NR 602 FINAL PRACTICE EXAM (PRIMARY CARE OF THE
CHILDBEARING) 2023/2024 REAL EXAM WITH 200
QUESTIONS & ANSWERS WITH RATIONALES NEW!!!!!!!!!!!
1. A 28-year-old woman at 6 weeks postpartum reports heavy, bright red vaginal
bleeding with clots. Her fundus is firm and at the umbilicus. What is the most
likely diagnosis?
A) Late postpartum hemorrhage
B) Subinvolution of the uterus
C) Retained products of conception
D) Endometritis
Correct Answer: C
Rationale: Heavy bleeding with clots at 6 weeks postpartum with a firm fundus
suggests retained products of conception. Subinvolution typically presents with a
boggy uterus. Endometritis presents with fever and uterine tenderness.
2. A 34-year-old woman at 8 weeks postpartum reports persistent lochia, pelvic
pain, and fever. On examination, the uterus is tender and enlarged. What is the
most appropriate management?
A) Oral antibiotics and outpatient follow-up
B) IV antibiotics and uterine curettage
C) Transvaginal ultrasound and endometrial biopsy
D) Pelvic rest and NSAIDs
Correct Answer: C
Rationale: Persistent lochia, pelvic pain, and fever with a tender, enlarged uterus
suggest retained products of conception or endometritis. Transvaginal ultrasound is
the first step to evaluate for retained tissue. Endometrial biopsy may be needed if
infection is suspected.
3. A 26-year-old woman at 4 weeks postpartum reports unilateral breast pain,
erythema, and fever. She is breastfeeding. What is the most appropriate treatment?
A) Continue breastfeeding and apply warm compresses
B) Stop breastfeeding and start antibiotics
C) Start dicloxacillin and continue breastfeeding
D) Incision and drainage
Correct Answer: C
,Rationale: Mastitis is treated with antibiotics (dicloxacillin or cephalexin) and
continued breastfeeding or pumping to empty the breast. Abscess requires incision
and drainage.
4. A 32-year-old woman at 10 weeks postpartum reports severe headache, visual
changes, and nausea. Her blood pressure is 160/105 mmHg. What is the most
likely diagnosis?
A) Postpartum preeclampsia
B) Migraine with aura
C) Intracranial hemorrhage
D) Tension headache
Correct Answer: A
Rationale: Postpartum preeclampsia can occur up to 6 weeks postpartum. Severe
headache, visual changes, and elevated blood pressure are classic symptoms. This
requires immediate evaluation and treatment with magnesium sulfate and
antihypertensives.
5. A 29-year-old woman at 2 weeks postpartum reports a feeling of incomplete
bladder emptying. A post-void residual volume is 200 mL. What is the most
appropriate initial management?
A) Insert a Foley catheter
B) Prescribe an alpha-blocker
C) Pelvic floor physical therapy
D) Voiding diary and scheduled voiding
Correct Answer: D
Rationale: Postpartum voiding dysfunction is common. A post-void residual >150
mL indicates incomplete emptying. Initial management includes voiding diary,
scheduled voiding, and double voiding. Catheterization is reserved for retention
>300 mL or failure of conservative measures.
6. A 33-year-old woman at 12 weeks postpartum reports a sudden onset of
shortness of breath and pleuritic chest pain. She is tachycardic and hypoxic. What
is the most likely diagnosis?
A) Pulmonary embolism
B) Peripartum cardiomyopathy
C) Pneumonia
D) Pneumothorax
Correct Answer: A
,Rationale: Postpartum women are at increased risk of venous thromboembolism.
Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxia suggest pulmonary
embolism. Immediate CT angiography is diagnostic.
7. A 27-year-old woman at 6 weeks postpartum reports persistent fatigue, mood
swings, and difficulty bonding with her infant. She scores 15 on the Edinburgh
Postnatal Depression Scale. What is the most appropriate management?
A) Reassurance and follow-up in 2 weeks
B) Referral for psychotherapy and start antidepressant
C) Increase sleep and reduce stressors
D) Referral to a psychiatrist for hospitalization
Correct Answer: B
Rationale: A score of ≥13 on the EPDS indicates probable depression.
Psychotherapy and antidepressants (SSRIs) are recommended. Sertraline is
preferred in lactation. Hospitalization is reserved for suicidal ideation or psychosis.
8. A 31-year-old woman at 8 weeks postpartum reports persistent pelvic pain and
dyspareunia. On examination, there is a tender, nodular mass near the vaginal cuff.
What is the most likely diagnosis?
A) Vaginal hematoma
B) Pelvic abscess
C) Endometrioma
D) Granulation tissue
Correct Answer: D
Rationale: Granulation tissue at the episiotomy or vaginal cuff site can cause
persistent pain, bleeding, and dyspareunia. It appears as a tender, nodular mass and
is treated with silver nitrate cauterization.
