NARM Practice Exam 600 Questions - (481-570) Postpartum

Question 1

481 . You’re giving Phoebe information and advice about treating clogged ducts and mastitis. Which of the following do you not recommend to her?
a) Ensure you get enough rest, ideally skin-to-skin with baby, nursing on demand. Relaxing in the tub or taking a warm shower before nursing can help soften clogs and stimulate flow.
b) When breastfeeding, use different positions including pointing the baby’s chin opposite the area with the clogged duct, and try dangle feeding.
c) Have support group provide meals, or buy in from a restaurant food that you can eat while breastfeeding, ideally plant-based and low in saturated fat. Boost iron, electrolytes and Vitamin C. Aim for 3-4 quarts of water intake each day.
d) Poke root tincture 6 drops q6h, echinacea capsule 1 q6h, lecithin capsule 1 q6h, daily probiotics, Vitamin C (including IV, if desired), phytolacca 6X or 30C, and/or Belladonna 6X or 30C.

Answer 1

D

Question 2

482 . Which of the following contains only items that would normally help treat sore nipples?
a) If lips are not flanged open when breastfeeding, manually correct this. If latch is not good, pull the nursing baby off the breast and correct this.
b) Apply topical agents which can be left on the nipple for subsequent feeds, such as honey, or apply expressed breastmilk.
c) Stopping nursing on one side after the baby has stopped visibly/audibly swallowing, and leave that side exposed to the air at least whilst feeding on the other side.
d) Assess for tongue tie (refer if present) or chomping down (discontinue bottle/pacifier), and ensure the same nursing position is used at every feed.

Answer 2

C

Question 3

483 . When a baby is latching, which of the following is not ideal?
a) Wait for a wide gape before latching
b) Ensure the nipple can be seen sliding slightly in and out of the newborn’s mouth when sucking
c) Ensure a large part of the areola is in the mouth, with more areola showing above the mouth than below
d) Ensure lips are flared

Answer 3

B

Question 4

484 . Which of the following is an accurate description for breast milk jaundice?
a) A type of jaundice associated with breast-feeding, typically occurring 1 week after birth. Rarely causes complications.
b) A common type of jaundice that affects approximately 70% of exclusively breast-fed babies (and approximately 50% of formula-fed babies). Self-limiting, but phototherapy speeds up resolution.
c) A type of jaundice that occurs when a baby is exclusively formula-fed, and is therefore lacking the proteins found in breast milk that normally help with breaking down bilirubin.
d) A type of jaundice that develops in newborns who are struggling with breastfeeding and aren’t getting enough breast milk.

Answer 4

A

Question 5

485 . During a 6-week postpartum bimanual exam on Paula, you palpate the adnexal region. Lateral and posterior to the uterus, you palpate a 2-3cm mass, which is slightly tender. What do you suspect this is?
a) The bladder
b) An ovary with a large cyst
c) The cervix
d) A normal ovary

Answer 5

D

Question 6

486 . You’re giving your client advice on family planning. Which of the following is inaccurate?
a) There are many chemical contraceptive options, some of which are hormonal and some not. Before using any of these methods, ask the provider about the effect on breastfeeding/chestfeeding, and the long-term effect on fertility. Several methods affect fertility for a prolonged period of time after discontinuation.
b) Lactational amenorrhea can be very effective if all of the following are met: the infant is less than 6 months old, exclusively breastfeeding on demand and has fewer than 4 hours between feeds during the day and fewer than 6 hours at night, and menses have not returned.
c) There are various different natural family planning methods. In general, the better you get to know your body and to understand your ovulation patters, the more effective the method is at preventing unwanted pregnancy.
d) There are several barrier methods, including cervical caps, male and female condoms and diaphragms. The effectiveness can be improved with use of spermicide, and these have the added benefit of preventing transmission of STDs.

Answer 6

D

Question 7

487 . You’re giving Phoebe information and advice about symptoms of mastitis, including unilateral pain and redness, a fever above 101F, malaise, fatigue and flu-like symptoms, and give advice on treating clogged ducts and mastitis. Which of the following do you not recommend to her?
a) Warm compresses on the breast before feeds can be very beneficial, including warm salt water or fenugreek tea. Cold cabbage leaves after feeds can decrease inflammation and engorgement.
b) Aim to fully empty breasts at each feeding, ensuring a good latch, and gently massage or squeeze the breast while the baby is nursing. Hand express or pump after feeds if necessary.
c) Massage can help, but it’s not comfortable! Put coconut or olive oil on your breast, and then use your fingers to knead in circles over painful areas, gradually moving towards the nipple, or use a wide-toothed comb to comb over the plugged area down to the nipple.
d) Take advice from others, including breastfeeding support groups and IBCLCs, with caution. Midwives are experts at breastfeeding, and so they should be the first (and, ideally, only) person you go to for advice about all things breastfeeding, including mastitis. Antibiotics are rarely, if ever, indicated with mastitis.

