Certified Midwife Exam Prep Case Studies & Practical Application 4

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?

Accepted Answer

Proceed with induction or cesarean delivery without delay

Answer

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?

Accepted Answer

Provide a safety plan, document findings, and give information about local resources

Answer

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?

Accepted Answer

Clindamycin IV if susceptibility confirmed

Answer

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?

Accepted Answer

Medical nutrition therapy and blood glucose monitoring for 1-2 weeks before considering insulin

Answer

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?

Accepted Answer

Respect her autonomous decision and continue to provide supportive care with monitoring

Answer

Informed, competent clients have the right to refuse interventions; the midwife must respect autonomy, document thoroughly, and continue offering care.

Certified Midwife Exam Prep Practice Test

Certified Midwife Exam Prep Practice Test

Certified Midwife Exam Prep Case Studies & Practical Application 4