AMCB CNM Exam Questions

Page 9 of 40

161.

Which of the following is a clinical intrapartum indication for a pediatric provider's involvement in a birth? 

  • Chorioamnionitis

  • Category II fetal heart rate tracing

  • Opioid analgesia four hours before birth

  • Congenital abnormality

Correct answer: Chorioamnionitis

Chorioamnionitis is a clinical intrapartum indication for a pediatrician or neonatologist to be present at birth. 

A category III fetal heart rate tracing is an intrapartum indication for a pediatric provider to be present at birth. Opioid analgesia given within an hour before is an indication. Congenital abnormalities are an obstetric indication, not an intrapartum indication.

162.

A midwife is discussing an ultrasound report with a patient that demonstrates placenta accreta. What is the PRIMARY concern during the course of their pregnancy and birth? 

  • Postpartum hemorrhage

  • Placental abruption

  • Placental calcifications

  • Chorioamnionitis

Correct answer: Postpartum hemorrhage

Placenta accrete is the invasion of the placenta into the myometrium of the uterus. The greatest concern with placenta accrete is the possibility of severe hemorrhage, and delivery requires a multidisciplinary team with specialists, surgeons, a neonatologist, and blood bank involvement. 

Placental abruption, calcifications, and chorioamnionitis are not significant concerns for placenta accreta. Premature birth is another possible complication of placenta accreta.

163.

Which suture material is MOST commonly used for the repair of perineal lacerations? 

  • Vicryl

  • Prolene

  • Silk

  • Chromic gut

Correct answer: Vicryl

Vicryl is the most common type of suture material used for the repair of perineal lacerations.

Chromic gut is an absorbable suture material that is an adequate alternative to vinyl, but less commonly used. Prolene is traditionally used for skin closure. Silk is nonabsorbable, and vicryl is absorbable. 

164.

A patient who underwent embryo cryopreservation is now ready for a frozen embryo transfer (FET). Which of the following statements made by the patient about FET MOST indicates the patient requires further education about the process?

  • "The embryos will be thawed within 24 hours of being frozen."

  • "Using frozen embryos has a similar success rate to using fresh embryos."

  • "My endometrial lining will be prepared with hormones before the transfer."

  • "Each fertilized embryo is a human life."

Correct answer: "The embryos will be thawed within 24 hours of being frozen."

Embryos can be stored for extended periods (often years) before being thawed and transferred. They are not transferred within 24 hours of cryopreservation.

Frozen Embryo Transfer (FET) cycles can have similar success rates to fresh embryo transfers. Hormonal preparations are used to prepare the endometrial lining for implantation. Stating that each fertilized embryo is a human life represents a stated moral belief on the part of the patient, not a stated misunderstanding of the process. While clinicians involved in assisted reproductive technologies may not agree with the patient's perspective, this statement does not require reeducation of the patient. 

165.

A 28-year-old primigravida at 32 weeks gestation presents with sudden onset of severe right upper quadrant pain and nausea. Her blood pressure is 153/95 mmHg. Which of the following is the MOST likely diagnosis?

  • Preeclampsia with severe features

  • Placental abruption

  • Cholecystitis

  • Round ligament pain

Correct answer: Preeclampsia with severe features

Preeclampsia with severe features can manifest with hypertension and right upper quadrant pain due to liver involvement. The liver can become edematous and distend the Glisson's capsule, causing pain. 

Cholecystitis, or inflammation of the gallbladder, can also cause right upper quadrant pain but is typically not associated with hypertension. Placental abruption usually presents with vaginal bleeding and uterine tenderness or contractions. Round ligament pain is a sharp pain or jabbing feeling often felt in the lower belly or groin area on one or both sides. It is one of the most common complaints during pregnancy and is considered a normal part of pregnancy.

166.

What is a first-line pharmacologic treatment for fibromyalgia?

  • Serotonin and noradrenergic reuptake inhibitors

  • Tramadol

  • Acetaminophen

  • Nonsteroidal anti-inflammatory drugs

Correct Answer: Serotonin and noradrenergic reuptake inhibitors

Serotonin and noradrenergic reuptake inhibitors (SNRIs) are FDA-approved drugs to treat fibromyalgia and reduce pain. 

Tramadol is not recommended as a first-line treatment. Acetaminophen and NSAIDs are over-the-counter analgesics that can be used to treat fibromyalgia.

167.

A midwife is evaluating a fetal heart rate (FHR) tracing with minimal variability and a baseline of 130 bpm. There is a 9-minute prolonged deceleration that recovers. Which of the following is the appropriate FHR tracing classification? 