Answer 7

D

Question 8

488 . Your client has been breastfeeding for a week when she calls to say that she’s having stabbing pains behind the areola when nursing, and her nipple feels like it’s burning and itches. When you go to see her, you note flaking skin on the nipple, and patches of shiny skin around that on the areola. Which of the following is not an appropriate part of the management?
a) Use antifungal medications such a miconazole or clotrimazole, or corticosteroid cream.
b) Use gentian violet on nipples/areolas and the baby’s mouth, or use acidophilus solution or coconut oil. Wash all clothes with high heat.
c) Ensure nipples stay warm and damp between feeds. One method is to express a little milk into a breastpad, and to wear this until the subsequent feed.
d) Taking probiotics, limiting or eliminating dietary sugar, and washing with grapefruit seed extract rinse or dilute apple cider vinegar after a feed.

Answer 8

C

Question 9

489 . Which of the following is a sign of good breast/nipple health when lactating?
a) Shiny, flaky red skin on the nipples, showing thrush is present.
b) Areas of the breast that are very tender to the touch, showing high milk presence in those lobules.
c) Cracked or bleeding nipples, showing baby is nursing frequently.
d) Visible engorgement on the third day after giving birth.

Answer 9

D

Question 10

490 . How long will it usually take for a circumcised penis to heal?
a) 2-3 weeks
b) Approximately a month
c) 3-5 days
d) 7-10 days

Answer 10

D

Question 11

491 . A deep vein thrombosis is not always found in the leg. Which of the following is not a sign/symptom of a DVT in an upper extremity?
a) Swelling in the arm or hand
b) Neck pain
c) Shortness of breath
d) Shoulder pain

Answer 11

C

Question 12

492 . UV rays help convert trans-bilirubin into a water-soluble cis-bilirubin isomer, which is easily excreted through urine. Which of these methods does not describe an appropriate recommendation for phototherapy?
a) On sunny days, place the newborn in indirect sunlight coming through a window.
b) If placing the neonate in direct midday sun, sunscreen designed for an infant’s skin should be used, or the skin covered.
c) On cloudy days, or in early morning or evening sun, place the newborn in direct sun.
d) Alternate laying the neonate on their front and their back, wearing just a diaper. Minimal formula supplementation may be indicated to avoid dehydration.

Answer 12

B

Question 13

493 . Philippa is showing signs of having postpartum blues. Which of the following is not good advice for her?
a) Encourage seeking and accepting support from family and friends.
b) Reassure Philippa that this is common and usually resolves by 1-2 weeks postpartum.
c) Ensure Philippa has lots of contact with others, in person or virtually, including friends, family and other new parents.
d) Refer Philippa to a psychotherapist for counselling.

Answer 13

D

Question 14

494 . Olivia is Rh negative and has decided she wants RhoGAM postpartum only if the baby is Rh positive. You took a cord blood sample, but have not yet had results back on blood type. By how many hours postpartum should Olivia have the RhoGAM to attempt to avoid isoimmunization?
a) 1 hour
b) 120 hours
c) 72 hours
d) 24 hours

Answer 14

C

Question 15

495 . Which of the following is not a sign/symptom of a superficial thrombophlebitis?
a) Hardening of a vein
b) Cramping pain in affected leg, usually beginning in the calf
c) Darkening of the skin over a vein
d) Calor, rubor, dolor and tumor along a vein

Answer 15

B

Question 16

496 . Which of the following is not a common sign/symptom of postpartum preeclampsia?
a) Seizures
b) Nausea/vomiting
c) Abnormal vision
d) Headache

Answer 16

A

Question 17

497 . Oralia transferred to hospital during labor because she wanted pharmacologic help with pain. She’s now 4 days postpartum and you’re visiting her at home. Oralia shows you her records from her time in hospital, which includes a CBC with WBC count around 19,000. She’s very concerned about this, as she worries she could have picked up an infection in hospital. What advice should you give her?
a) Oralia may have picked up an infection, as that value is outside the normal pregnancy range of 6,000-17,000, so you should carefully screen her for any signs or symptoms, and recommend that she boost her immune system with a healthful diet high in Vitamin C and antioxidants.
b) It’s likely that she did pick up an infection in hospital, as they’re full of sick people, passing infections around between them all. It’s a shame that Oralia felt the need to deliver her baby in such a place!
c) It’s normal for WBC count to rise to 15,000 or higher during labor, and may increase to 25,000 or 30,000 without being pathological if labor was prolonged. You can retest her today if she’d like, as levels should have begun to fall back towards prepregnant levels (3,900-12,500) by now.
d) Normal WBC count in pregnancy is 23,000-29,500, so Oralia’s WBC count is below normal range, and so it is possible that she picked up an infection in hospital. Oralia should ensure she has a healthy diet and should contact you if any signs/symptoms of infection arise.

Answer 17

C

Question 18

498 . Which of the following is not a sign/symptom of a puerperal UTI?
a) Urinary urgency
b) Oliguria
c) Lower abdominal pain
d) Dysuria

Answer 18

B

Question 19

499 . Pamella has been suffering from mild depression. Which of the following would not suggest to you that Pamella’s depression had worsened to severe PPD?
a) Sudden onset of delusional beliefs or hallucinations.
b) Thoughts of harming herself or her baby.
c) Increased difficulty with caring for her baby or herself.
d) Increased withdrawal from normal life.

