3. Maternal health assessment (31-60)

Question 1

31 . Maternal infection, preeclampsia, maternal malnutrition, dysfunctional labor, hemorrhage, IUGR, RDS and neonatal abstinence syndrome are all risks related to what?
a) Pregnancy achieved through IVF
b) Drug use during pregnancy
c) HIV
d) Depression

Answer 1

B

Question 2

32 . What is allostatic load?
a) The wear and tear on the body that accumulates due to chronic or repeated stress or epigenetic inherited stress, as in the cases of ongoing resource scarcity or racism.
b) The pressure on the cervix when the pelvis is positioned such that the presenting part exerts maximum pressure there.
c) The change in blood pressure when moving from prone to standing.
d) The additional work the cardiac muscles must do during pregnancy.

Answer 2

A

Question 3

33 . Which of the following is within normal limits for the eyes?
a) Pupils around 0.5 mm different in size when exposed to equal light on both sides.
b) Pupil constricts under direct response to light but dilates under consensual response to light.
c) Pupil constricts under consensual response to light but dilates under direct response to light.
d) Pupils more than 1.5 mm different in size when exposed to different levels of light.

Answer 3

A

Question 4

34 . You’re counselling a client on changes she should make to her lifestyle, and explain that if she does not make the change, she is likely to cause significant impacts on the fetus, including CNS abnormalities, abnormal facies (low-set ears, a thin upper lip and an under-developed jaw), microcephaly, antepartum and postpartum growth retardation, impaired eyesight and even death. What is your client currently doing?
a) Drinking alcohol
b) Insufficient iodine intake, e.g. by eating sea salt instead of iodized salt.
c) Excessive intake of caffeine
d) Smoking

Answer 4

A

Question 5

35 . You ask a client to sit with her back exposed, make a fist, and gently pound down one side of the client’s back with the ulnar surface of your fist, beginning at the scapular area and ending at the midportion of her buttock, noting if the client winces, jumps or expresses pain at any point, then repeat on the other side. You note no signs of pain. What do you record in the chart?
a) Lordosis within normal limits
b) No scoliosis
c) No kyphosis
d) No CVAT

Answer 5

D

Question 6

36 . What is true when taking blood pressure?
a) The first sound you hear is the diastolic reading, which indicates the pressure in the arteries when the heart is actively pumping.
b) The first sound you hear is the systolic reading, which indicates the pressure in the arteries when the heart is actively pumping.
c) The first sound you hear is the diastolic reading, which indicates the pressure in the arteries when the heart is at rest.
d) The first sound you hear is the systolic reading, which indicates the pressure in the arteries when the heart is at rest.

Answer 6

B

Question 7

37 . Which list contains only things you might want to counsel a client to change about their health or behavior during pregnancy?
a) 6 cups of coffee daily, moderate swimming within comfort levels.
b) Smoking 10 cigarettes a day, drinking 10 cups of water a day.
c) Sleeping 8 hours per night, adding salt to food ‘to taste’.
d) 2 alcoholic drinks a day, excessive exercise.

Answer 7

D

Question 8

38 . Spontaneous abortion, abnormal placentation, preeclampsia, IUGR, low birth weight, congenital heart disease, prematurity, apnea and SIDS are all risks associated with what?
a) Pregnancy achieved through IVF
b) Maternal tobacco use
c) Advanced maternal age
d) Poor maternal nutrition

Answer 8

B

Question 9

39 . Gael was taking the contraceptive pill when they became pregnant. What effect might this have on your care?
a) The contraceptive pill has reduced Gael’s risk of certain cancers, and has likely improved their nutritional status by increasing absorption of vitamins and minerals.
b) The contraceptive pill has reduced the risk of Gael having a hemorrhage, including a postpartum hemorrhage.
c) Gael’s hormonal balance was unaffected by the contraceptive pill, but if they were taking other hormones, these might have had an impact on their weight and could have increased the risk of liver and gallbladder problems.
d) Without additional information, Gael’s EDD will be uncertain. If they can’t narrow down the date of conception, a dating ultrasound would be appropriate.

