Deck 1: General Healthcare Skills

Question 1

A 38-year-old client at 12 weeks' gestation tested positive for gonorrhea. Which of the following actions by the midwife is the least appropriate for the client?

A)Administer a single oral dose of azithromycin.
B)Administer a single dose of ceftriaxone through the IM route.
C)Instruct the client to avoid sexual contact until the infection is cured.
D)Administer a single dose ciprofloxacin through the IM route.

Answer 1

Administer a single dose ciprofloxacin through the IM route.

Question 2

A midwife reviews the result of a client's syphilis serology test. The client, a G2P1 at 12 weeks' gestation, tested positive. Which of the following is the priority action of the midwife?

A)Administer a single dose of benzathine penicillin G through the intramuscular route.
B)Inform the client that she should avoid any form of sexual contact until she is treated.
C)Inform the client that drug treatment may not be effective at this time and that a cesarean section will be necessary during delivery.
D)Monitor the client for early detection of Jarisch-Herxheimer reaction.

Answer 2

Administer a single dose of benzathine penicillin G through the intramuscular route.

Question 3

A pregnant client comes to the facility complaining of nausea, epigastric pain and general malaise. Physical assessment reveals right upper quadrant tenderness. The midwife suspects that the client has a HELLP syndrome. A series of laboratory exams are ordered for further evaluation. Which laboratory result would indicate a diagnosis other than HELLP syndrome?

A)Red blood cells appearing fragmented on a peripheral blood smear.
B)Platelet count is 180,000 platelets/µL.
C)Elevated alanine aminotransferase.
D)Elevated serum aspartate aminotransferase.

Answer 3

Platelet count is 180,000 platelets/µL.

Question 4

A midwife tells a client who is trying to get pregnant to eat fresh fruits and green and leafy vegetables before conceiving. The midwife also recommends 400 mcg of folic acid a day. Once she gets pregnant, the midwife may recommend that the client increase her folic acid intake to 600 mcg per day during the first trimester. Which of the following is not a benefit of folic acid supplementation before and during pregnancy?

A)It prevents the formation of large but ineffective red blood cells.
B)It prevents neural tube defects.
C)It decreases the baby's risk for cleft lip or palate.
D)It ensures proper functioning of the thyroid gland.

Question 5

A client who is 8 weeks pregnant tells a midwife that she has a strange craving for laundry starch. The client says, "I think I am losing my mind, but I need to tell someone about this odd behavior." Which of the following interventions is the most appropriate for the client?

A)Encourage the client to stop eating laundry starch.
B)Inform the client her behavior is an indirect way of calling attention to the pregnancy.
C)Initiate iron supplementation.
D)Initiate a high-carbohydrate diet.

Question 6

A midwife is managing the care of four clients. She should administer RhoGAM to the following clients:
1.A client at 28 weeks' gestation who received a RhoGAM injection 72 hours after the delivery of her first child.
2.A G2P1 client at 28 weeks' gestation who gave birth to an Rh-positive baby two years ago.
3.An Rh-negative client at 15 weeks' gestation who develops bleeding after an amniocentesis.
4.An Rh-negative client at 12 weeks' gestation who is admitted due to ectopic pregnancy.

A)1, 2
B)1, 2, 3
C)1, 3, 4
D)1, 2, 3, 4

Question 7

A midwife is about to perform a Leopold's maneuver on a client who is at 25 weeks' gestation. Before the examination, which of the following actions by the midwife is the least appropriate?

A)Instruct the client to empty her bladder.
B)Wash hands, dry with a clean towel, and then palpate for the fetal outline.
C)Place the client in the dorsal recumbent position, supine with the knees flexed.
D)Use the palms to palpate for the fetal outline.

Question 8

A 45-year-old client comes to the facility due to vaginal bleeding in between menses lasting 1 to 2 days. The client's usual menstrual cycle is 30 days. Her menstrual flow usually lasts between 3 and 4 days. A sonohysterogram is performed, and an endometrial polyp is found. The midwife expects which treatment following the diagnosis?

A)Total hysterectomy
B)Subtotal hysterectomy
C)Hysteroscopicpolypectomy
D)Dilatation and curettage

Question 9

A 25 - year - old client comes to the facility complaining of abrupt and severe lower abdominal pain, which radiates to the lower back and thighs. The client says the pain usually lasts for 20 minutes, resolves and then comes back again. The pain has started 12 hours before the consult. The client also reports vomiting, excessive sweating and constipation. Assessment findings include fever, tachycardia and tenderness over the lower abdominal region, with greater pain reported on the side. Urine human chorionic gonadotropin test is negative. Which of the following diagnostic tests is ordered for further evaluation and diagnosis?

