WOMEN'S HEALTH NURSE PRACTITIONER
CERTIFICATION TEST LATEST UPDATE NCC
1. A 4 year-old female is brought in to the clinic by her mother who reports that she is constantly
scratching "her private part". The patient states that it itches. On exam, the vagina is red and irritated.
How should the NP proceed?
A) Call child protection for suspected sexual abuse
B) Prescribe a cortisone cream
C) Collect a vaginal swab of the external vagina for microscopic evaluation
D) Prescribe a topical antifungal C) Collect a vaginal swab of the external vagina for microscopic
evaluation
Explanation:
This child has a vaginitis. There are many diagnoses in the differential including pinworms, yeast, contact
irritants from soap or bubble bath, etc. Since the diagnosis is not clear, some evaluation must occur in
order to determine the diagnosis so proper treatment can be initiated. Since the description of the
problem does not indicate what the diagnosis is, it is inappropriate to treat with a cortisone cream or
topical antifungal.
Which form of birth control presents the highest risk to a female patient if she is exposed to a sexually
transmitted disease (STD)?
A) Intrauterine device
B) Progestin only pill
C) Diaphragm
D) Oral contraceptives A) Intrauterine device
,Explanation:
Exposure to an STD always increases the likelihood of contracting an STD. However, the patient is at very
high risk of developing pelvic inflammatory disease when there is an implanted foreign body. An
example of this is an intrauterine device (IUD). The risk is also increased with a diaphragm, but, because
it is not implanted for long periods at a time, the risk is less than with an IUD
What choice below has no precautions for oral contraceptive pill use?
A) Gallbladder disease
B) 5 months post-partum and lactating
C) Blood pressure 160/100
D) Varicose veins D) Varicose veins
Explanation:
One of the major components of gallstones is estrogen. A patient with underlying gallbladder disease
should not receive oral contraceptives (OC) since they will increase estrogen exposure and theoretically,
formation of gallstones. Patients who are less than 6 months post-partum should avoid OCs until they
are 6 months post-partum because OCs can decrease the quantity of breast milk produced.
Hypertension is a contraindication to OC use because of the increased risk of stroke. Varicose veins are
not a contraindication.
Three of the following interventions are appropriately used to prevent osteoporosis after menopause.
Which one is not?
A) Limited alcohol intake
B) Performance of weight-bearing activities for 40 mins. at least 5 days/week
C) Estrogen replacement therapy
D) Adequate calcium & vitamin D intake C) Estrogen replacement therapy
,Explanation:
Prevention of osteoporosis may be optimized by elimination of risk factors and engaging in interventions
that maximize bone density. Good nutrition from infancy throughout adulthood is a major component
of good bone health. Others include engaging in weight-bearing exercises, adequate intake of calcium
and vitamin D, smoking cessation, limiting alcohol consumption to moderate amounts, and avoidance
when possible of medications that may decrease bone density (corticosteroids, anticonvulsants).
Osteoporosis occurs at accelerated rates in women who are post-menopausal. The lack of estrogen can
produce rapid bone loss due to bone resorption. Estrogen replacement is not used to prevent or treat
osteoporosis.
A 50 year-old female believes that she is "menopausal". She complains of "hot flashes" and has not had
menses in 12 months. Which of the following test results may be helpful for confirmation of
menopause?
A) Increased thyroid stimulating hormone
B) Decreased follicle stimulating hormone
C)Hypoestrogenemia
D) Increased follicle stimulating hormone D) Increased follicle stimulating hormone
Explanation:
Follicle stimulating hormone (FSH) begins to rise during menopausal transition. This stage of menopause
begins with variation in menstrual cycle length and ends 12 months after the final menses. If the patient
is older than 45 years and menstrual cycle dysfunction has been ruled out, menopause should be
considered. Possibly the best approach to diagnosing menopause is to ask and observe clinical
manifestations. An elevated FSH is not necessary to make a diagnosis of menopause but is commonly
done in clinical practice. Diagnosis entails a review of her symptoms. Specifically, changes in bleeding
patterns, hot flashes, sleep disturbances, and genitourinary symptoms are characteristic of menopause.
An initial pharmacologic approach to a patient who is diagnosed with primary dysmenorrhea could be:
A) acetaminophen.
, B) NSAIDs at the time symptoms begin or onset of menses.
C) NSAIDs prior to the onset of menses.
D) combination acetaminophen and NSAIDs B) NSAIDs at the time symptoms begin or onset of menses.
Explanation:
Pain associated with dysmenorrhea is likely due to prostaglandins which can cause prolonged
contraction of the uterus. This produces uterine ischemia, sometimes termed "uterine angina". NSAIDs
(non-steroidal anti-inflammatory drugs) are prostaglandin synthesis inhibitors. These are usually started
at the onset of menses or onset of symptoms and continued for 2-3 days depending on the symptom
pattern of the patient. There is no demonstrated increase in efficacy when acetaminophen is added or
given alone.
Clue cells are found in patients with:
A) leukemia.
B) bacterial vaginosis.
C) epidermal fungal infections.
D) pneumonia. B) bacterial vaginosis
Explanation:
The hallmark finding in a patient with bacterial vaginosis (BV) is clue cells on microscopic exam. Clue
cells are epithelial cells with adherent bacteria. The most common clinical feature is an unpleasant,
"fishy" smelling discharge that is more noticeable after sexual intercourse. BV can produce a cervicitis. It
is a risk factor for HIV acquisition and transmission. Metronidazole is the most successful therapy. The
usual oral regimen is 500 mg twice daily for 7 days. Alcohol should be avoided.
