NARM Practice Exam 600 Questions - (61-120) Maternal health assessment

Question 1

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

Answer 1

B

Question 2

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

Answer 2

A

Question 3

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

Answer 3

C?

Question 4

64 . When looking at a nevus, what is not an ‘ABCDE’ sign that it could be a malignant melanoma? (e.g. A = Asymmetrical shape. The two halves don’t match.)
a) E = Evolving. Change in size, shape, color or elevation, or new bleeding, itching or crusting.
b) C = color. Multiple colors are present, with different shades of brown, tan, black or even red, white or blue.
c) D = Diameter. Anything over the size of a pencil eraser.
d) B = Brown. It is a uniform brown (or tan) color throughout.

Answer 4

D

Question 5

65 . 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) Asymmetry in breast contour, such as bulge or indentation
c) Accessory breast tissue, including supernumerary nipple or areola.
d) Orange-peel skin

Answer 5

C

Question 6

66 . Ian, your client’s partner, has a family history of dizygotic twins. Does this increase the risk of twins in your client?
a) Yes. Dizygotic twins result from the release of more than 1 egg, which is affected by the genetics of the father of the baby.
b) 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.
c) 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.
d) 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.

Answer 6

B

Question 7

67 . Approximately how high should you pump the blood pressure cuff?
a) To 120 mm Hg
b) To 180 ml
c) To 200 ml
d) To 160 mm Hg

Answer 7

D

Question 8

68 . Which of the following is not a behavioral risk factor for sexually transmitted infection?
a) Sex under the influence of alcohol or drugs
b) Serial monogamy
c) Under 25 years of age
d) Unprotected sex

Answer 8

C?

Question 9

69 . Which of the following is within normal limits for the eyes?
a) Pupils more than 1.5 mm different in size when exposed to different levels of light.
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 around 0.5 mm different in size when exposed to equal light on both sides.

Answer 9

D

Question 10

70 . 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) Ashkenazi Jews: Tay-Sachs disease, Southeast Asians: α-thalassemia
d) Northern Europeans: cystic fibrosis, Chinese: postpartum hemorrhage

Answer 10

C

Question 11

71 . Which of the following is most likely to be appropriate for out of hospital birth?
a) Previous incision in the fundus
b) Prior low transverse cesarean section
c) Previous inverted T cesarean section
d) Prior vertical cesarean section

Answer 11

B

Question 12

72 . Which answer best explains why knowing of any history of abuse is helpful to a midwife?
a) It helps the midwife tailor their care more appropriately to the needs of the client.
b) It tells the midwife they should expect a longer labor so they can plan to arrive later.
c) It tells the midwife that CPS involvement might be required after the birth.
d) It helps the midwife have empathy for their client if there is retarded dilation.

Answer 12

A

Question 13

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

Answer 13

A

Question 14

74 . 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 2 other times, with 1 stillbirth at 32 weeks and 1 term birth with a living baby.
b) Gianna has been pregnant 3 times before this, with all pregnancies resulting in a spontaneous abortion.
c) Gianna has been pregnant twice before with 1 stillbirth at 41 weeks and 1 miscarriage at 7 weeks.
d) Gianna has been pregnant 3 times before, with 2 first trimester miscarriages and a baby born alive at 39 weeks.

Answer 14

C

Question 15

75 . Hosanna tells you she has a condition that she can’t quite recall the name of, but it’s something like “cardioneurogenic synchrony”, where certain triggers such as the sight of blood or extreme emotional distress cause her heart rate and blood pressure to suddenly drop. What is this condition called, and what happens next?
a) Vasovagal resuscitation or neurocardiogenic synthesis, wherein certain triggers reduce non-vital organs’ demands.
b) Vasovagal response or neurocardiogenic syncope, wherein certain triggers cause the individual to faint.
c) Vasovagal repetition or neurocardiogenic skipping, wherein heart rate and blood pressure drop and then the client experiences palpitations.
d) Vasovagal reduction or neurocardiogenic slowing, wherein certain triggers slow heart rate and respiratory rate and reduce blood pressure. Without intervention, death follows.

