NRNP 6552 MIDTERM EXAM WEEK 6 2026/2027 | Women's
Health Primary Care | 100 Verified Questions & Answers |
Pass Guaranteed - A+ Graded
Section 1: Reproductive Health & Gynecologic Disorders (Q1-25)
Q1. A 32-year-old presents with heavy menstrual bleeding for 6 months. The NP uses
the PALM-COEIN classification. Which component represents the "PALM" category?
A. Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic
B. Polyps, adenomyosis, leiomyoma, malignancy/hyperplasia
C. Polycystic ovaries, anovulation, leiomyoma, metrorrhagia
D. Pelvic pain, adhesions, lesions, masses
Correct Answer: B. Polyps, adenomyosis, leiomyoma, malignancy/hyperplasia
[CORRECT]
Rationale: PALM represents structural causes of abnormal uterine bleeding (Polyps,
Adenomyosis, Leiomyoma, Malignancy/hyperplasia), while COEIN represents
non-structural causes. Options A, C, and D mix incorrect or non-PALM categories.
Correct Answer: B
Q2. A 45-year-old with AUB undergoes transvaginal ultrasound showing a thickened
endometrium of 14 mm. She has no risk factors for malignancy. What is the next best
step?
A. Start combined oral contraceptives and reassess in 3 months
B. Perform endometrial biopsy to rule out hyperplasia or malignancy
C. Prescribe cyclic medroxyprogesterone 10 mg for 10 days
D. Order pelvic MRI to better characterize the endometrium
Correct Answer: B. Perform endometrial biopsy to rule out hyperplasia or malignancy
[CORRECT]
Rationale: Endometrial thickness >4-5 mm in postmenopausal women or persistent
AUB in perimenopausal women warrants biopsy to exclude malignancy; imaging alone
is insufficient. Options A and C delay diagnosis, and option D is not first-line.
Correct Answer: B
,Q3. A 38-year-old smoker (10 cigarettes/day) requests combined hormonal
contraception. According to CDC MEC, what is the recommendation?
A. Category 1: Use without restriction
B. Category 2: Advantages generally outweigh risks
C. Category 3: Risks generally outweigh advantages
D. Category 4: Unacceptable health risk
Correct Answer: C. Category 3: Risks generally outweigh advantages [CORRECT]
Rationale: For women ≥35 years who smoke <15 cigarettes/day, CHC is CDC MEC
Category 3; ≥15 cigarettes/day is Category 4. This patient's age and smoking status
increase cardiovascular risk. Options A and B underestimate risk, and option D applies
to heavier smoking.
Correct Answer: C
Q4. A 28-year-old requests the most effective reversible contraception. She has a
history of migraines without aura and normal BP. Which option is most appropriate?
A. Combined oral contraceptive pills
B. Copper IUD
C. Levonorgestrel 52 mg IUD
D. Depot medroxyprogesterone acetate injection
Correct Answer: C. Levonorgestrel 52 mg IUD [CORRECT]
Rationale: The levonorgestrel IUD is a LARC method with >99% efficacy, minimal
systemic progestin effects, and is safe in migraines without aura; it is more effective
than options A and D and has lower bleeding than the copper IUD for many users.
Option A is less effective, option B may increase menstrual bleeding, and option D
requires quarterly visits.
Correct Answer: C
Q5. A 19-year-old presents 48 hours after unprotected intercourse requesting
emergency contraception. She is not on any regular contraception. Which is the most
effective option?
A. Levonorgestrel 1.5 mg single dose
B. Ulipristal acetate 30 mg single dose
C. Yuzpe regimen (combined estrogen-progestin)
D. Insertion of copper IUD within 5 days
Correct Answer: D. Insertion of copper IUD within 5 days [CORRECT]
,Rationale: The copper IUD is the most effective emergency contraception (99%
effective) and provides ongoing contraception; it can be inserted up to 5 days after
intercourse. Options A and B are less effective, and option C is the least effective and
has more side effects.
Correct Answer: D
Q6. A 24-year-old is asymptomatic. According to 2026 USPSTF guidelines, at what age
should routine chlamydia and gonorrhea screening stop for average-risk women?
A. 21 years
B. 25 years
C. 30 years
D. 65 years
Correct Answer: B. 25 years [CORRECT]
Rationale: USPSTF recommends screening for chlamydia and gonorrhea in sexually
active women age 24 years and younger; routine screening is not recommended for
average-risk women over 25 unless at increased risk. Options A, C, and D do not reflect
the age cutoff.
Correct Answer: B
Q7. A 26-year-old is diagnosed with pelvic inflammatory disease (PID). She is mildly ill
and outpatient management is appropriate. Which regimen is recommended by CDC
2026 guidelines?
