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Quiz Session - Attempts With Random Questions

AMCB CNM Exam Questions

Page 6 of 40

101.

A 22-year-old woman presents with recurrent vulvovaginal candidiasis. Which of the following is MOST likely to be a contributing factor?

  • Frequent douching

  • Use of intrauterine device

  • Use of barrier contraceptives

  • High intake of fermented foods

Correct answer: Frequent douching

Frequent douching can alter the vaginal flora, leading to recurrent vulvovaginal candidiasis.  

Use of an intrauterine device and a high intake of fermented foods are not associated with an increased risk of candidiasis. Use of barrier contraceptives can actually reduce the risk of some vaginal infections.

102.

A newborn is diagnosed with a congenital diaphragmatic hernia. What is the MOST appropriate initial management?

  • Intubation and ventilation

  • Surgical repair

  • Bowel decompression

  • Positive pressure mask ventilation

Correct answer: Intubation and ventilation

Intubation and ventilation are important in congenital diaphragmatic hernia to prevent pulmonary hypoplasia and manage respiratory distress. 

Surgical repair will be necessary but immediate stabilization will be necessary first. Bowel decompression is not part of the initial management. Positive pressure mask ventilation is not preferred over intubation and ventilation.

103.

Which of the following is NOT a stage in the process of uterine involution?

  • Menstruation

  • Uterine contraction

  • Myometrial cell autolysis

  • Epithelial regeneration

Correct answer: Menstruation

Menstruation resumes after childbirth, but it is not a stage of uterine involution. It is part of the menstrual cycle.

Uterine contractions control bleeding and are the first stage that facilitates uterine involution. Myometrial cell autolysis is the programmed cell death of the myometrium of the uterus. After cell death, the epithelium (lower layer of the uterus) regenerates to complete the process.

104.

A certified nurse-midwife is discussing the indications for a Tdap vaccination with a client who is fully vaccinated. Which of the following is an appropriate indication for the client to receive a Tdap vaccine?

  • A Tdap should be given after a severe, dirty wound.

  • They should receive a Tdap booster every 5 years.

  • A pregnant person should receive Tdap in the second trimester.

  • A Tdap should be administered at 65 years old.

Correct answer: A Tdap should be given after a severe, dirty wound. 

The Tdap is given every 10 years as a booster. It can also be given after a significant, dirty wound. 

A Tdap booster is only recommended for those above 65 if they have not yet received the vaccine or require a 10-year booster. Pregnant people should be offered a dose of Tdap every pregnancy between 27 and 36 weeks gestation to enable maternal pertussis antibodies to transfer to the newborn.

105.

A client presents to the office with an unplanned pregnancy that they plan to continue. They are currently smoking one pack of cigarettes a day. The midwife discusses smoking cessation. 

Which of the following statements indicates that the client needs further education? 

  • "I should cut back slowly so that I don't stress the baby."

  • "Quitting smoking will decrease my risk of pregnancy complications."

  • "Even cutting back on smoking can improve my pregnancy outcomes."

  • "Smoking cigarettes can significantly harm my baby."

Correct answer: "I should cut back slowly so that I don't stress the baby."

Cutting back on cigarettes will not stress the baby. The risk of pregnancy complications from smoking increases with the number of cigarettes smoked. 

Quitting smoking or even cutting back will decrease the risk of smoking-related pregnancy complications and can improve pregnancy outcomes. 

106.

A patient presents to the midwifery clinic complaining of unilateral nipple blanching following breastfeeding. Which of the following is the MOST likely diagnosis? 

  • Raynaud's phenomenon

  • Nipple candidiasis

  • Nipple bleb

  • Mastitis 

Correct answer: Raynaud's phenomenon

Raynaud's phenomenon is nipple vasospasm following breastfeeding or when exposed to cold. The nipple color blanches or changes to purple, and it can be unilateral or bilateral. 

Candidiasis presents as a red, flaky, shiny areola or red and shiny nipple. A nipple bleb is a small nipple blister filled with serous fluid. Mastitis causes an edematous, erythematous wedge-shaped reddened area in one breast. Patients develop fevers that are typically over 101.3 degrees Fahrenheit.

107.

A 48-year-old woman presents with irregular menstrual cycles and spotting. She has been on bioidentical hormone replacement therapy (BHRT) for menopausal symptoms. What is the most concerning potential cause of her bleeding?

  • Endometrial hyperplasia

  • Endometrial polyp

  • Uterine fibroids

  • Ovarian cysts

Correct answer: Endometrial hyperplasia

Bioidentical Hormone Replacement Therapy (BHRT), especially unopposed estrogen, can increase the risk of endometrial hyperplasia, which can lead to cancer.

Endometrial polyps can cause spotting but are less concerning than hyperplasia. Uterine fibroids can cause heavy bleeding but are less concerning than hyperplasia in this context. Ovarian cysts don't typically cause irregular menstrual bleeding.

