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Quiz Session - Attempts With Random Questions

AMCB CNM Exam Questions

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1.

A midwife observes neonatal jaundice. Which of the following is true about physiologic jaundice?

  • The peak total bilirubin remains below 13 mg/dL.

  • Bilirubin rises quickly in the first 24 hours after birth.

  • Physiologic jaundice is visible at more than 10 after birth.

  • The infant should be placed in sunlight to resolve their jaundice.

Correct answer: Peak total bilirubin is below 13 mg/dL.

The following points are true of physiologic jaundice:

  • The peak total bilirubin remains below 13 mg/dL.
  • Bilirubin rises slowly and peaks in the first three to four days after birth.
  • It is not visible after 10 days after birth.

Indirect sunlight may be helpful, but physiologic jaundice will typically resolve on its own unless the cause is pathological. 

2.

A patient presents to discuss labwork. Their bloodwork shows a mean corpuscular volume (MCV) of 74 fL. 

Which of the following diagnoses is most likely?

  • Iron-deficiency anemia 

  • Pernicious anemia

  • Hemolytic anemia

  • Folate-deficiency anemia

Correct answer: Iron-deficiency anemia 

Iron-deficiency anemia is a type of microcytic anemia (MCV < 80 fL), as is thalassemia. 

Pernicious anemia (vitamin B12 deficiency) and folate deficiency anemia are both macrocytic anemia (MCV > 100 fL). Hemolytic anemia is normocytic (MCV of 80 to 100 fL).

3.

A client is moving quickly through labor. Their prenatal record is positive for group B Streptococcus (GBS), but the nurses are having trouble placing an IV. Which of the following is the best option?

  • Assist the nurse with placing the IV

  • Give the antibiotics by intramuscular injection

  • Administer oral antibiotics now and again in four hours

  • Explain that antibiotics cannot prevent GBS disease

Correct answer: Assist the nurse with placing the IV

Oral or intramuscular antibiotic regimens are not comparably effective to intravenous antibiotics in preventing early onset disease. Prophylactic intravenous antibiotics decrease this risk.

4.

A CNM is assessing a postpartum patient who had a cesarean section. Which of the following findings is a PRIORITY to address?

  • Incisional redness

  • Scant lochia

  • Mild incisional pain

  • Soft, non-distended abdomen

Correct answer: Incisional redness

Incisional redness can be indicative of an infection and should be further investigated. 

Scant lochia is normal post-cesarean section. Mild incisional pain is expected post-surgery. A soft, non-distended abdomen is a normal finding.

5.

A CNM is caring for a postpartum patient who is at high risk for endometritis. Which of the following signs should the CNM monitor for?

  • Tachycardia

  • Hypertension

  • Polyuria

  • Hyperreflexia

Correct answer: Tachycardia

Tachycardia can be an early sign of infection such as endometritis and should be monitored closely in high-risk patients. 

Hypertension, polyuria, and hyperreflexia are not typically associated with endometritis or uterine infection.

6.

A non-stress test shows a baseline fetal heart rate of 150 bpm with moderate variability, two accelerations in 20 minutes, and no decelerations or fetal movement. How would you interpret these findings?

  • Reactive

  • Non-reactive

  • Indeterminate

  • Hypoactive

Correct answer: Reactive

A non-stress test is considered reactive if there are at least two accelerations in a 20-minute period, with or without fetal movement, indicating fetal well-being. 

Non-reactive results indicate a lack of sufficient accelerations, suggesting potential fetal compromise. Indeterminate and hypoactive are not standard interpretations of non-stress tests.

7.

A mother with gestational diabetes delivers a 4.5 kg baby. Which of the following conditions is the newborn MOST at risk for?

  • Hypoglycemia

  • Hyperglycemia

  • Hyperbilirubinemia

  • Hypocalcemia

Correct answer: Hypoglycemia

Infants born to mothers with gestational diabetes are at an increased risk for hypoglycemia shortly after birth. This is because they produce extra insulin in response to the mother's high blood sugar levels. After birth, when they no longer receive high glucose levels from the mother, they can become hypoglycemic. 

Hyperglycemia, hyperbilirubinemia, and hypocalcemia are potential complications in newborns but are not directly related to maternal diabetes.

8.

