UTA NURS 5337 Family Clinical Practice 1: Practice Test 2
(Units 8-13) - Questions with Correct Answers
100 questions
1. A pregnant woman at 10 weeks has nausea and vomiting without dehydration. First-line
pharmacologic therapy is:
A. Ondansetron as first choice
B. Promethazine IV
C. Vitamin B6 (pyridoxine) with or without doxylamine
D. Metoclopramide long-term
Correct Answer: C. Vitamin B6 (pyridoxine) with or without doxylamine
Rationale: ACOG recommends pyridoxine alone or combined with doxylamine as first-line for nausea
and vomiting of pregnancy. Ondansetron and others are used for persistent symptoms. Weight loss,
ketonuria and dehydration suggest hyperemesis gravidarum needing IV fluids.
2. A woman has severe mood symptoms, irritability, and bloating that occur in the 2 weeks
before menses and resolve after, impairing work. First-line treatment for PMDD is:
A. Benzodiazepines daily
B. An SSRI, either continuously or during the luteal phase
C. Oxycodone
D. High-dose vitamin C
Correct Answer: B. An SSRI, either continuously or during the luteal phase
Rationale: PMDD responds well to SSRIs such as sertraline or fluoxetine, taken daily or only in the luteal
phase, and drospirenone-containing pills are another option. Benzodiazepines and opioids carry
dependence risk. Vitamin C is not effective.
3. Fezolinetant, a newer nonhormonal therapy for hot flashes, works by:
A. Blocking neurokinin-3 receptors in the hypothalamic thermoregulatory center
B. Replacing estrogen
C. Inhibiting serotonin reuptake
D. Blocking dopamine
Correct Answer: A. Blocking neurokinin-3 receptors in the hypothalamic thermoregulatory
center
Rationale: Fezolinetant antagonizes NK3 receptors on KNDy neurons that drive hot flashes when
estrogen falls; liver enzymes are monitored because of hepatotoxicity reports. It is not a hormone, SSRI or
dopamine blocker.
,4. In the second trimester, a fundal height of 24 cm at 24 weeks indicates:
A. Growth restriction
B. Macrosomia
C. Polyhydramnios
D. Appropriate fetal growth
Correct Answer: D. Appropriate fetal growth
Rationale: From about 20 to 36 weeks, fundal height in centimeters approximates gestational age, within
2 cm. A measurement of 24 cm at 24 weeks is appropriate. Discrepancies over 2 to 3 cm prompt
ultrasound for growth problems or amniotic fluid abnormalities.
5. A postmenopausal woman has vaginal dryness and dyspareunia without hot flashes. The
preferred treatment is:
A. Systemic estrogen-progestin therapy
B. Oral antibiotics
C. Low-dose vaginal estrogen
D. Douching
Correct Answer: C. Low-dose vaginal estrogen
Rationale: Genitourinary syndrome of menopause responds well to low-dose vaginal estrogen, which has
minimal systemic absorption and does not require a progestogen in most women. Moisturizers and
lubricants are first steps. Systemic therapy is not needed for isolated local symptoms.
6. Any bleeding in a postmenopausal woman not on hormone therapy requires:
A. Evaluation with transvaginal ultrasound or endometrial biopsy
B. Observation for 1 year
C. Starting estrogen therapy
D. No evaluation if light
Correct Answer: A. Evaluation with transvaginal ultrasound or endometrial biopsy
Rationale: Postmenopausal bleeding is endometrial cancer until proven otherwise; an endometrial
thickness of 4 mm or less on ultrasound makes cancer unlikely, while thicker linings or persistent bleeding
require biopsy. Even light bleeding needs evaluation. Starting estrogen would mask the problem.
,7. A patient misses one active combined oral contraceptive pill. She should:
A. Stop the pack and start a new one
B. Use emergency contraception immediately
C. Take no further pills that month
D. Take the missed pill as soon as possible and continue the pack; no backup is needed
Correct Answer: D. Take the missed pill as soon as possible and continue the pack; no
backup is needed
Rationale: For one missed pill (less than 48 hours late), the CDC advises taking it right away and
continuing as usual without backup. Missing two or more pills requires 7 days of backup and possibly
emergency contraception. Stopping the pack increases pregnancy risk.
8. Group B Streptococcus screening by rectovaginal culture is performed at:
A. 36 0/7 to 37 6/7 weeks
B. 12 weeks
C. 28 weeks
D. At delivery only
Correct Answer: A. 36 0/7 to 37 6/7 weeks
Rationale: ACOG recommends GBS culture at 36 to 37 weeks so results are valid within the 5-week
window before delivery; positive women receive intrapartum penicillin to prevent early-onset neonatal
sepsis. Earlier testing may not reflect colonization at delivery.
