NSG 6320 AGNP Board Exam – Women’s Health
Prescription Exam
1. Question:
Which of the following is NOT a common side effect associated with the use
of etonogestrel/ethinyl estradiol (NuvaRing), a contraceptive vaginal ring?
Vaginitis
Breast tenderness
Increased appetite
Severe headache Correct
Explanation:
A common side effect NOT associated with the use of etonogestrel/ethinyl
estradiol (NuvaRing) is severe headache. The systemic side effects of
NuvaRing are the same as with oral contraceptives. Vaginitis and local skin
irritation may occur with the use of the intravaginal ring. Danger signs of
contraceptives can be remembered using the acronym ACHES: A-Severe
abdominal pain (may be indicative of hepatic tumors); C-Severe chest pain or
shortness of breath; H-Severe headaches; E-eye problems (blurred vision,
flashing lights, or blindness); S-Severe leg pain.
2. Question:
A common side effect associated with the use of progestin-only
contraceptives is:
depression.
amenorrhea. Correct
hypertension.
edema.
Explanation:
Common side effects of progestin-only contraceptives are menstrual cycle
changes (e.g., spotting, breakthrough bleeding, prolonged cycles and
eventually, amenorrhea). Other side effects are breast tenderness,
headaches, and mood changes.
3. Question:
The drug of choice to control mild abnormal uterine bleeding in a 25-year-old
woman with future childbearing plans is:
estrogen only.
androgen therapy
gonadotropin-releasing hormone analogs.
progesterone only. Correct
Explanation:
,A combined estrogen/progesterone oral contraceptive or progesterone only
would be the treatment of choice for mild abnormal uterine bleeding in a
woman of childbearing age. Severe uterine bleeding is usually treated on an
emergency basis with a short course of high-dose estrogen therapy.
Treatment with androgens would only be indicated for short-term use for
refractory bleeding.
4. Question:
Nonhormonal treatments for menopausal symptoms include:
benzodiazepines.
copper intrauterine device.
selective serotonin reuptake inhibitors. Correct
antiepileptic/antiseizure medications.
Explanation:
Nonhormonal treatments for menopausal symptoms include selective
serotonin reuptake inhibitors and serotonin norepinephrine reuptake
inhibitors.
5. Question:
In the presence of mild hyperandrogenic symptoms related to polycystic
ovarian syndrome (PCOS), the initial recommended treatment is:
norethindrone/ethinyl estradiol (Lo Loestrin). Correct
medroxyprogesterone (Provera).
ethinyl estradiol (Estinyl).
metformin (Glucophage).
Explanation:
In the presence of mild hyperandrogenic symptoms related to polycystic
ovarian syndrome (PCOS), the initial recommended treatment is a
combination oral contraceptive (i.e. norethindrone/ethinyl estradiol [Lo
Loestrin]). Combined oral contraceptive therapy modestly inhibits
gonadotropin secretion and thus gonadotropin-sensitive ovarian androgen
production, and increases hepatic production of sex hormone binding
globulin (SHBG), which further decreases free testosterone.
6. Question:
Which of the following medications would NOT be beneficial in the treatment
of pain associated with fibrocystic breast disease?
Spironolactone (Aldactone)
Norethindrone/ethinyl estradiol (Lo Loestrin)
Danazol
Fluoxetine (Sarafem) Correct
Explanation:
,Fluoxetine (Sarafem), an SSRI, is NOT recommended for the treatment of
pain associated with fibrocystic breast disease. Spironolactone, a potassium-
sparing diuretic; danazol, an androgen; and norethindrone/ethinyl estradiol,
a combination oral contraceptive, may all be used for the treatment of pain
associated with fibrocystic breast disease. Vitamin B6, vitamin E and evening
primrose oil may be beneficial as well. Bromocriptine (Parlodel) may be used
for more severe disease.
7. Question:
The copper component of the ParaGard intrauterine device to prevent
pregnancy is thought to:
thicken the endometrium and cervical mucus.
decrease the movement of ovum through the fallopian tubes.
interfere with estrogen uptake and decrease sperm motility. Correct
suppress ovulation.
Explanation:
The copper component in the ParaGard intrauterine device is thought to
prevent pregnancy by interfering with estrogen uptake, potentiating the local
inflammatory response, and decreasing sperm motility.
8. Question:
The drug of choice to control mild abnormal uterine bleeding in a teenage
patient is:
estrogen only.
androgen therapy.
gonadotropin-releasing hormone analogs.
combination estrogen/progesterone. Correct
Explanation:
A combined estrogen/progesterone oral contraceptive or progesterone only
would be the treatment of choice for mild abnormal uterine bleeding in a
teenager. Severe uterine bleeding is usually treated on an emergency basis
with a short course of high-dose estrogen therapy. Treatment with
androgens would only be indicated for short-term use to manage refractory
bleeding.
