NUR 257 Chronic Exam 4 | Questions and
Answers | 2025 New Update | 100%
Correct - Galen College of Nursing
SECTION I: ENDOMETRIOSIS (Questions 1–18)
1. A 32-year-old female presents with severe dysmenorrhea, deep dyspareunia, and chronic
pelvic pain that worsens during menstruation. She reports fatigue and difficulty conceiving for
the past 18 months. Which of the following is the gold standard for diagnosing endometriosis?
A. Transvaginal ultrasound
B. Serum CA-125
C. Laparoscopy with direct visualization and biopsy
D. MRI of the pelvis
Correct Answer: C
Rationale: Laparoscopy with direct visualization and histologic confirmation remains the gold
standard for diagnosing endometriosis. While transvaginal ultrasound can identify ovarian
endometriomas and guide management, a normal ultrasound does not exclude endometriosis.
CA-125 lacks sensitivity and specificity for diagnosis.
2. A nurse is educating a patient newly diagnosed with endometriosis. Which of the following
statements by the patient indicates a need for further teaching?
A. "This condition can affect my fertility."
B. "Hormonal treatments work by stopping my periods."
C. "A normal ultrasound means I definitely don't have endometriosis."
D. "Laparoscopy can both diagnose and treat this condition."
Correct Answer: C
Rationale: The patient requires further teaching because a normal ultrasound does NOT rule
out endometriosis. Endometriosis can be present even when imaging is normal, and
laparoscopy may still be necessary. The other statements are accurate.
,3. Which of the following are recognized risk factors for developing endometriosis? (Select All
That Apply)
A. Early menarche
B. Short menstrual cycle length
C. High body mass index
D. Nulliparity
E. Family history of endometriosis
Correct Answers: A, B, D, E
Rationale: Risk factors for endometriosis include younger age at menarche, shorter menstrual
cycle length, lower body mass index (not high), nulliparity, and positive family history. A low
BMI, not high BMI, is associated with increased risk.
4. A 28-year-old female with suspected endometriosis has been prescribed a combined oral
contraceptive pill taken continuously. Which statement best describes the therapeutic
mechanism?
A. It cures the endometriosis implants.
B. It reduces bleeding and inflammation, thereby decreasing pain.
C. It increases estrogen levels to suppress symptoms.
D. It permanently eliminates the need for surgical intervention.
Correct Answer: B
Rationale: Hormonal treatments for endometriosis, including combined oral contraceptives,
work by reducing bleeding and inflammation from endometriotic implants and reducing pain,
often by stopping periods. They are not curative and do not eliminate the potential need for
surgery.
5. A patient with endometriosis asks the nurse how long she should try hormonal therapy
before expecting symptom improvement. What is the appropriate response?
A. "You should notice improvement within one week."
B. "Give it at least 3–6 months to work."
C. "If it doesn't work in 2 weeks, you'll need surgery."
D. "Hormonal therapy only works after surgery."
Correct Answer: B
,Rationale: Patients should be advised to give hormonal treatment at least 3–6 months to work
before determining effectiveness.
6. Which of the following clinical manifestations are commonly associated with endometriosis?
(Select All That Apply)
A. Dysmenorrhea
B. Dyspareunia
C. Pain with bowel movements during menstruation
D. Heavy, irregular uterine bleeding
E. Asymptomatic presentation in some women
Correct Answers: A, B, C, E
Rationale: Common symptoms include dysmenorrhea, dyspareunia, pain with bowel
movements or urination (worse during periods), and infertility. Some women have no symptoms
at all. Heavy, irregular uterine bleeding is more characteristic of uterine fibroids.
7. A nurse is reviewing the pathophysiology of endometriosis. Which statement is most
accurate?
