NUR 684 Women's Health
Final Exam 2026
Questions and Answers ()
Verified Answers
Primary Care Women's Health for Nurse Practitioners
Advanced Practice Nursing Education
Aligned with ACOG, USPSTF, CDC, and NAMS 2026-2027 Guidelines
65 Questions | 7 Sections | Scenario-Based and Evidence-Based
,Section 1: Breast Health and Benign Breast Conditions
Assessment, Breast Lumps, Galactorrhea, Nipple Discharge, and Breast Cancer Risk Factors
Q1: A 24-year-old female presents to the clinic with a palpable breast lump she discovered during a
self-breast examination. The lump is freely movable, firm, rubbery, and non-tender. She reports it
does not change in size with her menstrual cycle. Based on these findings, what is the most likely
diagnosis?
A. Breast cyst
B. Fibroadenoma
C. Invasive ductal carcinoma
D. Fat necrosis
Correct Answer: B
Rationale: Fibroadenoma is the most common breast mass in women under 30 years of age. It classically presents as a
freely movable, firm, rubbery, non-tender mass that does not vary with the menstrual cycle. Breast cysts are typically
fluctuant and often change with the menstrual cycle. Invasive ductal carcinoma usually presents as a fixed, hard mass with
irregular borders. Fat necrosis often follows trauma and may present with skin retraction or dimpling. The age and classic
clinical presentation strongly support fibroadenoma as the correct diagnosis per ACOG and NUR 684 curriculum
guidelines.
Q2: A 32-year-old woman reports spontaneous bilateral milky nipple discharge. She is not pregnant
or breastfeeding. Her serum prolactin level is elevated at 85 ng/mL (normal < 25 ng/mL). Which of
the following is the most likely cause of her galactorrhea?
A. Heavy tobacco use
B. Hyperprolactinemia
C. Intraductal papilloma
D. Mammary duct ectasia
Correct Answer: B
Rationale: Galactorrhea is defined as inappropriate lactation not associated with pregnancy or breastfeeding. Potential
causes include hyperprolactinemia (the most common endocrine cause), certain medications (e.g., antipsychotics,
metoclopramide), hypothyroidism, and nipple stimulation. Heavy tobacco use is NOT a typical cause of galactorrhea and is
a common distractor on NUR 684 examinations. Intraductal papilloma typically causes bloody or serosanguineous
unilateral discharge from a single duct. Mammary duct ectasia presents with greenish-brown sticky discharge from multiple
ducts and is most common in perimenopausal women. Elevated prolactin levels confirm hyperprolactinemia as the etiology.
Q3: A 48-year-old perimenopausal woman presents with a burning sensation behind her nipples and
spontaneous greenish-brown sticky discharge from multiple ducts. On examination, there are no
palpable masses and no skin changes. What is the most likely diagnosis?
A. Paget's disease of the nipple
B. Intraductal papilloma
C. Mammary duct ectasia
D. Ductal carcinoma in situ (DCIS)
, Correct Answer: C
Rationale: Mammary duct ectasia is a benign condition most commonly seen in perimenopausal women. It presents with a
burning sensation behind the nipples and spontaneous greenish-brown sticky discharge from multiple ducts. There are no
palpable masses and no associated skin changes, which distinguishes it from malignant conditions. Paget's disease of the
nipple always involves the nipple itself with itching, redness, crusting, and ulceration. Intraductal papilloma typically causes
unilateral, single-duct bloody discharge. DCIS would not present with this clinical picture and is typically detected on
mammography rather than by clinical symptoms alone.
Q4: A 52-year-old woman presents with an itchy, red, moist patch on her left nipple with crusting and
ulceration. The nipple appears eczematous. Biopsy reveals underlying ductal carcinoma in situ
(DCIS). What is the most likely diagnosis?