9. Question:
A benefit associated with the use of medroxyprogesterone acetate (Depo-
Provera), a progestin-only contraceptive, is:
decreased risk of pelvic inflammatory disease. Correct
decreased risk of cardiovascular risk factors.
decreased risk of weight gain.
decreased risk of osteoporosis.
Explanation:
, Benefits associated with the use of medroxyprogesterone acetate (Depo-
Provera), a progestin-only contraceptive, include decreased risk of
endometrial cancer and pelvic inflammatory disease. Further benefits of
Depo-Provera are decreased menstrual cramps, reduction in heavy uterine
bleeding, decreased premenstrual syndrome symptoms, and decreased
breast tenderness. Patients receiving Depo-Provera are at increased risk for
experiencing a significant decrease in bone mineral density.
10. Question:
Progestin-only contraceptives:
do not alter the quality or quantity of breast milk. Correct
are not safe for use in women with cardiovascular disease.
increase a patient's risk for pelvic inflammatory disease.
are contraindicated in the presence of moderate hypertension.
Explanation:
Progestin-only contraceptives do not alter the quality or quantity of breast
milk in lactating women. They may be used in women with cardiovascular
risk factors. They are also safe for use in women who have an absolute or
relative contraindication to estrogen and combined oral contraceptives, such
as: age >45 years, breastfeeding, smoking, mild to moderate hypertension,
well-controlled diabetes, or history of stroke or depression.
11. Question:
Late breakthrough bleeding or amenorrhea while taking an oral
contraceptive may mean that the oral contraceptive has:
not enough estrogen.
too much estrogen.
not enough progestin. Correct
too much progestin.
Explanation:
Late breakthrough bleeding or amenorrhea while taking an oral
contraceptive may mean that the oral contraceptive has too little progestin.
Progesterone, LH and FSH are responsible for regulating endometrium
shedding. If a woman is not pregnant, the corpus luteum disappears. The
primary mechanism of action of hormonal contraceptives is that they
suppress the secretion of gonadotropins (follicle-stimulating hormone, FSH
and LH) through negative feedback inhibition.
12. Question:
In the prevention of pregnancy, medroxyprogesterone acetate (Depo-
Provera) should be administered at least every:
4 weeks.
8 weeks.
Prescription Exam
1. Question:
Which of the following is NOT a common side effect associated with the use
of etonogestrel/ethinyl estradiol (NuvaRing), a contraceptive vaginal ring?
Vaginitis
Breast tenderness
Increased appetite
Severe headache Correct
Explanation:
A common side effect NOT associated with the use of etonogestrel/ethinyl
estradiol (NuvaRing) is severe headache. The systemic side effects of
NuvaRing are the same as with oral contraceptives. Vaginitis and local skin
irritation may occur with the use of the intravaginal ring. Danger signs of
contraceptives can be remembered using the acronym ACHES: A-Severe
abdominal pain (may be indicative of hepatic tumors); C-Severe chest pain or
shortness of breath; H-Severe headaches; E-eye problems (blurred vision,
flashing lights, or blindness); S-Severe leg pain.
2. Question:
A common side effect associated with the use of progestin-only
contraceptives is:
depression.
amenorrhea. Correct
hypertension.
edema.
Explanation:
Common side effects of progestin-only contraceptives are menstrual cycle
changes (e.g., spotting, breakthrough bleeding, prolonged cycles and
eventually, amenorrhea). Other side effects are breast tenderness,
headaches, and mood changes.
3. Question:
The drug of choice to control mild abnormal uterine bleeding in a 25-year-old
woman with future childbearing plans is:
estrogen only.
androgen therapy
gonadotropin-releasing hormone analogs.
progesterone only. Correct
Explanation:
,A combined estrogen/progesterone oral contraceptive or progesterone only
would be the treatment of choice for mild abnormal uterine bleeding in a
woman of childbearing age. Severe uterine bleeding is usually treated on an
emergency basis with a short course of high-dose estrogen therapy.
Treatment with androgens would only be indicated for short-term use for
refractory bleeding.
4. Question:
Nonhormonal treatments for menopausal symptoms include:
benzodiazepines.
copper intrauterine device.
selective serotonin reuptake inhibitors. Correct
antiepileptic/antiseizure medications.
Explanation:
Nonhormonal treatments for menopausal symptoms include selective
serotonin reuptake inhibitors and serotonin norepinephrine reuptake
inhibitors.
