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KELSEY'SMIDWIFERY & WOMEN'S HEALTH NURSE
PRACTITIONER CERTIFICATION REVIEW EXAM QUESTIONS
WITH VERIFIED QUESTIONS DETAILED RATIONALES
GRADED A+
KELSEY'S-STYLE PRACTICE EXAM
Midwifery & Women's Health Nurse Practitioner Certification Review
250 Original Practice Questions with Answers and Rationales
Questions 1–25
1. A 28-year-old woman presents with a 3-day history of vulvar itching and thick, white, curdy
discharge. She recently completed a course of amoxicillin for strep throat. Wet mount reveals
budding hyphae. What is the most appropriate treatment?
• A) Metronidazole 500 mg BID × 7 days
• B) Fluconazole 150 mg PO × 1 dose
• C) Doxycycline 100 mg BID × 7 days
• D) Penicillin G benzathine 2.4 million units IM
Answer: B) Fluconazole 150 mg PO × 1 dose
Rationale: The presentation is classic for vulvovaginal candidiasis, especially following antibiotic
use. Budding hyphae on wet mount confirm Candida. First-line treatment is a single oral dose of
fluconazole or topical azole therapy.
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2. A 32-year-old woman reports postcoital bleeding. Which of the following would NOT be
included in the initial assessment?
• A) Pap smear
• B) Endometrial biopsy
• C) Pelvic ultrasound
• D) CBC with differential
Answer: B) Endometrial biopsy
Rationale: Postcoital bleeding in a reproductive-age woman warrants evaluation for cervical
causes (Pap, cultures, colposcopy if indicated), infection, and structural lesions. Endometrial
biopsy is not part of the initial workup in a premenopausal woman without other risk factors.
3. A non-pregnant reproductive-age patient has a positive urine pregnancy test, serum hCG of
1,200 mIU/mL, and a transvaginal ultrasound showing no intrauterine pregnancy. What is the
most appropriate next step?
• A) Diagnose ectopic pregnancy and initiate methotrexate
• B) Repeat hCG in 48 hours and ultrasound in 1 week
• C) Perform dilation and curettage
• D) Obtain serum progesterone level
Answer: B) Repeat hCG in 48 hours and ultrasound in 1 week
Rationale: At hCG levels below the discriminatory zone (typically 3,500 mIU/mL), absence of an
intrauterine pregnancy is inconclusive. Serial hCG measurements and repeat ultrasound
differentiate viable intrauterine pregnancy, ectopic, or failed pregnancy. Immediate intervention
is premature.
4. A patient presents with a non-tender, indurated ulcer on the labia and unilateral inguinal
lymphadenopathy. Which diagnostic test is most appropriate?
• A) Dark-field microscopy of the ulcer exudate
• B) Viral culture of the ulcer base
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• C) RPR with confirmatory FTA-ABS
• D) NAAT for Chlamydia trachomatis
Answer: A) Dark-field microscopy of the ulcer exudate
Rationale: The presentation is classic for primary syphilis (chancre). Dark-field microscopy
directly visualizes Treponema pallidum and is definitive in early syphilis. Serologic tests may be
negative in primary syphilis.
5. Which of the following is considered a normal surface characteristic of the cervix during
speculum exam?
• A) Small, yellow, raised areas around the cervix
• B) Friable, bleeding tissue at the cervical os
• C) Red patches with occasional white spots
• D) Irregular, granular surface with red patches
Answer: A) Small, yellow, raised areas around the cervix
Rationale: Nabothian cysts (small, yellow, raised areas) are normal findings. Friable bleeding
tissue, red patches, and granular surfaces require further evaluation.
6. A 35-year-old woman reports 6 months of hypermenorrhea, backache, and pelvic pressure.
Exam reveals a 12-week-size uterus with irregular contour. What does this most likely
represent?
• A) Uterine cancer
• B) Dysfunctional uterine bleeding
• C) Uterine fibroid
• D) Fecal impaction
Answer: C) Uterine fibroid
Rationale: An enlarged, irregularly contoured uterus with heavy bleeding and pelvic pressure is
classic for leiomyomas (fibroids), the most common benign tumor of the female genital tract.
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7. A 24-year-old female is diagnosed with primary dysmenorrhea. Which medication is first-
line for symptom control?
• A) Antianxiety medications
• B) NSAIDs
• C) Combined oral contraceptives
• D) Opioid analgesics
Answer: B) NSAIDs
Rationale: NSAIDs are first-line for primary dysmenorrhea because they inhibit prostaglandin
synthesis, the primary mediator of dysmenorrheic pain. COCs are second-line.
8. An 18-year-old female presents with secondary amenorrhea. Exam shows normal
secondary sex characteristics and normal genitalia. Pregnancy is ruled out. Which finding
would necessitate further evaluation?
• A) Elevated cholesterol
• B) Androgen deficiency
• C) Galactorrhea
• D) Hirsutism
Answer: C) Galactorrhea
Rationale: Galactorrhea with secondary amenorrhea suggests hyperprolactinemia, which
requires evaluation (prolactin level, TSH, possible pituitary imaging). Hirsutism would suggest
PCOS; isolated cholesterol elevation is not a primary amenorrhea workup priority.
