ADVANCED PRACTICE NURSING EDUCATION - NURSE PRACTITIONER TRACK
NSG 6430 WOMEN'S HEALTH
FINAL EXAMINATION - REVISED AND GRADED A
South University | Comprehensive Final Exam Preparation Guide | Aligned with 2026-2027 Curriculum Standards
Course NSG 6430 - Women's Health (Nurse Practitioner Track)
Institution South University - Advanced Practice Nursing Education
Total Questions 120 questions across 8 sections (Q1-Q120)
Cognitive Levels 25% Recall | 50% Application | 25% Analysis
75% scenario-based | 25% direct recall; 4 options (A-D) with one correct answer;
Question Style
select-all-that-apply included in applicable sections
Verified answers marked [CORRECT] with detailed evidence-based rationales and
Answer Key
clinical pearls
Curriculum Updated for the 2026/2027 academic year examination standards
SECTION 1: Reproductive Health and Gynecological Disorders
Abnormal Uterine Bleeding, Fibroids, Endometriosis, PCOS, and Vulvar Conditions (Questions 1-30)
Q1: A 28-year-old woman presents with a six-month history of irregular, unpredictable uterine
bleeding. She is obese, has facial hirsutism, and reports menses occurring only two to three times per
year. Transvaginal ultrasound shows no structural pathology. What is the most common cause of
abnormal uterine bleeding (AUB) in premenopausal women such as this patient?
A. Uterine leiomyomas
B. Anovulation with unopposed estrogen stimulation of the endometrium [CORRECT]
C. Endometrial polyps
D. Inherited coagulopathy
Correct Answer: B
Rationale: Anovulation accounts for approximately 70% of AUB in premenopausal women. Chronic
anovulation produces unopposed estrogen, causing endometrial proliferation without the progesterone
withdrawal needed for orderly shedding, which results in irregular, unpredictable bleeding. This patient's
obesity, hirsutism, and oligomenorrhea strongly suggest polycystic ovary syndrome, a classic cause of
anovulatory AUB. Leiomyomas and polyps (structural causes) are excluded by her normal ultrasound, and
coagulopathy is more typical of heavy bleeding beginning at menarche.
South University - NSG 6430 Nurse Practitioner Track 1
,NSG 6430 Women's Health Final Examination (Revised and Graded A) South University
Q2: A 35-year-old woman presents with increasingly heavy but regular menstrual periods. Transvaginal
ultrasound reveals a 3-cm intramural leiomyoma distorting the endometrial cavity. Using the FIGO
PALM-COEIN classification system, which category best describes the cause of her abnormal uterine
bleeding?
A. P - Polyps
B. A - Adenomyosis
C. L - Leiomyomas [CORRECT]
D. C - Coagulopathy
Correct Answer: C
Rationale: The PALM-COEIN system classifies AUB causes as Polyps, Adenomyosis, Leiomyomas,
Malignancy, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, and Not yet classified. A
structural uterine fibroid causing heavy menstrual bleeding maps directly to the L (Leiomyomas) category.
Adenomyosis typically presents with a boggy, diffusely enlarged uterus, and coagulopathy is suggested by
bleeding since menarche with bruising or epistaxis, neither of which is present here.
Q3: A 44-year-old woman with an 8-cm intramural fibroid has severe heavy menstrual bleeding with
hemoglobin 9.6 g/dL. She desires uterine preservation and is scheduled for hysteroscopic evaluation
before planned myomectomy. Which preoperative pharmacologic strategy is most appropriate?
A. Systemic estrogen therapy to stabilize the endometrium
B. Long-term combined hormonal contraceptive monotherapy without further evaluation
C. Immediate hysterectomy referral
D. GnRH agonist therapy to shrink the fibroid and improve hemoglobin before surgery
[CORRECT]
Correct Answer: D
Rationale: GnRH agonists induce a temporary hypoestrogenic state that reduces fibroid volume and
bleeding, allowing hemoglobin recovery before myomectomy. Estrogen therapy is NOT recommended
because unopposed estrogen can stimulate fibroid growth and worsen bleeding. Progestin therapy or surgical
referral are acceptable alternatives, but hysterectomy contradicts her stated desire for uterine preservation.
Q4: A 26-year-old nulliparous woman reports severe cyclic pelvic pain beginning several days before
menses, deep dyspareunia, painful defecation during menses, and chronic fatigue. Pelvic examination
reveals a fixed, tender retroverted uterus with nodularity along the uterosacral ligaments. Transvaginal
ultrasound is normal. What is the most likely diagnosis?
