Family Nurse Practitioner Practice Exam

In the case of a postmenopausal woman experiencing random episodes of vaginal bleeding, the most appropriate management step is to perform an endometrial biopsy. This is because postmenopausal bleeding is considered abnormal and may be indicative of underlying pathologies, including endometrial hyperplasia or endometrial cancer. The endometrial biopsy allows for direct evaluation of the endometrial lining, enabling clinicians to determine the cause of the bleeding and to rule out malignancy effectively.

Other procedures such as a cervical biopsy, Pap smear, or colposcopy are not the primary focus in this scenario. A cervical biopsy targets abnormalities in the cervix and typically follows the identification of cervical lesions. A Pap smear is primarily a screening tool for cervical cancer and is not designed to investigate postmenopausal bleeding. Colposcopy is a procedure used to further investigate abnormal Pap smear results but does not assess the endometrial cavity where bleeding in a postmenopausal woman is likely originating from.

Therefore, endometrial biopsy is the most direct and relevant procedure for addressing the concern of possible endometrial pathology in a patient with postmenopausal bleeding.