NSG500 / NSG 500
Exam 3: Advanced Health Assessment
Questions and Verified Answers | 100% Correct | Grade A
Wilkes University | Curriculum Standards
Section 1: Genitourinary and Reproductive Health Assessment (Male and Female)
Q1: A 28-year-old female presents for her annual well-woman examination. She reports her last menstrual
period (LMP) was 3 weeks ago. Her menstrual cycles are regular at 28-day intervals with 5 days of moderate
flow. She uses a combined oral contraceptive pill for contraception. Which component of the GTPAL system
should the nurse practitioner document for this patient?
A. G = 0, T = 0, P = 0, A = 0, L = 0 [CORRECT]
B. G = 1, T = 0, P = 0, A = 0, L = 0
C. G = 0, T = 0, P = 0, A = 1, L = 0
D. G = 0, T = 0, P = 0, A = 0, L = 1
Correct Answer: A
Rationale: The GTPAL system documents obstetric history: Gravida (total pregnancies), Term births, Preterm births, Abortions
(spontaneous or induced), and Living children. This patient has no history of pregnancy, so all values are 0. Gravida refers to the
number of pregnancies regardless of outcome, not the number of deliveries. Term and preterm refer to the number of births at specific
gestational ages. Using oral contraceptives does not affect GTPAL documentation.
Q2: A 24-year-old woman presents with a thick, white, curd-like vaginal discharge, intense vulvar pruritus, and
dyspareunia. The vaginal pH is 4.0. Which of the following is the most likely diagnosis?
A. Bacterial vaginosis
B. Trichomoniasis
C. Vulvovaginal candidiasis [CORRECT]
D. Atrophic vaginitis
Correct Answer: C
Rationale: Vulvovaginal candidiasis presents with thick, white, curd-like (cottage cheese) discharge, intense pruritus, and a vaginal pH
of 4.0 to 4.5, which is within the normal range. Bacterial vaginosis presents with thin, grayish, homogeneous discharge with a fishy
odor and a pH greater than 4.5. Trichomoniasis presents with a frothy, yellow-green discharge and a pH of 4.5 to 5.5. Atrophic
vaginitis typically occurs in postmenopausal women due to decreased estrogen and presents with vaginal dryness and dyspareunia.
Q3: A 35-year-old female presents with lower abdominal pain, fever of 101.2 F, mucopurulent cervical
discharge, and cervical motion tenderness on bimanual examination. Which finding is most consistent with
pelvic inflammatory disease (PID)?
A. Negative cervical motion tenderness with adnexal fullness
B. Cervical motion tenderness, adnexal tenderness, and fever [CORRECT]
C. A palpable adnexal mass without cervical discharge
NSG500 Exam 3 - Advanced Health Assessment | Page 1
, D. Midline uterine tenderness without fever or discharge
Correct Answer: B
Rationale: The diagnosis of PID is clinically based on the presence of cervical motion tenderness (chandelier sign), uterine tenderness,
or adnexal tenderness plus at least one additional criterion including oral temperature greater than 101 F, mucopurulent cervical or
vaginal discharge, elevated ESR or CRP, or laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis. A
palpable adnexal mass without fever or discharge is more concerning for an ovarian cyst or tubo-ovarian abscess. Midline uterine
tenderness alone is nonspecific and may be associated with many conditions including endometriosis or early pregnancy.
Q4: A 52-year-old African American male presents with complaints of urinary frequency, urgency, nocturia
(3-4 times per night), weak urinary stream, and a sensation of incomplete bladder emptying. The nurse
practitioner suspects benign prostatic hyperplasia (BPH). Which finding on digital rectal exam (DRE) would
most support this diagnosis?
A. A hard, irregular, fixed nodule on the prostate
B. An enlarged, symmetric, smooth, and firm prostate [CORRECT]
C. A tender, boggy prostate with fluctuance
D. A small, atrophic prostate gland
Correct Answer: B
Rationale: BPH typically presents with an enlarged, symmetric, smooth, and firm prostate on DRE, reflecting the benign hyperplastic
growth of the transition zone. A hard, irregular, fixed nodule is highly suspicious for prostate cancer. A tender, boggy prostate with
fluctuance suggests acute prostatitis or prostatic abscess. A small, atrophic prostate is not consistent with BPH and may be seen in
hypogonadism or after androgen deprivation therapy.
Q5: A nurse practitioner is performing a speculum exam on a 32-year-old female. Which technique is correct
for inserting the speculum?
