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(Completed) NR602 Week 8 Final Exam

A 16-year-old presents with her mother for a “routine checkup.” The mother states she must remain in the room because “she’s a minor.” What is the BEST approach?

1. Conduct the entire history with the mother present to avoid conflict
2. Explain that part of the visit includes confidential one-on-one time and then speak privately with the teen ✓
3. Refuse the visit unless the mother agrees to leave
4. Ask the teen to disclose sexual history only if the mother requests it

A 16-year-old adolescent who denies sexual activity and with a negative sexually transmitted infection (STI) risk presents with cramping pain that begins with menses and has occurred monthly since menarche. Her history strongly suggests primary dysmenorrhea, and she has no fever, abnormal discharge, or pelvic masses. Based on current best practices, what is the MOST appropriate next step in evaluation?

1. Performing a routine pelvic examination to assess for adnexal tenderness
2. Ordering pelvic imaging to rule out cysts or structural abnormalities
3. Completing a rectal examination to evaluate for deep pelvic endometrial implants
4. Deferring pelvic examination because her history is consistent with primary dysmenorrhea ✓

A patient presents 8 weeks postpartum with persistent fatigue, sleep disturbance, feelings of hopelessness, and difficulty bonding with her infant. Symptoms have been present for 4 weeks. What is the MOST appropriate first-line pharmacologic treatment?

1. Antipsychotic medication
2. Selective serotonin reuptake inhibitor ✓
3. Lithium
4. Benzodiazepine

A 48-year-old endurance athlete presents with vaginal dryness and dyspareunia. She reports amenorrhea for 8 months. Which underlying mechanism MOST likely explains her symptoms?

1. Increased ovarian follicular activity
2. Increased estrogen production from peripheral conversion
3. Hypothalamic suppression leading to decreased estrogen production ✓
4. Increased prolactin levels from pituitary tumor

A pregnant patient at 28 weeks has routine labs drawn. Her results show a hemoglobin of 10.8 g/dL, a hematocrit of 32%, and a mild increase in leukocytes. Based on expected laboratory changes in pregnancy, what is the BEST interpretation of these findings?

1. The results indicate early iron deficiency anemia requiring immediate iron infusion therapy
2. The elevated white blood cell count suggests an acute infection requiring further diagnostic evaluation
3. The reductions in hemoglobin and hematocrit represent pathologic blood loss and need urgent investigation
4. The findings are consistent with normal pregnancy changes related to hemodilution and physiologic leukocytosis ✓

A patient says “If you need to do it, just get it over with,” while tensing and bringing her knees together during speculum insertion. What is the BEST next step?

1. Stop, acknowledge the statement, and offer options to pause, modify, or defer ✓
2. Reassure the patient the exam is almost done and continue
3. Continue quickly to minimize total exposure time
4. Ask the patient to relax to allow completion

A 6-year-old child presents with a 3-day history of fever, decreased appetite, and new onset of vomiting. The parent reports no urine output in the last 10 hours. On exam, the child is listless, has dry mucous membranes, delayed capillary refill, and tachycardia. Based on pediatric primary care assessment principles, which action is the MOST appropriate next step?

1. Prescribe an antiemetic to control vomiting before reassessing hydration status
2. Refer the child for urgent evaluation for possible moderate to severe dehydration requiring intravenous fluids ✓
3. Order routine outpatient labs and schedule a follow-up visit in 24 hours
4. Recommend oral rehydration therapy at home every 5–10 minutes to restore fluid balance

A novice NP is unsure whether to include carotid auscultation during a routine ambulatory gynecology visit physical exam. What is the MOST appropriate technique for the NP to perform?

1. Include only maneuvers that are part of a standardized template
2. Include maneuvers only when the NP can state why the maneuver’s information is needed ✓
3. Include all maneuvers to avoid missing pathology
4. Omit cardiovascular assessment unless the patient reports chest pain

A 15-year-old adolescent is brought to the clinic by a parent who reports declining grades and social withdrawal. When interviewed privately, the adolescent reports feeling “down” for the past 3 weeks, loss of interest in sports, poor sleep, fatigue, difficulty concentrating, and feelings of worthlessness. Which conclusion is MOST appropriate based on this information?

1. The adolescent meets the criteria for major depressive disorder with significant functional impairment ✓
2. A diagnosis of major depressive disorder cannot be made until symptoms persist for 6 months
3. The symptoms are consistent with normal adolescent mood variation and require reassurance only
4. The presentation suggests mild depressive symptoms without the need for further assessment

Which nipple discharge characteristic is MOST concerning for malignancy?

1. Spontaneous unilateral bloody discharge with a palpable mass ✓
2. Bilateral milky discharge with nipple manipulation
3. Bilateral clear discharge during pregnancy
4. Green multi-ductal discharge in a 55-year-old patient

A 13-year-old adolescent is newly diagnosed with type 2 diabetes. According to recommended screening guidelines for youth with diabetes, which evaluation should be INITIATED at the time of diagnosis and repeated annually?

1. Thyroid-stimulating hormone testing to assess for autoimmune thyroid disease
2. Neuropathy screening delayed until five years after diagnosis
3. Tissue transglutaminase antibody testing to screen for celiac disease
4. Dilated eye examination to evaluate for diabetic retinopathy ✓

A pregnant patient with a body mass index (BMI) outside the normal range reports persistent nausea in early pregnancy and difficulty following nutrition advice. She asks how she can best meet her nutritional needs once her symptoms improve. Which recommendation by the NP is MOST appropriate?