Answer 15

B

Question 16

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

Answer 16

A

Question 17

77 . Which of the following is least likely to increase the risk of exposure to blood-borne pathogens?
a) Sharing needles
b) Blood transfusion
c) Sharing cigarettes
d) Unprotected sex

Answer 17

C

Question 18

78 . Where in the neck should you palpate to look for enlarged lymph nodes?
a) Periauricular, supraclavicular, supramandibular, supramentum, ventral and dorsal to the internal jugular, and occipital.
b) Suboccipital, retro- and pre-auricular, submandibular, submental, posterior triangle of the neck, supraclavicular and anterior and posterior to the internal jugular vein.
c) Suprarhinal, circumauricular, supraoccipital, submandibular, lateral triangle of the neck, ventral and dorsal to the internal jugular vein.
d) Subocular, suboccipuital, pre- and post-auricular, medial of the mentum, anterior triangle of the neck, anterior and posterior to the internal jugular vein.

Answer 18

B

Question 19

79 . You’re about to perform a Pap test on a client, but first want to confirm something very important. What?
a) Whether the client has a latex allergy
b) Whether she’s ever had an abnormal Pap
c) What the results of her last Pap were
d) What size speculum she normally has for Pap tests

Answer 19

A

Question 20

80 . 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 20

B

Question 21

81 . Your client, Israel, is very private, and has requested that you not do a breast exam on her. You’re discussing breastfeeding and ask her to describe her nipples. She says that they’re not inverted, and that the left one points to the left and the right points forwards. What is your response?
a) This is abnormal and may be a sign of breast cancer, so you recommend that Israel has a mammogram. You explain the procedure to her and what she might do so that she can feel comfortable with the level of privacy.
b) You recommend that Israel use a breast pump on that side from 37 weeks, gently pulling the nipple to the right as she pumps, as this will correct the deviation.
c) Whilst the nipple direction should post no problem with breastfeeding, you recognize that the act of doing so might be emotionally uncomfortable for her, and so spend time discussing this.
d) This should pose no problems with breastfeeding, as the nipples are not retracted or inverted, so you reassure her that you expect she will have a wonderful breastfeeding journey.

Answer 21

A?

Question 22

82 . 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) Approximately the size of an orange.
c) Approximately the size of a grapefruit.
d) Bimanual examination is not appropriate at 12 weeks, as you would feel the fundus well above the pubic bone by then.

Answer 22

C

Question 23

83 . 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) 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.
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) 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.

Answer 23

B

Question 24

84 . At 4 weeks postpartum, Itzel tells you that she’s found a lump in her breast and is very concerned that it may be cancer. What do you do?
a) Ask Itzel if she feels the same structure in her other breast, as she may be feeling normal breast structure. Ask about symptoms of a clogged duct. If she’s comfortable with it, you can do a breast exam yourself to check. If there’s any question that it might be a tumor, refer to a physician.
b) The risk of developing breast cancer while breastfeeding is tiny, and Itzel can reduce this even further by practicing extended or natural term breastfeeding. With a total time of 10 years of breastfeeding, Itzel would have reduced her risks of breast cancer to zero. You recommend that she continue breastfeeding for at least a couple of years.
c) This is normal breast structure, as breasts feel very ‘lumpy’ at this stage in breastfeeding. You should reassure Itzel that everything is normal and she can continue breastfeeding without any concern.
d) This is a clogged milk duct. She should pump on that side with the pump directed towards the clog, or breastfeed with baby’s chin pointing in that direction, and should take lecithin. If she develops a fever, she should contact you, as this would indicate mastitis.

Answer 24

A

Question 25

85 . 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 palpate normal ovaries in the adnexal region, lateral and posterior to the uterus.
b) You palpate normal ovaries in the adnexal region, lateral to the uterus.
c) You cannot palpate the ovaries.
d) You find enlarged ovaries.

Answer 25

D

Question 26

86 . 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 26

D

Question 27

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

Answer 27

C

Question 28

88 . 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 gland for presence or absence of goiter.
b) Palpating the thyroid gland for enlargement, tumor, asymmetry, tenderness or nodules.
c) Palpating the thyroid cartilage for presence or absence of goiter.
d) Palpating the thyroid cartilage for enlargement, tumor, asymmetry, tenderness or nodules.