A)Doppler ultrasound
B)Computed tomography
C)Pelvic ultrasound
D)Magnetic resonance imaging

Question 10

A 23 - year - old client who has never been pregnant comes to the clinic due to an irregularity in her menstrual periods. The midwife obtains the client's history and performs a thorough physical assessment. Which of the following details in client's history is not considered normal and should be further evaluated?

A)The client had her first menstrual period at age 12.
B)The client's menstrual cycle is 34 days, on the average.
C)The client's menstrual blood loss per period is about 100 mL.
D)The client's average duration of menstrual flow is 7 days.

Question 11

An 18 - year - old G0P0 client tells a midwife that she usually soaks a maxi sanitary pad in less than three hours every time she gets her period. Large clots are also passed. The client's menstrual cycle lasts 30 days and her average duration of menstrual flow is 5 days. The client also informs the midwife that she usually experiences vaginal bleeding in between periods. The flow usually lasts for 2 days, and the amount of blood loss is the same as that of the blood loss during her regular menstrual period. Based on the history, the midwife determines that the client has:

A)Oligomenorrhea
B)Menorrhagia
C)Metrorrhagia
D)Menometrorrhagia

Question 12

A 25 - year - old client comes to the clinic for a Pap smear. The result of the test reveals a low grade squamous intraepithelial lesion or LSIL. Which of the following is the next action of the midwife?

A)Inform the client that a repeat Pap smear should be done in three months.
B)Inform the client that she needs to have a Pap smear in two years.
C)Perform colposcopy
D)Inform the client that she needs to have a Pap smear after a year.

Question 13

Which of the following clients has the greatest risk for uterine fibroids?

A)A 30 - year - old Chinese American who has a BMI of 30 and smokes 2 packs of cigarettes a day.
B)A 43 - year - old Caucasian who has a BMI of 32 and smokes 2 packs of cigarettes daily.
C)A 25 - year - old Black American who has a BMI of 32; cigarette smoking is denied.
D)A 25 - year - old of Mediterranean descent who has a BMI of 30; cigarette smoking is denied.

Question 14

A midwife is caring for a client who recently had an induced abortion through suction curettage. After the procedure, the client develops disseminated intravascular coagulation. The client's platelet count is 35,000 platelets/µL. Which of the following is the midwife's priority action when caring for the client?

A)Administer heparin.
B)Administer oxygen at 6L/min.
C)Increase fluid intake.
D)Prepare to administer platelet replacement.

Question 15

A midwife initiates therapy for an infection in a client. The client is instructed to return a week later for a repeat culture so that the midwife can monitor the effectiveness of the medication in eliminating the causative agent of the infection. The client is most likely infected with:

A)Neisseria gonorrhoeae
B)Treponemapallidium
C)HSV - 1
D)HSV - 2

Question 16

A client is diagnosed with chlamydia infection. Which of the following is not a risk of untreated chlamydia?

A)Infertility
B)Pelvic inflammatory disease
C)Having a child infected with conjunctivitis
D)Having a child with developmental problems

Question 17

A client complains of a crop of sores in the genitalia, flu - like symptoms and swollen glands. The client is diagnosed with herpes. Which of the following instructions is the least appropriate for the client?

A)Avoid rubbing the sores.
B)Wear loose underwear made of cotton.
C)Apply hydrogen peroxide solution on sores.
D)Use cool and wet compresses for relief.

Question 18

A midwife is assessing a client who visits for a follow up examination after an abdominal hysterectomy. The midwife determines that the client has a hematoma. Which of the following findings supports the diagnosis?

A)Normal value of hemoglobin level.
B)Increased hemoglobin values.
C)Decreased hematocrit concentration.
D)Hyperthermia

Question 19

The midwife is creating a teaching plan for a program that encourages clients to have their regular Pap smear. Which of the following groups of clients is the midwife's priority?

A)Clients infected with Treponema pallidum.
B)Clients with a history of genitalia herpes.
C)Clients who are on oral contraceptives.
D)Clients who have plans of conceiving within the next year.

Question 20

Which of the following clients has the least risk for candidiasis?

A)A client who regularly douches.
B)A client diagnosed with Addison's disease.
C)A client who is 8 weeks pregnant.
D)A client who is sexually active.

Question 21

A midwife suspects that a 23 - year - old client has trichomoniasis. Which of the following findings is most suggestive of this infection?