Answer 9

D

Question 10

40 . Which of the following is an abnormal observation at an antepartum breast exam?
a) Striae of the breasts in third trimester.
b) Shrunken breast in first trimester.
c) Broadening and increased pigmentation of areola with mottling beyond the areola, both observed in second trimester.
d) Dilated subcutaneous veins in late first trimester.

Answer 10

B

Question 11

41 . You’re meeting Gala (a vocal ‘pro-life’ activist) for the first time at her intake appointment, and have recorded a GTPALM of G3,T1,P1,A1,L2,M0. Is this a possible history?
a) You don’t have enough information in the question to answer this.
b) Yes. Gala had 1 Term baby, 1 Preterm baby, 1 Abortion and no Multiples, and so has been pregnant 3 times, with 2 of the babies she’s carried still living.
c) No. Gala has not had any Multiple pregnancies, but 1 Term baby, 1 Preterm baby (pregnancy ended after 20 weeks) and 1 Abortion (pregnancy ended before 20 weeks) adds up to 3 babies, and she’s currently pregnant, so her Gravida cannot be 3 if this is all true.
d) It’s highly unlikely, as Gala is pro-life, and so it’s not likely that she had an abortion.

Answer 11

C

Question 12

42 . You attempt to palpate a client’s ovaries by bimanual exam. Which of the following would tell you that referral to a physician is appropriate?
a) You cannot palpate the ovaries.
b) You palpate normal ovaries in the adnexal region, lateral and posterior to the uterus.
c) You find enlarged ovaries.
d) You palpate normal ovaries in the adnexal region, lateral to the uterus.

Answer 12

C

Question 13

43 . Isabelle thinks she is 12 weeks pregnant. You perform a bimanual examination. What size would you expect the uterus to be?
a) Approximately the size of a cantaloupe.
b) Bimanual examination is not appropriate at 12 weeks, as you would feel the fundus well above the pubic bone by then.
c) Approximately the size of a grapefruit.
d) Approximately the size of an orange.

Answer 13

C

Question 14

44 . The father of your client’s baby admits to you that he drank heavily in the weeks leading up to conception. What impact could this have on the pregnancy?
a) Limited research suggests that alcohol may cause epigenetic changes in sperm, and that this could lead to changes in the fetal neocortex.
b) There is no evidence to suggest that alcohol consumption in the father of a baby has any impact on the pregnancy.
c) The baby may go through neonatal abstinence syndrome because of it.
d) You should call CPS, as the mother and baby could be at risk of domestic abuse.

Answer 14

A

Question 15

45 . What are some pregnancy outcomes associated with chronic stress?
a) Reduced risk of miscarriage, higher APGARS, lower rates of postpartum depression.
b) Obesity, insulin resistance, cardiovascular disease.
c) Racism, ongoing resource scarcity, living with a chronic disease.
d) Preterm birth, low birth weight, changes in fetal brain development.

Answer 15

D

Question 16

46 . Helen is Rh-negative and her husband is Rh-positive. She gets RhoGAM at 28 weeks. Which statement is true?
a) RhoGAM is effective for approximately 3 weeks. If she wants a second dose of RhoGAM after birth, you have 24 hours to determine baby’s Rh factor and administer the RhoGAM if appropriate.
b) RhoGAM is effective for approximately 12 weeks. If she wants a second dose of RhoGAM after birth, you have 72 hours to determine baby’s Rh factor and administer the RhoGAM if appropriate.
c) RhoGAM is effective for approximately 3 weeks. If she wants a second dose of RhoGAM after birth, you have 72 hours to determine baby’s Rh factor and administer the RhoGAM if appropriate.
d) RhoGAM is effective for approximately 12 weeks. If she wants a second dose of RhoGAM after birth, you have 24 hours to determine baby’s Rh factor and administer the RhoGAM if appropriate.