Answer 19

A

Question 20

500 . At Paula’s 2-day postpartum appointment, her uterus was around 2cm below her umbilicus. Today is day 7 postpartum, and it’s now 4cm below the umbilicus, and Paula reports that it’s tender to the touch. Which of the following is not a reasonable choice of management?
a) Give methergine 0.2mg q3-4 hours for 3 days
b) Refer for ultrasound
c) Obtain lochia sample for culture
d) Give 10 units of Pitocin IM

Answer 20

D

Question 21

501 . Which of these is the best sign that a baby is currently nursing?
a) The baby falls asleep, showing that they have nursed well enough to be ‘milk drunk’.
b) The newborn has a bowel movement whilst sucking.
c) Slow, deep sucks in the beginning to achieve letdown, followed by short, rapid sucks, accompanied by audible or visible swallowing.
d) Short, rapid sucks in the beginning, followed by slow, deep sucks to draw down milk, and audible/visible swallowing.

Answer 21

D

Question 22

502 . A neonate you’ve been caring for had signs of jaundice at your last visit, 2 days ago. At that stage, you judged bilirubin levels to be around 9 mg/dl, as the jaundice covered the head down to the level of the bottom of the rib cage. You’d given instructions to help reduce jaundice, and to call you if symptoms worsened. Today, the neonate has tachypnea, a high-pitched cry, poor tone, and the mother reports two instances of emesis. What action do you take?
a) Refer to the pediatrician. The neonate is showing signs of worsening hyperbilirubinemia.
b) Refer to the pediatrician. The neonate is showing signs of kernicterus.
c) Initiate immediate emergency transfer. The neonate is showing signs of worsening hypobilirubinemia.
d) Initiate immediate emergency transfer. The neonate is showing signs of kernicterus.

Answer 22

D

Question 23

503 . Which of the following is in the differential diagnosis for an infected vaginal tear?
a) Diastasis recti
b) Symphysis pubis diastasis
c) Postpartum preeclampsia
d) Vaginal hematoma

Answer 23

D

Question 24

504 . Which is not a common management option for postpartum UTI in a breastfeeding client?
a) Ampicillin
b) Amoxicillin
c) Metronidazole
d) Cephalosporins

Answer 24

C

Question 25

505 . A postpartum client has an elevated temperature and abdominal pain, and you suspect endometritis. Which of the following is not an alternative diagnosis that merits consideration?
a) UTI
b) DVT
c) Septic pelvic thrombophlebitis
d) Pneumonia

Answer 25

B

Question 26

506 . You’re at Pippa’s 4-day postpartum appointment, and she tells you she recently started feeling very overwhelmed, tearful and restless. She says she’s not been sleeping well and feels frustrated about her constant responsibility for the baby, but that she’s continued loving and caring for him, and breastfeeding is going well other than her nipples are still quite tender. What is the most likely diagnosis?
a) Postpartum blues
b) Postpartum insomnia
c) Postpartum psychosis
d) Postpartum depression

Answer 26

A

Question 27

507 . Oonagh suffered a late second trimester stillbirth 4 days ago. She’s decided not to pump and donate milk, and wants help in stopping her milk production. You visit her today, and find her painfully engorged and in tears. Which of these is not a recommendation you might give her?
a) Whilst only small amounts of milk should be expressed if needed for comfort, Oonagh might want to consider saving some for having made into breastmilk jewelry. Hair or ashes can also be added, if desired.
b) Acetaminophen or ibuprofen can be used for analgesia if needed.
c) Ice packs can be used (wrapped in a layer of cloth) to help ease the discomfort.
d) Expressing as much milk as possible while taking a warm shower can help relieve engorgement.

Answer 27

D

Question 28

508 . Which of the following is not a sign of postpartum hemorrhage?
a) Heavy bleeding, including clots
b) Elevated pulse
c) Elevated temperature
d) Elevated blood pressure

Answer 28

D

Question 29

509 . Which of the following midwifery management choices would not be appropriate for a mild infection of a vaginal tear?
a) Keep area dry, cool and clean
b) Consult a physician
c) Administer broad spectrum antibiotics
d) Debriding tissue

Answer 29

D

Question 30

510 . Which of the following is not a common sign/symptom of infection of a vaginal tear?
a) Red and inflamed wound edges
b) Localized pain and edema
c) Temperature of over 103 F
d) Wound separations or purulent exudate

Answer 30

C

Question 31

511 . What is the most appropriate management for puerperal infection of the uterus?
a) Since GBS is by far the most common cause, treatment with Penicillin G is the best option, unless the client has a known allergy to this.
b) Since many different organisms could be responsible (strep, staph, E. coli, and many others), culturing is advisable in order to identify which antibiotic to prescribe.
c) It is difficult to know which antiviral is most appropriate for any given infection, but oseltamivir phosphate and zanamivir are generally good choices. If these do not help, peramivir can be given instead.
d) Antifungal creams and pessaries such as clotrimazole are most appropriate in the breastfeeding client. Oral fluconazole can also be prescribed, as only small amounts transfer to breastmilk.

Answer 31

B

Question 32

512 . Pamella is showing signs of mild postpartum depression. Which of the following is not good advice for her?
a) Suggest you screen for thyroid problems, as postpartum thyroiditis can cause symptoms of depression and fatigue.
b) Encourage a healthful diet rich in amino acids, tryptophan, omega fatty acids, B complex Vitamins and magnesium and to avoid coffee, alcohol and cigarettes.
c) Refer for treatment from a physician and/or counsellor and ensure she has a good support system, including from other parents. Ensure she and her partner both know how to look for worsening depression.
d) Reassure Pamella that postpartum depression generally resolves itself within 3-6 weeks, and ensure she knows there is no judgment from you.

