1
NRNP 6552 FINAL EXAM VERSION A 2026/2027 |
Comprehensive Women's Health Final
Assessment | Walden University | 100 Verified
Q&A | A Grade | Pass Guaranteed
Section 1: Reproductive Tract Disorders & Gynecologic Cancers
(Questions 1–22)
Q1. A 32-year-old woman presents with heavy menstrual bleeding (HMB) lasting 10
days. Pelvic ultrasound shows a 2 cm submucosal fibroid. Using the PALM-COEIN
classification system, which category does this represent?
A. C - Coagulopathy
B. A - Adenomyosis
C. L - Leiomyoma
D. E - Endometrial
Correct Answer: C. L - Leiomyoma [CORRECT]
Rationale: The PALM-COEIN system classifies AUB: PALM = structural (Polyp,
Adenomyosis, Leiomyoma, Malignancy/hyperplasia); COEIN = non-structural
(Coagulopathy, Ovulatory, Endometrial, Iatrogenic, Not yet classified). A submucosal
fibroid is a leiomyoma. ACOG PB 220; PALM-COEIN Classification.
Q2. A 45-year-old woman presents with intermenstrual bleeding. Transvaginal
ultrasound shows a 1.5 cm endometrial polyp. Which management is most
appropriate?
A. Observation only
B. Hysteroscopic polypectomy
C. Endometrial ablation
D. Total hysterectomy
Correct Answer: B. Hysteroscopic polypectomy [CORRECT]
,2
Rationale: Endometrial polyps causing symptoms (intermenstrual bleeding,
infertility) should be removed hysteroscopically with histopathologic evaluation to
rule out hyperplasia or malignancy. Observation is reserved for asymptomatic small
polyps in low-risk patients. ACOG PB 128; ASCCP Guidelines.
Q3. A 28-year-old woman with AUB has a BMI of 42 and PCOS. Endometrial biopsy
shows complex hyperplasia without atypia. Which treatment is first-line?
A. Total hysterectomy
B. Progestin therapy (oral or LNG-IUD) with weight loss
C. Tamoxifen
D. Observation with repeat biopsy in 6 months
Correct Answer: B. Progestin therapy (oral or LNG-IUD) with weight loss
[CORRECT]
Rationale: Complex hyperplasia without atypia has a 3% risk of progression to
cancer and is treated with progestin therapy (oral medroxyprogesterone or LNG-IUD)
plus weight loss. Hysterectomy is reserved for atypical hyperplasia or failed medical
management. Tamoxifen increases endometrial cancer risk. ACOG PB 149; SGO
Guidelines.
Q4. A 50-year-old postmenopausal woman presents with painless vaginal bleeding.
Endometrial biopsy shows grade 1 endometrioid adenocarcinoma. Which risk factor
is most strongly associated with her diagnosis?
A. Multiparity
B. Obesity and unopposed estrogen
C. Oral contraceptive use
D. Smoking
Correct Answer: B. Obesity and unopposed estrogen [CORRECT]
,3
Rationale: Endometrial cancer risk factors include obesity (peripheral aromatization
of androgens to estrone), unopposed estrogen (anovulation, estrogen-only HRT),
tamoxifen use, Lynch syndrome, and nulliparity. Multiparity and OCPs are protective.
Smoking is protective for endometrial but not cervical cancer. ACOG PB 149; NCCN
Endometrial Cancer Guidelines.
Q5. A 35-year-old woman presents with a 6 cm simple ovarian cyst on ultrasound.
CA-125 is 15 U/mL. Which management is most appropriate?
A. Immediate laparotomy
B. Repeat ultrasound in 6-12 weeks
C. PET-CT scan
D. Chemotherapy
Correct Answer: B. Repeat ultrasound in 6-12 weeks [CORRECT]
Rationale: Simple ovarian cysts <8-10 cm in premenopausal women with normal
CA-125 are typically functional and resolve spontaneously. Follow-up ultrasound in
6-12 weeks is appropriate. Complex cysts, solid components, or elevated CA-125
warrant further evaluation. ACOG PB 174; O-RADS Ultrasound Guidelines.
