APEA WOMEN'S HEALTH FINAL EXAM
& PRACTICE EXAM 4 2026 question and
answers
Question 1
A 48-year-old woman presents after discovering a painless lump in the upper outer quadrant of
her right breast during self-examination two weeks ago. She denies fever, trauma, nipple
discharge, or breast pain. Her mother was diagnosed with breast cancer at age 55.
Mammography reveals a 3.1-cm irregular spiculated mass, and biopsy confirms HER2-
positive, estrogen receptor-positive invasive ductal carcinoma.
Before initiating trastuzumab therapy, which baseline assessment is most important?
A. Liver function tests
B. Echocardiogram to evaluate left ventricular ejection fraction
C. Pulmonary function testing
D. Bone mineral density scan
Correct Answer: B
Rationale
Trastuzumab is associated with reversible cardiomyopathy and decreased left ventricular ejection
fraction (LVEF). Cardiac function should be assessed before treatment and monitored regularly
throughout therapy.
Question 2
Six months after beginning trastuzumab therapy, the patient complains of increasing fatigue,
dyspnea on exertion, orthopnea, and bilateral ankle edema.
Which complication should the clinician suspect first?
A. Pulmonary embolism
B. Congestive heart failure secondary to trastuzumab
C. Acute renal failure
,APEA WOMEN'S HEALTH FINAL EXAM
& PRACTICE EXAM 4 2026 question and
answers
D. Pulmonary fibrosis
Correct Answer: B
Rationale
Symptoms of dyspnea, orthopnea, and peripheral edema are concerning for trastuzumab-induced
cardiomyopathy and require immediate cardiac evaluation.
Question 3
A 52-year-old postmenopausal woman has completed surgery for ER-positive breast cancer
and has been prescribed tamoxifen.
Which statement made by the patient demonstrates correct understanding of medication
teaching?
A. "If I develop abnormal vaginal bleeding, I should notify my healthcare provider
immediately."
B. "Tamoxifen completely eliminates my risk of another breast cancer."
C. "I no longer need routine gynecologic examinations."
D. "Hot flashes mean the medication is not working."
Correct Answer: A
Rationale
Tamoxifen has estrogen agonist effects on the endometrium and increases the risk of endometrial
hyperplasia and carcinoma. Any abnormal uterine bleeding requires prompt evaluation.
Question 4
,APEA WOMEN'S HEALTH FINAL EXAM
& PRACTICE EXAM 4 2026 question and
answers
A 24-year-old woman presents with severe lower abdominal pain, fever of 102°F (38.9°C),
dyspareunia, and purulent cervical discharge. Pelvic examination demonstrates cervical motion
tenderness and bilateral adnexal tenderness.
Which diagnosis is most likely?
A. Acute appendicitis
B. Pelvic inflammatory disease
C. Ruptured ovarian cyst
D. Endometrial hyperplasia
Correct Answer: B
Rationale
Pelvic inflammatory disease is diagnosed clinically based on pelvic pain, cervical motion
tenderness, uterine or adnexal tenderness, fever, and evidence of cervical infection.
Question 5
The patient asks why prompt treatment of pelvic inflammatory disease is important.
Which response by the clinician is most accurate?
A. "Without treatment, your blood pressure may increase."
B. "Untreated PID can result in infertility, chronic pelvic pain, and ectopic pregnancy."
C. "The infection always resolves without antibiotics."
D. "Treatment is only necessary if you become pregnant."
Correct Answer: B
Rationale
, APEA WOMEN'S HEALTH FINAL EXAM
& PRACTICE EXAM 4 2026 question and
answers
Tubal scarring caused by PID significantly increases the risk of infertility and future ectopic
pregnancy.
Question 6
A 30-year-old woman presents with six weeks of amenorrhea, vaginal spotting, and severe left
lower quadrant pain. Her pregnancy test is positive.
Which diagnosis must be excluded immediately?
A. Endometriosis
B. Ectopic pregnancy
C. Leiomyoma
D. Ovarian cyst
Correct Answer: B
Rationale
Amenorrhea, unilateral pelvic pain, and vaginal bleeding are classic findings of ectopic
pregnancy.
Question 7
Which diagnostic combination provides the most accurate initial evaluation for suspected ectopic
pregnancy?