An 84 year-old female patient is a resident in an assisted living facility. She has early dementia. She
walks daily and has had urinary incontinence for years. Her urinary incontinence is likely to be:
CERTIFICATION TEST LATEST UPDATE NCC
1. A 4 year-old female is brought in to the clinic by her mother who reports that she is constantly
scratching "her private part". The patient states that it itches. On exam, the vagina is red and irritated.
How should the NP proceed?
A) Call child protection for suspected sexual abuse
B) Prescribe a cortisone cream
C) Collect a vaginal swab of the external vagina for microscopic evaluation
D) Prescribe a topical antifungal C) Collect a vaginal swab of the external vagina for microscopic
evaluation
Explanation:
This child has a vaginitis. There are many diagnoses in the differential including pinworms, yeast, contact
irritants from soap or bubble bath, etc. Since the diagnosis is not clear, some evaluation must occur in
order to determine the diagnosis so proper treatment can be initiated. Since the description of the
problem does not indicate what the diagnosis is, it is inappropriate to treat with a cortisone cream or
topical antifungal.
Which form of birth control presents the highest risk to a female patient if she is exposed to a sexually
transmitted disease (STD)?
A) Intrauterine device
B) Progestin only pill
C) Diaphragm
D) Oral contraceptives A) Intrauterine device
,Explanation:
Exposure to an STD always increases the likelihood of contracting an STD. However, the patient is at very
high risk of developing pelvic inflammatory disease when there is an implanted foreign body. An
example of this is an intrauterine device (IUD). The risk is also increased with a diaphragm, but, because
it is not implanted for long periods at a time, the risk is less than with an IUD
What choice below has no precautions for oral contraceptive pill use?
A) Gallbladder disease
B) 5 months post-partum and lactating
C) Blood pressure 160/100
D) Varicose veins D) Varicose veins
Explanation:
One of the major components of gallstones is estrogen. A patient with underlying gallbladder disease
should not receive oral contraceptives (OC) since they will increase estrogen exposure and theoretically,
formation of gallstones. Patients who are less than 6 months post-partum should avoid OCs until they
are 6 months post-partum because OCs can decrease the quantity of breast milk produced.
Hypertension is a contraindication to OC use because of the increased risk of stroke. Varicose veins are
not a contraindication.
Three of the following interventions are appropriately used to prevent osteoporosis after menopause.
Which one is not?
A) Limited alcohol intake
B) Performance of weight-bearing activities for 40 mins. at least 5 days/week
C) Estrogen replacement therapy
D) Adequate calcium & vitamin D intake C) Estrogen replacement therapy
,Explanation:
Prevention of osteoporosis may be optimized by elimination of risk factors and engaging in interventions
that maximize bone density. Good nutrition from infancy throughout adulthood is a major component
of good bone health. Others include engaging in weight-bearing exercises, adequate intake of calcium
and vitamin D, smoking cessation, limiting alcohol consumption to moderate amounts, and avoidance
when possible of medications that may decrease bone density (corticosteroids, anticonvulsants).
Osteoporosis occurs at accelerated rates in women who are post-menopausal. The lack of estrogen can
produce rapid bone loss due to bone resorption. Estrogen replacement is not used to prevent or treat
osteoporosis.
A 50 year-old female believes that she is "menopausal". She complains of "hot flashes" and has not had
menses in 12 months. Which of the following test results may be helpful for confirmation of
menopause?
A) Increased thyroid stimulating hormone
B) Decreased follicle stimulating hormone
C)Hypoestrogenemia
D) Increased follicle stimulating hormone D) Increased follicle stimulating hormone
Explanation:
Follicle stimulating hormone (FSH) begins to rise during menopausal transition. This stage of menopause
begins with variation in menstrual cycle length and ends 12 months after the final menses. If the patient
is older than 45 years and menstrual cycle dysfunction has been ruled out, menopause should be
considered. Possibly the best approach to diagnosing menopause is to ask and observe clinical
manifestations. An elevated FSH is not necessary to make a diagnosis of menopause but is commonly
done in clinical practice. Diagnosis entails a review of her symptoms. Specifically, changes in bleeding
patterns, hot flashes, sleep disturbances, and genitourinary symptoms are characteristic of menopause.
An initial pharmacologic approach to a patient who is diagnosed with primary dysmenorrhea could be:
A) acetaminophen.
, B) NSAIDs at the time symptoms begin or onset of menses.
C) NSAIDs prior to the onset of menses.
D) combination acetaminophen and NSAIDs B) NSAIDs at the time symptoms begin or onset of menses.
Explanation:
Pain associated with dysmenorrhea is likely due to prostaglandins which can cause prolonged
contraction of the uterus. This produces uterine ischemia, sometimes termed "uterine angina". NSAIDs
(non-steroidal anti-inflammatory drugs) are prostaglandin synthesis inhibitors. These are usually started
at the onset of menses or onset of symptoms and continued for 2-3 days depending on the symptom
pattern of the patient. There is no demonstrated increase in efficacy when acetaminophen is added or
given alone.
Clue cells are found in patients with:
A) leukemia.
B) bacterial vaginosis.
C) epidermal fungal infections.
D) pneumonia. B) bacterial vaginosis
Explanation:
The hallmark finding in a patient with bacterial vaginosis (BV) is clue cells on microscopic exam. Clue
cells are epithelial cells with adherent bacteria. The most common clinical feature is an unpleasant,
"fishy" smelling discharge that is more noticeable after sexual intercourse. BV can produce a cervicitis. It
is a risk factor for HIV acquisition and transmission. Metronidazole is the most successful therapy. The
usual oral regimen is 500 mg twice daily for 7 days. Alcohol should be avoided.
An 84 year-old female patient is a resident in an assisted living facility. She has early dementia. She
walks daily and has had urinary incontinence for years. Her urinary incontinence is likely to be:
