GYN

Question 1

A woman who is currently pregnant reports that she has had three previous pregnancies: twins
delivered at 35-weeks gestation (both living), one at 38-weeks gestation (living), and one
miscarriage at 16-weeks gestation. How will this be recorded as her G/TPAL in her electronic
medical record?
a. G4P:1113
b. G4P:1213
c. G5P:1113
d. G5P:1213

Answer 1

ANS: A
Using the notation G (number of pregnancies), T (term deliveries), P (preterm deliveries), A
(abortions—elective or spontaneous), and L (living children), this patient is G4P:1113. She is
in her fourth pregnancy, so is G4. She has had one delivery at 38 weeks or more, one delivery
(of twins) at less than 36 weeks gestation, one spontaneous abortion, and has three living
children.

Question 2

A pregnant woman who is overweight has no previous history of hypertension (HTN) or
diabetes mellitus (DM). Her initial screening exam reveals a blood pressure of 140/90 and a
fasting blood glucose of 128 mg/dL. What will the practitioner do?
a. Initiate insulin therapy.
b. Monitor blood pressure and fasting blood glucose closely.
c. Prescribe an antihypertensive medication.
d. Refer the patient to a high-risk pregnancy specialist.

Answer 2

ANS: B
This woman, although she has no previous history of HTN or DM, is at elevated risk because
of obesity. Her initial screening lab values are at the high end of normal, indicating potential
development of gestational HTN and gestational DM. The initial response of the practitioner
should be to monitor the patient closely and consider treatment at the first signs of
development of these complications. Referral is warranted when these conditions become
severe.

Question 3

The mother of a 3-day-old newborn reports that her infant health care providers every 4 hours
during the day and sleeps 6 hours at night. What will the provider recommend?
a. Awakening the baby every 3 hours to health care provider
b. Continuing this schedule until the infant is 6 months old
c. Ensuring that her infant health care providers for 15 to 20 minutes each time
d. Pumping her breasts to maintain her milk supply

Answer 3

ANS: A
Newborn infants should health care provider 8 to 12 times daily and mothers should be
encouraged to awaken a sleepy baby to health care provider every 2 to 3 hours or more often.
The feedings will gradually space out as the infant is older.

Question 4

An infant who has just begun nursing develops hyperbilirubinemia. What will the provider tell
the mother?
a. To decrease the frequency of breastfeeding
b. To supplement feedings with extra water
c. To switch to formula until the bilirubin level drops
d. To use a breast pump to increase her milk supply

Answer 4

ANS: D
Infants with suboptimal breastfeeding can have starvation jaundice and mothers should be
encouraged to increase the frequency of breastfeeding and should be offered a breast pump to
increase milk supply. It is not recommended to supplement with water or sugar water or to
switch to formula.

Question 5

A mother who has been breastfeeding her infant for several weeks develops a fever, breast
warmth, and breast tenderness. What will the provider recommend?
a. Ice packs and decreased frequency of nursing
b. Ice packs and increased frequency of nursing
c. Warm packs and decreased frequency of nursing
d. Warm packs and increased frequency of nursing

Answer 5

ANS: D
This mother has symptoms of mastitis. She should be encouraged to use warm packs for
comfort and to increase the frequency of nursing to relieve the pressure.

Question 6

To help prevent unplanned pregnancies, which group of providers may make the most impact
by providing contraceptive counseling to women?
a. Counselors in STI clinics
b. Gynecologists
c. Practitioners in walk-in clinics
d. Primary care providers

Answer 6

ANS: D
Women receive most of their preventive care from nongynecologic providers, so PCPs have a
unique opportunity to provide contraceptive counseling to women. Women seek care in STI
clinics and gynecology clinics for specific reasons often after contraceptive counseling is no
longer preventive.

Question 7

An adolescent female calls a primary care clinic to report that she has missed two periods and
is having morning nausea and vomiting. What will the provider suggest?
a. Coming to the clinic for pregnancy testing
b. Making an appointment with a gynecologist
c. Purchasing a home pregnancy test kit
d. Referral to a community health clinic

Answer 7

ANS: A
Patients who feel especially vulnerable and are in denial about a pregnancy may not want to
take a test at home, desiring immediate guidance when a result is discovered. Referring to
another provider will only alienate this adolescent further.

Question 8

A provider sees a woman who has just learned she is pregnant with an unplanned pregnancy.
What is an initial step in helping this woman make decisions about his pregnancy?
a. Actively listen to the woman’s concerns and questions.
b. Ask the mother if the father of the baby will be involved.
c. Make a referral to an obstetrician for more information.
d. Offer information about both adoption and abortion.