Answer 32

D

Question 33

513 . You’re performing a vaginal exam postpartum. You insert 2 fingers and push posteriorly against the vaginal musculature. You ask your client to bear down. Which of these is not an accurate description of an observation and associated diagnosis?
a) Bulging of the vulvar end of the posterior vaginal wall: rectocele
b) Bulging of the cervical end of the anterior vaginal wall: cystocele
c) Bulging of the distal end of the posterior vaginal wall: urethrocele
d) Involuntary loss of urine on bearing down: stress incontinence

Answer 33

C

Question 34

514 . Regarding breastfeeding/chestfeeding, which of the following statements is not true?
a) Being away from an infant can affect milk production, even if pumping regularly
b) When pumping at work, it is best if the client distracts themselves, rather than thinking of the baby or looking at photos of them
c) Stress load can impact milk production
d) State laws about spaces and breaks for pumping vary, and a midwife should know their local laws

Answer 34

B

Question 35

515 . Petra just gave birth to a 9lb 8oz occiput posterior baby, after around 2 hours of pushing. There was a shoulder dystocia, and you had to work quite hard to resolve it, using suprapubic pressure and eventually adducting the anterior shoulder and sweeping that arm out, at which point the baby delivered. Understandably, Petra was in a lot of discomfort afterwards. She did not want to get up to empty her bladder, and asked you to catheterize her. Today is her 1-day postpartum appointment, and she tells you she has unrelenting pain in the anterior pelvis and suprapubic region, radiating out to her hip joints and down her legs. She says she’s still not got up to use the restroom, and she cannot even lift her legs because of the pain. What diagnosis do you suspect?
a) Symphysis pubis diastasis
b) Fractured pelvis
c) Hematoma
d) Sciatica

Answer 35

A

Question 36

516 . What height should the fundus be 2 weeks postpartum?
a) Not palpable
b) You should not be measuring fundal height postpartum, as this can increase bleeding
c) Approximately 5-6cm above the symphysis pubis
d) Halfway between the symphysis pubis and the umbilicus

Answer 36

A

Question 37

517 . Which of the following vital sign changes is normal postpartum?
a) A rise in blood pressure from 118/74 in labor to 132/86 on day 2 with client reporting this is due to upper abdominal pain.
b) A fall in blood pressure from 110/64 to 74/46 in the first few hours postpartum due to reduced blood volume.
c) A rise in pulse to 100 bpm on day 2 due to decreased blood volume.
d) A fall in pulse to 70 bpm in the first few hours postpartum due to an increased stroke volume.

Answer 37

D

Question 38

518 . Which of the following is not a cause for concern in a penis healing after circumcision?
a) Swelling increasing after the first 24 hours
b) No voiding for the first 24 hours
c) Edema of the remaining foreskin within 24 hours, with scant serosanguinous drainage
d) Pustular drainage

Answer 38

C

Question 39

519 . Which of the following is not in the differential diagnosis for superficial thrombophlebitis?
a) Varicosities
b) Amniotic fluid embolism
c) Cellulitis
d) Hematoma

Answer 39

B

Question 40

520 . Baby Penda was born late last night and you’re visiting her and her mother, Mariama, today. You’ve been there for 40 minutes, chatting about the birth and how they’re both doing, and Penda has been sleeping peacefully throughout. Mariama is exclusively breastfeeding, and says that, other than having to repeatedly try to stimulate Penda to get her to nurse, there haven’t been any problems with it. Mariama is from Senegal and Penda’s father is an American of Italian descent, and Penda has a beautiful olive-brown skin. When you eventually hold her, you touch her nose and see her father’s greenish-yellow Italian coloring coming through. After 10 glorious minutes of holding the sleeping baby, you finish up your appointment and arrange to see them again in 2 days’ time, unless they want you to visit sooner. Before that appointment, Mariama ends up in the ER with Penda in critical condition. Which diagnosis did you probably miss?
a) Pathological jaundice
b) Persistent hypertension of the newborn
c) Sleepy baby syndrome
d) Neonatal diabetes

Answer 40

A

Question 41

521 . When collecting a subjective postpartum history from a client, which of the following is not an important consideration?
a) Ensure you use the correct sized blood pressure cuff.
b) Listen for any red flags, and follow up on them.
c) Respond in non-judgmental ways to answers given.
d) Ask both open- and closed-questions.

Answer 41

A

Question 42

522 . Which of the following is in the differential diagnosis for diastasis recti?
a) Intestinal obstruction
b) Symphysis pubis diastasis
c) Hepatitis
d) Ventral hernia

Answer 42

D

Question 43

523 . Phoebe has been reluctant to show you her breasts, but today is her third day postpartum and she’s been struggling with breastfeeding, so asks you to look. Which of the following would you be hoping to see?
a) A warm, red area on one breast
b) Concave nipples
c) A pale-yellow liquid visible dripping from her nipple when the baby cries
d) Tubular breasts

Answer 43

C

Question 44

524 . Which of the following is not a good step when preparing to breastfeed/chestfeed a baby?
a) Ensure the parent is comfortable and has easy access to water
b) Position baby’s belly towards parent
c) The baby should be positioned so the nipple is just below the nose
d) Ensure the head is turned slightly left or right of midline, depending upon nursing position and side.