A. Mammary duct ectasia
B. Atopic dermatitis of the nipple
C. Paget's disease of the nipple
D. Nipple adenoma
Correct Answer: C
Rationale: Paget's disease of the nipple is a malignant condition in which the nipple is always involved. It commonly
presents with itching, red, moist patches, crusting, and ulceration of the nipple that may initially be mistaken for eczema or
dermatitis. However, the key distinguishing feature is the association with underlying DCIS or invasive breast cancer,
confirmed on biopsy. Itching is a common symptom, unlike mammary duct ectasia which presents with burning and
multicolored discharge. The presence of underlying malignancy differentiates Paget's disease from benign dermatologic
conditions of the nipple, which is a critical differential diagnosis point per ACOG guidelines.
Q5: A 45-year-old woman presents with rapid onset of diffuse erythema and edema of her right
breast with peau d'orange (fine dimpling) of the skin. The breast feels warm and thickened. There is
no palpable discrete mass. What is the most appropriate next step in management?
A. Reassure and schedule follow-up in 2 weeks
B. Prescribe oral antibiotics for mastitis and re-evaluate
C. Immediate referral for urgent breast imaging and biopsy
D. Recommend warm compresses and over-the-counter analgesics
Correct Answer: C
Rationale: Inflammatory breast cancer is an aggressive malignancy that presents with rapid onset of diffuse erythema,
edema, and peau d'orange (fine dimpling) of the breast. Unlike typical breast cancer, it often lacks a palpable discrete
mass. The rapid onset and skin changes can mimic mastitis, but the absence of systemic fever, the lack of response to
antibiotics, and the characteristic peau d'orange should raise suspicion for this aggressive malignancy. Immediate referral
for urgent breast imaging (mammogram and/or MRI) and skin punch biopsy is required. Delaying diagnosis by treating
empirically with antibiotics or reassuring the patient can lead to significant delays in diagnosing this aggressive cancer,
which has a poorer prognosis than other breast cancer subtypes.
Q6: A 42-year-old woman undergoes screening mammography, and the radiologist reports that her
breasts are classified as heterogeneously dense (Breast Imaging Reporting and Data System
[BI-RADS] category C). She asks the nurse practitioner about her breast cancer risk. Which response
is most accurate?
Final Exam 2026
Questions and Answers ()
Verified Answers
Primary Care Women's Health for Nurse Practitioners
Advanced Practice Nursing Education
Aligned with ACOG, USPSTF, CDC, and NAMS 2026-2027 Guidelines
65 Questions | 7 Sections | Scenario-Based and Evidence-Based
,Section 1: Breast Health and Benign Breast Conditions
Assessment, Breast Lumps, Galactorrhea, Nipple Discharge, and Breast Cancer Risk Factors
Q1: A 24-year-old female presents to the clinic with a palpable breast lump she discovered during a
self-breast examination. The lump is freely movable, firm, rubbery, and non-tender. She reports it
does not change in size with her menstrual cycle. Based on these findings, what is the most likely
diagnosis?
A. Breast cyst
B. Fibroadenoma
C. Invasive ductal carcinoma
D. Fat necrosis
Correct Answer: B
Rationale: Fibroadenoma is the most common breast mass in women under 30 years of age. It classically presents as a
freely movable, firm, rubbery, non-tender mass that does not vary with the menstrual cycle. Breast cysts are typically
fluctuant and often change with the menstrual cycle. Invasive ductal carcinoma usually presents as a fixed, hard mass with
irregular borders. Fat necrosis often follows trauma and may present with skin retraction or dimpling. The age and classic
clinical presentation strongly support fibroadenoma as the correct diagnosis per ACOG and NUR 684 curriculum
guidelines.
Q2: A 32-year-old woman reports spontaneous bilateral milky nipple discharge. She is not pregnant
or breastfeeding. Her serum prolactin level is elevated at 85 ng/mL (normal < 25 ng/mL). Which of
the following is the most likely cause of her galactorrhea?
