Certified Midwife Exam Prep Case Studies & Practical Application 4 — Questions and Answers
Question 1: A multipara at 42 weeks has oligohydramnios (AFI 4 cm) and a non-reactive NST. The biophysical profile scores 2/10. What is the appropriate management?
- Proceed with induction or cesarean delivery without delay (Correct answer)
- Repeat BPP in 24 hours if fetal movement is present
- Administer IV fluids and recheck AFI in 4 hours
- Begin daily NST monitoring and await spontaneous labor
Correct answer: Proceed with induction or cesarean delivery without delay
A BPP of 2/10 is abnormal and indicates significant fetal compromise requiring immediate delivery regardless of gestational age.
Question 2: During a prenatal visit, a 24-year-old at 16 weeks discloses she has been experiencing intimate partner violence. What is the midwife's priority response?
- Provide a safety plan, document findings, and give information about local resources (Correct answer)
- Contact law enforcement immediately to report the abuse
- Encourage couples counseling and defer further discussion to her partner's presence
- Refer to social work and take no further action during this visit
Correct answer: Provide a safety plan, document findings, and give information about local resources
The priority is client safety: offering a safety plan, non-judgmental documentation, and resources while respecting her autonomy.
Question 3: A client at 37 weeks has a positive Group B Streptococcus (GBS) culture. She arrives in active labor at 6 cm. She reports a penicillin allergy with prior anaphylaxis. What antibiotic is indicated?
- Vancomycin IV
- Ampicillin IV
- Clindamycin IV if susceptibility confirmed (Correct answer)
- Erythromycin IV
Correct answer: Clindamycin IV if susceptibility confirmed
For patients with high-risk penicillin allergy (anaphylaxis) and GBS susceptibility to clindamycin, IV clindamycin is the recommended alternative.
Question 4: An 18-year-old primigravida at 30 weeks is diagnosed with gestational diabetes after a 3-hour GTT. Her fasting glucose is 98 mg/dL. What is the initial management?
- Medical nutrition therapy and blood glucose monitoring for 1-2 weeks before considering insulin (Correct answer)
- Immediate initiation of insulin therapy
- Metformin only, as it is preferred in young clients
- Dietary changes alone with no monitoring required until third trimester
Correct answer: Medical nutrition therapy and blood glucose monitoring for 1-2 weeks before considering insulin
First-line GDM management is medical nutrition therapy with blood glucose monitoring; pharmacotherapy is added only if glucose targets are not met after dietary intervention.
Question 5: A 35-year-old G1P0 at 39 weeks refuses induction of labor despite counseling about increased perinatal mortality risks. She is well-informed and competent. What is the midwife's ethical obligation?
- Respect her autonomous decision and continue to provide supportive care with monitoring (Correct answer)
- Seek a court order to compel induction for fetal benefit
- Discharge the client from care for non-compliance
- Proceed with induction as the fetal welfare supersedes client autonomy
Correct answer: Respect her autonomous decision and continue to provide supportive care with monitoring
Informed, competent clients have the right to refuse interventions; the midwife must respect autonomy, document thoroughly, and continue offering care.
Question 6: A newborn develops jaundice at 18 hours of life. Total bilirubin is 14 mg/dL. The mother is blood type O negative and the newborn is A positive. What is the likely cause?
- ABO incompatibility causing hemolytic disease of the newborn (Correct answer)
- Physiologic jaundice peaking early
- Breastfeeding jaundice due to inadequate intake
- Rh incompatibility due to maternal anti-D antibodies
Correct answer: ABO incompatibility causing hemolytic disease of the newborn
Jaundice within 24 hours with an O negative mother and A positive infant strongly suggests ABO hemolytic disease causing accelerated bilirubin production.
Question 7: A client at 8 weeks with an intrauterine pregnancy is found to have a beta-hCG that rises only 18% in 48 hours. She has mild one-sided pelvic discomfort but no bleeding. What is the most concerning diagnosis?
- Ectopic pregnancy (Correct answer)
- Normal early intrauterine pregnancy
- Threatened miscarriage
- Anembryonic pregnancy
Correct answer: Ectopic pregnancy
Although an IUP is confirmed, a slow-rising hCG with unilateral pelvic pain raises concern for heterotopic pregnancy or early ectopic with concurrent IUP; serial evaluation is essential.
Certified Midwife Exam Prep Case Studies & Practical Application 4
A multipara at 42 weeks has oligohydramnios (AFI 4 cm) and a non-reactive NST.
The biophysical profile scores 2/10.
What is the appropriate management?