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Quiz Session - Attempts With Random Questions

AMCB CNM Exam Questions

Page 7 of 40

121.

A postpartum patient with a history of hypertension presents with a blood pressure of 162/99 mmHg, headache, and blurred vision. Which of the following actions should the CNM take IMMEDIATELY?

  • Administer antihypertensive medication

  • Encourage deep breathing and relaxation

  • Order a CT scan

  • Administer magnesium sulfate

Correct answer: Administer antihypertensive medication

In a hypertensive crisis with symptoms like headache and blurred vision, immediate administration of antihypertensive medication is crucial to prevent complications such as stroke or seizure. 

Encouraging deep breathing and relaxation is not sufficient to manage hypertension. Ordering a CT scan may be necessary for diagnosing complications but does not address the immediate need to lower blood pressure. Administering magnesium sulfate is used for eclampsia and preeclampsia. Given the patient's history, they are more likely to experience an acute exacerbation of chronic hypertension. Antihypertensive should be administered first, then follow-up assessment should be performed to evaluate other potential complications.

122.

A midwife is providing education to a patient about the various types of newborn heat loss. Which statement made by the patient indicates a need for further education? 

  • "Newborns lose the most heat through adaptative heat loss."

  • "Convection is the loss of heat from the body to the cooler air."

  • "Conduction is newborn heat loss from the skin to cold blankets."

  • "Radiation is when heat moves to cooler surfaces that are not in direct contact." 

Correct answer: "Newborns can lose more heat through adaptative heat loss."

The types of newborn heat loss include convection, conduction, radiation, and evaporation. Adaptative heat loss is not one of these methods.

123.

A midwife is providing education to a 28-week patient regarding a nonstress test (NST). Which of the following statements is true? 

  • Accelerations during an NST can be stimulated by vibroacoustic stimulation (VAS).

  • Half of all fetuses at 28 weeks of gestation experience accelerations with fetal movement.

  • Inconclusive FHR tracings fail to demonstrate the required accelerations within 40 minutes.

  • A reactive NST at 28 weeks involves two accelerations of 15 bpm or more for at least 15 seconds.

Correct answer: Accelerations during an NST can be stimulated by vibroacoustic stimulation (VAS).

Accelerations during an NST can be stimulated by vibroacoustic stimulation (VAS), or they can be spontaneous. 

At 28 weeks of gestation, 75 percent of all fetuses experience FHR accelerations with fetal movement. Nonreactive FHR tracings fail to demonstrate the required accelerations within 40 minutes. A reactive NST at 28 weeks means two accelerations (or more) of greater than 10 bpm or more for at least 10 seconds.

124.

Which statement is true about a newborn's glucose level following birth? 

  • Hypoglycemia should be measured in symptomatic infants.

  • Glucose is lowest approximately 30 minutes following birth.

  • Symptomatic infants should feed within 2 hours after birth.

  • Asymptomatic infants with a glucose level of 43 mg/dL must receive IV glucose.

Correct answer: Hypoglycemia should be measured in symptomatic infants.

Hypoglycemia should be measured in symptomatic infants and infants at increased risk. 

Glucose is the lowest 1.5 to 5 hours following birth. Symptomatic infants should feed within 1 hour after birth. Symptomatic infants with glucose levels below 40 mg/dL should receive intravenous (IV) glucose. 

125.

Which of the following is NOT a risk factor for endometrial cancer?

  • Use of combined oral contraceptives

  • Nulliparity

  • Early menarche

  • Obesity

Correct answer: Use of combined oral contraceptives

Use of combined oral contraceptives reduces the risk of endometrial cancer.

Women who haven't given birth have a slightly higher risk of developing endometrial cancer when compared to those who have. Starting periods at a younger age increases exposure to estrogen, raising the risk of endometrial cancer. Excess fat tissue can increase estrogen levels, which can increase the risk of endometrial cancer.

126.

A 50-year-old patient presents for a wellness visit and is at average risk for breast cancer. Which of the following is a true statement by the patient about when to schedule a mammogram?

  • "I can choose to switch to biennial testing based on what the evidence says."

  • "I'll continue to test every year according to the American Cancer Society."

  • "The ACOG recommends that I should get my first mammogram this year."

  • "The USPTF says that I should get tested every other year starting at 40 years old."

Correct answer: "I can choose to switch to biennial testing based on what the evidence says."

Medical organizations have different initiation dates and timelines for screening mammograms. However, all organizations provide the opportunity for biennial screening by 55 years of age.

  • The American Cancer Society recommends that women start annual mammograms at age 45. At 55, patients can switch to biennial screening or continue with annual screening.
  • The American College of Obstetricians and Gynecologists (ACOG) recommends that providers offer biennial or annual mammograms for patients ages 40 through 49; screening is recommended by age 50 if it has not been initiated.
  • The United States Preventive Services Task Force (USPTF) recommends biennial screening for patients between 50 and 74 years.

These recommendations allow flexibility based on patient preference and risk factors.

127.

Which of the following BEST promotes an infant's attachment to their mother?

