Question 1

A 35-year-old visits the midwife after a home pregnancy test indicated a positive result. The client informs the midwife that the pregnancy is not planned and that she has been taking progestin-only birth control pills for the past year. During the history taking, the client informs the midwife that she has been taking isotretinoin for her severe, recalcitrant cystic acne for three months before the pregnancy. The client drinks at least three bottles of beer a day and is taking cocaine on a daily basis. Based on the client's history, which of the following substances is least likely to cause birth defects?

Accepted Answer

Progestin-only birth control pills are least likely to cause birth defects. Research reveals that the risk of females who were on progestin-only birth control pills having babies with birth defects is no higher than the general population. Isotretinoin may cause dysplastic ears, microcephaly or facial dysmorphism. Alcohol may cause craniofacial abnormalities. Cocaine causes birth defects that usually involve the urinary tract.

Question 2

A midwife suspects that a client at 18 weeks' gestation has a hydatidiform mole. Which of the following assessment findings does not support this diagnosis?

Accepted Answer

Vaginal spotting of dark-brown blood, not bright red blood, is usually associated with hydatidiform mole. The uterus tends to expand more rapidly than the usual rate in cases of hydatidiform mole. The fundus height is normally palpated at the umbilicus at 20 weeks.

Question 3

A female client with an IUD comes to the facility after testing positive in the home pregnancy kit. Physical examination and laboratory tests are ordered to verify the pregnancy. After reviewing the test results, the midwife determines that the client is 8 weeks pregnant. Which of the following is the next action of the midwife?

Accepted Answer

The next action of the midwife is to notify a physician for removal of the IUD. A sonogram is ordered to rule out ectopic pregnancy, which is one of the most common complications of pregnancy with the IUD in place. The IUD may be left in place, but the client might then be at risk for ectopic pregnancy, miscarriage and pelvic inflammatory disease.

Question 4

A midwife teaches a client that before palpating her breasts during breast self-examination, she needs to inspect her breasts for abnormalities in which of the following positions?
I.With her arms relaxed at her sides
II.With her arms lifted over her head
III.With her hands pressed against the hips
IV.With her hands pressed against the waist, leaning forward

Accepted Answer

Before palpating the breasts, the client should begin her monthly breast self-examination with inspection or observation of her breasts in the following positions: arms relaxed at her sides, arms lifted over her head, hands pressed against the hips and hands pressed together at the waist. The client should be instructed to look at each breast carefully and individually and to compare them. Lumps, dimpling, irregular shape, significant asymmetry and discharges should be reported.

Question 5

A midwife is teaching a female client how to perform a breast self-examination. On return demonstration, which of the following actions by the client indicates that further teaching is necessary?

Accepted Answer

The client needs further teaching if she uses the tips of her second, third and fourth fingers to press every part of her breast. The client should use the pads of her fingers to palpate her breasts.

Question 6

A 14-year-old comes to the clinic after a home pregnancy test indicated that she is pregnant. Physical examination and laboratory tests confirm that the client is 12 weeks pregnant. The midwife also notes that the client has signs of anorexia nervosa. A series of tests are conducted, revealing anemia. On the second visit, the client informs the midwife that she has decided to have an abortion and she wants to know her options. The midwife tries to encourage the client to talk to her mother, but the client refuses. Which of the following is the next action of the midwife?

Accepted Answer

The next action of the midwife is to thoroughly explain to the effects of abortion and the additional risks posed by anorexia nervosa and anemia. Knowing about the complications involved, the client may agree to inform her mother of the pregnancy. If the client refuses to inform her mother in spite of the teaching, the midwife may report the client's condition to state officials. When caring for a pregnant adolescent, one of the main goals of a midwife is to encourage the client's family members to participate in the care. The midwife may implement other activities that may facilitate communication between mother and child before informing the state about the client's condition.

Quiz 3: Maternal Health Assessment

A midwife suspects that a client at 18 weeks' gestation has a hydatidiform mole. Which of the following assessment findings does not support this diagnosis?

A midwife is teaching a female client how to perform a breast self-examination. On return demonstration, which of the following actions by the client indicates that further teaching is necessary?