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WHNP-BC practice questions

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Question 1Assessment, diagnosis, and clinical decision-making in women's health

A 66-year-old woman has had regular cervical cytology and HPV co-testing with normal results for the past 15 years and no history of CIN 2 or worse. What is the most appropriate recommendation?

  1. Perform colposcopy before discontinuing screening
  2. Continue co-testing every 5 years until age 75
  3. Continue annual cytology indefinitely
  4. Discontinue cervical cancer screening Correct answer.

Explanation

Cervical cancer screening may stop at age 65 when a woman has adequate prior negative screening (for example, three consecutive negative cytology results or two consecutive negative co-tests within the past 10 years, most recent within 5 years) and no history of CIN 2 or worse in the past 25 years. Continued screening beyond that point adds little benefit in this population.

Question 2Assessment, diagnosis, and clinical decision-making in women's health

A 42-year-old woman palpates a firm, 2-cm mass in the right breast. There are no skin changes and no nipple discharge. What is the most appropriate initial step?

  1. Excisional biopsy without any imaging
  2. Diagnostic mammography with targeted ultrasound Correct answer.
  3. Serum CA 15-3 measurement
  4. Reassurance and re-examination in 6 months

Explanation

A palpable breast mass in a woman aged 30 or older is evaluated with diagnostic imaging (mammography plus targeted ultrasound) before tissue sampling, forming the imaging component of triple assessment along with clinical examination and tissue diagnosis. Imaging guides whether biopsy is needed and which method to use.

Question 3Assessment, diagnosis, and clinical decision-making in women's health

A sexually active 22-year-old woman with no symptoms presents for a routine visit. Which screening test is most appropriate?

  1. Serum HSV-2 serology
  2. Saline wet mount microscopy
  3. Chlamydia and gonorrhea NAAT Correct answer.
  4. Annual Pap smear alone

Explanation

Annual screening for chlamydia and gonorrhea by nucleic acid amplification testing is recommended for sexually active women aged 24 and younger, and for older women at increased risk. These infections are often asymptomatic, so symptom-based testing misses cases.

Question 4Assessment, diagnosis, and clinical decision-making in women's health

A 28-year-old woman reports thin, grayish vaginal discharge with a fishy odor. Wet mount shows epithelial cells coated with bacteria, vaginal pH is 5.0, and the whiff test is positive. Which diagnosis is most likely?

  1. Bacterial vaginosis Correct answer.
  2. Vulvovaginal candidiasis
  3. Trichomoniasis
  4. Desquamative inflammatory vaginitis

Explanation

Bacterial vaginosis is diagnosed when at least three Amsel criteria are met: homogeneous discharge, vaginal pH above 4.5, a positive whiff test, and clue cells on wet mount. This patient has all four findings.

Question 5Assessment, diagnosis, and clinical decision-making in women's health

A 26-year-old woman whose last menstrual period was 7 weeks ago has a positive pregnancy test, lower abdominal pain, and spotting. She is hemodynamically stable. Transvaginal ultrasound shows no intrauterine gestational sac and no adnexal mass, and serum hCG is 1,800 mIU/mL. What is the best next step?

  1. Medical abortion with mifepristone and misoprostol
  2. Immediate laparoscopy
  3. Repeat serum hCG in 48 hours Correct answer.
  4. Reassurance and return in 2 weeks

Explanation

When the hCG level is below the discriminatory zone (roughly 1,500 to 3,500 mIU/mL), an empty uterus may simply reflect a pregnancy too early to see, so the location of the pregnancy is unknown. Serial hCG measurements with repeat ultrasound distinguish a viable intrauterine pregnancy from an ectopic or nonviable pregnancy.

Question 6Assessment, diagnosis, and clinical decision-making in women's health

A 24-year-old woman has oligomenorrhea, hirsutism, and acne, with elevated total testosterone and no other identified cause. Which combination of findings best supports a diagnosis of polycystic ovary syndrome?

  1. Elevated FSH and hot flashes
  2. Elevated prolactin with galactorrhea
  3. Regular menses with a single ovarian cyst
  4. Oligo-ovulation and hirsutism Correct answer.

