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Quiz Session - Attempts With Random Questions

AMCB CNM Exam Questions

Page 8 of 40

141.

Which of the following statements is true about anesthesia and analgesia during labor?

  • Analgesia is different from anesthesia. 

  • Analgesia is used immediately prior to birth.

  • Anesthesia includes hypnotics, sedatives, and opioids.

  • Anesthesia medications can have an amnesiac effect. 

Correct answer: Analgesia is different from anesthesia.

Analgesia decreases the pain sensation, but anesthesia provides a complete neurologic block. 

Analgesia should be avoided within one hour before birth because it can cause respiratory depression in the fetus. Options include hypnotics, sedatives, and opioids. Analgesia medications can have an amnesiac effect. 

142.

Which of the following statements is TRUE regarding the classification criteria for rheumatoid arthritis (RA)?

  • Rheumatoid nodules and symmetric arthritis may not be present

  • Category A (joint involvement) is scored on a scale of 2 to 10

  • The score-based algorithm includes 7 categories for classification

  • The symptom duration category gives 1 point for symptoms lasting 6 months or more

Correct answer: Rheumatoid nodules and symmetric arthritis may not be present

The 2010 criteria do not include the presence of rheumatoid nodules, radiographic erosive changes, and symmetric arthritis because they may not be present in early RA. 

The classification criteria for RA include four categories (A-D) for classification. Category A is joint involvement and scored on a scale of 0 to 5, depending on the number of affected joints and joint size with clinical synovitis. The symptom duration category gives 1 point for symptoms lasting 6 weeks or more and zero points if not.

143.

Which of the following is the MOST common vaginal infection for women of childbearing age?

  • Bacterial vaginosis

  • Trichomoniasis

  • Vulvovaginal candidiasis

  • Chlamydia

Correct answer: Bacterial vaginosis

Bacterial vaginosis is the most common vaginal infection for women ages 15 to 44. 

Vulvovaginal candidiasis is the second most common vaginal infection, and trichomoniasis occurs less frequently. Chlamydia is the most common reportable STI, not vaginal infection.

144.

A midwife is providing anticipatory guidance regarding menopause to a patient. Which of the following statements is true about menopause?

  • Menstrual cycle changes are the primary clinical diagnostic criterion.

  • The average life expectancy of women in the US is 71.6 years old.

  • The average age of menopause in the United States is 47 years old.

  • Perimenopause starts 12 months prior to menopause.

Correct answer: Menstrual cycle changes are the primary clinical diagnostic criterion.

According to the STRAW reproductive-aging continuum by the North American Menopause Society, menstrual cycle changes are the primary clinical diagnostic criteria, and hormone evaluations are supportive criteria. 

The average life expectancy of women is 81.2 years old, meaning most people spend over one-third of their lives beyond menopause. The average age of menopause in the United States is 52 years old. Perimenopause is the period between the menopause transition and 12 months following the final menstrual period (FMP). 

145.

Which of the following will the midwife MOST likely include in their plan of care for a patient with premenstrual syndrome (PMS)?

  • Educate the patient about lifestyle changes

  • Increase electrolytes like sodium

  • Order a hormone panel from the lab

  • Recommend a progesterone-dominant drug

Correct answer: Educate the patient about lifestyle changes

Premenstrual syndrome is initially treated with conservative management like reducing stress, improving diet, increasing physical activity, and providing reassurance that the symptoms are valid. The patient should be encouraged to return if PMS symptoms are not relieved by conservative management.

A low-salt diet may be recommended as supportive management. A laboratory panel is not necessary, as PMS is diagnosed by symptoms. PMS occurs during the luteal phase and starts about 5 to 11 days before the menses. The luteal phase is the progesterone-dominant phase.

146.

A midwife assists with a partial breech extraction. Which of the following is true?

  • The midwife should empty the patient's bladder before the second stage.

  • The midwife should be ready with the ultrasound machine.

  • The midwife should have oxytocin ready for protraction disorder.

