×

Quiz Session - Attempts With Random Questions

AMCB CNM Exam Questions

Page 3 of 40

41.

A newborn's preductal peripheral capillary oxygen saturation levels remain constant at 66% for the first three minutes after birth. Which of the following is CORRECT about this reading?

  • Levels should steadily increase each minute for the first five minutes

  • Levels should increase within five minutes after birth

  • Levels should reach 85% three minutes after birth

  • This is a normal finding

Correct answer: Levels should steadily increase each minute for the first five minutes

Preductal peripheral capillary oxygen saturation levels should increase each minute for the first five minutes. One minute after birth, they should be 60% to 65%. Two minutes afterwards, they should be 65% to 70%. Three minutes afterwards, they should be 70% to 75%. 

Levels should increase within five minutes after birth. However, it is more correct to say they should increase each minute. Levels should reach 75%, not 85%, three minutes after birth. This patient's levels are not normal.

42.

The mother of a child born with Down syndrome asks the CNM how it will affect the child's intellect. Which of the following BEST guides the CNM's response?

  • "The degree of intellectual impairment varies significantly among individuals."

  • "The degree of intellectual impairment correlates with the extent of deformities."

  • "The degree of intellectual impairment correlates with the extent of associated cardiac anomalies."

  • "Intellectual impairment with Down syndrome is quite predictable."

Correct answer: "The degree of intellectual impairment varies significantly among individuals."

The degree of intellectual impairment varies significantly among individuals with Down syndrome so cannot be predicted. 

There is not a strong correlation between the degree of intellectual impairment and the extent of deformities or cardiac anomalies. 

43.

A client presents to a prenatal clinic at 7 weeks of gestation, and the midwife notes a bluish discoloration of the cervix. What is this sign called?

  • Chadwick sign

  • Goodell sign

  • Hegar sign

  • Cervical cyanosis

Correct answer: Chadwick sign

The Chadwick sign is a bluish discoloration of the cervix and vagina that occurs between 6 and 8 weeks of gestation. 

The Goodell sign involves softening of the cervix, and the Hegar sign involves softening of the lower uterine segment.  

44.

Which of the following would NOT be a contraindication to tocolysis?

  • Spontaneous rupture of membranes

  • Chroioamnionitis

  • Placental abruption

  • Placenta previa

Correct answer: Spontaneous rupture of membranes

Tocolysis is used to delay birth and allows providers to provide steriods to hasten lung maturity. Spontaneous rupture of membranes does not contraindicate tocolysis and may initiate the onset of labor, requiring tocolysis. 

Chroioamnionitis, placental abruption, and placenta previa are all contraindications to tocolysis in most circumstances.

45.

Which of the following is the MOST effective tocolytic?

  • Nifedipine

  • Terbutaline

  • Magnesium sulfate 

  • Ethanol

Correct answer: Nifedipine

Nifedipine is a calcium channel blocker that is the most effective and common tocolytic.

Terbutaline is a drug that is no longer used as a tocolytic. Magnesium sulfate acts on vascular smooth muscle to cause vasodilation but is ineffective as a tocolytic; instead, it is recommended for neuroprotection. Ethanol was used as a tocolytic decades ago but is ineffective.

46.

Which of the following is the MOST common risk factor for ectopic pregnancy?

  • Pelvic inflammatory disease

  • Previous ectopic pregnancy

  • Intrauterine device use

  • Advanced maternal age

Correct answer: Pelvic inflammatory disease

Pelvic inflammatory disease (PID) can cause scarring of the fallopian tubes, increasing the risk of ectopic pregnancy. 

A previous ectopic pregnancy does increase the risk of a subsequent ectopic pregnancy, but PID is a more common risk factor in the general population. Intrauterine device (IUD) use is associated with a decreased risk of pregnancy overall. If a pregnancy does occur with an IUD in place, there's an increased risk of it being ectopic, but this is less common than PID-related ectopic pregnancies. Advanced maternal age is associated with many pregnancy complications, but it's not a direct risk factor for ectopic pregnancy.

47.

A 32-year-old woman presents with a 6-month history of irregular menstrual cycles. She reports occasional hot flashes and night sweats. Which of the following is the MOST likely diagnosis?

  • Premature ovarian insufficiency

  • Polycystic ovary syndrome (PCOS)

  • Perimenopause

  • Hyperprolactinemia

Correct answer: Premature ovarian insufficiency

Premature Ovarian Insufficiency (POI) refers to the loss of ovarian function before age 40. Women with POI may have irregular or skipped periods and might experience menopausal symptoms such as hot flashes. The condition can be diagnosed through elevated FSH levels and low estrogen levels.

PolyCystic Ovary Syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS might have prolonged or infrequent menstrual periods and excess male hormone (androgen) levels, but they don't typically experience hot flashes. Perimenopause is the transition phase before menopause. While it can cause hot flashes, it usually starts in a woman's late 40s and is less likely to be the cause in a 32-year-old. Hyperprolactinemia refers to elevated levels of prolactin in the blood. While it can cause menstrual irregularities, it doesn't typically cause hot flashes.

