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Quiz Session - Attempts With Random Questions

AMCB CNM Exam Questions

Page 5 of 40

81.

Which of the following statements is true about prenatal cell-free DNA testing? 

  • Cell-free DNA testing screens for problems with sex chromosomes.

  • The placenta should not release fetal DNA into the bloodstream.

  • Prenatal cell-free DNA testing evaluates for neural tube defects.

  • The cell-free DNA test is a diagnostic tool for aneuploidy.

Correct answer: Cell-free DNA testing screens for problems with sex chromosomes.

Cell-free DNA testing screens for trisomy 13, 18, and 21 and problems with sex chromosomes. This testing occurs as early as 10 weeks, and results return in 1 to 2 weeks.

Prenatal cell-free DNA testing evaluates the small amount of DNA that the placenta releases in the maternal bloodstream. Cell-free DNA testing does not screen for neural tube defects. This screening test can indicate an increased risk for fetal aneuploidy.

82.

A midwife notes a fetal heart rate (FHR) of 102 bpm for 11 minutes. Which of the following is the FHR baseline? 

  •  Bradycardia 

  • Marked bradycardia

  • Normal range baseline

  • Baseline shift

Correct answer: Bradycardia 

Bradycardia is an FHR below 110 bpm for 10 minutes or longer.

Marked bradycardia is an FHR below 100 bpm for 10 minutes or longer. The normal baseline range is 110 to 160 bpm. There is no information to indicate a shift in the baseline.

83.

A newborn exhibits excessive drooling, reflux, and cyanosis during the first feed. What condition should be suspected?

  • Tracheoesophageal fistula

  • Gastroesophageal reflux

  • Occult omphalocele

  • Pyloric stenosis

Correct answer: Tracheoesophageal fistula

A tracheoesophageal fistula is a congenital condition where there's an abnormal connection between the esophagus and the trachea. This can lead to symptoms like excessive drooling, reflux, and cyanosis during feeding, as food can enter the trachea and lungs. 

GastroEsophageal Reflux Disease (GERD) can cause spitting up and irritability but does not typically result in excessive drooling and cyanosis. Omphaloceles are not typically occult and are not likely to cause this particular symptom set. Pyloric stenosis typically presents with projectile vomiting, not reflux and drooling; cyanosis is also unlikely with this condition unless aspiration occurs.

84.

An Rh-positive patient is on postpartum day 1. The patient gave birth in February, is rubella immune, and was reluctant to get any injections during pregnancy. Which of the following injections should the patient be offered before discharge? 

  • Influenza

  • MMR

  • Varicella

  • Rho(D) immune globulin

Correct answer: Influenza

The patient didn't get any vaccinations during pregnancy, including influenza. The influenza vaccine should be offered annually during the flu season, which occurs between October to May. 

This patient is rubella-immune and does not need a rubella vaccine. There is no evidence that the patient is not immune to varicella. The patient is Rh-positive and does not receive Rhogam.

85.

A 27-year-old woman presents with amenorrhea and a history of tuberculosis. Which of the following endocrine glands MIGHT be affected, leading to her amenorrhea?

  • Adrenal gland

  • Thyroid gland

  • Parathyroid gland

  • Pineal gland

Correct answer: Adrenal gland

Tuberculosis can affect the adrenal glands, destroying them and leading to Addison's disease. This, ultimately, can cause amenorrhea.

While thyroid disorders can cause amenorrhea, TB doesn't typically affect the thyroid. The parathyroid gland and pineal glands are not typically associated with amenorrhea and are not commonly affected by tuberculosis.

86.

A 30-year-old woman presents with a painful, swollen lump in the labia majora. Which of the following is the MOST likely diagnosis?

  • Bartholin's cyst

  • Skene's duct cyst

  • Vulvar carcinoma

  • Lichen sclerosus

Correct answer: Bartholin's cyst

A Bartholin's cyst occurs when the Bartholin's gland, located at the entrance to the vagina, becomes blocked. It can become painful and swollen if infected.

Skene's duct cysts are located near the urethra and are less common. Vulvar carcinoma is a serious condition but would present with other signs and symptoms and is less likely to be the cause. Lichen sclerosus is a skin condition that causes itching and white patches on the vulva, not a lump.

87.

A 31-year-old woman presents with amenorrhea and is found to have low FSH, LH, and estradiol levels. MRI of the brain reveals a non-enhancing lesion in the hypothalamus. What is the MOST likely diagnosis?

  • Craniopharyngioma

  • Prolactinoma

  • Meningioma

  • Glioma

Correct answer: Craniopharyngioma

A craniopharyngioma is a benign tumor near the pituitary gland that can affect its function, leading to low FSH, LH, and estradiol.

