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AMCB CNM Exam Questions
Page 4 of 40
61.
Which of the following occurs during uterine involution?
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Uterine contraction
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Apoptosis of myometrial cells
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Degeneration of the epithelium
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Decreasing cell numbers
Correct answer: Uterine contraction
Involution involves three steps:
- uterine contraction
- autolysis of myometrial cells
- regeneration of the epithelium
Uterine involution is the process of the uterus returning to the state before pregnancy, which results from cell-size reduction and not a decreasing number of cells.
62.
A newborn presents with a cleft lip and palate. Which of the following interventions is most crucial during feeding?
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Using a specialized cleft palate bottle and nipple
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Feeding in a supine position
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Offering larger volumes of milk less frequently
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Avoiding any oral feedings
Correct answer: Using a specialized cleft palate bottle and nipple
Babies with a cleft lip and palate have an opening in the upper lip and roof of the mouth, which can make feeding challenging. Using a specialized bottle and nipple can help prevent aspiration and ensure the baby receives adequate nutrition.
Feeding in a supine position can increase the risk of aspiration. Offering larger volumes less frequently can lead to inadequate intake and dehydration. Avoiding oral feedings altogether is not necessary with the right equipment and technique.
63.
Which of the following is an abnormal vital sign for a newborn?
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Pulse ox of 78% at 8 minutes
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32 breaths/min
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Heart rate of 108 bpm
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Pulse ox of 60% at 1 minute
Correct answer: Pulse ox of 78% at 8 minutes
Normal vital signs for an infant are as follows:
- respiratory rate 30 to 60 breaths per minute
- pulse ox 60 to 65% at 1 minute after birth
- pulse ox 80 to 85 percent between 5 and 10 minutes
- heart rate greater than 100 beats per minute
64.
Which of the following findings is MOST concerning when assessing a newborn's neurological status?
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Persistent Moro reflex at eight months of age
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Absence of the rooting reflex at six months of age
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Absence of the grasp reflex at three months of age
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Presence of the stepping reflex at one month of age
Correct answer: Persistent Moro reflex at eight months of age
Moro reflex should disappear by six months of age. Persistence beyond this age is concerning and warrants further neurological evaluation.
Absence of the rooting reflex at six months of age is normal, as it typically disappears by four to six months. Absence of the grasp reflex at three months of age is normal, as it typically disappears by two months of age. Presence of the stepping reflex at one month of age is normal, although it will typically disappear around this time.
65.
A midwife is reviewing a patient's complete blood count (CBC) following an annual wellness exam. Their hemoglobin level is 11.5 g/dL, and their mean corpuscle volume (MCV) is 75 fL.
What type of anemia does this patient have?
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Microcytic anemia
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Macrocytic anemia
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Normocytic anemia
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B12 deficiency
Correct answer: Microcytic anemia
Anemia is classified according to RBC size:
- microcytic anemia (MCV <80 fL)
- macrocytic anemia (MCV >100 fL
- mormocytic MCV 80-100 fL
A B12 deficiency causes macrocytic anemia and would need further studies.
66.
Which statement is TRUE about a chorionic villus biopsy (CVB)?
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It is contraindicated in those with maternal blood group sensitization
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A CVB is performed after 20 weeks of gestation
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A CVB will only assess fetal lung maturity
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A CVB screens for prenatal genetic disorders
Correct answer: It is contraindicated in those with maternal blood group sensitization
A chorionic villus biopsy is contraindicated in the case of maternal blood group sensitization.
A CVB is performed between 10 and 13 weeks of gestation, but an amniocentesis is done from 14 to 16 weeks to assess fetal lung maturity. A chorionic villus biopsy is used to diagnose prenatal genetic disorders, not screen for them.
67.
A patient is experiencing contractions every 5 minutes that last 60 seconds for the last hour. They present to the clinic to be assessed for active labor, and the midwife determines that the cervix is closed, thick, and high. The midwife discusses how to differentiate between active labor and other contractions.
Which of the following is true?
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The patient should return when the contractions are stronger and closer together.
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Braxton Hicks contractions only occur during early labor.
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The patient should return when contractions are every 5 minutes.
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Active labor contractions involve tightening of only the abdomen.
Correct answer: The patient should return when the contractions are stronger and closer together.
Active labor occurs when the contractions grow stronger and closer together. Braxton Hicks contractions can occur beginning in the second trimester.
Active labor contractions can include abdominal tightening, low back pain, pain that wraps around the abdomen to the back, or cramping that radiates to the thighs.
