NR-602 Final Exam Study Guide Updated: Primary Care
of the Childbearing & Childrearing Family Practicum –
Chamberlain
1. A 16-year-old female presents with 3 months of irregular menses, acne, and hirsutism.
What is the most likely diagnosis?
Answer: Polycystic ovary syndrome (PCOS)
Rationale: PCOS is diagnosed using Rotterdam criteria (hyperandrogenism, ovulatory
dysfunction, polycystic ovaries on ultrasound). Acne + hirsutism + irregular menses = classic
presentation.
2. What is the first-line pharmacologic treatment for PCOS-related menstrual irregularity in
an adolescent not desiring pregnancy?
Answer: Combined oral contraceptives (COCs)
Rationale: COCs regulate cycles, reduce androgen levels, and improve acne/hirsutism.
Metformin is second-line.
3. A pregnant patient at 28 weeks gestation has a 1-hour glucose challenge test result of
155 mg/dL. What is the next step?
Answer: 3-hour 100g oral glucose tolerance test (OGTT)
*Rationale: GCT cutoff is 130–140 mg/dL. 155 is elevated, so diagnostic OGTT is needed to
confirm GDM.*
4. Group B Streptococcus (GBS) screening in pregnancy is recommended at:
Answer: 36 0/7 – 37 6/7 weeks gestation
Rationale: Rectovaginal swab at 36–37 weeks best predicts intrapartum colonization. Results
valid for 5 weeks.
,5. A newborn has jaundice at 18 hours of life. Total bilirubin is 12 mg/dL. What is the most
appropriate next step?
Answer: Evaluate for pathologic jaundice (Coombs test, blood type, CBC, reticulocyte
count)
*Rationale: Jaundice <24 hours is always pathologic. Must rule out hemolytic disease
(ABO/Rh incompatibility), sepsis, or G6PD deficiency.*
6. What vaccine should be deferred in pregnancy unless indicated for outbreak or travel?
Answer: Measles-mumps-rubella (MMR)
Rationale: MMR is live attenuated; contraindicated in pregnancy due to theoretical risk to
fetus. Give postpartum.
7. Recommended first-line treatment for uncomplicated gonorrhea in a non-pregnant 20-
year-old female:
Answer: Ceftriaxone 500 mg IM once
Rationale: CDC guidelines – ceftriaxone 500 mg IM (or 1g if >150 kg). Doxycycline 100 mg
BID x7 days for possible chlamydia coinfection.
8. A 6-month-old presents with fever, rhinorrhea, and a “slapped cheek” rash. What is the
likely pathogen?
Answer: Parvovirus B19 (fifth disease)
Rationale: Classic prodrome + “slapped cheeks” then lacy reticular rash. Rash appears after
fever resolves.
9. Which medication is safe to treat hypertension in a breastfeeding mother?
Answer: Labetalol
Rationale: Labetalol, nifedipine, and enalapril are preferred in lactation. Avoid ACEIs (except
enalapril, captopril) and atenolol.
10. Minimum number of well-child visits recommended by the AAP in the first 12 months:
Answer: 6 visits (newborn, 1, 2, 4, 6, 9 months)
, *Rationale: Timing: birth, 1 mo, 2 mo, 4 mo, 6 mo, 9 mo, then 12 mo. Total 7 if including 12-
month visit, but “first 12 months” usually means up to 12 months old.*
11. A 2-year-old has a blood lead level of 15 mcg/dL. What is the next step?
Answer: Nutritional assessment, environmental investigation, and repeat lead level
*Rationale: CDC reference level is 3.5 mcg/dL. Level ≥5 requires case management. 15 is
moderate – need source identification, iron/calcium counseling, repeat in 1 month.*
12. A postpartum woman reports headache, blurred vision, and right upper quadrant pain 5
days after delivery. BP 160/110. What is the diagnosis?
Answer: Postpartum preeclampsia
*Rationale: Preeclampsia can occur up to 6 weeks postpartum. Headache + visual changes +
RUQ pain + hypertension = severe features.*
13. First-line treatment for an acute migraine in a pregnant patient:
Answer: Acetaminophen 1000 mg + caffeine
*Rationale: Acetaminophen is safest analgesic in pregnancy. Avoid NSAIDs after 20 weeks
(oligohydramnios, ductus arteriosus closure). Sumatriptan is second-line.*
14. A 12-month-old is not yet able to pull to stand. What should the NP do?
Answer: Refer for developmental evaluation
Rationale: By 12 months, gross motor milestones: stand independently, pull to stand, cruise.
Delay warrants early intervention referral.
15. Which intrauterine device (IUD) has the indication for heavy menstrual bleeding?
Answer: Levonorgestrel-releasing IUD (Mirena)
Rationale: Mirena is FDA-approved for HMB. Decreases endometrial thickness over time.
16. A 4-week-old has poor feeding, vomiting that is becoming projectile, and olive-shaped
mass on palpation. Diagnosis?