108.

A midwife is educating the 66-year-old patient about vertebral fracture assessments (VFAs) and osteoporosis. What finding from a bone mineral density test would indicate the need for a VFA?

  • T-score -1.6

  • T-score -1.0

  • Z-score 1.0

  • Z-score 1.5

Correct answer: T-score -1.6

The midwife should consider a VFA for those who are 65 to 69 years old with a T-score below -1.5. Those who are 70 years old or older should consider receiving VFAs for a T-score below -1.0.

109.

A patient presents to the clinic to discuss the fertility awareness method (FAM). Which of the following items in their medical history will MOST likely decrease the effectiveness of FAM? 

  • A variable schedule

  • Grand multiparity

  • A supportive partner

  • 28- to 30-day menstrual cycles

Correct answer: A variable schedule

An inconsistent or busy schedule may create more difficulty for patients seeking to track their cycles and determine their fertile window.

Grand multiparity (or parity in general) has no effect on the ability to use FAM as a contraceptive method. A supportive and cooperative partner is essential for FAM success. A 28- to 30-day menstrual cycle is considered regular, so FAM would likely be a good fit.

110.

Which of the following clients is at risk of longer labor?

  • Grand multiparity

  • Intrauterine growth restriction (IUGR)

  • Premature labor 

  • Cocaine usage

Correct answer: Grand multiparity

Grand-multiparous patients are at increased risk for prolonged and dysfunctional labor. 

IUGR  may lead to faster labor. Premature labor does not cause longer labor. Cocaine usage can cause precipitous birth.

111.

A midwife is attending a birth when they observe the "turtle sign" and request assistance. Which of the following maneuvers would the midwife attempt?

  • Perform Wood's screw maneuver

  • Place the patient in the Trendelenburg position

  • Attempt delivery of the anterior arm

  • Cut a mediolateral episiotomy

Correct answer: Perform Wood's screw maneuver

After identifying shoulder dystocia, the midwife will request assistance from a physician, pediatrician, anesthesia, and other nursing staff. The midwife will encourage the patient to stop pushing and initiate maneuvers to manage the shoulder dystocia. The midwife should perform the McRoberts maneuver, request suprapubic pressure, rotate the shoulders to oblique, deliver the posterior arm, attempt delivery in Gaskin, or attempt Wood's screw maneuver.  

Trendelenberg positioning will not promote the delivery of the anterior shoulder. The anterior shoulder has impinged on the pubic bone, so the midwife should attempt to deliver the posterior arm. An episiotomy is only useful to increase space for the hands to perform the above maneuvers.

112.

A midwife palpates a longitudinal lie with a hard, round prominence in the fundus that is mobile. Which presentation is this?  

  • Breech

  • Shoulder

  • Face

  • Vertex

Correct answer: Breech

Breech presentation involves a longitudinal lie with a hard, round prominent in the fundus that is mobile. 

A shoulder presentation is a transverse presentation with the shoulder as the presenting part. A face presentation is a longitudinal lie with a cephalic presentation, but the head is extended and the occiput is proximal to the spine. In a vertex presentation, the head is the presenting part.

113.

Which of the following reflexes should elicit a fencing posture?

  • Tonic neck response

  • Moro reflex

  • Palmar grasp reflex

  • Stepping reflex

Correct answer: Tonic neck response

The tonic neck response results in extension of the arm on the side to which the neck is rotated and flexion of the contralateral arm. This posture is sometimes referred to as the fencing posture.  

The fencing posture should not be elicited when assessing the Moro reflex, palmar grasp reflex, and stepping reflex. 

114.

A pregnant patient at 32 weeks of gestation presents to the midwifery clinic with a blood pressure of 142/91. The patient complains of a mild headache, low back pain, and epigastric pain. 

Which of the following is the severe feature of preeclampsia? 

  • Epigastric pain

  • Mild headache

  • Low back pain

  • Blood pressure 142/91

Correct answer: Epigastric pain

Epigastric or right upper quadrant pain is a severe feature of preeclampsia. Other severe features include thrombocytopenia, renal insufficiency, impaired liver function, and cerebral or visual symptoms. A mild headache may be a severe feature, but a mild headache is not diagnostic. Typically, the headache associated with preeclampsia will persist despite the administration of analgesics and rest. 

Low back pain is a common pregnancy discomfort. A blood pressure of 142/91 is elevated but not a severe feature. A systolic blood pressure greater than 160 and a diastolic greater than 110 are severe features. 

115.

A 49-year-old client reports irregular menstrual cycles and an increased menstrual flow. Their cycles have changed from every 29 days to 21 days. Based on this information, what stage is most likely?

