WHNP-BC Practice Exam: 300 ANCC-Style Questions
with Detailed Rationales for Women's Health Nurse
Practitioner Certification
Domain 1: Assessment & Diagnosis (Questions 1–105)
Question 1
A 24-year-old G0 presents with a 3-month history of irregular menstrual cycles
occurring every 21–45 days. She reports acne on her face and chest, and
increased facial hair. Her BMI is 31. On physical exam, you note acanthosis
nigricans on the back of her neck. What is the MOST likely diagnosis?
A. Hypothalamic amenorrhea
B. Polycystic ovary syndrome (PCOS)
C. Hyperprolactinemia
D. Thyroid dysfunction
Correct Answer: B. Polycystic ovary syndrome (PCOS)
Rationale: PCOS is the most common endocrine disorder in reproductive-aged
women. The diagnostic criteria (Rotterdam) require two of three: oligo-ovulation
or anovulation (irregular cycles), clinical or biochemical signs of
hyperandrogenism (acne, hirsutism), and polycystic ovaries on ultrasound.
Acanthosis nigricans is a marker of insulin resistance, common in PCOS.
Hypothalamic amenorrhea presents with low BMI, not obesity.
Hyperprolactinemia causes galactorrhea. Thyroid dysfunction causes cycle
changes but not hyperandrogenism.
Question 2
A 32-year-old G2P2 presents with a 6-month history of heavy menstrual bleeding
(soaking through a super-plus tampon every 1-2 hours for the first 2 days of her
cycle). Her hemoglobin is 9.2 g/dL. Pelvic ultrasound reveals a 4 cm submucosal
fibroid. What is the MOST appropriate next step in diagnosis?
1|Page
,A. Endometrial biopsy
B. Saline infusion sonography (SIS)
C. Hysteroscopy with biopsy
D. CA-125 blood test
Correct Answer: C. Hysteroscopy with biopsy
Rationale: Submucosal fibroids are a common cause of heavy menstrual bleeding
(menorrhagia) and anemia. Hysteroscopy is the gold standard for visualizing the
endometrial cavity, confirming the location and size of the fibroid, and obtaining
an endometrial biopsy if needed. SIS is less invasive but does not allow biopsy.
Endometrial biopsy alone misses focal lesions. CA-125 is not indicated for fibroids
(elevated in endometriosis or malignancy).
Question 3
A 45-year-old perimenopausal woman presents with a 3-month history of hot
flashes, night sweats, and vaginal dryness. She has a history of estrogen receptor-
positive breast cancer treated with mastectomy and tamoxifen 2 years ago. What
is the MOST appropriate next step in assessing her symptoms?
A. Order serum FSH and estradiol levels
B. Perform a bone density scan
C. Document symptom severity and discuss non-hormonal treatment options
D. Prescribe low-dose vaginal estrogen cream
Correct Answer: C. Document symptom severity and discuss non-hormonal
treatment options
Rationale: This patient has irreversible contraindication to estrogen therapy (ER+
breast cancer). Hormonal therapy (including vaginal estrogen, though low
systemic absorption) is generally avoided or used with extreme caution and
oncology consultation after ER+ cancer. The priority is to assess severity and offer
evidence-based non-hormonal treatments (SSRIs/SNRIs, gabapentin, oxybutynin,
lifestyle). FSH/estradiol levels are not needed to confirm menopause given age
and symptoms.
2|Page
,Question 4
A 28-year-old G0 presents with a 2-day history of severe right lower quadrant
pain, nausea, and fever (T 101.5°F). Last menstrual period was 10 days ago. She
has an intrauterine device (IUD) placed 6 months ago. On exam, she has cervical
motion tenderness and right adnexal tenderness. Urine hCG is negative. What is
the MOST appropriate next step?
A. Remove IUD and discharge with oral doxycycline
B. Obtain transvaginal ultrasound
C. Start outpatient oral antibiotics for pelvic inflammatory disease (PID)
D. Admit for IV antibiotics and remove IUD after 48 hours
Correct Answer: B. Obtain transvaginal ultrasound
Rationale: In a patient with suspected PID who has an IUD, imaging (transvaginal
ultrasound) is essential to rule out tubo-ovarian abscess (TOA) before initiating
treatment. If TOA is present, hospitalization and IV antibiotics are required, and
IUD removal may be delayed. Outpatient treatment is not appropriate for this
severity (fever, severe pain). The correct sequence: imaging → then treatment
based on findings.
Question 5
A 52-year-old postmenopausal woman presents with a single episode of painless
vaginal spotting. She is not on hormone therapy. Transvaginal ultrasound shows
an endometrial stripe of 8 mm. What is the MOST appropriate next step?