A. Ceftriaxone 500 mg IM once plus doxycycline 100 mg PO BID for 7 days
B. Ceftriaxone 500 mg IM once plus doxycycline 100 mg PO BID for 14 days plus
metronidazole 500 mg PO BID for 14 days
C. Azithromycin 1 g PO once plus metronidazole 500 mg PO BID for 7 days
D. Levofloxacin 500 mg PO daily for 14 days alone
Correct Answer: B. Ceftriaxone 500 mg IM once plus doxycycline 100 mg PO BID for 14
days plus metronidazole 500 mg PO BID for 14 days [CORRECT]
Rationale: CDC outpatient PID regimen requires ceftriaxone (or other cephalosporin)
plus doxycycline for 14 days plus metronidazole to cover anaerobes; single-dose
azithromycin or fluoroquinolone monotherapy is insufficient. Options A lacks
metronidazole, and options C and D are inadequate coverage.
Correct Answer: B
, Q8. A 30-year-old is diagnosed with chlamydia. Her partner is unable to come to the
clinic. In which situation is expedited partner therapy (EPT) most appropriate?
A. The partner is asymptomatic and there are no legal restrictions in the state
B. The partner has symptoms of urethral discharge
C. The patient has a known allergy to azithromycin
D. The partner is a male who has sex with men
Correct Answer: A. The partner is asymptomatic and there are no legal restrictions in
the state [CORRECT]
Rationale: EPT provides prescriptions or medications for partners without clinical
evaluation; it is appropriate for heterosexual partners in states where legal and when the
partner is asymptomatic. Options B requires clinical evaluation, option C affects the
patient not the partner's therapy, and option D has higher risk of other STIs requiring full
evaluation.
Correct Answer: A
Q9. A 29-year-old presents with a painless vulvar ulcer and regional lymphadenopathy.
Darkfield microscopy is unavailable. Which test is most appropriate for diagnosing
primary syphilis?
A. Treponemal antibody test (EIA/CIA) alone
B. Nontreponemal test (RPR/VDRL) alone
C. Nucleic acid amplification test (NAAT) from the lesion
D. Both nontreponemal and treponemal tests
Correct Answer: D. Both nontreponemal and treponemal tests [CORRECT]
Rationale: Syphilis diagnosis requires both nontreponemal (RPR/VDRL) for
screening/quantification and treponemal (EIA/TP-PA) for confirmation; using either
alone can yield false negatives or biological false positives. Options A and B are
insufficient alone, and option C is not standard for syphilis.
Correct Answer: D
Q10. A 25-year-old is diagnosed with trichomoniasis. She is not pregnant. Which
treatment is recommended?
A. Metronidazole 2 g orally in a single dose
B. Metronidazole 500 mg orally twice daily for 7 days
C. Tinidazole 2 g orally in a single dose
D. Either A or B
Health Primary Care | 100 Verified Questions & Answers |
Pass Guaranteed - A+ Graded
Section 1: Reproductive Health & Gynecologic Disorders (Q1-25)
Q1. A 32-year-old presents with heavy menstrual bleeding for 6 months. The NP uses
the PALM-COEIN classification. Which component represents the "PALM" category?
A. Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic
B. Polyps, adenomyosis, leiomyoma, malignancy/hyperplasia
C. Polycystic ovaries, anovulation, leiomyoma, metrorrhagia
D. Pelvic pain, adhesions, lesions, masses
Correct Answer: B. Polyps, adenomyosis, leiomyoma, malignancy/hyperplasia
[CORRECT]
Rationale: PALM represents structural causes of abnormal uterine bleeding (Polyps,
Adenomyosis, Leiomyoma, Malignancy/hyperplasia), while COEIN represents
non-structural causes. Options A, C, and D mix incorrect or non-PALM categories.
Correct Answer: B
Q2. A 45-year-old with AUB undergoes transvaginal ultrasound showing a thickened
endometrium of 14 mm. She has no risk factors for malignancy. What is the next best
step?
A. Start combined oral contraceptives and reassess in 3 months
B. Perform endometrial biopsy to rule out hyperplasia or malignancy
C. Prescribe cyclic medroxyprogesterone 10 mg for 10 days
D. Order pelvic MRI to better characterize the endometrium
Correct Answer: B. Perform endometrial biopsy to rule out hyperplasia or malignancy
[CORRECT]
Rationale: Endometrial thickness >4-5 mm in postmenopausal women or persistent
AUB in perimenopausal women warrants biopsy to exclude malignancy; imaging alone
is insufficient. Options A and C delay diagnosis, and option D is not first-line.
Correct Answer: B
,Q3. A 38-year-old smoker (10 cigarettes/day) requests combined hormonal
contraception. According to CDC MEC, what is the recommendation?
A. Category 1: Use without restriction
B. Category 2: Advantages generally outweigh risks
C. Category 3: Risks generally outweigh advantages
D. Category 4: Unacceptable health risk
Correct Answer: C. Category 3: Risks generally outweigh advantages [CORRECT]
Rationale: For women ≥35 years who smoke <15 cigarettes/day, CHC is CDC MEC
Category 3; ≥15 cigarettes/day is Category 4. This patient's age and smoking status
increase cardiovascular risk. Options A and B underestimate risk, and option D applies
to heavier smoking.
