WHNP certification, the women's health NP board exam

A 23-year-old woman's Pap test shows LSIL. She has no prior abnormal results. According to ASCCP guidelines, the nurse practitioner should

1. Resume screening in 3 years
   Returning to the routine 3-year interval ignores the abnormal result; a 1-year repeat is still needed to confirm the change has cleared.
2. Refer for colposcopy
   Colposcopy for LSIL is the pathway for patients 25 and older; applying the adult rule to a 23-year-old leads to overtreatment of lesions that usually clear.
3. Repeat cytology in 1 year
   For ages 21 to 24, ASCCP management of LSIL is repeat cytology in 1 year, because most low-grade lesions in young patients regress and colposcopy adds harm without benefit.

Item 422680 · Flag an error

A postpartum patient is exclusively breastfeeding and has had no menses. The lactational amenorrhea method is reliable contraception until the infant is

1. 3 months old
   Three months understates the window; with exclusive breastfeeding and no menses the method stays reliable until 6 months, so stopping it at 3 months adds an unnecessary method early.
2. 9 months old
   Nine months stretches the method too far; after 6 months infants take solids, suckling drops and ovulation can return before the first period.
3. 6 months old
   Lactational amenorrhea is reliable (about 98 %) only while all three criteria hold: no menses, exclusive or nearly exclusive breastfeeding, and an infant younger than 6 months.

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A patient has vulvar pruritus and thick white discharge. Vaginal pH is 4.0 and the whiff test is negative. These findings are most consistent with

1. vulvovaginal candidiasis
   Itching with thick white discharge, a normal pH of 4.0 to 4.5 and a negative whiff test is the profile of vulvovaginal candidiasis; KOH shows the yeast or pseudohyphae.
2. trichomoniasis
   Trichomoniasis raises vaginal pH above 4.5 and often gives frothy yellow-green discharge with a positive whiff test; normal pH makes it unlikely.
3. bacterial vaginosis
   Bacterial vaginosis gives thin gray discharge, a pH above 4.5 and a positive amine (whiff) test; a normal pH with a negative whiff test points elsewhere.

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A 31-year-old has had no menses for 6 months since a dilation and curettage for retained tissue after a miscarriage. Her weight is stable, and hCG, TSH, prolactin and FSH are normal. The most likely diagnosis is

1. primary ovarian insufficiency
   Primary ovarian insufficiency would raise FSH into the menopausal range; a normal FSH rules it out, and the timing after a procedure points to the uterus, not the ovary.
2. intrauterine adhesions
   Amenorrhea that starts after curettage of a recently pregnant uterus, with normal hCG, TSH, prolactin and FSH, points to intrauterine adhesions (Asherman syndrome); hysteroscopy confirms and treats it.
3. functional hypothalamic amenorrhea
   Functional hypothalamic amenorrhea follows weight loss, heavy exercise or stress and usually shows low-normal gonadotropins; her stable weight and the clear link to curettage argue against a central cause.

Item 423232 · Flag an error

At 18 weeks, a schoolteacher exposed to fifth disease has positive parvovirus B19 IgM and IgG antibodies. The nurse practitioner should arrange

1. reassurance, since IgG shows immunity
   IgG alone suggests past infection, but a positive IgM marks a recent one; reading the IgG as immunity misses the fetal risk.
2. serial ultrasound with MCA Doppler
   Positive IgM with IgG means recent parvovirus B19 infection, so the fetus is followed with serial ultrasound and middle cerebral artery Doppler every 1 to 2 weeks for about 12 weeks to detect anemia and hydrops.
3. intravenous immune globulin now
   Immune globulin has no proven role in maternal parvovirus infection; fetal anemia, if it develops, is treated with intrauterine transfusion.

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