NSG 6430 WOMEN'S HEALTH FINAL EXAM (REVISED AND GRADED
A)
South University | Graduate Nursing Program | Nurse Practitioner
Track
Comprehensive Final Examination | 2026/2027 Academic Year
SECTION 1: REPRODUCTIVE HEALTH AND GYNECOLOGICAL DISORDERS (30
Questions)
Q1: What is the most common cause of abnormal uterine bleeding in premenopausal
women?
A. Uterine fibroids
B. Endometrial polyps
C. Anovulation [CORRECT]
D. Adenomyosis
Correct Answer: C
Rationale:
● Correct Answer Explanation: Anovulation is the most common cause of
abnormal uterine bleeding (AUB) in premenopausal women, accounting for
, approximately 70% of cases in this age group. Without ovulation, no corpus
luteum forms, resulting in unopposed estrogen stimulation of the endometrium.
This leads to endometrial proliferation without the stabilizing effect of
progesterone, causing irregular, unpredictable, and often heavy bleeding patterns.
The endometrium becomes thick and unstable, shedding irregularly.
● Why A is incorrect: While uterine fibroids (leiomyomas) are a common cause of
heavy menstrual bleeding (menorrhagia), they are structural abnormalities and
not the most frequent etiology of overall abnormal uterine bleeding patterns.
Fibroids cause bleeding through distortion of the endometrial cavity, increased
endometrial surface area, and interference with uterine contractility.
● Why B is incorrect: Endometrial polyps can cause intermenstrual bleeding or
menorrhagia but are less common than anovulation. Polyps are focal
overgrowths of endometrial glands and stroma that project from the endometrial
surface.
● Why D is incorrect: Adenomyosis (endometrial tissue within the myometrium)
causes heavy, painful periods but is less common than anovulation and typically
presents in women aged 35-50 with established risk factors (prior uterine
surgery, multiparity).
● Clinical Pearl: The PALM-COEIN classification system categorizes AUB causes:
Polyps, Adenomyosis, Leiomyomas, Malignancy/hyperplasia (structural);
Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified
(non-structural). Anovulation falls under "Ovulatory dysfunction."
● Guideline Reference: ACOG Practice Bulletin No. 220: Diagnosis and
Management of Abnormal Uterine Bleeding (2020); FIGO Classification System
(PALM-COEIN)
● Exam Strategy: When "most common" appears in questions about AUB in
reproductive-age women, anovulation is the statistically correct answer. Consider
patient age—anovulation peaks at adolescence and perimenopause.
Q2: The nurse practitioner is performing a bimanual exam on a new OB patient and
notices that the lower portion of the patient's uterus is soft. This is known as:
A. Chadwick's sign
B. Goodell's sign
C. Hegar's sign [CORRECT]
,D. McDonald's sign
Correct Answer: C
Rationale:
● Correct Answer Explanation: Hegar's sign refers to the softening and
compressibility of the lower uterine segment (the isthmus) that occurs around
6-8 weeks of gestation. This early pregnancy sign is detected during bimanual
examination when the cervix and uterine fundus feel separate due to the
softened isthmus between them. It results from increased vascularization and
edema of the decidua and myometrium under the influence of estrogen and
progesterone.
● Why A is incorrect: Chadwick's sign is the bluish or purplish discoloration of the
cervix, vagina, and vulva caused by increased vascular congestion and venous
stasis. It appears at approximately 6-8 weeks but is a visual, not palpatory, sign.
● Why B is incorrect: Goodell's sign is the softening of the cervix itself that occurs
during pregnancy. While also an early sign, it refers specifically to cervical
consistency, not the lower uterine segment.
● Why D is incorrect: McDonald's sign (or sign of Hegar's alternative description)
refers to the ease with which the uterine fundus can be flexed against the cervix
on bimanual examination. However, the specific finding of lower uterine segment
softening is definitively Hegar's sign.