A. Repeat ultrasound in 6 months
B. Endometrial biopsy
C. Saline infusion sonography (SIS)
D. Observation with symptom diary
Correct Answer: B. Endometrial biopsy
Rationale: Any postmenopausal bleeding requires evaluation. The normal
endometrial stripe is typically <4-5 mm in postmenopausal women not on
hormone therapy (≤4 mm is considered normal by ACOG). A stripe of 8 mm is
abnormal and warrants tissue sampling (office endometrial biopsy) to rule out
3|Page
, endometrial hyperplasia or cancer. SIS is useful for focal lesions but not first-line
for abnormal stripe. Observation is inappropriate.
Question 6
A 22-year-old G0 presents with a 2-week history of a thin, gray-white, fishy-
smelling vaginal discharge. She denies itching or dysuria. Wet mount shows clue
cells and a positive whiff test (fishy odor with KOH). What is the MOST likely
diagnosis?
A. Bacterial vaginosis (BV)
B. Trichomoniasis
C. Candidiasis
D. Atrophic vaginitis
Correct Answer: A. Bacterial vaginosis (BV)
Rationale: BV is the most common cause of vaginal discharge in reproductive-
aged women. Diagnostic criteria (Amsel criteria) require 3 of 4: thin, homogenous
gray-white discharge; pH >4.5; positive whiff test (fishy odor with 10% KOH); clue
cells on wet mount (>20% of epithelial cells). BV is not an STI but is associated
with sexual activity. Trichomoniasis causes frothy, yellow-green discharge.
Candidiasis causes thick, white, "cottage cheese" discharge with pruritus. Atrophic
vaginitis occurs in postmenopausal women.
Question 7
A 35-year-old G2P2 presents with a 1-year history of cyclic pelvic pain beginning 3
days before menses and resolving 2 days after menses. She also reports deep
dyspareunia and pain with bowel movements during her period. Pelvic exam
reveals tenderness upon palpation of the uterosacral ligaments. What is the
MOST appropriate next step to confirm the diagnosis?
A. Transvaginal ultrasound
B. MRI pelvis
C. Diagnostic laparoscopy
D. CA-125 blood test
Correct Answer: C. Diagnostic laparoscopy
4|Page
with Detailed Rationales for Women's Health Nurse
Practitioner Certification
Domain 1: Assessment & Diagnosis (Questions 1–105)
Question 1
A 24-year-old G0 presents with a 3-month history of irregular menstrual cycles
occurring every 21–45 days. She reports acne on her face and chest, and
increased facial hair. Her BMI is 31. On physical exam, you note acanthosis
nigricans on the back of her neck. What is the MOST likely diagnosis?
A. Hypothalamic amenorrhea
B. Polycystic ovary syndrome (PCOS)
C. Hyperprolactinemia
D. Thyroid dysfunction
Correct Answer: B. Polycystic ovary syndrome (PCOS)
Rationale: PCOS is the most common endocrine disorder in reproductive-aged
women. The diagnostic criteria (Rotterdam) require two of three: oligo-ovulation
or anovulation (irregular cycles), clinical or biochemical signs of
hyperandrogenism (acne, hirsutism), and polycystic ovaries on ultrasound.
Acanthosis nigricans is a marker of insulin resistance, common in PCOS.
Hypothalamic amenorrhea presents with low BMI, not obesity.
Hyperprolactinemia causes galactorrhea. Thyroid dysfunction causes cycle
changes but not hyperandrogenism.
Question 2
A 32-year-old G2P2 presents with a 6-month history of heavy menstrual bleeding
(soaking through a super-plus tampon every 1-2 hours for the first 2 days of her
cycle). Her hemoglobin is 9.2 g/dL. Pelvic ultrasound reveals a 4 cm submucosal
fibroid. What is the MOST appropriate next step in diagnosis?
1|Page
,A. Endometrial biopsy
B. Saline infusion sonography (SIS)
C. Hysteroscopy with biopsy
D. CA-125 blood test
Correct Answer: C. Hysteroscopy with biopsy
Rationale: Submucosal fibroids are a common cause of heavy menstrual bleeding
(menorrhagia) and anemia. Hysteroscopy is the gold standard for visualizing the
endometrial cavity, confirming the location and size of the fibroid, and obtaining
an endometrial biopsy if needed. SIS is less invasive but does not allow biopsy.
Endometrial biopsy alone misses focal lesions. CA-125 is not indicated for fibroids
(elevated in endometriosis or malignancy).