A midwife performs a manual placenta removal. Which of the following interventions will the midwife most likely incorporate into the plan of care?

  • Prophylactic antibiotics

  • Bakri balloon

  • Dilation and curettage

  • Catheterization

Correct answer: Prophylactic antibiotics

Prophylactic antibiotics should be given to prevent a postpartum uterine infection from manual manipulation.

A Bakri balloon is used to tamponade the uterine lining in the case of a postpartum hemorrhage. A dilation and curettage (D&C) procedure is necessary only if products of conception remain. The patient should be catheterized if they are unable to void on their own or there are signs of hemorrhage due to urinary retention.

9.

While talking with a patient, a midwife explains that their diabetes is secondary to another cause. What of the following statements is true about secondary diabetes and its causes?

  •  It can be caused by hormonal changes in pancreatic disease.

  • It is a chronic disease that will not spontaneously resolve.

  • Secondary diabetes cannot be caused by tumors.

  • Secondary diabetes is rarely caused by medication.

Correct answer: Hormonal changes secondary to pancreatic disease may antagonize insulin action.

Secondary diabetes occurs as a reaction to other medical conditions. Hormonal changes secondary to pancreatic disease antagonize insulin action. Pancreatic disease or other endocrinopathies can cause an excess of hormones, such as growth hormone, cortisol, glucagon, and epinephrine. 

Gestational diabetes may spontaneously resolve in the postpartum period. Secondary diabetes can be caused by a noncancerous tumor that develops in an adrenal gland called a pheochromocytoma. Secondary diabetes can be caused by medications like phenytoin, estrogen, and glucocorticoids.

10.

A newborn is noted to have a flat, bluish discoloration on the back and buttocks. What is this finding commonly referred to as?

  • Mongolian spot

  • Petechiae

  • Erythema toxicum

  • Hemangioma

Correct answer: Mongolian spot

Mongolian spots are benign, flat, bluish or blue-gray skin markings that appear at birth or shortly thereafter. They are most commonly found on the lower back or buttocks, especially in babies of Asian, Hispanic, or African descent. These spots are harmless and typically fade by school age. 

Petechiae are tiny red or purple spots caused by broken capillaries and can indicate bleeding or a more serious condition. Erythema toxicum is a common rash in newborns, appearing as red patches with a central white or yellow bump. Hemangiomas are raised birthmarks that grow on the skin's surface.

11.

A G1P0 client is on the labor and delivery unit in spontaneous labor at 9 cm, 100% effaced, and station +1. Four hours ago, they were 6 cm, 80% effaced, and -1 station. The bag of water is intact, and the fetal heart rate is 145 bpm with accelerations and early decelerations. They are drinking coconut water and rocking in the shower. 

Which of the following should be included in the labor management plan?

  • Expectant management

  • Amniotomy

  • Intravenous fluid therapy

  • Oxytocin augmentation

Correct answer: Expectant management

This client's labor pattern is normal and does not require amniotomy or oxytocin augmentation. There is no need for IV hydration if they are orally hydrating.

12.

Which of the following is a potential long-term cardiovascular risk associated with polycystic ovary syndrome (PCOS)?

  • Increased arterial stiffness

  • Decreased LDL cholesterol

  • Increased HDL cholesterol

  • PCOS does not increase potential long-term cardiovascular risks

Correct answer: Increased arterial stiffness

Polycystic ovary syndrome (PCOS) is known to increase potential long-term cardiovascular risks. Specifically, it leads to increased arterial stiffness.

PCOS is associated with increased LDL cholesterol and decreased HDL cholesterol.

13.

A patient presents in active labor, but fetal descent has slowed. The midwife attempts to assess clinical pelvimetry during labor and notes that the posterior pelvis is wider than the anterior pelvis. 

What is the classification of this pelvic type? 

  • Android

  • Anthropoid

  • Platypelloid

  • Gynecoid

Correct answer: Android

An android pelvis is heart-shaped or triangular, and the posterior pelvis is wider than the anterior. It has a poor prognosis for a vaginal birth, requiring operative delivery or cesarean section. 

