AMCB CNMFree Certified Nurse-Midwife practice test

Correct answer: C. It is a presumptive sign of pregnancy.

Amenorrhea is classified as a presumptive sign of pregnancy. Positive signs include fetal heart tones, ultrasound confirmation of pregnancy, or palpation of fetal movement by the provider. Probable signs include uterine enlargement, Hegar's sign, Goodell's sign, Piskacek's sign, ballottement, Braxton Hicks contractions, and a positive pregnancy test.

Correct answer: C. Order an ultrasound

A fundal height that is significantly larger than expected for gestational age may indicate macrosomia, polyhydramnios, or multiple gestation. An ultrasound is warranted to clarify the cause. Continuing routine care without investigation risks missing complications. Bed rest is not indicated based on fundal height alone. Dietary modification is premature without first establishing the underlying reason for the discrepancy.

Correct answer: B. Schedule a targeted anatomy ultrasound

Elevated AFP can signal neural tube defects, abdominal wall defects, or multiple gestations. A targeted anatomy ultrasound is the most appropriate first step to identify these conditions. Amniocentesis is more invasive and is generally reserved for cases with high suspicion of chromosomal anomalies. Repeating AFP in two weeks is less diagnostic than ultrasound and may delay important findings. Forgoing follow-up risks missing a significant abnormality.

Correct answer: A. Gestational diabetes

Gestational diabetes causes fetal hyperglycemia, which drives increased fetal urination and leads to polyhydramnios. Fetal anemia can contribute to hydrops fetalis and be associated with polyhydramnios, but gestational diabetes is the more common etiology. Twin-to-twin transfusion syndrome can cause polyhydramnios in the recipient twin, but this is specific to monochorionic twin pregnancies. Placental insufficiency usually results in oligohydramnios from reduced fetal urine production.

Correct answer: C. Chronic hypertension

Hypertension identified before 20 weeks gestation is consistent with chronic hypertension, as gestational hypertensive disorders typically arise after 20 weeks. Gestational hypertension is defined as new-onset hypertension after 20 weeks without proteinuria. Preeclampsia requires hypertension plus proteinuria or end-organ dysfunction, also emerging after 20 weeks. White coat hypertension would need readings obtained in multiple settings for confirmation.

Correct answer: B. Down syndrome

Low AFP combined with elevated hCG is a classic triple screen pattern associated with Down syndrome (Trisomy 21). Neural tube defects typically produce elevated AFP. Trisomy 18 (Edwards syndrome) is associated with low levels of AFP, hCG, and estriol simultaneously. A normal pregnancy does not match this pattern of analyte results.

Correct answer: B. Perform a three-hour glucose tolerance test

An abnormal one-hour glucose challenge test requires confirmation with a three-hour glucose tolerance test before diagnosing gestational diabetes. A single elevated screening result is not diagnostic on its own. Repeating the same one-hour screen is not an appropriate diagnostic approach. Continuing routine care without further evaluation would be inappropriate given the abnormal result.

Correct answer: A. Oral glucose tolerance test

The oral glucose tolerance test (OGTT) is the gold standard for diagnosing gestational diabetes mellitus in a patient with no prior history of diabetes. Hemoglobin A1c reflects long-term glucose control and is not used as the primary test for gestational diabetes. Fasting blood glucose can suggest hyperglycemia but is not the definitive test for gestational diabetes. Urine glucose testing lacks the specificity and sensitivity needed to diagnose gestational diabetes mellitus.

Correct answer: D. Conservative expectant management

In a clinically stable patient with no active bleeding or uterine contractions, placenta previa is managed conservatively with expectant observation. Cesarean delivery is reserved for maternal or fetal compromise. Tocolytics may be used if preterm labor coexists, but are not indicated for placenta previa alone. Rh immune globulin administration is relevant for Rh-negative patients but does not constitute management of placenta previa.

Correct answer: C. Hydrops fetalis

Parvovirus B19 infection during pregnancy can cause severe fetal anemia leading to hydrops fetalis, which is the primary fetal concern. Neural tube defects, intrauterine growth restriction, and premature rupture of membranes are not characteristic complications of parvovirus B19.