Answer 44

D

Question 45

525 . Patricia gave birth on Tuesday to a healthy, 8lb 3oz baby, Sammy. The newborn exam was unremarkable, but you noticed jaundice of the head on Thursday, and of the head and down to the nipple line on Friday. Other than the level that the jaundice has reached down to on the body, which of the following allows you to determine the level of jaundice present?
a) Use a glucometer to assess total bilirubin levels.
b) Indent the skin on Sammy’s upper chest and let go, noting how long the skin remains blanched to a yellowish color.
c) Press an icterometer to Sammy’s nose or forehead if the baby is lighter-skinned, and against the inside of a lip if the baby has darker skin. Match blanched skin hue to swatches.
d) Assess color in room with high-watt light bulbs.

Answer 45

C

Question 46

526 . Which of the following timings for return of menses is abnormal?
a) Return of menses at 6 weeks for a non-breastfeeding/pumping client.
b) Return of menses at 5 months for a non-breastfeeding/pumping client.
c) Return of menses at 9 months for a breastfeeding/pumping client.
d) Return of menses at 6 weeks for a breastfeeding/pumping client.

Answer 46

B

Question 47

527 . Which is the appropriate management for a client with postpartum preeclampsia?
a) Refer the client to a physician, expecting IV magnesium sulfate and antihypertensive medication to be prescribed.
b) Like gestational preeclampsia, which spontaneously resolves after birth, postpartum preeclampsia resolves upon cessation of breastfeeding; tell the client to stop immediately.
c) Like gestational preeclampsia, which spontaneously resolves after birth, postpartum preeclampsia resolves once hormones are balanced. Advise client starts taking a hormonal BCP immediately.
d) Refer the client to a physician, expecting a full hysterectomy might be needed.

Answer 47

A

Question 48

528 . Which of the following would you not normally evaluate at a 3-4-day postpartum appointment?
a) Breasts for engorgement or signs of clogged ducts, and nipples for signs of cracking
b) The lochia for color, amount and odor (should be serosa, lighter flow)
c) Edinburgh Postnatal Depression Scale (should be <10)
d) The uterus for normal inversion (should be around 3-4 cm below umbilicus)

Answer 48

C

Question 49

529 . Which of the following is not in the differential diagnosis for DVT?
a) Popliteal venous aneurism
b) Lymphedema
c) Chronic venous insufficiency
d) Mastitis

Answer 49

D

Question 50

530 . Sammy was born 4 days ago, and blood results following your diagnosis of physiological jaundice are back; bilirubin is 8 mg/dl, which matched with your assessment that jaundice stopped at the nipple line. Which of the following is most likely to reduce the jaundice?
a) Formula feeding approximately every 3 hours.
b) After breastfeeding, give Sammy around 0.5-1 oz of water.
c) Exclusively breastfeeding, 10-12 times a day.
d) Reduce breastfeeding to 3 or 4 times a day, and give formula for every other feed.

Answer 50

C

Question 51

531 . Which of the following describes a physiologic temperature rise postpartum?
a) A rise to 102 F following a report of clogged ducts in a client.
b) A rise to 102 F in the first 24 hours following a prolonged labor.
c) A rise to 100 F due to infection of a perineal tear.
d) A rise to 100 F on day 3 in a breastfeeding client.

Answer 51

D

Question 52

532 . You’ve just helped your client birth her baby, but noted obvious jaundice from head to knees in the newborn exam. Which of these is not appropriate management?
a) Initiate immediate transfer
b) Explain possible treatments, including phototherapy and the possibility of the need for an exchange transfusion
c) Tell your client to breastfeed as often as possible after you’ve left, ideally 8-10 times a day, and to call you if the jaundice spreads to hands and feet.
d) Draw cord blood in both red- and purple-topped tubes for baseline bilirubin levels

Answer 52

C

Question 53

533 . Which of the following is a normal change in lochia?
a) Passing clots the size of an orange, but no larger.
b) Yellowish lochia at 12 days postpartum.
c) Recurrence of bright red bleeding following strenuous housework.
d) Bleeding slows to spotting at 6 weeks postpartum.

Answer 53

B

Question 54

534 . Which of the following is not appropriate management for diastasis symphysis pubis?
a) Bed rest, ideally with a trapeze bar to facilitate movement
b) Compression socks should be worn since movement will be reduced
c) Shuffle when walking
d) Wearing a ‘belly band’, tightly wrapped around the mid-abdomen

Answer 54

D

Question 55

535 . Olivia gave birth 36 hours ago, and weighed herself just before your appointment today. She is very disappointed that she only lost 12 lb during birth. What do you say to her?
a) She should be pleased she didn’t lose more, as that would only have happened if she hemorrhaged! (Or had twins.)
b) This is concerning, as it suggests she’s got edema. She should reduce salt intake if it is high, and eat more magnesium, potassium, and B6-rich foods.
c) This is absolutely normal. She will probably lose a few more pounds this week as a result of fluid loss.
d) This is significantly more weight than most people lose during birth, so she should be very pleased.

