Women's Health Nurse Practitioner (WHNP) Certification
2026 Latest Study Guide Clinical Review | Verified Answers
| Complete Success Preparation Workbook
SECTION 1: GYNECOLOGIC AND REPRODUCTIVE HEALTH (33%)
This is the largest domain on the WHNP exam, covering reproductive anatomy and
physiology, gynecologic disorders, fertility awareness and contraception, sexual
health, STIs, and menopause.
Question 1
A 24-year-old nulliparous woman presents with a 6-month history of irregular
menstrual cycles, hirsutism, and acne. She reports weight gain of 15 pounds over
the past year despite no change in diet or exercise. Her BMI is 32 kg/m².
Laboratory studies show: LH 18 mIU/mL, FSH 6 mIU/mL, testosterone 75 ng/dL,
and a negative pregnancy test. What is the most likely diagnosis?
A. Cushing's syndrome
B. Polycystic ovary syndrome (PCOS)
C. Congenital adrenal hyperplasia
D. Androgen-secreting tumor
Correct Answer: B
Rationale: This patient meets the Rotterdam criteria for PCOS: (1) oligo-
ovulation or anovulation (irregular cycles), (2) clinical or biochemical
hyperandrogenism (hirsutism, acne, elevated testosterone), and (3) polycystic
ovaries on ultrasound (not required for diagnosis but often present). The LH:FSH
ratio > 2 (18:6 = 3:1) is classic for PCOS. Cushing's syndrome presents with moon
facies, buffalo hump, and purple striae. Congenital adrenal hyperplasia typically
presents with elevated 17-hydroxyprogesterone. Androgen-secreting tumors are
rare and cause rapid-onset, severe virilization.
Question 2
,A 28-year-old woman presents with a 2-month history of heavy menstrual bleeding
lasting 8-10 days each cycle. She reports passing clots and soaking through pads
every 1-2 hours. Her hemoglobin is 9.5 g/dL. She is not pregnant and has no
history of bleeding disorders. Pelvic examination is normal. What is the most
appropriate next step in management?
A. Endometrial biopsy
B. Tranexamic acid and iron supplementation
C. Hysterectomy
D. Oral contraceptive pills
Correct Answer: B
Rationale: This patient has heavy menstrual bleeding (HMB) with anemia (Hb
9.5). The first-line medical management for HMB without structural pathology
includes tranexamic acid (an antifibrinolytic that reduces menstrual blood loss by
30-50%) and iron supplementation to correct anemia. Oral contraceptive pills are
also effective but are not first-line in a patient desiring pregnancy or with
contraindications. Endometrial biopsy is indicated for women > 45 or with risk
factors for endometrial hyperplasia. Hysterectomy is reserved for refractory cases.
Question 3
A 32-year-old woman presents with acute pelvic pain, fever of 101.5°F, and
cervical motion tenderness on examination. She has a purulent vaginal discharge
and reports unprotected sexual intercourse with a new partner 2 weeks ago. What
is the most appropriate empiric treatment regimen?
A. Doxycycline 100 mg PO BID for 14 days
B. Ceftriaxone 250 mg IM single dose + Azithromycin 1 g PO single dose
C. Ceftriaxone 500 mg IM single dose + Doxycycline 100 mg PO BID for 14
days ± Metronidazole 500 mg PO BID for 14 days
D. Metronidazole 500 mg PO BID for 14 days
Correct Answer: C
Rationale: This patient has pelvic inflammatory disease (PID) . The CDC
recommends empiric treatment covering Neisseria gonorrhoeae, Chlamydia
trachomatis, and anaerobes. The regimen is: ceftriaxone 500 mg IM (for
gonorrhea) + doxycycline 100 mg PO BID for 14 days (for chlamydia)
,± metronidazole 500 mg PO BID for 14 days (for anaerobes, especially if severe
or with tubo-ovarian abscess). Doxycycline alone does not cover gonorrhea.
Ceftriaxone + azithromycin is appropriate for uncomplicated gonorrhea but not for
PID.
Question 4
A 45-year-old woman presents with a 3-month history of hot flashes, night sweats,
and vaginal dryness. She has not had a menstrual period for 14 months. She has no
contraindications to hormone therapy. What is the most appropriate management?
A. Low-dose systemic estrogen therapy (ET)
B. Low-dose systemic estrogen + progestin therapy (EPT)
C. Selective serotonin reuptake inhibitor (SSRI)
D. Vaginal moisturizers only
Correct Answer: A
Rationale: This patient is in menopause (12 months of amenorrhea) and
has vasomotor symptoms (hot flashes, night sweats) and vulvovaginal
symptoms (vaginal dryness). For a woman without a uterus, unopposed
systemic estrogen therapy (ET) is the most effective treatment for moderate-to-
severe vasomotor symptoms. Estrogen + progestin (EPT) is used in women with an
intact uterus to prevent endometrial hyperplasia. SSRIs are second-line for
vasomotor symptoms. Vaginal moisturizers may help vaginal dryness but do not
address vasomotor symptoms.