9. A 25-year-old woman at 4 weeks postpartum reports difficulty latching and
nipple pain. On examination, the nipples are erythematous and cracked. What is
the most appropriate intervention?
A) Recommend breastfeeding cessation
B) Prescribe topical antifungal cream
C) Referral to a lactation consultant
D) Start oral antibiotics
Correct Answer: C
Rationale: Nipple pain and poor latch are common breastfeeding challenges.
Referral to a lactation consultant is the most appropriate intervention to assess
latch, positioning, and feeding technique. Antifungals are used if thrush is
diagnosed.
, 10. A 30-year-old woman at 6 weeks postpartum reports heavy, prolonged
menstrual bleeding. Her hemoglobin is 9.5 g/dL. What is the most appropriate next
step?
A) Oral contraceptives
B) Tranexamic acid
C) Transvaginal ultrasound
D) Endometrial biopsy
Correct Answer: C
Rationale: Heavy menstrual bleeding in the postpartum period warrants evaluation
for retained products of conception, uterine fibroids, or endometrial pathology.
Transvaginal ultrasound is the first-line diagnostic tool.
11. A 28-year-old woman at 12 weeks postpartum has a thyroid-stimulating
hormone (TSH) of 0.05 mIU/L and a free T4 of 2.8 ng/dL. She reports palpitations
and anxiety. What is the most likely diagnosis?
A) Graves' disease
B) Postpartum thyroiditis (hyperthyroid phase)
C) Subclinical hyperthyroidism
D) Toxic nodular goiter
Correct Answer: B
Rationale: Postpartum thyroiditis presents with transient hyperthyroidism 2-6
months postpartum, followed by hypothyroidism. TSH is suppressed with elevated
free T4. Symptoms are usually mild and self-limiting. Beta-blockers may be used
for symptom control.
12. A 32-year-old woman at 6 months postpartum reports fatigue, weight gain, and
cold intolerance. Her TSH is 12 mIU/L. What is the most appropriate
management?
A) Levothyroxine 25 mcg daily
B) Levothyroxine 50 mcg daily
C) Levothyroxine 100 mcg daily
D) No treatment, recheck in 6 weeks
Correct Answer: B
Rationale: Postpartum hypothyroidism with TSH >10 mIU/L requires thyroid
hormone replacement. Levothyroxine 50 mcg daily is a typical starting dose for
overt hypothyroidism. Dose is adjusted based on TSH levels.
CHILDBEARING) 2023/2024 REAL EXAM WITH 200
QUESTIONS & ANSWERS WITH RATIONALES NEW!!!!!!!!!!!
1. A 28-year-old woman at 6 weeks postpartum reports heavy, bright red vaginal
bleeding with clots. Her fundus is firm and at the umbilicus. What is the most
likely diagnosis?
A) Late postpartum hemorrhage
B) Subinvolution of the uterus
C) Retained products of conception
D) Endometritis
Correct Answer: C
Rationale: Heavy bleeding with clots at 6 weeks postpartum with a firm fundus
suggests retained products of conception. Subinvolution typically presents with a
boggy uterus. Endometritis presents with fever and uterine tenderness.
2. A 34-year-old woman at 8 weeks postpartum reports persistent lochia, pelvic
pain, and fever. On examination, the uterus is tender and enlarged. What is the
most appropriate management?
A) Oral antibiotics and outpatient follow-up
B) IV antibiotics and uterine curettage
C) Transvaginal ultrasound and endometrial biopsy
D) Pelvic rest and NSAIDs
Correct Answer: C
Rationale: Persistent lochia, pelvic pain, and fever with a tender, enlarged uterus
suggest retained products of conception or endometritis. Transvaginal ultrasound is
the first step to evaluate for retained tissue. Endometrial biopsy may be needed if
infection is suspected.
3. A 26-year-old woman at 4 weeks postpartum reports unilateral breast pain,
erythema, and fever. She is breastfeeding. What is the most appropriate treatment?
A) Continue breastfeeding and apply warm compresses
B) Stop breastfeeding and start antibiotics
C) Start dicloxacillin and continue breastfeeding
D) Incision and drainage
Correct Answer: C
,Rationale: Mastitis is treated with antibiotics (dicloxacillin or cephalexin) and
continued breastfeeding or pumping to empty the breast. Abscess requires incision
and drainage.
4. A 32-year-old woman at 10 weeks postpartum reports severe headache, visual
changes, and nausea. Her blood pressure is 160/105 mmHg. What is the most
likely diagnosis?
A) Postpartum preeclampsia
B) Migraine with aura
C) Intracranial hemorrhage
D) Tension headache
Correct Answer: A
Rationale: Postpartum preeclampsia can occur up to 6 weeks postpartum. Severe
headache, visual changes, and elevated blood pressure are classic symptoms. This
requires immediate evaluation and treatment with magnesium sulfate and
antihypertensives.