Answer 28

B

Question 29

89 . 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) Excessive intake of caffeine
c) Smoking
d) Insufficient iodine intake, e.g. by eating sea salt instead of iodized salt.

Answer 29

A

Question 30

90 . Which list of gynecological history items is matched correctly with a risk to pregnancy caused by them?
a) Cone biopsy: retarded dilation, Fibroids: though growth normally slows in pregnancy, they can cause fetal malpresentation.
b) IUD: scarring of uterine lining, LEEP: incompetent cervix.
c) Cervical cauterization/cryosurgery: scarring may cause abnormal placentation, LEEP: premature labor.
d) Fibroids: macrosomic fetus, IUD: cervical rigidity.

Answer 30

B

Question 31

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

Answer 31

D

Question 32

92 . 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) 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.
b) You don’t have enough information in the question to answer this.
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 32

C

Question 33

93 . You receive a call from your midwifery partner’s client, who tells you she has the date of her most recent Tdap vaccination, as she’d not been sure which vaccines she’d had recently. Why did your partner ask her for this information?
a) If the client had been given the vaccine in a previous pregnancy, it is not recommended that she have it again in this pregnancy.
b) Tdap vaccination in pregnancy confers some protection against pertussis to the infant through transplacental transfer of maternal antibodies from mother to infant, lasting for a few months, and until the infant can begin DTaP from 2 months.
c) Tdap vaccination in pregnancy confers some protection against tetanus to the infant through transplacental transfer of maternal antibodies from mother to infant, lasting for a few months, and until the infant can begin DTaP from 2 months.
d) Tdap vaccination is contraindicated in pregnancy, as it contains methylmercury.

Answer 33

B

Question 34

94 . Which is not a valid reason for recording the general appearance and skin condition of a client at their initial appointment?
a) To make a judgement on the client’s ability to pay for their services.
b) As a baseline so that you can watch for deterioration in mental health during pregnancy.
c) As a baseline so that you can watch for deterioration in physical health during pregnancy.
d) To help you identify any current issues with physical or mental health or economic status.

Answer 34

A

Question 35

95 . 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 additional work the cardiac muscles must do during pregnancy.
c) The pressure on the cervix when the pelvis is positioned such that the presenting part exerts maximum pressure there.
d) The change in blood pressure when moving from prone to standing.

Answer 35

A

Question 36

96 . Which list contains only medical conditions where the client would generally not be considered appropriate for care out of hospital under a midwife?
a) Preeclampsia, intrauterine growth restriction, low economic status.
b) Asthma, placenta previa in the third trimester, history of cancer, multiple gestation.
c) HIV or AIDS, cardiovascular disease, severe psychiatric illness, Rh-isoimmunization.
d) Eclampsia, insulin dependent diabetes, maternal age over 40, hypertension.

Answer 36

C

Question 37

97 . 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) Those diagnosed with this STI should generally have significantly fewer Pap tests, as these can trigger an outbreak.
b) It’s associated with cervical cancer.
c) The STI can be cured with a topical application of trichloroacetic acid.
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 37

B

Question 38

98 . At Ida’s initial appointment, you get repeated blood pressure readings of 154/96. Which of the following is not true?
a) Ida appears to be an ideal client for out of hospital birth.
b) Ida may have ‘white coat syndrome’ and a normal BP. She should take her blood pressure when relaxed at home and report this to you.
c) Ida appears to have preexisting hypertension
d) Ida is at increased risk of placental abruption and IUGR.

Answer 38

A

Question 39

99 . 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,P2,A2,L3,M1
b) G5,T1,P2,A2,L3,M1
c) G4,T1,P3,A1,L3,M1
d) G5,T1,P3,A1,L3,M1

Answer 39

B

Question 40

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

Answer 40

A

Question 41

101 . Which STI below has correct details listed?
a) Chlamydia: vertical transmission at the time of birth is possible, and can cause PID and blindness. Prophylactic erythromycin is very effective at preventing the latter (far more effective than at preventing ophthalmalgia neonatorum caused by gonorrhea).
b) Herpes: vertical transmission at the time of birth through the birth canal is possible, with severe CNS, ocular damage or neonatal death as common outcomes. Recurrences are far more severe than the primary outbreak.
c) Gonorrhea: can be passed at the time of birth through birth canal, and can cause pneumonia and ophthalmia neonatorum if left untreated. Prophylactic erythromycin is very effective at preventing the latter (far more effective than at preventing ON caused by chlamydia).
d) Syphilis: crosses the placenta and can cause fetal malformations, with a high risk of fetal or neonatal death. It also causes placental malformations and there is a risk of congenital syphilis infection.

