[GRH] Gynecologic Reproductive Health for
the Advanced Practice Nurse C GRH
Certification Review Guide
**Question 1. Which hormone surge initiates ovulation in the normal menstrual cycle?**
A) Follicle‑stimulating hormone (FSH)
B) Luteinizing hormone (LH)
C) Progesterone
D) Estrogen
Answer: B
Explanation: A rapid rise in LH (the LH surge) triggers rupture of the dominant follicle and
release of the oocyte, marking ovulation.
**Question 2. A 28‑year‑old woman presents with a 6‑month history of oligomenorrhea,
hirsutism, and acne. Which laboratory finding best supports a diagnosis of PCOS?**
A) Elevated prolactin
B) Low serum testosterone
C) Elevated serum LH:FSH ratio >2:1
D) Decreased AMH
Answer: C
Explanation: PCOS commonly shows an increased LH:FSH ratio (often >2:1) due to increased
pulsatile GnRH secretion; AMH is usually elevated, not decreased.
**Question 3. According to USPSTF guidelines, at what age should average‑risk women begin
biennial mammography screening?**
A) 30 years
B) 40 years
C) 45 years
D) 50 years
,[GRH] Gynecologic Reproductive Health for
the Advanced Practice Nurse C GRH
Certification Review Guide
Answer: D
Explanation: USPSTF recommends biennial screening mammography for average‑risk women
starting at age 50; women aged 40‑49 may choose individualized screening.
**Question 4. Which of the following is the most appropriate initial treatment for bacterial
vaginosis in a non‑pregnant woman?**
A) Oral metronidazole 500 mg twice daily for 7 days
B) Intravaginal clindamycin cream for 7 days
C) Oral fluconazole single dose
D) Intravaginal miconazole cream for 7 days
Answer: A
Explanation: First‑line therapy for BV is oral metronidazole 500 mg BID for 7 days; intravaginal
metronidazole or clindamycin are alternatives.
**Question 5. A 35‑year‑old woman with a history of hypertension presents for contraception
counseling. Which method is contraindicated due to her hypertension?**
A) Levonorgestrel IUD
B) Combined oral contraceptive pills
C) Progestin‑only implant
D) Copper IUD
Answer: B
Explanation: Combined hormonal contraceptives containing estrogen increase thrombotic risk
and are contraindicated in women with uncontrolled hypertension.
,[GRH] Gynecologic Reproductive Health for
the Advanced Practice Nurse C GRH
Certification Review Guide
**Question 6. Which of the following best describes the histologic appearance of endometrial
tissue located within the myometrium?**
A) Endometrial hyperplasia
B) Adenomyosis
C) Leiomyoma
D) Endometrial carcinoma
Answer: B
Explanation: Adenomyosis is characterized by ectopic endometrial glands and stroma within the
myometrial wall.
**Question 7. Which screening test is recommended for detection of high‑risk human
papillomavirus (HPV) in women aged 30‑65 years?**
A) Cervical cytology alone every 3 years
B) HPV DNA testing alone every 5 years
C) Co‑testing with Pap smear and HPV DNA every 5 years
D) Visual inspection with acetic acid (VIA) annually
Answer: C
Explanation: For women 30‑65, co‑testing (Pap + HPV) every 5 years is an accepted screening
strategy.
**Question 8. A 22‑year‑old woman presents with dysuria, urinary frequency, and a positive
nitrite test. Which organism is most likely responsible?**
A) Gardnerella vaginalis
B) Trichomonas vaginalis
C) Escherichia coli
, [GRH] Gynecologic Reproductive Health for
the Advanced Practice Nurse C GRH
Certification Review Guide
D) Candida albicans
Answer: C
Explanation: E. coli is the most common cause of uncomplicated urinary tract infection and
produces nitrite on dipstick testing.
**Question 9. Which of the following is the first‑line pharmacologic therapy for primary
dysmenorrhea?**
A) Oral contraceptive pills
B) Ibuprofen 400 mg every 6 hours as needed
C) Intramuscular medroxyprogesterone acetate
D) Leuprolide acetate monthly injection
Answer: B
Explanation: NSAIDs such as ibuprofen inhibit prostaglandin synthesis and are first‑line for
primary dysmenorrhea.
