Certified Midwife Exam Prep Case Studies & Practical Application 3

Question 1

A client at 34 weeks presents with painless bright red vaginal bleeding. She denies contractions and fetal heart tones are 145 bpm. What is the most likely diagnosis and first action?

Accepted Answer

Placenta previa; perform ultrasound before any vaginal examination

Answer

Painless bright red bleeding at 34 weeks suggests placenta previa; digital vaginal exam is contraindicated until placental location is confirmed by ultrasound.

Question 2

During second-stage labor a fetal heart rate tracing shows a prolonged deceleration to 70 bpm for 3 minutes. Cervix is 10 cm and the vertex is at +2 station. What is the priority action?

Accepted Answer

Reposition the client, apply oxygen, and prepare for operative delivery

Answer

A prolonged deceleration with a vertex at +2 station at full dilation requires urgent resuscitative measures and preparation for assisted or operative delivery.

Question 3

A 26-year-old at 10 weeks gestation reports nausea, vomiting, a uterus larger than expected, and a beta-hCG of 280,000 mIU/mL. Ultrasound shows a snowstorm pattern. What is the management?

Accepted Answer

Suction curettage followed by serial beta-hCG monitoring

Answer

A snowstorm pattern on ultrasound with markedly elevated beta-hCG is diagnostic of a complete hydatidiform mole requiring suction evacuation and surveillance.

Question 4

A client delivers a 4,400 g infant and has an estimated blood loss of 600 mL. Uterus is boggy after oxytocin administration and massage. What is the next pharmacological option?

Accepted Answer

Methylergonovine (Methergine) IM if no hypertension is present

Answer

Methylergonovine is the next uterotonic after oxytocin failure if the client has no hypertension, acting on uterine smooth muscle to enhance tone.

Question 5

A newborn at 2 hours of life has a blood glucose of 38 mg/dL, jitteriness, and poor feeding. The infant was born at 39 weeks to a mother with gestational diabetes. What is the priority intervention?

Accepted Answer

Initiate a glucose gel protocol and attempt breastfeeding

Answer

Symptomatic neonatal hypoglycemia in an IDM is managed first with glucose gel and breastfeeding before escalating to IV glucose if unresponsive.

Certified Midwife Exam Prep Practice Test

Certified Midwife Exam Prep Practice Test

Certified Midwife Exam Prep Case Studies & Practical Application 3