Assessment and diagnostics for the women's health NP
Facts read from nccwebsite.org · last checked Nov 7, 2026
This area is 12% of the exam, and it is about getting the data right: the female and male reproductive exam, which lab or image to order, and what a result means for the next step.
Practice questions
60 questions written to the WHNP-BC outline; each choice is explained once you pick.
From the guide's assessment study list (guide, p. 10):
Health history: medical, surgical, obstetric and gynecologic, sexual, family and social history, allergies and medication reconciliation
Physical exam focused on major deviations, including the breast and the female and male reproductive exam
Blood studies: CBC, typing and antibody screen, hemoglobin electrophoresis, glucose tolerance and A1C, clotting studies, serologies and hormones
Urine and genital specimens: urinalysis and cultures, vaginal microscopy, cervical and vaginal cultures, discharge and STI testing
Cervical cytology and HPV testing, biopsies, tests for ruptured membranes and fetal fibronectin
Genetic testing, the hepatitis panel, and imaging: ultrasound, mammography and bone densitometry
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Exam findings and test results: 15 questions
0 / 15 answered15 questions
Tap an option: why each one is right or wrong appears under it.
Assessment, Diagnostic Testing and Interpretation · 12%
On bimanual examination, the uterine fundus cannot be felt through the abdominal wall but is palpable through the posterior fornix and on rectovaginal examination. This finding is most consistent with
A retroverted uterus tilts backward toward the sacrum, so the fundus is felt through the posterior fornix and on rectovaginal exam but not through the abdominal wall.
An anteverted uterus tilts forward, so the fundus is felt between the abdominal and vaginal hands, not posteriorly.
Anteflexion describes the fundus bent forward on the cervix; it places the fundus anteriorly, the opposite of this finding.
Assessment, Diagnostic Testing and Interpretation · 12%
A 68-year-old with long-standing diabetes has constant dribbling, a weak stream, and a sense of incomplete emptying. The most useful initial test is
Dribbling, a weak stream and incomplete emptying in a patient with diabetic autonomic neuropathy suggest overflow incontinence, and a postvoid residual by bladder scan or catheter is the first test to show retention.
Cystoscopy looks for bladder lesions in hematuria or recurrent infection; it does not measure emptying and is not an initial incontinence test.
Multichannel urodynamics is reserved for complex or refractory cases before surgery; ordering it first skips the simple bedside test that answers the main question.
Assessment, Diagnostic Testing and Interpretation · 12%
Several hours after a vaginal birth, a patient has severe perineal pain out of proportion to her repair, with a tense, bluish, tender swelling of the labia. Vital signs are stable. The most likely diagnosis is
Normal edema is soft and diffuse, and pain stays proportional to the repair; a tense discolored mass is not normal swelling.
Dehiscence usually appears days later, often with infection, and shows a separated wound rather than a tense bluish mass.
Pain out of proportion to the repair with a tense, bluish, tender labial swelling within hours of birth is a vulvar hematoma; large or expanding ones need evacuation.
Assessment, Diagnostic Testing and Interpretation · 12%
A 40-year-old with regular cycles and heavy menstrual bleeding has a 4-cm submucosal fibroid on ultrasound. Using PALM-COEIN, her bleeding is classified as
AUB-O applies to anovulatory, unpredictable bleeding; her regular cycles point to a structural cause.
In PALM-COEIN, a leiomyoma causing bleeding is AUB-L (submucosal subtype AUB-Lsm); regular cycles make ovulatory dysfunction unlikely.
AUB-P is for endometrial or endocervical polyps; a 4-cm submucosal mass is a fibroid, not a polyp.
Assessment, Diagnostic Testing and Interpretation · 12%
In a woman with oligomenorrhea and hirsutism, which test screens for nonclassic congenital adrenal hyperplasia before PCOS is diagnosed?
An elevated LH-to-FSH ratio is common in PCOS but is not a diagnostic criterion, and it cannot exclude congenital adrenal hyperplasia.
Nonclassic 21-hydroxylase deficiency mimics PCOS, and an early-morning follicular-phase 17-hydroxyprogesterone screens for it before PCOS is diagnosed.
A morning cortisol tests for adrenal insufficiency or, with suppression, Cushing syndrome; it is usually normal in nonclassic CAH and does not screen for it.
Assessment, Diagnostic Testing and Interpretation · 12%
A 44-year-old multipara has increasingly heavy, painful periods. Bimanual exam reveals a symmetrically enlarged, boggy, tender uterus. The most likely diagnosis is
Endometriosis causes dysmenorrhea and dyspareunia with uterosacral nodularity or fixed adnexa, usually with a normal-sized uterus.
A uniformly enlarged, boggy, tender uterus with heavy painful periods in a parous woman in her 40s is the classic picture of adenomyosis.
Fibroids enlarge the uterus irregularly and feel firm and nodular; they cause heavy bleeding but rarely a soft, tender, symmetric uterus.