A)Thin and grayish white vaginal discharge with a fishy odor.
B)Purulent vaginal discharge.
C)Greenish - gray, frothy vaginal discharge.
D)Thick, white vaginal discharge with severe perineal itching.

Question 22

A client complains of thin and grayish - white vaginal discharge with a fishy odor. These symptoms are most likely caused by:

A)Candida albicans.
B)Trichomonas.
C)Gardnerellavaginalis.
D)Treponema pallidum.

Question 23

A midwife is teaching a group of clients about toxic shock syndrome. Which of the following clients has the greatest risk of developing this condition?

A)A client who engages in unprotected sex.
B)A clienton steroid therapy.
C)A clientwho wears tampons during menstruation.
D)A clientwith a history of genital herpes.

Question 24

A midwife is assessing four clients with signs and symptoms involving the reproductive system. All clients are engaging in heterosexual sexual relationships. The midwife requires identification and treatment of sexual partners of all of the following clients except:

A)A client diagnosed with genital herpes.
B)A client diagnosed with chlamydia.
C)A client diagnosed with bacterial vaginosis.
D)A client with hepatitis B.

Question 25

A client presents with a painless, ulcerative crater that is within a papule in the vulva. The client says she had an unprotected sex with a new sexual partner three weeks ago. Dark field microscopy of lesions identifies Treponema pallidum. The client is most likely diagnosed with:

A)Primary syphilis
B)Secondary syphilis
C)Tertiary syphilis
D)Latent syphilis

Question 26

A client with a history of syphilis presents with ataxia. Further assessment reveals diminished deep tendon reflexes, proprioception and pain sensation. The midwife determines that the client has neurosyphilis. Which of the following statements is true about the client's condition?

A)The client is in the secondary stage of syphilis.
B)The client is not infectious.
C)The signs of primary syphilis most likely occurred about 2 years ago.
D)The client is not treatable.

Question 27

A client comes to the clinic complaining of pain in the pelvic area. The client tells the midwife that she feels a vague sense of bladder fullness after voiding. Constant sensation to void is also reported. The client is diagnosed with cystitis. Which of the following instructions given by the midwife is the most appropriate for the client?

A)Wear underwear made of nylon.
B)Douche at least twice a month.
C)Increase intake of cranberry juice.
D)Relieve the discomfort with tub baths.

Question 28

A client complains of urinary frequency and pain in the external urethral orifice at the start of voiding. The midwife suspects that the client is most likely experiencing:

A)Cystitis.
B)Pyelonephritis.
C)Urethritis.
D)Ureteritis.

Question 29

A diaphragm is initially fitted to a 23 - year - old client by the midwife. Which of the following occurrences would not necessitate another fitting?

A)She goes through a dilatation and curettage.
B)She gains 20 pounds.
C)She gets pregnant.
D)She loses 10 pounds.

Question 30

A series of laboratory tests reveals that a male client's spermatozoa are immobilized by vaginal secretions due to an immunological factor. The following interventions are appropriate for the client except:

A)Administer clomiphene citrate to the male client.
B)Administer corticosteroids to the client's female partner.
C)Instruct the couple abstain from sex for the next 6 months.
D)Instruct the male client to wear a condom for the next 6 months.

Question 31

A couple is considering artificial insemination after the man fails to respond to medications that intend to increase his sperm count. Which of the following statements about artificial insemination is false?

A)A donor's sperm can be used.
B)The sperm is instilled into the female reproductive tract one day after ovulation.
C)It involves selective termination of gestational sacs.
D)The sperm is instilled into the cervix or uterus.

Question 32

A couple is considering in vitro fertilization and embryo transfer after learning that the client's fallopian tubes are blocked. Which of the following statements about in vitro fertilization and embryo transfer is/are true? I.Embryo transfer involves insertion of one or more fertilized ova about 40 hours after fertilization.
II.After the pregnancy is implanted, the client's prenatal care is the same as that for any pregnant female.
III.In vitro fertilization involves fertilization of one or more mature oocytes removed from a female's ovary in a controlled or laboratory environment.
IV.The procedure involves selective termination of gestational sacs.

A)I, II and III
B)I, III and IV
C)II, III and IV
D)All of the statements are true.

Question 33

Clomiphene citrate is prescribed to a client to stimulate ovulation. Which of the following statements by the midwife is the most appropriate for this client?

A)"If no results are obtained after the second course of clomiphene citrate therapy, the therapy will be discontinued."
B)"Blurring of vision is an expected side effect of the medication."
C)"Bruising or bleeding should be reported."
D)"Blood samples are obtained periodically."

Question 34

A midwife in a community health center teaches a group of clients about the importance of Pap smears. Which of the following clients requires a Pap smear immediately?

