NR509 WEEK 8 FINAL EXAM [2026]

A 30-year-old female presents to the clinic with a malodorous vaginal discharge and mild vulvar itching that has persisted for approximately three weeks. She denies dysuria and dyspareunia but notes that the odor worsens after intercourse and during her recent menstrual period. Pelvic and rectal exam findings include: No erythema or lesions of the external genitalia. Thin, white, homogeneous vaginal discharge with a mild fishy odor. No discharge is visible from the cervical os after swabbing. Vaginal pH >4.5. Uterus midline, no adnexal masses. Rectal exam is unremarkable. Based on clinical history and examination findings, which of the following is the MOST accurate interpretation of these findings?

Answers: A - D

A. Chlamydial cervicitis
B. Bacterial vaginosis ✅
C. Trichomoniasis
D. Vulvovaginal candidiasis

Correct Answer: B. Bacterial vaginosis

A 45-year-old female presents to the clinic for heavy periods and pelvic pain during her menses. Symptoms have been ongoing for approximately 12 months and are worsening. She reached menarche at age 13 years and her cycles have remained regular when not pregnant. She is a G4P3, and her partner has had a vasectomy. Her LMP was 1 week ago. On bimanual exam, large mass is palpated which is located midline between the substernal notch and the umbilicus. Adnexal areas are without abnormality, and the rectal exam is normal. Which is the MOST LIKELY interpretation of these findings?

Answers: A - D

A. Pregnancy
B. Bartholin gland enlargement
C. Ovarian mass
D. Fundal uterine fibroids ✅

Correct Answer: D. Fundal uterine fibroids

When palpating the left lower quadrant (LLQ), which of the following structures is most likely to be palpable if stool is present?

Answers: A - D

A. Sigmoid colon ✅
B. Appendix
C. Gallbladder
D. Duodenum

Correct Answer: A. Sigmoid colon

A 35-year-old female with a known history of migraines presents with worsening symptoms. She reports waking up at night with headaches and nausea, which is new. Medications include progestin-only pill (POP) and a multivitamin. She otherwise considers herself healthy and denies other medical conditions. Which action by the NP is the MOST appropriate next step?

Answers: A - D

A. Discontinue OCPs and diagnose her with medication-overuse headache
B. Continue POPs and recommend over-the-counter analgesics for migraine management
C. Prescribe a triptan for acute migraine relief and reassess in two weeks
D. Refer for neuroimaging to evaluate secondary causes of headache ✅

Correct Answer: D. Refer for neuroimaging to evaluate secondary causes of headache

A 16-year-old male presents to the clinic with a history of a congenital right upper eyelid drooping as represented in this image. He has no complaints and denies injury or trauma. Which cranial nerve (CN) is involved in this condition?

ADA Description: Male with right upper eyelid drooping.

Answers: A - D

A. Oculomotor (CN III) ✅
B. Vagus (CN X)
C. Optic (CN II)
D. Trochlear (CN IV)

Correct Answer: A. Oculomotor (CN III)