A. Pelvic CT scan
B. Quantitative serum β-hCG with transvaginal ultrasound
C. Pap smear
& PRACTICE EXAM 4 2026 question and
answers
Question 1
A 48-year-old woman presents after discovering a painless lump in the upper outer quadrant of
her right breast during self-examination two weeks ago. She denies fever, trauma, nipple
discharge, or breast pain. Her mother was diagnosed with breast cancer at age 55.
Mammography reveals a 3.1-cm irregular spiculated mass, and biopsy confirms HER2-
positive, estrogen receptor-positive invasive ductal carcinoma.
Before initiating trastuzumab therapy, which baseline assessment is most important?
A. Liver function tests
B. Echocardiogram to evaluate left ventricular ejection fraction
C. Pulmonary function testing
D. Bone mineral density scan
Correct Answer: B
Rationale
Trastuzumab is associated with reversible cardiomyopathy and decreased left ventricular ejection
fraction (LVEF). Cardiac function should be assessed before treatment and monitored regularly
throughout therapy.
Question 2
Six months after beginning trastuzumab therapy, the patient complains of increasing fatigue,
dyspnea on exertion, orthopnea, and bilateral ankle edema.
Which complication should the clinician suspect first?
A. Pulmonary embolism
B. Congestive heart failure secondary to trastuzumab
C. Acute renal failure
,APEA WOMEN'S HEALTH FINAL EXAM
& PRACTICE EXAM 4 2026 question and
answers
D. Pulmonary fibrosis
Correct Answer: B
Rationale
Symptoms of dyspnea, orthopnea, and peripheral edema are concerning for trastuzumab-induced
cardiomyopathy and require immediate cardiac evaluation.
Question 3
A 52-year-old postmenopausal woman has completed surgery for ER-positive breast cancer
and has been prescribed tamoxifen.
Which statement made by the patient demonstrates correct understanding of medication
teaching?
A. "If I develop abnormal vaginal bleeding, I should notify my healthcare provider
immediately."
B. "Tamoxifen completely eliminates my risk of another breast cancer."
C. "I no longer need routine gynecologic examinations."
D. "Hot flashes mean the medication is not working."
Correct Answer: A
Rationale
Tamoxifen has estrogen agonist effects on the endometrium and increases the risk of endometrial
hyperplasia and carcinoma. Any abnormal uterine bleeding requires prompt evaluation.
Question 4
,APEA WOMEN'S HEALTH FINAL EXAM
& PRACTICE EXAM 4 2026 question and
answers
A 24-year-old woman presents with severe lower abdominal pain, fever of 102°F (38.9°C),
dyspareunia, and purulent cervical discharge. Pelvic examination demonstrates cervical motion
tenderness and bilateral adnexal tenderness.
Which diagnosis is most likely?
A. Acute appendicitis
B. Pelvic inflammatory disease
C. Ruptured ovarian cyst
D. Endometrial hyperplasia
Correct Answer: B
Rationale
Pelvic inflammatory disease is diagnosed clinically based on pelvic pain, cervical motion
tenderness, uterine or adnexal tenderness, fever, and evidence of cervical infection.
Question 5
The patient asks why prompt treatment of pelvic inflammatory disease is important.
Which response by the clinician is most accurate?
A. "Without treatment, your blood pressure may increase."
B. "Untreated PID can result in infertility, chronic pelvic pain, and ectopic pregnancy."
C. "The infection always resolves without antibiotics."
D. "Treatment is only necessary if you become pregnant."
Correct Answer: B
Rationale
, APEA WOMEN'S HEALTH FINAL EXAM
& PRACTICE EXAM 4 2026 question and
answers
Tubal scarring caused by PID significantly increases the risk of infertility and future ectopic
pregnancy.
Question 6
A 30-year-old woman presents with six weeks of amenorrhea, vaginal spotting, and severe left
lower quadrant pain. Her pregnancy test is positive.
Which diagnosis must be excluded immediately?
A. Endometriosis
B. Ectopic pregnancy
C. Leiomyoma
D. Ovarian cyst
Correct Answer: B
Rationale
Amenorrhea, unilateral pelvic pain, and vaginal bleeding are classic findings of ectopic
pregnancy.
Question 7
Which diagnostic combination provides the most accurate initial evaluation for suspected ectopic
pregnancy?
A. Pelvic CT scan
B. Quantitative serum β-hCG with transvaginal ultrasound
C. Pap smear