● Clinical Pearl: The "classic" early signs of pregnancy are often tested together:
○ Hegar's sign: Softening of lower uterine segment (palpation)
○ Chadwick's sign: Bluish discoloration of cervix/vulva (visual)
○ Goodell's sign: Softening of cervix (palpation)
○ Braxton Hicks contractions: Intermittent painless contractions (late first
trimester onward)
● Pathophysiology: These changes result from increased estrogen and
progesterone causing vascular congestion, edema, and hypertrophy of uterine
and cervical tissues.
● Exam Strategy: Associate "Hegar" with "lower uterus" (both have 'e' and 'g'
sounds); "Goodell" with "cervix" (both start with hard consonants); "Chadwick"
with "color/blue" (visual sign).
, Q3: A 30-year-old woman presents with a 4 cm simple ovarian cyst found incidentally on
ultrasound. She is asymptomatic and has regular menses. What is the most appropriate
management?
A. Immediate surgical consultation for cystectomy
B. Repeat transvaginal ultrasound in 6-12 weeks [CORRECT]
C. MRI to evaluate for malignancy
D. Tumor markers (CA-125, CEA, AFP)
Correct Answer: B
Rationale:
● Correct Answer Explanation: Simple ovarian cysts <5-6 cm in reproductive-age
women are almost always functional cysts (follicular or corpus luteum) that
resolve spontaneously within 1-3 menstrual cycles. The appropriate management
is expectant management with repeat ultrasound in 6-12 weeks (preferably
shortly after menses to avoid confusing with new follicular cyst). This avoids
unnecessary surgery and associated risks while confirming resolution.
● Why A is incorrect: Immediate surgery is inappropriate for a simple cyst <5 cm
without symptoms or concerning features (solid components, papillary
projections, septations, ascites). Surgery risks include ovarian damage,
adhesions, and anesthesia complications.
● Why C is incorrect: MRI is not indicated for simple cysts and is reserved for
complex cysts where ultrasound is inconclusive or malignancy is suspected. It is
expensive and unnecessary for this scenario.
● Why D is incorrect: Tumor markers are not indicated for simple cysts in
reproductive-age women. CA-125 is nonspecific and elevated in many benign
conditions (endometriosis, PID, pregnancy). Tumor markers are used when
imaging suggests malignancy.
A)
South University | Graduate Nursing Program | Nurse Practitioner
Track
Comprehensive Final Examination | 2026/2027 Academic Year
SECTION 1: REPRODUCTIVE HEALTH AND GYNECOLOGICAL DISORDERS (30
Questions)
Q1: What is the most common cause of abnormal uterine bleeding in premenopausal
women?
A. Uterine fibroids
B. Endometrial polyps
C. Anovulation [CORRECT]
D. Adenomyosis
Correct Answer: C
Rationale:
● Correct Answer Explanation: Anovulation is the most common cause of
abnormal uterine bleeding (AUB) in premenopausal women, accounting for
, approximately 70% of cases in this age group. Without ovulation, no corpus
luteum forms, resulting in unopposed estrogen stimulation of the endometrium.
This leads to endometrial proliferation without the stabilizing effect of
progesterone, causing irregular, unpredictable, and often heavy bleeding patterns.
The endometrium becomes thick and unstable, shedding irregularly.
● Why A is incorrect: While uterine fibroids (leiomyomas) are a common cause of
heavy menstrual bleeding (menorrhagia), they are structural abnormalities and
not the most frequent etiology of overall abnormal uterine bleeding patterns.
Fibroids cause bleeding through distortion of the endometrial cavity, increased
endometrial surface area, and interference with uterine contractility.
● Why B is incorrect: Endometrial polyps can cause intermenstrual bleeding or
menorrhagia but are less common than anovulation. Polyps are focal
overgrowths of endometrial glands and stroma that project from the endometrial
surface.
● Why D is incorrect: Adenomyosis (endometrial tissue within the myometrium)
causes heavy, painful periods but is less common than anovulation and typically
presents in women aged 35-50 with established risk factors (prior uterine
surgery, multiparity).
● Clinical Pearl: The PALM-COEIN classification system categorizes AUB causes:
Polyps, Adenomyosis, Leiomyomas, Malignancy/hyperplasia (structural);
Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified
(non-structural). Anovulation falls under "Ovulatory dysfunction."