Answer 41

D

Question 42

102 . Your client was a smoker prior to pregnancy, but quit 3 months prior to conception. However, her husband, Ibrahim, continues to smoke. What counselling would be appropriate?
a) Whilst maternal smoking has a significant negative effect on the fetus, exposure to secondhand smoke has a (less significant) positive effect on the fetus. Ibrahim should continue smoking until the baby is born.
b) Exposure to secondhand smoke has no negative effects, but Ibrahim should quit smoking for the sake of his own health.
c) Whilst maternal smoking has a significant negative effect on the fetus, paternal smoking has no effect. However, Ibrahim should aim to quit smoking before the baby is born so that the baby does not have exposure to secondhand smoke.
d) There are significant negative effects on a fetus of both maternal smoking and exposure to secondhand smoke. Ibrahim should aim to quit smoking or, at the least, should not smoke around your client.

Answer 42

D

Question 43

103 . You’re having your final postpartum appointment with Isley, and are going over breast self-examination. Which is not an appropriate recommendation?
a) Cover every square inch of your breast, and continue into the armpit.
b) Press the breast against the chest wall when feeling it, rather than squeezing areas between fingers.
c) Lie on your back when feeling your breasts, with the arm on the side of the body you’re feeling raised, and a small pillow under that shoulder.
d) Once your cycle resumes, you should do the breast-exam in the day or two before your menstrual cycle

Answer 43

D

Question 44

104 . 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) 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.
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) 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.

Answer 44

C

Question 45

105 . 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 ate blueberries not long after the symptoms started.
b) Ivanna recently travelled to Brazil.
c) Ivanna went on a bike ride the day before symptoms began.
d) Ivanna did not have the flu vaccine this year.

Answer 45

B

Question 46

106 . Holly is allergic to milk. After birth, she has approximately 450 ml blood loss and decides she would like an IV. You only have Lactated Ringers solution. Is it safe to give this to someone with a milk allergy?
a) Yes. Lactate is not chemically similar to lactose, and sodium lactate does not contain milk protein.
b) No. Lactate is chemically identical to lactose, and sodium lactate contains milk protein.
c) No. Whilst lactate is not chemically similar to lactose, sodium lactate contains milk protein.
d) Yes. Whilst lactate is chemically identical to lactose, sodium lactate does not contain milk protein.

Answer 46

A

Question 47

107 . Your client, Haya, was adopted as a baby, and knows nothing about her biological family. In what way will this affect your care?
a) Maya will probably not respond well to a ‘motherly’ midwife during labor, so you should plan to be forceful.
b) It is likely that Maya was severely malnourished as an infant, which could have significantly impacted her health. You will need to remain observant for relevant problems.
c) You know it is virtually certain that Maya will have a prolonged labor because of her lack of a relationship with her biological mother.
d) You will not know Maya’s family medical history, which would have given you additional information about potential risk factors for Haya or the pregnancy, and so will need to be more ‘prepared for anything’ than ever!

Answer 47

D

Question 48

108 . At your first trimester intake appointment, you stand towards your client’s feet and place your hand palm down over the right lower quadrant, near the iliac spine. You move this hand upwards 2-3cm at a time towards the lower costal margin, having the client take a deep breath each time. What are you doing?
a) You’re feeling for the fundus. At 12 weeks, you expect it to be barely palpable above the pelvic margin. If higher, you would suspect inaccurate dates or hydatidiform mole.
b) You’re feeling for costovertebral angle tenderness. If present, a kidney infection may be present, though this can also be due to a kidney stone, ureteropelvic junction obstruction or other cause.
c) You’re attempting to feel the spleen. If you do, splenomegaly is present, though there are many causes for this. Referral is appropriate if there is no known cause.
d) You’re feeling for the liver to hit the caudal aspect of your hand, feeling for any hardness or nodules.

