Barkley WHNP Diagnostic Readiness Test (DRT) #1 100
Practice Questions & Detailed Rationales for Women’s
Health Nurse Practitioner Certification 2026-2027
SECTION 1: WELL-WOMAN GYNECOLOGY & PREVENTIVE CARE
(Questions 1-25)
1. A 22-year-old woman presents for her first Pap test. According to current
ASCCP guidelines, cervical cancer screening with cytology alone should begin at
age:
A. 18
B. 21
C. 25
D. 30
Answer: B
Rationale: Current ASCCP and USPSTF guidelines recommend initiating cervical cancer
screening at age 21, regardless of sexual history.
2. A 30-year-old woman has a Pap test with HPV co-testing. The result is negative
for intraepithelial lesion or malignancy (NILM) and HPV negative. The
recommended follow-up is:
A. Repeat co-testing in 1 year
B. Repeat co-testing in 3 years
C. Repeat co-testing in 5 years
D. Colposcopy
Answer: C
Rationale: For women aged 30-65 with a negative co-test (NILM and HPV negative),
routine screening is recommended no sooner than every 5 years.
,3. Which of the following is a known risk factor for cervical cancer?
A. Multiparity
B. Persistent infection with high-risk HPV types 16 and 18
C. Early menopause
D. Endometriosis
Answer: B
Rationale: Persistent infection with oncogenic (high-risk) HPV types, especially 16 and
18, is the primary cause of cervical cancer.
4. The quadrivalent HPV vaccine (Gardasil) protects against which HPV types?
A. 6, 11, 16, 18
B. 16, 18, 31, 33
C. 31, 33, 45, 52
D. 6, 11, 16, 18, 31, 33, 45, 52, 58
Answer: A
Rationale: The quadrivalent vaccine covers HPV 6 and 11 (low-risk, cause 90% of genital
warts) and HPV 16 and 18 (high-risk, cause 70% of cervical cancers).
5. A 45-year-old woman reports irregular, heavy menses and hot flashes. Her FSH
level is elevated. Which phase of reproductive aging is she most likely
experiencing?
A. Premenopause
B. Perimenopause (menopause transition)
C. Postmenopause
D. Primary ovarian insufficiency
Answer: B
,Rationale: The menopause transition (perimenopause) is characterized by menstrual
cycle irregularity, vasomotor symptoms, and elevated FSH levels.
6. The most common cause of secondary amenorrhea in a reproductive-age
woman after pregnancy has been ruled out is:
A. Asherman's syndrome
B. Polycystic ovary syndrome (PCOS)
C. Hypothalamic amenorrhea
D. Premature ovarian failure
Answer: B
Rationale: PCOS is the most common endocrine cause of secondary amenorrhea.
7. A 27-year-old woman with PCOS is seeking contraception. Which method also
addresses her underlying hyperandrogenism and menstrual irregularity?
A. Copper IUD
B. Combined oral contraceptives (COCs)
C. Progestin-only pill
D. Condoms
Answer: B
Rationale: COCs suppress ovarian androgen production and increase SHBG, reducing
free testosterone. They also regulate menstrual cycles.
8. A 52-year-old woman complains of vulvovaginal dryness, dyspareunia, and
urinary urgency. She is not interested in systemic hormone therapy. What is the
most appropriate first-line treatment for her genitourinary syndrome of
menopause?
A. Oral ospemifene
B. Vaginal estrogen therapy
, C. Systemic estrogen therapy
D. Vaginal moisturizers
Answer: B
Rationale: Vaginal estrogen therapy is the most effective treatment for GSM and is
appropriate when systemic therapy is not desired, as it has minimal systemic absorption.
9. A 24-year-old female requests routine screening. What is the standard protocol
for cervical cancer screening?
A. Cytology alone every 3 years
B. Primary HPV testing every 5 years
C. Cytology with HPV co-testing every 3 years
D. Cytology with HPV co-testing every 5 years
Answer: A
Rationale: ASCCP guidelines mandate cytology alone for ages 21-29. Primary HPV or
co-testing is avoided due to high transient viral clearance rates in this age group.
10. A 35-year-old female presents for a routine checkup. What is the preferred
screening strategy?
A. Cytology alone every 3 years
B. Co-testing every 5 years
C. Co-testing every 10 years
D. Primary HPV testing every 3 years
Answer: B
Rationale: For ages 30-65, screening with primary HPV or co-testing every 5 years
provides optimal reassurance and sensitivity.