A. Pelvic inflammatory disease
B. Interstitial cystitis
C. Endometriosis [CORRECT]
D. Irritable bowel syndrome
Correct Answer: C
Rationale: The classic triad of endometriosis is dysmenorrhea, dyspareunia, and dyschezia, and the triad
plus uterosacral nodularity and a fixed retroverted uterus is highly suggestive. A normal ultrasound does not
exclude endometriosis because superficial implants are frequently not visualized on imaging. PID is
supported by fever, cervical motion tenderness, and discharge; interstitial cystitis features urinary urgency
and suprapubic pain without cyclic correlation; IBS is characterized by bowel pattern changes without
gynecologic findings.
South University - NSG 6430 Nurse Practitioner Track 2
,NSG 6430 Women's Health Final Examination (Revised and Graded A) South University
Q5: For the 26-year-old woman in the previous scenario with suspected endometriosis, which
diagnostic approach provides the definitive (gold standard) diagnosis?
A. Serial serum CA-125 measurements
B. Transvaginal ultrasound with Doppler flow studies
C. Magnetic resonance imaging of the pelvis without contrast
D. Laparoscopy with direct visualization and biopsy of implants [CORRECT]
Correct Answer: D
Rationale: Laparoscopy with direct visualization, ideally with histologic confirmation of implants, remains
the gold standard for diagnosing endometriosis. Ultrasound and MRI can detect endometriomas but miss
peritoneal implants, and CA-125 is nonspecific and may be mildly elevated in many benign conditions,
limiting its diagnostic value. Imaging is useful to plan surgery but cannot exclude disease.
Q6: A 19-year-old woman with polycystic ovary syndrome (oligomenorrhea, hirsutism, acne, BMI 34)
does not desire pregnancy at this time. Which intervention is the best first-line choice to regulate her
menstrual cycles?
A. A combined hormonal contraceptive (pill, patch, or ring) [CORRECT]
B. Clomiphene citrate ovulation induction
C. Spironolactone monotherapy
D. Weight-neutral observation with annual ultrasound
Correct Answer: A
Rationale: Combined hormonal contraceptives are first-line therapy for menstrual cycle regulation in
PCOS because they suppress luteinizing hormone, reduce ovarian androgen production, increase sex
hormone-binding globulin, and protect the endometrium from unopposed estrogen. They also improve acne
and hirsutism. Clomiphene is reserved for women who desire pregnancy, and spironolactone is an adjunct
for androgenic symptoms and requires contraception because of antiandrogenic fetal effects.
Q7: A nurse practitioner is evaluating a 22-year-old woman for suspected polycystic ovary syndrome
using the Rotterdam criteria. Which finding is NOT one of the three Rotterdam diagnostic criteria?
A. Oligo-ovulation or anovulation
B. Clinical or biochemical hyperandrogenism
C. Polycystic ovarian morphology on ultrasound
D. An elevated LH-to-FSH ratio [CORRECT]
Correct Answer: D
Rationale: The Rotterdam criteria require two of three findings: oligo-ovulation or anovulation, clinical or
biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound. Although an elevated
LH-to-FSH ratio is frequently seen in PCOS, it is not a diagnostic criterion and should never be used to
confirm or exclude the diagnosis. Requiring this ratio is a classic NSG 6430 testing pitfall.
Q8: Which of the following best describes the normal physiologic function of the Bartholin glands?
A. Lubrication of the vaginal opening during sexual arousal [CORRECT]
B. Production of estrogen after menopause
C. Filtration of urine to prevent incontinence
D. Structural support of the uterus within the pelvis
Correct Answer: A
Rationale: The Bartholin glands are bilateral vestibular glands located at approximately the 4 and 8 o'clock
positions of the vaginal opening, and they secrete mucus that lubricates the vaginal opening during sexual
arousal. They have no role in estrogen production, urinary continence, or uterine support, which makes those
South University - NSG 6430 Nurse Practitioner Track 3
, NSG 6430 Women's Health Final Examination (Revised and Graded A) South University
distractors physiologically impossible.
Q9: A 32-year-old woman arrives reporting a painful, swollen area at the vaginal opening that has
developed over two days. She has difficulty sitting and walking because of the pain. Examination
reveals a tense, exquisitely tender 4-cm mass at the posterolateral introitus with overlying erythema.
What condition should the nurse practitioner primarily evaluate?