Answer 8

ANS: A
The initial step is to actively listen to the woman to determine what her concerns and needs
are. The provider should give unbiased information and answer any questions the woman has.
Asking her about the father’s involvement puts an emphasis on other concerns. Referring her
to an obstetrician conveys a desire to avoid helping her with her problems. Giving information
that she has not asked for conveys a judgment about what she should do.

Question 9

A female patient has lower abdominal pain, nausea, and vomiting and reports missing a period 3 weeks prior. The patient reports using an intrauterine device for contraception. A serum
BhCG is 1500 mIU/mL. What will the provider do, based on these findings?
a. Perform a transvaginal ultrasound
b. Recheck the -hCG level in 4 to 6 weeks
c. Refer for a diagnostic laparoscopy
d. Tell the patient that a viable pregnancy is likely

Answer 9

ANS: A
With elevations in serum -hCG greater than 1000 mIU/mL, transvaginal US can usually
detect both viable and nonviable ectopic pregnancies without subjecting women to the risks of
an invasive procedure. A diagnostic laparoscopy is the definitive test for ectopic pregnancy
and should be performed if the US is indeterminate. The level is already high enough that a
fetus would be detectable on US, so rechecking this level is not indicated. Patients who use
IUDs are at higher risk for ectopic pregnancy; telling this woman that a viable pregnancy is
likely should not occur until diagnostic tests are performed.

Question 10

A patient is determined to have a nonruptured ectopic pregnancy within 1 week of a missed

period. Which treatment will the specialist order?
a. Laparoscopy
b. Leucovorin rescue
c. Methotrexate
d. Mifepristone

Answer 10

ANS: C
In an early nonruptured ectopic pregnancy, methotrexate is widely used. Leucovorin rescue
and mifepristone are used as adjunctive medications with methotrexate. Laparoscopy is
performed when a ruptured ectopic pregnancy is present

Question 11

What is a possible cause of decreased arousal, libido, and orgasm in a postmenopausal
woman?
a. Diminished testosterone
b. Endometriosis
c. Low estrogen levels
d. Uterine prolapse

Answer 11

ANS: A
Diminished testosterone has been implicated in deceased arousal, libido, and orgasm in
women. Endometriosis is a common cause of deep dyspareunia. Low estrogen causes vaginal
dryness, coital pain, and decreased desire. Uterine prolapse causes deep dyspareunia.

Question 12

A female patient with vaginal atrophy is prescribed a local estrogen therapy product with
conjugated equine estrogen cream. What will the provider recommend as adjunctive therapy
for this patient?
a. Adding progesterone to the regimen
b. Pelvic floor physical therapy
c. Treatment with a testosterone patch
d. Trigger point injections

Answer 12

ANS: A
Conjugated equine estrogen is absorbed systemically, so the patient will need progesterone to
prevent unopposed estrogen stimulation of the endometrium. Pelvic floor PT and trigger point
injections are used for dyspareunia. Testosterone patches are used for decreased arousal and
desire.

Question 13

A provider is caring for a couple who are trying to conceive. To most accurately evaluate
ovulation and luteal surge in the woman, what test will the provider recommend or perform?
a. Basal body temperature
b. Maintaining a menstrual calendar
c. Plasma mid luteal progesterone concentration level
d. Urinary luteal hormone home kit

Answer 13

ANS: D
A home kit to assess urinary luteal hormone can identify the surge that precedes ovulation by
1 or 2 days; these kits, when done with an afternoon or evening urine sample, correlate well
with peak serum LH. Basal body temperature is an easy, convenient, and inexpensive method
to assess ovulatory function, but the resultant curves may be difficult to interpret. Menstrual
calendars are less accurate. Plasma mid luteal progesterone concentration levels are
presumptive of ovulation but cannot assess the quality of the luteal phase.

Question 14

A postmenopausal woman who is overweight and who has hyperlipidemia and a history of
infertility develops vaginal bleeding and reports a feeling of pelvic pressure. The provider
suspects a genital tract cancer and refers the patient for diagnostic evaluation. What is the
likely cause of this woman’s symptoms?
a. Cervical cancer
b. Endometrial cancer
c. Ovarian cancer
d. Vaginal cancer

Answer 14

ANS: B
This woman has symptoms characteristic of endometrial cancer, including her health history,
bleeding, and pelvic pressure. Cervical cancer, ovarian cancer, and vaginal cancer typically do
not have symptoms.