Explanation

The Rotterdam criteria require two of three findings: oligo-ovulation or anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound. Oligo-ovulation plus clinical hyperandrogenism satisfies the criteria after other disorders such as thyroid disease and hyperprolactinemia are excluded.

Question 7Assessment, diagnosis, and clinical decision-making in women's health

A 58-year-old woman who is 4 years postmenopausal reports a new episode of vaginal bleeding. She takes no hormonal therapy. What is the most appropriate next step?

  1. Reassurance that atrophic vaginitis is the likely cause
  2. Endometrial biopsy Correct answer.
  3. Immediate hysterectomy
  4. Repeat evaluation in 6 months

Explanation

Postmenopausal bleeding is considered endometrial cancer until proven otherwise and requires tissue evaluation, with endometrial biopsy as the first-line test. Transvaginal ultrasound may be used as an adjunct, but a reassuring thickness does not replace tissue sampling in this setting.

Question 8Assessment, diagnosis, and clinical decision-making in women's health

Which test is the reference standard for diagnosing endometriosis?

  1. Transvaginal ultrasound
  2. Pelvic MRI
  3. Laparoscopy with biopsy Correct answer.
  4. Serum CA-125

Explanation

Direct visualization of endometriotic implants at laparoscopy, ideally with histologic confirmation, remains the reference standard for diagnosis. Imaging and tumor markers can support the clinical diagnosis but cannot exclude peritoneal disease.

Question 9Assessment, diagnosis, and clinical decision-making in women's health

A 22-year-old woman has sudden severe right-sided pelvic pain with nausea and vomiting. Examination reveals a tender adnexal mass about 8 cm in size, and the pregnancy test is negative. Which imaging study should be obtained first?

  1. Pelvic ultrasound with Doppler Correct answer.
  2. Hysterosalpingography
  3. MRI of the pelvis in 6 weeks
  4. Abdominal radiograph

Explanation

Sudden severe unilateral pelvic pain with nausea, vomiting, and an adnexal mass suggests ovarian torsion, a surgical emergency. Pelvic ultrasound with Doppler is the first-line study to assess ovarian size, edema, and blood flow and to exclude other causes.

Question 10Assessment, diagnosis, and clinical decision-making in women's health

A previously normotensive woman at 34 weeks' gestation has a blood pressure of 150/95 mmHg on two occasions 6 hours apart, 2+ proteinuria, and a platelet count of 95,000/mm³. Which statement best characterizes these findings?

  1. BP ≥140/90 twice plus proteinuria or end-organ dysfunction Correct answer.
  2. Generalized seizure in a woman with new hypertension
  3. Isolated BP of 140/90 on one reading with edema
  4. BP 130/85 with mild ankle edema

Explanation

Preeclampsia is new hypertension after 20 weeks' gestation accompanied by proteinuria or evidence of end-organ dysfunction such as thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms. A single elevated reading or isolated edema is insufficient for the diagnosis.

Question 11Assessment, diagnosis, and clinical decision-making in women's health

At what gestational age is routine screening for gestational diabetes performed in an average-risk pregnant woman?

  1. 24 to 28 weeks Correct answer.
  2. At the first prenatal visit
  3. 32 to 34 weeks
  4. 16 to 18 weeks

Explanation

Universal screening for gestational diabetes is performed at 24 to 28 weeks' gestation with a one- or two-step glucose test. Earlier testing is reserved for women with risk factors such as prior gestational diabetes, obesity, or polycystic ovary syndrome.

Question 12Assessment, diagnosis, and clinical decision-making in women's health

An unsensitized Rh-negative woman with an Rh-positive partner is receiving routine antenatal care. When should anti-D immune globulin be given prophylactically?

  1. At delivery only
  2. Only if the father is confirmed to be Rh positive
  3. At 28 weeks and within 72 hours after delivery Correct answer.
  4. At 12 weeks only

Explanation

Routine antenatal prophylaxis with anti-D immune globulin is given at about 28 weeks' gestation, and a second dose is given within 72 hours of delivery if the newborn is Rh positive. Additional doses are indicated after sensitizing events such as amniocentesis, vaginal bleeding, or abdominal trauma.

Question 13Assessment, diagnosis, and clinical decision-making in women's health

Which condition is an absolute contraindication to combined oral contraceptive use?

  1. Migraine with aura Correct answer.
  2. History of gestational diabetes
  3. Migraine without aura
  4. Well-controlled hypertension at age 40

Explanation

Migraine with focal neurologic symptoms is a WHO MEC category 4 condition for combined hormonal contraception because of the increased risk of ischemic stroke. Estrogen-containing methods should be avoided in these women.

Question 14Assessment, diagnosis, and clinical decision-making in women's health

Which method is the most effective form of emergency contraception?

  1. Copper intrauterine device placed within 5 days Correct answer.
  2. Levonorgestrel 1.5 mg orally
  3. Yuzpe regimen of combined oral contraceptives
  4. Ulipristal acetate 30 mg orally

Explanation

The copper intrauterine device is the most effective emergency contraceptive, with a failure rate well under 1%, and it also provides ongoing contraception. It can be inserted up to 5 days after unprotected intercourse.

Question 15Assessment, diagnosis, and clinical decision-making in women's health

A 52-year-old woman reports 14 months of amenorrhea and vasomotor symptoms. She has a uterus, takes no medications, and has no other symptoms. What is the most appropriate way to confirm the diagnosis of menopause?

  1. Serial FSH levels every three months
  2. Progesterone challenge test
  3. Clinical diagnosis alone; no testing needed Correct answer.
  4. Endometrial biopsy

Explanation

Menopause is a clinical diagnosis defined by 12 months of amenorrhea in a woman aged 45 or older without another cause, accompanied by typical symptoms. Follicle-stimulating hormone testing is not required and serial levels add no useful information.

Question 16Assessment, diagnosis, and clinical decision-making in women's health

At what age should routine osteoporosis screening with dual-energy x-ray absorptiometry begin for a woman with no additional risk factors?

  1. 70 years
  2. 65 years Correct answer.
  3. 75 years
  4. 50 years

Explanation

Routine bone density screening with DXA is recommended for all women at age 65. Earlier screening is reserved for women with risk factors such as prior fracture, low body weight, smoking, or a strong family history.

Question 17Assessment, diagnosis, and clinical decision-making in women's health

A 32-year-old woman has been having regular unprotected intercourse for 1 year without conceiving. How is infertility defined in this situation?

  1. 12 months of unprotected intercourse without conception Correct answer.
  2. 6 months of unprotected intercourse without conception
  3. 3 months of any intercourse
  4. 24 months of unprotected intercourse without conception

Explanation

Infertility is defined as 12 months of regular unprotected intercourse without conception. Evaluation is offered sooner, after 6 months, for women aged 35 or older and at any time when known risk factors such as amenorrhea or prior pelvic inflammatory disease are present.

Question 18Assessment, diagnosis, and clinical decision-making in women's health

Which finding is part of the minimum clinical criteria for diagnosing pelvic inflammatory disease?

  1. Cervical motion, uterine, or adnexal tenderness Correct answer.
  2. Elevated peripheral white blood cell count
  3. Temperature greater than 38.3°C
  4. Positive NAAT for chlamydia

Explanation

The minimum criteria for pelvic inflammatory disease are cervical motion tenderness, uterine tenderness, or adnexal tenderness in a sexually active young woman with pelvic pain and no other identified cause. Empiric treatment is started when these criteria are present, even before laboratory results return.

Question 19Assessment, diagnosis, and clinical decision-making in women's health

A 30-year-old woman has frothy yellow-green discharge and a punctate cervical appearance. Wet mount shows motile flagellated organisms. Which treatment is appropriate?

  1. Doxycycline 100 mg orally twice daily for 7 days
  2. Azithromycin 1 g orally once
  3. Fluconazole 150 mg orally once
  4. Metronidazole 500 mg orally twice daily for 7 days Correct answer.

Explanation

Trichomoniasis is treated with metronidazole or tinidazole, and sexual partners should be treated as well. A 7-day course of metronidazole 500 mg twice daily is one recommended regimen, with a single 2-g dose as an alternative.

Question 20Assessment, diagnosis, and clinical decision-making in women's health

A 30-year-old woman has a screening result that is positive for HPV 16, and reflex cytology is negative for intraepithelial lesion or malignancy. What is the next step?

  1. Repeat co-testing in 1 year
  2. Colposcopy Correct answer.
  3. Loop electrosurgical excision procedure
  4. Repeat cytology in 3 years

Explanation

Under current risk-based management, a positive test for HPV 16 or 18 warrants colposcopy regardless of the cytology result because of the high risk of underlying high-grade disease. Neither repeat testing nor immediate excision is the appropriate initial step.

Question 21Assessment, diagnosis, and clinical decision-making in women's health

A 35-year-old woman has an ASC-US result on cervical cytology, and reflex HPV testing is negative. What is the recommended follow-up?

  1. Repeat co-testing in 3 years Correct answer.
  2. Repeat cytology in 6 months
  3. Colposcopy now
  4. Cryotherapy of the cervix

Explanation

ASC-US cytology with a negative HPV result carries a low risk of high-grade disease, so the patient returns to routine screening with co-testing in 3 years. More aggressive evaluation exposes her to unnecessary procedures.

Question 22Assessment, diagnosis, and clinical decision-making in women's health

A 44-year-old woman has heavy menstrual bleeding and a bulky, enlarged uterus; ultrasound shows multiple intramural fibroids. Which initial management is most appropriate for control of bleeding?

  1. Immediate endometrial ablation
  2. Levonorgestrel intrauterine device or NSAIDs Correct answer.
  3. Hysterectomy
  4. GnRH agonist therapy indefinitely

Explanation

For fibroid-related heavy bleeding without a pressing indication for surgery, medical therapy such as a levonorgestrel intrauterine device, NSAIDs, tranexamic acid, or hormonal treatment is first-line. Surgery is reserved for refractory symptoms, rapid growth, or fertility-related indications.

Question 23Assessment, diagnosis, and clinical decision-making in women's health

A 55-year-old woman reports leaking urine when she coughs, sneezes, or laughs. She denies urgency, frequency, and nocturia. Which type of incontinence is most likely?

  1. Urge incontinence
  2. Functional incontinence
  3. Overflow incontinence
  4. Stress incontinence Correct answer.

Explanation

Stress incontinence is leakage with increased intra-abdominal pressure such as coughing, sneezing, laughing, or lifting, and it occurs without urgency. It results from urethral hypermobility or intrinsic sphincter deficiency.

Question 24Assessment, diagnosis, and clinical decision-making in women's health

What is the recommended approach to screening for intimate partner violence in a women's health practice?

  1. Screening only if the patient volunteers a history of abuse
  2. Routine screening at periodic visits and prenatal care Correct answer.
  3. Screening only when visible injuries are present
  4. Declining to screen because screening causes harm

Explanation

Professional guidelines recommend routine screening for intimate partner violence at periodic visits and in settings such as prenatal, family planning, and emergency care. Screening only for injuries or disclosure misses most affected women, because abuse often occurs without visible signs.

Question 25Assessment, diagnosis, and clinical decision-making in women's health

A 26-year-old woman at 12 weeks' gestation reports 2 weeks of depressed mood, anhedonia, and sleep disturbance. Which instrument is most appropriate for initial screening?

  1. Mini-Mental State Examination
  2. Patient Health Questionnaire-9 Correct answer.
  3. CAGE questionnaire
  4. Generalized Anxiety Disorder-7

Explanation

The Patient Health Questionnaire-9 is a validated tool for depression screening and is widely used in pregnancy and the postpartum period; the Edinburgh Postnatal Depression Scale is an alternative. A positive screen prompts further assessment for diagnosis and treatment.

Question 26Assessment, diagnosis, and clinical decision-making in women's health

At what age should average-risk cervical cancer screening with cytology begin for a woman who is not immunocompromised?

  1. At age 25
  2. At age 21 Correct answer.
  3. At age 30
  4. At age 18 or at first intercourse

Explanation

Average-risk cervical cancer screening begins at age 21, regardless of age at first intercourse. Screening before 21 is not recommended because cervical cancer is rare and transient HPV infections are common in adolescents.

Question 27Assessment, diagnosis, and clinical decision-making in women's health

A woman delivers a term infant and has heavy vaginal bleeding within the first hour postpartum. What is the most common cause of postpartum hemorrhage?

  1. Coagulopathy
  2. Genital tract laceration
  3. Retained placental tissue
  4. Uterine atony Correct answer.

Explanation

Uterine atony is the most common cause of postpartum hemorrhage, accounting for roughly 70% to 80% of cases. Initial management includes uterine massage and uterotonics.

Question 28Assessment, diagnosis, and clinical decision-making in women's health

A 28-year-old woman reports a thin gray vaginal discharge with a fishy odor. Saline microscopy shows vaginal epithelial cells coated with adherent bacteria. Which finding is most consistent with bacterial vaginosis?

  1. Budding yeast with pseudohyphae
  2. Clue cells Correct answer.
  3. Increased polymorphonuclear cells
  4. Motile flagellated protozoa

Explanation

Clue cells are vaginal epithelial cells covered with adherent bacteria and are the microscopic hallmark of bacterial vaginosis. Diagnosis also relies on thin gray discharge, pH greater than 4.5, a positive whiff test, or clue cells.

Question 29Assessment, diagnosis, and clinical decision-making in women's health

A 22-year-old sexually active woman has no symptoms and requests screening. According to guidelines, how often should she be screened for chlamydia?

  1. Only if symptoms develop
  2. Once at age 21
  3. Every 3 years until age 30
  4. Annually through age 24 Correct answer.

Explanation

Annual chlamydia screening is recommended for all sexually active women age 24 or younger, and for older women with risk factors. Screening is done regardless of symptoms because most infections are asymptomatic.

Question 30Assessment, diagnosis, and clinical decision-making in women's health

Using Naegele's rule, what is the estimated date of delivery for a woman whose last menstrual period began on June 5?

  1. March 19 of the following year
  2. April 12 of the following year
  3. March 12 of the following year Correct answer.
  4. March 5 of the following year

Explanation

Naegele's rule adds 7 days to the first day of the last menstrual period, subtracts 3 months, and adds 1 year. June 5 plus 7 days is June 12; minus 3 months gives March 12 of the following year.

Question 31Assessment, diagnosis, and clinical decision-making in women's health

At what gestational age should routine group B streptococcus screening be performed?

  1. 24 to 28 weeks
  2. At the time of admission for delivery only
  3. 18 to 22 weeks
  4. 36 0/7 to 37 6/7 weeks Correct answer.

Explanation

Routine group B streptococcus screening is performed at 36 0/7 to 37 6/7 weeks' gestation, when culture results best predict colonization at delivery. Earlier screening is not routinely recommended.

Question 32Assessment, diagnosis, and clinical decision-making in women's health

A 19-year-old woman has crampy pelvic pain with each menses that begins on day 1 and lasts 2 days. She has no dyspareunia and a normal pelvic exam. What is the most appropriate initial treatment?

  1. Diagnostic laparoscopy
  2. Opioid analgesics as needed
  3. NSAIDs beginning before menses Correct answer.
  4. Empiric antibiotic therapy

Explanation

Primary dysmenorrhea is caused by prostaglandin-mediated uterine contractions. NSAIDs taken before the onset of menses and continued for the first 1 to 2 days are first-line therapy.

Question 33Assessment, diagnosis, and clinical decision-making in women's health

A 30-year-old woman has vulvar pruritus and a thick white discharge. Vaginal pH is 4.0, and KOH microscopy shows budding yeast with pseudohyphae. What is the most likely diagnosis?

  1. Bacterial vaginosis
  2. Trichomoniasis
  3. Atrophic vaginitis
  4. Vulvovaginal candidiasis Correct answer.

Explanation

A normal vaginal pH with budding yeast and pseudohyphae on KOH microscopy is diagnostic of vulvovaginal candidiasis. Pruritus and thick white discharge are typical.

Question 34Assessment, diagnosis, and clinical decision-making in women's health

A 24-year-old woman at 16 weeks' gestation has a urine culture growing more than 100,000 CFU/mL of E. coli. She has no urinary symptoms. What is the recommended management?

  1. Reassure her that no treatment is needed
  2. Begin suppressive therapy for the remainder of pregnancy
  3. Repeat the culture in 2 weeks
  4. Treat with an appropriate antibiotic Correct answer.

Explanation

Asymptomatic bacteriuria in pregnancy is treated with antibiotics to reduce the risk of pyelonephritis and preterm birth. A repeat culture without treatment is not appropriate.

Question 35Assessment, diagnosis, and clinical decision-making in women's health

A 48-year-old woman reports 6 months of irregular, heavy uterine bleeding. She has no other symptoms and a normal pelvic exam. What is the next step in evaluation?

  1. Transvaginal ultrasound only
  2. Endometrial biopsy Correct answer.
  3. Pap smear
  4. Observation for 3 more months

Explanation

Abnormal uterine bleeding in women age 45 and older requires endometrial sampling to evaluate for endometrial hyperplasia or cancer. Transvaginal ultrasound alone cannot exclude malignancy.

Question 36Assessment, diagnosis, and clinical decision-making in women's health

A 30-year-old woman has a cervical cytology result of atypical glandular cells. What is the recommended initial evaluation?

  1. Immediate loop electrosurgical excision
  2. HPV testing alone
  3. Colposcopy with endocervical sampling Correct answer.
  4. Repeat cytology in 6 months

Explanation

Atypical glandular cells on cytology require colposcopy with endocervical sampling because the abnormality may reflect cervical, endometrial, or adnexal disease. Women age 35 and older or with risk factors also undergo endometrial sampling.

Question 37Health promotion, disease prevention, and well-woman primary care

A 28-year-old woman with no chronic medical conditions is planning a pregnancy within the next year. Which supplement should the nurse practitioner recommend?

  1. Folic acid 4 mg daily
  2. Calcium carbonate 1200 mg daily
  3. Folic acid 400 mcg daily Correct answer.
  4. Ferrous sulfate 65 mg daily

Explanation

A daily folic acid intake of 400 mcg begun at least one month before conception reduces the risk of neural tube defects. The 4 mg dose is reserved for women with a prior pregnancy affected by a neural tube defect or other high-risk conditions.

Question 38Health promotion, disease prevention, and well-woman primary care

At what age should cervical cancer screening begin for an average-risk woman?

  1. 21 years Correct answer.
  2. 30 years
  3. 18 years
  4. 25 years

Explanation

Cytology-based screening begins at age 21 regardless of age at sexual debut. Screening before 21 is not recommended because cervical cancer is rare in this age group and HPV infections usually clear spontaneously.

Question 39Health promotion, disease prevention, and well-woman primary care

Annual screening for chlamydia is recommended for sexually active women through which age?

  1. 18 years
  2. 35 years and younger
  3. 24 years and younger Correct answer.
  4. 20 years

Explanation

Annual chlamydia and gonorrhea screening is recommended for all sexually active women aged 24 and younger, and for older women with risk factors such as a new partner or multiple partners.

Question 40Health promotion, disease prevention, and well-woman primary care

Tdap vaccination during pregnancy should be administered during which window?

  1. Immediately postpartum
  2. Between 27 and 36 weeks of gestation Correct answer.
  3. Before 13 weeks of gestation
  4. Between 13 and 20 weeks of gestation

Explanation

Tdap is given during weeks 27 through 36 of every pregnancy to maximize transplacental transfer of pertussis antibodies to the newborn. Postpartum vaccination does not provide the same passive protection.

Question 41Health promotion, disease prevention, and well-woman primary care

How much moderate-intensity aerobic activity should a healthy adult woman accumulate each week?

  1. 300 minutes at minimum
  2. 150 minutes Correct answer.
  3. 75 minutes
  4. 60 minutes

Explanation

National guidelines recommend at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity weekly, plus muscle-strengthening activity on 2 or more days.

Question 42Health promotion, disease prevention, and well-woman primary care

At what age is the HPV vaccine routinely recommended for girls?

  1. 18 years
  2. 11 to 12 years Correct answer.
  3. 15 years
  4. 9 years

Explanation

Routine HPV vaccination is recommended at ages 11 to 12, though the series may be started as early as age 9. Catch-up vaccination is recommended through age 26, with shared decision-making from 27 to 45.

Question 43Health promotion, disease prevention, and well-woman primary care

Which instrument is the recommended initial screen for depression at a well-woman visit?

  1. Mini-Mental State Examination
  2. CAGE questionnaire
  3. GAD-7
  4. PHQ-2 Correct answer.

Explanation

The PHQ-2 is the brief validated first-step screen, with a positive result prompting the full PHQ-9 to assess severity. All adults should be screened for depression when systems are in place for follow-up.

Question 44Health promotion, disease prevention, and well-woman primary care

Which screening tool best identifies unhealthy alcohol use in a nonpregnant adult woman?

  1. PHQ-9
  2. AUDIT-C Correct answer.
  3. DAST-10
  4. CRAFFT

Explanation

The AUDIT-C is a brief validated instrument for detecting unhealthy alcohol use in adults. The CRAFFT is designed for adolescents and the DAST-10 screens for drug use rather than alcohol.

Question 45Health promotion, disease prevention, and well-woman primary care

At what age should average-risk colorectal cancer screening begin?

  1. 50 years
  2. 60 years
  3. 55 years
  4. 45 years Correct answer.

Explanation

Current guidance lowers the start of colorectal cancer screening to age 45 for average-risk adults, prompted by rising incidence in younger adults. Screening continues through age 75, with individualized decisions thereafter.

Question 46Health promotion, disease prevention, and well-woman primary care

At what age is routine bone mineral density testing recommended for average-risk women?

  1. 50 years
  2. 70 years
  3. 65 years Correct answer.
  4. 75 years

Explanation

DXA screening is recommended for all women aged 65 and older, and earlier for younger postmenopausal women with risk factors or a FRAX-estimated risk that warrants treatment.

Question 47Health promotion, disease prevention, and well-woman primary care

Which patient meets current criteria for annual low-dose CT lung cancer screening?

  1. A 60-year-old never-smoker with a family history of lung cancer
  2. A 75-year-old with a 15 pack-year history who quit 20 years ago
  3. A 62-year-old current smoker with a 25 pack-year history Correct answer.
  4. A 45-year-old who quit 20 years ago with a 10 pack-year history

Explanation

Screening is recommended for adults aged 50 to 80 with at least a 20 pack-year history who currently smoke or quit within the past 15 years. The 62-year-old current smoker with 25 pack-years meets every criterion.

Question 48Health promotion, disease prevention, and well-woman primary care

Hepatitis C antibody screening is recommended for which population?

  1. All adults aged 18 to 79 at least once Correct answer.
  2. Only adults with a history of injection drug use
  3. Only adults born between 1945 and 1965
  4. Only pregnant women at delivery

Explanation

Universal one-time hepatitis C screening is recommended for all adults aged 18 to 79, in addition to risk-based testing at any age. Birth-cohort testing alone would miss a large share of infections.

Question 49Health promotion, disease prevention, and well-woman primary care

Human immunodeficiency virus screening should be offered to which patients?

  1. All patients aged 15 to 65 at least once Correct answer.
  2. Only pregnant patients
  3. Only patients who specifically request testing
  4. Only patients with identified behavioral risk factors

Explanation

Opt-out HIV screening is recommended for all patients aged 15 to 65 at least once, with more frequent testing for those at ongoing risk. Risk-based or request-only testing fails to identify a substantial proportion of infections.

Question 50Health promotion, disease prevention, and well-woman primary care

Which history finding warrants referral for BRCA1/BRCA2 genetic counseling and testing?

  1. Two first-degree relatives with breast cancer before age 50 Correct answer.
  2. A mother with type 2 diabetes diagnosed at age 55
  3. A personal history of cervical cancer at age 38
  4. Ashkenazi Jewish ancestry with no family history of cancer

Explanation

Multiple relatives with early-onset breast cancer is a recognized criterion for genetic risk evaluation. Ancestry alone, without personal or family cancer history, does not by itself meet referral criteria.