A. Insert the speculum blade laterally and rotate 90 degrees once fully inserted
B. Apply firm downward pressure on the perineum while advancing the speculum
C. Warm the speculum, apply water-based lubricant to the blades, and insert at a 45-degree angle directed
toward the sacrum, then lower the handle after insertion [CORRECT]
D. Insert the speculum with the blades open to maximize the initial view of the vaginal walls
Correct Answer: C
Rationale: The correct technique involves warming the speculum for patient comfort, applying water-based lubricant (not petroleum
jelly, which can interfere with cytology), inserting at a 45-degree angle posteriorly toward the sacrum following the natural curve of the
vagina, then lowering the handle to open the blades and visualize the cervix. Inserting laterally and rotating may cause patient
discomfort and tissue trauma. Firm downward pressure is not part of proper technique. Inserting with blades open would cause
discomfort and should only be done after the speculum is fully inserted.
Q6: A 22-year-old sexually active female presents for a routine Pap smear and HPV co-test. According to the
USPSTF screening guidelines, which recommendation is most appropriate for this patient?
A. Pap smear alone every 3 years beginning at age 21
B. Pap smear with HPV co-testing every 5 years beginning at age 25 [CORRECT]
C. HPV testing alone every 5 years beginning at age 21
D. Pap smear every year until age 30, then every 3 years
Correct Answer: B
Rationale: Current USPSTF guidelines (2018) recommend cervical cancer screening for women aged 21 to 29 with Pap smear alone
every 3 years, and for women aged 30 to 65 with three options: Pap smear alone every 3 years, HPV testing alone every 5 years, or Pap
smear with HPV co-testing every 5 years. For this 22-year-old patient, Pap smear alone every 3 years is the appropriate
NSG500 Exam 3 - Advanced Health Assessment | Page 2
,recommendation. HPV co-testing is not recommended before age 30 in average-risk women. Annual Pap smears have not been
recommended for many years and increase the risk of false-positive results and unnecessary procedures.
Q7: A 19-year-old male presents with sudden onset of severe right testicular pain, nausea, and vomiting that
began 4 hours ago. The testis is swollen, tender, and elevated with an abnormal transverse lie. Which condition
is the priority diagnosis?
A. Epididymitis
B. Testicular torsion [CORRECT]
C. Varicocele
D. Hydrocele
Correct Answer: B
Rationale: Testicular torsion is a surgical emergency that requires intervention within 6 hours to salvage the testis. It presents with
sudden, severe testicular pain, nausea, vomiting, an elevated testis (high-riding testis), and an abnormal transverse lie. The cremasteric
reflex is typically absent. Epididymitis presents more gradually with pain, dysuria, and pyuria, and the testis is typically in a normal
position. A varicocele feels like a 'bag of worms' on palpation, is more common on the left side, and is not acutely painful. A hydrocele
presents as a painless, fluid-filled swelling that transilluminates.
Q8: A 45-year-old female presents with a 3-month history of progressive pelvic pressure, menorrhagia, and
urinary frequency. On bimanual examination, the uterus is enlarged, irregular, and nodular, approximately 14
weeks in size. Which condition is most likely?
A. Ovarian cancer
B. Uterine fibroids (leiomyomas) [CORRECT]
C. Endometriosis
D. Adenomyosis
Correct Answer: B
Rationale: Uterine fibroids (leiomyomas) are the most common benign tumors in women and present with menorrhagia, pelvic pressure
or pain, urinary frequency due to bladder compression, and an enlarged, irregular, nodular uterus on bimanual examination. Ovarian
cancer typically presents with a palpable adnexal mass rather than uterine enlargement, and symptoms are often vague including
bloating and early satiety. Endometriosis typically presents with dysmenorrhea, dyspareunia, and infertility, and the uterus is usually
normal in size on examination. Adenomyosis typically causes a symmetrically enlarged, globular uterus rather than an irregular,
nodular one.
Q9: A urinalysis reveals the following findings: specific gravity 1.030, pH 5.5, negative glucose, negative
ketones, 2+ protein, positive nitrites, positive leukocyte esterase, and 10-20 WBCs/HPF on microscopy. Which
condition is most consistent with these results?
