BARKLEY WHNP DIAGNOSTIC
READINESS TEST (DRT) #1
QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF
Core Domains
• Reproductive Health and Gynecology
• Obstetric and Antepartum Care
• Intrapartum and Postpartum Care
• Breast Health and Disorders
• Menstrual Disorders and Hormonal Imbalances
• Contraception and Family Planning
• Menopause and Perimenopausal Management
• Sexually Transmitted Infections and Infectious Diseases
• Well-Woman Care and Preventive Health
• Pharmacology and Medication Management in Women's Health
Introduction
This comprehensive Diagnostic Readiness Test (DRT) is designed to assess
the advanced clinical knowledge, diagnostic reasoning, and evidence-
,based practice skills required for the Women's Health Nurse Practitioner
(WHNP) certification examination. Developed in the style of Barkley &
Associates, this rigorous examination assesses advanced clinical
reasoning, diagnostic acumen, and evidence-based management across
the breadth of women's health conditions encountered by the WHNP.
Through a combination of multiple-choice questions and clinical vignettes,
candidates are expected to demonstrate proficiency in managing
gynecologic and obstetric conditions, applying clinical guidelines, and
making sound clinical decisions in complex patient scenarios. Emphasis is
placed on integrating evidence-based practice, patient safety, cultural
competence, and interprofessional collaboration in the delivery of
women's healthcare across the lifespan.
SECTION ONE: QUESTIONS 1–100
Question 1
A 32-year-old woman presents with a 3-month history of irregular
menstrual cycles, facial hair growth, and acne. Her BMI is 32 kg/m².
Laboratory findings reveal a testosterone level of 70 ng/dL (normal <50)
and an LH-to-FSH ratio of 2.5:1. What is the most likely diagnosis?
A. Cushing's syndrome
B. Polycystic ovarian syndrome (PCOS)
C. Congenital adrenal hyperplasia
D. Ovarian hyperthecosis
B. Polycystic ovarian syndrome (PCOS)
RATIONALE: PCOS is a common endocrine disorder characterized
by chronic anovulation, hyperandrogenism, and polycystic ovaries.
Clinical features include irregular menses, hirsutism, acne, and obesity.
Laboratory findings include elevated testosterone, elevated LH-to-FSH
ratio (>2:1), and normal 17-hydroxyprogesterone (which distinguishes
,PCOS from congenital adrenal hyperplasia). Cushing's syndrome
presents with moon facies, buffalo hump, and abdominal striae. Ovarian
hyperthecosis presents with severe hyperandrogenism and is less
common.
Question 2
A 28-year-old G1P0 woman at 36 weeks gestation presents with sudden
onset of painless vaginal bleeding. She has a history of two previous
cesarean sections. Her vital signs are BP 110/70, HR 98, and fetal heart
rate is 140 with moderate variability. What is the most appropriate next
step?
A. Perform a digital cervical examination
B. Perform a sterile speculum examination
C. Obtain a transvaginal ultrasound
D. Prepare for immediate cesarean delivery
B. Perform a sterile speculum examination
RATIONALE: In a patient with third-trimester bleeding and a history
of previous cesarean sections, placenta previa or accreta must be
considered. A digital cervical examination is contraindicated until
placenta previa is excluded because it can provoke hemorrhage. A
sterile speculum examination is appropriate to visualize the cervix and
determine if bleeding is from a cervical source. Transvaginal ultrasound
is used to confirm placenta previa but should be performed after
speculum examination. Immediate cesarean delivery is indicated only if
the patient is hemodynamically unstable or there is fetal distress.
Question 3
A 45-year-old woman presents with a 6-month history of heavy
menstrual bleeding with clots, pelvic pressure, and urinary frequency.
Pelvic examination reveals an enlarged, irregularly shaped uterus
, consistent with a 14-week size. Transvaginal ultrasound shows multiple
intramural and subserosal fibroids. What is the most appropriate initial
management?
A. Hysterectomy
B. Myomectomy
C. Hormonal therapy with a levonorgestrel-releasing intrauterine device
(LNG-IUD)
D. Observation with annual follow-up
C. Hormonal therapy with a levonorgestrel-releasing intrauterine
device (LNG-IUD)
RATIONALE: Symptomatic uterine fibroids causing heavy menstrual
bleeding can be managed with hormonal therapy. The LNG-IUD reduces
menstrual blood loss by 70–90% and is a first-line treatment for women
who desire to retain their uterus. Hysterectomy is definitive but invasive
and should be reserved for women who have completed childbearing or
have failed medical management. Myomectomy is appropriate for
women who desire future fertility. Observation is only appropriate for
asymptomatic fibroids.
Question 4
A 34-year-old woman with a history of endometriosis presents with
worsening dysmenorrhea, dyspareunia, and chronic pelvic pain. She
has failed conservative management with NSAIDs and oral
contraceptives. What is the most appropriate next step in management?