1. Advise her to rely primarily on food sources and avoid vitamin supplementation unless deficiencies appear
2. Recommend avoiding all dairy products during pregnancy to prevent exposure to foodborne pathogens
3. Suggest meeting with a dietician skilled in prenatal nutrition and beginning balanced meals with prenatal vitamins once nausea subsides ✓
4. Encourage her to increase caloric intake by 350 calories per day beginning immediately in the first trimester

Which patient scenario BEST supports offering speculum self-insertion as a trauma-informed option?

1. A patient with suspected pelvic inflammatory disease needing urgent bimanual exam
2. An asymptomatic patient requesting an STI screen by urine NAAT
3. A patient due for cervical cytology who reports prior painful speculum exams ✓
4. A patient with heavy vaginal bleeding and hemodynamic instability

A 45-year-old patient presents with spontaneous unilateral bloody nipple discharge from a single duct. There is no history of trauma or infection. What is the MOST likely etiology?

1. Galactorrhea
2. Mammary duct ectasia
3. Physiologic discharge
4. Intraductal papilloma ✓

A 12-year-old child presents with persistent worry about school performance, frequent reassurance seeking, difficulty sleeping, and multiple stomachaches without a physical cause. The parent reports that these symptoms have been occurring for several months and are not tied to any recent stressful event. Based on this presentation, which interpretation is MOST consistent with generalized anxiety disorder (GAD)?

1. The symptoms indicate a situational anxiety response that is limited to a specific trigger and resolves when the stressor is removed
2. The symptoms demonstrate excessive, generalized worry across multiple areas that is persistent and not linked to a single event ✓
3. The presentation reflects an adjustment-related worry pattern that is directly caused by a recent environmental change
4. The findings suggest performance-based anxiety that occurs only in settings where competence is being evaluated

A patient is accompanied by a partner who insists on staying for the entire visit and answers questions for her. The patient is quiet and frequently glances at the partner before responding. What is the MOST appropriate NP action?

1. Ask the partner to wait outside, stating it is clinic policy to speak privately with every patient ✓
2. Document the partner’s answers since collateral history is helpful
3. Continue the interview to avoid escalating conflict
4. Reschedule the visit with security present

A patient using an ovulation predictor kit asks why the test becomes positive shortly before ovulation rather than at the exact moment the ovum is released. Which physiologic event BEST explains the timing of ovulation in relation to the positive test result?

1. Declining follicle-stimulating hormone (FSH) levels directly cause rupture of the dominant follicle once estrogen peaks
2. Progesterone secretion from the corpus luteum triggers immediate oocyte release from the ovary
3. Estrogen withdrawal at the end of the follicular phase initiates enzymatic digestion of the follicular wall
4. A sustained high estrogen level induces a positive feedback luteinizing hormone (LH) surge that precedes ovulation by 34–36 hours ✓

A 27-year-old patient presents 6 days postpartum reporting tearfulness, emotional lability, and fatigue. She denies suicidal ideation, is bonding with her infant, and reports adequate sleep when able. Symptoms began 3 days ago. What is the MOST appropriate management?

1. Initiate mood stabilizer therapy
2. Refer for inpatient psychiatric admission
3. Initiate selective serotonin reuptake inhibitor therapy
4. Provide reassurance and supportive counseling ✓

A 32-year-old presents with “vaginal bleeding” for 2 weeks. She reports the blood is most noticeable only after urination and denies soaking pads. Which focused history question MOST directly helps localize the bleeding source?

1. “Do you see blood only after urinating or after a bowel movement?” ✓
2. “How severe is the bleeding on a 0–10 scale?”
3. “How many bleeding episodes have you had in the last 6–12 months?”
4. “Does the bleeding occur after intercourse?”

A 10-year-old presents with daily hand-washing rituals that take over an hour, repeated checking behaviors, and intrusive thoughts about harm coming to family members. The child attempts to hide these behaviors and becomes visibly distressed if unable to complete the routines. Based on this presentation, which interpretation BEST differentiates obsessive compulsive disorder (OCD) from normal childhood rituals?

1. The behaviors represent typical developmental routines that cause only mild anxiety and do not disrupt the child’s normal activities
2. The pattern shows intrusive obsessions and distress-driven compulsions that are time-consuming and significantly impair daily functioning ✓
3. The symptoms suggest generalized worries related to everyday events and are directly connected to identifiable stressors
4. The presentation indicates superstitious games that children often use to cope with uncertainty without causing distress or disruption

A 19-year-old patient reports severe cramping pain that begins on the first day of menses. She states the pain has been present since early adolescence and improves only slightly with rest. Based on the pathophysiology of her condition, which intervention is MOST appropriate to reduce her symptoms?

Answers: A – D

A Encouraging heat therapy to relax uterine muscle tension during menstruation
B Recommending hormonal suppression to prevent cyclic endometrial proliferation
C Initiating NSAID therapy to block prostaglandin-mediated uterine contractions
D Ordering pelvic imaging to evaluate for structural causes of menstrual pain

 

 

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Related: (Completed) NR601 Week 8 Final Exam