48.

A 26-year-old woman presents with amenorrhea and is found to have normal FSH and LH levels but low estradiol levels. Which of the following is the MOST likely potential cause for her condition?

  • Ovarian resistance syndrome

  • Androgen insensitivity syndrome

  • Luteal phase defect

  • Hypergonadotropic hypogonadism

Correct answer: Ovarian resistance syndrome

In ovarian resistance syndrome, the ovaries are resistant to the action of gonadotropins, leading to low estradiol despite normal FSH and LH.

Androgen insensitivity syndrome results in individuals who are genetically male but have female external characteristics. It is not related to this presentation. Luteal phase defect is a problem with progesterone production post-ovulation. It doesn't cause low estradiol with normal FSH/LH. Hypergonadotropic hypogonadism would result in elevated FSH and LH levels.

49.

A 35-year-old patient presents to the clinic to be screened for STIs and initiate contraception today. Their medical history includes chronic hypertension that has resolved and Roux-en-Y gastric bypass. Their blood pressure is normal, and their weight is 157 lbs. They report exposure to chlamydia. 

Which of the following contraceptives is the best option for this patient?

  • Transdermal contraceptive system

  • Combined oral contraception

  • Progestin-only pill

  • Intrauterine system

Correct answer: Transdermal contraceptive system

The transdermal contraceptive system is safe for a patient with a suspected STI and malabsorptive bariatric surgery. 

Both combined oral contraception and progestin-only pill absorption can be affected by this surgery. The intrauterine system should not be placed with a clinical suspicion of gonorrhea or chlamydia.

50.

What are the current recommendations regarding clinical breast exams (CBEs)?

  • The ACOG recommends a CBE annually starting at age 40.

  • No professional organizations recommend CBE.

  • CBE is recommended annually at wellness visits.

  • ACOG advises against CBE for patients ages 20-39.

Correct answer: The ACOG recommends a CBE annually starting at age 40.

The ACOG recommends annual CBEs starting at 40. 

However, the USPTF and ACS do not recommend CBE for those at average risk of breast cancer. No organization recommends CBEs annually for all wellness exams. The ACOG recommends CBE every one to three years for patients ages 20-39.

51.

A fetal heart rate tracing shows late decelerations. What is the MOST likely cause?

  • Uteroplacental insufficiency

  • Fetal head compression

  • Umbilical cord compression

  • Maternal hypertension

Correct answer: Uteroplacental insufficiency

Late decelerations indicate reduced oxygen flow to the fetus. This is often due to uteroplacental insufficiency. 

Fetal head compression is likely to lead to early decelerations, not late decelerations. Cord compression is more likely to cause variable decelerations. Maternal hypotension may cause late decelerations. However, it is not as common a cause of late decelerations as uteroplacental insufficiency.

52.

A patient asks how long sperm can live after sexual intercourse. They are anxious because they ovulated approximately five days after last having intercourse. Which statement is true? 

  • The patient can become pregnant with the timing of recent intercourse and ovulation.

  • Sperm cannot live for five days in the patient's reproductive tract. 

  • Five days after intercourse is too late to take plan B contraception.

  • Fertilization is unlikely to occur because the ovum cannot survive for five days.

Correct answer: The patient can become pregnant with the timing of recent intercourse and ovulation.

Healthy sperm can live for three to five days in the female reproductive tract and are able to fertilize the egg.

In optimal conditions, healthy sperm can live up to five days in the female reproductive tract. Plan B contraception can be taken within five days following unprotected intercourse. However, the longer the interval between intercourse and plan B, the less effective it is. The ovum will survive for up to 24 hours, but this does not affect sperm survival.

53.

A midwife is discussing the signs and symptoms of osteoporosis with a patient. Which of the following statements by the patient indicates a need for further education? 

  • "Thickening fingernails or toenails may be a sign of osteoporosis."

  • "Spontaneous collapse of the vertebrae may signal osteoporosis."

  • "A height loss of more than 1.5 inches can signal osteoporosis."

  • "A chronic backache that doesn't improve could indicate osteoporosis."

Correct answer: "Thickening fingernails or toenails may be a sign of osteoporosis."

Signs and symptoms of osteoporosis include backache, spontaneous fracture or collapse of vertebrae, height loss of more than 1.5 inches, kyphosis, and fractures of the spine, hip, and wrist. 

54.

Which of the following is the MOST common cause of anemia in pregnancy?

  • Iron-deficiency anemia

  • Folate-deficiency anemia

  • Anemia of chronic disease

  • Hemolytic anemia

Correct answer: Iron-deficiency anemia

Iron-deficiency anemia is the most common cause of anemia in pregnancy due to increased iron demands for the growing fetus and placenta as well as the expansion of maternal red blood cell volume. Iron-deficiency anemia accounts for 25% of all anemias experienced during pregnancy. 