A. Nephrotic syndrome
B. Urinary tract infection (cystitis) [CORRECT]
C. Diabetic nephropathy
D. Glomerulonephritis
Correct Answer: B
Rationale: Positive nitrites (produced by Enterobacteriaceae that reduce nitrates to nitrites) and positive leukocyte esterase (indicating
pyuria) together with WBCs on microscopy are classic findings of a urinary tract infection. The presence of nitrites is highly specific for
UTI caused by gram-negative organisms, most commonly E. coli. Nephrotic syndrome would present with massive proteinuria (3+ to
4+), hypoalbuminemia, edema, and lipiduria but would not have nitrites or leukocyte esterase. Diabetic nephropathy presents with
microalbuminuria or proteinuria, not nitrites. Glomerulonephritis presents with proteinuria, hematuria, and RBC casts, not nitrites or
positive leukocyte esterase.
NSG500 Exam 3 - Advanced Health Assessment | Page 3
, Q10: A 30-year-old female presents with oligomenorrhea, hirsutism, acne, and an elevated BMI of 32.
Laboratory testing reveals elevated LH:FSH ratio greater than 2:1 and elevated total and free testosterone.
Pelvic ultrasound reveals enlarged ovaries with multiple peripheral cysts. Which is the most likely diagnosis?
A. Cushing syndrome
B. Polycystic ovary syndrome (PCOS) [CORRECT]
C. Congenital adrenal hyperplasia
D. Ovarian cancer
Correct Answer: B
Rationale: PCOS is diagnosed using the Rotterdam criteria, which require two of three findings: oligo/anovulation, clinical or
biochemical signs of hyperandrogenism (hirsutism, acne, elevated testosterone), and polycystic ovaries on ultrasound. The elevated
LH:FSH ratio (typically 2:1 or 3:1) and elevated testosterone support the diagnosis. Cushing syndrome presents with central obesity,
moon face, buffalo hump, striae, and elevated cortisol, not with polycystic ovaries or elevated LH:FSH ratio. Congenital adrenal
hyperplasia presents with elevated 17-hydroxyprogesterone. Ovarian cancer would present with a solid or complex adnexal mass, not
with the endocrine symptoms described.
Q11: A 40-year-old male presents with a painless scrotal mass that has been gradually enlarging over the past 2
months. On examination, the mass is firm, does not transilluminate, and cannot be separated from the testis.
What is the most appropriate next step in management?
A. Reassure the patient and schedule follow-up in 3 months
B. Prescribe antibiotics and re-evaluate in 2 weeks
C. Order a scrotal ultrasound and refer urgently to urology [CORRECT]
D. Order a CT scan of the abdomen and pelvis
Correct Answer: C
Rationale: A firm, non-transilluminating scrotal mass that cannot be separated from the testis is concerning for testicular cancer until
proven otherwise. The most appropriate next step is a scrotal ultrasound (the imaging modality of choice for scrotal pathology) and
urgent urology referral. Testicular cancer is the most common solid tumor in men aged 15 to 35. A hydrocele would transilluminate and
would be separable from the testis. Delaying evaluation or treating with antibiotics without a confirmed diagnosis is inappropriate for a
mass suspicious for malignancy. CT scanning is used for staging after a diagnosis is confirmed, not as the initial diagnostic test.
Q12: A 26-year-old female presents with a painless, clean-based genital ulcer on the labia majora. She reports
unprotected sexual intercourse with a new partner 3 weeks ago. Dark-field microscopy of the ulcer exudate
reveals spirochetes. Which of the following is the most appropriate treatment?
A. Oral acyclovir 400 mg three times daily for 7-10 days
B. Intramuscular penicillin G benzathine 2.4 million units as a single dose [CORRECT]
C. Oral azithromycin 1 g as a single dose
D. Oral fluconazole 150 mg as a single dose
Correct Answer: B
Rationale: This patient has primary syphilis, which presents with a painless chancre (genital ulcer) that is clean-based with indurated
borders. Dark-field microscopy revealing spirochetes (Treponema pallidum) confirms the diagnosis. The treatment of choice for
primary syphilis is intramuscular penicillin G benzathine 2.4 million units as a single dose. Acyclovir is used for herpes simplex virus
(HSV) infections, which present with painful vesicles or shallow ulcers, not a painless chancre. Azithromycin 1 g is used for Chlamydia
trachomatis. Fluconazole is used for candidiasis.
Q13: A nurse practitioner is evaluating a pregnant patient at her first prenatal visit at 10 weeks gestation. The
patient reports a history of one spontaneous abortion at 8 weeks and one live birth at 39 weeks via cesarean
section. How should the nurse practitioner document her obstetric history using the GTPAL system?
