Question 1

A midwife is teaching a pregnant client safe techniques for exercising. Which of the following teachings is not a safe way of exercising when pregnant?

Accepted Answer

The client must be taught not to point the toes when doing leg exercises. During pregnancy, the relaxin levels increase, causing the arch of the foot to fall. Extending the heel may cause pain and may impede venous return. Hyperextending the lower back may cause muscle strain. Practicing second stage pushing may increase intrauterine pressure and cause rupture of membranes. The client must roll over to the side first and then push up when rising from the floor to avoid straining the abdominal muscles.

Question 2

A midwife is teaching a client at 20 weeks' gestation how to perform abdominal muscle contractions. Which of the following is not a benefit of this exercise?

Accepted Answer

Abdominal muscle contractions do not stretch the perineal muscles. Abdominal muscle contractions prevent constipation, alleviate back pain and help restore muscle tone after pregnancy. Tailor sitting, squatting and Kegel exercises are exercises that stretch the perineal muscles.

Question 3

A pregnant client asks the midwife about nonpharmacologic methods for managing labor pains. The midwife informs her about a method that is based on the idea that childbirth is a natural and joyful process. This method also stresses the importance of having the birth support partner during the pregnancy, labor and early postpartum period. It also encourages walking during labor. The midwife is teaching which method to the client?

Accepted Answer

The midwife is teaching the Bradley method. This method includes interventions that promote childbirth as a joyous and natural process. It includes muscle toning exercises, limiting of foods that contain preservatives and abdominal breathing. The Bradley method encourages walking during labor and using an internal focus point as a disassociation technique. The Lamaze method utilizes controlled breathing to reduce pain during labor. The Psychosexual method includes conscientious relaxation techniques and progressive breathing to encourage flowing with the contractions. The Dick-Read method intends to break the chain of events that may lead to tension, as it can cause or worsen the pain.

Question 4

A 25-year-old client at 7 weeks' gestation comes to the clinic for her first prenatal visit. The client tells the midwife that a friend recently gave birth to a baby with Down syndrome and that she is concerned about her baby's chances of developing the same diagnosis. The midwife informs the client that a combined first trimester screening test may be ordered as early as the 11th week of her pregnancy to help evaluate the fetus's risk for chromosomal abnormalities. The midwife informs the client that all of the following tests are included in the combined first trimester screening test except:

Accepted Answer

The alpha-fetoprotein screening test is scheduled during the second trimester, between the 16th and 18th week of gestation. During the first trimester the midwife may schedule the client for nuchal translucency screening, pregnancy-associated plasma protein screening or PAPP-A and human chorionic gonadotropin test to determine the fetus's risk for any chromosomal abnormalities, such as Down syndrome and trisomy 18. The combined first trimester screening test or CFTS is an accurate, non-invasive and optional prenatal screening test than can be scheduled as early as 11th week of pregnancy.

Question 5

A client at 8 weeks' gestation comes to the clinic for her first prenatal visit. The client tells the midwife that a cousin of hers gave birth to a femalebaby with Down syndrome a year ago. The client is anxious that her baby may develop the same genetic disorder and is requesting an immediate amniocentesis. Which of the following statements by the midwife is the appropriate?

Accepted Answer

The midwife should inform the client that amniocentesis is usually performed between 15 and 16 weeks' gestation to ensure sufficient amniotic fluid. Chorionic villi sampling may be performed between 10 and 12 weeks' gestation.

Question 6

A midwife is creating a teaching plan for a group of adolescent clients who are pregnant for the first time. The main purpose of the teaching session is to promote nutritional health during pregnancy. Which of the following consideration is least important when creating the teaching plan?

Accepted Answer

When teaching a group of adolescent clients who are pregnant, the midwife should mainly consider the involvement of the clients' families, the financial status of the clients and the clients' cultures. Even a client who is receptive to changing her eating habits may have some difficulties if her family resists the changes. In adolescents, it is most important that the food preparers are willing to effect the change. If a client belongs to a low-income group, the client should be helped to secure financial assistance during her pregnancy. Food intake and eating habits are greatly influenced by culture.

Question 7

A midwife is managing the nutritional status of a 13-year-old client at 12 weeks' gestation. When working with an adolescent client, which of the following interventions is the most effective?

Accepted Answer

The midwife should allow the client to reject traditional foods and respect her decisions. This is the most effective intervention when working with an adolescent client. Adolescents are searching for their identities during this stage, and they have a tendency to reject foods that their primary caregivers or parents see as important for them. The other options would be less effective interventions. The midwife should ensure that the client's diet includes adequate nutrients. Adolescent clients must consume more than 2,500 calories per day. The client should be taught to prepare her snacks early in the day because it is during this time when she has the most energy. The midwife has to work with the client's food preparer because adolescents are not usually in charge of cooking the food they eat.

Question 8

A client is in her 18th week of pregnancy. Which of the following psychosocial changes is expected at this time?

Accepted Answer

During the 18th week of pregnancy, the client begins to concentrate on how it will feel to be a parent or how she will feel during the delivery. This is manifested by role-playing. During the first trimester, the major developmental task is to accept the pregnancy. Ambivalence is a common reaction, and it can also occur in clients who planned for the pregnancy. During the second trimester, an important developmental task is to accept the baby as a separate entity, and during during the third trimester, the major developmental task is to prepare for the baby. Options C and D are commonly seen in clients during the third trimester.

Question 9

A midwife is teaching a group of clients about the importance of performing breast self-examination every month. The midwife is most concerned about increasing the awareness of its importance in which group of clients?

Accepted Answer

Research shows that females with ovarian cancer are at risk of developing breast cancer. Breast self-examination may detect cancerous tumors, resulting in early treatment and better prognosis. The other options are not correct.