Answer 16

B

Question 17

47 . Genesis is 11 weeks pregnant and tells you she has been pregnant 4 times before this. She lost the first at 6 weeks and the second at 18 weeks. She was then pregnant with twins, who were safely born via cesarean at 35 weeks. Her fourth pregnancy was a VBAC at 40 weeks and 3 days. Her twins and the most recent baby are all alive and well. What would you record for GTPALM (Gravida, Term, Preterm, Abortion, Living, Multiples)?
a) G4,T1,P3,A1,L3,M1
b) G5,T1,P2,A2,L3,M1
c) G4,T1,P2,A2,L3,M1
d) G5,T1,P3,A1,L3,M1

Answer 17

B

Question 18

48 . Which list has a correct list of ethnic groups and select genetic disease processes for which they are at increased risk?
a) African Blacks: sickle cell, Mediterranean peoples: adult lactase deficiency
b) Japanese: Vitamin D deficiency, Scandinavians: β-thalassemia
c) Northern Europeans: cystic fibrosis, Chinese: postpartum hemorrhage
d) Ashkenazi Jews: Tay-Sachs disease, Southeast Asians: α-thalassemia

Answer 18

D

Question 19

49 . Which of the following is an abnormal observation at a breast exam of a lactating client, warranting referral to a physician?
a) Crusting, indicating dried discharge.
b) Erosion, ulceration or significant roughness of the nipple.
c) Mild erythema, cracking or bruising.
d) Tenderness on palpation.

Answer 19

B

Question 20

50 . Gloria is at her intake appointment with you, and tells you that her LMP was on 7/31. She remembers because her husband left town 4 days later, before they’d had the opportunity for intercourse. Her cycles are normally 42 days long, and her husband arrived home about 2 weeks before it was due. What might be a sensible 40-week EDD for Gloria?
a) May 1st
b) May 29th
c) May 8th
d) May 22nd

Answer 20

D

Question 21

51 . In which of the following situations is RhoGAM not appropriate?
a) Following an Rh-negative person being injured in a road traffic accident during pregnancy.
b) When an Rh-negative person is experiencing a miscarriage.
c) For an Rh-positive baby who was born to an Rh-negative mother.
d) Following amniocentesis in an Rh-negative, Du-negative woman during pregnancy.

Answer 21

C

Question 22

52 . When doing a Pap on your client, Heidi, you saw genital warts, which she said were asymptomatic. Test results have now shown that she is infected with a common STI that can be transmitted at the time of birth through the birth canal. Whilst neonates who are infected generally do not have any complications, it can cause growths in the neonatal throat and hence respiratory distress syndrome. What else is true about this STI?
a) It’s associated with cervical cancer.
b) The STI can be cured with a topical application of trichloroacetic acid.
c) Those diagnosed with this STI should generally have significantly fewer Pap tests, as these can trigger an outbreak.
d) If no sores or only external sores are present at the time of birth and they are covered by surgical film or spray-on bandage, vaginal birth might be safe.

Answer 22

A

Question 23

53 . At your intake appointment with Ivy, you discover she has hyperthyroidism controlled by PTU. What do you do?
a) Hyperthyroidism does not pose a significant risk to the fetus if it is well-controlled with medication, so Ivy is appropriate for midwifery care.
b) Consult a midwifery textbook or other resource so you can refer to a physician if this is a Category C, D or X.
c) You’ve never heard of PTU, so this must be a safe medication, as you’ve carefully read about all unsafe medications.
d) Consult a midwifery textbook or other resource so you can refer to a physician if this is a Category A or B.

Answer 23

B

Question 24

54 . At your intake appointment with Gianna at 24 weeks, she gives you her OB records from this pregnancy, which state she is Gravida 3, Para 1. Which of the following could be true?
a) Gianna has been pregnant 3 times before this, with all pregnancies resulting in a spontaneous abortion.
b) Gianna has been pregnant twice before with 1 stillbirth at 41 weeks and 1 miscarriage at 7 weeks.
c) Gianna has been pregnant 3 times before, with 2 first trimester miscarriages and a baby born alive at 39 weeks.
d) Gianna has been pregnant 2 other times, with 1 stillbirth at 32 weeks and 1 term birth with a living baby.

