NU661 MIDTERM EXAM 2026/2027 | Primary Care of
Childbearing Woman Review | Regis College | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1: Reproductive Anatomy, Physiology, & Menstrual Cycle (12
Questions)
Q1: A 24-year-old nulligravida presents to the women's health clinic with irregular
menses occurring every 35–50 days. She reports acne and mild hirsutism. Which
hormone imbalance is most likely responsible for her clinical presentation?
A. Elevated follicle-stimulating hormone (FSH) with normal luteinizing hormone (LH)
[CORRECT]
B. Elevated luteinizing hormone (LH) with normal follicle-stimulating hormone (FSH)
C. Elevated progesterone with decreased estradiol
D. Elevated prolactin with decreased thyroid-stimulating hormone
Correct Answer: A
Rationale: Polycystic ovary syndrome (PCOS), suggested by oligomenorrhea, acne, and
hirsutism, is characterized by elevated LH:FSH ratio (typically >2:1), not elevated FSH
with normal LH. Elevated FSH with normal LH suggests ovarian failure. Elevated
progesterone would cause regular cycles, and hyperprolactinemia typically causes
amenorrhea with galactorrhea, not hirsutism. (ACOG Practice Bulletin No. 194, 2018;
reaffirmed 2026)
,Q2: During a routine pelvic examination, a nurse practitioner palpates a firm, smooth,
mobile mass approximately 6 cm in the right adnexa of a 32-year-old patient. The mass
is nontender, and the patient is asymptomatic. Which anatomical structure is most likely
the origin of this finding?
A. Uterine corpus
B. Ovarian follicle
C. Broad ligament
D. Cervix
Correct Answer: B
Rationale: A smooth, mobile, nontender adnexal mass in a reproductive-age woman is
most consistent with a benign ovarian neoplasm or functional cyst. Uterine corpus
masses (leiomyomas) are typically midline and not mobile. Broad ligament masses are
rare and usually fixed. Cervical masses would be palpated on vaginal exam, not in the
adnexa. (ACOG Practice Bulletin No. 174, 2016; reaffirmed 2026)
Q3: A 28-year-old patient asks about the physiological changes occurring during the
luteal phase of her menstrual cycle. Which statement by the nurse practitioner is most
accurate?
A. "The endometrium undergoes proliferation under estrogen influence during this
phase."
B. "Progesterone dominance causes endometrial secretion and preparation for
implantation." [CORRECT]
C. "Follicular maturation peaks and LH surge triggers ovulation during the luteal phase."
D. "Estrogen levels drop precipitously, causing menstruation to begin immediately."
Correct Answer: B
Rationale: The luteal phase is characterized by progesterone dominance from the
corpus luteum, causing secretory endometrial changes. Endometrial proliferation
occurs in the follicular phase under estrogen. Follicular maturation and LH surge occur
,in the late follicular phase, not luteal. Estrogen and progesterone decline at the end of
the luteal phase if no implantation occurs, triggering menstruation, not during the entire
luteal phase. (ACOG Committee Opinion No. 651, 2015; reaffirmed 2026)
Q4: A nurse practitioner is educating a 19-year-old patient about the
hypothalamic-pituitary-ovarian axis. The patient asks which hormone directly stimulates
ovulation. Which response is correct?
A. Follicle-stimulating hormone (FSH)
B. Luteinizing hormone (LH) [CORRECT]
C. Human chorionic gonadotropin (hCG)
D. Gonadotropin-releasing hormone (GnRH)
Correct Answer: B
Rationale: The midcycle LH surge triggers final oocyte maturation and ovulation within
24–36 hours. FSH stimulates follicular growth but does not directly cause ovulation.
hCG maintains corpus luteum function in pregnancy. GnRH stimulates pituitary release
of FSH and LH but does not act directly on the ovary. (ACOG Committee Opinion No.
651, 2015; reaffirmed 2026)
Q5: A 35-year-old patient presents with menorrhagia and is found to have a 4-cm
submucosal leiomyoma on transvaginal ultrasound. The nurse practitioner explains that
this type of fibroid is most likely to cause which complication?
A. Deep dyspareunia
B. Infertility and pregnancy loss [CORRECT]
C. Ovarian torsion
D. Cervical insufficiency
Correct Answer: B
, Rationale: Submucosal leiomyomas distort the endometrial cavity, interfering with
implantation and increasing risk of infertility and miscarriage. Deep dyspareunia is
associated with posterior wall fibroids. Ovarian torsion is unrelated to uterine fibroids.
Cervical fibroids, not submucosal, may cause cervical insufficiency. (ACOG Practice
Bulletin No. 228, 2021; reaffirmed 2026)
Q6: During a well-woman visit, a 26-year-old patient reports heavy menstrual bleeding
with clots and severe cramping that has progressively worsened over 2 years. She
denies intermenstrual bleeding. Which condition should the nurse practitioner suspect
first?
A. Endometrial hyperplasia
B. Adenomyosis
C. Endometriosis [CORRECT]
D. Cervical dysplasia
Correct Answer: C
Rationale: Progressive dysmenorrhea and menorrhagia in a young woman are classic
for endometriosis. Endometrial hyperplasia typically presents with intermenstrual
bleeding in perimenopausal women. Adenomyosis more commonly affects multiparous
women over 35. Cervical dysplasia is usually asymptomatic and detected on Pap
smear. (ACOG Practice Bulletin No. 760, 2018; reaffirmed 2026)
Q7: A nurse practitioner is reviewing the anatomy of the pelvic floor with a patient
preparing for childbirth. Which muscle group forms the primary supportive layer of the
pelvic floor?