A. Heavy tobacco use
B. Hyperprolactinemia
C. Intraductal papilloma
D. Mammary duct ectasia
Correct Answer: B
Rationale: Galactorrhea is defined as inappropriate lactation not associated with pregnancy or breastfeeding. Potential
causes include hyperprolactinemia (the most common endocrine cause), certain medications (e.g., antipsychotics,
metoclopramide), hypothyroidism, and nipple stimulation. Heavy tobacco use is NOT a typical cause of galactorrhea and is
a common distractor on NUR 684 examinations. Intraductal papilloma typically causes bloody or serosanguineous
unilateral discharge from a single duct. Mammary duct ectasia presents with greenish-brown sticky discharge from multiple
ducts and is most common in perimenopausal women. Elevated prolactin levels confirm hyperprolactinemia as the etiology.
Q3: A 48-year-old perimenopausal woman presents with a burning sensation behind her nipples and
spontaneous greenish-brown sticky discharge from multiple ducts. On examination, there are no
palpable masses and no skin changes. What is the most likely diagnosis?
A. Paget's disease of the nipple
B. Intraductal papilloma
C. Mammary duct ectasia
D. Ductal carcinoma in situ (DCIS)
, Correct Answer: C
Rationale: Mammary duct ectasia is a benign condition most commonly seen in perimenopausal women. It presents with a
burning sensation behind the nipples and spontaneous greenish-brown sticky discharge from multiple ducts. There are no
palpable masses and no associated skin changes, which distinguishes it from malignant conditions. Paget's disease of the
nipple always involves the nipple itself with itching, redness, crusting, and ulceration. Intraductal papilloma typically causes
unilateral, single-duct bloody discharge. DCIS would not present with this clinical picture and is typically detected on
mammography rather than by clinical symptoms alone.
Q4: A 52-year-old woman presents with an itchy, red, moist patch on her left nipple with crusting and
ulceration. The nipple appears eczematous. Biopsy reveals underlying ductal carcinoma in situ
(DCIS). What is the most likely diagnosis?
A. Mammary duct ectasia
B. Atopic dermatitis of the nipple
C. Paget's disease of the nipple
D. Nipple adenoma
Correct Answer: C
Rationale: Paget's disease of the nipple is a malignant condition in which the nipple is always involved. It commonly
presents with itching, red, moist patches, crusting, and ulceration of the nipple that may initially be mistaken for eczema or
dermatitis. However, the key distinguishing feature is the association with underlying DCIS or invasive breast cancer,
confirmed on biopsy. Itching is a common symptom, unlike mammary duct ectasia which presents with burning and
multicolored discharge. The presence of underlying malignancy differentiates Paget's disease from benign dermatologic
conditions of the nipple, which is a critical differential diagnosis point per ACOG guidelines.
Q5: A 45-year-old woman presents with rapid onset of diffuse erythema and edema of her right
breast with peau d'orange (fine dimpling) of the skin. The breast feels warm and thickened. There is
no palpable discrete mass. What is the most appropriate next step in management?
A. Reassure and schedule follow-up in 2 weeks
B. Prescribe oral antibiotics for mastitis and re-evaluate
C. Immediate referral for urgent breast imaging and biopsy
D. Recommend warm compresses and over-the-counter analgesics
Correct Answer: C
Rationale: Inflammatory breast cancer is an aggressive malignancy that presents with rapid onset of diffuse erythema,
edema, and peau d'orange (fine dimpling) of the breast. Unlike typical breast cancer, it often lacks a palpable discrete
mass. The rapid onset and skin changes can mimic mastitis, but the absence of systemic fever, the lack of response to
antibiotics, and the characteristic peau d'orange should raise suspicion for this aggressive malignancy. Immediate referral
for urgent breast imaging (mammogram and/or MRI) and skin punch biopsy is required. Delaying diagnosis by treating
empirically with antibiotics or reassuring the patient can lead to significant delays in diagnosing this aggressive cancer,
which has a poorer prognosis than other breast cancer subtypes.
Q6: A 42-year-old woman undergoes screening mammography, and the radiologist reports that her
breasts are classified as heterogeneously dense (Breast Imaging Reporting and Data System
[BI-RADS] category C). She asks the nurse practitioner about her breast cancer risk. Which response
is most accurate?
