Certified Midwife Exam Prep Pharmacology & Medications in Midwifery 1 — Questions and Answers
Question 1: Which uterotonic agent is the first-line choice for active management of the third stage of labor according to WHO guidelines?
- Misoprostol
- Oxytocin (Correct answer)
- Ergometrine
- Carboprost
Correct answer: Oxytocin
Oxytocin (10 IU IM) is the WHO-recommended first-line uterotonic for active management of the third stage of labor due to its efficacy and favorable side-effect profile.
Question 2: A patient in active labor is receiving IV oxytocin for augmentation. Which finding would prompt the midwife to immediately discontinue the infusion?
- Mild lower back pain between contractions
- Prolonged fetal heart rate deceleration lasting 3 minutes (Correct answer)
- Cervical dilation progressing to 7 cm
- Maternal request for additional pain management
Correct answer: Prolonged fetal heart rate deceleration lasting 3 minutes
Prolonged fetal heart rate decelerations indicate uterine hyperstimulation or fetal compromise, requiring immediate oxytocin discontinuation to restore fetal oxygenation.
Question 3: What is the standard dose of Vitamin K prophylaxis administered to neonates to prevent hemorrhagic disease of the newborn?
- 0.5 mg IM
- 1 mg IM (Correct answer)
- 2 mg IM
- 5 mg IM
Correct answer: 1 mg IM
The standard neonatal Vitamin K prophylaxis dose is 1 mg IM given within 6 hours of birth to prevent vitamin K deficiency bleeding (VKDB).
Question 4: Which antibiotic is preferred for Group B Streptococcus (GBS) intrapartum prophylaxis in a penicillin-allergic patient with low risk of anaphylaxis?
- Vancomycin
- Clindamycin
- Cefazolin (Correct answer)
- Erythromycin
Correct answer: Cefazolin
Cefazolin is the ACOG-preferred alternative for GBS prophylaxis in penicillin-allergic patients with low anaphylaxis risk because of its proven efficacy and safety.
Question 5: A patient with severe preeclampsia is receiving magnesium sulfate. Which clinical finding most clearly indicates magnesium toxicity?
- Urine output of 35 mL/hr
- Loss of deep tendon reflexes (Correct answer)
- Respiratory rate of 16 breaths/min
- Serum magnesium level of 5 mEq/L
Correct answer: Loss of deep tendon reflexes
Loss of deep tendon reflexes is a key early clinical sign of magnesium toxicity, indicating serum levels have exceeded the therapeutic range.
Question 6: Which analgesic is contraindicated in a breastfeeding mother due to the risk of Reye's syndrome in the infant?
- Acetaminophen
- Ibuprofen
- Aspirin (Correct answer)
- Naproxen
Correct answer: Aspirin
Aspirin is contraindicated during breastfeeding because salicylates are excreted in breast milk and have been associated with Reye's syndrome in nursing infants.
Question 7: A patient at 36 weeks gestation presents with a blood pressure of 165/112 mmHg. Which antihypertensive agent is a first-line choice for acute management?
- Enalapril
- Labetalol (Correct answer)
- Lisinopril
- Atenolol
Correct answer: Labetalol
Labetalol IV is a recommended first-line agent for acute severe hypertension in pregnancy; ACE inhibitors (enalapril, lisinopril) are contraindicated in pregnancy.
Certified Midwife Exam Prep Pharmacology & Medications in Midwifery 1
Which uterotonic agent is the first-line choice for active management of the third stage of labor according to WHO guidelines?