NRNP 6552 MIDTERM EXAM ACTUAL VERSION 2026 | Advanced Reproductive Health Care | Walden University | Verified Q&A | Pass Guaranteed - A+ Graded

Pass the NRNP 6552 Midterm Exam on your first attempt with this actual exam version for Advanced Reproductive Health Care at Walden University. This A+ Graded resource contains verified questions and answers from the actual midterm exam covering all key content areas including reproductive anatomy and physiology (female reproductive system: ovaries, fallopian tubes, uterus, cervix, vagina, external genitalia; male reproductive system: testes, epididymis, vas deferens, seminal vesicles, prostate, penis; hormonal regulation: hypothalamic-pituitary-ovarian axis, GnRH, FSH, LH, estrogen, progesterone, inhibin; menstrual cycle: follicular phase, ovulation, luteal phase, endometrial changes), preconception counseling (preconception risk assessment, medical history review, genetic carrier screening, folic acid supplementation (0.4-0.8 mg daily for neural tube defect prevention), lifestyle modifications (smoking cessation, alcohol reduction, weight optimization, nutrition), immunization review (rubella, varicella, hepatitis B, influenza, Tdap), chronic disease management (diabetes, hypertension, thyroid disorders, mental health conditions), medication review (teratogenic medications), environmental and occupational exposures), contraception methods and management (combined hormonal contraceptives (CHCs): oral pills (monophasic, multiphasic, extended-cycle), transdermal patch (Xulane, Twirla), vaginal ring (NuvaRing, Annovera); progestin-only methods: progestin-only pills (POPs/minipill), depot medroxyprogesterone acetate (DMPA/Depo-Provera), etonogestrel implant (Nexplanon); intrauterine devices (IUDs): copper IUD (Paragard, effective up to 10-12 years, non-hormonal emergency contraception), levonorgestrel IUDs (Mirena (8 years), Kyleena (5 years), Liletta (8 years), Skyla (3 years)); barrier methods: external (male) condoms, internal (female) condoms, diaphragm (Caya, traditional with spermicide), cervical cap (FemCap), contraceptive sponge (Today Sponge); spermicides (nonoxynol-9); fertility awareness-based methods (FABMs): calendar/rhythm method, standard days method (CycleBeads), basal body temperature (BBT) method, cervical mucus method (Billings, Creighton, Marquette), symptothermal method (combines BBT and mucus), lactational amenorrhea method (LAM) (criteria: exclusively breastfeeding, amenorrheic, 6 months postpartum); emergency contraception (EC): ulipristal acetate (Ella) (effective up to 120 hours, prescription only), levonorgestrel (Plan B One-Step, Take Action, generic) (effective up to 72-120 hours, OTC for all ages), copper IUD (most effective, up to 5 days post-ovulation); permanent sterilization: tubal ligation (laparoscopic, mini-laparotomy, postpartum), bilateral salpingectomy (preferred for ovarian cancer risk reduction), vasectomy (male sterilization); effectiveness (perfect use vs typical use, Pearl Index), contraindications (Estrogen-containing contraceptives: age ≥35 with smoking, uncontrolled hypertension, migraine with aura, history of DVT/PE, known thrombophilia, active liver disease, breast cancer, pregnancy), side effects management, patient education (STI protection, adherence, what to do if missed pills, when to start, return to fertility), infertility evaluation and treatment (infertility definition: failure to conceive after 12 months of unprotected intercourse (6 months if age ≥35 or risk factors), female factor infertility: ovulatory disorders (PCOS, hypothalamic dysfunction, POI, hyperprolactinemia, thyroid dysfunction), tubal factor (PID, endometriosis, prior ectopic, tubal surgery, hydrosalpinx), uterine factor (fibroids, polyps, adhesions (Asherman's), congenital anomalies (septate, bicornuate, unicornuate)), cervical factor (cervical stenosis, hostile mucus), male factor infertility: semen analysis abnormalities (WHO 