Certified Midwife Exam Prep Certified Midwife 2 — Questions and Answers
Question 1: A client at 36 weeks gestation presents with sudden severe headache, visual disturbances, and BP of 160/110 mmHg. What is the priority intervention?
- Administer magnesium sulfate IV and prepare for delivery (Correct answer)
- Reassure the client and schedule a follow-up in 24 hours
- Prescribe oral antihypertensives and monitor at home
- Perform a non-stress test and await results
Correct answer: Administer magnesium sulfate IV and prepare for delivery
Severe-range blood pressure with neurological symptoms indicates severe preeclampsia requiring magnesium sulfate for seizure prophylaxis and urgent delivery planning.
Question 2: Which fetal heart rate pattern requires immediate intervention and expedited delivery?
- Sinusoidal pattern with absent variability (Correct answer)
- Moderate variability with occasional accelerations
- Early decelerations in active labor
- Variable decelerations that resolve quickly with position change
Correct answer: Sinusoidal pattern with absent variability
A sinusoidal FHR pattern is associated with severe fetal anemia or hypoxia and is a Category III tracing requiring immediate action.
Question 3: When using a partograph, a labor curve crossing to the right of the action line indicates:
- Need for obstetric evaluation and possible intervention (Correct answer)
- Normal labor progress for a nullipara
- Imminent second stage of labor
- Adequate uterine contractions
Correct answer: Need for obstetric evaluation and possible intervention
Crossing the action line on the partograph signals that labor is not progressing adequately and obstetric review is required.
Question 4: A newborn at 1 minute of life has a heart rate of 90 bpm, weak cry, flexion of extremities, grimace to stimulation, and blue hands and feet. What is the APGAR score?
- 6 (Correct answer)
- 4
- 8
- 5
Correct answer: 6
HR <100 (1) + weak cry (1) + some flexion (1) + grimace (1) + acrocyanosis (1) = 6.
Question 5: Which finding on a biophysical profile (BPP) receives a score of 0 rather than 2?
- Absent fetal breathing movements over 30 minutes (Correct answer)
- Three discrete body movements in 30 minutes
- One episode of limb extension with return to flexion
- Reactive non-stress test with two accelerations
Correct answer: Absent fetal breathing movements over 30 minutes
Fetal breathing movements must be present for at least 30 seconds within 30 minutes to score 2; absence scores 0.
Question 6: A client at 10 weeks gestation reports first-trimester bleeding. Transvaginal ultrasound shows an empty gestational sac measuring 25 mm. The most appropriate diagnosis is:
- Anembryonic pregnancy (blighted ovum) (Correct answer)
- Threatened abortion
- Ectopic pregnancy
- Normal intrauterine pregnancy
Correct answer: Anembryonic pregnancy (blighted ovum)
A mean sac diameter ≥25 mm without an embryo is diagnostic of an anembryonic pregnancy.
Question 7: Which group B Streptococcus (GBS) prophylaxis regimen is recommended for a penicillin-allergic client with low anaphylaxis risk?
- Cefazolin 2 g IV then 1 g IV every 8 hours (Correct answer)
- Clindamycin 900 mg IV every 8 hours regardless of sensitivity
- Vancomycin 1 g IV every 12 hours
- Ampicillin 2 g IV then 1 g IV every 4 hours
Correct answer: Cefazolin 2 g IV then 1 g IV every 8 hours
CDC guidelines recommend cefazolin for penicillin-allergic clients at low risk of anaphylaxis because cross-reactivity is very low.
Certified Midwife Exam Prep Certified Midwife 2
A client at 36 weeks gestation presents with sudden severe headache, visual disturbances, and BP of 160/110 mmHg.
What is the priority intervention?