  • The mother's responsiveness to the infant's needs

  • The mother speaking to the infant in a soothing voice as soon as possible after birth

  • Regular breastfeeding

  • Avoidance of separation of the mother and infant in the immediate postpartum period

Correct answer: The mother's responsiveness to the infant's needs

The mother's responsiveness to the infant's needs develops the infant's attachment to their mother. 

Skin-to-skin contact after birth, breastfeeding, and the avoidance of separation in the immediate postpartum period promote bonding, the connection from the mother to the infant, more than the infant's attachment to its mother. The mother speaking to the infant in a soothing voice as soon as possible after birth is not considered an important component of developing the infant's attachment.

128.

During a newborn exam, the midwife notes irritability and skin vesicles. Which of the following is the midwife's PRIMARY concern?

  • Herpes simplex virus (HSV)

  • Toxoplasmosis

  • Cytomegalovirus

  • Nonbullous impetigo

Correct answer: Herpes simplex virus (HSV)

HSV symptoms include:

  • skin vesicles
  • irritability
  • seizures
  • dyspnea, grunting, cyanosis, tachypnea, or apnea
  • jaundice
  • central nervous system (CNS) issues
  • shock

Cytomegalovirus symptoms include hearing or vision loss, intellectual disability, microcephaly, and other issues. While clinical evidence of CMV occurs at birth, symptoms may not develop for two years. Toxoplasmosis results in deafness and a lower IQ. Impetigo also includes vesicles but is relatively benign in comparison to the other conditions; the priority is ruling out HSV.

129.

A patient is concerned they are at risk for postpartum infection. Which of the following is true about postpartum infections?

  • C-section infection rates are approximately 10% to 15%.

  • Vaginal births are at higher risk than cesarean section.

  • The most common causative organism is Escherichia coli.

  • Criteria include one oral temperature greater than 38 degrees Celsius.

Correct answer: C-section infection rates are approximately 10% to 15%.

Postpartum infections affect 10% to 15% of cesarean births. Vaginal births have a lower risk for infection, with approximately 2% resulting in postpartum infections. 

The most common infectious organisms are streptococcal and staphylococcus organisms. A fever related to infection involves a temperature of 38 degrees Celsius or higher for more than one day (after day one postpartum). 

130.

A midwife educates a patient about fetal development. Which of the following statements is correct?

  • A morula enters the uterus on post-fertilization day 3.

  • A blastocyst occurs between the zygote and morula stages.

  • A zygote is a cell with 23 chromosomes after fertilization.

  • The conceptus is made of the placenta and membrane tissue only.

Correct answer: A morula enters the uterus on post-fertilization day 3.

Fetal development occurs from fertilization to the fetus becoming fully developed. A morula is a cluster of cells formed by blastomeres that enter the uterus 3 days after fertilization. 

A blastocyst occurs between the morula and embryo stages. A zygote is a diploid cell with 46 chromosomes, occurring after the ovum is fertilized by spermatozoa. The conceptus consists of the embryo (fetus), placenta, and membrane tissue.

131.

You receive a laboratory report on a 25-year-old woman at 28 weeks gestation. Her hemoglobin is 9.5 g/dL, hematocrit is 28%, and mean corpuscular volume (MCV) is 70 fL. Which of the following conditions is MOST likely?

  • Iron-deficiency anemia

  • Folate deficiency anemia

  • Normal hematological status

  • Thalassemia

Correct answer: Iron-deficiency anemia

The decreased hemoglobin, hematocrit, and Mean Corpuscular Volume (MCV) indicate microcytic anemia. During pregnancy, iron deficiency is the most common cause of microcytic anemia. 

Folate deficiency anemia typically presents as macrocytic anemia, not microcytic. These results are abnormal and do not indicate a normal hematological status. Thalassemia is a genetic condition that can cause microcytic anemia; however, it doesn't typically present or worsen during pregnancy. Given the patient's pregnancy, iron-deficiency anemia is a far more probable condition.

132.

A 55-year-old postmenopausal woman presents with a complaint of vaginal dryness and dyspareunia. Which of the following treatments is BEST appropriate for her symptoms?

  • Topical estrogen cream

  • Oral estrogen therapy

  • Progesterone-only pills

  • Non-hormonal vaginal moisturizers

Correct answer: Topical estrogen cream

Topical estrogen cream can be applied directly to the vaginal tissues, providing localized relief from vaginal dryness and dyspareunia without exposing the entire body to higher levels of estrogen.

Oral estrogen therapy can treat systemic symptoms of menopause, such as hot flashes and night sweats. However, for localized symptoms like vaginal dryness and dyspareunia, topical treatments are often more appropriate. Progesterone-only pills are not typically used to treat vaginal dryness or dyspareunia. Non-hormonal vaginal moisturizers can provide temporary relief from vaginal dryness but may not be as effective or long-lasting as topical estrogen treatments.

133.

What is a first-line pharmacologic treatment for mild acne during pregnancy?

  • Benzoyl peroxide wash

  • Retinoic acid derivatives

  • Oral tetracycline derivatives

  • Topical clindamycin

Correct answer: Benzoyl peroxide wash

Topical medications alone (or in combination) are ideal for treating mild acne. Benzoyl peroxide has antibacterial and comedolytic properties and is safe during pregnancy. 

