Test Bank for Women’s Healthcare in Advanced Practice Nursing,
3rd Edition by Alexander, Versie, Elizabeth, Joyce & Heather –
Actual Questions with Verified Answers & Rationales |
Comprehensive Study Guide for A+ Exam Success
All chapters included
Coverage Overview:
Menopause & Hormone Therapy: Vasomotor symptoms, vaginal atrophy, HT regimens (combined vs
unopposed), risks (breast cancer, VTE, stroke), nonhormonal options (paroxetine, venlafaxine,
gabapentin), local therapies (vaginal DHEA, ospemifene), duration and contraindications.
Gynecologic Oncology & Genetics: BRCA1/2 risk-reducing salpingo-oophorectomy, STIC, ovarian
cancer staging/adjuvant therapy, endometrial hyperplasia/cancer (tamoxifen-related), vulvar lichen
sclerosus and VIN/dVIN, Paget’s disease, cervical cancer, mastectomy and chemoprevention.
Pregnancy & Obstetric Complications: Preeclampsia/eclampsia/HELLP (magnesium sulfate,
antihypertensives), preterm birth prevention (cerclage, vaginal progesterone), PPROM, multiple gestation,
placenta previa/accreta spectrum, VBAC/TOLAC, uterine rupture, gestational diabetes, hyperemesis
gravidarum.
Infertility & ART: PCOS (letrozole, metformin), endometriosis and fertility, ovulation induction, OHSS
management, hydrosalpinx and IVF, uterine septum, recurrent pregnancy loss, PGT.
Contraception: Hormonal methods (OCPs, implant, IUS, DMPA), nonhormonal methods, WHO MEC
categories (migraine with aura, smoking, obesity, VTE risk).
Gynecologic Disorders: Endometriosis (medical and surgical management), adenomyosis, fibroids
(hysteroscopic myomectomy, UAE), abnormal uterine bleeding (PALM-COEIN), endometrial polyps,
PID/Fitz-Hugh-Curtis, chronic pelvic pain.
Infectious Disease: Vulvovaginal candidiasis (suppressive therapy, non-albicans species), bacterial
vaginosis, STIs (chlamydia, gonorrhea, PID, expedited partner therapy), UTI prevention in postmenopausal
women.
Breast Health: Benign breast disease, high-risk lesions (ADH, LCIS), breast cancer surveillance (MRI,
mammogram), risk-reducing medications (tamoxifen, raloxifene, aromatase inhibitors).
Sexual Health & Vulvar Disorders: Dyspareunia, vaginal atrophy, lichen sclerosus, vulvar intraepithelial
neoplasia, vulvar cancer, sexual dysfunction.
Osteoporosis & Bone Health: Screening, bisphosphonates, denosumab, teriparatide, aromatase inhibitor-
induced bone loss, calcium/vitamin D supplementation.
Urogynecology: Pelvic organ prolapse, pessary management, urinary incontinence, recurrent UTI.
,Q1. A 45-year-old woman who has been experiencing irregular menstrual cycles over the
past six months asks about the likely cause. Which physiologic change associated with
perimenopause is primarily responsible for this pattern of irregular bleeding?
A) Elevated follicle-stim hormone levels causing anovulatory cycles
B) A sudden drop in estrogen production from ovarian failure
C) ✓ Erratic ovulation and inconsistent progesterone secretion leading to
unpredictable endometrial shedding
D) Decreased thyroid function affecting the hypothalamic-pituitary-ovarian axis
Perimenopause is marked by fluctuating ovarian function, resulting in inconsistent ovulation
and progesterone levels, which cause irregular bleeding patterns.
Q2. A 32-year-old woman with a history of polycystic ovary syndrome is trying to conceive
and has been prescribed letrozole for ovulation induction. Which statement best describes
the mechanism of action of letrozole for this indication?
A) It directly stimulates the pituitary to release FSH and LH
B) It acts as an estrogen agonist to enhance follicle maturation
C) ✓ It inhibits aromatase, lowering estrogen levels and leading to increased
gonadotropin secretion
D) It blocks androgen receptors to reduce insulin resistance
,Letrozole is an aromatase inhibitor that reduces peripheral estrogen production, removing
negative feedback and thereby increasing endogenous FSH and LH release, which
promotes ovulation.