68.
A midwife is reviewing an ultrasound report and sees that the 38-week fetus is in the third percentile for estimated fetal weight. Which of the following interventions would the midwife include in the plan of care?
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Doppler flow studies
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Expectant management
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Clinical pelvimetry
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Contraction stress test
Correct answer: Doppler flow studies
Intrauterine growth restriction (IUGR) is a diagnosis based on ultrasound measurements of a fetus measuring below the fifth percentile for estimated fetal weight (EFW). Doppler flow studies, serial growth ultrasounds, serial BPPs with NSTs (weekly or twice weekly), and placenta grading are all recommended.
Expectant management would not be appropriate, as it is important to perform additional diagnostics to evaluate the growth of the fetus. Clinical pelvimetry would be appropriate for a macrosomic infant but is unlikely to be necessary for an infant with restricted growth. A gestational age of below 37 weeks is a relative contraindication to a contraction stress test (CST).
69.
A 36-year-old woman at 37 weeks gestation presents with a breech presentation. Which of the following is the MOST appropriate management?
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Offer external cephalic version
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Schedule a cesarean section
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Induce labor
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Explain that an episiotomy will be necessary during delivery
Correct answer: Offer external cephalic version
For a breech presentation at term, an external cephalic version can be offered to try to turn the fetus to a head-down position, potentially allowing for a normal vaginal delivery.
Scheduling a cesarean section might be considered if external cephalic version is unsuccessful or contraindicated. Inducing labor with a breech presentation increases the risk of complications and is typically not recommended. An episiotomy may be necessary during delivery if a normal vaginal delivery is elected; however, external cephalic version should typically be attempted first.
70.
Which of the following statements about engorged breasts requires correction by the CNM?
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"At least this will make it easier for my baby to feed."
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"Putting cold cabbage leaves in my bra may help."
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"I should not pump as much as possible to relieve my engorgement."
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"I can't stand this; it's so uncomfortable."
Correct answer: "At least this will make it easier for my baby to feed."
Breast engorgement may hinder feedings and make it more difficult for infants to latch, especially when severe.
Putting cold cabbage leaves into one's brassiere may promote comfort and slowly absorb excess milk. Pumping as much as possible to relieve engorgement increases breast milk production and worsens engorgement. A statement expressing difficulty coping should be addressed by the CNM but does not require correction.
71.
A patient presents to the clinic and reports that they have recently undergone treatment for an alcohol-use disorder. They describe daily drinking a "fifth of vodka and a few beers."
For which of the following should the midwife screen the patient?
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Vitamin B12 deficiency
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Sickle cell anemia
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Leukocytosis
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Thrombocytosis
Correct answer: Vitamin B12 deficiency
Vitamin B12 deficiency, also known as pernicious anemia, can occur because alcohol decreases vitamin B12 absorption.
Sickle cell anemia is a genetic condition that has nothing to do with alcohol use. Leukocytosis, which is an elevated white blood cell (WBC) count, is not as much of a concern with alcohol use disorder as leukopenia, a lower WBC count. Thrombocytopenia is more likely to occur with chronic alcohol use.
72.
A midwife cares for a patient at 10 days postpartum who has been shifting from sadness to giddiness rapidly since about four days postpartum. She states that she feels well overall but is distressed by frequent crying.
Which of the following diagnoses is MOST appropriate at this time?
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Postpartum blues
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Postpartum psychosis
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Postpartum depression
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Postpartum anxiety
Correct answer: Postpartum blues
Postpartum blues occur three to five days after birth and usually resolve by two weeks postpartum. If these feelings and behaviors continue beyond two weeks, postpartum depression is likely.
Postpartum psychosis is a severe situation involving disordered thinking, hallucinations, or delusions. Postpartum anxiety involves intrusive thoughts, worry, insomnia, and avoidant behaviors.
73.
A pregnant patient without any vaccinations is a nursing student and reads about the increased risk of immunosuppression due to pregnancy. They would like to receive any vaccines that are safe during their pregnancy.
Which of the following vaccines is safe to receive during pregnancy?
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Hepatitis B
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Varicella
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Rubella
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Intranasal influenza
Correct answer: Hepatitis B
The hepatitis B vaccine can be given to high-risk women who are antigen- and antibody-negative during pregnancy. This patient is in nursing school and may encounter blood and bodily fluids, which carry hepatitis B.
Rubella is contraindicated in pregnancy because it is an attenuated live-virus vaccine. Varicella and intranasal influenza are also contraindicated as attenuated live-virus vaccines.