NSG500 Exam 3 - Advanced Health Assessment | Page 4
Exam 3: Advanced Health Assessment
Questions and Verified Answers | 100% Correct | Grade A
Wilkes University | Curriculum Standards
Section 1: Genitourinary and Reproductive Health Assessment (Male and Female)
Q1: A 28-year-old female presents for her annual well-woman examination. She reports her last menstrual
period (LMP) was 3 weeks ago. Her menstrual cycles are regular at 28-day intervals with 5 days of moderate
flow. She uses a combined oral contraceptive pill for contraception. Which component of the GTPAL system
should the nurse practitioner document for this patient?
A. G = 0, T = 0, P = 0, A = 0, L = 0 [CORRECT]
B. G = 1, T = 0, P = 0, A = 0, L = 0
C. G = 0, T = 0, P = 0, A = 1, L = 0
D. G = 0, T = 0, P = 0, A = 0, L = 1
Correct Answer: A
Rationale: The GTPAL system documents obstetric history: Gravida (total pregnancies), Term births, Preterm births, Abortions
(spontaneous or induced), and Living children. This patient has no history of pregnancy, so all values are 0. Gravida refers to the
number of pregnancies regardless of outcome, not the number of deliveries. Term and preterm refer to the number of births at specific
gestational ages. Using oral contraceptives does not affect GTPAL documentation.
Q2: A 24-year-old woman presents with a thick, white, curd-like vaginal discharge, intense vulvar pruritus, and
dyspareunia. The vaginal pH is 4.0. Which of the following is the most likely diagnosis?
A. Bacterial vaginosis
B. Trichomoniasis
C. Vulvovaginal candidiasis [CORRECT]
D. Atrophic vaginitis
Correct Answer: C
Rationale: Vulvovaginal candidiasis presents with thick, white, curd-like (cottage cheese) discharge, intense pruritus, and a vaginal pH
of 4.0 to 4.5, which is within the normal range. Bacterial vaginosis presents with thin, grayish, homogeneous discharge with a fishy
odor and a pH greater than 4.5. Trichomoniasis presents with a frothy, yellow-green discharge and a pH of 4.5 to 5.5. Atrophic
vaginitis typically occurs in postmenopausal women due to decreased estrogen and presents with vaginal dryness and dyspareunia.
Q3: A 35-year-old female presents with lower abdominal pain, fever of 101.2 F, mucopurulent cervical
discharge, and cervical motion tenderness on bimanual examination. Which finding is most consistent with
pelvic inflammatory disease (PID)?
A. Negative cervical motion tenderness with adnexal fullness
B. Cervical motion tenderness, adnexal tenderness, and fever [CORRECT]
C. A palpable adnexal mass without cervical discharge
NSG500 Exam 3 - Advanced Health Assessment | Page 1
, D. Midline uterine tenderness without fever or discharge
Correct Answer: B
Rationale: The diagnosis of PID is clinically based on the presence of cervical motion tenderness (chandelier sign), uterine tenderness,
or adnexal tenderness plus at least one additional criterion including oral temperature greater than 101 F, mucopurulent cervical or
vaginal discharge, elevated ESR or CRP, or laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis. A
palpable adnexal mass without fever or discharge is more concerning for an ovarian cyst or tubo-ovarian abscess. Midline uterine
tenderness alone is nonspecific and may be associated with many conditions including endometriosis or early pregnancy.
Q4: A 52-year-old African American male presents with complaints of urinary frequency, urgency, nocturia
(3-4 times per night), weak urinary stream, and a sensation of incomplete bladder emptying. The nurse
practitioner suspects benign prostatic hyperplasia (BPH). Which finding on digital rectal exam (DRE) would
most support this diagnosis?
A. A hard, irregular, fixed nodule on the prostate
B. An enlarged, symmetric, smooth, and firm prostate [CORRECT]
C. A tender, boggy prostate with fluctuance
D. A small, atrophic prostate gland
Correct Answer: B
Rationale: BPH typically presents with an enlarged, symmetric, smooth, and firm prostate on DRE, reflecting the benign hyperplastic
growth of the transition zone. A hard, irregular, fixed nodule is highly suspicious for prostate cancer. A tender, boggy prostate with
fluctuance suggests acute prostatitis or prostatic abscess. A small, atrophic prostate is not consistent with BPH and may be seen in
hypogonadism or after androgen deprivation therapy.
Q5: A nurse practitioner is performing a speculum exam on a 32-year-old female. Which technique is correct
for inserting the speculum?