A. Endometrial tissue grows inside the uterine cavity.
B. Endometrial-like tissue is found outside the uterine cavity and responds to hormonal cycles.
C. It is caused by an overgrowth of uterine muscle cells.
D. It results from HPV infection.
Correct Answer: B
Rationale: Endometriosis is characterized by the presence of endometrial glands and stroma
outside the endometrial cavity. These ectopic tissues are estrogen-dependent and induce a
chronic inflammatory process.
8. A 35-year-old female with endometriosis is prescribed a GnRH agonist. The nurse should
include which instruction?
A. "This medication will increase your estrogen levels."
B. "You may experience menopausal-like symptoms such as hot flashes."
C. "This is a permanent form of contraception."
D. "You should take this medication orally every day."
, Correct Answer: B
Rationale: GnRH agonists create a hypoestrogenic state, which can cause menopausal-like side
effects including hot flashes, vaginal dryness, and mood changes. They are used when other
treatments have failed.
9. Which of the following best describes why endometriosis can cause infertility?
A. It causes cervical stenosis.
B. It can create adhesions and scarring that distort pelvic anatomy.
C. It destroys the pituitary gland.
D. It prevents ovulation permanently.
Correct Answer: B
Rationale: Endometriosis can cause adhesions, scarring, and anatomical distortion of the pelvis
that can interfere with conception. Up to 50% of women presenting with infertility have
endometriosis.
10. A patient with endometriosis reports that her pain is not controlled with NSAIDs and
combined oral contraceptives. What is the next most appropriate intervention?
A. Increase the NSAID dose indefinitely
B. Consider laparoscopic surgical removal of lesions
C. Start antibiotic therapy
D. Discontinue all treatment and observe
Correct Answer: B
Rationale: Surgical removal of endometriotic lesions via laparoscopy should be considered if
first-line hormonal therapies are ineffective or contraindicated. Surgery can also be diagnostic.
11. A nurse is assessing a patient with suspected endometriosis. Which finding during a pelvic
examination would be most consistent with this diagnosis?
A. A smooth, mobile uterus
B. Nodularity of the uterosacral ligament
C. A firm, enlarged uterus
D. Cervical motion tenderness
Answers | 2025 New Update | 100%
Correct - Galen College of Nursing
SECTION I: ENDOMETRIOSIS (Questions 1–18)
1. A 32-year-old female presents with severe dysmenorrhea, deep dyspareunia, and chronic
pelvic pain that worsens during menstruation. She reports fatigue and difficulty conceiving for
the past 18 months. Which of the following is the gold standard for diagnosing endometriosis?
A. Transvaginal ultrasound
B. Serum CA-125
C. Laparoscopy with direct visualization and biopsy
D. MRI of the pelvis
Correct Answer: C
Rationale: Laparoscopy with direct visualization and histologic confirmation remains the gold
standard for diagnosing endometriosis. While transvaginal ultrasound can identify ovarian
endometriomas and guide management, a normal ultrasound does not exclude endometriosis.
CA-125 lacks sensitivity and specificity for diagnosis.
2. A nurse is educating a patient newly diagnosed with endometriosis. Which of the following
statements by the patient indicates a need for further teaching?
A. "This condition can affect my fertility."
B. "Hormonal treatments work by stopping my periods."
C. "A normal ultrasound means I definitely don't have endometriosis."
D. "Laparoscopy can both diagnose and treat this condition."
Correct Answer: C
Rationale: The patient requires further teaching because a normal ultrasound does NOT rule
out endometriosis. Endometriosis can be present even when imaging is normal, and
laparoscopy may still be necessary. The other statements are accurate.
,3. Which of the following are recognized risk factors for developing endometriosis? (Select All
That Apply)
A. Early menarche
B. Short menstrual cycle length
C. High body mass index
D. Nulliparity
E. Family history of endometriosis
Correct Answers: A, B, D, E
Rationale: Risk factors for endometriosis include younger age at menarche, shorter menstrual
cycle length, lower body mass index (not high), nulliparity, and positive family history. A low
BMI, not high BMI, is associated with increased risk.
