Certified Midwife Exam Prep Case Studies & Practical Application 2 — Questions and Answers
Question 1: A 28-year-old G2P1 at 39 weeks presents with sudden onset severe epigastric pain and BP 158/105. Her urine dipstick shows 3+ protein. What is the priority action?
- Administer magnesium sulfate and arrange immediate delivery (Correct answer)
- Discharge with instructions to monitor BP at home
- Perform a nonstress test and reassess in 4 hours
- Administer oral antihypertensives and recheck in 1 hour
Correct answer: Administer magnesium sulfate and arrange immediate delivery
Severe epigastric pain with hypertension and proteinuria indicates severe preeclampsia with features requiring immediate magnesium sulfate for seizure prophylaxis and delivery.
Question 2: During a home birth, a primigravida at 41 weeks delivers the head but the shoulders do not follow. The McRoberts maneuver fails after 30 seconds. What is the next intervention?
- Apply suprapubic pressure while maintaining McRoberts position (Correct answer)
- Fundal pressure to push the baby out
- Immediately apply Kristeller maneuver
- Ask the client to push harder with the next contraction
Correct answer: Apply suprapubic pressure while maintaining McRoberts position
When McRoberts alone fails, adding suprapubic pressure is the second step in managing shoulder dystocia before progressing to other maneuvers.
Question 3: A 32-year-old at 36 weeks has a fundal height of 32 cm. Fetal movement is normal and the client reports no complaints. What is the most appropriate next step?
- Order an ultrasound to evaluate growth and amniotic fluid (Correct answer)
- Reassure the client that variation in fundal height is normal
- Schedule immediate induction due to suspected IUGR
- Recommend increased caloric intake and follow up in 2 weeks
Correct answer: Order an ultrasound to evaluate growth and amniotic fluid
A fundal height 4 cm less than gestational age warrants ultrasound to evaluate for intrauterine growth restriction and oligohydramnios.
Question 4: A newborn is born at 37 weeks with Apgar scores of 7 at 1 minute and 9 at 5 minutes. The infant has mild grunting and nasal flaring at 20 minutes of life. What is the most appropriate action?
- Transfer to a higher level of care for respiratory evaluation (Correct answer)
- Reassure the parents that late preterm grunting is always benign
- Begin supplemental feedings to prevent hypoglycemia
- Initiate skin-to-skin and monitor without further evaluation
Correct answer: Transfer to a higher level of care for respiratory evaluation
Persistent respiratory distress at 20 minutes in a late preterm infant warrants evaluation for respiratory distress syndrome and possible transfer.
Question 5: A client at 38 weeks presents with decreased fetal movement for 12 hours. A biophysical profile scores 6/10 with oligohydramnios. What is the correct interpretation and management?
- Equivocal result indicating delivery is recommended (Correct answer)
- Normal result; repeat BPP in one week
- Abnormal result requiring immediate cesarean section
- Normal result; encourage oral hydration and recheck movements
Correct answer: Equivocal result indicating delivery is recommended
A BPP of 6/10 is equivocal, and when combined with oligohydramnios in a term pregnancy, delivery is the recommended management.
Question 6: A G3P2 labors at 8 cm for 3 hours without progress. Contractions occur every 3 minutes lasting 50 seconds. Fetal heart tones are reassuring. What should the midwife consider?
- Arrest of active phase due to inadequate uterine activity or malposition (Correct answer)
- Normal active phase progress; continue expectant management
- Immediate transfer for cesarean due to prolonged labor
- Amniotomy to accelerate dilation without further assessment
Correct answer: Arrest of active phase due to inadequate uterine activity or malposition
No cervical change for 4+ hours at ≥6 cm with adequate contractions meets the criteria for active phase arrest and warrants evaluation of cause.
Question 7: A breastfeeding client at day 4 postpartum reports bilateral breast engorgement, mild fever of 37.8°C, and fatigue. The breasts are firm but no focal area of hardness or erythema is noted. What is the diagnosis?
- Physiologic engorgement (Correct answer)
- Early mastitis
- Breast abscess
- Blocked milk duct
Correct answer: Physiologic engorgement
Bilateral engorgement with low-grade fever on day 3-5 postpartum without focal redness or mass is consistent with normal physiologic engorgement.
Certified Midwife Exam Prep Case Studies & Practical Application 2
A 28-year-old G2P1 at 39 weeks presents with sudden onset severe epigastric pain and BP 158/105.
Her urine dipstick shows 3+ protein.
What is the priority action?