Certified Midwife Exam Prep Case Studies & Practical Application 2

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?

Accepted Answer

Administer magnesium sulfate and arrange immediate delivery

Answer

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?

Accepted Answer

Apply suprapubic pressure while maintaining McRoberts position

Answer

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?

Accepted Answer

Order an ultrasound to evaluate growth and amniotic fluid

Answer

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?

Accepted Answer

Transfer to a higher level of care for respiratory evaluation

Answer

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?

Accepted Answer

Equivocal result indicating delivery is recommended

Answer

A BPP of 6/10 is equivocal, and when combined with oligohydramnios in a term pregnancy, delivery is the recommended management.

Certified Midwife Exam Prep Practice Test

Certified Midwife Exam Prep Practice Test

Certified Midwife Exam Prep Case Studies & Practical Application 2