NARM-CPM CERTIFIED PROFESSIONAL MIDWIFE EXAM. ACTUAL 2024 EXAM PREPARATION DOCUMENT GRADED A+ Latest Version: 6.0

Question: 1 Answer: D Question: 2 Answer: A NARM -CPM CERTIFIED PROFESSIONAL MIDWIFE EXAM . ACTUAL 2024 EXAM PREPARATION DOCUMENT GRADED A+ Latest Version: 6.0 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. Explanation: Administering a single dose of ciprofloxacin through the IM route is the least appropriate intervention for the client. Fluoroquinolones, such as ciprofloxacin and ofloxacin, should not be used to treat gonococcal infections in pregnant clients. These medications may inhibit proper formation of the DNA and may cause birth defects. Ceftriaxone is administered to treat Neisseria gonorrhoeae. Chlamydia infections commonly co-occur with gonococcal infections, so azithromycin should also be administered. Ceftriaxone and azithromycin are considered pregnancy Category B medications. Medications in this category have failed to demonstrate risks to the fetus, but there are no well-controlled studies in pregnant females. These medications must only be given if the benefits outweigh the risks. Untreated gonococcal infections in pregnant clients may cause miscarriage, infection of the amniotic sac and fluid and pre-term premature rupture of the membranes. 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. Explanation: The priority action of the midwife is to administer a single dose of benzathine penicillin G through the intramuscular route. The midwife should monitor the client for any signs of Jarisch -Herxheimerp reaction, a reaction to syphilis treatment occurring during the first 24 hours of the therapy. Penicillin G can effectively treat syphilis if it is given before 16 weeks’ gestation. Options B and C are appropriate actions but they are not the midwife’s priority action. Syphilis may be transmitted from mother to child starting from 16 weeks’ gestation and through vaginal delivery, so cesarean section should be considered if the client is untreated. Untreated syphilis may cause congenital syphilis, which is characterized by failure to thrive, saddle nose and rash on the palms, toes, genitalia, anus, mouth and Question: 3 Answer: B Question: 4 Answer: D face. 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. Explanation: A platelet count higher than 100,000 platelets/μL does not support the diagnosis of HELLP syndrome. HELLP syndrome, a variation of pregnancy -induced hypertension, is characterized by hemolysis, elevated liver enzymes and low platelets. Hemolysis is manifested by the RBCs appearing fragmented on a peripheral blood smear. The liver enzymes alanine aminotransferase and aspartate aminotransferase are elevated because of hemorrhage and necrosis of the liver. 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. Explanation: Iodine, not folic acid, improves thyroid function. The other options are all benefits of folic acid supplementation. As the blood volume doubles during pregnancy, the body’s need for folic acid increases. Without supplementation, the mother may develop megaloblastic anemia, which is