NR 566 Final Exam Version 1 Newest Actual Exam With Complete Questions And
Correct Detailed Answers (Verified Answers) |Already Graded A+
Question 1
A 55-year-old female patient is seeking alternatives to Hormone Replacement Therapy (HRT) for
the prevention of postmenopausal osteoporosis. Which of the following pharmacological
combinations are recognized as effective alternatives for bone health without the use of
traditional estrogen?
A) Raloxifene and Bisphosphonates
B) Testosterone and Finasteride
C) Conjugated estrogens and Medroxyprogesterone
D) Tamoxifen and Fluoxetine
E) Calcitonin and Alprazolam
Correct Answer: A) Raloxifene and Bisphosphonates
Rationale: For women who cannot or choose not to take traditional hormone replacement
therapy, Raloxifene (a Selective Estrogen Receptor Modulator) and Bisphosphonates (such
as Alendronate) serve as primary alternatives. Raloxifene provides estrogen-like effects on
bone to increase bone mineral density, while Bisphosphonates inhibit osteoclast-mediated
bone resorption. Calcitonin is also an option, though less potent. Options B and D are
incorrect as they do not address the primary goal of osteoporosis prevention in this context,
and Option C is traditional HRT.
Question 2
Which of the following medications is classified as a Selective Estrogen Receptor Modulator
(SERM) that provides the benefits of estrogen, such as bone protection, while avoiding
drawbacks like stimulation of the endometrium?
A) Estradiol
B) Progesterone
C) Raloxifene
D) Norethindrone
E) Levonorgestrel
Correct Answer: C) Raloxifene
Rationale: Selective Estrogen Receptor Modulators (SERMs) like Raloxifene, Tamoxifen,
and Toremifene are unique because they act as estrogen agonists in some tissues (like bone)
and estrogen antagonists in others (like the breast and uterus). Raloxifene specifically helps
prevent osteoporosis and reduces the risk of breast cancer without increasing the risk of
endometrial cancer, unlike pure estrogen (Option A). Options D and E are progestins.
Question 3
A patient presents with dysfunctional uterine bleeding (DUB). Which of the following is the
standard pharmacological intervention to stabilize the endometrium and control the bleeding?
A) A 3-day course of high-dose Vitamin K
, 2
B) A 10-14 day course of progestin
C) Immediate surgical ablation
D) Continuous testosterone therapy
E) A single dose of Methotrexate
Correct Answer: B) A 10-14 day course of progestin
Rationale: Dysfunctional uterine bleeding is often the result of anovulation and an estrogen-
only environment that leads to an unstable, hypertrophied endometrium. Administering a
10-14 day course of a progestin (such as Medroxyprogesterone) converts the proliferative
endometrium into a secretory endometrium. When the progestin is stopped, a withdrawal
bleed occurs, effectively "resetting" the cycle.
Question 4
In the treatment of primary amenorrhea where estrogen levels are confirmed to be low, what is
the recommended duration for progestin administration to induce a withdrawal bleed?
A) 1 day
B) 2-3 days
C) 5-10 days
D) 30 days
E) Progestin should never be used if estrogen is low
Correct Answer: C) 5-10 days
Rationale: In cases of amenorrhea where the patient has low estrogen, progestin is
administered for 5-10 days to induce menstrual flow. This is often used as a diagnostic tool
(the Progestin Challenge) or as a therapeutic measure to ensure the outflow tract is patent
and the endometrium is responsive. If no bleeding occurs, it suggests either very low
estrogen or an anatomical issue.
Question 5
What is the primary oncological benefit of incorporating long-term progestin therapy in a woman
with an intact uterus who is also receiving estrogen?
A) Protection against breast cancer
B) Protection against ovarian cancer
C) Protection against endometrial cancer
D) Protection against cervical cancer
E) Protection against hepatic carcinoma
Correct Answer: C) Protection against endometrial cancer
Rationale: Unopposed estrogen therapy in a woman with an intact uterus significantly
increases the risk of endometrial hyperplasia and subsequent endometrial cancer.