Answer 55

C

Question 56

536 . Which of the following statements about postpartum psychosis is incorrect?
a) The average duration of postpartum psychosis is 40 days, but it recurs in 50-75% of cases.
b) This is the most severe form of postpartum depression, and usually results after a gradual worsening of PPD signs and symptoms.
c) Can start as early as 2-3 days postpartum or as late as 1 year postpartum, but usually starts within 2-4 weeks of birth.
d) This is a life-threatening emergency and requires immediate psychiatric evaluation and treatment.

Answer 56

B

Question 57

537 . You’re performing a bimanual exam on Paula 6 weeks postpartum, and palpate a pear-shaped organ in the midline and anterior. What observation is abnormal for this organ?
a) Immovable
b) Firm
c) Non-tender
d) Smooth

Answer 57

A

Question 58

538 . What findings should you have on palpation of the uterus a few hours after birth?
a) Firm, fundus approximately at the umbilicus.
b) Firm, fundus 2-4cm above the umbilicus.
c) Boggy, fundus approximately at the umbilicus.
d) Intermittently firm and soft, fundus 2-4cm above the umbilicus.

Answer 58

A

Question 59

539 . 36 hours postpartum, Olivia (G4P4004) complains of terrible after pains. Which of the following is not a good relief measure for them?
a) Emptying the bladder frequently, and then lying prone with a pillow under her lower abdomen.
b) Breastfeeding
c) Ibuprofen (preferable) or acetaminophen.
d) Strong ginger tea, motherwort or hellonias virburnum

Answer 59

B

Question 60

540 . At 3 weeks postpartum, Pam contacts you to say that she’s feeling down. She tells you she expected this time to be a happy, love-filled time of baby cuddles and naps, but instead she isn’t sleeping and feels she’s not a good mother. She denies any thoughts of self-harm or of harming her baby, and says she is eating relatively well but her appetite isn’t always great. Pam admits that she sometimes looks at her crying baby but can’t find the energy to go through all the motions of finding out what exactly is making him cry and so she just holds and rocks him. What is the most likely diagnosis?
a) Postpartum depression (currently mild or moderate)
b) Postpartum depression (currently severe)
c) Postpartum blues
d) Postpartum psychosis

Answer 60

A

Question 61

541 . Olivia texts you on day 3 to tell you she finally had a bowel movement postpartum, but she had to insert her finger into her vagina and push backwards on it to manage this. What does this suggest, and what action should you take?
a) Fecal incontinence: refer to pelvic floor therapist.
b) A cystocele: refer to pelvic floor therapist.
c) Urinary incontinence: refer to pelvic floor therapist.
d) A rectocele: refer to pelvic floor therapist.

Answer 61

D

Question 62

542 . Which of the following is not recommended for the uncircumcised penis?
a) Use gentle baby wipes to clean the penis when changing a dirty diaper
b) Point the penis down when putting on a fresh diaper
c) Clean the outside of the penis with mild soap and water with baths
d) By around 6 months, the foreskin will have separated from the glans, and parents should begin retracting it and cleaning under it

Answer 62

D

Question 63

543 . Which of the following outlines the appropriate management for DVT?
a) The client should take NSAIDs such as ibuprofen or aspirin and wear support stockings, but should also be told to watch out for the signs and symptoms of a pulmonary embolism, and to go to the nearest emergency room should any develop.
b) The client should apply a warm compress to the affected area and elevate it. Support stockings should be encouraged.
c) The client should be referred to their PCP during business hours. Treatment involves medications to thin the blood, such as heparin or warfarin.
d) The client should go to the nearest emergency room. Treatment involves preventing growth of the clot, preventing pulmonary embolism and reducing the risk of additional clots in the future.

Answer 63

D

Question 64

544 . In which of the following situations would you not be concerned about potentially worsening condition of a newborn with jaundice who was undergoing at-home phototherapy?
a) Neonatal skin has turned from yellow-tinged to red and peeling. Skin pinch test has delayed return to normal.
b) Neonate sleeps very well between feeds, and is difficult to rouse during them. Neonate is having 0-1 bowel movements each day.
c) Neonate is producing scant amounts of pale-colored urine. Neonate rouses to feed and nurses vigorously for 15-20 minutes every 2-3 hours.
d) Neonate is producing copious amounts of brown-colored urine. Icterometer shows progressively lower levels of bilirubin.

Answer 64

D

Question 65

545 . Which of the following is not in the differential diagnosis for postpartum UTI?
a) Pancreatitis
b) Cholecystitis
c) Placental abruption
d) Appendicitis

Answer 65

C

Question 66

546 . Which of the following is not a sign/symptom of uterine infection?
a) General malaise
b) Malodorous lochia
c) Pelvic pain
d) Uterine superinvolution

Answer 66

D

Question 67

547 . Paula had a second-degree tear that you repaired. Today, you discover a vaginal hematoma. Which of the following is not a risk associated with this finding?
a) Blood loss amounting to hemorrhage
b) Infection
c) Uterine rupture in a subsequent pregnancy
d) Anemia

Answer 67

C

Question 68

548 . 36 hours postpartum, you’re visiting Olivia, and examine her perineum. Which of these would be a normal finding?
a) The vagina is still somewhat open, and the area may have bruising and significant swelling. Wounds will be healing well, with red, edematous skin around stitches and only localized pain in those areas.
b) The introitus is not gaping as widely as in the immediate postpartum, and edema is reduced. Vaginal walls are smooth, and there is no sign of infection or hematoma.
c) The vaginal os is smaller, and the area looks to be healing well, with no sign of infection. It will still be tender, especially if there was tearing. Vaginal rugae will have returned, but prepregnant tone will not be completely restored.
d) The vaginal opening has contracted, but the vagina itself has not regained tone. There is no sign of infection, and the small tear you repaired is healing well: the stitch at the surface is holding, despite the physiologic purple swelling underneath it.