Question 10

A client had a miscarriage and underwent a cervical dilatation and curettage procedure. Before discharge, the midwife instructs the client about certain activities that have to be limited or avoided in the next few weeks. The midwife determines that the health teaching has been successful if the client says:

Accepted Answer

The teaching has been successful if the client says that she will avoid tub baths for a week. The client may engage in vaginal intercourse after two weeks. Tampons have to be avoided for a week. The client may gradually increase her activities; bed rest is not necessary.

Question 11

A midwife is teaching a group of clients about Norplant as a contraceptive method. Norplant is contraindicated for which of the following clients?

Accepted Answer

The contraceptive is not indicated for a client who has or may have breast cancer. Other contraindications include undiagnosed uterine bleeding, active liver disease and pregnancy. Norplant may be used by adolescents who are sexually active and by clients who are breastfeeding.

Question 12

A 15-year-old comes to the facility and asks the midwife about her contraceptive options. Which of the following is the least appropriate method of contraception for this client?

Accepted Answer

Periodic abstinence is the least recommended method of contraception for adolescents. Natural family planning involves fertility awareness methods that greatly rely on the menstrual cycles. It may take a few more years before the client can fully establish a regular menstrual cycle. Natural family methods also require the adolescent to avoid sex during certain times. This may be a difficult task for an adolescent who is exposed to peer pressure or who lacks confidence or assertiveness.

Question 13

The following clients are contraindicated for diaphragm use except for:

Accepted Answer

A client with umbilical hernia is not contraindicated for diaphragm use. Clients with a history of toxic shock syndrome, allergy to rubber and recurrent UTI are contraindicated for diaphragm use. Diaphragm use is also not recommended for a client whose uterus is prolapsed, retroflexed or anteflexed to such a degree that the cervix is also displaced. Urinary tract infections are a risk of diaphragm use because of the pressure on the urethra.

Question 14

A midwife is creating a teaching plan for a client who is scheduled for tubal ligation. Which of the following teachings should not be included in the plan?

Accepted Answer

The occurrence of sharp shoulder pain may be expected after the surgery. Tubal ligation involves infusion of carbon dioxide into the incision to lift the abdominal wall upward. Until carbon dioxide is absorbed, the client may experience abdominal bloating and sharp shoulder pain for the first 24 hours. Unprotected coitus is avoided because the sperm may get trapped in the tube and fertilize an ovum, causing ectopic pregnancy. In contrast to hysterectomy, tubal ligation does not affect the menstrual cycle. Coitus is safe three days after the procedure.

Question 15

A couple visits the facility for a fertility assessment. A semen analysis is ordered. Which of the following suggests a likely fertility problem?
I.Sperm count = 15 million per milliliter of seminal fluid.
II.Sperm motility = 80%
III.Sperm progressive motility = 35%
IV.Ejaculation volume = 1.2 cc

Accepted Answer

A sperm count of 15 million per milliliter of seminal fluid and ejaculation volume of less than 1.2 cc indicate a likely fertility problem. The minimum sperm count that is considered normal is 20 million per milliliter of seminal fluid. A volume less than 1.50 cc decreases fertility. Sperm motility must be at least 60%, and the sperm progressive motility must be at least 25%.

Question 16

A midwife is assessing the fertility of couples who have been trying to conceive for a period of time without success. Which of the following couples has primary infertility?

Accepted Answer

Infertility is engaging in unprotected sex for one year without an occurring pregnancy. If the couple has no previous conceptions, it is called primary infertility. If the couple reported a previous conception, it is called secondary infertility.

Question 17

A midwife is teaching a group of clients between the ages of 19 and 20 about breast examination. Which of the following statements made by one of the participants indicates that further teaching is needed?

Accepted Answer

Starting at age 40, clinical breast examination should be done every year. The other options are accurate statements about breast health. Premenopausal clients should perform breast self-examination on a monthly basis, about a week after the menses.

Question 18

There are many reasons why midwives should be concerned with professional ethics. Which of the following is the main and critical purpose of applied professional ethics?

Accepted Answer

The main and critical role of applied professional ethics is to maintain internal regulation and avoid external regulation. Self-regulation is preferred because no one knows midwifery better than its members. With self-regulation, external agencies are less likely to interfere with the practice. Ethical codes foster professional identity and encourage midwives to define themselves and communicate who they are in relation to others. Through professional ethics, the consumers and care givers are protected, causing increased confidence in the profession. Ethical codes also signal professional maturity, which stimulates further development of ethical codes and guidelines.

Question 19

A 43-year-old client comes to the clinic with her partner for a series of fertility tests. The client's partner used to be the midwife's patient from another facility, and the midwife is certain that he tested positive for HIV. The client is unaware of her partner's diagnosis. The midwife talks to the partner in private, and, although he acknowledges that that he used to be her patient, he denies that he tested positive for HIV and refuses to talk to his partener about his diagnosis. What should the midwife's next action be?

Accepted Answer

The next action of the midwife is to urge the client to persuade her partner to have an HIV test with her. This action may be supported by educating the client about the effects, risks and treatment options of HIV. The midwife has the duty to protect the health of the client, but she also has to respect the partner's privacy. Urging the client to persuade her partner to take the test with her is ethical. There are certain situations in which the midwife has the legal duty to report cases that threaten public safety. The midwife may inform the client about the partner's diagnosis if she has attempted to resolve this issue through all other possible means.

Question 20

Before discharging a pregnant client against medical advice (AMA), which of the following actions by the midwife is the most appropriate?

Accepted Answer

Before discharging a client AMA, the midwife should ensure that the client is aware of the risks of leaving the facility. The midwife should also inform the client that she can come back to the facility any time. Follow-up appointments should be arranged before discharge.

Quiz 4: Midwifery Counseling and Education