Retinoic acid derivatives are topical medications that can treat mild acne, but they are not recommended during pregnancy. Oral tetracycline (and its derivatives) are contraindicated during pregnancy. Topical clindamycin can be used during pregnancy for moderate acne, not mild.

134.

A pregnant patient at 10 weeks of gestation presents to the office complaining of nearly constant nausea for four weeks. They vomit 3-4 times per day and have dry heaves nearly every hour when they are awake. Their urinalysis indicates no leukocytes or nitrites but does show ketones and trace protein. 

Which of the following is the midwife MOST likely to diagnose?

  • Hyperemesis gravidarum

  • Mild nausea and vomiting in pregnancy

  • Gallstones

  • Foodborne illness

Correct answer: Hyperemesis gravidarum

Hyperemesis gravidarum is persistent vomiting during pregnancy that is unrelated to other causes and correlates with a Pregnancy Unique Quantification of Emesis (PUQE) score of 13. A PUQE score of 13 indicates severe nausea and vomiting in pregnancy (NVP). Ketonuria and weight loss are indicative of hyperemesis gravidarum.

Mild cases of NVP have a score of 6 or less. While gallstones and foodborne illness may occur during pregnancy, the timing and duration of nausea and vomiting more closely match the presentation of nausea and vomiting in pregnancy (or hyperemesis gravidarum).

135.

Which of the following statements by a postpartum patient regarding involutional pain BEST indicates understanding of teaching on the topic?

  • "Ibuprofen is a good medicine to use to treat this pain."

  • "The pain will decrease when I nurse."

  • "This pain will decrease in intensity with future births."

  • "Changing positions will make this pain worse."

Correct answer: "Ibuprofen is a good medicine to use to treat this pain."

Involutional pain is pain that occurs as the uterus returns to its normal size. It can be treated using ibuprofen and acetaminophen.

Changing positions is an effective nonpharmacologic pain relief method. Nursing increases involutional pain. Involutional pain is likely to increase in intensity with each subsequent birth.

136.

A CNM is caring for a postpartum patient who is Rh-negative and has an Rh-positive newborn. Which of the following interventions is MOST appropriate?

  • Administering Rho(D) immune globulin

  • No intervention is necessary

  • Drawing a maternal type and cross

  • Monitoring the newborn for anemia

Correct answer: Administering Rho(D) immune globulin

Administering Rho(D) immune globulin to an Rh-negative mother who has an Rh-positive newborn can prevent the development of antibodies that could affect future pregnancies.

Monitoring the patient for jaundice does not address Rh incompatibility. Failure to intervene can cause the development of maternal antibodies that will affect future pregnancy. Drawing a maternal type and cross or monitoring the newborn for anemia does not address Rh incompatibility and is not indicated based on the information given.

137.

Which of the following is the MOST common cause of postmenopausal bleeding?

  • Atrophic vaginitis

  • Endometrial cancer

  • Uterine fibroids

  • Ovarian cysts

Correct answer: Atrophic vaginitis

Atrophic vaginitis is the thinning and inflammation of the vaginal walls due to decreased estrogen, leading to bleeding. Of the available options, this is the most common cause of postmenopausal bleeding.

While endometrial cancer is a serious cause of postmenopausal bleeding, it's not the most common cause. Uterine fibroids typically decrease in size after menopause and are less likely to cause bleeding. Ovarian cysts rarely cause postmenopausal bleeding.

138.

A midwife is present for a patient's second stage of labor. Which type of pushing should the midwife explain to the patient? 

  • Open glottis pushing 

  • Closed glottis pushing

  • Laboring down 

  • Valsalva pushing

Correct answer: Open glottis pushing 

Open glottis pushing is physiologic, and patients should be coached to push in this manner. Closed glottis pushing is also known as Valsalva pushing. It can decrease blood flow to the uterus, cause more fetal heart rate decelerations, and increase the risk of perineal trauma. 

Laboring down is passive descent; this should occur before active pushing and can allow a patient with an epidural to rest.

139.

A midwife is reviewing the results of a pelvic ultrasound with a patient. The midwife tells the patient that their ectopic endometrium is found within the myometrium.

Which of the following diagnoses is MOST likely?

  • Adenomyosis

  • Endometrial carcinoma

  • Uterine fibroids

  • Leiomyomata uteri

Correct answer: Adenomyosis

In adenomyosis, the ectopic endometrium is found within the myometrium and can sometimes be diagnosed on pelvic ultrasound.

Endometrial carcinoma is uterine cancer. Uterine fibroids (leiomyomata uteri) are nodular, discrete tumors of varying sizes that can appear as one or many.

140.

Where would a midwife expect to find a nabothian cyst?

  • Cervix

  • Fourchette

  • Introitus

  • Urethra

Correct answer: Cervix

A nabothian cyst looks like a small, raised, round area on the cervix. It is yellow or white and is also known as a Naboth follicle.  

The fourchette is the posterior of the vaginal orifice where the labia minora meet. Bartholin's cyst is found posteriorly on each side of the introitus. Skene's cysts are found on either side of the urethra.

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