Answer 68

B

Question 69

549 . You’re performing a Pap test at Paula’s 6-week postpartum appointment. Which of the following statements is most accurate?
a) A medium-sized speculum is normally appropriate. The cervix will likely be situated high in the vaginal vault, will likely feel firm, and the external os will probably take of the form of a slit rather than a dimple.
b) A medium-sized speculum is normally appropriate. The cervix will likely be situated high in the vaginal vault, will likely feel soft, and the external os will probably take of the form of a dimple.
c) A small speculum is normally appropriate. The cervix will likely be situated low in the vaginal vault, will likely feel firm, and the external os will probably take of the form of a slit rather than a dimple.
d) A small speculum is normally appropriate. The cervix will likely be situated low in the vaginal vault, will likely feel soft, and the external os will probably take of the form of a dimple.

Answer 69

A

Question 70

550 . You see Olivia about 36 hours postpartum, and she says she’s worried about her bleeding. What is normal for lochia at this stage?
a) Rubra, like heavy menstrual period, with a fleshy smell. A few small clots, no more than the size of a grape. May need to change pad every hour.
b) Pink in color, with a metallic or slightly musty smell. Tampons should be changed regularly to monitor flow, but would not need changing more than every 2-3 hours due to being full.
c) Bright red, and heavy enough to require changing sanitary pads at least every hour. Some small clots may be present, but none larger than a golf ball.
d) Serosa, heavy enough to need to change pads 3 or 4 times a day. Few clots, and none large.

Answer 70

A

Question 71

551 . You’re teaching your client how to contract and release the ischiocavernosus and transverse perineal muscles, elevator and diaphragm muscles and the pubococcygeal muscle, separately and in unison. Why?
a) These exercises stretch the muscles of the pelvic floor and birth canal.
b) These exercises stretch the muscles of the pelvic floor.
c) These exercises strengthen the muscles of the birth canal.
d) These exercises strengthen the muscles of the pelvic floor and birth canal.

Answer 71

D

Question 72

552 . Which of the following statements about breastfeeding/chestfeeding is not accurate?
a) If the parent has the flu or another infection, breastmilk helps protect the infant. It might be preferable to limit exposure in person, however, and so pumped milk given by another care provider may be appropriate.
b) Genetics, endocrinology and epigenetics all effect breastmilk production and feeding.
c) If the parent is HIV positive, they can be reassured that breastfeeding/chestfeeding is perfectly safe, as the virus is not passed through breastmilk.
d) If the parents has diabetes mellitus, breastfeeding/chestfeeding can help reduce the risk of the baby developing diabetes. Insulin can still be used as needed.

Answer 72

C

Question 73

553 . At Paula’s 6-week appointment, you have her lie down and put her chin to her chest and curl up a little, while you place your fingers just below the xiphoid process, and then inch them caudally to the symphysis pubis, along the linea alba. What are you checking for?
a) Symphysis pubis diastasis: if less than finger breadths.
b) Diastasis recti: if less than 2 finger breadths.
c) Symphysis pubis diastasis: if 2 or more finger breadths.
d) Diastasis recti: if 2 or more finger breadths.

Answer 73

D

Question 74

554 . Which of the following statements about breastfeeding/chestfeeding is most accurate?
a) Contaminants from environmental exposure, such as pesticides in food or chemicals from cleaning products can enter the breastmilk, and hence formula feeding is best for anyone not eating an organic plant-based diet or who is using harsh chemicals for cleaning.
b) Contaminants from environmental exposure, such as pesticides in food or chemicals from cleaning products do not enter the breastmilk, but they are not present in formula either, and so both are equally safe. Only breastmilk contains antibodies, however.
c) Contaminants from environmental exposure, such as pesticides in food or chemicals from cleaning products can enter the breastmilk, but breastfeeding/chestfeeding is still thought to improve a child’s cognitive scores as compared to formula feeding in the vast majority of cases.
d) Contaminants from environmental exposure, such as pesticides in food or chemicals from cleaning products never enter the breastmilk, but these chemicals are present in formula, and so breastfeeding/chestfeeding is the safest option.

Answer 74

C

Question 75

555 . Which of the following is not an appropriate part of midwifery management for superficial thrombophlebitis?
a) Ibuprofen or aspirin can help reduce the symptoms of the inflammation.
b) Apply warm compresses to the affected area and elevate it.
c) Wear support stockings.
d) In rare cases, stripping the veins is appropriate, especially if the client has varicose veins.

