Certified Midwife Exam Prep Postpartum Care & Newborn Assessment 2 — Questions and Answers
Question 1: A postpartum patient on day 3 reports a temperature of 38.4°C (101.1°F). Which source of fever is most common in the first 24 hours postpartum?
- Endometritis
- Urinary tract infection
- Breast engorgement/mastitis
- Physiologic milk fever (Correct answer)
Correct answer: Physiologic milk fever
A low-grade temperature spike in the first 24 hours postpartum is often attributed to physiologic milk fever or normal inflammatory response, not infection.
Question 2: Which clinical finding is most consistent with endometritis in a postpartum patient?
- Uterine tenderness, fever, and foul-smelling lochia (Correct answer)
- Breast erythema and induration
- Calf pain with dorsiflexion
- Unilateral leg swelling and warmth
Correct answer: Uterine tenderness, fever, and foul-smelling lochia
Endometritis presents with uterine tenderness, fever, and malodorous lochia typically beginning 2–5 days postpartum.
Question 3: A breastfeeding mother at 2 weeks postpartum reports a red, tender, wedge-shaped area on her breast with fever and flu-like symptoms. What is the most likely diagnosis?
- Breast abscess
- Plugged milk duct
- Mastitis (Correct answer)
- Galactocele
Correct answer: Mastitis
Mastitis presents with a localized red, painful, wedge-shaped area, fever, and myalgias typically in the first few weeks postpartum.
Question 4: What is the recommended first-line treatment for mastitis in a breastfeeding patient without abscess?
- Discontinue breastfeeding and apply ice
- Continue breastfeeding, antibiotics (dicloxacillin or cephalexin), and warm compresses (Correct answer)
- Incision and drainage
- IV antibiotics and hospital admission
Correct answer: Continue breastfeeding, antibiotics (dicloxacillin or cephalexin), and warm compresses
First-line treatment for mastitis includes continued frequent breastfeeding to empty the breast, oral antibiotics covering Staphylococcus aureus, and warm compresses.
Question 5: Which Edinburgh Postnatal Depression Scale (EPDS) score threshold should prompt further clinical evaluation for postpartum depression?
- ≥5
- ≥10 (Correct answer)
- ≥15
- ≥20
Correct answer: ≥10
An EPDS score of ≥10 is the commonly used threshold to prompt further clinical assessment for postpartum depression.
Question 6: A postpartum patient at 6 weeks reports persistent sadness, inability to bond with her infant, and passive suicidal ideation. What is the most appropriate immediate action?
- Reassure her this is normal baby blues and schedule a routine follow-up
- Screen with EPDS and refer for urgent psychiatric evaluation (Correct answer)
- Prescribe an antidepressant and follow up in 1 month
- Advise her to increase social support and exercise
Correct answer: Screen with EPDS and refer for urgent psychiatric evaluation
Passive suicidal ideation in a postpartum patient requires formal screening and urgent psychiatric referral to ensure patient safety.
Certified Midwife Exam Prep Postpartum Care & Newborn Assessment 2
A postpartum patient on day 3 reports a temperature of 38.4°C (101.1°F).
Which source of fever is most common in the first 24 hours postpartum?