Assessment, Diagnostic Testing and Interpretation · 12%
A 34-year-old has hirsutism that developed over 4 months, with deepening voice and clitoromegaly. Total testosterone is 250 ng/dL. The most appropriate next step is
Rapid virilization with a total testosterone above about 150 to 200 ng/dL suggests an ovarian or adrenal tumor, so pelvic ultrasound and adrenal imaging come before any diagnosis of PCOS.
A pill plus spironolactone treats PCOS-type hirsutism; starting it here masks a possible tumor and delays its removal.
Waiting 6 months is unsafe when virilization has developed over months; signs like clitoromegaly and voice change call for evaluation now.
Assessment, Diagnostic Testing and Interpretation · 12%
A 28-year-old has had no period for 5 months. Her pregnancy test is negative, and she has no hirsutism or galactorrhea. The most appropriate initial laboratory tests are
Single estradiol or progesterone values vary widely and do not identify the cause of amenorrhea as the core panel does.
Androgen levels are added only when there are signs of hyperandrogenism, and she has no hirsutism.
After pregnancy is excluded, the core work-up of secondary amenorrhea is TSH, prolactin and FSH, which separate thyroid disease, hyperprolactinemia, ovarian insufficiency and hypothalamic causes.
Assessment, Diagnostic Testing and Interpretation · 12%
During a speculum exam, the nurse practitioner sees a 1-cm raised, friable lesion on the cervix. Her HPV cotest 1 year ago was negative. The most appropriate next step is
A visible raised, friable cervical lesion needs biopsy whatever the prior screening result, because cytology and HPV tests can miss an invasive cancer.
A negative cotest supports routine intervals in a patient with a normal cervix; it does not cover a lesion that is visible now.
Treating as cervicitis delays tissue diagnosis; infection causes diffuse friability and discharge, not a discrete raised lesion.
Assessment, Diagnostic Testing and Interpretation · 12%
Examining a man being evaluated for infertility, the nurse practitioner palpates a soft left scrotal mass that feels like a bag of worms when he stands and decreases when he lies down. The most likely diagnosis is
A varicocele is a dilated pampiniform plexus, usually on the left, that feels like a bag of worms on standing and shrinks lying down; it is a common correctable cause of male infertility.
An indirect hernia comes through the inguinal ring, may reach the scrotum and enlarges with coughing; it does not feel like a tangle of veins.
A hydrocele is a smooth fluid collection around the testis that transilluminates and does not collapse when he lies down.
Assessment, Diagnostic Testing and Interpretation · 12%
CA-125 testing is most appropriately used for
CA-125 rises with endometriosis, fibroids, menses, pregnancy and pelvic infection, so an elevated value never confirms cancer; tissue does.
CA-125 adds information when an adnexal mass is found, especially after menopause, where an elevated value supports referral to gynecologic oncology.
Screening average-risk women with CA-125, alone or with ultrasound, has not reduced ovarian cancer deaths and causes false positives and needless surgery.
Assessment, Diagnostic Testing and Interpretation · 12%
A diagnostic mammogram is reported as BI-RADS 3, probably benign. The most appropriate next step is
Returning to routine yearly screening fits BI-RADS 1 and 2; a probably benign finding still needs short-interval follow-up to prove stability.
BI-RADS 3 (probably benign, under 2 % malignancy risk) is managed with a short-interval diagnostic mammogram or ultrasound at 6 months, then periodic follow-up for about 2 years.
Biopsy is the recommendation for BI-RADS 4 and 5; using it for category 3 confuses the categories and adds procedures without benefit.
A running total sits here; it fills in after your last pick.
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Reading results without the usual mistakes
Wet mount versus NAAT. Saline microscopy misses a large share of trichomoniasis; CDC (2021) prefers a nucleic acid amplification test. Bacterial vaginosis is diagnosed by Amsel criteria (three of four) or Gram stain.
Cervical results by risk. ASCCP's 2019 guidelines base management on the estimated risk from the current result plus history, not on the result alone. HPV 16 or 18 with normal cytology goes straight to colposcopy. The USPSTF cervical statement in force is still the 2018 final; its 2024 draft had not been finalized when we checked in November 2026.
Testing for ruptured membranes. Nitrazine paper turns falsely positive with blood, semen or bacterial vaginosis. ACOG Practice Bulletin 217 (2020) pairs pooling and pH with a fern test, and adds ultrasound or an immunoassay when the picture stays unclear.
T-score or Z-score. Use the T-score for postmenopausal women and the Z-score for premenopausal women (ISCD official positions).
Glucose tests in pregnancy. Testing at 24–28 weeks uses either the one-step 75-g test or the two-step 50-g then 100-g approach; the ADA does not accept A1C alone for diagnosing gestational diabetes at that stage.
hCG trends. One value cannot place a pregnancy. Serial values 48 hours apart are read with a transvaginal ultrasound, and a slower rise alone does not prove an ectopic pregnancy (ACOG Practice Bulletin 193).
FSH and menopause. Over 45 with typical symptoms, menopause is a clinical diagnosis; FSH swings during the transition and misleads (The Menopause Society).