A. Insert the speculum blade laterally and rotate 90 degrees once fully inserted
B. Apply firm downward pressure on the perineum while advancing the speculum
C. Warm the speculum, apply water-based lubricant to the blades, and insert at a 45-degree angle directed
toward the sacrum, then lower the handle after insertion [CORRECT]
D. Insert the speculum with the blades open to maximize the initial view of the vaginal walls
Correct Answer: C
Rationale: The correct technique involves warming the speculum for patient comfort, applying water-based lubricant (not petroleum
jelly, which can interfere with cytology), inserting at a 45-degree angle posteriorly toward the sacrum following the natural curve of the
vagina, then lowering the handle to open the blades and visualize the cervix. Inserting laterally and rotating may cause patient
discomfort and tissue trauma. Firm downward pressure is not part of proper technique. Inserting with blades open would cause
discomfort and should only be done after the speculum is fully inserted.
Q6: A 22-year-old sexually active female presents for a routine Pap smear and HPV co-test. According to the
USPSTF screening guidelines, which recommendation is most appropriate for this patient?
A. Pap smear alone every 3 years beginning at age 21
B. Pap smear with HPV co-testing every 5 years beginning at age 25 [CORRECT]
C. HPV testing alone every 5 years beginning at age 21
D. Pap smear every year until age 30, then every 3 years
Correct Answer: B
Rationale: Current USPSTF guidelines (2018) recommend cervical cancer screening for women aged 21 to 29 with Pap smear alone
every 3 years, and for women aged 30 to 65 with three options: Pap smear alone every 3 years, HPV testing alone every 5 years, or Pap
smear with HPV co-testing every 5 years. For this 22-year-old patient, Pap smear alone every 3 years is the appropriate
NSG500 Exam 3 - Advanced Health Assessment | Page 2
,recommendation. HPV co-testing is not recommended before age 30 in average-risk women. Annual Pap smears have not been
recommended for many years and increase the risk of false-positive results and unnecessary procedures.
Q7: A 19-year-old male presents with sudden onset of severe right testicular pain, nausea, and vomiting that
began 4 hours ago. The testis is swollen, tender, and elevated with an abnormal transverse lie. Which condition
is the priority diagnosis?
A. Epididymitis
B. Testicular torsion [CORRECT]
C. Varicocele
D. Hydrocele
Correct Answer: B
Rationale: Testicular torsion is a surgical emergency that requires intervention within 6 hours to salvage the testis. It presents with
sudden, severe testicular pain, nausea, vomiting, an elevated testis (high-riding testis), and an abnormal transverse lie. The cremasteric
reflex is typically absent. Epididymitis presents more gradually with pain, dysuria, and pyuria, and the testis is typically in a normal
position. A varicocele feels like a 'bag of worms' on palpation, is more common on the left side, and is not acutely painful. A hydrocele
presents as a painless, fluid-filled swelling that transilluminates.
Q8: A 45-year-old female presents with a 3-month history of progressive pelvic pressure, menorrhagia, and
urinary frequency. On bimanual examination, the uterus is enlarged, irregular, and nodular, approximately 14
weeks in size. Which condition is most likely?
A. Ovarian cancer
B. Uterine fibroids (leiomyomas) [CORRECT]
C. Endometriosis
D. Adenomyosis
Correct Answer: B
Rationale: Uterine fibroids (leiomyomas) are the most common benign tumors in women and present with menorrhagia, pelvic pressure
or pain, urinary frequency due to bladder compression, and an enlarged, irregular, nodular uterus on bimanual examination. Ovarian
cancer typically presents with a palpable adnexal mass rather than uterine enlargement, and symptoms are often vague including
bloating and early satiety. Endometriosis typically presents with dysmenorrhea, dyspareunia, and infertility, and the uterus is usually
normal in size on examination. Adenomyosis typically causes a symmetrically enlarged, globular uterus rather than an irregular,
nodular one.
Q9: A urinalysis reveals the following findings: specific gravity 1.030, pH 5.5, negative glucose, negative
ketones, 2+ protein, positive nitrites, positive leukocyte esterase, and 10-20 WBCs/HPF on microscopy. Which
condition is most consistent with these results?