  • Category II 

  • Category I 

  • Category III

  • Indeterminate

Correct answer: Category II 

In a category II tracing, a prolonged deceleration can be between 2 to 10 minutes long. 

A category I tracing is a normal result that is associated with a normal acid-base balance and a normal baseline, moderate FHR variability, variability, and absent late or variable decelerations. A category III tracing is associated with absent variability and bradycardia, recurrent variable decelerations, recurrent late decelerations, and sinusoidal patterns. 

The tracing is not indeterminate because the midwife can evaluate the patient's baseline, variability, and other factors.

168.

Which of the following questions is LEAST important to answer immediately following birth?

  • Is the heart rate at least 100 bpm?

  • Is the newborn at term gestation?

  • Is the tone good?

  • Is the baby breathing or crying?

Correct answer: Is the heart rate at least 100 bpm?

While heart rate should quickly be assessed during the first minute of life, the three most important questions to ask immediately after birth are if the newborn is at term gestation, if the tone is good, and if the baby is breathing or crying.

169.

A postpartum patient with a medical history of Roux-en-Y gastric bypass is breastfeeding. The midwife is providing discharge teaching. Which of the following is the priority supplement?

  • Vitamin B12 

  • Fenugreek

  • Milk thistle

  • Vitamin E

Correct answer: Vitamin B12

Roux-en-Y gastric bypass is a restrictive-malabsorptive procedure to facilitate weight loss. The surgery increases the risk of vitamin B12 deficiency, so 500 mcg PO daily should be taken for life.

Fenugreek and milk thistle may be recommended for lactation support, but their medical history has not demonstrated any need to increase supply. While a prenatal vitamin is recommended to support vitamin E, additional supplementation isn't required.

170.

A midwife is getting ready to leave when a client who has just given birth describes sudden, agonizing perineal pain. Which of the following diagnoses is likely?

  • Perineal hematoma

  • Postpartum hemorrhage

  • Vaginal candidiasis

  • Fourth-degree laceration

Correct answer: Perineal hematoma

A perineal hematoma often presents as a sudden onset of excruciating perineal pain following birth. 

A postpartum hemorrhage will not usually cause increased pain. While vaginal candidiasis is possible, it is unlikely to have a sudden and agonizing onset. Finally, a fourth-degree laceration should not cause a sudden onset of agonizing pain.

171.

Which of the following is NOT assessed during vaginal examinations while a patient is in labor?

  • Cervical tone

  • Cervical dilation

  • Cervical effacement

  • Fetal descent

Correct answer: Cervical tone

Cervical tone is not typically considered important to assess during vaginal examinations while a patient is in labor. 

Cervical dilation and effacement along with fetal descent are all assessed in a vaginal examination during labor.

172.

A midwife is educating a patient about healthy weight gain during pregnancy. The patient has a prepregnancy body mass index (BMI) of 28. 

Which of the following weight gain ranges is recommended for this patient?

  • 15 to 25 lbs

  • 25 to 35 lbs

  • 11 to 20 lbs

  • 28 to 40 lbs

Correct answer: 15 to 25 lbs

A BMI of 28 is in the overweight range. For patients who start pregnancy overweight, the recommended weight gain range is 15 to 25 lbs. 

People of a healthy prepregnancy weight are advised to gain 25 to 35 lbs. Patients who are obese should gain 11 to 20 lbs. People who are underweight before pregnancy are encouraged to gain 28 to 40 lbs.

173.

A 25-year-old woman at 30 weeks gestation presents with polyhydramnios on ultrasound. Which of the following conditions is MOST commonly associated with this finding?

  • Gestational diabetes

  • Fetal anemia

  • Twin-to-twin transfusion syndrome

  • Placental insufficiency

Correct answer: Gestational diabetes

Gestational diabetes can lead to fetal hyperglycemia, which can cause increased fetal urination, resulting in polyhydramnios. 

Fetal anemia can lead to hydrops fetalis, which can be associated with polyhydramnios, but gestational diabetes is a more common cause. Twin-to-twin transfusion syndrome can cause polyhydramnios due to increased blood volume in the recipient twin, but it's specific to monochorionic twin pregnancies. Placental insufficiency typically leads to oligohydramnios, not polyhydramnios, due to decreased fetal urine production.

174.

A midwife is discussing recommendations about clinical breast examination (CBE) with a 35-year-old patient. Which of the following indicates that the patient requires further education?

  • "I should get an annual CBE until my first mammogram."

  • "The ACOG recommends yearly CBEs after 40 years old."

  • "CBEs aren't recommended for women at an average risk of breast cancer."

  • "Nodular breast changes occur in more than half of adult women my age."

Correct answer: "I should get an annual CBE until my first mammogram."