9. Which of the following statements about mammography is accurate?
• A) Mammography should not be performed if there is breast pain or nipple retraction
• B) All women ≥40 years should have annual mammography
• C) Mammography should be annual for all women of childbearing age
• D) Mammography should be performed annually after first pregnancy
Answer: B) All women ≥40 years should have annual mammography
KELSEY'SMIDWIFERY & WOMEN'S HEALTH NURSE
PRACTITIONER CERTIFICATION REVIEW EXAM QUESTIONS
WITH VERIFIED QUESTIONS DETAILED RATIONALES
GRADED A+
KELSEY'S-STYLE PRACTICE EXAM
Midwifery & Women's Health Nurse Practitioner Certification Review
250 Original Practice Questions with Answers and Rationales
Questions 1–25
1. A 28-year-old woman presents with a 3-day history of vulvar itching and thick, white, curdy
discharge. She recently completed a course of amoxicillin for strep throat. Wet mount reveals
budding hyphae. What is the most appropriate treatment?
• A) Metronidazole 500 mg BID × 7 days
• B) Fluconazole 150 mg PO × 1 dose
• C) Doxycycline 100 mg BID × 7 days
• D) Penicillin G benzathine 2.4 million units IM
Answer: B) Fluconazole 150 mg PO × 1 dose
Rationale: The presentation is classic for vulvovaginal candidiasis, especially following antibiotic
use. Budding hyphae on wet mount confirm Candida. First-line treatment is a single oral dose of
fluconazole or topical azole therapy.
,Page 2 of 82
2. A 32-year-old woman reports postcoital bleeding. Which of the following would NOT be
included in the initial assessment?
• A) Pap smear
• B) Endometrial biopsy
• C) Pelvic ultrasound
• D) CBC with differential
Answer: B) Endometrial biopsy
Rationale: Postcoital bleeding in a reproductive-age woman warrants evaluation for cervical
causes (Pap, cultures, colposcopy if indicated), infection, and structural lesions. Endometrial
biopsy is not part of the initial workup in a premenopausal woman without other risk factors.
3. A non-pregnant reproductive-age patient has a positive urine pregnancy test, serum hCG of
1,200 mIU/mL, and a transvaginal ultrasound showing no intrauterine pregnancy. What is the
most appropriate next step?
• A) Diagnose ectopic pregnancy and initiate methotrexate
• B) Repeat hCG in 48 hours and ultrasound in 1 week
• C) Perform dilation and curettage
• D) Obtain serum progesterone level
Answer: B) Repeat hCG in 48 hours and ultrasound in 1 week
Rationale: At hCG levels below the discriminatory zone (typically 3,500 mIU/mL), absence of an
intrauterine pregnancy is inconclusive. Serial hCG measurements and repeat ultrasound
differentiate viable intrauterine pregnancy, ectopic, or failed pregnancy. Immediate intervention
is premature.
4. A patient presents with a non-tender, indurated ulcer on the labia and unilateral inguinal
lymphadenopathy. Which diagnostic test is most appropriate?
• A) Dark-field microscopy of the ulcer exudate
• B) Viral culture of the ulcer base
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• C) RPR with confirmatory FTA-ABS
• D) NAAT for Chlamydia trachomatis
Answer: A) Dark-field microscopy of the ulcer exudate
Rationale: The presentation is classic for primary syphilis (chancre). Dark-field microscopy
directly visualizes Treponema pallidum and is definitive in early syphilis. Serologic tests may be
negative in primary syphilis.
5. Which of the following is considered a normal surface characteristic of the cervix during
speculum exam?
• A) Small, yellow, raised areas around the cervix
• B) Friable, bleeding tissue at the cervical os
• C) Red patches with occasional white spots
• D) Irregular, granular surface with red patches
Answer: A) Small, yellow, raised areas around the cervix
Rationale: Nabothian cysts (small, yellow, raised areas) are normal findings. Friable bleeding
tissue, red patches, and granular surfaces require further evaluation.
6. A 35-year-old woman reports 6 months of hypermenorrhea, backache, and pelvic pressure.
Exam reveals a 12-week-size uterus with irregular contour. What does this most likely
represent?
• A) Uterine cancer
• B) Dysfunctional uterine bleeding
• C) Uterine fibroid
• D) Fecal impaction
Answer: C) Uterine fibroid
Rationale: An enlarged, irregularly contoured uterus with heavy bleeding and pelvic pressure is
classic for leiomyomas (fibroids), the most common benign tumor of the female genital tract.
, Page 4 of 82
7. A 24-year-old female is diagnosed with primary dysmenorrhea. Which medication is first-
line for symptom control?
• A) Antianxiety medications
• B) NSAIDs
• C) Combined oral contraceptives
• D) Opioid analgesics
Answer: B) NSAIDs
Rationale: NSAIDs are first-line for primary dysmenorrhea because they inhibit prostaglandin
synthesis, the primary mediator of dysmenorrheic pain. COCs are second-line.
8. An 18-year-old female presents with secondary amenorrhea. Exam shows normal
secondary sex characteristics and normal genitalia. Pregnancy is ruled out. Which finding
would necessitate further evaluation?
• A) Elevated cholesterol
• B) Androgen deficiency
• C) Galactorrhea
• D) Hirsutism
Answer: C) Galactorrhea
Rationale: Galactorrhea with secondary amenorrhea suggests hyperprolactinemia, which
requires evaluation (prolactin level, TSH, possible pituitary imaging). Hirsutism would suggest
PCOS; isolated cholesterol elevation is not a primary amenorrhea workup priority.
9. Which of the following statements about mammography is accurate?
• A) Mammography should not be performed if there is breast pain or nipple retraction
• B) All women ≥40 years should have annual mammography
• C) Mammography should be annual for all women of childbearing age
• D) Mammography should be performed annually after first pregnancy
Answer: B) All women ≥40 years should have annual mammography