6th edition reference values: sperm concentration ≥16 million/mL, total count ≥39 million, motility ≥42%, morphology ≥4% normal forms), varicocele, hormonal disorders, obstruction, genetic abnormalities (Klinefelter syndrome, Y chromosome microdeletions, CFTR mutations); diagnostic testing: ovulation assessment (LH surge kits, mid-luteal progesterone 3 ng/mL), ovarian reserve testing (day 3 FSH, estradiol, AMH (anti-Müllerian hormone), antral follicle count (AFC)), hysterosalpingography (HSG) for tubal patency, sonohysterography (saline infusion sonohysterography (SIS)) for uterine cavity evaluation, hysteroscopy (diagnostic and operative), laparoscopy for endometriosis and pelvic pathology; treatment options: ovulation induction (clomiphene citrate (CC) (50-150 mg days 3-7 or 5-9), letrozole (2.5-7.5 mg days 3-7, preferred for PCOS), gonadotropins (FSH, hMG, highly purified, recombinant) with monitoring, intrauterine insemination (IUI) (timing with LH surge or hCG trigger), in vitro fertilization (IVF) (controlled ovarian hyperstimulation, egg retrieval, fertilization, embryo transfer), intracytoplasmic sperm injection (ICSI) for male factor, donor gametes (sperm, egg, embryo), surrogacy (traditional vs gestational), preimplantation genetic testing (PGT-A, PGT-M, PGT-SR), fertility preservation (egg freezing, embryo freezing, sperm banking, ovarian tissue cryopreservation), sexually transmitted infections (STIs) comprehensive screening (USPSTF screening recommendations: chlamydia and gonorrhea for all sexually active women 25 years and older women at increased risk, syphilis for all pregnant women and at-risk individuals, HIV for all ages 15-65, hepatitis B and C for at-risk, HPV co-testing every 5 years for women 30-65), diagnosis, and management (chlamydia trachomatis: azithromycin 1g orally single dose OR doxycycline 100mg orally BID x 7 days, test of cure at 3-4 weeks in pregnancy, retest in 3 months, expedited partner therapy (EPT) where legal; neisseria gonorrhoeae: ceftriaxone 500mg IM single dose (higher doses for ≥150kg or pharyngeal infection) PLUS azithromycin 1g orally single dose OR doxycycline 100mg BID x 7 days due to resistance concerns, test of cure in 7-14 days for pharyngeal infection, retest in 3 months; treponema pallidum (syphilis): primary (chancre), secondary (rash, condylomata lata, fever, lymphadenopathy), latent (early 1 year, late 1 year), tertiary (neurosyphilis, cardiovascular, gummatous), treatment: benzathine penicillin G (2.4 million units IM single dose for primary/secondary/early latent, 3 doses for late latent, aqueous crystalline penicillin G IV for neurosyphilis), doxycycline for penicillin-allergic non-pregnant (late latent only), Jarsch-Herxheimer reaction (fever, chills, myalgia within 24 hours), partner evaluation and treatment; herpes simplex virus (HSV-1, HSV-2): primary vs recurrent infection, diagnosis via PCR or culture, treatment: episodic therapy (acyclovir 400mg TID x 5-10 days, valacyclovir 1g BID x 7-10 days, famciclovir 250mg TID x 7-10 days), suppressive therapy (acyclovir 400mg BID, valacyclovir 500mg-1g daily, famciclovir 250mg BID) for frequent recurrences (≥6/year), pregnancy management (suppressive therapy at 36 weeks, C-section for active lesions at delivery); human papillomavirus (HPV): vaccination (Gardasil 9, approved for ages 9-45, catch-up through 26, shared decision-making 27-45), anogenital warts treatment: patient-applied (podofilox 0.5% solution/gel, imiquimod 5% cream, sinecatechins 15% ointment), provider-administered (cryotherapy, trichloroacetic acid (TCA) 80-90%, surgical removal (excision, electrocautery, laser), intralesional interferon), no treatment of subclinical HPV; human immunodeficiency virus (HIV): pre-exposure prophylaxis (PrEP) (Truvada (FTC/TDF), Descovy (FTC/TAF) for MSM and transgender women, cabotegravir (Apretude) injectable every 2 months), post-exposure prophylaxis (PEP) within 72 hours (28-day course