD are safe.
3. When performing a speculum exam on a menarcheal 13-year-old, which blade
size and approach minimizes patient distress while visualizing the cervix?
A. Pedersen narrow, warmed, inserted at 30° downward angle
B. Graves medium, room temperature, horizontal insertion
C. Pedersen narrow, pre-soaked in lidocaine gel, 45° angle
D. Huffman narrow, chilled, posterior pressure
Answer: A
Rationale: Pedersen narrow blades fit most nulliparous adolescents; warming
pg. 1
, reduces vaginismus reflex (AAP 2025). Lidocaine gel is not evidence-based, and
chilled specula increase discomfort. Graves blades are too wide.
4. A 32-year-old G2P2 with 6-week amenorrhea presents with spotting and β-hCG
1,800 IU/L. Transvaginal ultrasound shows empty uterus with endometrial
thickness 8 mm, no adnexal masses, and free fluid in cul-de-sac. What is the next
best action?
A. Repeat β-hCG in 48 h
B. Immediate methotrexate
C. Uterine aspiration
D. Prescribe misoprostol
Answer: A
Rationale: β-hCG <3,500 IU/L with no intrauterine or ectopic visualization
requires serial β-hCG to determine viability or ectopic trend (ACOG 2023).
Methotrexate or aspiration is premature without established diagnosis.
5. Which screening strategy is recommended for Chlamydia trachomatis in a 17-
year-old sexually active female?
A. Annual cervical cytology only
B. Annual nucleic acid amplification test (NAAT) from urine or vaginal swab
C. Biannual NAAT if prior partner >5 years older
D. Only if symptomatic
Answer: B
Rationale: CDC 2025 STI guidelines recommend annual NAAT screening for all
sexually active women ≤24 y regardless of symptoms. Cervical cytology does not
detect chlamydia; age-based, not partner-age, determines frequency.
6. A 45-year-old woman reports 10 months of amenorrhea, hot flashes, and FSH 45
IU/L. She still uses combined oral contraceptives (COC). What is the most
appropriate guidance?
A. Stop COC now; diagnose menopause
B. Continue COC until age 50
C. Switch to menopausal hormone therapy
D. Repeat FSH in 6 weeks off COC
Answer: D
Rationale: COC suppresses FSH; accurate menopause diagnosis requires 12 mo
amenorrhea off hormonal contraception (NAMS 2024). Repeat FSH after 6-week
pill-free interval clarifies status.
7. A patient with PCOS desires pregnancy. Which medication is first-line for
ovulation induction per 2025 ACOG/ASRM guidelines?
A. Clomiphene citrate
B. Letrozole
C. Metformin alone
pg. 2
, D. Gonadotropins
Answer: B
Rationale: Letrozole has superior ovulation and live-birth rates vs clomiphene in
PCOS (ACOG 2024). Metformin alone is less effective; gonadotropins are second-
line.
8. A 28-year-old G1P0 at 10 weeks gestation asks about non-invasive prenatal
testing (NIPT). Which statement is correct?
A. Screens only for trisomy 21
B. Can determine fetal sex at 10 weeks
C. Requires chorionic villus sampling for confirmation
D. False-positive rate >10%
Answer: B
Rationale: Cell-free DNA detects fetal sex chromosomes by 9–10 weeks with
>99% accuracy (ACOG 2025). It screens common aneuploidies, has <0.15% false-
positive rate, and positive results need invasive testing.
9. Which vaccine is contraindicated in pregnancy?
A. Tdap
B. Influenza inactivated
C. MMR
D. COVID-19 mRNA
Answer: C
Rationale: MMR is live-attenuated and contraindicated due to theoretical fetal
risk (CDC 2025). Tdap, inactivated influenza, and COVID-19 vaccines are
recommended.
10. A 38-year-old woman with BRCA1 mutation completes childbearing. What is the
most effective risk-reducing strategy?
A. Annual MRI and mammography
B. Risk-reducing salpingo-oophorectomy by age 40
C. Tamoxifen chemoprevention
D. Bilateral mastectomy only
Answer: B
Rationale: BRCA1 carriers have 40–60% lifetime ovarian cancer risk; salpingo-
oophorectomy by 40 reduces risk 80% and breast cancer 50% (NCCN 2025).
Surveillance does not prevent disease.
11. A 21-year-old reports dysuria and intermenstrual bleeding. Cervical motion
tenderness is noted. NAAT positive for N. gonorrhoeae. Which regimen is
recommended for uncomplicated gonorrhea in 2025?
A. Ceftriaxone 500 mg IM ×1
B. Cefixime 400 mg PO ×1
C. Azithromycin 1 g PO ×1
pg. 3