Question 5
A 27-year-old woman presents with a 3-month history of amenorrhea,
galactorrhea, and headaches. She is not pregnant and has no history of thyroid
disease. Her prolactin level is 75 ng/mL (normal < 25). What is the most likely
diagnosis?
A. Polycystic ovary syndrome
B. Prolactinoma
C. Hypothyroidism
D. Empty sella syndrome
, Correct Answer: B
Rationale: This patient has hyperprolactinemia with amenorrhea, galactorrhea,
and headaches — classic for prolactinoma, a benign pituitary adenoma. Prolactin
levels > 100-200 ng/mL are highly suggestive of prolactinoma. Hypothyroidism
can cause mild hyperprolactinemia but typically presents with other symptoms
(fatigue, weight gain, cold intolerance). PCOS does not cause galactorrhea. Empty
sella syndrome is an incidental finding that does not cause elevated prolactin.
Question 6
A 22-year-old woman is requesting contraception. She has a history of migraines
with aura and smokes 10 cigarettes per day. Which contraceptive method
is contraindicated for this patient?
A. Copper intrauterine device (IUD)
B. Progestin-only pill
C. Combined oral contraceptive pill (COCP)
D. Etonogestrel implant
Correct Answer: C
Rationale: Combined oral contraceptives (COCs) are contraindicated in
women with migraines with aura due to an increased risk of ischemic stroke.
Smoking further increases this risk. The copper IUD, progestin-only pill, and
etonogestrel implant are all safe options that do not contain estrogen. This patient
should be counseled on estrogen-free contraceptive options and smoking cessation.
Question 7
A 34-year-old woman presents with a 2-month history of worsening dysmenorrhea,
heavy menstrual bleeding, and chronic pelvic pain. She has a history of
endometriosis diagnosed 5 years ago. On examination, the uterus is enlarged and
irregularly shaped. Ultrasound reveals multiple intramural and subserosal fibroids.
What is the most appropriate next step in management?
A. Leuprolide acetate (GnRH agonist)
B. Hysterectomy
2026 Latest Study Guide Clinical Review | Verified Answers
| Complete Success Preparation Workbook
SECTION 1: GYNECOLOGIC AND REPRODUCTIVE HEALTH (33%)
This is the largest domain on the WHNP exam, covering reproductive anatomy and
physiology, gynecologic disorders, fertility awareness and contraception, sexual
health, STIs, and menopause.
Question 1
A 24-year-old nulliparous woman presents with a 6-month history of irregular
menstrual cycles, hirsutism, and acne. She reports weight gain of 15 pounds over
the past year despite no change in diet or exercise. Her BMI is 32 kg/m².
Laboratory studies show: LH 18 mIU/mL, FSH 6 mIU/mL, testosterone 75 ng/dL,
and a negative pregnancy test. What is the most likely diagnosis?
A. Cushing's syndrome
B. Polycystic ovary syndrome (PCOS)
C. Congenital adrenal hyperplasia
D. Androgen-secreting tumor
Correct Answer: B
Rationale: This patient meets the Rotterdam criteria for PCOS: (1) oligo-
ovulation or anovulation (irregular cycles), (2) clinical or biochemical
hyperandrogenism (hirsutism, acne, elevated testosterone), and (3) polycystic
ovaries on ultrasound (not required for diagnosis but often present). The LH:FSH
ratio > 2 (18:6 = 3:1) is classic for PCOS. Cushing's syndrome presents with moon
facies, buffalo hump, and purple striae. Congenital adrenal hyperplasia typically
presents with elevated 17-hydroxyprogesterone. Androgen-secreting tumors are
rare and cause rapid-onset, severe virilization.
Question 2
,A 28-year-old woman presents with a 2-month history of heavy menstrual bleeding
lasting 8-10 days each cycle. She reports passing clots and soaking through pads
every 1-2 hours. Her hemoglobin is 9.5 g/dL. She is not pregnant and has no
history of bleeding disorders. Pelvic examination is normal. What is the most
appropriate next step in management?