  • Early menopausal transition 

  • Early postmenopause

  • Late postmenopause

  • Late menopausal transition

Correct answer: Early menopausal transition 

An early menopausal transition is characterized by a variable menstrual cycle length of 7 or more days. A late menopausal transition involves intervals of amenorrhea for more than 60 days. 

Early postmenopause is divided into two parts: the first 12 months and until high FSH and low estradiol levels stabilize. Late menopause occurs over the remaining lifespan, and symptoms are often related to increasing atrophic changes in urogenital tissues.

116.

A midwife is performing a physical assessment on a patient with dark, curly, coarse pubic hair covering the mons pubis that has not spread to the thighs. The patient has a breast contour with the areolar area forming a secondary mound. 

Which of the following Tanner stages is indicated by these findings?

  • IV

  • V

  • III

  • II

Correct answer: IV

Tanner stage IV breast development is where an areolar area forms a secondary mound on the breast contour. Tanner stage IV involves an increased quantity of pubic hair that has a coarser texture, and the labia and mons are well covered. It does not spread to the medial thighs until Tanner stage V. 

Tanner stage V also involves a feminine triangle and adult distribution of pubic hair. In Tanner stage V, breast development involves the areola as part of the breast contour, and the nipples project. 

Tanner stage III is when pubic hair begins to curl, and there is no secondary contour on the breast. Stage II consists of breast buds and increased areolar size with straight and countable pubic hair.

117.

A 38-year-old woman with a history of PCOS wants to conceive. Which of the following medications should be used FIRST to induce ovulation?

  • Clomiphene citrate

  • Medications will not help induce ovulation in a woman over 35 years old who has PCOS

  • Metformin

  • Gonadotropins

Correct answer: Clomiphene citrate

Clomiphene citrate is an ovulatory stimulant. It's the first-line treatment for anovulation in PCOS patients. It works by binding to estrogen receptors in the hypothalamus, leading to an increase in the release of FSH and LH, which in turn stimulates ovulation.

Clomiphene citrate can be used to induce ovulation in women with PCOS, even if they are over 35 years old. Metformin, an insulin-sensitizing agent, can be used in PCOS to treat insulin resistance and can help with ovulation, but it's not the first-line for ovulation induction. Gonadotropins (like FSH and LH) can be used to induce ovulation but are typically reserved for women who don't respond to clomiphene or letrozole.

118.

A midwife is caring for a laboring patient at 38 weeks of gestation following a spontaneous rupture of membranes (SROM). Upon cervical examination, the midwife palpates a pulsating soft piece of tissue looped around the fetal head. 

Which of the following is the next best step?

  • Elevate the fetal head and change the maternal position to knee-chest

  • Apply a fetal scalp electrode (FSE) and intrauterine pressure catheter (IUPC)

  • Manipulate the tissue back into the uterus and palpate for pulsation

  • Call a physician and prepare for an operative vaginal delivery 

Correct answer: Elevate the fetal head and change the maternal position to knee-chest

Every midwife must know the emergency response to the complication of umbilical cord response. Cord prolapse can occur with the rupturing of membranes and is identified by palpation of the cord during vaginal examination (or if visible at the vaginal introitus). The midwife should elevate the presenting part of the cord and assist the client into the knee-chest position or a steep left-lateral Trendelenburg position. 

Applying an FSE or IUPC would require removing hands from elevating the presenting part. Manipulation of the cord may cause cord spasm, and palpating the cord pulsations is not an adequate indicator of fetal status. Finally, the midwife should call the physician to prepare for a cesarean section, not an operative vaginal delivery.

119.

During a birth, fluid is dripping into the baby's mouth and nose. Which of the following is the next step?

  • Wipe fluid from the baby's face with a soft cloth

  • Bulb suction the baby's mouth and nose

  • Perform routine suctioning of the baby on the perineum

  • Evaluate the baby to see if suctioning is indicated

Correct answer: Wipe fluid from the baby's face with a soft cloth

Fluid should be wiped from the baby's face, mouth, and nose with a soft cloth. Routine suctioning of a newborn on the perineum or with a bulb syringe is not indicated. 

Infants' respiration should always be evaluated. However, the midwife does not need to wait to wipe the fluid away during birth.

120.

A patient presents with a medical history of painful ovarian cysts. They request contraception today and are not aware of any current ovarian cysts. Which option is the best choice considering their medical history? 

  • Combined hormonal contraception

  • Copper intrauterine device (IUD)

  • Progestin-only pills (POPs)

  • Vaginal spermicides

Correct answer: Combined hormonal contraception

Ovarian cysts cannot be resolved with combined hormonal contraception, but these drugs can suppress gonadotropin levels to prevent recurrence of ovarian cysts. 

The copper IUD is nonhormonal and has no influence on ovarian cysts. POPs have an unpredictable effect on ovulation, unlike combined hormonal contraception, and can either improve or worsen ovarian cysts. Spermicides do not improve ovarian cysts. 

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