A. Hysterectomy
B. GnRH agonist therapy
C. Laparoscopic excision of endometriosis
D. Progestin-only therapy
B. GnRH agonist therapy
READINESS TEST (DRT) #1
QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF
Core Domains
• Reproductive Health and Gynecology
• Obstetric and Antepartum Care
• Intrapartum and Postpartum Care
• Breast Health and Disorders
• Menstrual Disorders and Hormonal Imbalances
• Contraception and Family Planning
• Menopause and Perimenopausal Management
• Sexually Transmitted Infections and Infectious Diseases
• Well-Woman Care and Preventive Health
• Pharmacology and Medication Management in Women's Health
Introduction
This comprehensive Diagnostic Readiness Test (DRT) is designed to assess
the advanced clinical knowledge, diagnostic reasoning, and evidence-
,based practice skills required for the Women's Health Nurse Practitioner
(WHNP) certification examination. Developed in the style of Barkley &
Associates, this rigorous examination assesses advanced clinical
reasoning, diagnostic acumen, and evidence-based management across
the breadth of women's health conditions encountered by the WHNP.
Through a combination of multiple-choice questions and clinical vignettes,
candidates are expected to demonstrate proficiency in managing
gynecologic and obstetric conditions, applying clinical guidelines, and
making sound clinical decisions in complex patient scenarios. Emphasis is
placed on integrating evidence-based practice, patient safety, cultural
competence, and interprofessional collaboration in the delivery of
women's healthcare across the lifespan.
SECTION ONE: QUESTIONS 1–100
Question 1
A 32-year-old woman presents with a 3-month history of irregular
menstrual cycles, facial hair growth, and acne. Her BMI is 32 kg/m².
Laboratory findings reveal a testosterone level of 70 ng/dL (normal <50)
and an LH-to-FSH ratio of 2.5:1. What is the most likely diagnosis?
A. Cushing's syndrome
B. Polycystic ovarian syndrome (PCOS)
C. Congenital adrenal hyperplasia
D. Ovarian hyperthecosis
B. Polycystic ovarian syndrome (PCOS)
RATIONALE: PCOS is a common endocrine disorder characterized
by chronic anovulation, hyperandrogenism, and polycystic ovaries.
Clinical features include irregular menses, hirsutism, acne, and obesity.
Laboratory findings include elevated testosterone, elevated LH-to-FSH
ratio (>2:1), and normal 17-hydroxyprogesterone (which distinguishes
,PCOS from congenital adrenal hyperplasia). Cushing's syndrome
presents with moon facies, buffalo hump, and abdominal striae. Ovarian
hyperthecosis presents with severe hyperandrogenism and is less
common.
Question 2
A 28-year-old G1P0 woman at 36 weeks gestation presents with sudden
onset of painless vaginal bleeding. She has a history of two previous
cesarean sections. Her vital signs are BP 110/70, HR 98, and fetal heart
rate is 140 with moderate variability. What is the most appropriate next
step?
A. Perform a digital cervical examination
B. Perform a sterile speculum examination
C. Obtain a transvaginal ultrasound
D. Prepare for immediate cesarean delivery
B. Perform a sterile speculum examination
RATIONALE: In a patient with third-trimester bleeding and a history
of previous cesarean sections, placenta previa or accreta must be
considered. A digital cervical examination is contraindicated until
placenta previa is excluded because it can provoke hemorrhage. A
sterile speculum examination is appropriate to visualize the cervix and
determine if bleeding is from a cervical source. Transvaginal ultrasound
is used to confirm placenta previa but should be performed after
speculum examination. Immediate cesarean delivery is indicated only if
the patient is hemodynamically unstable or there is fetal distress.
Question 3
A 45-year-old woman presents with a 6-month history of heavy
menstrual bleeding with clots, pelvic pressure, and urinary frequency.
Pelvic examination reveals an enlarged, irregularly shaped uterus
, consistent with a 14-week size. Transvaginal ultrasound shows multiple
intramural and subserosal fibroids. What is the most appropriate initial
management?
A. Hysterectomy
B. Myomectomy
C. Hormonal therapy with a levonorgestrel-releasing intrauterine device
(LNG-IUD)
D. Observation with annual follow-up
C. Hormonal therapy with a levonorgestrel-releasing intrauterine
device (LNG-IUD)
RATIONALE: Symptomatic uterine fibroids causing heavy menstrual
bleeding can be managed with hormonal therapy. The LNG-IUD reduces
menstrual blood loss by 70–90% and is a first-line treatment for women
who desire to retain their uterus. Hysterectomy is definitive but invasive
and should be reserved for women who have completed childbearing or
have failed medical management. Myomectomy is appropriate for
women who desire future fertility. Observation is only appropriate for
asymptomatic fibroids.
Question 4
A 34-year-old woman with a history of endometriosis presents with
worsening dysmenorrhea, dyspareunia, and chronic pelvic pain. She
has failed conservative management with NSAIDs and oral
contraceptives. What is the most appropriate next step in management?
A. Hysterectomy
B. GnRH agonist therapy
C. Laparoscopic excision of endometriosis
D. Progestin-only therapy
B. GnRH agonist therapy
