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Quiz Session - Attempts With Random Questions

AMCB CNM Exam Questions

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21.

A midwife is educating a pregnant patient about intimate partner violence (IPV). Which of the following is true?

  • Pregnant people are at increased risk for IPV.

  • One-quarter of all women will experience abuse.

  • The risk of abuse increases with age in women.

  • LGBTQ+ people are at a lower risk of IPV.

Correct answer: Pregnant people are at increased risk for IPV.

Pregnant people have an increased risk for IPV compared to their nonpregnant peers. More than half of all women will experience abuse in their lifetime. The highest risk of IPV is among reproductive-age women. 

LGBTQ+ people experience violence from their peers at higher rates than cisgender, heterosexual people.

22.

When do the vaginal rugae return postpartum?

  • 3 to 4 weeks

  • 6 to 10 weeks

  • 7 days

  • 3 days

Correct answer: 3 to 4 weeks

Vaginal rugae return to the vagina at approximately 3 to 4 weeks postpartum. 

By 6 to 10 weeks postpartum, the vaginal epithelium returns to baseline. At 7 days, the perineal skin should appear healed. By 3 days, the vagina will likely be edematous, bruised, and relaxed with decreased tone.

23.

A student midwife is concerned about the management of the first stage of labor for a low-risk G1P0 patient who is 6 cm dilated and progressing normally. The fetal heart rate is category I, and the midwife is anticipating a spontaneous vaginal birth. The patient is utilizing hydrotherapy for pain management. 

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

  • Intermittent fetal heart rate (FHR) monitoring

  • Initiate an intravenous (IV) catheter

  • Prepare the patient for an epidural

  • Apply external continuous FHR monitoring

Correct answer: Intermittent fetal heart rate (FHR) monitoring

Intermittent fetal heart rate monitoring is appropriate for low-risk pregnancies. 

Nothing in the patient's history demonstrates a requirement for an IV catheter or external continuous FHR monitoring. The patient has not expressed a need for an epidural. 

24.

A community midwife is preparing their bag for a client with an imminent birth and is concerned about a potential postpartum hemorrhage. The midwife wants to bring a medication that is safe at room temperature, can be left with the client, and can be taken over the first 24 hours postpartum. 

Which of the following medications would the midwife prepare?

  • Methylergonovine 0.2 mg every 6 hours

  • Oxytocin 10 mg IM for one dose

  • Misoprostol 1,000 mcg twice daily

  • 15-methyl-F2alpha-prostaglandin 250 mcg once

Correct answer: Methylergonovine 0.2 mg every 6 hours

Oral methylergonovine is an oral medication that can be given over the first 24 hours postpartum. The dosage is typically 0.2 mg PO every 6 hours. 

Oxytocin is given intramuscularly or intravenously for the indications of active management or hemorrhage and should not be left with the client. Misoprostol at 1,000 mcg should not be left with the client, but it may be given during a hemorrhage. Finally, 15-methyl-F2alpha-prostaglandin 250 mcg (Hemabate) is given IM or intramyometrially and must be refrigerated.

25.

A 32-year-old woman presents with chronic pelvic pain. On examination, nodules are felt along the uterosacral ligaments. Which of the following is the MOST likely diagnosis?

  • Endometriosis

  • Uterine fibroids

  • Ovarian cysts

  • Pelvic inflammatory disease

Correct answer: Endometriosis

Endometriosis involves endometrial tissue growing outside the uterus, often leading to nodules or endometriomas on structures like the uterosacral ligaments.

While ovarian cysts can cause pelvic pain, they don't result in nodules on the uterosacral ligaments. Uterine fibroids are benign tumors in the uterus and don't cause nodules on the uterosacral ligaments. Pelvic Inflammatory Disease (PID) is an infection of the female reproductive organs and doesn't typically cause nodules on the uterosacral ligaments.

26.

A patient presents to the midwifery clinic for a contraception visit. They have no contraindications to any medications and are looking for the most effective form of contraception. Which type of contraception is the midwife MOST likely to suggest? 

  • Intrauterine contraception

  • Combination hormonal contraception

  • Depot medroxyprogesterone injection

  • Diaphragm

Correct answer: Intrauterine contraception

Intrauterine contraception (IUC) or an intrauterine device (IUD) results in fewer than 1 pregnancy per 100 users in a year. It is one of the most effective types of contraception, other than the progestin-only implant and permanent sterilization. 

Combination hormonal contraception, a depot medroxyprogesterone injection, and the diaphragm result in 6 to 12 pregnancies per 100 users each year.

27.

Which of the following is true about non-stress tests (NST)?

  • Reactive NSTs have at least two periods of acceleration that meet certain criteria.

  • The parameters for reactivity remain the same from 24 weeks gestation onward.

  • The most common cause of a nonreactive non-stress test is fetal distress.