Prolactinoma would elevate prolactin levels. While meningioma and gliomas can be found in the brain, they don't typically cause these hormonal changes.

88.

Which of the following pregnant patients is the MOST appropriate candidate for betamethasone? 

  • A patient at 33 weeks with a cervical change from 3 cm to 4 cm

  • A patient at 34 weeks who is likely to deliver within the hour

  • A patient at 18 weeks with a cervix that has dilated to 7 cm

  • A patient at 37 weeks who is contracting every 2 to 3 minutes and 4 cm

Correct answer: A patient at 33 weeks with a cervical change from 3 cm to 4 cm

A patient at 33 weeks with a cervical change from 3 cm to 4 cm will have the time to benefit from a betamethasone injection to mature the fetal lungs.

A patient who is likely to deliver within the hour will not benefit from betamethasone. The betamethasone is not administered prior to viability, and 18 weeks is too early. A patient at 37 weeks gestation is considered at term and would not be an appropriate candidate.

89.

A midwife is counseling a perimenopausal patient about changes to ovarian hormones. Which statement is true about ovarian hormones and menopause? 

  • Anti-mullerian hormone is undetectable 5 years after menopause.

  • Estradiol is the most plentiful estrogen following menopause.

  • Follicle-stimulating hormone levels decrease with ovarian follicles.

  • Inhibin B peptide levels increase as ovarian follicles decrease.

Correct answer: Anti-mullerian hormone is undetectable 5 years after menopause.

Anti-mullerian hormone (AMH) is undetectable 5 years after menopause. 

Estrone is the major source of estrogen following menopause. Follicle-stimulating hormone (FSH) levels increase and inhibit B peptide levels as ovarian follicles decrease.

90.

Which of the following patients CANNOT undergo a myomectomy?

  • A patient who has a history of a hysterectomy

  • A patient who is 80 years old 

  • A patient who is actively pregnant

  • A patient who has a submucosal fibroid

Correct answer: A patient who has a history of a hysterectomy

A myomectomy involves the removal of uterine fibroids while preserving the uterus. A patient who has a history of a hysterectomy cannot receive a myomectomy due to the absence of a uterus.

While a patient of advanced age may be more likely to undergo a hysterectomy, myomectomy may still be an option. Myomectomy during pregnancy does create an increased risk to the pregnancy but is still possible. A patient who has a submucosal fibroid would have an indication for a myomectomy.

91.

A client who had a baby two weeks ago called the answering service to report heavy vaginal bleeding. They state, "I am changing pads every hour because they are soaked with bright red blood." 

Which of the following is the best plan of care?

  • Ask them to report to the triage unit at the hospital for evaluation

  • Explain this is normal bleeding for one week postpartum

  • Encourage them to monitor the bleeding for the next 12 hours and call if it worsens

  • Ask them to visit the clinic if the discharge is malodorous

Correct answer: Ask them to report to the triage unit at the hospital for evaluation

At two weeks postpartum, lochia should not be bright red, and the amount should decrease. Soaking one pad per hour is always abnormal. The client should be evaluated for postpartum hemorrhage regardless of whether the discharge is malodorous.

92.

A 50-year-old woman presents with a sensation of pelvic pressure. On examination, a bulge is noted at the vaginal introitus. Which of the following is the MOST likely diagnosis?

  • Pelvic organ prolapse

  • Uterine fibroids

  • Ovarian cyst

  • Bartholin's cyst

Correct answer: Pelvic organ prolapse

Pelvic organ prolapse involves the descent of pelvic organs, causing a bulge at the vaginal introitus.

Uterine fibroids are benign tumors in the uterus and don't present as a bulge at the vaginal introitus. Ovarian cysts are fluid-filled sacs in the ovaries and are not palpable at the vaginal introitus. Bartholin's cyst would present as a localized swelling near the vaginal opening, not as a generalized bulge.

93.

Which of the following statements is TRUE about nitrous oxide?

  • Nitrous oxide is an anxiolytic and analgesic medication.

  • Nitrous oxide has no risk of adverse reactions.

  • Nitrous oxide has an unpleasant taste or odor to some patients.

  • One benefit of nitrous is that it doesn't cross the placenta.

Correct answer: Nitrous oxide is an anxiolytic and analgesic medication.

Nitrous oxide is an anxiolytic and analgesic inhalant that is self-administered by the patient.

Nitrous oxide has a risk of adverse reactions like neuroapoptosis, loss of consciousness, nausea and vomiting, megaloblastic anemia, and others at high doses. Nitrous oxide is an odorless and tasteless gas that crosses the placenta.

94.

A laboring woman's contractions are two minutes apart, lasting 90 seconds, and are strong in intensity. What is the PRIORITY action?