of three-drug regimen), antiretroviral therapy (ART) for all HIV-positive individuals regardless of CD4 count, perinatal transmission prevention (ART for pregnant women, scheduled C-section if viral load 1000 copies/mL near delivery, zidovudine for newborn, avoidance of breastfeeding in resource-rich settings); trichomonas vaginalis: metronidazole 2g orally single dose OR tinidazole 2g orally single dose (preferred due to lower resistance), alternative: metronidazole 500mg BID x 7 days, treat partners, retest in 3 months due to high reinfection; mycoplasma genitalium: increasing resistance, treatment: azithromycin 1g orally single dose (but resistance increasing) or moxifloxacin 400mg daily x 7-14 days (fluoroquinolone resistance also emerging), doxycycline 100mg BID x 7 days followed by moxifloxacin, test of cure recommended; bacterial vaginosis (BV): Amsel criteria (4 of: homogeneous gray/white discharge, clue cells on wet mount, vaginal pH 4.5, positive whiff test (fishy odor with 10% KOH)), Nugent score (Gram stain), treatment: metronidazole 500mg BID x 7 days OR metronidazole gel 0.75% once daily x 5 days OR clindamycin cream 2% once daily x 7 days, tinidazole 2g daily x 2 days or 1g daily x 5 days (alternative), avoid alcohol with metronidazole/tinidazole (disulfiram-like reaction), treat symptomatic pregnant women, no routine treatment of partners; vulvovaginal candidiasis (VVC): uncomplicated (sporadic, mild-moderate, immunocompetent, non-pregnant) treatment: azoles (miconazole, clotrimazole, tioconazole OTC intravaginal x 1-7 days, butoconazole prescription intravaginal x 1-3 days, terconazole prescription intravaginal x 3-7 days, fluconazole 150mg orally single dose), complicated (recurrent (≥4 episodes/year), severe, immunocompromised, pregnancy, diabetes, non-albicans species): fluconazole 150mg orally every 72 hours x 2-3 doses OR longer course intravaginal azoles, maintenance: fluconazole 150mg weekly for 6 months, pregnancy: topical azoles only (7-day course); pelvic inflammatory disease (PID): CDC diagnostic criteria (minimal: uterine/adnexal tenderness, cervical motion tenderness), additional criteria (oral temp 101°F, abnormal cervical/vaginal discharge, elevated ESR/CRP, documented cervical infection with N. gonorrhoeae or C. trachomatis), definitive criteria (endometrial biopsy with plasma cell endometritis, laparoscopic findings, TVUS or MRI with thickened fluid-filled tubes), outpatient treatment: ceftriaxone 500mg IM single dose PLUS doxycycline 100mg BID x 14 days with or without metronidazole 500mg BID x 14 days, inpatient treatment: IV ceftriaxone 1g every 24 hours plus doxycycline plus metronidazole, criteria for hospitalization (pregnancy, severe illness (nausea/vomiting, high fever), tubo-ovarian abscess, unable to follow up, immunocompromised, failed outpatient therapy); vulvovaginal conditions (lichen sclerosus: chronic inflammatory condition, figure-of-eight distribution, parchment-like skin, white papules/plaques, atrophy, adhesions, fissuring, intense pruritus, treatment: ultrapotent topical corticosteroids (clobetasol propionate 0.05% ointment once/twice daily for 2-4 weeks then taper), long-term maintenance, surgical management for scarring/obliteration, increased risk of vulvar squamous cell carcinoma (lifelong follow-up); lichen planus: reticulated white striae (Wickham striae), erosive form most symptomatic, treatment: topical corticosteroids (class I-II), topical calcineurin inhibitors (tacrolimus), systemic corticosteroids for severe cases; vulvodynia: chronic vulvar pain 3 months without identifiable cause, subtypes (generalized vs localized, provoked vs unprovoked), treatment: multidisciplinary approach (cognitive behavioral therapy (CBT), pelvic floor physical therapy (biofeedback, trigger point release, dilators), topical lidocaine 5% ointment (applied 20-30 minutes before intercourse for provoked vestibulodynia), tricyclic antidepressants (amitriptyline, nortriptyline starting 10-25 mg nightly, titrate to 50-150 mg), SNRIs (duloxetine 30-60 mg, venlafaxine 75-150 mg), gabapentin (300-900 mg TID) or pregabalin (75-150 mg BID), vestibulectomy for localized provoked vestibulodynia refractory to conservative treatment); vaginismus: persistent difficulty with vaginal penetration despite desire (primary vs secondary), treatment: pelvic floor physical therapy (graduated dilators, biofeedback), cognitive behavioral therapy, botulinum toxin injection for severe refractory cases; breast health (clinical breast exam technique (inspection (symmetry, contour, skin changes (dimpling, peau d'orange, erythema, retraction), nipple discharge/asymmetry/retraction), palpation (vertical strip pattern, bimanual technique, axillary lymph node assessment), breast self-awareness (recognizing normal baseline, not formal BSE), mammography screening guidelines: ACR (annual starting at 40), ACOG (annual starting at 40), USPSTF (biennial 50-74, individualized decision 40-49), high-risk screening (lifetime risk ≥20%): annual mammogram plus breast MRI (alternating every 6 months), evaluation of breast masses: diagnostic mammogram (additional views including spot compression, magnification, rolled lateral), breast ultrasound (cyst vs solid, simple vs complex, vascularity), core needle biopsy (ultrasound-guided, stereotactic, or MRI-guided), fine needle aspiration (FNA) for simple cysts, MRI for high-risk screening or problem-solving, breast pain (mastalgia): cyclic (luteal phase, bilateral, diffuse) treatment (supportive bra, NSAIDs, evening primrose oil, danazol, tamoxifen in severe cases), non-cyclic (focal, often musculoskeletal or chest wall) evaluation (r/o focal lesion, treat underlying cause), nipple discharge evaluation: physiologic (bilateral, multiductal, white/green/brown, spontaneous vs expressible) vs pathologic (unilateral, single duct, spontaneous, serous/bloody/clear), workup (prolactin level, TSH, ductography, ductoscopy, biopsy for persistent pathologic discharge), benign breast conditions: fibrocystic changes (most common, cyclic pain, palpable nodularity, simple cysts, treatment: supportive bra, NSAIDs, oral contraceptives, danazol for severe, avoid methylxanthines controversial), fibroadenomas (most common benign tumor in young women, mobile, rubbery, well-circumscribed, observation (if 2-3 cm, not growing, biopsy-proven), cryoablation, vacuum-assisted excision, surgical excision for large/growing), cysts (simple anechoic, thin-walled, posterior enhancement, no internal echoes - no further evaluation, complex cysts (septations, mural nodules, thick wall) require aspiration and/or biopsy), intraductal papilloma (single duct bloody discharge, central vs peripheral, excision for symptomatic/atypical); cervical cancer prevention and screening (HPV vaccination: Gardasil 9 (9-valent: 6,11,16,18,31,33,45,52,58), routine at ages 11-12 (starting at 9), catch-up through 26, shared decision-making ages 27-45, 2-dose series if started before 15 (0,6-12 months), 3-dose series if started at 15 or older (0,2,6 months), Pap smear: liquid-based cytology (LBC) preferred over conventional, preparation (avoid 48 hours before: intercourse, douching, tampons, vaginal meds, optimal timing mid-cycle (days 10-20), collection technique (endocervical brush for transformation zone, spatula for ectocervix, preserve in fixative), Bethesda System for Reporting Cervical Cytology: NILM (negative), ASC-US (atypical squamous cells of undetermined significance), LSIL (low-grade squamous intraepithelial lesion - HPV effect/CIN 1), ASC-H (atypical squamous cells cannot exclude HSIL), HSIL (high-grade squamous intraepithelial lesion - CIN 2/3), AGC (atypical glandular cells), carcinoma (adenocarcinoma, squamous cell carcinoma), HPV testing: primary HPV screening (high-risk HPV types 16/18/other), co-testing (Pap + HPV), triage of ASC-US with HPV reflex testing, colposcopy: indications (ASC-US HPV+, ASC-H, LSIL, HSIL, AGC, persistent ASC-US, abnormal HPV test with negative cytology in certain situations), technique (acetic acid 3-5%, identification of transformation zone (type 1,2,3), abnormal findings: acetowhite epithelium (dense/thin), punctation (fine/coarse), mosaicism (fine/coarse), atypical vessels (retiform, glomerular), Lugol's iodine (Schiller's test) for glycogen-rich tissue, biopsy of most abnormal areas, endocervical curettage (ECC) if type 2-3 TZ or unsatisfactory exam, cervical intraepithelial neoplasia (CIN) management: CIN 1 (observation with repeat co-testing at 12 months, colposcopy if persistent, treatment (ablation/cryotherapy, LEEP) not recommended unless persistent 2 years or patient concerns), CIN 2/3 (treatment recommended: LEEP (loop electrosurgical excision procedure), CKC (cold knife conization), ablation (cryotherapy, laser ablation) only for CIN 2 if margins fully visualized and endocervical sampling negative, follow-up co-testing at 6 and 12 months post-treatment), adenocarcinoma in situ (AIS) (excisional procedure (CKC preferred to LEEP), hysterectomy if fertility complete), abnormal uterine bleeding (AUB) evaluation (detailed history (onset, duration, volume, frequency, intermenstrual bleeding, postcoital bleeding, relationship to menstrual cycle), physical exam (bimanual, speculum), labs (pregnancy test (hCG), CBC (anemia), TSH (thyroid dysfunction), prolactin (hyperprolactinemia), FSH (ovarian reserve, perimenopause), coagulation studies (if bleeding disorder suspected), imaging: transvaginal ultrasound (TVUS) (endometrial thickness (normal proliferative 4-5mm, secretory 8-10mm, postmenopausal 4-5mm), saline infusion sonography (SIS)/sonohysterography (for intracavitary lesions: polyps, fibroids, adhesions, congenital anomalies), MRI for deep adenomyosis, hysteroscopy (diagnostic and operative), PALM-COEIN classification system (Polyp (AUB-P), Adenomyosis (AUB-A), Leiomyoma (AUB-L (submucosal, other)), Malignancy/hyperplasia (AUB-M), Coagulopathy (AUB-C), Ovulatory dysfunction (AUB-O), Endometrial (AUB-E), Iatrogenic (AUB-I), Not yet classified (AUB-N)), polycystic ovary syndrome (PCOS) diagnosis (Rotterdam criteria: requires 2 of 3: (1) oligo-anovulation (cycles 35 days or 8 cycles per year), (2) clinical (hirsutism (Ferriman-Gallwey score ≥8-9), acne, alopecia) or biochemical hyperandrogenism (elevated free testosterone, DHEA-S, androstenedione), (3) polycystic ovarian morphology on ultrasound (≥20 follicles per ovary or ovarian volume ≥10 mL, 2018 updated criteria), exclude other etiologies (thyroid dysfunction, hyperprolactinemia, CAH, androgen-secreting tumor, Cushing's syndrome), PCOS management: lifestyle modification (diet, exercise, weight loss (5-10% improves metabolic and reproductive outcomes)), hormonal contraceptives (first-line for cycle regulation, androgen blockade (progestins with anti-androgenic properties: drospirenone, norgestimate, desogestrel)), metformin (500-2500 mg/day, for metabolic dysfunction (impaired glucose tolerance, diabetes), not first-line for ovulation induction, may improve menstrual regularity and weight), anti-androgens (spironolactone 50-200 mg/day for hirsutism/acne (monitor potassium, pregnancy prevention due to teratogenicity), finasteride 2.5-5 mg daily, eflornithine cream for facial hirsutism), fertility treatment: letrozole (2.5-7.5 mg days 3-7, first-line, lower risk of multiple pregnancy than clomiphene, better live birth rates in PCOS), clomiphene citrate (50-150 mg days 5-9, second-line), gonadotropins (FSH with low-dose step-up protocol, monitoring for OHSS and multiples), IVF for refractory cases; endometriosis diagnosis (clinical presentation: dysmenorrhea (cyclic pain beginning before menses, worsening with age), dyspareunia (deep pain with intercourse), dyschezia (pain with bowel movements), dysuria (pain with urination), chronic pelvic pain, infertility), physical exam (uterosacral