  • The midwife should guide the infant's body out to the umbilicus.

Correct answer: The midwife should empty the patient's bladder before the second stage.

The midwife should empty the patient's bladder before the second stage in this case.

An ultrasound machine is not likely to be necessary during a breech birth. Oxytocin for protraction disorders is controversial, and a cesarean section is typically indicated. The birth should be hands-off until the body is born to the infant's umbilicus.

147.

Which of the following is true about the ovarian cycle?

  • The follicular phase begins on day one of menses.

  • During the follicular phase, progesterone is secreted.

  • The ovarian cycle is comprised of four phases.

  • The luteal phase is the last seven days of the cycle.

Correct answer: The follicular phase begins on day one of menses.

The follicular phase begins on the first day of menstruation and continues until ovulation occurs. 

During the luteal phase, the corpus luteum secretes progesterone. The ovarian cycle is comprised of three phases: follicular, ovulation, and luteal. The luteal phase is the period from ovulation to menses; it may vary from person to person but is usually considered to be 14 days.

148.

A patient is experiencing significant hot flashes that are disrupting her daily activities. She asks to discuss hormone replacement therapy (HRT). Her uterus is intact. Which of the following is the BEST option to prescribe?

  • Estrogen-progesterone therapy

  • Topical estrogen vaginal cream

  • Estrogen vaginal ring

  • Progesterone suppositories

Correct answer: Estrogen-progesterone therapy

Oral estrogen and progesterone are given to improve moderate to severe vasomotor symptoms.

Because the patient still has a uterus, she should take progesterone with systemic estrogen. Topical local hormonal treatments would not improve hot flashes, only vaginal symptoms.

149.

A 26-year-old woman presents with a complaint of vaginal discharge with a fishy odor. Wet mount preparation shows clue cells. What is the MOST appropriate treatment?

  • Metronidazole

  • Fluconazole

  • Clindamycin

  • Ceftriaxone

Correct answer: Metronidazole

Metronidazole is the treatment of choice for bacterial vaginosis, which presents with vaginal discharge and a fishy odor with clue cells on wet mount. 

Fluconazole is used to treat yeast infections but is not the preferred treatment for bacterial vaginosis. Clindamycin is an alternative treatment for bacterial vaginosis but not the first choice. Ceftriaxone is used to treat gonorrhea but is not routinely used to treat bacterial vaginosis.

150.

Which of the following is a contraindication for a vacuum-assisted vaginal delivery?

  • Fetal gestation fewer than 34 weeks

  • Maternal exhaustion

  • Occiput posterior position

  • Prolonged second stage of labor

Correct answer: Fetal gestation fewer than 34 weeks

Vacuum-assisted delivery is contraindicated before 34 weeks due to the risk of intraventricular hemorrhage in the fetus. 

Maternal exhaustion, occiput posterior position, and a prolonged second stage might make vacuum delivery more challenging, but they are not absolute contraindications.

151.

Which of the following should NOT be combined with magnesium sulfate?

  • Nifedipine

  • Albuterol

  • Penicillin 

  • Calcium gluconate

Correct answer: Nifedipine

Calcium channel blockers interact with magnesium sulfate and should not be administered concurrently. 

Calcium gluconate is the antidote for magnesium sulfate and may be combined with magnesium sulfate if toxic effects develop. Albuterol and penicillin are not necessary to avoid combining with magnesium sulfate like calcium channel blockers are.

152.

Thirty-five minutes after giving birth, a patient has not yet birthed the placenta. Which of the following is the midwife's priority concern? 

  • Retained placenta

  • Endometritis

  • Subinvolution

  • Postpartum hemorrhage

Correct answer: Retained placenta

If the third stage lasts longer than 30 minutes, a retained placenta is likely. 

Endometritis, subinvolution, and postpartum hemorrhage are concerns related to retained placenta. However, the priority intervention is to notify the consulting physician. 

153.

What is the most common etiology of postpartum hemorrhage? 