A. Bartholin gland cyst or abscess [CORRECT]
B. Skene gland carcinoma
C. Lichen sclerosus
D. Vulvar hematoma
Correct Answer: A
Rationale: A painful, swollen vaginal introital mass that causes difficulty sitting or walking is the classic
presentation of an obstructed and infected Bartholin duct, evolving into a cyst or abscess. Lichen sclerosus
presents as white, atrophic, itchy epithelial change rather than an acute tender mass, and a hematoma is
usually associated with trauma, obstetric injury, or anticoagulation.
Q10: The 32-year-old woman above is diagnosed with an infected Bartholin gland cyst with abscess
formation. Which interventions should the nurse practitioner include in the management plan? Select all
that apply: (1) Warm sitz baths for comfort and drainage, (2) Incision and drainage of the abscess, (3)
Antibiotic therapy, (4) Topical corticosteroid application.
A. 1 and 4 only
B. 2, 3, and 4 only
C. All four interventions
D. 1, 2, and 3 only [CORRECT]
Correct Answer: D
Rationale: Infected Bartholin cysts are managed with warm sitz baths for comfort and spontaneous
drainage, incision and drainage (with Word catheter placement or marsupialization for recurrence
prevention) when abscessed, and antibiotics when infection is significant. Topical corticosteroids are NOT
indicated because they suppress local immunity, do not treat the infection, and could worsen the abscess.
Klebsiella is not a common causative organism; typical flora include Escherichia coli, Staphylococcus,
Streptococcus, gonorrhea, and chlamydia.
Q11: Which microorganism is NOT commonly implicated as a cause of Bartholin gland infection?
A. Escherichia coli
B. Neisseria gonorrhoeae
C. Klebsiella species [CORRECT]
D. Chlamydia trachomatis
Correct Answer: C
Rationale: Common Bartholin gland pathogens include Escherichia coli and other enteric flora,
Staphylococcus aureus, Streptococcus species, and sexually transmitted organisms such as Neisseria
gonorrhoeae and Chlamydia trachomatis. Klebsiella is NOT a common organism responsible for Bartholin
gland infection, making it the classic incorrect answer on the NSG 6430 exam. When Bartholin cultures are
obtained, testing should include gonorrhea and chlamydia NAAT.
South University - NSG 6430 Nurse Practitioner Track 4
NSG 6430 WOMEN'S HEALTH
FINAL EXAMINATION - REVISED AND GRADED A
South University | Comprehensive Final Exam Preparation Guide | Aligned with 2026-2027 Curriculum Standards
Course NSG 6430 - Women's Health (Nurse Practitioner Track)
Institution South University - Advanced Practice Nursing Education
Total Questions 120 questions across 8 sections (Q1-Q120)
Cognitive Levels 25% Recall | 50% Application | 25% Analysis
75% scenario-based | 25% direct recall; 4 options (A-D) with one correct answer;
Question Style
select-all-that-apply included in applicable sections
Verified answers marked [CORRECT] with detailed evidence-based rationales and
Answer Key
clinical pearls
Curriculum Updated for the 2026/2027 academic year examination standards
SECTION 1: Reproductive Health and Gynecological Disorders
Abnormal Uterine Bleeding, Fibroids, Endometriosis, PCOS, and Vulvar Conditions (Questions 1-30)
Q1: A 28-year-old woman presents with a six-month history of irregular, unpredictable uterine
bleeding. She is obese, has facial hirsutism, and reports menses occurring only two to three times per
year. Transvaginal ultrasound shows no structural pathology. What is the most common cause of
abnormal uterine bleeding (AUB) in premenopausal women such as this patient?
A. Uterine leiomyomas
B. Anovulation with unopposed estrogen stimulation of the endometrium [CORRECT]
C. Endometrial polyps
D. Inherited coagulopathy
Correct Answer: B
Rationale: Anovulation accounts for approximately 70% of AUB in premenopausal women. Chronic
anovulation produces unopposed estrogen, causing endometrial proliferation without the progesterone
withdrawal needed for orderly shedding, which results in irregular, unpredictable bleeding. This patient's
obesity, hirsutism, and oligomenorrhea strongly suggest polycystic ovary syndrome, a classic cause of
anovulatory AUB. Leiomyomas and polyps (structural causes) are excluded by her normal ultrasound, and
coagulopathy is more typical of heavy bleeding beginning at menarche.
