MSN FNP 1 – Exam 2 – Advanced Clinical Concepts and
Diagnostic Reasoning – Questions and Answers
This document includes a complete set of questions and answers for Exam 2 in the MSN
FNP 1 course. Covered topics span diagnostic reasoning, symptom interpretation, system-
specific pathophysiology, and clinical case evaluations. The material is structured to
reinforce understanding of key principles essential for family nurse practitioner training.
1. A 25-year-old female presents with a 3-day history of vaginal discharge and
painful urination. The discharge is intermittent throughout the day, described
as yellow and thick, no odor, she denies pruitis. There has been slight vaginal
spotting. she has associated dysuria and increased urinary frequency. Her
last sexual contact was approximately 1 week ago. She had a UTI a year ago
but this "feels different".
PMH: Negative
Medications: TriNessa OCP
PSH: Negative
NKA
SH: Biomedical engineer, travels frequently, drinks alcohol 1-2 times per week
(4-5 drinks at a time). Nonsmoker, no drug use. Sexual multiple partners over
the past 6 mo, uses condoms irregularly.
Wet mount: no mobile flagella, no clue cells, no hyphae, neg whiff test What
are some other things you would like to know about Claire?
What are some differential diagnosis for Claire?: Last menstrual period
History of STDs/treatment
Urine (UTI dipstick, chlamydia, gonorrhea)
HIV screening and syphilis test
,Differential diagnosis- UTI (probably not due to discharge and feeling different),
chlamydia, gonorrhea
Patient needs education and treatment for gonorrhea/chlamydia is ceftriaxone
single 500 mg IM and doxycycline 100 mg 2x daily for 7 days; retest for chlamydia
and gonorrhea in 3 months
2. If a patient has bacterial vaginosis, which of the following would be seen?
A. Gray or milky discharge
B. Foul-smelling
C. Flagellated protozoa under microscope
D. Thick, white, curd-like discharge (cottage-cheese
appearance)
E. Fishy odor
F. Elevated pH (>4.5)
G. Strawberry cervix
H. Yellow-green, frothy discharge
I. Inflammation of vaginal canal
J. Clue cells under microscope
K. Positive whiff test
L. Pseudo hyphae under microscope
M. Normal pH (4.0-4.5):
A. Gray or milky discharge
E. Fishy odor
F. Elevated pH (>4.5)
J. Clue cells under microscope
K. Positive whiff test
3. If a patient has trichomoniasis, which of the following would be seen?
A. Gray or milky discharge
B. Foul-smelling
C. Flagellated protozoa under microscope
D. Thick, white, curd-like discharge (cottage-cheese appearance)
E. Fishy odor
F. Elevated pH (>4.5)
G. Strawberry cervix
,H. Yellow-green, frothy discharge
I. Inflammation of vaginal canal
J. Clue cells under microscope
K. Positive whiff test
L. Pseudo hyphae under microscope
M. Normal pH (4.0-4.5):
B. Foul-smelling
C. Flagellated protozoa under microscope
F. Elevated pH (>4.5)
G. Strawberry cervix
H. Yellow-green, frothy discharge
I. Inflammation of vaginal canal
4. If a patient has a yeast infection, which of the following would be seen?
A. Gray or milky discharge
B. Foul-smelling
C. Flagellated protozoa under microscope
D. Thick, white, curd-like discharge (cottage-cheese appearance)
E. Fishy odor
F. Elevated pH (>4.5)
G. Strawberry cervix
H. Yellow-green, frothy discharge
I. Inflammation of vaginal canal
J. Clue cells under microscope
K. Positive whiff test
L. Pseudo hyphae under microscope
M. Normal pH (4.0-4.5):
D. Thick, white, curd-like discharge (cottage-cheese appearance)
I. Inflammation of vaginal canal
L. Pseudo hyphae under microscope
M. Normal pH (4.0-4.5)
5. If a male patient has a single, well defined, non-tender, indurated ulcer
with clean base measuring approximately 1 cm on the coronal sulcus of the
penis with no discharge, what would you expect?: Syphilis
, This patient would indicate: HIV screening, RPR, FTA-ABS, chlamydia and
gonorrhea testing, TPA assay
Reassess in 2 weeks to assess for canker healing, STI screenings every 3-6 months
6. A patient presents with a 3 week history of small, flesh-colored growths on
his penis. He reports having a new sexual partner 2 months ago. Physical
examination reveals multiple papular lesions, 2-5 mm in diameter, clustered
on the penile shaft and base. The lesions are painless, non-pruritic, and have
a cauliflower-like appearance.
What would you suspect and how is it treated?: Genital warts from HPV
Imiquimod cream
7. A female presents with painful genital lesions that began 3 days ago. She
reports multiple small, painful vesicles on the labia and perineum,
accompanied by burning, itching, and dysuria. She also notes mild fever,
headache, and malaise.
What do you suspect and how would you treat this?: Genital herpes
Acyclovir, valacyclovir 7-10 days (for initial outbreak) or 5 days (subsequent out-
breaks) and suppressive therapy (multiple outbreaks a year)
Hydrocortisone cream for inflammation
8. When should solid food be introduced to an infant?
A. 12 months of age
B. 10 months of age
C. 8 months of age
D. 6 months of age: D. 6 months of age
9. Which of these differentiated ingredients is NOT found in infant
formula regulated by the FDA? A. Cow's milk
B. Protein hydrolysate
C. Human dehydrated milk
D. Soy: C. Human dehydrated milk
The other 3 ingredients are the main ingredients formula HAVE to have
Diagnostic Reasoning – Questions and Answers
This document includes a complete set of questions and answers for Exam 2 in the MSN
FNP 1 course. Covered topics span diagnostic reasoning, symptom interpretation, system-
specific pathophysiology, and clinical case evaluations. The material is structured to
reinforce understanding of key principles essential for family nurse practitioner training.