● Guideline Reference: ACOG Practice Bulletin No. 220: Diagnosis and
Management of Abnormal Uterine Bleeding (2020); FIGO Classification System
(PALM-COEIN)
● Exam Strategy: When "most common" appears in questions about AUB in
reproductive-age women, anovulation is the statistically correct answer. Consider
patient age—anovulation peaks at adolescence and perimenopause.
Q2: The nurse practitioner is performing a bimanual exam on a new OB patient and
notices that the lower portion of the patient's uterus is soft. This is known as:
A. Chadwick's sign
B. Goodell's sign
C. Hegar's sign [CORRECT]
,D. McDonald's sign
Correct Answer: C
Rationale:
● Correct Answer Explanation: Hegar's sign refers to the softening and
compressibility of the lower uterine segment (the isthmus) that occurs around
6-8 weeks of gestation. This early pregnancy sign is detected during bimanual
examination when the cervix and uterine fundus feel separate due to the
softened isthmus between them. It results from increased vascularization and
edema of the decidua and myometrium under the influence of estrogen and
progesterone.
● Why A is incorrect: Chadwick's sign is the bluish or purplish discoloration of the
cervix, vagina, and vulva caused by increased vascular congestion and venous
stasis. It appears at approximately 6-8 weeks but is a visual, not palpatory, sign.
● Why B is incorrect: Goodell's sign is the softening of the cervix itself that occurs
during pregnancy. While also an early sign, it refers specifically to cervical
consistency, not the lower uterine segment.
● Why D is incorrect: McDonald's sign (or sign of Hegar's alternative description)
refers to the ease with which the uterine fundus can be flexed against the cervix
on bimanual examination. However, the specific finding of lower uterine segment
softening is definitively Hegar's sign.
● Clinical Pearl: The "classic" early signs of pregnancy are often tested together:
○ Hegar's sign: Softening of lower uterine segment (palpation)
○ Chadwick's sign: Bluish discoloration of cervix/vulva (visual)
○ Goodell's sign: Softening of cervix (palpation)
○ Braxton Hicks contractions: Intermittent painless contractions (late first
trimester onward)
● Pathophysiology: These changes result from increased estrogen and
progesterone causing vascular congestion, edema, and hypertrophy of uterine
and cervical tissues.
● Exam Strategy: Associate "Hegar" with "lower uterus" (both have 'e' and 'g'
sounds); "Goodell" with "cervix" (both start with hard consonants); "Chadwick"
with "color/blue" (visual sign).
, Q3: A 30-year-old woman presents with a 4 cm simple ovarian cyst found incidentally on
ultrasound. She is asymptomatic and has regular menses. What is the most appropriate
management?
A. Immediate surgical consultation for cystectomy
B. Repeat transvaginal ultrasound in 6-12 weeks [CORRECT]
C. MRI to evaluate for malignancy
D. Tumor markers (CA-125, CEA, AFP)
Correct Answer: B
Rationale:
● Correct Answer Explanation: Simple ovarian cysts <5-6 cm in reproductive-age
women are almost always functional cysts (follicular or corpus luteum) that
resolve spontaneously within 1-3 menstrual cycles. The appropriate management
is expectant management with repeat ultrasound in 6-12 weeks (preferably
shortly after menses to avoid confusing with new follicular cyst). This avoids
unnecessary surgery and associated risks while confirming resolution.
● Why A is incorrect: Immediate surgery is inappropriate for a simple cyst <5 cm
without symptoms or concerning features (solid components, papillary
projections, septations, ascites). Surgery risks include ovarian damage,
adhesions, and anesthesia complications.
● Why C is incorrect: MRI is not indicated for simple cysts and is reserved for
complex cysts where ultrasound is inconclusive or malignancy is suspected. It is
expensive and unnecessary for this scenario.
● Why D is incorrect: Tumor markers are not indicated for simple cysts in
reproductive-age women. CA-125 is nonspecific and elevated in many benign
conditions (endometriosis, PID, pregnancy). Tumor markers are used when
imaging suggests malignancy.