An anthropoid pelvis is oval-shaped, and the anteroposterior diameter is longer than the transverse diameter. A platypelloid pelvis is a flattened gynecoid-shape and has a wide transverse diameter with a short anteroposterior diameter (with a poor prognosis for vaginal birth). A gynecoid pelvis is round-shaped, as the transverse diameter is only slightly longer than the anteroposterior diameter.

14.

A patient gave birth by vacuum delivery. What are the effects of a vacuum birth on breastfeeding? 

  • The patient may be exhausted and in pain.

  • The newborn may have increased caloric needs.

  • Vacuum delivery may cause the newborn to have caput.

  • It may result in bruising of the infant's facial muscles.

Correct answer: The patient may be exhausted and in pain.

Following an operative vaginal delivery, the patient may be exhausted and in pain. Vacuum-assisted birth may result in cephalohematoma, not caput. The newborn will not have increased caloric needs specifically due to the mode of delivery. Bruising of the infant's facial muscles is more likely to occur with forceps.

15.

Which of the following medications is MOST appropriate for prophylaxis against group B streptococcus (GBS) in labor?

  • Ampicillin

  • Erythromycin

  • Ceftriaxone

  • Clindamycin

Correct answer: Ampicillin

Ampicillin or penicillin is the first-line prophylaxis for Group B Streptococcus (GBS) in labor due to the wide coverage of these antibiotics. 

Erythromycin and ceftriaxone are not first choices for GBS prophylaxis. Clindamycin can be used for penicillin-allergic women if the GBS strain is susceptible; however, it is not the first choice.

16.

Which of the following is a contraindication to HIV preexposure prophylaxis (PrEP)?

  • Renal function disorder

  • First trimester of pregnancy

  • Active hepatitis B infection

  • Injectable drug abuse

Correct answer: Renal function disorders

Preexposure prophylaxis (PrEP) reduces a person's transmission risk by as much as 92%. PrEP usage is contraindicated in those with renal function disorder, and laboratory testing for renal function should occur before initiation and every 6 months thereafter. 

PrEP is FDA-approved for use during pregnancy. PrEP suppresses the replication of HBV but may cause HBV infection to occur if medications are discontinued or missed. PrEP is prescribed for those at increased risk of HIV, including those who abuse intravenous injectable drugs.

17.

A woman in the second stage of labor is noted to have greenish amniotic fluid. What is the primary concern for the fetus?

  • Meconium aspiration

  • Chromosomal abnormalities

  • Intrauterine growth restriction

  • Shoulder dystocia

Correct answer: Meconium aspiration

Greenish amniotic fluid indicates the presence of meconium, which can be aspirated by the fetus, leading to meconium aspiration syndrome. 

The presence of meconium in the amniotic fluid does not significantly increase the risk of chromosomal abnormalities, intrauterine growth restriction, or shoulder dystocia.

18.

Which of the following is MOST expected in a patient with postpartum blues?

  • Labile emotions

  • Constant sadness

  • Suicidal thoughts

  • Feeling disconnected from one's baby

Correct answer: Labile emotions

Postpartum blues are typically characterized by very labile emotions that defy explanation. 

Constant sadness is not typically expected; rather, emotional lability with dramatic swings between happy and sad emotions are likely. Suicidal thoughts or feeling disconnected from one's baby are not typically associated with postpartum blues and may indicate the need for deeper assessments and interventions.

19.

Which of the following is a sign of acromegaly? 

  • Prominent brow ridge

  • Decreased height 

  • Slight jawline

  • Exophthalmos 

Correct answer: Prominent brow ridge

Acromegaly is caused by the excessive secretion of growth hormone, causing increased height, a prominent brow ridge, a prominent jawline, coarse facial features, overbite, and skin thickening on the face. 

Exophthalmos (bulging eyes) often occurs with hyperthyroidism, not acromegaly. 

20.

When considering tocolysis, which of the following is MOST effective?

  • A calcium channel blocker

  • Magnesium sulfate

  • Magnesium sulfate combined with a calcium channel blocker

  • A calcium channel blocker combined with a benzodiazepine

Correct answer: A calcium channel blocker

Calcium channel blockers are considered the most effective type of tocolytic. 

Magnesium sulfate can also be used to achieve tocolysis. Magnesium sulfate should not be combined with a calcium channel blocker due to drug interactions. Benzodiazepines are not utilized as tocolytics.

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