1. A 25-year-old female presents with a 3-day history of vaginal discharge and
painful urination. The discharge is intermittent throughout the day, described
as yellow and thick, no odor, she denies pruitis. There has been slight vaginal
spotting. she has associated dysuria and increased urinary frequency. Her
last sexual contact was approximately 1 week ago. She had a UTI a year ago
but this "feels different".
PMH: Negative
Medications: TriNessa OCP
PSH: Negative
NKA
SH: Biomedical engineer, travels frequently, drinks alcohol 1-2 times per week
(4-5 drinks at a time). Nonsmoker, no drug use. Sexual multiple partners over
the past 6 mo, uses condoms irregularly.
Wet mount: no mobile flagella, no clue cells, no hyphae, neg whiff test What
are some other things you would like to know about Claire?
What are some differential diagnosis for Claire?: Last menstrual period
History of STDs/treatment
Urine (UTI dipstick, chlamydia, gonorrhea)
HIV screening and syphilis test
,Differential diagnosis- UTI (probably not due to discharge and feeling different),
chlamydia, gonorrhea
Patient needs education and treatment for gonorrhea/chlamydia is ceftriaxone
single 500 mg IM and doxycycline 100 mg 2x daily for 7 days; retest for chlamydia
and gonorrhea in 3 months
2. If a patient has bacterial vaginosis, which of the following would be seen?
A. Gray or milky discharge
B. Foul-smelling
C. Flagellated protozoa under microscope
D. Thick, white, curd-like discharge (cottage-cheese
appearance)
E. Fishy odor
F. Elevated pH (>4.5)
G. Strawberry cervix
H. Yellow-green, frothy discharge
I. Inflammation of vaginal canal
J. Clue cells under microscope
K. Positive whiff test
L. Pseudo hyphae under microscope
M. Normal pH (4.0-4.5):
A. Gray or milky discharge
E. Fishy odor
F. Elevated pH (>4.5)
J. Clue cells under microscope
K. Positive whiff test
3. If a patient has trichomoniasis, which of the following would be seen?
A. Gray or milky discharge
B. Foul-smelling
C. Flagellated protozoa under microscope
D. Thick, white, curd-like discharge (cottage-cheese appearance)
E. Fishy odor
F. Elevated pH (>4.5)
G. Strawberry cervix
,H. Yellow-green, frothy discharge
I. Inflammation of vaginal canal
J. Clue cells under microscope
K. Positive whiff test
L. Pseudo hyphae under microscope
M. Normal pH (4.0-4.5):
B. Foul-smelling
C. Flagellated protozoa under microscope
F. Elevated pH (>4.5)
G. Strawberry cervix
H. Yellow-green, frothy discharge
I. Inflammation of vaginal canal
4. If a patient has a yeast infection, which of the following would be seen?
A. Gray or milky discharge
B. Foul-smelling
C. Flagellated protozoa under microscope
D. Thick, white, curd-like discharge (cottage-cheese appearance)
E. Fishy odor
F. Elevated pH (>4.5)
G. Strawberry cervix
H. Yellow-green, frothy discharge
I. Inflammation of vaginal canal
J. Clue cells under microscope
K. Positive whiff test
L. Pseudo hyphae under microscope
M. Normal pH (4.0-4.5):
D. Thick, white, curd-like discharge (cottage-cheese appearance)
I. Inflammation of vaginal canal
L. Pseudo hyphae under microscope
M. Normal pH (4.0-4.5)
5. If a male patient has a single, well defined, non-tender, indurated ulcer
with clean base measuring approximately 1 cm on the coronal sulcus of the
penis with no discharge, what would you expect?: Syphilis
, This patient would indicate: HIV screening, RPR, FTA-ABS, chlamydia and
gonorrhea testing, TPA assay
Reassess in 2 weeks to assess for canker healing, STI screenings every 3-6 months
6. A patient presents with a 3 week history of small, flesh-colored growths on
his penis. He reports having a new sexual partner 2 months ago. Physical
examination reveals multiple papular lesions, 2-5 mm in diameter, clustered
on the penile shaft and base. The lesions are painless, non-pruritic, and have
a cauliflower-like appearance.
What would you suspect and how is it treated?: Genital warts from HPV
Imiquimod cream
7. A female presents with painful genital lesions that began 3 days ago. She
reports multiple small, painful vesicles on the labia and perineum,
accompanied by burning, itching, and dysuria. She also notes mild fever,
headache, and malaise.
What do you suspect and how would you treat this?: Genital herpes
Acyclovir, valacyclovir 7-10 days (for initial outbreak) or 5 days (subsequent out-
breaks) and suppressive therapy (multiple outbreaks a year)
Hydrocortisone cream for inflammation
8. When should solid food be introduced to an infant?
A. 12 months of age
B. 10 months of age
C. 8 months of age
D. 6 months of age: D. 6 months of age
9. Which of these differentiated ingredients is NOT found in infant
formula regulated by the FDA? A. Cow's milk
B. Protein hydrolysate
C. Human dehydrated milk
D. Soy: C. Human dehydrated milk
The other 3 ingredients are the main ingredients formula HAVE to have