Q6. A 55-year-old postmenopausal woman has a 4 cm complex ovarian cyst with
papillary projections and CA-125 of 85 U/mL. What is her Risk of Malignancy Index
(RMI) if ultrasound score is 3 and menopausal status score is 3?
A. 85
B. 255
C. 765
D. 1020
Correct Answer: C. 765 [CORRECT]
, 4
Rationale: RMI = U × M × CA-125 = 3 × 3 × 85 = 765. RMI >200 indicates high risk
for malignancy and warrants referral to a gynecologic oncologist. RMI 25-200 is
intermediate risk; <25 is low risk. ACOG PB 174; IOTA Criteria.
Q7. A 25-year-old woman presents with cyclic pelvic pain and dyspareunia. Pelvic
exam shows a tender, retroverted uterus with nodularity in the uterosacral ligaments.
Which diagnosis is most likely?
A. Pelvic inflammatory disease
B. Endometriosis
C. Adenomyosis
D. Ovarian torsion
Correct Answer: B. Endometriosis [CORRECT]
Rationale: Endometriosis presents with cyclic pelvic pain, dyspareunia,
dysmenorrhea, and infertility. Physical exam may reveal a fixed retroverted uterus,
uterosacral ligament nodularity, and tender adnexal masses (endometriomas). PID is
infectious with fever and discharge. ACOG PB 114; ESHRE Endometriosis Guidelines.
Q8. A 30-year-old woman with suspected endometriosis desires fertility preservation.
Which first-line medical treatment is most appropriate for her symptom
management?
A. Combined oral contraceptives or progestins
B. GnRH agonist with add-back therapy
C. Danazol
D. Aromatase inhibitor
Correct Answer: A. Combined oral contraceptives or progestins [CORRECT]
Rationale: COCs and progestins (oral, depot, LNG-IUD) are first-line for
endometriosis pain in women desiring fertility preservation. GnRH agonists with add-
NRNP 6552 FINAL EXAM VERSION A 2026/2027 |
Comprehensive Women's Health Final
Assessment | Walden University | 100 Verified
Q&A | A Grade | Pass Guaranteed
Section 1: Reproductive Tract Disorders & Gynecologic Cancers
(Questions 1–22)
Q1. A 32-year-old woman presents with heavy menstrual bleeding (HMB) lasting 10
days. Pelvic ultrasound shows a 2 cm submucosal fibroid. Using the PALM-COEIN
classification system, which category does this represent?
A. C - Coagulopathy
B. A - Adenomyosis
C. L - Leiomyoma
D. E - Endometrial
Correct Answer: C. L - Leiomyoma [CORRECT]
Rationale: The PALM-COEIN system classifies AUB: PALM = structural (Polyp,
Adenomyosis, Leiomyoma, Malignancy/hyperplasia); COEIN = non-structural
(Coagulopathy, Ovulatory, Endometrial, Iatrogenic, Not yet classified). A submucosal
fibroid is a leiomyoma. ACOG PB 220; PALM-COEIN Classification.
Q2. A 45-year-old woman presents with intermenstrual bleeding. Transvaginal
ultrasound shows a 1.5 cm endometrial polyp. Which management is most
appropriate?
A. Observation only
B. Hysteroscopic polypectomy
C. Endometrial ablation
D. Total hysterectomy
Correct Answer: B. Hysteroscopic polypectomy [CORRECT]
,2
Rationale: Endometrial polyps causing symptoms (intermenstrual bleeding,
infertility) should be removed hysteroscopically with histopathologic evaluation to
rule out hyperplasia or malignancy. Observation is reserved for asymptomatic small
polyps in low-risk patients. ACOG PB 128; ASCCP Guidelines.
Q3. A 28-year-old woman with AUB has a BMI of 42 and PCOS. Endometrial biopsy
shows complex hyperplasia without atypia. Which treatment is first-line?