ligament nodularity, tender nodules, fixed retroverted uterus, adnexal mass (endometrioma)), surgical diagnosis via laparoscopy with biopsy (gold standard, visual appearance (powder-burn lesions, red lesions, blue-black lesions, white scarred lesions, peritoneal pockets)), histologic confirmation (endometrial glands and stroma), endometriosis management: medical therapy (NSAIDs for pain (ibuprofen, naproxen), hormonal suppression (combined oral contraceptives (continuous or cyclic), progestins (norethindrone acetate, dienogest, depot medroxyprogesterone acetate, levonorgestrel IUD), GnRH agonists (leuprolide, goserelin, triptorelin, nafarelin) (3-6 months with add-back therapy (low-dose estrogen-progestin, norethindrone, bazedoxifene) to prevent hypoestrogenic side effects and bone loss), GnRH antagonists (elagolix 150-300 mg BID up to 24 months, relugolix combination (40 mg with estradiol 1 mg and norethindrone 0.5 mg daily), danazol (androgenic side effects limiting use), aromatase inhibitors (anastrozole, letrozole) for refractory pain, surgical treatment (excision (preferred over ablation for pain reduction), ablation (laser, electrocautery), hysterectomy (with or without bilateral salpingo-oophorectomy for definitive treatment after completion of childbearing), presacral neurectomy for midline pain), uterine fibroids (leiomyomas) classification (FIGO classification system: type 0 (pedunculated intracavitary), type 1 (50% intramural), type 2 (≥50% intramural), type 3 (intramural, touching endometrium), type 4 (intramural, completely within myometrium), type 5 (subserosal, ≥50% intramural), type 6 (subserosal, 50% intramural), type 7 (subserosal pedunculated), type 8 (other (cervical, broad ligament, parasitic)), symptoms: heavy menstrual bleeding (most common, menorrhagia), bulk symptoms (urinary frequency, constipation, pelvic pressure/pain, bloating), reproductive dysfunction (infertility, pregnancy loss, preterm labor, malpresentation), acute pain (degeneration (red degeneration in pregnancy), torsion of pedunculated fibroid), management: watchful waiting for asymptomatic, medical therapy (NSAIDs for pain, tranexamic acid for bleeding (1.3g TID x 5 days of menses), GnRH agonists (preoperative use for 3-4 months to reduce fibroid size and bleeding, improve hemoglobin), GnRH antagonists with add-back (elagolix/relugolix combination, oral, up to 24 months), oral contraceptives, progestin-releasing IUD (LNG-IUS) for bleeding reduction (may not reduce fibroid size), tranexamic acid, nonsteroidal anti-inflammatory drugs), minimally invasive procedures: uterine artery embolization (UAE) (small particle injection, symptom improvement 80-90%, not for patients desiring future fertility), radiofrequency ablation (Acessa (laparoscopic), Sonata (intracavitary/intramural) for type 1-6 fibroids up to 10 cm, preserves fertility), MRI-guided focused ultrasound (MRgFUS) (non-invasive, limited to certain fibroid characteristics), surgical options: myomectomy (abdominal (laparotomy), laparoscopic (robotic-assisted), hysteroscopic (for submucosal type 0-2), recurrence risk (up to 50-60% within 5 years), hysterectomy (definitive treatment, appropriate for completed childbearing, severe symptoms), ovarian cysts (functional cysts: follicular cysts (most common, asymptomatic, resolve spontaneously in 1-3 cycles, follow with ultrasound if 5 cm or symptomatic), corpus luteum cysts (may cause pain, can rupture or hemorrhage, supportive care, oral contraceptives for suppression), theca lutein cysts (associated with high hCG (molar pregnancy, multiples, ovarian hyperstimulation), resolve after hCG normalizes), pathologic cysts: dermoid/mature cystic teratoma (most common ovarian neoplasm in reproductive age, contains elements from all 3 germ layers (hair, teeth, sebum, thyroid), risk of torsion, management: laparoscopic cystectomy (preserve ovarian tissue), risk of recurrence low), cystadenoma (serous (most