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WHNP-BC® Practice Questions – Original Questions 1-175 with
Answers and Detailed Rationales
1. A 24-year-old woman presents for her first prenatal visit
at 8 weeks gestation. She has a history of epilepsy and takes
valproic acid. The WHNP should:
A) Discontinue the medication immediately
B) Continue the medication and prescribe folic acid 4 mg
daily
C) Switch to a newer antiepileptic without consultation
D) Reduce the dose by half
Answer: B) Continue the medication and prescribe folic acid
4 mg daily
Rationale: Women with epilepsy on antiepileptic medications
should continue their medication during pregnancy because
seizure activity poses greater risk to the mother and fetus.
Valproic acid is associated with neural tube defects, so high-
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dose folic acid (4 mg daily) is recommended. Medication
changes should be made in consultation with neurology,
ideally before conception.
2. A 32-year-old woman at 28 weeks gestation presents with
pruritus, especially on the palms and soles, and dark urine.
Laboratory testing reveals elevated total bile acids. The most
likely diagnosis is:
A) Preeclampsia
B) Intrahepatic cholestasis of pregnancy
C) Acute fatty liver of pregnancy
D) Viral hepatitis
Answer: B) Intrahepatic cholestasis of pregnancy
Rationale: Intrahepatic cholestasis of pregnancy presents
with pruritus (often on palms and soles), dark urine, and
elevated bile acids. It is associated with increased risk of fetal
distress, preterm birth, and stillbirth. Ursodeoxycholic acid is
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commonly used for treatment. Preeclampsia presents with
hypertension and proteinuria. Acute fatty liver presents with
nausea, vomiting, abdominal pain, and liver failure.
3. A 19-year-old woman presents with primary amenorrhea.
She has normal breast development but absent uterus on
ultrasound. Karyotype is 46,XY. The most likely diagnosis is:
A) Turner syndrome
B) Androgen insensitivity syndrome
C) Mayer-Rokitansky-Küster-Hauser syndrome
D) Asherman syndrome
Answer: B) Androgen insensitivity syndrome
Rationale: Androgen insensitivity syndrome occurs in 46,XY
individuals with complete resistance to androgens. They
have female external genitalia, breast development (from
estrogen conversion), but absent uterus and upper vagina.
Testes are present (often undescended). Turner syndrome is
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45,X with streak ovaries and short stature. MRKH is 46,XX
with absent uterus but normal ovaries.
4. A 45-year-old woman presents with heavy menstrual
bleeding. Pelvic ultrasound reveals a 3 cm submucosal
fibroid. The most appropriate initial management is:
A) Hysterectomy
B) Hysteroscopic myomectomy
C) GnRH agonist therapy alone
D) Observation without treatment
Answer: B) Hysteroscopic myomectomy
Rationale: Submucosal fibroids are often amenable to
hysteroscopic resection, which can relieve heavy bleeding
while preserving the uterus. GnRH agonists may be used
preoperatively to shrink fibroids or in perimenopausal
women. Hysterectomy is reserved for women who have
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WHNP-BC® Practice Questions – Original Questions 1-175 with
Answers and Detailed Rationales
1. A 24-year-old woman presents for her first prenatal visit
at 8 weeks gestation. She has a history of epilepsy and takes
valproic acid. The WHNP should:
A) Discontinue the medication immediately
B) Continue the medication and prescribe folic acid 4 mg
daily
C) Switch to a newer antiepileptic without consultation
D) Reduce the dose by half
Answer: B) Continue the medication and prescribe folic acid
4 mg daily
Rationale: Women with epilepsy on antiepileptic medications
should continue their medication during pregnancy because
seizure activity poses greater risk to the mother and fetus.
Valproic acid is associated with neural tube defects, so high-
1|Page
, Page |2
dose folic acid (4 mg daily) is recommended. Medication
changes should be made in consultation with neurology,
ideally before conception.
2. A 32-year-old woman at 28 weeks gestation presents with
pruritus, especially on the palms and soles, and dark urine.
Laboratory testing reveals elevated total bile acids. The most
likely diagnosis is:
A) Preeclampsia
B) Intrahepatic cholestasis of pregnancy
C) Acute fatty liver of pregnancy
D) Viral hepatitis
Answer: B) Intrahepatic cholestasis of pregnancy
Rationale: Intrahepatic cholestasis of pregnancy presents
with pruritus (often on palms and soles), dark urine, and
elevated bile acids. It is associated with increased risk of fetal
distress, preterm birth, and stillbirth. Ursodeoxycholic acid is
2|Page
, Page |3
commonly used for treatment. Preeclampsia presents with
hypertension and proteinuria. Acute fatty liver presents with
nausea, vomiting, abdominal pain, and liver failure.
3. A 19-year-old woman presents with primary amenorrhea.
She has normal breast development but absent uterus on
ultrasound. Karyotype is 46,XY. The most likely diagnosis is:
A) Turner syndrome
B) Androgen insensitivity syndrome
C) Mayer-Rokitansky-Küster-Hauser syndrome
D) Asherman syndrome
Answer: B) Androgen insensitivity syndrome
Rationale: Androgen insensitivity syndrome occurs in 46,XY
individuals with complete resistance to androgens. They
have female external genitalia, breast development (from
estrogen conversion), but absent uterus and upper vagina.
Testes are present (often undescended). Turner syndrome is
3|Page
, Page |4
45,X with streak ovaries and short stature. MRKH is 46,XX
with absent uterus but normal ovaries.
4. A 45-year-old woman presents with heavy menstrual
bleeding. Pelvic ultrasound reveals a 3 cm submucosal
fibroid. The most appropriate initial management is:
A) Hysterectomy
B) Hysteroscopic myomectomy
C) GnRH agonist therapy alone
D) Observation without treatment
Answer: B) Hysteroscopic myomectomy
Rationale: Submucosal fibroids are often amenable to
hysteroscopic resection, which can relieve heavy bleeding
while preserving the uterus. GnRH agonists may be used
preoperatively to shrink fibroids or in perimenopausal
women. Hysterectomy is reserved for women who have
4|Page