11. A 22-year-old female's Pap result shows ASC-US. What is the next step?
Practice Questions & Detailed Rationales for Women’s
Health Nurse Practitioner Certification 2026-2027
SECTION 1: WELL-WOMAN GYNECOLOGY & PREVENTIVE CARE
(Questions 1-25)
1. A 22-year-old woman presents for her first Pap test. According to current
ASCCP guidelines, cervical cancer screening with cytology alone should begin at
age:
A. 18
B. 21
C. 25
D. 30
Answer: B
Rationale: Current ASCCP and USPSTF guidelines recommend initiating cervical cancer
screening at age 21, regardless of sexual history.
2. A 30-year-old woman has a Pap test with HPV co-testing. The result is negative
for intraepithelial lesion or malignancy (NILM) and HPV negative. The
recommended follow-up is:
A. Repeat co-testing in 1 year
B. Repeat co-testing in 3 years
C. Repeat co-testing in 5 years
D. Colposcopy
Answer: C
Rationale: For women aged 30-65 with a negative co-test (NILM and HPV negative),
routine screening is recommended no sooner than every 5 years.
,3. Which of the following is a known risk factor for cervical cancer?
A. Multiparity
B. Persistent infection with high-risk HPV types 16 and 18
C. Early menopause
D. Endometriosis
Answer: B
Rationale: Persistent infection with oncogenic (high-risk) HPV types, especially 16 and
18, is the primary cause of cervical cancer.
4. The quadrivalent HPV vaccine (Gardasil) protects against which HPV types?
A. 6, 11, 16, 18
B. 16, 18, 31, 33
C. 31, 33, 45, 52
D. 6, 11, 16, 18, 31, 33, 45, 52, 58
Answer: A
Rationale: The quadrivalent vaccine covers HPV 6 and 11 (low-risk, cause 90% of genital
warts) and HPV 16 and 18 (high-risk, cause 70% of cervical cancers).
5. A 45-year-old woman reports irregular, heavy menses and hot flashes. Her FSH
level is elevated. Which phase of reproductive aging is she most likely
experiencing?
A. Premenopause
B. Perimenopause (menopause transition)
C. Postmenopause
D. Primary ovarian insufficiency
Answer: B
,Rationale: The menopause transition (perimenopause) is characterized by menstrual
cycle irregularity, vasomotor symptoms, and elevated FSH levels.
6. The most common cause of secondary amenorrhea in a reproductive-age
woman after pregnancy has been ruled out is:
A. Asherman's syndrome
B. Polycystic ovary syndrome (PCOS)
C. Hypothalamic amenorrhea
D. Premature ovarian failure
Answer: B
Rationale: PCOS is the most common endocrine cause of secondary amenorrhea.
7. A 27-year-old woman with PCOS is seeking contraception. Which method also
addresses her underlying hyperandrogenism and menstrual irregularity?
A. Copper IUD
B. Combined oral contraceptives (COCs)
C. Progestin-only pill
D. Condoms
Answer: B
Rationale: COCs suppress ovarian androgen production and increase SHBG, reducing
free testosterone. They also regulate menstrual cycles.
8. A 52-year-old woman complains of vulvovaginal dryness, dyspareunia, and
urinary urgency. She is not interested in systemic hormone therapy. What is the
most appropriate first-line treatment for her genitourinary syndrome of
menopause?
A. Oral ospemifene
B. Vaginal estrogen therapy
, C. Systemic estrogen therapy
D. Vaginal moisturizers
Answer: B
Rationale: Vaginal estrogen therapy is the most effective treatment for GSM and is
appropriate when systemic therapy is not desired, as it has minimal systemic absorption.
9. A 24-year-old female requests routine screening. What is the standard protocol
for cervical cancer screening?
A. Cytology alone every 3 years
B. Primary HPV testing every 5 years
C. Cytology with HPV co-testing every 3 years
D. Cytology with HPV co-testing every 5 years
Answer: A
Rationale: ASCCP guidelines mandate cytology alone for ages 21-29. Primary HPV or
co-testing is avoided due to high transient viral clearance rates in this age group.
10. A 35-year-old female presents for a routine checkup. What is the preferred
screening strategy?
A. Cytology alone every 3 years
B. Co-testing every 5 years
C. Co-testing every 10 years
D. Primary HPV testing every 3 years
Answer: B
Rationale: For ages 30-65, screening with primary HPV or co-testing every 5 years
provides optimal reassurance and sensitivity.
11. A 22-year-old female's Pap result shows ASC-US. What is the next step?