common benign epithelial tumor, thin-walled, unilocular, clear fluid) vs mucinous (multilocular, thick septations, mucoid fluid), management: cystectomy or oophorectomy), endometrioma (chocolate cyst (old blood), associated with endometriosis, management: laparoscopic cystectomy (improves pain and fertility), malignancy concerns (simple cyst 10 cm, no septations, no solid component, no internal echoes - benign, complex cysts with solid component, thick septations, internal echoes, papillary projections, ascites, elevated CA-125, age 50, postmenopausal require surgical evaluation (oophorectomy, staging)), complications: ovarian torsion (surgical emergency, sudden severe unilateral pain, nausea/vomiting, adnexal mass on exam, Doppler ultrasound may show absent or decreased venous/arterial flow, management: surgical detorsion, oophoropexy for recurrent, oophorectomy if ovary non-viable (black/purple, no improvement after detorsion)), rupture (acute pain, hemoperitoneum, surgical management for hemodynamic instability or ongoing bleeding), hemorrhage (hemorrhagic cyst, pain, expectant management if stable, surgery if unstable), pelvic inflammatory disease (PID) CDC diagnostic criteria (minimal criteria for empiric treatment: uterine tenderness, adnexal tenderness, cervical motion tenderness (chandelier sign) in sexually active young woman and at risk for STIs), additional criteria (oral temperature 101°F (38.3°C), abnormal cervical mucopurulent discharge, vaginal discharge with WBCs on saline microscopy, elevated ESR or CRP, documented cervical infection with N. gonorrhoeae or C. trachomatis), definitive criteria (endometrial biopsy with plasma cell endometritis, transvaginal ultrasound or MRI showing thickened fluid-filled tubes with or without free fluid or tubo-ovarian complex, laparoscopic abnormalities consistent with PID), treatment: outpatient (ceftriaxone 500mg IM single dose PLUS doxycycline 100mg orally BID x 14 days with or without metronidazole 500mg orally BID x 14 days), inpatient (IV ceftriaxone 1g every 24 hours PLUS doxycycline PLUS metronidazole, alternative IV regimens (cefoxitin 2g every 6 hours plus doxycycline, or clindamycin plus gentamicin)), criteria for hospitalization (pregnancy, severe illness (nausea/vomiting, high fever, septic appearance), tubo-ovarian abscess (TOA), inability to follow up or tolerate outpatient regimen, immunocompromised, failed outpatient therapy (no improvement in 72 hours)), follow-up (clinical improvement in 48-72 hours, retest for chlamydia/gonorrhea in 3 months), reproductive health in special populations (adolescent reproductive health: confidentiality (minor consent laws vary by state for contraception, STI testing/treatment, prenatal care), Title X family planning services, HEEADSSS assessment (Home, Education/Employment, Eating, Activities, Drugs/Alcohol, Sexuality, Suicide/Depression, Safety), menstrual disorders (dysmenorrhea (first-line NSAIDs, combined oral contraceptives), abnormal uterine bleeding (evaluate for bleeding disorders (von Willebrand disease), PCOS, thyroid dysfunction), contraception counseling (LARC preferred (IUDs, implant) due to highest effectiveness and continuation rates), STI screening (chlamydia/gonorrhea annually for sexually active 25 years, HIV, syphilis, hepatitis B based on risk), HPV vaccination (routine at 11-12 years, catch-up through 26), LGBTQ+ health: transgender care (gender-affirming hormone therapy (GAHT): feminizing (estradiol + spironolactone or GnRH agonists), masculinizing (testosterone), monitoring labs (estradiol/testosterone levels, metabolic panel, lipids, CBC, prolactin for feminizing, hemoglobin/hematocrit, lipids for masculinizing), fertility preservation counseling before initiating GAHT, sexual health screening based on anatomy (cervical cancer screening for transgender men with intact cervix, breast cancer screening for transgender women with breast tissue development, prostate cancer