  • Prepare for imminent delivery

  • Administer pain relief

  • Evaluate fundal height

  • Encourage ambulation

Correct answer: Prepare for imminent delivery

Frequent, long, and strong contractions suggest advanced labor and imminent delivery. 

Pain relief is important to consider; however, it is secondary to preparing for delivery when delivery is imminent. Ambulation isn't recommended when delivery is imminent. It may be appropriate to evaluate the patient's cervix; however, evaluating fundal height is unlikely to be helpful.

95.

Which condition MOST commonly occurs with fetal urinary tract obstruction?

  • Oligohydramnios

  • Polyhydramnios

  • Placenta previa

  • Macrosomia

Correct answer: Oligohydramnios

Fetal genitourinary abnormalities can result in a diagnosis of oligohydramnios after 16 to 20 weeks of gestation. Oligohydramnios is generally present with renal agenesis and fetal urinary tract obstruction.

Polyhydramnios is idiopathic in 50% to 60% of cases. Other causes of polyhydramnios include fetal anomalies, fetal infection, twin-to-twin infusion, maternal diabetes, isoimmunization, and multiple gestations. Placenta previa is not related to urinary tract obstruction. Macrosomia commonly co-occurs with polyhydramnios and gestational diabetes, not oligohydramnios.

96.

A newborn is found to have a cleft lip and palate. What is the PRIORITY nursing intervention?

  • Feeding assistance

  • Surgical repair

  • Genetic counseling

  • Parental support

Correct answer: Feeding assistance

Feeding assistance is crucial for newborns with a cleft lip and palate to ensure adequate nutrition. 

Surgical repair will be necessary but is not an immediate intervention. Genetic counseling and parental support may be important but are not the immediate priority.

97.

Which of the following statements made by a mother of a neonate illustrates the need for further teaching following education about patent ductus arteriosus in a newborn?

  • "This may spontaneously resolve over the next few weeks."

  • "This may require surgical intervention."

  • "The prognosis is usually good."

  • "This condition increases blood flow to my baby's lungs."

Correct answer: "This may spontaneously resolve over the next few weeks."

Patent ductus arteriosus requires surgical correction and is not likely to spontaneously resolve. It is true that the prognosis is usually good with this condition and that it increases pulmonary blood flow.

98.

A midwife has disclosed the positive result of a urine pregnancy test to a patient who was not planning to become pregnant. Which of the following is true regarding unintended pregnancy? 

  • More than half of all pregnancies in the US are unintended.

  • Approximately 57% of pregnancies in the US are unwanted.

  • Midwives should share their feelings about the patient's options.

  • All pregnant patients should be congratulated during confirmation.

Correct answer: More than half of all pregnancies are unintended.

At least half of all pregnancies in the US are unintended. Unintended pregnancy is one that is unplanned at the time of conception. It does not necessarily mean the pregnancy is unwanted. 

The midwife should provide options in a nondirective manner and withhold personal judgment regarding the patient's options. The midwife should discuss the patient's feelings about the pregnancy confirmation and not assume the news will be considered positive.

99.

A CNM is assessing a newborn immediately after delivery. Which of the following findings requires IMMEDIATE intervention?

  • Grunting with each breath

  • Heart rate of 120 beats per minute

  • Respiratory rate of 40 breaths per minute

  • Acrocyanosis

Correct answer: Grunting with each breath

Grunting is an expiratory sound made by the newborn in an attempt to increase functional residual capacity and improve oxygenation; it is a sign of respiratory distress and requires immediate intervention. 

A heart rate of 120 beats per minute is normal for a newborn. A respiratory rate of 40 breaths per minute is within the normal range for a newborn. Acrocyanosis, or bluish discoloration of the hands and feet, is a normal finding in the first 24 hours of life.

100.

A patient received a positive noninvasive prenatal test for trisomy 21 at 14 weeks of gestation. The midwife has provided information about all options, and they have chosen to proceed with prenatal diagnostic testing. 

What is the midwife likely going to include in their plan of care? 

  • Place a referral for an amniocentesis

  • Schedule a chorionic villus biopsy

  • Order percutaneous umbilical blood sampling

  • Perform a nuchal translucency ultrasound

Correct answer: Place a referral for an amniocentesis

Amniocentesis is a diagnostic test for genetic disorders like trisomy 21 that is performed between 14 and 16 weeks. 

A CVB is performed between 10 to 13 weeks, and this patient is already 14 weeks. Percutaneous umbilical blood sampling (or cordocentesis) is used to diagnose Rh (anti-D) disease, fetal infections, blood factor abnormalities, genetic disease, and fetal hypoxia after 20 weeks. Nuchal translucency is a screening ultrasound for trisomy 21 but is not a diagnostic test.

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