**Question 10. In a postmenopausal woman, a bone density T‑score of –2.6 indicates which
condition?**
A) Osteopenia
B) Osteoporosis
C) Normal bone density
D) Osteomalacia
Answer: B
Explanation: A T‑score ≤ –2.5 defines osteoporosis according to WHO criteria.
the Advanced Practice Nurse C GRH
Certification Review Guide
**Question 1. Which hormone surge initiates ovulation in the normal menstrual cycle?**
A) Follicle‑stimulating hormone (FSH)
B) Luteinizing hormone (LH)
C) Progesterone
D) Estrogen
Answer: B
Explanation: A rapid rise in LH (the LH surge) triggers rupture of the dominant follicle and
release of the oocyte, marking ovulation.
**Question 2. A 28‑year‑old woman presents with a 6‑month history of oligomenorrhea,
hirsutism, and acne. Which laboratory finding best supports a diagnosis of PCOS?**
A) Elevated prolactin
B) Low serum testosterone
C) Elevated serum LH:FSH ratio >2:1
D) Decreased AMH
Answer: C
Explanation: PCOS commonly shows an increased LH:FSH ratio (often >2:1) due to increased
pulsatile GnRH secretion; AMH is usually elevated, not decreased.
**Question 3. According to USPSTF guidelines, at what age should average‑risk women begin
biennial mammography screening?**
A) 30 years
B) 40 years
C) 45 years
D) 50 years
,[GRH] Gynecologic Reproductive Health for
the Advanced Practice Nurse C GRH
Certification Review Guide
Answer: D
Explanation: USPSTF recommends biennial screening mammography for average‑risk women
starting at age 50; women aged 40‑49 may choose individualized screening.
**Question 4. Which of the following is the most appropriate initial treatment for bacterial
vaginosis in a non‑pregnant woman?**
A) Oral metronidazole 500 mg twice daily for 7 days
B) Intravaginal clindamycin cream for 7 days
C) Oral fluconazole single dose
D) Intravaginal miconazole cream for 7 days
Answer: A
Explanation: First‑line therapy for BV is oral metronidazole 500 mg BID for 7 days; intravaginal
metronidazole or clindamycin are alternatives.
**Question 5. A 35‑year‑old woman with a history of hypertension presents for contraception
counseling. Which method is contraindicated due to her hypertension?**
A) Levonorgestrel IUD
B) Combined oral contraceptive pills
C) Progestin‑only implant
D) Copper IUD
Answer: B
Explanation: Combined hormonal contraceptives containing estrogen increase thrombotic risk
and are contraindicated in women with uncontrolled hypertension.
,[GRH] Gynecologic Reproductive Health for
the Advanced Practice Nurse C GRH
Certification Review Guide
**Question 6. Which of the following best describes the histologic appearance of endometrial
tissue located within the myometrium?**
A) Endometrial hyperplasia
B) Adenomyosis
C) Leiomyoma
D) Endometrial carcinoma
Answer: B
Explanation: Adenomyosis is characterized by ectopic endometrial glands and stroma within the
myometrial wall.
**Question 7. Which screening test is recommended for detection of high‑risk human
papillomavirus (HPV) in women aged 30‑65 years?**
A) Cervical cytology alone every 3 years
B) HPV DNA testing alone every 5 years
C) Co‑testing with Pap smear and HPV DNA every 5 years
D) Visual inspection with acetic acid (VIA) annually
Answer: C
Explanation: For women 30‑65, co‑testing (Pap + HPV) every 5 years is an accepted screening
strategy.
**Question 8. A 22‑year‑old woman presents with dysuria, urinary frequency, and a positive
nitrite test. Which organism is most likely responsible?**
A) Gardnerella vaginalis
B) Trichomonas vaginalis
C) Escherichia coli
, [GRH] Gynecologic Reproductive Health for
the Advanced Practice Nurse C GRH
Certification Review Guide
D) Candida albicans
Answer: C
Explanation: E. coli is the most common cause of uncomplicated urinary tract infection and
produces nitrite on dipstick testing.
**Question 9. Which of the following is the first‑line pharmacologic therapy for primary
dysmenorrhea?**
A) Oral contraceptive pills
B) Ibuprofen 400 mg every 6 hours as needed
C) Intramuscular medroxyprogesterone acetate
D) Leuprolide acetate monthly injection
Answer: B
Explanation: NSAIDs such as ibuprofen inhibit prostaglandin synthesis and are first‑line for
primary dysmenorrhea.
**Question 10. In a postmenopausal woman, a bone density T‑score of –2.6 indicates which
condition?**
A) Osteopenia
B) Osteoporosis
C) Normal bone density
D) Osteomalacia
Answer: B
Explanation: A T‑score ≤ –2.5 defines osteoporosis according to WHO criteria.