Answer 24

B

Question 25

55 . Ian, your client’s partner, has a family history of dizygotic twins. Does this increase the risk of twins in your client?
a) No. Dizygotic twins result from an embryo splitting into two identical embryos, but a family history of this in the father of the baby does not affect the likelihood of this occurring.
b) Yes. Dizygotic twins result from the release of more than 1 egg, which is affected by the genetics of the father of the baby.
c) Yes. Dizygotic twins result from an embryo splitting into two identical embryos, and a family history of this in the father of the baby is a risk factor for this.
d) No. Dizygotic twins result from the release of more than 1 egg, which is not affected by the genetics of the father of the baby.

Answer 25

D

Question 26

56 . Joy and her husband are at Joy’s 32 week appointment and you notice bruising on her arms. When you ask her about it, she says she must have got them carrying her grocery bags in from the car the other day, but looks you straight in the eye and makes a ‘trapped’ hand signal (thumb across palm, closing fingers over it). Which of the following is the best response?
a) Say nothing about it, but call Joy later. Check she’s alone and then give her advice and resources for local groups that can help her. Ensure she moves to a safe home as soon as possible.
b) Say nothing about it, but make an excuse for a few seconds alone with Joy, such as to weigh her in the bathroom. Ask if she’s OK and if she needs help. Set up a code word for “I can’t talk now” and call to follow up later. Help with resources.
c) Immediately confront Joy’s husband. You need to show him that he can’t push women around, so be assertive, and tell him that his behavior is unacceptable, as he could be putting his child’s life in danger. Tell him you will not hesitate to call the police if he lays a finger on Joy again.
d) Find an excuse to leave the room for a moment, e.g. ‘to check urine results’ and call the police, telling them that your client is pregnant and in danger, and ask that they arrest him immediately.

Answer 26

B

Question 27

57 . Ivanna reports fever, chills, headache, muscle aches, nausea, vomiting and diarrhea. She’s tested negative for the flu and other common viruses. Which piece of information might help identify what’s wrong with her?
a) Ivanna went on a bike ride the day before symptoms began.
b) Ivanna did not have the flu vaccine this year.
c) Ivanna recently travelled to Brazil.
d) Ivanna ate blueberries not long after the symptoms started.

Answer 27

C

Question 28

58 . Which of the following observations in a breast examination would not warrant referral or consultation with a physician?
a) Retraction signs such as dimpling, puckering or furrows
b) Orange-peel skin
c) Accessory breast tissue, including supernumerary nipple or areola.
d) Asymmetry in breast contour, such as bulge or indentation

Answer 28

C

Question 29

59 . Which of the following describes how you can most effectively palpate axillae for lymph nodes?
a) Have the client raise their arm to 90 degrees. Palpate firmly with your fingertips: anteriorly, posteriorly, along the upper arm and very deep in the center of the axilla, ensuring the client does not move their arm at all as you palpate, and that they keep muscles tense.
b) Have the client raise their arm to 90 degrees. Palpate gently with your fingertips: anteriorly, posteriorly, along the upper arm and deep in the center of the axilla, ensuring the client does not move their arm at all as you palpate, and that they keep muscles tense.
c) Support the client’s arm with one of your own. Gently palpate with your fingertips: anteriorly, posteriorly, along the upper arm and deep in the center of the axilla, moving the client’s arm through a full range of motion as you palpate.
d) Support the client’s arm with one of your own. Palpate firmly with your fingertips: anteriorly, posteriorly, along the upper arm and very deep in the center of the axilla, moving the client’s arm through a full range of motion as you palpate.

Answer 29

C

Question 30

60 . You’re standing behind your client with your hands on the client’s neck, just lateral of the sagittal plane, and you ask the client to swallow. What are you doing?
a) Palpating the thyroid cartilage for enlargement, tumor, asymmetry, tenderness or nodules.
b) Palpating the thyroid gland for presence or absence of goiter.
c) Palpating the thyroid cartilage for presence or absence of goiter.
d) Palpating the thyroid gland for enlargement, tumor, asymmetry, tenderness or nodules.

Answer 30

D