Certified Midwife Exam Prep Case Studies & Practical Application 5

Question 1

A client at 32 weeks with twin gestation develops sudden onset dyspnea, cough, and hypoxia. She has no fever or productive cough. Vital signs show HR 122 and SpO2 88% on room air. What is the priority diagnosis to rule out?

Accepted Answer

Pulmonary embolism

Answer

Twin pregnancy significantly increases the risk of venous thromboembolism; sudden dyspnea and hypoxia without fever must prompt urgent workup for pulmonary embolism.

Question 2

A laboring client at 7 cm with ruptured membranes suddenly reports a gush of fluid. On sterile vaginal exam the midwife palpates a pulsating cord at the introitus. What is the immediate action?

Accepted Answer

Elevate the presenting part manually, call for emergency cesarean, and maintain upward pressure until delivery

Answer

Cord prolapse requires immediate manual elevation of the presenting part to relieve compression while preparing for emergency cesarean delivery.

Question 3

A client at 22 weeks has a uterus at 28-week size, severe nausea, and hyperemesis. Ultrasound shows bilateral ovarian cysts with a 'ground glass' appearance and no fetal heartbeat. What is the most likely diagnosis?

Accepted Answer

Complete hydatidiform mole with theca lutein cysts

Answer

Bilateral theca lutein cysts arise from hCG overstimulation and are classic findings associated with complete hydatidiform mole.

Question 4

A 29-year-old at 38 weeks has been pushing for 2.5 hours. The fetal head is at +3 station, occiput anterior, and the FHR tracing shows late decelerations with decreased variability. What is the next step?

Accepted Answer

Prepare for operative vaginal delivery or emergent cesarean based on provider capability

Answer

Recurrent late decelerations with decreased variability at +3 station after prolonged pushing indicate fetal compromise requiring delivery by the most expedient route.

Question 5

A postpartum client at day 7 calls reporting a red, warm, swollen right calf and difficulty walking. She had a cesarean delivery and is not yet ambulating well. What is the priority action?

Accepted Answer

Refer immediately to an emergency department for DVT workup and possible anticoagulation

Answer

Unilateral calf swelling, warmth, and erythema in a postoperative patient are classic signs of deep vein thrombosis requiring urgent diagnosis and anticoagulation.

Certified Midwife Exam Prep Practice Test

Certified Midwife Exam Prep Practice Test

Certified Midwife Exam Prep Case Studies & Practical Application 5