Progestins antagonize the proliferative effect of estrogen on the uterine lining. Therefore,
progestin is always added to estrogen therapy for women with a uterus to provide essential
protection against endometrial malignancy.
, 3
Question 6
A nurse practitioner is discussing estrogen replacement options with a patient. Which compound
is recognized as the most active endogenous estrogenic compound available for oral
administration?
A) Estriol
B) Estrone
C) Estradiol
D) Equilin
E) Ethinyl Estradiol
Correct Answer: C) Estradiol
Rationale: Estradiol (E2) is the most active and potent of the endogenous estrogens
produced by the ovaries. While ethinyl estradiol is a synthetic version commonly used in
oral contraceptives due to its high bioavailability, estradiol remains the most active natural
compound. It is available in various oral and non-oral formulations for hormone
replacement.
Question 7
What is a significant physiological advantage of using a transdermal estrogen patch over oral
estrogen formulations?
A) It increases the first-pass metabolism in the liver
B) It allows for a higher total estrogen dose
C) It results in lower risks of DVT, PE, and stroke
D) It must be changed every 4 hours
E) It is the only way to treat vaginal atrophy
Correct Answer: C) It results in lower risks of DVT, PE, and stroke
Rationale: Transdermal estrogen patches bypass the "first-pass" metabolism in the liver.
This results in more stable blood levels of the hormone and a lower risk of thromboembolic
events (DVT, PE, and stroke) compared to oral estrogens, which stimulate the production
of clotting factors in the liver. Additionally, transdermal routes cause less nausea and
vomiting.
Question 8
The "Femring" is an intravaginal ring used in clinical practice primarily to treat which of the
following symptoms?
A) Dysfunctional uterine bleeding
B) Systemic hot flashes and night sweats
C) Primary syphilis
D) Polycystic Ovarian Syndrome (PCOS)
E) Endometriosis pain
Correct Answer: B) Systemic hot flashes and night sweats
, 4
Rationale: Unlike some low-dose vaginal rings that only treat local symptoms, the Femring
provides a systemic dose of estrogen. It is indicated for the treatment of moderate-to-severe
vasomotor symptoms (hot flashes and night sweats) as well as vulvar and vaginal atrophy.
It is replaced every 3 months.
Question 9
When a patient is switching from one type of oral contraceptive (OC) to another, what is the "no
gap" method?
A) Taking a 7-day break between packs
B) Doubling the dose of the new OC for the first week
C) Moving directly from the last active pill of the old pack to the first active pill of the new pack
D) Taking both types of pills for 14 days
E) Waiting for the first day of the next menses to start the new pack
Correct Answer: C) Moving directly from the last active pill of the old pack to the first active
pill of the new pack
Rationale: The "no gap" method involves starting the new oral contraceptive packs
immediately after finishing the active pills of the previous pack, without taking the
placebo/reminder pills. This ensures that there is no drop in hormone levels that could lead
to breakthrough ovulation, thereby maintaining contraceptive efficacy.
Question 10
A patient is starting her first pack of oral contraceptives and chooses the "First Sunday" onset
method. What education must the nurse practitioner provide regarding backup contraception?
A) No backup is needed
B) Backup is needed for 24 hours
C) Backup is needed for 7 days
D) Backup is needed for the entire first month
E) Backup is needed only on the days she misses a pill
Correct Answer: C) Backup is needed for 7 days
Rationale: If OC therapy is started on the first day of the menstrual cycle, no backup is
needed. However, if the "Sunday Start" method is used (starting the first Sunday after
menses begins), the patient must use a backup method (like condoms) for the first 7 days of
the pack to ensure suppression of the follicular phase of the cycle.
Question 11
In which of the following scenarios is short-term androgen therapy (e.g., Fluoxymesterone)
clinically indicated for an adolescent male?