Folate-deficiency anemia is less common due to routine prenatal supplementation. Anemia of chronic disease is less common in pregnancy and would be associated with underlying, chronic conditions. Hemolytic anemia in pregnancy can be due to various causes, including autoimmune disorders, but it's less common than iron-deficiency anemia.

55.

Which of the following is LEAST likely to be a concern caused by meconium aspiration?

  • Embolic pulmonary circulation obstruction leading to a ventilation-perfusion mismatch

  • Physical barrier to gas exchange

  • Irritation and thickening of the alveolar walls

  • Vasospasm that can cause persistent fetal circulation

Correct answer: Embolic pulmonary circulation obstruction leading to a ventilation-perfusion mismatch

Meconium aspiration can lead to vasoconstriction and vasospasm but does not commonly lead to embolic pulmonary circulation obstruction. 

Meconium aspiration can cause a physical barrier to gas exchange, irritation and thickening of the alveolar walls (chemical pneumonitis), and vasospasm leading to persistent fetal circulation.

56.

A 70-year-old patient has been vomiting, and the midwife is evaluating them for signs of dehydration. Physical exam findings are as follows: 

  • respiratory rate 16 
  • blood pressure 110/78 
  • heart rate 80 bpm
  • urine: amber, positive ketones, specific gravity 1.03

Which of the following indicates dehydration in this older adult?

  • Urine specific gravity

  • Heart rate

  • Urine color

  • Blood pressure changes

Correct answer: Urine specific gravity

Dehydration signs in older adults include the following:

  • specific gravity > 1.025, indicating concentrated urine
  • oliguria
  • sunken eyes
  • lack of axillary perspiration
  • orthostatic blood pressure changes
  • dry mucous membranes
  • tachycardia
  • tenting over the clavicle and on the forehead

This client's heart rate is normal and not indicative of tachycardia. Their urine color is likely to indicate dehydration but is not diagnostic. The blood pressure may show orthostatic changes, but only one blood pressure is documented.

57.

Which of the following is NOT associated with Down syndrome?

  • Nuchal thinning

  • Flattened nose

  • Protuberant tongue

  • Simian palmar crease

Correct answer: Nuchal thinning

Nuchal thickening, not nuchal thinning, is associated with Down syndrome. 

A flattened nose, large and protuberant tongue, and simian palmar crease are all associated with Down syndrome.

58.

The midwife is discussing diethylstilbestrol (DES) with a patient whose mother used it. How did DES impact the reproductive organs of women in utero? 

  • About 25% of those exposed experienced structural changes to the cervix and vagina.

  • The reproductive organs of their grandchildren are in no way affected by DES.

  • There is a decreased incidence of ectopic pregnancy in those affected.

  • Those who were exposed to DES are no longer in midwifery care.

Correct answer: 25% of those exposed experienced structural changes to the cervix and vagina.

DES is a nonsteroidal estrogen approved by the FDA for use from 1940-1971 to prevent miscarriage and premature labor. About 25% of women exposed experienced structural changes to the cervix and vagina. The reproductive organs of grandchildren may be affected by DES and are currently undergoing studies. There is an increased incidence of ectopic pregnancy among those affected. 

While clients exposed to DES are older than 35 years old, they can still be cared for by midwives. 

59.

Which statement is true about acquired immunity in newborns? 

  • Natural immunity includes physical barriers like the skin.

  • Maternal immunoglobulin G (IgG) does not cross the placenta.

  • Passive immunity increases slowly throughout childhood.

  • Newborn natural and acquired immune systems are robust.

Correct answer: Natural immunity includes physical barriers like the skin.

Natural immunity includes physical barriers like the skin and mucosa, and chemical barriers include gastric acid.

Maternal IgG crosses the placenta, conferring passive immunity to the fetus when the mother has encountered viruses. Passive immunity diminishes slowly throughout childhood with the active production of IgG. The natural and acquired immune systems of newborns are immature, and they still are at risk for infection and sepsis.

60.

A midwife is educating a patient about newborn jaundice during their 24-hour home visit. Which of the following is true about physiologic and pathologic jaundice? 

  • Conjugated bilirubin is higher than unconjugated in pathologic jaundice.

  • Physiologic jaundice is visible within the first 24 hours after birth.

  • Pathologic jaundice lasts about 5 to 7 days following birth. 

  • Total bilirubin peaks at 14 mg/dL in physiologic jaundice.

Correct answer: Conjugated bilirubin is higher than unconjugated in pathologic jaundice.

In pathologic jaundice, the conjugated (direct) bilirubin is higher than the unconjugated. 

Physiologic jaundice is not visible for the first 24 hours after birth. Pathologic jaundice typically lasts longer than 7 days after birth. Total bilirubin peaks below 13 mg/dL in physiologic jaundice.

×