The influenza injection is considered safe for pregnant people to receive.
74.
A 30-year-old woman at 22 weeks gestation presents with a persistent cough and a positive tuberculin skin test. What is the MOST appropriate next step?
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Obtain a chest X-ray with abdominal shielding
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Start isoniazid therapy
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Quarantine the patient
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Start multidrug antitubercular therapy
Correct answer: Obtain a chest X-ray with abdominal shielding
A positive tuberculin skin test in a symptomatic patient warrants further evaluation. A chest X-ray with abdominal shielding protects the fetus from radiation while allowing for evaluation of the mother's lungs and diagnosis of active TB.
Starting isoniazid therapy without confirming the diagnosis might not be appropriate. Isoniazid is used to treat latent TB, but the presence of symptoms suggests active TB, which requires a different treatment approach. Quarantining the patient without a definitive diagnosis is premature. Starting multidrug antitubercular therapy is reserved for confirmed cases of active TB, which first requires a chest X-ray.
75.
Which of the following is true about the human microbiome?
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Vaginal microbial flora has a protective effect on an infant's health.
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The vaginal microbiome has no demonstrable effect on the newborn.
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The microbial flora of an infant is the same regardless of feeding type.
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Infants born by a cesarean section benefit from the vaginal microbiome.
Correct answer: Vaginal microbial flora has a protective effect on an infant's health.
Research demonstrates that the vaginal microbiome has a protective effect on infant health.
Breastfeeding establishes healthy microbial colonization in infants. Infants born vaginally benefit from the vaginal microbiome.
76.
A midwife hangs intravenous fluids for a patient with signs of dehydration during labor. Which of the following is NOT a common intravenous fluid for labor?
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Dextrose 5% in water (D5W)
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0.9% NaCl solution
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Lactated Ringer's solution
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5% dextrose with lactated Ringer's solution (D5LR)
Correct answer: Dextrose 5% in water (D5W)
D5W is not commonly used during labor. Lactated Ringer's is commonly used, followed by 0.9% NaCl solution and D5LR.
77.
A patient is breastfeeding and wants to discuss the most effective contraceptive option that is safe for breastfeeding. Which postpartum contraception is the midwife MOST likely to prescribe?
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Levornogestrol intrauterine system
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Combined hormonal contraception
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Lactation amenorrhea method
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Progestin-only pill (POP)
Correct answer: Levornogestrol intrauterine system
The levonorgestrel intrauterine system has only a 0.2% first-year failure rate and is good for three to six years. After removal, the return to fertility is quick.
Combined hormonal contraception is controversial for breastfeeding. The lactation amenorrhea method is less effective than the levonorgestrel intrauterine system (IUS). The POP is safe for breastfeeding but less effective than the IUS.
78.
Which of the following medications is NOT typically used to manage hirsutism in polycystic ovary syndrome?
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Clomiphene citrate
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Spironolactone
-
Finasteride
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Eflornithine cream
Correct answer: Clomiphene citrate
Clomiphene citrate is used for ovulation induction in those with PolyCystic Ovary Syndrome (PCOS), not to treat hirsutism.
Spironolactone and finasteride are anti-androgen medications and can help reduce hirsutism. Eflornithine cream is a topical treatment to slow facial hair growth.
79.
A 3-day-old newborn has a weight loss of 11% from the birth weight. The baby is exclusively breastfed. What is the MOST appropriate action?
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Increase breastfeeding frequency
-
Supplement with formula
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Admit for observation
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No intervention is necessary
Correct answer: Increase breastfeeding frequency
Weight loss of 7-10% of the birth weight is expected following birth; however, 11% may be slightly excessive and indicates intervention may be necessary. Increasing breastfeeding frequency can help in increasing the newborn’s intake and weight.
Supplementing with formula can interfere with breastfeeding success and should only be attempted if breastfeeding attempts are inadequate. Admission for observation is unnecessary for an 11% weight loss.
80.
A certified nurse-midwife is practicing community midwifery on a laboring client with blood pressures of 193/117 and "the worst headache of my life." The client with preeclampsia with severe features lost intravenous access and required immediate magnesium sulfate administration.
In an emergency, which of the following routes of administration is appropriate?
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Intramuscular (IM)
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Intraosseous (IO)
-
Sublingual (SL)
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Per rectum (PR)
Correct answer: Intramuscular (IM)
Magnesium sulfate is normally given intravenously but can be given intramuscularly. However, the intramuscular route is less preferable due to the variability of effective concentration levels.