Question 15

A woman asks about her risk of ovarian cancer. To best assess risk in this patient, what will
the provider do first?
a. Ask about parity and age of menarche
b. Evaluate age of menopause
c. Obtain a family history
d. Order testing for the BRCA gene

Answer 15

ANS: C
The family history is the best predictor of ovarian cancer risk. The other factors contribute,
but not as significantly as family history. If there is a strong family history, testing for the
BRCA gene is indicated.

Question 16

A woman who has had routine Pap tests all her adult life has an abnormal Pap. What will the
provider tell her about this result?
a. Colposcopy with biopsy is necessary
b. She may have vaginal cancer
c. She most likely has early cervical cancer
d. The result most likely indicates HPV infection

Answer 16

ANS: A
The Pap test is a screen and should be followed by colposcopy with biopsy. Women who have
had Pap tests routinely are less likely to have cervical cancer

Question 17

A previously healthy 22-year-old female reports experiencing pain in the rectovaginal area
with sexual intercourse. What is the most likely cause of this patient’s discomfort?
a. Atherosclerosis
b. Endometriosis
c. Inadequate lubrication
d. Psychological issues

Answer 17

ANS: B
In the premenopausal woman, endometriosis is the most common cause of dyspareunia,
especially when it involves the rectovaginal area. Atherosclerosis and inadequate lubrication
may occur in older women. Psychological issues are less common.

Question 18

A perimenopausal woman reports a recent onset of moderate to severe pain with sexual

intercourse. Which treatment will the provider prescribe initially to treat this pain?
a. Botulism injections
b. Topical corticosteroids
c. Topical estrogen
d. Water-based lubrication

Answer 18

ANS: C
If the problem is estrogen-insufficient dryness, which occurs during menopause, topical
estrogen is effective for moderate to severe pain. Botulism injections are useful when spasms
are the cause of pain. Topical corticosteroids are not indicated. Water-based lubrication may
be effective for mild symptoms.

Question 19

An adolescent female reports crampy pelvic pain radiating to the back, sacrum, and inner
thighs during the first 2 days of each menstrual period, associated with nausea and loose tools.
She asks about what causes these symptoms. What will the provider tell her?
a. Excess prostaglandins, vasopressin will cause these symptoms.
b. Mechanical cervical obstruction and severe uterine flexion are likely causes.
c. Nulliparity and her young age are correlated with these symptoms.
d. The most likely cause at her age is anovulatory menstrual cycles.

Answer 19

ANS: A
Chemical mediators, including prostaglandins, vasopressin, and other substances originating
from phospholipids, have been shown to produce the symptoms and associated symptoms of
dysmenorrhea. Mechanical obstruction and severe cervical flexion have no substantial
evidence to support their role in causing these symptoms. Nulliparity and age have not shown
correlation with dysmenorrhea. Ovulation causes increased release of chemical mediators, so
anovulatory cycles will result in fewer symptoms.

Question 20

A 35-year-old woman without a previous history of dysmenorrhea reports lower pelvic pain
and irregular bleeding between periods. What is the initial action in managing this patient?
a. Obtaining a pelvic transvaginal ultrasound with saline infusion
b. Ordering a CBC, erythrocyte sedimentation rate, and cultures
c. Performing an abdominal, pelvic, and rectovaginal examination
d. Prescribing a trial of nonsteroidal anti-inflammatory medications (NSAIDs)

Answer 20

ANS: C
Symptoms that occur later in life are more likely to be secondary dysmenorrhea and must be
investigated, beginning with a thorough abdominal, pelvic, and rectovaginal exam. Other tests
may be performed if indicated by findings on the physical exam. NSAIDs are first-line
therapy for primary dysmenorrhea.

Question 21

A patient diagnosed with primary dysmenorrhea has taken nonsteroidal anti-inflammatory
medications (NSAIDs) and COX-2 inhibitors without getting relief from symptoms. What
will the provider suggest?
a. A combined oral contraceptive (OCP)
b. Complementary therapies
c. Intrauterine (IUD) device implantation
d. Narcotic analgesics as needed

Answer 21

ANS: A
OCPs have demonstrated some effectiveness and should be tried in this instance. IUDs are
used in Europe but have not been approved for this use in the United States. Complementary
therapies have not been sufficiently studied. Narcotic analgesics are not recommended for this
level of pain.