5. A 29-year-old woman at 2 weeks postpartum reports a feeling of incomplete
bladder emptying. A post-void residual volume is 200 mL. What is the most
appropriate initial management?
A) Insert a Foley catheter
B) Prescribe an alpha-blocker
C) Pelvic floor physical therapy
D) Voiding diary and scheduled voiding
Correct Answer: D
Rationale: Postpartum voiding dysfunction is common. A post-void residual >150
mL indicates incomplete emptying. Initial management includes voiding diary,
scheduled voiding, and double voiding. Catheterization is reserved for retention
>300 mL or failure of conservative measures.
6. A 33-year-old woman at 12 weeks postpartum reports a sudden onset of
shortness of breath and pleuritic chest pain. She is tachycardic and hypoxic. What
is the most likely diagnosis?
A) Pulmonary embolism
B) Peripartum cardiomyopathy
C) Pneumonia
D) Pneumothorax
Correct Answer: A
,Rationale: Postpartum women are at increased risk of venous thromboembolism.
Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxia suggest pulmonary
embolism. Immediate CT angiography is diagnostic.
7. A 27-year-old woman at 6 weeks postpartum reports persistent fatigue, mood
swings, and difficulty bonding with her infant. She scores 15 on the Edinburgh
Postnatal Depression Scale. What is the most appropriate management?
A) Reassurance and follow-up in 2 weeks
B) Referral for psychotherapy and start antidepressant
C) Increase sleep and reduce stressors
D) Referral to a psychiatrist for hospitalization
Correct Answer: B
Rationale: A score of ≥13 on the EPDS indicates probable depression.
Psychotherapy and antidepressants (SSRIs) are recommended. Sertraline is
preferred in lactation. Hospitalization is reserved for suicidal ideation or psychosis.
8. A 31-year-old woman at 8 weeks postpartum reports persistent pelvic pain and
dyspareunia. On examination, there is a tender, nodular mass near the vaginal cuff.
What is the most likely diagnosis?
A) Vaginal hematoma
B) Pelvic abscess
C) Endometrioma
D) Granulation tissue
Correct Answer: D
Rationale: Granulation tissue at the episiotomy or vaginal cuff site can cause
persistent pain, bleeding, and dyspareunia. It appears as a tender, nodular mass and
is treated with silver nitrate cauterization.
9. A 25-year-old woman at 4 weeks postpartum reports difficulty latching and
nipple pain. On examination, the nipples are erythematous and cracked. What is
the most appropriate intervention?
A) Recommend breastfeeding cessation
B) Prescribe topical antifungal cream
C) Referral to a lactation consultant
D) Start oral antibiotics
Correct Answer: C
Rationale: Nipple pain and poor latch are common breastfeeding challenges.
Referral to a lactation consultant is the most appropriate intervention to assess
latch, positioning, and feeding technique. Antifungals are used if thrush is
diagnosed.
, 10. A 30-year-old woman at 6 weeks postpartum reports heavy, prolonged
menstrual bleeding. Her hemoglobin is 9.5 g/dL. What is the most appropriate next
step?
A) Oral contraceptives
B) Tranexamic acid
C) Transvaginal ultrasound
D) Endometrial biopsy
Correct Answer: C
Rationale: Heavy menstrual bleeding in the postpartum period warrants evaluation
for retained products of conception, uterine fibroids, or endometrial pathology.
Transvaginal ultrasound is the first-line diagnostic tool.
11. A 28-year-old woman at 12 weeks postpartum has a thyroid-stimulating
hormone (TSH) of 0.05 mIU/L and a free T4 of 2.8 ng/dL. She reports palpitations
and anxiety. What is the most likely diagnosis?
A) Graves' disease
B) Postpartum thyroiditis (hyperthyroid phase)
C) Subclinical hyperthyroidism
D) Toxic nodular goiter
Correct Answer: B
Rationale: Postpartum thyroiditis presents with transient hyperthyroidism 2-6
months postpartum, followed by hypothyroidism. TSH is suppressed with elevated
free T4. Symptoms are usually mild and self-limiting. Beta-blockers may be used
for symptom control.
12. A 32-year-old woman at 6 months postpartum reports fatigue, weight gain, and
cold intolerance. Her TSH is 12 mIU/L. What is the most appropriate
management?
A) Levothyroxine 25 mcg daily
B) Levothyroxine 50 mcg daily
C) Levothyroxine 100 mcg daily
D) No treatment, recheck in 6 weeks
Correct Answer: B
Rationale: Postpartum hypothyroidism with TSH >10 mIU/L requires thyroid
hormone replacement. Levothyroxine 50 mcg daily is a typical starting dose for
overt hypothyroidism. Dose is adjusted based on TSH levels.