A) To increase athletic performance for school sports
B) To treat acne vulgaris
C) For delayed sexual maturation causing significant emotional distress
D) To treat type 1 diabetes
Correct Detailed Answers (Verified Answers) |Already Graded A+
Question 1
A 55-year-old female patient is seeking alternatives to Hormone Replacement Therapy (HRT) for
the prevention of postmenopausal osteoporosis. Which of the following pharmacological
combinations are recognized as effective alternatives for bone health without the use of
traditional estrogen?
A) Raloxifene and Bisphosphonates
B) Testosterone and Finasteride
C) Conjugated estrogens and Medroxyprogesterone
D) Tamoxifen and Fluoxetine
E) Calcitonin and Alprazolam
Correct Answer: A) Raloxifene and Bisphosphonates
Rationale: For women who cannot or choose not to take traditional hormone replacement
therapy, Raloxifene (a Selective Estrogen Receptor Modulator) and Bisphosphonates (such
as Alendronate) serve as primary alternatives. Raloxifene provides estrogen-like effects on
bone to increase bone mineral density, while Bisphosphonates inhibit osteoclast-mediated
bone resorption. Calcitonin is also an option, though less potent. Options B and D are
incorrect as they do not address the primary goal of osteoporosis prevention in this context,
and Option C is traditional HRT.
Question 2
Which of the following medications is classified as a Selective Estrogen Receptor Modulator
(SERM) that provides the benefits of estrogen, such as bone protection, while avoiding
drawbacks like stimulation of the endometrium?
A) Estradiol
B) Progesterone
C) Raloxifene
D) Norethindrone
E) Levonorgestrel
Correct Answer: C) Raloxifene
Rationale: Selective Estrogen Receptor Modulators (SERMs) like Raloxifene, Tamoxifen,
and Toremifene are unique because they act as estrogen agonists in some tissues (like bone)
and estrogen antagonists in others (like the breast and uterus). Raloxifene specifically helps
prevent osteoporosis and reduces the risk of breast cancer without increasing the risk of
endometrial cancer, unlike pure estrogen (Option A). Options D and E are progestins.
Question 3
A patient presents with dysfunctional uterine bleeding (DUB). Which of the following is the
standard pharmacological intervention to stabilize the endometrium and control the bleeding?
A) A 3-day course of high-dose Vitamin K
, 2
B) A 10-14 day course of progestin
C) Immediate surgical ablation
D) Continuous testosterone therapy
E) A single dose of Methotrexate
Correct Answer: B) A 10-14 day course of progestin
Rationale: Dysfunctional uterine bleeding is often the result of anovulation and an estrogen-
only environment that leads to an unstable, hypertrophied endometrium. Administering a
10-14 day course of a progestin (such as Medroxyprogesterone) converts the proliferative
endometrium into a secretory endometrium. When the progestin is stopped, a withdrawal
bleed occurs, effectively "resetting" the cycle.
Question 4
In the treatment of primary amenorrhea where estrogen levels are confirmed to be low, what is
the recommended duration for progestin administration to induce a withdrawal bleed?
A) 1 day
B) 2-3 days
C) 5-10 days
D) 30 days
E) Progestin should never be used if estrogen is low
Correct Answer: C) 5-10 days
Rationale: In cases of amenorrhea where the patient has low estrogen, progestin is
administered for 5-10 days to induce menstrual flow. This is often used as a diagnostic tool
(the Progestin Challenge) or as a therapeutic measure to ensure the outflow tract is patent
and the endometrium is responsive. If no bleeding occurs, it suggests either very low
estrogen or an anatomical issue.
Question 5
What is the primary oncological benefit of incorporating long-term progestin therapy in a woman
with an intact uterus who is also receiving estrogen?
A) Protection against breast cancer
B) Protection against ovarian cancer
C) Protection against endometrial cancer
D) Protection against cervical cancer
E) Protection against hepatic carcinoma
Correct Answer: C) Protection against endometrial cancer
Rationale: Unopposed estrogen therapy in a woman with an intact uterus significantly
increases the risk of endometrial hyperplasia and subsequent endometrial cancer.