Question 22

Which patient meets the criteria currently presented for a diagnosis of current abnormal
uterine bleeding?
a. A 45-year old who has experienced heavy menstrual void since menses began
b. A 25-year old reporting being “so fatigued after my periods”
c. A 15-year old who reports “using more pads than I did when I first got my period”
d. 35-year old experiencing a significant increase in bleeding over the last 8 months

Answer 22

ANS: D
Chronic AUB has been defined as bleeding from the uterine corpus that is abnormal in
duration, volume, frequency, or regularity and has been present for the majority of the past 6
months. The other options present signs that are not usual or have been confirmed as
abnormal for that particular patient

Question 23

When determining the cause of a patient’s abnormal uterine bleeding (AUB), which
diagnostics would the provider consider initially? (Select all that apply.)
a. Liver function tests
b. Serum level of human chorionic gonadotropin
c. Thyroid-stimulating hormone
d. Total and free testosterone
e. Cervical cultures

Answer 23

ANS: B, C, E
Diagnostic tests prescribed initially for AUB include serum human chorionic gonadotropin
levels, thyroid-stimulating hormone level and cervical cultures. Liver function tests and total
and free testosterone levels are more advanced tests

Question 24

A woman diagnosed with chronic pelvic pain most likely has a gynecological cause for her

symptoms. Which treatment will the provider recommend initially?
a. Counseling and support
b. Hysterectomy
c. Neurostimulation
d. Oral contraceptives

Answer 24

ANS: D
Oral contraceptives may be helpful and are a good initial choice. Counseling and support are
necessary throughout management, but do not help with symptom relief. Hysterectomy may
be indicated if there are more severe structural problems but does not always alleviate
symptoms. Neurostimulation is used when neuropathic pain is present.

Question 25

A female patient identified as having the BRCA mutation asks which intervention will reduce
the risk of breast cancer the most? What will the provider tell her?
a. Breast magnetic resonance imaging (MRI)
b. Clinical breast examination every 6 months
c. Early childbearing and breastfeeding
d. Prophylactic mastectomy

Answer 25

ANS: D
Although all the options help to reduce breast cancer risk, patients with BRCA mutation are at
extremely high risk and will benefit most from prophylactic mastectomy and oophorectomy.
MRI can help detect invasive cancers earlier.

Question 26

A postmenopausal woman reports unilateral breast pain that she describes as sharp and
burning and localized to one area. A breast examination reveals no dimpling, discharge, or
masses. Which diagnostic test will the provider order?
a. Bilateral mammography
b. Focused ultrasound
c. Hormone levels
d. Needle biopsy

Answer 26

ANS: A
Bilateral mammography is usually performed in postmenopausal women with noncyclic
breast pain, although the likelihood of abnormal findings is low. Focused ultrasound may be
performed in addition to mammography if indicated. Hormone levels are generally normal.
Needle biopsy is performed if a suspicious mass is identified.

Question 27

A woman who has just weaned her infant from breastfeeding develops signs of mastitis and is
treated with antibiotics. At a follow-up visit, the provider notes marked breast edema and
erythema of the affected breast. What will the provider do next?
a. Consult with a surgeon for I&D of the breast
b. Counsel the patient to apply warm compresses
c. Prescribe antibiotics to treat MRSA infection
d. Refer the patient for an immediate biopsy

Answer 27

ANS: D
Patients treated for mastitis who do not respond to antibiotics and who have persistent
erythema and edema are likely to have inflammatory breast carcinoma and should be referred
for a biopsy immediately. MRSA infection is possible, but these symptoms are severe, and the
patient needs immediate evaluation. Warm compresses and surgical K&D are not indicated

Question 28

An adolescent female presents with amenorrhea. The provider notes short stature, neck
webbing, and a pigeon chest deformity. Based on these symptoms, what is the underlying
disorder most likely causing this patient’s amenorrhea?
a. Androgen insensitivity
b. Hypothyroidism
c. Polycystic ovarian disease
d. Turner’s syndrome

Answer 28

ANS: D
Turner’s syndrome is characterized by congenital short stature, neck webbing, and a pigeon
chest. Androgen insensitivity is characterized by a complete absence of axillary and pubic
hair. Hypothyroidism will cause changes in vital signs, weight gain, and fatigue. Polycystic
ovarian disease causes metabolic syndrome

Question 29

A 16-year-old female is diagnosed with primary amenorrhea. A pregnancy test is negative.
Further testing reveals a normal TSH and an elevated prolactin level. Which test will the
provider order next?
a. Clomiphene challenge test
b. Magnetic resonance imaging (MRI)
c. Progesterone challenge test
d. Serum dehydroepiandrosterone (DHEA)