Annual CBEs do not stop just because mammograms occur. The ACOG recommends an annual CBE after age 40, while the ACS and USPTF do not recommend a CBE for women with an average risk of breast cancer. 

Palpable changes in breast nodules are observed in over 50% of women 20 to 50 years of age (primarily in those 35 to 50 years).

175.

A midwife performs a Rinne test that is positive. What does this mean?

  • A positive Rinne test is normal.

  • This result suggests conductive hearing loss.

  • The result means bone conduction is greater than air conduction.

  • The tuning fork was placed on the malleus bone.

Correct answer: A positive Rinne test is normal.

A Rinne test is performed to compare bone conduction with air conduction. When a Rinne test is positive, it is normal, meaning air conduction is greater than bone conduction. If it is negative, meaning the bone conduction is greater than air conduction, it suggests conductive hearing loss. 

The tuning fork is applied to the mastoid bone.

176.

A midwife cares for a low-risk patient in the first stage of labor. Their membranes have ruptured; they are 5 cm dilated and prefer to remain upright. 

Which of the following fetal monitoring and activity orders would the midwife include in the plan of care? 

  • Up ad-lib and intermittent fetal monitoring

  • Encourage bed rest and continuous external monitoring

  • Up ad-lib and continuous external monitoring

  • Encourage bed rest and continuous internal monitoring

Correct answer: Up ad-lib and intermittent fetal monitoring

This patient has no obstetric risk factors. The fetal heart rate can be auscultated intermittently, as long as fetal well-being is ascertained. The patient may ambulate and does not need to remain on bed rest at this time.

177.

A patient is confused about the benefits of breastfeeding and requests guidance. Which of the following is helpful for breastfeeding promotion?

  • Place the newborn in skin-to-skin contact

  • Provide a pacifier if the patient's nipples are sore

  • Offer formula after a successful breastfeeding session

  • Initiate breastfeeding in the first two hours after birth

Correct answer: Place the newborn in skin-to-skin contact

Skin-to-skin contact promotes breastfeeding. 

Pacifier use before the breastfeeding relationship is established can interfere. A physiologic breastfeeding relationship should be supported, and offering formula can decrease the frequency of breastfeeding, affecting supply. Breastfeeding should be initiated in the first hour following birth.

178.

A patient with a breech presentation is spontaneously bearing down, and the birth is imminent. Which of the following is true?

  • The fetal back should spontaneously rotate anteriorly.

  • Keep hands off the breech until the scapula is born.

  • Avoid the Mauriceau-Smellie-Veit maneuver to maintain head flexion.

  • Apply downward traction to deliver the head by the curve of Carus.

Correct answer: The fetal back should spontaneously rotate anteriorly.

The fetal back should spontaneously rotate anteriorly, and the head should not be allowed to rotate to the occiput posterior (OP) position. 

Keep hands off the breech until the fetus is born to the umbilicus. Employ the Mauriceau-Smellie-Veit maneuver to maintain head flexion if it is needed. Apply upward traction to deliver the head by the curve of Carus while elevating the body.

179.

A midwife is discussing a patient's concerns about prolonged bleeding while on oral hormonal contraception for the last 90 days. What hormonal contraception change would the midwife MOST likely suggest? 

  • Prescribe a stronger progestational agent

  • Prescribe a pill with a weaker estrogenic effect

  • Change the time of day the pill is taken

  • Ask the patient to return in 30 days

Correct answer: Prescribe a stronger progestational agent

Prescribing a stronger progestational agent or switching to a different progestational agent will often resolve bleeding irregularities related to oral contraception. 

Prescribing a pill with a weaker estrogenic effect will not be effective because lower doses of estrogen are likely to be insufficient to support the endometrium. Changing the time of day will not resolve prolonged bleeding, which is likely related to poor endometrial support.

180.

A client is complaining of a unilateral erythematous and edematous area in the breast, a headache, and a fever of 102 degrees Fahrenheit. The client is allergic to amoxicillin. Which of the following is the recommended antibiotic? 

  • Clindamycin 300 mg PO QID for 10 days

  • Dicloxacillin 500 mg PO QID for 14 days 

  • Flucloxacillin 500 mg PO QID for 10 days

  • Cephalexin 500 mg QID for 14 days

Correct answer: Clindamycin 300 mg PO QID for 10 days

For those who are penicillin-allergic, the recommended first-line antibiotic is clindamycin 300 mg PO QID  for 10 to 14 days. Those who are not allergic to penicillin should be prescribed dicloxacillin or flucloxacillin 500 mg PO QID for 14 days or cephalexin 500 mg QID for 10 to 14 days.