  • A non-stress test primarily evaluates the frequency of fetal movement.

Correct answer: Reactive NSTs have at least two periods of acceleration that meet certain criteria.

Reactive NSTs have at least two periods of acceleration that meet certain criteria. The parameters for a reactive NST after 32 weeks are at least two increases of 15 beats per minute (bpm) over the baseline, lasting for at least 15 seconds. 

The parameters from 24 weeks to 32 weeks are two increases of 10 bpm for at least 10 seconds. The most common cause of a nonreactive NST is inactivity or fetal sleep cycles. A nonstress test primarily evaluates fetal well-being.

28.

How does cord clamping affect a neonate's extrauterine transition? 

  • Delayed cord clamping provides significant benefits for the neonate.

  • An elevated position on the maternal chest is best during delayed clamping.

  • The cord should be clamped 60 seconds postpartum to avoid polycythemia.

  • The infant should be placed below the vaginal introitus immediately after birth.

Correct answer: Delayed cord clamping provides significant benefits for the neonate.

There are significant benefits of delayed cord clamping for newborns and preterm neonates. A neutral position on the maternal abdomen is preferred, and the infant's position below the introitus theoretically may cause polycythemia. 

29.

A 42-year-old client presents for an annual wellness exam. Their past medical history includes a nontraditional hip fracture, migraines with aura, and a body mass index of 16. Social history is positive for one glass of wine three days per week. 

Which of the following is the priority action?

  • Order a bone mineral density test

  • Encourage healthy weight gain

  • Recommend abstinence from alcohol

  • Prescribe combination oral contraceptives

Correct answer: Order a bone mineral density test

This patient's history of a nontraditional hip fracture and low BMI indicates a risk for osteoporosis, and a bone mineral density test should be ordered. A Z-score from a bone mineral density test compares bone density in a premenopausal woman to an age-, ethnicity-, and gender-matched model. Excessive alcohol use is defined as more than three drinks per week.  Combination oral contraceptive pills would be inappropriate because of this patient's history of migraine with aura.  

Healthy weight gain can be recommended but is not the priority.

30.

A midwife is managing a client with ovulatory dysfunction. What is the MOST likely intervention to include in the plan of care?

  • Clomiphene citrate

  • Vaginal progesterone

  • Hysterosalpingogram

  • Surgical repair

Correct answer: Clomiphene citrate

Clomiphene citrate can induce ovulation in those with ovulatory dysfunction.

Vaginal and intramuscular progesterone is used to treat a luteal phase defect. A hysterosalpingogram is used to evaluate the shape of the uterine cavity and tubal patency. Surgical repair is used to treat varicocele or tubal occlusion (i.e., obstruction).

31.

A patient presents to the office due to urinary frequency and dysuria. Their midwife diagnoses a urinary tract infection (UTI) and educates the patient. 

Which of the following statements made by the patient about UTIs indicates a need for further education?

  • "Since I have a low BMI, I am at increased risk of UTI."

  • "Urethritis is inflammation of the distal urethra."

  • "Cystitis cases are often caused by ascending bacteria."

  • "More than half of all women develop cystitis in their lifetime."

Correct answer: "Since I have a low BMI, I am at increased risk of UTI."

Obesity increases the risk for UTI, not low BMI. 

Urethritis means inflammation of the urethra. The majority of UTIs are caused by bacteria that enter and climb the urinary tract. Over half of all women develop cystitis in their lifetime.

32.

A G2P2 woman who received an epidural gave birth precipitously to a small-for-gestational-age (SGA) infant male. She sustained a third-degree perineal laceration. Which of the following factors increases the risk of urinary retention?

  • Third-degree perineal laceration

  • SGA infant

  • A narrow pelvic outlet

  • Precipitous delivery

Correct answer: A third-degree perineal laceration

Nulliparity, large-for-gestational-age (LGA) infants, and lacerations increase the risk of urinary retention. Epidural anesthesia also increases the risk for urinary retention post-delivery.

A precipitous delivery is not a risk factor for urinary retention. A narrow pelvic outlet is associated with an increased risk of emergency cesarean section (C/S) because of protracted labor but is not associated with urinary retention.

33.

A CNM is caring for a newborn with a diaphragmatic hernia. Which of the following interventions is MOST appropriate?

  • Administer supplemental oxygen

  • Initiate positive pressure mask ventilation

  • Place the baby in a prone position

  • Insert a nasogastric tube and initiate feedings

Correct answer: Administer supplemental oxygen

In diaphragmatic hernia, lung development is compromised, leading to respiratory distress. Administering supplemental oxygen can help in improving oxygenation, which is crucial in managing babies with compromised lung function. 

