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Quiz Session - Attempts With Random Questions

AMCB CNM Exam Questions

Page 10 of 40

181.

A couple is experiencing infertility. Which statistics are correct regarding infertility?

  • Unexplained infertility occurs in 10% to 25% of cases.

  • Female factor infertility is 50% to 75% of cases.

  • Male factor infertility occurs in 50% to 75% of cases.

  • Combined male and female factors occur in 10% to 25% of cases.

Correct answer: Unexplained infertility occurs in 10% to 25% of cases.

Unexplained infertility occurs in 10% to 25% of all cases of infertility.

Female factor infertility occurs in about 25% to 50% of cases, male factor occurs in approximately 25% to 50%, and combined female and male factors occur in 30% of cases. 

182.

A term newborn has a heart rate of 50 beats per minute despite adequate ventilation. What next intervention is MOST important ?

  • Start chest compressions

  • Continue positive pressure ventilation

  • Administer epinephrine

  • Intubation

Correct answer: Start chest compressions

Chest compressions are indicated when the heart rate is below 60 beats per minute despite adequate ventilation. 

Continuing positive pressure ventilation alone is not sufficient intervention for this patient. Epinephrine is administered if the heart rate remains below 60 beats per minute despite 30 seconds of effective positive pressure ventilation and chest compressions. Intubation is also indicated; however, initiating chest compressions is the immediate next step in resuscitation.

183.

A patient has been diagnosed with incontinence related to multiple sclerosis (MS). What is this type of incontinence?

  • Functional incontinence

  • Stress urinary incontinence

  • Urge incontinence

  • Overflow incontinence

Correct answer: Functional incontinence

In functional incontinence, patients are often aware of the urge to urinate but have a physical condition that interferes with their ability to make it to a restroom. 

Stress urinary incontinence is when urine leaks from the bladder during physical exertion like exercising, coughing, laughing, or sneezing. In urge incontinence, the person may feel that they have to urinate even though their bladder is empty; these cases may be related to a neurologic cause. Overflow incontinence prevents the bladder from completely emptying during urination and may result from a blockage in the bladder. 

184.

Which of the following muscles is NOT part of the levator ani?

  • Bulbocavernosus

  • Pubovaginalis

  • Iliococcygeus

  • Pubococcygeus

Correct answer: Bulbocavernosus

Bulbocavernosus (sphincter vaginalis) is the perineal muscle between the anus and the genitals.

The levator ani includes the iliococcygeus, and the pubococcygeus includes pubovaginalis, puborectalis, and pubococcygeus proper. 

185.

A 52-year-old postmenopausal woman presents with vaginal bleeding. She has been on tamoxifen for breast cancer for two years. What is the MOST concerning potential cause of her bleeding?

  • Endometrial cancer

  • Atrophic vaginitis

  • Uterine fibroids

  • Ovarian cysts

Correct answer: Endometrial cancer

Tamoxifen, although used to treat breast cancer, has a known side effect of increasing the risk of endometrial cancer.

Atrophic vaginitis can cause postmenopausal bleeding, but the risk of endometrial cancer due to tamoxifen is more concerning. Uterine fibroids typically decrease in size after menopause, decreasing the likelihood of them causing vaginal bleeding. Ovarian cysts don't typically cause vaginal bleeding.

186.

A midwife notes a prolonged fetal heart rate (FHR) deceleration immediately following spontaneous rupture of membranes. Which of the following is the midwife's PRIMARY concern? 

  • Umbilical cord prolapse

  • Meconium-stained fluid

  • Placental abruption

  • Uterine rupture

Correct answer: Umbilical cord prolapse

Umbilical cord prolapse is the presumptive diagnosis if a prolonged FHR occurs immediately following the rupture of membranes. 

Meconium-stained fluid is caused by fetal distress. Placental abruption may or may not cause fetal distress, depending on the severity of bleeding. A less severe abruption has a less severe presentation. The primary sign of uterine rupture is a loss of fetal station, not fetal distress with rupture of membranes.

187.

A patient is diagnosed with hemoglobin S trait. Which of the following would the midwife most likely incorporate into the plan of care? 

  • Paternal blood screening and genetic counseling

  • Antenatal testing between 32 and 34 weeks

  • Pharmacological pain management

  • Preparing for intense pain of a sickle cell crisis during labor

Correct answer: Paternal blood screening and genetic counseling

Having a hemoglobin S trait means that the patient carries one gene for sickle cell but is not affected by the disease. However, they could pass that gene to their child; if the father has the gene as well, the child could be affected. Thus, paternal blood screening and genetic counseling are recommended to provide additional information related to sickle cell risk. 