  • Uterine atony 

  • Obstetric trauma

  • Perineal lacerations

  • Retained placenta

Correct answer: Uterine atony 

Uterine atony is the primary etiology of postpartum hemorrhage, accounting for 70% to 90% of postpartum hemorrhages. 

Other causes are obstetric trauma, lacerations, retained placenta, placenta accreta, coagulation issues, and uterine inversion.

154.

The 55-year-old client reports for an annual wellness exam. The patient has an average risk of colon cancer. They underwent a colonoscopy at age 45 but have not had any screening since. 

Which of the following colon cancer screening options should the midwife recommend?

  • Colonoscopy

  • CT colonography

  • Flexible sigmoidoscopy

  • No testing needed

Correct Answer: Colonoscopy

A colonoscopy is a first-line screening test for colon cancer. The patient's last colonoscopy was 10 years ago. 

Flexible sigmoidoscopy and CT colonography should be performed every 5 years. Colonoscopy should be performed every 10 years for a person of average risk.  

155.

For which patient is carboprost contraindicated?

  • A patient with a history of asthma

  • A patient with gestational hypertension

  • A patient with a history of gestational diabetes

  • A patient with a severe postpartum hemorrhage

Correct answer: A patient with a history of asthma

Carboprost (Hemabate) is contraindicated in those with a history of asthma because it has been demonstrated to exacerbate asthma.

Carboprost should be used cautiously in patients with hypertension and diabetes. Hemabate is given to patients with the indication of a severe postpartum hemorrhage.

156.

Which of the following is NOT a fetal heart rate (FHR) monitoring technique? 

  • FHR on sonogram

  • Continuous fetal monitoring

  • Internal FHR 

  • Intermittent FHR by fetoscope

Correct answer: FHR on sonogram

A sonogram is not an FHR-monitoring technique.

Continuous fetal monitoring consists of external FHR detection and tracing FHR. Internal FHR monitoring is done by fetal scalp electrodes in high-risk cases. Intermittent FHR auscultation is done by a fetoscope or Doppler.

157.

A midwife is discussing vision screening recommendations for visual acuity and glaucoma with a 21-year-old patient. The patient's medical history includes diabetes and mild asthma that is well controlled with an inhaler. 

Which of the following vision screening recommendations is true for this patient? 

  • Annually

  • Every 3 to 5 years 

  • Every 2 to 4 years

  • Every 1 to 2 years

Correct answer: Annually

The vision screening recommendations by the American Academy of Ophthalmology for visual acuity and glaucoma are yearly for diabetic patients of any age. 

Patients between 20 and 39 years of age should be seen every 3 to 5 years. Those who are 40 to 64 years old should be seen every 2 to 4 years. People who are 65 years or older should be seen every 1 to 2 years.

158.

A midwife performs a vaginal exam and palpates the presenting part at the level of the ischia spines. Which of the following is the likely fetal station?

  • 0 station

  • -1 station

  • +1 station

  • Ballotable

Correct answer: 0 station

The presenting part at the level of the ischia spines is at zero station.

-1 station means the presenting part is one centimeter above the level of the ischial spine. +1 station means the presenting part is one centimeter below the level of the ischial spine. Ballotable means that the presenting part floats up when pressure is applied.

159.

A patient presents with anogenital warts. What is one of the types of HPV that causes this symptom? 

  • Type 6

  • Type 16

  • Type 18

  • Type 33

Correct answer: Type 6

Anogenital warts are typically caused by type 6 or 11. 

Types 16 and 18 are high-risk forms of HPV that are more likely to cause cervical cancer. Type 33 is also considered an oncogenic HPV type.

160.

For labor pain, which of the following medications has the fewest adverse reactions at low doses?

  • Nitrous oxide

  • Butorphanol

  • Nalbuphine

  • Morphine sulfate

Correct answer: Nitrous oxide

Nitrous oxide has few adverse effects at low doses and when self-administered.

The other options are opioid narcotics, which can cause respiratory distress and neonatal abstinence syndrome.

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