Initiating positive pressure mask ventilation can be harmful, as it can increase the risk of gastric distention and worsen respiratory distress; intubation is preferred to avoid gastric distention. Placing the baby in a prone position is not a standard intervention for diaphragmatic hernia. Inserting a nasogastric tube is appropriate to decompress the stomach, but initiating feedings is contraindicated.

34.

Which of the following BEST describes the primary purpose of the APGAR score?

  • To quantify the newborn's condition 

  • To predict long-term outcomes

  • To provide a reflection of acidemia

  • To determine the need for resuscitation

Correct answer: To quantify the newborn's condition 

APGAR scores are used to quantify a newborn's condition and their response to resuscitation. 

APGAR scores are poor predictors of long-term outcomes, provide a poor reflection of acidemia, and should not be used to determine the need for resuscitation or how resuscitation is conducted.

35.

A midwife is discussing how the rotation of the fetal head maximizes the anterior-posterior (AP) diameter. Which of the following is the related cardinal movement of labor? 

  • Internal rotation

  • External rotation 

  • Restitution 

  • Flexion

Correct answer: Internal rotation

Internal rotation is the 45-degree rotation to the occiput anterior that allows the head to maximize the anterior-posterior diameter of the gynecoid pelvis. External rotation is when the head rotates 45 degrees and the shoulders complete the rotation to allow delivery in the direct AP diameter. 

Restitution is when the fetal vertex rotates to 45 degrees as the shoulders enter the AP diameter. In flexion, the vertex begins partially flexed and transitions to completely flexed when reaching the pelvic floor to change the presenting diameter of the suboccipitobregmatic to 9.5 cm.

36.

Which of the following conditions is LEAST likely to be tested for in a metabolic screening test?

  • Cytomegalovirus 

  • Congenital hypothyroidism

  • Cystic fibrosis

  • Tyrosinemia

Correct answer: Cytomegalovirus

Cytomegalovirus is an infection that has high mortality rates in newborns and is not a metabolic condition. A metabolic screening test is likely to test for metabolic disorders that include congenital hypothyroidism, cystic fibrosis, and tyrosinemia.

37.

A 50-year-old postmenopausal woman presents with a complaint of vaginal dryness and dyspareunia. Which of the following is the MOST appropriate initial treatment?

  • Lubricants

  • High-dose estrogen therapy

  • Progesterone therapy

  • Selective serotonin reuptake inhibitors (SSRIs)

Correct answer: Lubricants 

Lubricants can be used to alleviate vaginal dryness and dyspareunia in postmenopausal women as a non-hormonal option. 

Estrogen therapy can be used but is not the first-line treatment for postmenopausal dyspareunia and vaginal dryness. Progesterone therapy and Selective Serotonin Reuptake Inhibitors (SSRIs) are not typically used to treat vaginal dryness or dyspareunia.

38.

What is the difference between prenatal genetic screening and prenatal diagnostic testing?

  • Prenatal diagnostics are confirmatory tests of a genetic disorder.

  • Prenatal screening tests use cells from a fetus or placenta.

  • Prenatal diagnostic tests describe the risk of genetic disorders.

  • Carrier screening is not a prenatal screening test.

Correct answer: Prenatal diagnostics are confirmatory tests of a genetic disorder.

Prenatal diagnostics are confirmatory tests of a genetic disorder that use cells from a fetus or placenta. Prenatal screening tests describe the risk of genetic disorders. 

Prenatal genetic screening tests can test the carrier for a genetic disorder, as well as perform prenatal genetic screening by blood and ultrasound.

39.

A midwife notes absent variability and recurrent variable decelerations. Which of the following is the fetal heart rate (FHR) classification? 

  • Category III

  • Category I

  • Category II

  • Unable to determine

Correct answer: Category III

Category III involves absent variability with recurrent variable (or late) decelerations, bradycardia, or a sinusoidal pattern.

Category I and category II do not include absent variability. Category I indicates moderate variability and no variable or late decelerations. Category II may have minimal variability or recurrent variable decelerations but not absent variability with recurrent late or variable decelerations. There is enough information to make a determination.

40.

Which endocrine glands regulate reproductive steroid hormone production by positive and negative feedback loops?

  • Hypothalmic-pituitary-ovarian (H-P-O) axis

  • Sex-hormone binding globulin (SHBG)

  • Ovarian hormones 

  • Anti-Mullerian hormone

Correct answer: Hypothalmic-pituitary-ovarian (H-P-O) axis

Three endocrine organs (hypothalamus, pituitary, and ovaries) coordinate functions related to positive and negative feedback loops to regulate reproductive steroid hormone production.

Sex-hormone binding globulin (SHBG) is a serum protein that binds to sex hormones like estrogen and testosterone in the blood. It transports the hormones and targets specific receptors on tissues. Ovarian hormones include estrogen, progesterone, and androgen. Anti-Mullerian hormone limits the number of primary follicles in the ovaries.

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