South University - NSG 6430 Nurse Practitioner Track 1
,NSG 6430 Women's Health Final Examination (Revised and Graded A) South University
Q2: A 35-year-old woman presents with increasingly heavy but regular menstrual periods. Transvaginal
ultrasound reveals a 3-cm intramural leiomyoma distorting the endometrial cavity. Using the FIGO
PALM-COEIN classification system, which category best describes the cause of her abnormal uterine
bleeding?
A. P - Polyps
B. A - Adenomyosis
C. L - Leiomyomas [CORRECT]
D. C - Coagulopathy
Correct Answer: C
Rationale: The PALM-COEIN system classifies AUB causes as Polyps, Adenomyosis, Leiomyomas,
Malignancy, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, and Not yet classified. A
structural uterine fibroid causing heavy menstrual bleeding maps directly to the L (Leiomyomas) category.
Adenomyosis typically presents with a boggy, diffusely enlarged uterus, and coagulopathy is suggested by
bleeding since menarche with bruising or epistaxis, neither of which is present here.
Q3: A 44-year-old woman with an 8-cm intramural fibroid has severe heavy menstrual bleeding with
hemoglobin 9.6 g/dL. She desires uterine preservation and is scheduled for hysteroscopic evaluation
before planned myomectomy. Which preoperative pharmacologic strategy is most appropriate?
A. Systemic estrogen therapy to stabilize the endometrium
B. Long-term combined hormonal contraceptive monotherapy without further evaluation
C. Immediate hysterectomy referral
D. GnRH agonist therapy to shrink the fibroid and improve hemoglobin before surgery
[CORRECT]
Correct Answer: D
Rationale: GnRH agonists induce a temporary hypoestrogenic state that reduces fibroid volume and
bleeding, allowing hemoglobin recovery before myomectomy. Estrogen therapy is NOT recommended
because unopposed estrogen can stimulate fibroid growth and worsen bleeding. Progestin therapy or surgical
referral are acceptable alternatives, but hysterectomy contradicts her stated desire for uterine preservation.
Q4: A 26-year-old nulliparous woman reports severe cyclic pelvic pain beginning several days before
menses, deep dyspareunia, painful defecation during menses, and chronic fatigue. Pelvic examination
reveals a fixed, tender retroverted uterus with nodularity along the uterosacral ligaments. Transvaginal
ultrasound is normal. What is the most likely diagnosis?
A. Pelvic inflammatory disease
B. Interstitial cystitis
C. Endometriosis [CORRECT]
D. Irritable bowel syndrome
Correct Answer: C
Rationale: The classic triad of endometriosis is dysmenorrhea, dyspareunia, and dyschezia, and the triad
plus uterosacral nodularity and a fixed retroverted uterus is highly suggestive. A normal ultrasound does not
exclude endometriosis because superficial implants are frequently not visualized on imaging. PID is
supported by fever, cervical motion tenderness, and discharge; interstitial cystitis features urinary urgency
and suprapubic pain without cyclic correlation; IBS is characterized by bowel pattern changes without
gynecologic findings.
South University - NSG 6430 Nurse Practitioner Track 2
,NSG 6430 Women's Health Final Examination (Revised and Graded A) South University
Q5: For the 26-year-old woman in the previous scenario with suspected endometriosis, which
diagnostic approach provides the definitive (gold standard) diagnosis?
A. Serial serum CA-125 measurements
B. Transvaginal ultrasound with Doppler flow studies
C. Magnetic resonance imaging of the pelvis without contrast
D. Laparoscopy with direct visualization and biopsy of implants [CORRECT]
Correct Answer: D
Rationale: Laparoscopy with direct visualization, ideally with histologic confirmation of implants, remains
the gold standard for diagnosing endometriosis. Ultrasound and MRI can detect endometriomas but miss
peritoneal implants, and CA-125 is nonspecific and may be mildly elevated in many benign conditions,
limiting its diagnostic value. Imaging is useful to plan surgery but cannot exclude disease.
Q6: A 19-year-old woman with polycystic ovary syndrome (oligomenorrhea, hirsutism, acne, BMI 34)
does not desire pregnancy at this time. Which intervention is the best first-line choice to regulate her
menstrual cycles?
A. A combined hormonal contraceptive (pill, patch, or ring) [CORRECT]
B. Clomiphene citrate ovulation induction
C. Spironolactone monotherapy
D. Weight-neutral observation with annual ultrasound
Correct Answer: A
Rationale: Combined hormonal contraceptives are first-line therapy for menstrual cycle regulation in
PCOS because they suppress luteinizing hormone, reduce ovarian androgen production, increase sex
hormone-binding globulin, and protect the endometrium from unopposed estrogen. They also improve acne
and hirsutism. Clomiphene is reserved for women who desire pregnancy, and spironolactone is an adjunct
for androgenic symptoms and requires contraception because of antiandrogenic fetal effects.