Antenatal testing between 32 and 34 weeks and pharmacological pain management are recommended for those who are affected by sickle cell disease. The intense pain of a sickle cell crisis can occur during labor for those affected by this disease. 

188.

A patient has presented for prenatal labwork at 28 weeks of gestation. Which of the following is not routine bloodwork at this gestation?

  • Rubella titer

  • Complete blood count 

  • RPR or VDRL

  • Gestational diabetes screening

Correct answer:  Rubella titer

The rubella titer is evaluated at the initial obstetric visit and is not routinely repeated in the third trimester. 

A complete blood count is repeated in the third trimester. The rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL), HIV, and HBsAg tests should be repeated. The chlamydia and gonorrhea cultures are also recommended to be repeated in the third trimester. 

Gestational diabetes screening should routinely occur between 24 and 28 weeks.

189.

Which of the following is an indication for magnesium sulfate during labor?

  • Fetal neuroprotection

  • Tocolytic

  • Anti-hypertensive agent

  • Status epilepticus

Correct answer: Fetal neuroprotection

A patient in preterm labor receives magnesium sulfate because it provides neuroprotection to the fetus.

Magnesium sulfate may have tocolytic properties but should not be given as a tocolytic. It is given to preeclamptic patients to reduce the risk of seizure. Magnesium sulfate is not recommended to treat status epileptics at this time.

190.

A 22-year-old client presents for their annual wellness exam. Their history is pertinent for smoking one pack daily, and they are interested in smoking cessation. They are positive on the depression screen and agree to initiate treatment with an antidepressant. =

Which is the BEST antidepressant for the midwife to prescribe?

  • Bupropion 

  • Sertraline

  • Escitalopram

  • Venlafaxine

Correct answer: Bupropion

Bupropion HCl can be used for smoking cessation. Approximately 1 to 2 weeks after the initiation of bupropion, the patient can quit smoking in conjunction with a nicotine patch.

Sertraline is an excellent option with a low side effect profile, but it would not assist with smoking cessation. Escitalopram (SSRI) and venlafaxine (an SNRI) would also not assist with smoking cessation and have not shown as low of a side effect profile as sertraline.

191.

Which of the following is NOT a common symptom of bacterial vaginosis?

  • Moderate to severe itching

  • Fishy odor

  • Greenish-yellow discharge

  • Burning sensation

Correct answer: Moderate to severe itching

Itching is more characteristic of yeast infections and is not typically seen with bacterial vaginosis.

A fishy odor, greenish-yellow discharge, and a burning sensation are all symptoms of bacterial vaginosis, which is caused by an imbalance in vaginal bacteria.

192.

A patient has not had a menstrual cycle for over three months. Which type of diagnosis is MOST appropriate? 

  • Secondary amenorrhea

  • Primary dysmenorrhea

  • Pregnancy

  • Abnormal uterine bleeding

Correct answer: Secondary amenorrhea

Secondary amenorrhea is the absence of menses in a previously normal-cycling person (for the length of at least three cycles). 

Primary dysmenorrhea is pain that begins shortly before the onset of menses. Pregnancy may be a reason for secondary amenorrhea, but it cannot be presumed without diagnostic tests. Amenorrhea is the absence of uterine bleeding.

193.

A midwife is caring for a patient in triage who presents with painful vaginal bleeding, a rigid uterus, and maternal tachycardia. What priority intervention will the midwife MOST likely include in the plan of care? 

  • Prepare for an immediate cesarean section

  • Perform expectant management

  • Admit for hospitalization and bed rest

  • Administer RhoGAM 

Correct answer: Prepare for an immediate cesarean section

Signs of shock, uterine rigidity, and painful vaginal bleeding indicate a complete placental abruption. With a complete placental abruption, the midwife should prepare for an immediate cesarean section and notify the consultant physician.

Expectant management may be acceptable for a marginal placental abruption but not a complete placental abruption. Bed rest and hospitalization are appropriate for painless bleeding with placenta previa. If the patient is unsensitized and Rh-negative, RhoGam is appropriate. However, the priority is proceeding with an immediate cesarean section.

194.

Which of the following is NOT tested in a triple screen?

  • Inhibin A

  • hCG

  • Estriol

  • AFP

Correct answer: Inhibin A

Serological testing—called a triple screen—tests hCG, estriol, and Alpha-FetoProtein (AFP). Inhibin A may be part of a quad screen in which all four analytes are tested. A triple screen, however, does not test inhibin A.