A. Endometrial biopsy
B. Tranexamic acid and iron supplementation
C. Hysterectomy
D. Oral contraceptive pills
Correct Answer: B
Rationale: This patient has heavy menstrual bleeding (HMB) with anemia (Hb
9.5). The first-line medical management for HMB without structural pathology
includes tranexamic acid (an antifibrinolytic that reduces menstrual blood loss by
30-50%) and iron supplementation to correct anemia. Oral contraceptive pills are
also effective but are not first-line in a patient desiring pregnancy or with
contraindications. Endometrial biopsy is indicated for women > 45 or with risk
factors for endometrial hyperplasia. Hysterectomy is reserved for refractory cases.
Question 3
A 32-year-old woman presents with acute pelvic pain, fever of 101.5°F, and
cervical motion tenderness on examination. She has a purulent vaginal discharge
and reports unprotected sexual intercourse with a new partner 2 weeks ago. What
is the most appropriate empiric treatment regimen?
A. Doxycycline 100 mg PO BID for 14 days
B. Ceftriaxone 250 mg IM single dose + Azithromycin 1 g PO single dose
C. Ceftriaxone 500 mg IM single dose + Doxycycline 100 mg PO BID for 14
days ± Metronidazole 500 mg PO BID for 14 days
D. Metronidazole 500 mg PO BID for 14 days
Correct Answer: C
Rationale: This patient has pelvic inflammatory disease (PID) . The CDC
recommends empiric treatment covering Neisseria gonorrhoeae, Chlamydia
trachomatis, and anaerobes. The regimen is: ceftriaxone 500 mg IM (for
gonorrhea) + doxycycline 100 mg PO BID for 14 days (for chlamydia)
,± metronidazole 500 mg PO BID for 14 days (for anaerobes, especially if severe
or with tubo-ovarian abscess). Doxycycline alone does not cover gonorrhea.
Ceftriaxone + azithromycin is appropriate for uncomplicated gonorrhea but not for
PID.
Question 4
A 45-year-old woman presents with a 3-month history of hot flashes, night sweats,
and vaginal dryness. She has not had a menstrual period for 14 months. She has no
contraindications to hormone therapy. What is the most appropriate management?
A. Low-dose systemic estrogen therapy (ET)
B. Low-dose systemic estrogen + progestin therapy (EPT)
C. Selective serotonin reuptake inhibitor (SSRI)
D. Vaginal moisturizers only
Correct Answer: A
Rationale: This patient is in menopause (12 months of amenorrhea) and
has vasomotor symptoms (hot flashes, night sweats) and vulvovaginal
symptoms (vaginal dryness). For a woman without a uterus, unopposed
systemic estrogen therapy (ET) is the most effective treatment for moderate-to-
severe vasomotor symptoms. Estrogen + progestin (EPT) is used in women with an
intact uterus to prevent endometrial hyperplasia. SSRIs are second-line for
vasomotor symptoms. Vaginal moisturizers may help vaginal dryness but do not
address vasomotor symptoms.
Question 5
A 27-year-old woman presents with a 3-month history of amenorrhea,
galactorrhea, and headaches. She is not pregnant and has no history of thyroid
disease. Her prolactin level is 75 ng/mL (normal < 25). What is the most likely
diagnosis?
A. Polycystic ovary syndrome
B. Prolactinoma
C. Hypothyroidism
D. Empty sella syndrome
, Correct Answer: B
Rationale: This patient has hyperprolactinemia with amenorrhea, galactorrhea,
and headaches — classic for prolactinoma, a benign pituitary adenoma. Prolactin
levels > 100-200 ng/mL are highly suggestive of prolactinoma. Hypothyroidism
can cause mild hyperprolactinemia but typically presents with other symptoms
(fatigue, weight gain, cold intolerance). PCOS does not cause galactorrhea. Empty
sella syndrome is an incidental finding that does not cause elevated prolactin.
Question 6
A 22-year-old woman is requesting contraception. She has a history of migraines
with aura and smokes 10 cigarettes per day. Which contraceptive method
is contraindicated for this patient?
A. Copper intrauterine device (IUD)
B. Progestin-only pill
C. Combined oral contraceptive pill (COCP)
D. Etonogestrel implant
Correct Answer: C
Rationale: Combined oral contraceptives (COCs) are contraindicated in
women with migraines with aura due to an increased risk of ischemic stroke.
Smoking further increases this risk. The copper IUD, progestin-only pill, and
etonogestrel implant are all safe options that do not contain estrogen. This patient
should be counseled on estrogen-free contraceptive options and smoking cessation.
Question 7
A 34-year-old woman presents with a 2-month history of worsening dysmenorrhea,
heavy menstrual bleeding, and chronic pelvic pain. She has a history of
endometriosis diagnosed 5 years ago. On examination, the uterus is enlarged and
irregularly shaped. Ultrasound reveals multiple intramural and subserosal fibroids.
What is the most appropriate next step in management?
A. Leuprolide acetate (GnRH agonist)
B. Hysterectomy