A)A 75 - year - old client who has had three negative tests in the past 10 years.
B)A 20 - year - old female college student who has never been sexually active.
C)A 70 - year - old clientwith a new sexual partner.
D)A 35 - year - old clientwho had three negative Pap smears in a row; her most recent Pap smear was obtained two years ago.

Question 35

A client who is being treated for alcohol abuse has thiamine deficiency. The client is encouraged to eat which food item to support the treatment of thiamine deficiency?

A)Salmon
B)Chicken
C)Pork
D)Green, leafy vegetables

Question 36

A client is encouraged to consume sufficient amounts of which food item to prevent iron - deficiency anemia?

A)Salmon
B)Chicken
C)Orange
D)Organ meats

Question 37

An 18 - year - old informs the midwife that she has a family history of osteoporosis. The client asks the midwife which food item she should eat to prevent this condition. Which of the following foods would not be a helpful suggestion for this client?

A)Cheese
B)Tomatoes
C)Tofu
D)Milk

Question 38

At a screening clinic, a 23 - year - old client has a cholesterol blood test. The midwife informs the client that healthy eating and moderate physical activity can keep her cholesterol level in the healthy range, which is below:

A)500 mg/dL
B)400 mg/dL
C)300 mg/dL
D)200 mg/dL

Question 39

A series of laboratory examinations are conducted for a client who is admitted to the facility for an annual checkup. Blood is drawn for serum electrolyte testing. Which of the following assessment findings requires further evaluation?

A)Sodium = 137 mEq/L
B)Potassium = 4.3 mEq/L
C)Chloride = 93 mEq/L
D)Bicarbonate = 27 mEq/L

Question 40

A 34 - year - old client is scheduled to have a glucose tolerance test in three days. Which of the following instructions by the midwife is the most appropriate for the client?

A)"Fast for 24 hours before the test."
B)"Eat a high - carbohydrate diet for three days before the test."
C)"Alcohol, smoking and coffee should be avoided for eight hours before the test."
D)"Be sure to exercise some time in the eight - hour period before the test and after the test."

Question 41

A 35 - year - old client comes to the facility to inquire about getting her basal mammogram. Which of the following instructions by the midwife is the most appropriate?

A)"Schedule a mammogram during your menstrual cycle."
B)"Avoid applying deodorants or creams under the arms or on the breasts before the test."
C)"Avoid over - the - counter pain medications before the test."
D)"Caffeine intake should be limited during the eight hours preceding the test."

Question 42

A midwife performs a bimanual pelvic examination on a 25 - year - old client during her annual examination. Which of the following findings indicates a need for further evaluation?

A)Cervical motion tenderness
B)The fallopian tubes and ovaries are not palpable.
C)The ovaries are smooth and firm.
D)The uterus is freely movable.

Question 43

A midwife is about to assess a client through the use of vaginal speculum. When choosing the size of the speculum, the midwife considers:
I.Age of the client
II.Size of the vagina
III.History of sexual intercourse
IV.Gravidity

A)I and II only
B)I and IV only
C)I, II and IV
D)All of the above.

Question 44

A midwife is about to conduct intravaginal assessment through the use of vaginal speculum on a G3P3 client. Cells will be taken for cytologic studies, and cultures are to be obtained. Which of the following actions by the midwife is the least appropriate?

A)The midwife uses a water - based gel to lubricate the speculum.
B)The midwife verifies that no vaginal medications were used before the procedure.
C)The midwife rolls a sterile, cotton - tipped applicator on the vaginal wall below the cervix to collect cells from the vaginal pool.
D)Before withdrawing the speculum, the midwife loosens the lever control. The blades are slowly closed, and the speculum is rotated.

Question 45

A midwife palpates for which of the following anatomic locations when evaluating the Bartholin's glands?

A)Over and along both sides of the urethra
B)Clitoris
C)Posterior labia majora
D)Labia minora

Question 46

A client is admitted to the facility due to alcohol abuse. During the first 24 hours, which of following interventions is the least appropriate?

A)Orient the client frequently.
B)Initiate seizure precautions.
C)Provide a quiet, non - stimulating environment.
D)Initiate bleeding precautions.

Question 47

A midwife is managing the care of a G2P3 client who is in treatment for alcohol abuse. Which of the following interventions is the most appropriate?

A)Help the client recognize that she cannot be accountable for all of her actions.
B)Avoid situations that precipitate angry feelings.
C)Focus the client's attention on the substance abuse problem.
D)Acknowledge that some of her behaviors are due to her alcohol problem.