195.

A newborn at one minute has a heart rate of 98, an O2 sat of 69%, a strong cry, active motion, and acrocyanosis. Which of the following CORRECTLY describes this newborn's APGAR score?

  • 8

  • 9

  • 7

  • 6

Correct answer: 8

APGAR scoring uses the following:

  • Heart rate: 0 = absent, 1 = <100, 2 = ≥100
  • Respiratory effort: 0 = absent, 1 = slow or irregular, 2 = strong cry
  • Tone: 0 = flaccid, 1 = flexion of extremities, 2 = active motion
  • Reflex irritability: 0 = no response, 1 = grimace, 2 = strong cry
  • Color: 0 = general cyanosis, 1 = acrocyanosis, 2 = completely pink

Using this scoring, the newborn would receive a score of 8. The patient's O2 sat does not factor into their APGAR score.

196.

A postpartum patient is exhibiting signs of endometritis. Which of the following symptoms is MOST indicative of this condition?

  • Fever and chills

  • Heavy vaginal bleeding

  • Hypertension

  • Severe abdominal pain

Correct answer: Fever and chills

Fever and chills are indicative of an infection, such as endometritis, which is an inflammation of the uterine lining. 

Heavy vaginal bleeding is more indicative of a hemorrhage than endometritis. Hypertension is not a typical symptom of endometritis. Severe abdominal pain can be associated with various conditions, such as endometriosis, and is not specific to endometritis.

197.

A patient with hypothyroidism presents for their initial prenatal visit. Which of the following is true about the management of hypothyroidism? 

  • Draw TSH every 4 to 6 weeks to adjust the drug dose.

  • Thyroid medication is used for short-term therapy.

  • Untreated hypothyroidism is associated with macrosomia.

  • Levothyroxine is not safe to use during the first trimester.

Correct answer: Draw TSH every 4 to 6 weeks to adjust their levothyroxine dose.

Draw TSH every 4 to 6 weeks to adjust the levothyroxine dose as needed to maintain trimester-specific TSH levels. 

Levothyroxine is for long-term use. Untreated hypothyroidism is associated with low birth weight, preterm birth, postpartum hemorrhage, and impaired fetal neuropsychological development. Levothyroxine is safe to use during pregnancy and lactation.

198.

A 6-week lactating postpartum patient presents to the office with complaints of dyspareunia. They have attempted to engage in sexual intercourse in the last week. Each time they engage in foreplay, she feels aroused but experiences entry dyspareunia.  

Which of the following would the midwife include in their plan of care? 

  • Explain that breastfeeding may affect vaginal lubrication.

  • Order estrogen cream as the first line of treating arousal.

  • Encourage the patient to switch to formula feeding to improve arousal.

  • Discuss postpartum uterine enlargement and how it affects dyspareunia.

Correct answer: Explain that breastfeeding may affect vaginal lubrication.

Estrogen cream is an option to prescribe for postpartum dyspareunia, but the midwife should educate the patient regarding changes in vaginal lubrication and encourage using a lubricant first. 

Switching to infant formula is unnecessary. In the postpartum period, the uterus should decrease in size, not enlarge.

199.

Which of the following gestation ranges characterizes very preterm birth?

  • <32 weeks 

  • 32 0/7 weeks through 33 6/7 weeks 

  • 34 0/7 weeks through 36 6/7 weeks

  • 28 0/7 weeks through 33 6/7 weeks

Correct answer: <32 weeks

Very preterm birth is defined as birth from <32 weeks through 33 and 6/7 weeks. Moderately preterm is 32 0/7 weeks through 33 6/7 weeks. Late preterm is 34 0/7 weeks through 36 6/7 weeks.

While 28 to 31 6/7 weeks is included in the classification of very preterm birth, very preterm birth also includes infants born before 28 weeks.

200.

Which of the following is an abnormal mood at 8 days postpartum?

  • Loss of pleasure

  • Labile emotions

  • Periods of crying

  • Giddiness

Correct answer: Loss of pleasure

Loss of pleasure is a sign of depression. 

The baby blues are profound hormone shifts starting around 3 to 5 days and ending at 1 to 2 weeks postpartum. At 8 days postpartum, the baby blues are a physiologic change that affects 80% of postpartum people.

Baby blues are labile emotions, which can be expressed by periods of crying that shift to giddiness. 

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