9. Depot medroxyprogesterone acetate (DMPA) carries a boxed warning about:
A. Loss of bone mineral density
B. Increased breast cancer risk
C. Blood clots in all users
D. Infertility after stopping
Correct Answer: A. Loss of bone mineral density
Rationale: DMPA lowers estrogen and reduces bone density, which mostly recovers after stopping; it
should not be withheld solely for this reason. Return of fertility may be delayed up to 10 to 18 months, but
infertility is not permanent. It does not carry a boxed warning for breast cancer or clots.
, 10. Quickening, the first maternal perception of fetal movement, usually occurs in a first
pregnancy at about:
A. 8 weeks
B. 18 to 20 weeks
C. 28 weeks
D. 36 weeks
Correct Answer: B. 18 to 20 weeks
Rationale: Primigravidas usually feel movement at 18 to 20 weeks, while multigravidas may feel it at 16
weeks. Eight weeks is too early, and later weeks would be considered delayed. Decreased fetal
movement later in pregnancy requires assessment.
11. A woman had unprotected intercourse 4 days ago and weighs 95 kg. The most effective
emergency contraception is:
A. Levonorgestrel 1.5 mg
B. Ulipristal after day 7
C. Combined pills taken daily
D. A copper IUD inserted within 5 days
Correct Answer: D. A copper IUD inserted within 5 days
Rationale: The copper IUD is the most effective emergency contraceptive (over 99%), works up to 5 days
after intercourse, is not weight-dependent and provides ongoing contraception. Levonorgestrel is less
effective at higher weights and after 72 hours. Ulipristal must be taken within 120 hours.
12. A 50-year-old with frequent hot flashes and no contraindications asks about treatment. The
most effective therapy is:
A. Black cohosh
B. Systemic estrogen therapy, with a progestogen if she has a uterus
C. Vitamin E
D. Gabapentin as first choice in all women
Correct Answer: B. Systemic estrogen therapy, with a progestogen if she has a uterus
Rationale: Hormone therapy is the most effective treatment for vasomotor symptoms in women under 60
or within 10 years of menopause; a progestogen protects the endometrium. Nonhormonal options such as
SSRIs, gabapentin or fezolinetant suit women who cannot use estrogen. Black cohosh and vitamin E
have weak evidence.
(Units 8-13) - Questions with Correct Answers
100 questions
1. A pregnant woman at 10 weeks has nausea and vomiting without dehydration. First-line
pharmacologic therapy is:
A. Ondansetron as first choice
B. Promethazine IV
C. Vitamin B6 (pyridoxine) with or without doxylamine
D. Metoclopramide long-term
Correct Answer: C. Vitamin B6 (pyridoxine) with or without doxylamine
Rationale: ACOG recommends pyridoxine alone or combined with doxylamine as first-line for nausea
and vomiting of pregnancy. Ondansetron and others are used for persistent symptoms. Weight loss,
ketonuria and dehydration suggest hyperemesis gravidarum needing IV fluids.
2. A woman has severe mood symptoms, irritability, and bloating that occur in the 2 weeks
before menses and resolve after, impairing work. First-line treatment for PMDD is:
A. Benzodiazepines daily
B. An SSRI, either continuously or during the luteal phase
C. Oxycodone
D. High-dose vitamin C
Correct Answer: B. An SSRI, either continuously or during the luteal phase
Rationale: PMDD responds well to SSRIs such as sertraline or fluoxetine, taken daily or only in the luteal
phase, and drospirenone-containing pills are another option. Benzodiazepines and opioids carry
dependence risk. Vitamin C is not effective.
3. Fezolinetant, a newer nonhormonal therapy for hot flashes, works by:
A. Blocking neurokinin-3 receptors in the hypothalamic thermoregulatory center
B. Replacing estrogen
C. Inhibiting serotonin reuptake
D. Blocking dopamine
Correct Answer: A. Blocking neurokinin-3 receptors in the hypothalamic thermoregulatory
center
Rationale: Fezolinetant antagonizes NK3 receptors on KNDy neurons that drive hot flashes when
estrogen falls; liver enzymes are monitored because of hepatotoxicity reports. It is not a hormone, SSRI or
dopamine blocker.
,4. In the second trimester, a fundal height of 24 cm at 24 weeks indicates:
A. Growth restriction
B. Macrosomia
C. Polyhydramnios
D. Appropriate fetal growth
Correct Answer: D. Appropriate fetal growth
Rationale: From about 20 to 36 weeks, fundal height in centimeters approximates gestational age, within
2 cm. A measurement of 24 cm at 24 weeks is appropriate. Discrepancies over 2 to 3 cm prompt
ultrasound for growth problems or amniotic fluid abnormalities.