4. A 28-year-old female with suspected endometriosis has been prescribed a combined oral
contraceptive pill taken continuously. Which statement best describes the therapeutic
mechanism?
A. It cures the endometriosis implants.
B. It reduces bleeding and inflammation, thereby decreasing pain.
C. It increases estrogen levels to suppress symptoms.
D. It permanently eliminates the need for surgical intervention.
Correct Answer: B
Rationale: Hormonal treatments for endometriosis, including combined oral contraceptives,
work by reducing bleeding and inflammation from endometriotic implants and reducing pain,
often by stopping periods. They are not curative and do not eliminate the potential need for
surgery.
5. A patient with endometriosis asks the nurse how long she should try hormonal therapy
before expecting symptom improvement. What is the appropriate response?
A. "You should notice improvement within one week."
B. "Give it at least 3–6 months to work."
C. "If it doesn't work in 2 weeks, you'll need surgery."
D. "Hormonal therapy only works after surgery."
Correct Answer: B
,Rationale: Patients should be advised to give hormonal treatment at least 3–6 months to work
before determining effectiveness.
6. Which of the following clinical manifestations are commonly associated with endometriosis?
(Select All That Apply)
A. Dysmenorrhea
B. Dyspareunia
C. Pain with bowel movements during menstruation
D. Heavy, irregular uterine bleeding
E. Asymptomatic presentation in some women
Correct Answers: A, B, C, E
Rationale: Common symptoms include dysmenorrhea, dyspareunia, pain with bowel
movements or urination (worse during periods), and infertility. Some women have no symptoms
at all. Heavy, irregular uterine bleeding is more characteristic of uterine fibroids.
7. A nurse is reviewing the pathophysiology of endometriosis. Which statement is most
accurate?
A. Endometrial tissue grows inside the uterine cavity.
B. Endometrial-like tissue is found outside the uterine cavity and responds to hormonal cycles.
C. It is caused by an overgrowth of uterine muscle cells.
D. It results from HPV infection.
Correct Answer: B
Rationale: Endometriosis is characterized by the presence of endometrial glands and stroma
outside the endometrial cavity. These ectopic tissues are estrogen-dependent and induce a
chronic inflammatory process.
8. A 35-year-old female with endometriosis is prescribed a GnRH agonist. The nurse should
include which instruction?
A. "This medication will increase your estrogen levels."
B. "You may experience menopausal-like symptoms such as hot flashes."
C. "This is a permanent form of contraception."
D. "You should take this medication orally every day."
, Correct Answer: B
Rationale: GnRH agonists create a hypoestrogenic state, which can cause menopausal-like side
effects including hot flashes, vaginal dryness, and mood changes. They are used when other
treatments have failed.
9. Which of the following best describes why endometriosis can cause infertility?
A. It causes cervical stenosis.
B. It can create adhesions and scarring that distort pelvic anatomy.
C. It destroys the pituitary gland.
D. It prevents ovulation permanently.
Correct Answer: B
Rationale: Endometriosis can cause adhesions, scarring, and anatomical distortion of the pelvis
that can interfere with conception. Up to 50% of women presenting with infertility have
endometriosis.
10. A patient with endometriosis reports that her pain is not controlled with NSAIDs and
combined oral contraceptives. What is the next most appropriate intervention?
A. Increase the NSAID dose indefinitely
B. Consider laparoscopic surgical removal of lesions
C. Start antibiotic therapy
D. Discontinue all treatment and observe
Correct Answer: B
Rationale: Surgical removal of endometriotic lesions via laparoscopy should be considered if
first-line hormonal therapies are ineffective or contraindicated. Surgery can also be diagnostic.
11. A nurse is assessing a patient with suspected endometriosis. Which finding during a pelvic
examination would be most consistent with this diagnosis?
A. A smooth, mobile uterus
B. Nodularity of the uterosacral ligament
C. A firm, enlarged uterus
D. Cervical motion tenderness
