Certified Midwife Exam Prep Risk Assessment & Management 2 — Questions and Answers
Question 1: A 34-year-old primigravida at 38 weeks has a BMI of 42. Which intrapartum complication should the midwife prioritize in the risk plan?
- Placenta previa
- Shoulder dystocia (Correct answer)
- Cord prolapse
- Vasa previa
Correct answer: Shoulder dystocia
Maternal obesity significantly increases the risk of macrosomia and shoulder dystocia, requiring proactive planning including McRoberts positioning readiness.
Question 2: Which VBAC candidate characteristic most significantly increases the risk of uterine rupture?
- Prior low transverse cesarean scar
- Inter-delivery interval less than 18 months (Correct answer)
- Estimated fetal weight over 3,500 g
- Maternal age over 35
Correct answer: Inter-delivery interval less than 18 months
An inter-delivery interval of less than 18 months is associated with significantly higher uterine rupture risk due to incomplete scar healing.
Question 3: A client with gestational diabetes at 36 weeks has a fasting glucose of 110 mg/dL despite dietary modifications. What is the most appropriate risk management step?
- Schedule delivery at 37 weeks
- Initiate insulin therapy (Correct answer)
- Increase dietary carbohydrate restriction
- Repeat glucose tolerance test
Correct answer: Initiate insulin therapy
When dietary modifications fail to achieve target fasting glucose levels in GDM, insulin therapy is indicated to reduce fetal and maternal complications.
Question 4: During active labor, a client's FHR tracing shows late decelerations with reduced variability. After repositioning and O2 administration, the pattern persists. What is the next risk management priority?
- Continue monitoring for 30 more minutes
- