Facts read from nccwebsite.org · last checked Nov 7, 2026
Primary care is 13% of the exam. NCC's area spans every body system; this page keeps the part where the patient's sex or life stage changes the answer. Adult chronic disease such as hypertension and diabetes is written up on the family NP pages linked below.
Practice questions
60 questions written to the WHNP-BC outline; each choice is explained once you pick.
NCC splits the area into two parts (guide, p. 11):
Problem recognition, management and referral by system: skin, HEENT, respiratory, cardiovascular, gastrointestinal, genitourinary, musculoskeletal, neurologic and psychiatric, endocrine, hematologic and rheumatologic
Health screening, education and counseling: age-appropriate cancer screening, diabetes, cardiovascular disease and lipids, weight, osteoporosis, healthy lifestyles, substance use, abuse and violence, reproductive life planning, parenting, sexuality, gender identity, preconception counseling and immunization
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15 primary care questions for women's health
0 / 15 answered15 questions
Tap an option: why each one is right or wrong appears under it.
Primary Care · 13%
A 58-year-old postmenopausal woman asks how much calcium she needs. Her recommended total daily calcium intake from diet and supplements is
1,500 mg exceeds the recommendation; more calcium from supplements adds kidney stone risk without further bone benefit.
For women over 50, the recommended total calcium intake from diet and supplements is 1,200 mg a day.
1,000 mg a day is the amount for women 19 to 50; postmenopausal needs are higher.
When screening women for unhealthy alcohol use, NIAAA defines at-risk drinking for women as more than
These numbers exceed the thresholds for women and would miss many women who are already drinking at risk.
NIAAA defines at-risk drinking for women as more than 7 drinks per week or more than 3 on any day; the thresholds are lower than for men because of differences in alcohol metabolism.
These cutoffs are stricter than the NIAAA definition and would label low-risk drinking as unhealthy.
A 38-year-old has a new 2-cm palpable mass in the left breast. The most appropriate initial imaging is
For a palpable breast mass in a woman 30 or older, ACR guidance is diagnostic mammography with targeted ultrasound, and a normal result does not end evaluation of a suspicious lump.
Ultrasound alone is the first test under age 30, where dense tissue limits mammography; at 38 a diagnostic mammogram is needed as well.
A screening mammogram is for women without symptoms; a palpable mass needs a diagnostic study with extra views and ultrasound.
A healthy, nonpregnant 26-year-old has 2 days of dysuria, frequency, and urgency, without fever, flank pain, or vaginal discharge. The most appropriate diagnostic approach is
Routine culture adds cost and delay in uncomplicated cystitis; it is needed for pyelonephritis, pregnancy, treatment failure or early recurrence.
Imaging is not part of the work-up of a single uncomplicated lower urinary tract infection in a young woman.
For a healthy nonpregnant woman with classic cystitis symptoms and no fever, flank pain or discharge, the diagnosis is clinical and treatment can start without a culture (IDSA); cultures are kept for recurrence, failure or complicated cases.
A mother with chronic hepatitis C asks whether she can keep breastfeeding. The nurse practitioner should advise her to
Discarding milk until the infection clears would stop breastfeeding for no reason, since milk does not carry the virus.
HBIG is for infants of mothers with hepatitis B; there is no immune globulin for hepatitis C.
CDC and AAP support breastfeeding with hepatitis C because the virus is not spread through milk; she should stop and discard milk only while nipples are cracked or bleeding.
A 26-year-old woman has moderate inflammatory acne despite 3 months of a topical retinoid and benzoyl peroxide. She also wants to prevent pregnancy. The most appropriate addition is
Isotretinoin is for severe nodular or scarring acne or failure of oral therapy; moderate acne does not need it first, and it requires two forms of contraception.
Topical antibiotics alone breed resistance and add little to a regimen that has already failed; they are used with benzoyl peroxide, not as the escalation step.
Several combined pills are FDA-approved for moderate acne in women who want contraception, and they lower androgen effects on the skin while providing contraception.
A 62-year-old woman is starting raloxifene for osteoporosis. The nurse practitioner should counsel her about an increased risk of
Raloxifene acts like estrogen on the clotting system, so it raises VTE risk about as much as estrogen therapy and is avoided in women with prior clots; it can also worsen hot flashes.
Raloxifene is antiestrogenic in breast tissue and lowers the risk of invasive estrogen receptor–positive breast cancer.
Unlike tamoxifen, raloxifene does not stimulate the endometrium, so it does not raise hyperplasia or endometrial cancer risk.
A 22-year-old woman planning pregnancy has a negative rubella IgG. The nurse practitioner should
MMR is a live vaccine and is contraindicated in pregnancy; waiting until she is pregnant misses the only safe time to give it.
A 6-month wait is longer than needed; CDC shortened the interval to 28 days, and inadvertent vaccination in early pregnancy has caused no congenital rubella.
A rubella-nonimmune woman planning pregnancy gets MMR now and is counseled to avoid pregnancy for 28 days after the live vaccine (CDC/ACIP).
A woman taking a combined oral contraceptive has sudden pleuritic chest pain and dyspnea. Her heart rate is 118 bpm and oxygen saturation is 91%. The nurse practitioner should
Sudden pleuritic chest pain, tachycardia and hypoxia in a woman taking estrogen suggest pulmonary embolism, which needs emergency imaging and treatment.
A D-dimer helps only when pretest probability is low; with hypoxia and tachycardia, waiting for an outpatient result delays care.
Albuterol treats bronchospasm; without wheeze, pleuritic pain and hypoxia on an estrogen product point to embolism.
A 30-year-old woman who takes lisinopril for hypertension says she may try to conceive. The nurse practitioner should counsel her that lisinopril
ACE inhibitors given in the second and third trimesters cause fetal renal failure, oligohydramnios and skull hypoplasia, so a woman who may conceive is switched to labetalol or nifedipine before pregnancy or as soon as it is confirmed.
Calling lisinopril safe ignores its boxed warning for fetal toxicity; continuing it into later pregnancy risks fetal kidney failure.
The established harm is from second- and third-trimester exposure, when fetal kidneys depend on angiotensin; first-trimester data are less consistent.
A 62-year-old postmenopausal woman has newly diagnosed iron deficiency anemia. She has no obvious source of bleeding. The nurse practitioner should
New iron deficiency anemia in a postmenopausal woman is presumed to come from GI blood loss until proven otherwise, so bidirectional endoscopy is needed to exclude cancer.
Treating with iron and rechecking delays finding the bleeding source; postmenopausal iron deficiency needs endoscopy even if the anemia corrects.
A negative stool test does not rule out a bleeding lesion, so it cannot replace endoscopy once iron deficiency is proven.
A 25-year-old originally from Somalia has type III female genital cutting (infibulation) and is planning pregnancy. The nurse practitioner should
Cutting done in childhood to a woman who is now an adult is not a child-protection report; a report applies when a girl is at risk.
Type III cutting can obstruct examination, intercourse and birth, so defibulation is ideally offered before pregnancy or by the second trimester, with nonjudgmental counseling.
Vaginal birth is possible after defibulation, which is done before or during pregnancy or at delivery; infibulation alone is not an indication for cesarean.
A 56-year-old postmenopausal woman has distressing low sexual desire. Genitourinary syndrome, depression and relationship factors have been addressed. The option with the best evidence is
The 2019 global consensus position supports transdermal testosterone, dosed to premenopausal physiologic levels, for postmenopausal hypoactive sexual desire disorder once other causes are addressed.
Oral testosterone products are not recommended for women because of adverse lipid and liver effects; transdermal delivery is preferred.
Flibanserin is FDA-approved only for premenopausal women with hypoactive sexual desire disorder, so it lacks approval and evidence after menopause.
A transgender man starting testosterone therapy should have which laboratory value monitored for the most common serious adverse effect?
Potassium is monitored with spironolactone in feminizing therapy; testosterone does not cause hyperkalemia.
Testosterone stimulates red cell production, and erythrocytosis (hematocrit above about 54 %) is the most common serious adverse effect, so hematocrit is checked at baseline and during therapy.
Prolactin is sometimes followed with estrogen therapy in transgender women; it is not the key safety test for testosterone.
A 26-year-old with heavy menstrual periods has a hemoglobin of 11.2 g/dL, MCV 64 fL, red cell count 5.9 million/µL, normal RDW and ferritin 85 ng/mL. The most likely cause of her microcytosis is
Iron deficiency would lower ferritin (usually below about 30 ng/mL) and the red cell count and widen the RDW; with a ferritin of 85 ng/mL, heavy menses are not the cause of this microcytosis.
A high red cell count with marked microcytosis, a normal RDW, a Mentzer index (MCV divided by RBC count) of about 11 and a normal ferritin point to thalassemia trait; hemoglobin electrophoresis confirms the type, and iron is not given.
Anemia of inflammation needs a chronic inflammatory illness and is usually normocytic or mildly microcytic with a low red cell count, not an MCV of 64 with a high count.
A running total sits here; it fills in after your last pick.
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Where a woman's history changes the answer
Migraine with aura. Combined hormonal contraception is category 4 at any age under the 2024 US MEC; progestin-only methods and IUDs stay available (US MEC 2024).
Cystitis drug choice. IDSA's guideline for uncomplicated cystitis lists nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days where local resistance is below 20%, or a single dose of fosfomycin; fluoroquinolones are held in reserve.
Violence screening. The USPSTF (2025) recommends screening women of reproductive age, including during pregnancy and after birth, for intimate partner violence and referring those who screen positive to ongoing support services.
Treating low bone density. A T-score at or below −2.5, or a hip or vertebral fragility fracture at any T-score, defines osteoporosis, and the American College of Physicians (2023) names bisphosphonates as initial therapy. Who to screen and when: FNP preventive screening.
Folic acid before conception. The USPSTF (2023) advises 0.4 to 0.8 mg daily for anyone who could become pregnant, starting at least a month before conception; a prior neural tube defect calls for a higher dose.
HPV vaccine in adults. ACIP recommends catch-up through age 26 and shared decision-making from 27 to 45; the adolescent schedule is on CPNP-PC health maintenance.
Does the WHNP exam test hypertension and diabetes?
It can, as part of primary care, but at the level of recognition, first-line care and referral, and often in the context of contraception or pregnancy.
Why is primary care only part of the exam?
NCC's outline is built around women's health, so primary care sits beside gynecology, obstetrics, assessment and pharmacology rather than replacing them.