5. A postmenopausal woman has vaginal dryness and dyspareunia without hot flashes. The
preferred treatment is:
A. Systemic estrogen-progestin therapy
B. Oral antibiotics
C. Low-dose vaginal estrogen
D. Douching
Correct Answer: C. Low-dose vaginal estrogen
Rationale: Genitourinary syndrome of menopause responds well to low-dose vaginal estrogen, which has
minimal systemic absorption and does not require a progestogen in most women. Moisturizers and
lubricants are first steps. Systemic therapy is not needed for isolated local symptoms.
6. Any bleeding in a postmenopausal woman not on hormone therapy requires:
A. Evaluation with transvaginal ultrasound or endometrial biopsy
B. Observation for 1 year
C. Starting estrogen therapy
D. No evaluation if light
Correct Answer: A. Evaluation with transvaginal ultrasound or endometrial biopsy
Rationale: Postmenopausal bleeding is endometrial cancer until proven otherwise; an endometrial
thickness of 4 mm or less on ultrasound makes cancer unlikely, while thicker linings or persistent bleeding
require biopsy. Even light bleeding needs evaluation. Starting estrogen would mask the problem.
,7. A patient misses one active combined oral contraceptive pill. She should:
A. Stop the pack and start a new one
B. Use emergency contraception immediately
C. Take no further pills that month
D. Take the missed pill as soon as possible and continue the pack; no backup is needed
Correct Answer: D. Take the missed pill as soon as possible and continue the pack; no
backup is needed
Rationale: For one missed pill (less than 48 hours late), the CDC advises taking it right away and
continuing as usual without backup. Missing two or more pills requires 7 days of backup and possibly
emergency contraception. Stopping the pack increases pregnancy risk.
8. Group B Streptococcus screening by rectovaginal culture is performed at:
A. 36 0/7 to 37 6/7 weeks
B. 12 weeks
C. 28 weeks
D. At delivery only
Correct Answer: A. 36 0/7 to 37 6/7 weeks
Rationale: ACOG recommends GBS culture at 36 to 37 weeks so results are valid within the 5-week
window before delivery; positive women receive intrapartum penicillin to prevent early-onset neonatal
sepsis. Earlier testing may not reflect colonization at delivery.
9. Depot medroxyprogesterone acetate (DMPA) carries a boxed warning about:
A. Loss of bone mineral density
B. Increased breast cancer risk
C. Blood clots in all users
D. Infertility after stopping
Correct Answer: A. Loss of bone mineral density
Rationale: DMPA lowers estrogen and reduces bone density, which mostly recovers after stopping; it
should not be withheld solely for this reason. Return of fertility may be delayed up to 10 to 18 months, but
infertility is not permanent. It does not carry a boxed warning for breast cancer or clots.
, 10. Quickening, the first maternal perception of fetal movement, usually occurs in a first
pregnancy at about:
A. 8 weeks
B. 18 to 20 weeks
C. 28 weeks
D. 36 weeks
Correct Answer: B. 18 to 20 weeks
Rationale: Primigravidas usually feel movement at 18 to 20 weeks, while multigravidas may feel it at 16
weeks. Eight weeks is too early, and later weeks would be considered delayed. Decreased fetal
movement later in pregnancy requires assessment.
11. A woman had unprotected intercourse 4 days ago and weighs 95 kg. The most effective
emergency contraception is:
A. Levonorgestrel 1.5 mg
B. Ulipristal after day 7
C. Combined pills taken daily
D. A copper IUD inserted within 5 days
Correct Answer: D. A copper IUD inserted within 5 days
Rationale: The copper IUD is the most effective emergency contraceptive (over 99%), works up to 5 days
after intercourse, is not weight-dependent and provides ongoing contraception. Levonorgestrel is less
effective at higher weights and after 72 hours. Ulipristal must be taken within 120 hours.
12. A 50-year-old with frequent hot flashes and no contraindications asks about treatment. The
most effective therapy is:
A. Black cohosh
B. Systemic estrogen therapy, with a progestogen if she has a uterus
C. Vitamin E
D. Gabapentin as first choice in all women
Correct Answer: B. Systemic estrogen therapy, with a progestogen if she has a uterus
Rationale: Hormone therapy is the most effective treatment for vasomotor symptoms in women under 60
or within 10 years of menopause; a progestogen protects the endometrium. Nonhormonal options such as
SSRIs, gabapentin or fezolinetant suit women who cannot use estrogen. Black cohosh and vitamin E
have weak evidence.