Answer 48

D

Question 49

109 . At her intake appointment at 11 weeks, you check Josephine’s quadriceps deep tendon reflexes and note 3+, symmetrical. Which is not a possible explanation?
a) Josephine has taken a CNS stimulant.
b) Josephine has anxiety.
c) Josephine has developed preeclampsia.
d) Josephine has hyperthyroidism.

Answer 49

C

Question 50

110 . When palpating above and below your client’s clavicle, you feel distinct nodule-like masses. What do you suspect?
a) Your client has a significant infection, and must start a course of antibiotics immediately. They should finish the entire course so they don’t risk developing resistant bacteria.
b) Your client may have cancer with advanced lymph-node involvement. They should see a physician as soon as possible.
c) Your client’s milk is ‘coming in’. They should expect their breasts to feel hard and warm soon, and this will extend into the armpit. They should try not to pump too much to ease discomfort, as this will only mean they produce more milk.
d) Your client appears to have an infection, and should either start with non-allopathic or allopathic treatment, depending upon their preferences.

Answer 50

B

Question 51

111 . Which of the following statements about BMI is correct?
a) BMI is calculated as weight divided by height squared (‘weight for height’).
b) BMI is calculated as height divided by weight squared (‘height for weight’).
c) For clients with low BMI (<19.8), approximately 12.5-18 lb weight gain is recommended during pregnancy.
d) For clients with high BMI (26.0-29.0), approximately 28-40 lb weight gain is recommended during pregnancy.

Answer 51

A

Question 52

112 . Which list contains only primary environmental exposures of concern during pregnancy?
a) Lead, mercury, ionizing and non-ionizing radiation, endocrine disruptors.
b) Hair treatments, most vaccines that contain the inactivated antigen or toxoid, such as Tdap.
c) Caffeine, sodium, alcohol, calcium.
d) Chronic stress, domestic violence, history of assault, death of a loved one.

Answer 52

A

Question 53

113 . Gael was taking the contraceptive pill when they became pregnant. What effect might this have on your care?
a) The contraceptive pill has reduced the risk of Gael having a hemorrhage, including a postpartum hemorrhage.
b) 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.
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 53

D

Question 54

114 . 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) The baby may go through neonatal abstinence syndrome because of it.
b) You should call CPS, as the mother and baby could be at risk of domestic abuse.
c) Limited research suggests that alcohol may cause epigenetic changes in sperm, and that this could lead to changes in the fetal neocortex.
d) There is no evidence to suggest that alcohol consumption in the father of a baby has any impact on the pregnancy.

Answer 54

C

Question 55

115 . At Irma’s initial physical exam, you note she is slightly hypothermic. Which of the following would not be a possible cause of this?
a) Hypothyroidism
b) Stress
c) Fasting
d) Hypoglycemia

Answer 55

B

Question 56

116 . Which of the following ways of asking questions on psychosocial history is most likely to produce accurate, honest answers?
a) Sending home a questionnaire to be filled in.
b) Asking the client when they are alone.
c) Asking the client and their intimate partner when the two of them are alone together.
d) Asking the client when their full birth support team is present.

Answer 56

A

Question 57

117 . Which of the following includes only demographic information you might record on a client?
a) Religion, occupation, education, marital status, gender, economic status and age.
b) Race, ethnicity, nationality, zip code, reproductive history.
c) Obstetric history, medical history, attitudes to midwifery care.
d) Gender, age of onset of menses, income, homeownership, employment status.

Answer 57

A

Question 58

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

Answer 58

C

Question 59

119 . 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 29th
b) May 22nd
c) May 8th
d) May 1st

Answer 59

B

Question 60

120 . During her 24 week appointment, Honor confides in you that she has been feeling that her muscles are tense and her chest is tight, that she’s always feeling close to panic and that she can’t stop worrying there’s something wrong with the baby. From this description, which is the most likely diagnosis?
a) Antepartum anxiety
b) Eclampsia
c) Antepartum depression
d) Hyperemesis gravidarum

Answer 60

A