A. Total hysterectomy
B. Progestin therapy (oral or LNG-IUD) with weight loss
C. Tamoxifen
D. Observation with repeat biopsy in 6 months
Correct Answer: B. Progestin therapy (oral or LNG-IUD) with weight loss
[CORRECT]
Rationale: Complex hyperplasia without atypia has a 3% risk of progression to
cancer and is treated with progestin therapy (oral medroxyprogesterone or LNG-IUD)
plus weight loss. Hysterectomy is reserved for atypical hyperplasia or failed medical
management. Tamoxifen increases endometrial cancer risk. ACOG PB 149; SGO
Guidelines.
Q4. A 50-year-old postmenopausal woman presents with painless vaginal bleeding.
Endometrial biopsy shows grade 1 endometrioid adenocarcinoma. Which risk factor
is most strongly associated with her diagnosis?
A. Multiparity
B. Obesity and unopposed estrogen
C. Oral contraceptive use
D. Smoking
Correct Answer: B. Obesity and unopposed estrogen [CORRECT]
,3
Rationale: Endometrial cancer risk factors include obesity (peripheral aromatization
of androgens to estrone), unopposed estrogen (anovulation, estrogen-only HRT),
tamoxifen use, Lynch syndrome, and nulliparity. Multiparity and OCPs are protective.
Smoking is protective for endometrial but not cervical cancer. ACOG PB 149; NCCN
Endometrial Cancer Guidelines.
Q5. A 35-year-old woman presents with a 6 cm simple ovarian cyst on ultrasound.
CA-125 is 15 U/mL. Which management is most appropriate?
A. Immediate laparotomy
B. Repeat ultrasound in 6-12 weeks
C. PET-CT scan
D. Chemotherapy
Correct Answer: B. Repeat ultrasound in 6-12 weeks [CORRECT]
Rationale: Simple ovarian cysts <8-10 cm in premenopausal women with normal
CA-125 are typically functional and resolve spontaneously. Follow-up ultrasound in
6-12 weeks is appropriate. Complex cysts, solid components, or elevated CA-125
warrant further evaluation. ACOG PB 174; O-RADS Ultrasound Guidelines.
Q6. A 55-year-old postmenopausal woman has a 4 cm complex ovarian cyst with
papillary projections and CA-125 of 85 U/mL. What is her Risk of Malignancy Index
(RMI) if ultrasound score is 3 and menopausal status score is 3?
A. 85
B. 255
C. 765
D. 1020
Correct Answer: C. 765 [CORRECT]
, 4
Rationale: RMI = U × M × CA-125 = 3 × 3 × 85 = 765. RMI >200 indicates high risk
for malignancy and warrants referral to a gynecologic oncologist. RMI 25-200 is
intermediate risk; <25 is low risk. ACOG PB 174; IOTA Criteria.
Q7. A 25-year-old woman presents with cyclic pelvic pain and dyspareunia. Pelvic
exam shows a tender, retroverted uterus with nodularity in the uterosacral ligaments.
Which diagnosis is most likely?
A. Pelvic inflammatory disease
B. Endometriosis
C. Adenomyosis
D. Ovarian torsion
Correct Answer: B. Endometriosis [CORRECT]
Rationale: Endometriosis presents with cyclic pelvic pain, dyspareunia,
dysmenorrhea, and infertility. Physical exam may reveal a fixed retroverted uterus,
uterosacral ligament nodularity, and tender adnexal masses (endometriomas). PID is
infectious with fever and discharge. ACOG PB 114; ESHRE Endometriosis Guidelines.
Q8. A 30-year-old woman with suspected endometriosis desires fertility preservation.
Which first-line medical treatment is most appropriate for her symptom
management?
A. Combined oral contraceptives or progestins
B. GnRH agonist with add-back therapy
C. Danazol
D. Aromatase inhibitor
Correct Answer: A. Combined oral contraceptives or progestins [CORRECT]
Rationale: COCs and progestins (oral, depot, LNG-IUD) are first-line for
endometriosis pain in women desiring fertility preservation. GnRH agonists with add-