Correct Answer: C
Q4. A 28-year-old requests the most effective reversible contraception. She has a
history of migraines without aura and normal BP. Which option is most appropriate?
A. Combined oral contraceptive pills
B. Copper IUD
C. Levonorgestrel 52 mg IUD
D. Depot medroxyprogesterone acetate injection
Correct Answer: C. Levonorgestrel 52 mg IUD [CORRECT]
Rationale: The levonorgestrel IUD is a LARC method with >99% efficacy, minimal
systemic progestin effects, and is safe in migraines without aura; it is more effective
than options A and D and has lower bleeding than the copper IUD for many users.
Option A is less effective, option B may increase menstrual bleeding, and option D
requires quarterly visits.
Correct Answer: C
Q5. A 19-year-old presents 48 hours after unprotected intercourse requesting
emergency contraception. She is not on any regular contraception. Which is the most
effective option?
A. Levonorgestrel 1.5 mg single dose
B. Ulipristal acetate 30 mg single dose
C. Yuzpe regimen (combined estrogen-progestin)
D. Insertion of copper IUD within 5 days
Correct Answer: D. Insertion of copper IUD within 5 days [CORRECT]
,Rationale: The copper IUD is the most effective emergency contraception (99%
effective) and provides ongoing contraception; it can be inserted up to 5 days after
intercourse. Options A and B are less effective, and option C is the least effective and
has more side effects.
Correct Answer: D
Q6. A 24-year-old is asymptomatic. According to 2026 USPSTF guidelines, at what age
should routine chlamydia and gonorrhea screening stop for average-risk women?
A. 21 years
B. 25 years
C. 30 years
D. 65 years
Correct Answer: B. 25 years [CORRECT]
Rationale: USPSTF recommends screening for chlamydia and gonorrhea in sexually
active women age 24 years and younger; routine screening is not recommended for
average-risk women over 25 unless at increased risk. Options A, C, and D do not reflect
the age cutoff.
Correct Answer: B
Q7. A 26-year-old is diagnosed with pelvic inflammatory disease (PID). She is mildly ill
and outpatient management is appropriate. Which regimen is recommended by CDC
2026 guidelines?
A. Ceftriaxone 500 mg IM once plus doxycycline 100 mg PO BID for 7 days
B. Ceftriaxone 500 mg IM once plus doxycycline 100 mg PO BID for 14 days plus
metronidazole 500 mg PO BID for 14 days
C. Azithromycin 1 g PO once plus metronidazole 500 mg PO BID for 7 days
D. Levofloxacin 500 mg PO daily for 14 days alone
Correct Answer: B. Ceftriaxone 500 mg IM once plus doxycycline 100 mg PO BID for 14
days plus metronidazole 500 mg PO BID for 14 days [CORRECT]
Rationale: CDC outpatient PID regimen requires ceftriaxone (or other cephalosporin)
plus doxycycline for 14 days plus metronidazole to cover anaerobes; single-dose
azithromycin or fluoroquinolone monotherapy is insufficient. Options A lacks
metronidazole, and options C and D are inadequate coverage.
Correct Answer: B
, Q8. A 30-year-old is diagnosed with chlamydia. Her partner is unable to come to the
clinic. In which situation is expedited partner therapy (EPT) most appropriate?
A. The partner is asymptomatic and there are no legal restrictions in the state
B. The partner has symptoms of urethral discharge
C. The patient has a known allergy to azithromycin
D. The partner is a male who has sex with men
Correct Answer: A. The partner is asymptomatic and there are no legal restrictions in
the state [CORRECT]
Rationale: EPT provides prescriptions or medications for partners without clinical
evaluation; it is appropriate for heterosexual partners in states where legal and when the
partner is asymptomatic. Options B requires clinical evaluation, option C affects the
patient not the partner's therapy, and option D has higher risk of other STIs requiring full
evaluation.
Correct Answer: A
Q9. A 29-year-old presents with a painless vulvar ulcer and regional lymphadenopathy.
Darkfield microscopy is unavailable. Which test is most appropriate for diagnosing
primary syphilis?
A. Treponemal antibody test (EIA/CIA) alone
B. Nontreponemal test (RPR/VDRL) alone
C. Nucleic acid amplification test (NAAT) from the lesion
D. Both nontreponemal and treponemal tests
Correct Answer: D. Both nontreponemal and treponemal tests [CORRECT]
Rationale: Syphilis diagnosis requires both nontreponemal (RPR/VDRL) for
screening/quantification and treponemal (EIA/TP-PA) for confirmation; using either
alone can yield false negatives or biological false positives. Options A and B are
insufficient alone, and option C is not standard for syphilis.
Correct Answer: D
Q10. A 25-year-old is diagnosed with trichomoniasis. She is not pregnant. Which
treatment is recommended?
A. Metronidazole 2 g orally in a single dose
B. Metronidazole 500 mg orally twice daily for 7 days
C. Tinidazole 2 g orally in a single dose
D. Either A or B