Progestins antagonize the proliferative effect of estrogen on the uterine lining. Therefore,
progestin is always added to estrogen therapy for women with a uterus to provide essential
protection against endometrial malignancy.
, 3
Question 6
A nurse practitioner is discussing estrogen replacement options with a patient. Which compound
is recognized as the most active endogenous estrogenic compound available for oral
administration?
A) Estriol
B) Estrone
C) Estradiol
D) Equilin
E) Ethinyl Estradiol
Correct Answer: C) Estradiol
Rationale: Estradiol (E2) is the most active and potent of the endogenous estrogens
produced by the ovaries. While ethinyl estradiol is a synthetic version commonly used in
oral contraceptives due to its high bioavailability, estradiol remains the most active natural
compound. It is available in various oral and non-oral formulations for hormone
replacement.
Question 7
What is a significant physiological advantage of using a transdermal estrogen patch over oral
estrogen formulations?
A) It increases the first-pass metabolism in the liver
B) It allows for a higher total estrogen dose
C) It results in lower risks of DVT, PE, and stroke
D) It must be changed every 4 hours
E) It is the only way to treat vaginal atrophy
Correct Answer: C) It results in lower risks of DVT, PE, and stroke
Rationale: Transdermal estrogen patches bypass the "first-pass" metabolism in the liver.
This results in more stable blood levels of the hormone and a lower risk of thromboembolic
events (DVT, PE, and stroke) compared to oral estrogens, which stimulate the production
of clotting factors in the liver. Additionally, transdermal routes cause less nausea and
vomiting.
Question 8
The "Femring" is an intravaginal ring used in clinical practice primarily to treat which of the
following symptoms?
A) Dysfunctional uterine bleeding
B) Systemic hot flashes and night sweats
C) Primary syphilis
D) Polycystic Ovarian Syndrome (PCOS)
E) Endometriosis pain
Correct Answer: B) Systemic hot flashes and night sweats
, 4
Rationale: Unlike some low-dose vaginal rings that only treat local symptoms, the Femring
provides a systemic dose of estrogen. It is indicated for the treatment of moderate-to-severe
vasomotor symptoms (hot flashes and night sweats) as well as vulvar and vaginal atrophy.
It is replaced every 3 months.
Question 9
When a patient is switching from one type of oral contraceptive (OC) to another, what is the "no
gap" method?
A) Taking a 7-day break between packs
B) Doubling the dose of the new OC for the first week
C) Moving directly from the last active pill of the old pack to the first active pill of the new pack
D) Taking both types of pills for 14 days
E) Waiting for the first day of the next menses to start the new pack
Correct Answer: C) Moving directly from the last active pill of the old pack to the first active
pill of the new pack
Rationale: The "no gap" method involves starting the new oral contraceptive packs
immediately after finishing the active pills of the previous pack, without taking the
placebo/reminder pills. This ensures that there is no drop in hormone levels that could lead
to breakthrough ovulation, thereby maintaining contraceptive efficacy.
Question 10
A patient is starting her first pack of oral contraceptives and chooses the "First Sunday" onset
method. What education must the nurse practitioner provide regarding backup contraception?
A) No backup is needed
B) Backup is needed for 24 hours
C) Backup is needed for 7 days
D) Backup is needed for the entire first month
E) Backup is needed only on the days she misses a pill
Correct Answer: C) Backup is needed for 7 days
Rationale: If OC therapy is started on the first day of the menstrual cycle, no backup is
needed. However, if the "Sunday Start" method is used (starting the first Sunday after
menses begins), the patient must use a backup method (like condoms) for the first 7 days of
the pack to ensure suppression of the follicular phase of the cycle.
Question 11
In which of the following scenarios is short-term androgen therapy (e.g., Fluoxymesterone)
clinically indicated for an adolescent male?
A) To increase athletic performance for school sports
B) To treat acne vulgaris
C) For delayed sexual maturation causing significant emotional distress
D) To treat type 1 diabetes
