Midwifery Exam Practice Questions

Midwifery Exam Practice Questions Related

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A student AGACNP just beginning his clinical rotation is observing his preceptor perform a physical survey on a patient who is brought in following a serious motor vehicle accident. The student observes that the physical examination includes rectovaginal examination, inspection of the urethral meatus, and palpation of the pelvic landmarks. The student knows the patient is being assessed for

  • A. Peritoneal bleeding
  • B. Retroperitoneal bleeding
  • C. Paresthesia
  • D. Pelvic fracture
Correct Answer: A

Rationale: The correct answer is A: Peritoneal bleeding. In a patient with a serious motor vehicle accident, a physical examination that includes rectovaginal examination, inspection of the urethral meatus, and palpation of pelvic landmarks is aimed at assessing for signs of internal bleeding, particularly peritoneal bleeding. Rectovaginal examination can detect blood in the rectouterine pouch, inspection of the urethral meatus can reveal blood at the urethral opening, and palpation of pelvic landmarks can identify tenderness or instability associated with internal bleeding. These findings would be indicative of potential peritoneal bleeding requiring urgent evaluation and management.

Summary of other choices:
B: Retroperitoneal bleeding - While physical examination findings may include signs such as flank ecchymosis or tenderness, the specific examinations mentioned are not typically performed to assess retroperitoneal bleeding.
C: Paresthesia - Paresthesia refers to abnormal sensations like tingling or numbness and

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K. T. presents for a routine wellness examination, and the review of systems is significant only for a markedly decreased capacity for intake and a vague sense of nausea after eating. K. T. denies any other symptoms the remainder of the GI review of systems is negative. His medical history is significant for complicated peptic ulcer disease that finally required resection for a perforated ulcer. The AGACNP advises the patient that

  • A. He will need endoscopy to evaluate the problem
  • B. Chronic gastroparesis is a known complication of ulcer surgery
  • C. Medication is unlikely to help, and he may need another surgery
  • D. His symptoms occur in 5 to 10% of people after ulcer surgery
Correct Answer: C

Rationale: Rationale for Correct Answer (C):
1. The patient's symptoms of decreased capacity for intake and nausea after eating suggest gastroparesis, a common complication post-ulcer surgery.
2. Given the history of complicated peptic ulcer disease and prior surgery, medication may be ineffective, necessitating potential reoperation.
3. The AGACNP advises that another surgery may be needed, indicating that medication alone may not suffice to address the issue.

Summary of Incorrect Choices:
A: Endoscopy is not necessary at this point as the symptoms are likely indicative of a functional issue rather than a structural problem.
B: While gastroparesis can occur post-ulcer surgery, the patient's symptoms are more suggestive of gastroparesis rather than chronic gastroparesis as a known complication.
D: The frequency of occurrence of symptoms after ulcer surgery is not relevant to the current management of the patient's symptoms.

A condition of trial of scar is

  • A. Estimated fetal weight of less than 3600g
  • B. Availability of a level one hospital nearby
  • C. Not more than two previous caesarean section scars
  • D. An adequate pelvis with true conjugate 10.5cm
Correct Answer: C

Rationale: Rationale for Correct Answer (C): A trial of scar is indicated when a woman has had no more than two previous caesarean sections. This is because the risk of uterine rupture increases with each subsequent caesarean section due to scar tissue weakening. Limiting the number of previous scars reduces this risk. Therefore, option C is correct.

Summary of Incorrect Choices:
A: Estimated fetal weight is not a determining factor for a trial of scar.
B: Availability of a level one hospital nearby is important for emergency situations but not a criteria for trial of scar.
D: Adequate pelvis with true conjugate 10.5cm is important for vaginal delivery but not a specific requirement for a trial of scar.

A patient with suspected Cushings syndrome is being evaluated to establish the diagnosis and cause. Patients with an adrenal tumor typically will demonstrate

  • A. Low ACTH and low cortisol
  • B. Low ACTH and high cortisol
  • C. High ACTH and low cortisol
  • D. High ACTH and high cortisol
Correct Answer: A

Rationale: The correct answer is A: Low ACTH and low cortisol. In a patient with an adrenal tumor causing Cushing's syndrome, the tumor itself produces excess cortisol independently of ACTH regulation. Therefore, ACTH levels are low due to negative feedback from high cortisol levels. As a result, cortisol levels are high, while ACTH levels are low.

Explanation for other choices:
B: Low ACTH and high cortisol - This suggests primary adrenal insufficiency (Addison's disease), not Cushing's syndrome.
C: High ACTH and low cortisol - This suggests secondary adrenal insufficiency, not Cushing's syndrome.
D: High ACTH and high cortisol - This is contradictory and not physiologically possible in the context of an adrenal tumor causing Cushing's syndrome.

According to the American College of Cardiology Foundation and the American Heart Association (ACCFAHA), the recommendation regarding antiplatelet therapy in patients with cardiovascular disease preoperatively is that

  • A. Antiplatelet therapy should be held for 10 days preoperatively
  • B. Cardiac consultation is required before an operation in patients who are on antiplatelet therapy
  • C. Medications should be continued unless concerns about hemostasis are significant
  • D. Antiplatelet therapy should be initiated in all high-risk cardiac procedures
Correct Answer: B

Rationale: Step-by-step rationale for why choice B is correct:
1. The ACCF/AHA recommends cardiac consultation before an operation for patients on antiplatelet therapy to assess the risk of bleeding versus thrombotic events.
2. Cardiac consultation helps determine the necessity of continuing, modifying, or stopping antiplatelet therapy.
3. This individualized approach ensures optimal perioperative management based on the patient's cardiovascular risk profile.
4. Choice A is incorrect as stopping antiplatelet therapy for 10 days can increase the risk of thrombotic events.
5. Choice C is incorrect as it oversimplifies the decision-making process without considering the patient's specific risks.
6. Choice D is incorrect because initiating antiplatelet therapy in all high-risk cardiac procedures may not be necessary for every patient.

Incidental antepartum haemorrhage is also referred to as

  • A. Intraplacental haemorrhage
  • B. Intrapartum haemorrhage
  • C. Extraplacental haemorrhage
  • D. Preterm haemorrhage
Correct Answer: C

Rationale: The correct answer is C: Extraplacental haemorrhage. Incidental antepartum haemorrhage refers to bleeding occurring outside the placenta, such as from the cervix or vaginal walls, before the onset of labor. This is not associated with the placenta itself (intraplacental - choice A). Similarly, it does not occur during labor (intrapartum - choice B) or specifically before term (preterm - choice D). Extraplacental haemorrhage captures the essence of bleeding unrelated to the placenta during the antepartum period.

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