5. Question:
In the presence of mild hyperandrogenic symptoms related to polycystic
ovarian syndrome (PCOS), the initial recommended treatment is:
norethindrone/ethinyl estradiol (Lo Loestrin). Correct
medroxyprogesterone (Provera).
ethinyl estradiol (Estinyl).
metformin (Glucophage).
Explanation:
In the presence of mild hyperandrogenic symptoms related to polycystic
ovarian syndrome (PCOS), the initial recommended treatment is a
combination oral contraceptive (i.e. norethindrone/ethinyl estradiol [Lo
Loestrin]). Combined oral contraceptive therapy modestly inhibits
gonadotropin secretion and thus gonadotropin-sensitive ovarian androgen
production, and increases hepatic production of sex hormone binding
globulin (SHBG), which further decreases free testosterone.
6. Question:
Which of the following medications would NOT be beneficial in the treatment
of pain associated with fibrocystic breast disease?
Spironolactone (Aldactone)
Norethindrone/ethinyl estradiol (Lo Loestrin)
Danazol
Fluoxetine (Sarafem) Correct
Explanation:
,Fluoxetine (Sarafem), an SSRI, is NOT recommended for the treatment of
pain associated with fibrocystic breast disease. Spironolactone, a potassium-
sparing diuretic; danazol, an androgen; and norethindrone/ethinyl estradiol,
a combination oral contraceptive, may all be used for the treatment of pain
associated with fibrocystic breast disease. Vitamin B6, vitamin E and evening
primrose oil may be beneficial as well. Bromocriptine (Parlodel) may be used
for more severe disease.
7. Question:
The copper component of the ParaGard intrauterine device to prevent
pregnancy is thought to:
thicken the endometrium and cervical mucus.
decrease the movement of ovum through the fallopian tubes.
interfere with estrogen uptake and decrease sperm motility. Correct
suppress ovulation.
Explanation:
The copper component in the ParaGard intrauterine device is thought to
prevent pregnancy by interfering with estrogen uptake, potentiating the local
inflammatory response, and decreasing sperm motility.
8. Question:
The drug of choice to control mild abnormal uterine bleeding in a teenage
patient is:
estrogen only.
androgen therapy.
gonadotropin-releasing hormone analogs.
combination estrogen/progesterone. Correct
Explanation:
A combined estrogen/progesterone oral contraceptive or progesterone only
would be the treatment of choice for mild abnormal uterine bleeding in a
teenager. Severe uterine bleeding is usually treated on an emergency basis
with a short course of high-dose estrogen therapy. Treatment with
androgens would only be indicated for short-term use to manage refractory
bleeding.
9. Question:
A benefit associated with the use of medroxyprogesterone acetate (Depo-
Provera), a progestin-only contraceptive, is:
decreased risk of pelvic inflammatory disease. Correct
decreased risk of cardiovascular risk factors.
decreased risk of weight gain.
decreased risk of osteoporosis.
Explanation:
, Benefits associated with the use of medroxyprogesterone acetate (Depo-
Provera), a progestin-only contraceptive, include decreased risk of
endometrial cancer and pelvic inflammatory disease. Further benefits of
Depo-Provera are decreased menstrual cramps, reduction in heavy uterine
bleeding, decreased premenstrual syndrome symptoms, and decreased
breast tenderness. Patients receiving Depo-Provera are at increased risk for
experiencing a significant decrease in bone mineral density.
10. Question:
Progestin-only contraceptives:
do not alter the quality or quantity of breast milk. Correct
are not safe for use in women with cardiovascular disease.
increase a patient's risk for pelvic inflammatory disease.
are contraindicated in the presence of moderate hypertension.
Explanation:
Progestin-only contraceptives do not alter the quality or quantity of breast
milk in lactating women. They may be used in women with cardiovascular
risk factors. They are also safe for use in women who have an absolute or
relative contraindication to estrogen and combined oral contraceptives, such
as: age >45 years, breastfeeding, smoking, mild to moderate hypertension,
well-controlled diabetes, or history of stroke or depression.
11. Question:
Late breakthrough bleeding or amenorrhea while taking an oral
contraceptive may mean that the oral contraceptive has:
not enough estrogen.
too much estrogen.
not enough progestin. Correct
too much progestin.
Explanation:
Late breakthrough bleeding or amenorrhea while taking an oral
contraceptive may mean that the oral contraceptive has too little progestin.
Progesterone, LH and FSH are responsible for regulating endometrium
shedding. If a woman is not pregnant, the corpus luteum disappears. The
primary mechanism of action of hormonal contraceptives is that they
suppress the secretion of gonadotropins (follicle-stimulating hormone, FSH
and LH) through negative feedback inhibition.
12. Question:
In the prevention of pregnancy, medroxyprogesterone acetate (Depo-
Provera) should be administered at least every:
4 weeks.
8 weeks.