Q3. A 58-year-old postmenopausal woman reports experiencing vaginal dryness,
dyspareunia, and occasional urinary urgency without dysuria or hematuria. She has a
history of breast cancer treated five years ago and is not a candidate for systemic hormone
therapy. Which local treatment is most appropriate for her genitourinary symptoms?
A) Low-dose systemic estrogen-progestin therapy
B) Vaginal estrogen cream twice weekly
C) ✓ Vaginal DHEA (prasterone) suppositories or ospemifene if not contraindicated
D) High-potency topical corticosteroid applied to the vulva
For women with contraindications to estrogen or systemic therapy, vaginal DHEA
(prasterone) can improve vaginal atrophy by local conversion to androgens and estrogens,
and ospemifene is a SERM indicated for dyspareunia; both provide targeted relief.
Q4. An adolescent female presents with primary amenorrhea, normal breast development,
and absent uterus on pelvic imaging. Karyotype analysis reveals 46,XY chromosomes.
What is the most likely diagnosis?
A) Turner syndrome
B) Polycystic ovary syndrome
, C) ✓ Complete androgen insensitivity syndrome
D) Congenital adrenal hyperplasia
Complete androgen insensitivity syndrome is characterized by a 46,XY karyotype with
insensitivity to androgens due to a mutation in the androgen receptor, resulting in female
external genitalia, breast development, absent uterus, and sparse pubic hair.
Q5. A 36-year-old pregnant woman at 28 weeks’ gestation reports persistent, severe itching
that is worse at night, primarily on the palms and soles. Laboratory studies reveal elevated
serum bile acids and normal transaminases. What is the most likely diagnosis?
A) Pruritic urticarial papules and plaques of pregnancy (PUPPP)
B) Pemphigoid gestationis
C) ✓ Intrahepatic cholestasis of pregnancy
D) Acute fatty liver of pregnancy
Intrahepatic cholestasis of pregnancy is characterized by intense pruritus, often starting on
the palms and soles, with elevated bile acids; it carries risks of preterm birth and fetal
distress and is managed with ursodeoxycholic acid.
Q6. A 24-year-old woman presents with a one-year history of cyclic pelvic pain,
dysmenorrhea, and deep dyspareunia that begins a few days before menses and improves
after menstruation. Pelvic examination reveals tender nodules along the uterosacral
ligaments. What is the most likely diagnosis?
3rd Edition by Alexander, Versie, Elizabeth, Joyce & Heather –
Actual Questions with Verified Answers & Rationales |
Comprehensive Study Guide for A+ Exam Success
All chapters included
Coverage Overview:
Menopause & Hormone Therapy: Vasomotor symptoms, vaginal atrophy, HT regimens (combined vs
unopposed), risks (breast cancer, VTE, stroke), nonhormonal options (paroxetine, venlafaxine,
gabapentin), local therapies (vaginal DHEA, ospemifene), duration and contraindications.
Gynecologic Oncology & Genetics: BRCA1/2 risk-reducing salpingo-oophorectomy, STIC, ovarian
cancer staging/adjuvant therapy, endometrial hyperplasia/cancer (tamoxifen-related), vulvar lichen
sclerosus and VIN/dVIN, Paget’s disease, cervical cancer, mastectomy and chemoprevention.
Pregnancy & Obstetric Complications: Preeclampsia/eclampsia/HELLP (magnesium sulfate,
antihypertensives), preterm birth prevention (cerclage, vaginal progesterone), PPROM, multiple gestation,
placenta previa/accreta spectrum, VBAC/TOLAC, uterine rupture, gestational diabetes, hyperemesis
gravidarum.
Infertility & ART: PCOS (letrozole, metformin), endometriosis and fertility, ovulation induction, OHSS
management, hydrosalpinx and IVF, uterine septum, recurrent pregnancy loss, PGT.
Contraception: Hormonal methods (OCPs, implant, IUS, DMPA), nonhormonal methods, WHO MEC
categories (migraine with aura, smoking, obesity, VTE risk).
Gynecologic Disorders: Endometriosis (medical and surgical management), adenomyosis, fibroids
(hysteroscopic myomectomy, UAE), abnormal uterine bleeding (PALM-COEIN), endometrial polyps,
PID/Fitz-Hugh-Curtis, chronic pelvic pain.
Infectious Disease: Vulvovaginal candidiasis (suppressive therapy, non-albicans species), bacterial
vaginosis, STIs (chlamydia, gonorrhea, PID, expedited partner therapy), UTI prevention in postmenopausal
women.