Answer 29

ANS: B
In patients with primary amenorrhea who have a negative pregnancy test, normal TSH, and
elevated prolactin, the provider may order MRI or CT of the sella turcica to identify
microadenomas and macroadenomas. If that is normal, a progesterone challenge test will be
ordered to evaluate estrogen status. Clomiphene challenge is ordered to evaluate
hypergonadotropic amenorrhea. Serum DHEA, if increased, indicates an adrenal origin for
androgen in women with hirsutism

Question 30

A 15-year-old female who participates in high school track and gymnastics is experiencing
amenorrhea after having eight normal periods. A pregnancy test is negative. What may be
included in management of this patient’s amenorrhea to restore normal periods? (Select all
that apply.)
a. Calcium and vitamin D supplementation
b. Clomiphene administration
c. Combination oral contraceptives
d. Dietician consultation
e. Estriol therapy

Answer 30

ANS: A, D
To help maintain bone density, vitamin D and calcium should be given to any women who
have amenorrhea. A dietician should be consulted to assist with healthy weight gain.
Clomiphene has also been used alone management of amenorrhea resulting from
hypogonadotropic syndromes. Estriol, a weak estrogen, can be used to restore normal
endocrine function in functional hypothalamic amenorrhea.

Question 31

A 16yearold
female reports breast tenderness and a “lump.” The primary care pediatric nurse practitioner palpates a small fluidfilled mass in her right breast. A pregnancy test is negative. Which action is correct?
A. Obtain a CBC to rule out infection.
B. Order an ultrasound of the mass.
C. Prescribe NSAIDs to treat her discomfort.
D. Reassure her that the findings are normal.

Answer 31

B. Order an ultrasound of the mass.

Question 32

A 16yearold
female has not had a menstrual period yet and is concerned. She denies sexual activity. An exam reveals an adult sexual maturity rating.
Which laboratory test will
the primary care pediatric nurse practitioner order initially?
A. Genetic test for Turner syndrome
B. Pituitary hormone tests
C. Pregnancy test
D. Thyroid function tests

Answer 32

C. Pregnancy test

Question 33

An adolescent female has periods every 30 days that are consistently heavy and last
from 5 to 8 days. What is her diagnosis?
A. Menometrorrhagia
B. Menorrhagia
C. Metrorrhagia
D. Polymenorrhea

Answer 33

B. Menorrhagia

Question 34

An adolescent female has heavy periods that are also irregular. The physical
exam is normal. A complete blood count reveals a hemoglobin of 8.9 g/dL.
What test will the
primary care pediatric nurse practitioner order next?

A. Coagulation studies
B. Creactive protein
C. Thyroid function
D. Ultrasound of pelvis

Answer 34

A. Coagulation studies

Question 35

A 14yearold female has AUB with a moderate increase in menstrual flow and irregular periods. Her hemoglobin is 13.1 g/dL. How will this be managed?

A. Iron supplementation and prostaglandin inhibitors
B. One OCP twice daily for 3 to 4 days and then daily
C. Progestin every day for 10 to 14 days
D. Referral to a pediatric gynecologist for treatment

Answer 35

A. Iron supplementation and prostaglandin inhibitors

Question 36

A sexually active adolescent female tests positive for N. gonorrhea and trachomatis. She tells the primary care pediatric nurse practitioner that she wants to be treated
today since she is moving out of town the next day. What will the nurse practitioner order?

A. Azithromycin 1 g PO in a single dose
B. Ceftriaxone 250 mg IM and azithromycin 1 g PO one time each
C. Doxycycline 100 mg PO bid for 7 days
D. Erythromycin base 500 mg PO qid for 7 days

Answer 36

B. Ceftriaxone 250 mg IM and azithromycin 1 g PO one time each

Question 37

A 16yearold sexually active female has a fever, bilateral lower abdominal pain,
and malaise. A speculum and bimanual exam reveal adnexal tenderness. The urinalysis is normal and cervical cultures are pending. What medications will the primary care pediatric nurse practitioner prescribe for this patient?

A. Azithromycin, doxycycline, and penicillin
B. Cefotaxime, azithromycin, and penicillin
C. Ceftriaxone, doxycycline, and metronidazole
D. Doxycycline, penicillin, and metronidazole

Answer 37

C. Ceftriaxone, doxycycline, and metronidazole