Q7: A nurse practitioner is evaluating a 22-year-old woman for suspected polycystic ovary syndrome
using the Rotterdam criteria. Which finding is NOT one of the three Rotterdam diagnostic criteria?
A. Oligo-ovulation or anovulation
B. Clinical or biochemical hyperandrogenism
C. Polycystic ovarian morphology on ultrasound
D. An elevated LH-to-FSH ratio [CORRECT]
Correct Answer: D
Rationale: The Rotterdam criteria require two of three findings: oligo-ovulation or anovulation, clinical or
biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound. Although an elevated
LH-to-FSH ratio is frequently seen in PCOS, it is not a diagnostic criterion and should never be used to
confirm or exclude the diagnosis. Requiring this ratio is a classic NSG 6430 testing pitfall.
Q8: Which of the following best describes the normal physiologic function of the Bartholin glands?
A. Lubrication of the vaginal opening during sexual arousal [CORRECT]
B. Production of estrogen after menopause
C. Filtration of urine to prevent incontinence
D. Structural support of the uterus within the pelvis
Correct Answer: A
Rationale: The Bartholin glands are bilateral vestibular glands located at approximately the 4 and 8 o'clock
positions of the vaginal opening, and they secrete mucus that lubricates the vaginal opening during sexual
arousal. They have no role in estrogen production, urinary continence, or uterine support, which makes those
South University - NSG 6430 Nurse Practitioner Track 3
, NSG 6430 Women's Health Final Examination (Revised and Graded A) South University
distractors physiologically impossible.
Q9: A 32-year-old woman arrives reporting a painful, swollen area at the vaginal opening that has
developed over two days. She has difficulty sitting and walking because of the pain. Examination
reveals a tense, exquisitely tender 4-cm mass at the posterolateral introitus with overlying erythema.
What condition should the nurse practitioner primarily evaluate?
A. Bartholin gland cyst or abscess [CORRECT]
B. Skene gland carcinoma
C. Lichen sclerosus
D. Vulvar hematoma
Correct Answer: A
Rationale: A painful, swollen vaginal introital mass that causes difficulty sitting or walking is the classic
presentation of an obstructed and infected Bartholin duct, evolving into a cyst or abscess. Lichen sclerosus
presents as white, atrophic, itchy epithelial change rather than an acute tender mass, and a hematoma is
usually associated with trauma, obstetric injury, or anticoagulation.
Q10: The 32-year-old woman above is diagnosed with an infected Bartholin gland cyst with abscess
formation. Which interventions should the nurse practitioner include in the management plan? Select all
that apply: (1) Warm sitz baths for comfort and drainage, (2) Incision and drainage of the abscess, (3)
Antibiotic therapy, (4) Topical corticosteroid application.
A. 1 and 4 only
B. 2, 3, and 4 only
C. All four interventions
D. 1, 2, and 3 only [CORRECT]
Correct Answer: D
Rationale: Infected Bartholin cysts are managed with warm sitz baths for comfort and spontaneous
drainage, incision and drainage (with Word catheter placement or marsupialization for recurrence
prevention) when abscessed, and antibiotics when infection is significant. Topical corticosteroids are NOT
indicated because they suppress local immunity, do not treat the infection, and could worsen the abscess.
Klebsiella is not a common causative organism; typical flora include Escherichia coli, Staphylococcus,
Streptococcus, gonorrhea, and chlamydia.
Q11: Which microorganism is NOT commonly implicated as a cause of Bartholin gland infection?
A. Escherichia coli
B. Neisseria gonorrhoeae
C. Klebsiella species [CORRECT]
D. Chlamydia trachomatis
Correct Answer: C
Rationale: Common Bartholin gland pathogens include Escherichia coli and other enteric flora,
Staphylococcus aureus, Streptococcus species, and sexually transmitted organisms such as Neisseria
gonorrhoeae and Chlamydia trachomatis. Klebsiella is NOT a common organism responsible for Bartholin
gland infection, making it the classic incorrect answer on the NSG 6430 exam. When Bartholin cultures are
obtained, testing should include gonorrhea and chlamydia NAAT.
South University - NSG 6430 Nurse Practitioner Track 4