screening for transgender women, STI screening based on sexual behaviors (CDC guidelines), mental health support, survivors of intimate partner violence (IPV) and sexual trauma: screening (HARK (Humiliation, Afraid, Rape, Kick), HUM (Hurt, Insult, Threaten, Scream), PVS (Partner Violence Screen), routine screening recommended, trauma-informed care (create safe environment, avoid re-traumatization, offer choices, collaborative approach, validate experiences), safety planning (identify safe place, code word, emergency contacts, escape plan, important documents, restraining order information), resources (National Domestic Violence Hotline , local shelters, advocacy services), mandatory reporting of child abuse and elder abuse (state-specific requirements), women with disabilities: access to care barriers (physical, communication, attitudinal), reproductive autonomy (support decision-making capacity, avoid assumptions about sexuality and parenting), contraception (consider ability to adhere, medication interactions with anticonvulsants, physical limitations for IUD placement, bone density concerns with DMPA), pregnancy care (monitoring for complications, anesthesia considerations, postpartum support), cervical cancer screening (positioning considerations, modified speculum examination, accommodations for communication), ethical and legal issues in reproductive health (informed consent (elements: disclosure, comprehension, voluntariness, competence, consent), special considerations for minors (mature minor doctrine, emancipated minor, judicial bypass for abortion), confidentiality (HIPAA, Title X protections, limits: mandatory reporting of abuse, reportable diseases, threats of harm, duty to warn), reproductive rights (contraception access (ACA mandate for no-cost contraception, religious exemptions), abortion access (post-Dobbs, state restrictions vary, medication abortion (mifepristone + misoprostol up to 10-11 weeks), procedural abortion (aspiration, D&E), telemedicine abortion, legal exceptions (life/health of pregnant person, rape, incest, fetal anomaly), mandatory waiting periods, parental involvement laws), cultural competence in reproductive health (understand diverse beliefs about family planning, pregnancy, childbirth, contraception, STIs, respectful of traditions while providing evidence-based care, use of interpreters, avoid assumptions based on appearance or ethnicity, address health disparities (maternal mortality, cervical cancer, STIs)), patient education and counseling (shared decision-making (present options with risks/benefits, elicit patient preferences and values, make joint decision), health literacy (teach-back method, plain language, visual aids, written materials at appropriate reading level (5th-6th grade recommended)), motivational interviewing (open-ended questions, affirmations, reflective listening, summarize, elicit change talk, roll with resistance), and evidence-based clinical guidelines from ACOG (Practice Bulletins, Committee Opinions), ASRM (Fertility and Sterility guidelines), CDC (STI Treatment Guidelines, US Medical Eligibility Criteria for Contraceptive Use (US MEC), US Selected Practice Recommendations for Contraceptive Use (US SPR)), USPSTF (screening recommendations for cervical cancer, breast cancer, STIs, depression, IPV), WHO (Medical Eligibility Criteria for Contraceptive Use, Selected Practice Recommendations for Contraceptive Use), and the Endocrine Society (PCOS, menopause, transgender health guidelines), each answer includes detailed clinical rationales to reinforce advanced practice nursing skills in reproductive health care. Perfect for WHNP, FNP, and advanced practice nursing students preparing for the NRNP 6552 Midterm Exam (Actual Exam Version) at Walden University. With our Pass Guarantee, you can confidently prepare for your Advanced Reproductive Health Care midterm exam. Download your complete NRNP 6552 Midterm Exam Actual Version instantly!