A. Nephrotic syndrome
B. Urinary tract infection (cystitis) [CORRECT]
C. Diabetic nephropathy
D. Glomerulonephritis
Correct Answer: B
Rationale: Positive nitrites (produced by Enterobacteriaceae that reduce nitrates to nitrites) and positive leukocyte esterase (indicating
pyuria) together with WBCs on microscopy are classic findings of a urinary tract infection. The presence of nitrites is highly specific for
UTI caused by gram-negative organisms, most commonly E. coli. Nephrotic syndrome would present with massive proteinuria (3+ to
4+), hypoalbuminemia, edema, and lipiduria but would not have nitrites or leukocyte esterase. Diabetic nephropathy presents with
microalbuminuria or proteinuria, not nitrites. Glomerulonephritis presents with proteinuria, hematuria, and RBC casts, not nitrites or
positive leukocyte esterase.
NSG500 Exam 3 - Advanced Health Assessment | Page 3
, Q10: A 30-year-old female presents with oligomenorrhea, hirsutism, acne, and an elevated BMI of 32.
Laboratory testing reveals elevated LH:FSH ratio greater than 2:1 and elevated total and free testosterone.
Pelvic ultrasound reveals enlarged ovaries with multiple peripheral cysts. Which is the most likely diagnosis?
A. Cushing syndrome
B. Polycystic ovary syndrome (PCOS) [CORRECT]
C. Congenital adrenal hyperplasia
D. Ovarian cancer
Correct Answer: B
Rationale: PCOS is diagnosed using the Rotterdam criteria, which require two of three findings: oligo/anovulation, clinical or
biochemical signs of hyperandrogenism (hirsutism, acne, elevated testosterone), and polycystic ovaries on ultrasound. The elevated
LH:FSH ratio (typically 2:1 or 3:1) and elevated testosterone support the diagnosis. Cushing syndrome presents with central obesity,
moon face, buffalo hump, striae, and elevated cortisol, not with polycystic ovaries or elevated LH:FSH ratio. Congenital adrenal
hyperplasia presents with elevated 17-hydroxyprogesterone. Ovarian cancer would present with a solid or complex adnexal mass, not
with the endocrine symptoms described.
Q11: A 40-year-old male presents with a painless scrotal mass that has been gradually enlarging over the past 2
months. On examination, the mass is firm, does not transilluminate, and cannot be separated from the testis.
What is the most appropriate next step in management?
A. Reassure the patient and schedule follow-up in 3 months
B. Prescribe antibiotics and re-evaluate in 2 weeks
C. Order a scrotal ultrasound and refer urgently to urology [CORRECT]
D. Order a CT scan of the abdomen and pelvis
Correct Answer: C
Rationale: A firm, non-transilluminating scrotal mass that cannot be separated from the testis is concerning for testicular cancer until
proven otherwise. The most appropriate next step is a scrotal ultrasound (the imaging modality of choice for scrotal pathology) and
urgent urology referral. Testicular cancer is the most common solid tumor in men aged 15 to 35. A hydrocele would transilluminate and
would be separable from the testis. Delaying evaluation or treating with antibiotics without a confirmed diagnosis is inappropriate for a
mass suspicious for malignancy. CT scanning is used for staging after a diagnosis is confirmed, not as the initial diagnostic test.
Q12: A 26-year-old female presents with a painless, clean-based genital ulcer on the labia majora. She reports
unprotected sexual intercourse with a new partner 3 weeks ago. Dark-field microscopy of the ulcer exudate
reveals spirochetes. Which of the following is the most appropriate treatment?
A. Oral acyclovir 400 mg three times daily for 7-10 days
B. Intramuscular penicillin G benzathine 2.4 million units as a single dose [CORRECT]
C. Oral azithromycin 1 g as a single dose
D. Oral fluconazole 150 mg as a single dose
Correct Answer: B
Rationale: This patient has primary syphilis, which presents with a painless chancre (genital ulcer) that is clean-based with indurated
borders. Dark-field microscopy revealing spirochetes (Treponema pallidum) confirms the diagnosis. The treatment of choice for
primary syphilis is intramuscular penicillin G benzathine 2.4 million units as a single dose. Acyclovir is used for herpes simplex virus
(HSV) infections, which present with painful vesicles or shallow ulcers, not a painless chancre. Azithromycin 1 g is used for Chlamydia
trachomatis. Fluconazole is used for candidiasis.
Q13: A nurse practitioner is evaluating a pregnant patient at her first prenatal visit at 10 weeks gestation. The
patient reports a history of one spontaneous abortion at 8 weeks and one live birth at 39 weeks via cesarean
section. How should the nurse practitioner document her obstetric history using the GTPAL system?
NSG500 Exam 3 - Advanced Health Assessment | Page 4