Answer: Hypertrophic pyloric stenosis
of the Childbearing & Childrearing Family Practicum –
Chamberlain
1. A 16-year-old female presents with 3 months of irregular menses, acne, and hirsutism.
What is the most likely diagnosis?
Answer: Polycystic ovary syndrome (PCOS)
Rationale: PCOS is diagnosed using Rotterdam criteria (hyperandrogenism, ovulatory
dysfunction, polycystic ovaries on ultrasound). Acne + hirsutism + irregular menses = classic
presentation.
2. What is the first-line pharmacologic treatment for PCOS-related menstrual irregularity in
an adolescent not desiring pregnancy?
Answer: Combined oral contraceptives (COCs)
Rationale: COCs regulate cycles, reduce androgen levels, and improve acne/hirsutism.
Metformin is second-line.
3. A pregnant patient at 28 weeks gestation has a 1-hour glucose challenge test result of
155 mg/dL. What is the next step?
Answer: 3-hour 100g oral glucose tolerance test (OGTT)
*Rationale: GCT cutoff is 130–140 mg/dL. 155 is elevated, so diagnostic OGTT is needed to
confirm GDM.*
4. Group B Streptococcus (GBS) screening in pregnancy is recommended at:
Answer: 36 0/7 – 37 6/7 weeks gestation
Rationale: Rectovaginal swab at 36–37 weeks best predicts intrapartum colonization. Results
valid for 5 weeks.
,5. A newborn has jaundice at 18 hours of life. Total bilirubin is 12 mg/dL. What is the most
appropriate next step?
Answer: Evaluate for pathologic jaundice (Coombs test, blood type, CBC, reticulocyte
count)
*Rationale: Jaundice <24 hours is always pathologic. Must rule out hemolytic disease
(ABO/Rh incompatibility), sepsis, or G6PD deficiency.*
6. What vaccine should be deferred in pregnancy unless indicated for outbreak or travel?
Answer: Measles-mumps-rubella (MMR)
Rationale: MMR is live attenuated; contraindicated in pregnancy due to theoretical risk to
fetus. Give postpartum.
7. Recommended first-line treatment for uncomplicated gonorrhea in a non-pregnant 20-
year-old female:
Answer: Ceftriaxone 500 mg IM once
Rationale: CDC guidelines – ceftriaxone 500 mg IM (or 1g if >150 kg). Doxycycline 100 mg
BID x7 days for possible chlamydia coinfection.
8. A 6-month-old presents with fever, rhinorrhea, and a “slapped cheek” rash. What is the
likely pathogen?
Answer: Parvovirus B19 (fifth disease)
Rationale: Classic prodrome + “slapped cheeks” then lacy reticular rash. Rash appears after
fever resolves.
9. Which medication is safe to treat hypertension in a breastfeeding mother?
Answer: Labetalol
Rationale: Labetalol, nifedipine, and enalapril are preferred in lactation. Avoid ACEIs (except
enalapril, captopril) and atenolol.
10. Minimum number of well-child visits recommended by the AAP in the first 12 months:
Answer: 6 visits (newborn, 1, 2, 4, 6, 9 months)
, *Rationale: Timing: birth, 1 mo, 2 mo, 4 mo, 6 mo, 9 mo, then 12 mo. Total 7 if including 12-
month visit, but “first 12 months” usually means up to 12 months old.*
11. A 2-year-old has a blood lead level of 15 mcg/dL. What is the next step?
Answer: Nutritional assessment, environmental investigation, and repeat lead level
*Rationale: CDC reference level is 3.5 mcg/dL. Level ≥5 requires case management. 15 is
moderate – need source identification, iron/calcium counseling, repeat in 1 month.*
12. A postpartum woman reports headache, blurred vision, and right upper quadrant pain 5
days after delivery. BP 160/110. What is the diagnosis?
Answer: Postpartum preeclampsia
*Rationale: Preeclampsia can occur up to 6 weeks postpartum. Headache + visual changes +
RUQ pain + hypertension = severe features.*
13. First-line treatment for an acute migraine in a pregnant patient:
Answer: Acetaminophen 1000 mg + caffeine
*Rationale: Acetaminophen is safest analgesic in pregnancy. Avoid NSAIDs after 20 weeks
(oligohydramnios, ductus arteriosus closure). Sumatriptan is second-line.*
14. A 12-month-old is not yet able to pull to stand. What should the NP do?
Answer: Refer for developmental evaluation
Rationale: By 12 months, gross motor milestones: stand independently, pull to stand, cruise.
Delay warrants early intervention referral.
15. Which intrauterine device (IUD) has the indication for heavy menstrual bleeding?
Answer: Levonorgestrel-releasing IUD (Mirena)
Rationale: Mirena is FDA-approved for HMB. Decreases endometrial thickness over time.
16. A 4-week-old has poor feeding, vomiting that is becoming projectile, and olive-shaped
mass on palpation. Diagnosis?
Answer: Hypertrophic pyloric stenosis