Answer 75

D

Question 76

556 . Your client had her baby circumcised shortly after birth, and you’re running through how to care for his penis with her. Which of these is not a recommendation you give?
a) Use vaseline or a healing salve after diaper changes
b) Once the penis is healed, clean the smegma off the tip at diaper changes
c) Clean the penis gently with alcohol after diaper changes
d) Change the diaper frequently, but leave the original gauze on for 24 hours, unless otherwise directed by the provider who did the surgery

Answer 76

C

Question 77

557 . Which of these is not a sign/symptom of a deep vein thrombosis?
a) An area of skin that feels warmer that the skin in the surrounding areas
b) Darkening of the skin over the affected area
c) Severe, unexplained pain in the foot or ankle
d) Swelling of foot, ankle or leg

Answer 77

B

Question 78

558 . Which of the following is not in the differential diagnosis for postpartum preeclampsia?
a) Gestational preeclampsia
b) Viral gastroenteritis
c) Migraine
d) Hepatitis

Answer 78

A

Question 79

559 . Olivia gave birth yesterday, and is now struggling with hemorrhoids. Which of the following is not a good recommendation for her?
a) Ice stiz bath
b) Warm sitz bath
c) Witch hazel compresses
d) Hot sitz bath

Answer 79

D

Question 80

560 . The four underlying causes of postpartum hemorrhage are sometimes listed as “the four T’s”. Which of the following is not one?
a) Tissue
b) Thrombosis
c) Time
d) Trauma

Answer 80

C

Question 81

561 . Which of the following is not a reasonable alternative diagnosis for a client you believe is experiencing a postpartum hemorrhage?
a) Normal postpartum bleeding and normal postpartum tiredness
b) Normal postpartum bleeding and preeclampsia
c) Normal postpartum bleeding and UTI
d) Normal postpartum bleeding and endometritis

Answer 81

B

Question 82

562 . Which of the following is not in the differential diagnosis for pubis symphysis diastasis in the immediate postpartum?
a) Osteomyelitis
b) Postpartum fracture
c) Venous thrombus embolism
d) Musculoskeletal low back pain

Answer 82

A

Question 83

563 . Olivia is 36 hours postpartum and has not yet had a bowel movement. What should you do?
a) Recommend that Olivia eat less fiber so she has less feces to pass, and that she increase water intake.
b) Recommend increasing fiber and fluid intake. If she cannot pass feces because they are too hard, recommend stool softeners. If all else fails, laxatives can be used.
c) Recommend witch hazel compresses or Preparation H ointment, a warm sitz bath and stool softeners.
d) Recommend that Olivia sit on the toilet with her feet elevated, and she uses a peri bottle to squirt on the area to ease discomfort.

Answer 83

B

Question 84

564 . At her recent appointment, Pamella was showing signs of mild depression. Which of the following should you be doing?
a) Phone Pamella’s emergency contacts and tell them of the situation. Explain that postpartum depression usually worsens with time and they need to be on the lookout for any signs that she has suicidal or infanticidal ideation.
b) Tell Pamella she needs to pull herself out of it, because postpartum depression negatively impacts child development.
c) Tell Pamella’s partner that she needs to be taught how to take on the responsibility of parenting alone in order to be able to improve her self-esteem.
d) Increase in-person and virtual contact with Pamella, unless your presence makes the situation worse.

Answer 84

D

Question 85

565 . You’re performing a vaginal exam 3 weeks postpartum and ask your client to tighten her muscles around the 2 fingers you have inserted. Her muscle tone is lax, and so you help teach her Kegels exercises. Which of the following is not an effect of improving muscle tone here?
a) May reduce the length of the second stage of any subsequent labors.
b) May improve support of the pelvic organs.
c) May decrease urinary continence.
d) May improve sexual satisfaction

Answer 85

C

Question 86

566 . Which of the following statements about breastfeeding/chestfeeding is not accurate?
a) A client should tell their doctor they are breastfeeding/chestfeeding if they are prescribed any medication, as these can pose safety risks to the baby as well as affecting supply.
b) Before taking over the counter medication, a client should check on its safety whilst lactating.
c) Smoking and recreational drugs should be avoided when breastfeeding/chestfeeding.
d) Since herbs are natural, there is no risk to the baby if the parent takes any whilst lactating. However, several herbs do reduce supply, and should be avoided.

Answer 86

D

Question 87

567 . Which of the following is not in the differential diagnostic for pathological jaundice?
a) Yellow tint to normal skin, e.g. neonate of Hispanic, Mediterranean or Asian origin
b) Meconium staining
c) Icterus
d) Physiologic jaundice

Answer 87

C

Question 88

568 . Which of the following would be a variation of normal lochia?
a) A foul smell to the lochia.
b) An increase in bleeding at 7-14 days postpartum due to secondary sloughing of placental eschar.
c) 1050ml blood loss within the first 24 hours of birth.
d) No decrease in bleeding by 5 days postpartum.

Answer 88

B

Question 89

569 . Which of the following is most likely to worsen diastasis recti?
a) Not exercising during pregnancy
b) Core stability strengthening
c) Belly binding
d) Surgery

Answer 89

A

Question 90

570 . What is the approximate expected rate of involution over the first 10 days postpartum, as measured by fundal height?
a) 1cm further below the umbilicus per day
b) 2cm further below the umbilicus per day
c) Between a 1cm increase and a 2cm decrease in fundal height each day, with a gradual decrease on average.
d) No change for the first 4-5 days, then 1-2cm decrease in height each day

Answer 90

A