Question 3
A 45-year-old perimenopausal woman presents with a 3-month history of hot
flashes, night sweats, and vaginal dryness. She has a history of estrogen receptor-
positive breast cancer treated with mastectomy and tamoxifen 2 years ago. What
is the MOST appropriate next step in assessing her symptoms?
A. Order serum FSH and estradiol levels
B. Perform a bone density scan
C. Document symptom severity and discuss non-hormonal treatment options
D. Prescribe low-dose vaginal estrogen cream
Correct Answer: C. Document symptom severity and discuss non-hormonal
treatment options
Rationale: This patient has irreversible contraindication to estrogen therapy (ER+
breast cancer). Hormonal therapy (including vaginal estrogen, though low
systemic absorption) is generally avoided or used with extreme caution and
oncology consultation after ER+ cancer. The priority is to assess severity and offer
evidence-based non-hormonal treatments (SSRIs/SNRIs, gabapentin, oxybutynin,
lifestyle). FSH/estradiol levels are not needed to confirm menopause given age
and symptoms.
2|Page
,Question 4
A 28-year-old G0 presents with a 2-day history of severe right lower quadrant
pain, nausea, and fever (T 101.5°F). Last menstrual period was 10 days ago. She
has an intrauterine device (IUD) placed 6 months ago. On exam, she has cervical
motion tenderness and right adnexal tenderness. Urine hCG is negative. What is
the MOST appropriate next step?
A. Remove IUD and discharge with oral doxycycline
B. Obtain transvaginal ultrasound
C. Start outpatient oral antibiotics for pelvic inflammatory disease (PID)
D. Admit for IV antibiotics and remove IUD after 48 hours
Correct Answer: B. Obtain transvaginal ultrasound
Rationale: In a patient with suspected PID who has an IUD, imaging (transvaginal
ultrasound) is essential to rule out tubo-ovarian abscess (TOA) before initiating
treatment. If TOA is present, hospitalization and IV antibiotics are required, and
IUD removal may be delayed. Outpatient treatment is not appropriate for this
severity (fever, severe pain). The correct sequence: imaging → then treatment
based on findings.
Question 5
A 52-year-old postmenopausal woman presents with a single episode of painless
vaginal spotting. She is not on hormone therapy. Transvaginal ultrasound shows
an endometrial stripe of 8 mm. What is the MOST appropriate next step?
A. Repeat ultrasound in 6 months
B. Endometrial biopsy
C. Saline infusion sonography (SIS)
D. Observation with symptom diary
Correct Answer: B. Endometrial biopsy
Rationale: Any postmenopausal bleeding requires evaluation. The normal
endometrial stripe is typically <4-5 mm in postmenopausal women not on
hormone therapy (≤4 mm is considered normal by ACOG). A stripe of 8 mm is
abnormal and warrants tissue sampling (office endometrial biopsy) to rule out
3|Page
, endometrial hyperplasia or cancer. SIS is useful for focal lesions but not first-line
for abnormal stripe. Observation is inappropriate.
Question 6
A 22-year-old G0 presents with a 2-week history of a thin, gray-white, fishy-
smelling vaginal discharge. She denies itching or dysuria. Wet mount shows clue
cells and a positive whiff test (fishy odor with KOH). What is the MOST likely
diagnosis?
A. Bacterial vaginosis (BV)
B. Trichomoniasis
C. Candidiasis
D. Atrophic vaginitis
Correct Answer: A. Bacterial vaginosis (BV)
Rationale: BV is the most common cause of vaginal discharge in reproductive-
aged women. Diagnostic criteria (Amsel criteria) require 3 of 4: thin, homogenous
gray-white discharge; pH >4.5; positive whiff test (fishy odor with 10% KOH); clue
cells on wet mount (>20% of epithelial cells). BV is not an STI but is associated
with sexual activity. Trichomoniasis causes frothy, yellow-green discharge.
Candidiasis causes thick, white, "cottage cheese" discharge with pruritus. Atrophic
vaginitis occurs in postmenopausal women.
Question 7
A 35-year-old G2P2 presents with a 1-year history of cyclic pelvic pain beginning 3
days before menses and resolving 2 days after menses. She also reports deep
dyspareunia and pain with bowel movements during her period. Pelvic exam
reveals tenderness upon palpation of the uterosacral ligaments. What is the
MOST appropriate next step to confirm the diagnosis?
A. Transvaginal ultrasound
B. MRI pelvis
C. Diagnostic laparoscopy
D. CA-125 blood test
Correct Answer: C. Diagnostic laparoscopy
4|Page
