Midwifery Test Questions

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A patient who has been in the intensive care unit for 17 days develops hyponatremic hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is 320 mOsmL kg H2O. Clinical signs include tachycardia and hypotension. The adult-gerontology acute care nurse practitioners initial treatment is to

  • A. reduce serum osmolality by infusing a 5% dextrose in 0.2% sodium chloride solution
  • B. reduce serum sodium concentration by infusing a 0.45% sodium chloride solution
  • C. replenish volume by infusing a 0.9% sodium chloride solution
  • D. replenish volume by infusing a 5% dextrose in water solution.
Correct Answer: B

Rationale: The correct answer is B: reduce serum sodium concentration by infusing a 0.45% sodium chloride solution. In hyponatremic hyperosmolality, the primary goal is to correct the low serum sodium levels. A 0.45% sodium chloride solution is hypotonic, which helps to slowly correct the serum sodium concentration without causing rapid shifts in osmolality. Infusing a hypotonic solution will gradually increase the serum sodium levels, addressing the underlying issue. Choices A, C, and D are incorrect because they do not directly address the low serum sodium levels, which is essential in treating hyponatremic hyperosmolality. Infusing a 5% dextrose in 0.2% sodium chloride solution (Choice A) or a 5% dextrose in water solution (Choice D) would not correct the low sodium levels. Replenishing volume with a 0.9% sodium chloride solution (Choice C) would not directly

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When a hand or foot lies alongside the presenting part, the presentation is said to be

  • A. Footling
  • B. Transverse
  • C. Cephalic
  • D. Compound
Correct Answer: D

Rationale: The correct answer is D: Compound. In compound presentation, a hand or foot is alongside the presenting part, usually the head. This can complicate the delivery process. A: Footling presentation means the foot presents first. B: Transverse presentation is when the baby is lying sideways. C: Cephalic presentation is normal, with the head presenting first. In this scenario, D is the correct answer as it specifically describes the situation where a hand or foot is alongside the presenting part.

A major predisposing factor to cardiac disease in pregnancy includes

  • A. Rheumatic heart disease
  • B. Notable peripheral oedema
  • C. Easy fatiguability
  • D. Basal crepitation
Correct Answer: A

Rationale: The correct answer is A: Rheumatic heart disease. This is because rheumatic heart disease is a known risk factor for cardiac complications during pregnancy due to the strain pregnancy places on the heart. Choice B, notable peripheral edema, is a symptom of heart failure but not a predisposing factor. Choice C, easy fatiguability, is a non-specific symptom and not a direct predisposing factor. Choice D, basal crepitation, is a sign of possible lung pathology and not directly related to cardiac disease in pregnancy. Therefore, the correct answer is A as it directly relates to an increased risk of cardiac issues during pregnancy.

Predisposing factors to uterine rupture include

  • A. Nulliparity, neglected obstructed labor
  • B. Breech presentation, multiple pregnancy
  • C. Neglected obstructed labor, high parity
  • D. Obstetric maneuvers, breech presentation
Correct Answer: C

Rationale: The correct answer is C because neglected obstructed labor and high parity are well-established predisposing factors to uterine rupture. Neglected obstructed labor can cause prolonged pressure on the uterus, leading to weakening and potential rupture. High parity (having given birth multiple times) can also increase the risk of uterine rupture due to repeated stretching and strain on the uterine muscles.

A, B, and D are incorrect because nulliparity (never given birth), breech presentation, multiple pregnancy, and obstetric maneuvers are not as strongly associated with uterine rupture as neglected obstructed labor and high parity. These factors may increase the risk of other complications during childbirth but are not primary predisposing factors for uterine rupture.

The appropriate time to perform external cephalic version in a breech presentation is at

  • A. 36 gestational weeks
  • B. 38 gestational weeks
  • C. 42 gestational weeks
  • D. 40 gestational weeks
Correct Answer: A

Rationale: Rationale for correct answer (A): At 36 weeks, the baby has enough room to move, reducing risks of complications during external cephalic version. Earlier intervention also allows for possible repeat attempts if needed. This timing aligns with guidelines for optimal success rates.

Summary of other choices:
B: 38 weeks may be too late as the baby may have less space to turn.
C: 42 weeks is post-term and poses risks for both the baby and the mother.
D: 40 weeks is close to full term and may not allow for adequate time for successful version.

The AGACNP is receiving report from the recovery room on a patient who just had surgical resection for pheochromocytoma. He knows that which class of drugs should be available immediately to manage hypertensive crisis, a possible consequence of physical manipulation of the adrenal medulla?

  • A. Alpha-adrenergic antagonists
  • B. Beta-adrenergic antagonists
  • C. Intravenous vasodilators
  • D. Arteriolar dilators
Correct Answer: D

Rationale: Step-by-step rationale for why D is correct:
1. Arteriolar dilators such as sodium nitroprusside are used to manage hypertensive crisis by rapidly reducing blood pressure.
2. Pheochromocytoma surgery can result in catecholamine release, causing severe hypertension.
3. Arteriolar dilators act directly on blood vessels to lower blood pressure quickly.
4. Alpha-adrenergic antagonists (A) can worsen hypotension, beta-adrenergic antagonists (B) can lead to unopposed alpha-adrenergic effects, and intravenous vasodilators (C) may not act rapidly enough.

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