A. Obturator internus
B. Levator ani complex [CORRECT]
C. Piriformis
Childbearing Woman Review | Regis College | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1: Reproductive Anatomy, Physiology, & Menstrual Cycle (12
Questions)
Q1: A 24-year-old nulligravida presents to the women's health clinic with irregular
menses occurring every 35–50 days. She reports acne and mild hirsutism. Which
hormone imbalance is most likely responsible for her clinical presentation?
A. Elevated follicle-stimulating hormone (FSH) with normal luteinizing hormone (LH)
[CORRECT]
B. Elevated luteinizing hormone (LH) with normal follicle-stimulating hormone (FSH)
C. Elevated progesterone with decreased estradiol
D. Elevated prolactin with decreased thyroid-stimulating hormone
Correct Answer: A
Rationale: Polycystic ovary syndrome (PCOS), suggested by oligomenorrhea, acne, and
hirsutism, is characterized by elevated LH:FSH ratio (typically >2:1), not elevated FSH
with normal LH. Elevated FSH with normal LH suggests ovarian failure. Elevated
progesterone would cause regular cycles, and hyperprolactinemia typically causes
amenorrhea with galactorrhea, not hirsutism. (ACOG Practice Bulletin No. 194, 2018;
reaffirmed 2026)
,Q2: During a routine pelvic examination, a nurse practitioner palpates a firm, smooth,
mobile mass approximately 6 cm in the right adnexa of a 32-year-old patient. The mass
is nontender, and the patient is asymptomatic. Which anatomical structure is most likely
the origin of this finding?
A. Uterine corpus
B. Ovarian follicle
C. Broad ligament
D. Cervix
Correct Answer: B
Rationale: A smooth, mobile, nontender adnexal mass in a reproductive-age woman is
most consistent with a benign ovarian neoplasm or functional cyst. Uterine corpus
masses (leiomyomas) are typically midline and not mobile. Broad ligament masses are
rare and usually fixed. Cervical masses would be palpated on vaginal exam, not in the
adnexa. (ACOG Practice Bulletin No. 174, 2016; reaffirmed 2026)
Q3: A 28-year-old patient asks about the physiological changes occurring during the
luteal phase of her menstrual cycle. Which statement by the nurse practitioner is most
accurate?
A. "The endometrium undergoes proliferation under estrogen influence during this
phase."
B. "Progesterone dominance causes endometrial secretion and preparation for
implantation." [CORRECT]
C. "Follicular maturation peaks and LH surge triggers ovulation during the luteal phase."
D. "Estrogen levels drop precipitously, causing menstruation to begin immediately."
Correct Answer: B
Rationale: The luteal phase is characterized by progesterone dominance from the
corpus luteum, causing secretory endometrial changes. Endometrial proliferation
occurs in the follicular phase under estrogen. Follicular maturation and LH surge occur
,in the late follicular phase, not luteal. Estrogen and progesterone decline at the end of
the luteal phase if no implantation occurs, triggering menstruation, not during the entire
luteal phase. (ACOG Committee Opinion No. 651, 2015; reaffirmed 2026)
Q4: A nurse practitioner is educating a 19-year-old patient about the
hypothalamic-pituitary-ovarian axis. The patient asks which hormone directly stimulates
ovulation. Which response is correct?
A. Follicle-stimulating hormone (FSH)
B. Luteinizing hormone (LH) [CORRECT]
C. Human chorionic gonadotropin (hCG)
D. Gonadotropin-releasing hormone (GnRH)
Correct Answer: B
Rationale: The midcycle LH surge triggers final oocyte maturation and ovulation within
24–36 hours. FSH stimulates follicular growth but does not directly cause ovulation.
hCG maintains corpus luteum function in pregnancy. GnRH stimulates pituitary release
of FSH and LH but does not act directly on the ovary. (ACOG Committee Opinion No.
651, 2015; reaffirmed 2026)
Q5: A 35-year-old patient presents with menorrhagia and is found to have a 4-cm
submucosal leiomyoma on transvaginal ultrasound. The nurse practitioner explains that
this type of fibroid is most likely to cause which complication?
A. Deep dyspareunia
B. Infertility and pregnancy loss [CORRECT]
C. Ovarian torsion
D. Cervical insufficiency
Correct Answer: B
, Rationale: Submucosal leiomyomas distort the endometrial cavity, interfering with
implantation and increasing risk of infertility and miscarriage. Deep dyspareunia is
associated with posterior wall fibroids. Ovarian torsion is unrelated to uterine fibroids.
Cervical fibroids, not submucosal, may cause cervical insufficiency. (ACOG Practice
Bulletin No. 228, 2021; reaffirmed 2026)
Q6: During a well-woman visit, a 26-year-old patient reports heavy menstrual bleeding
with clots and severe cramping that has progressively worsened over 2 years. She
denies intermenstrual bleeding. Which condition should the nurse practitioner suspect
first?
A. Endometrial hyperplasia
B. Adenomyosis
C. Endometriosis [CORRECT]
D. Cervical dysplasia
Correct Answer: C
Rationale: Progressive dysmenorrhea and menorrhagia in a young woman are classic
for endometriosis. Endometrial hyperplasia typically presents with intermenstrual
bleeding in perimenopausal women. Adenomyosis more commonly affects multiparous
women over 35. Cervical dysplasia is usually asymptomatic and detected on Pap
smear. (ACOG Practice Bulletin No. 760, 2018; reaffirmed 2026)
Q7: A nurse practitioner is reviewing the anatomy of the pelvic floor with a patient
preparing for childbirth. Which muscle group forms the primary supportive layer of the
pelvic floor?
A. Obturator internus
B. Levator ani complex [CORRECT]
C. Piriformis