Breast Health: Benign breast disease, high-risk lesions (ADH, LCIS), breast cancer surveillance (MRI,
mammogram), risk-reducing medications (tamoxifen, raloxifene, aromatase inhibitors).
Sexual Health & Vulvar Disorders: Dyspareunia, vaginal atrophy, lichen sclerosus, vulvar intraepithelial
neoplasia, vulvar cancer, sexual dysfunction.
Osteoporosis & Bone Health: Screening, bisphosphonates, denosumab, teriparatide, aromatase inhibitor-
induced bone loss, calcium/vitamin D supplementation.
Urogynecology: Pelvic organ prolapse, pessary management, urinary incontinence, recurrent UTI.
,Q1. A 45-year-old woman who has been experiencing irregular menstrual cycles over the
past six months asks about the likely cause. Which physiologic change associated with
perimenopause is primarily responsible for this pattern of irregular bleeding?
A) Elevated follicle-stim hormone levels causing anovulatory cycles
B) A sudden drop in estrogen production from ovarian failure
C) ✓ Erratic ovulation and inconsistent progesterone secretion leading to
unpredictable endometrial shedding
D) Decreased thyroid function affecting the hypothalamic-pituitary-ovarian axis
Perimenopause is marked by fluctuating ovarian function, resulting in inconsistent ovulation
and progesterone levels, which cause irregular bleeding patterns.
Q2. A 32-year-old woman with a history of polycystic ovary syndrome is trying to conceive
and has been prescribed letrozole for ovulation induction. Which statement best describes
the mechanism of action of letrozole for this indication?
A) It directly stimulates the pituitary to release FSH and LH
B) It acts as an estrogen agonist to enhance follicle maturation
C) ✓ It inhibits aromatase, lowering estrogen levels and leading to increased
gonadotropin secretion
D) It blocks androgen receptors to reduce insulin resistance
,Letrozole is an aromatase inhibitor that reduces peripheral estrogen production, removing
negative feedback and thereby increasing endogenous FSH and LH release, which
promotes ovulation.
Q3. A 58-year-old postmenopausal woman reports experiencing vaginal dryness,
dyspareunia, and occasional urinary urgency without dysuria or hematuria. She has a
history of breast cancer treated five years ago and is not a candidate for systemic hormone
therapy. Which local treatment is most appropriate for her genitourinary symptoms?
A) Low-dose systemic estrogen-progestin therapy
B) Vaginal estrogen cream twice weekly
C) ✓ Vaginal DHEA (prasterone) suppositories or ospemifene if not contraindicated
D) High-potency topical corticosteroid applied to the vulva
For women with contraindications to estrogen or systemic therapy, vaginal DHEA
(prasterone) can improve vaginal atrophy by local conversion to androgens and estrogens,
and ospemifene is a SERM indicated for dyspareunia; both provide targeted relief.
Q4. An adolescent female presents with primary amenorrhea, normal breast development,
and absent uterus on pelvic imaging. Karyotype analysis reveals 46,XY chromosomes.
What is the most likely diagnosis?
A) Turner syndrome
B) Polycystic ovary syndrome
, C) ✓ Complete androgen insensitivity syndrome
D) Congenital adrenal hyperplasia
Complete androgen insensitivity syndrome is characterized by a 46,XY karyotype with
insensitivity to androgens due to a mutation in the androgen receptor, resulting in female
external genitalia, breast development, absent uterus, and sparse pubic hair.
Q5. A 36-year-old pregnant woman at 28 weeks’ gestation reports persistent, severe itching
that is worse at night, primarily on the palms and soles. Laboratory studies reveal elevated
serum bile acids and normal transaminases. What is the most likely diagnosis?
A) Pruritic urticarial papules and plaques of pregnancy (PUPPP)
B) Pemphigoid gestationis
C) ✓ Intrahepatic cholestasis of pregnancy
D) Acute fatty liver of pregnancy
Intrahepatic cholestasis of pregnancy is characterized by intense pruritus, often starting on
the palms and soles, with elevated bile acids; it carries risks of preterm birth and fetal
distress and is managed with ursodeoxycholic acid.
Q6. A 24-year-old woman presents with a one-year history of cyclic pelvic pain,
dysmenorrhea, and deep dyspareunia that begins a few days before menses and improves
after menstruation. Pelvic examination reveals tender nodules along the uterosacral
ligaments. What is the most likely diagnosis?
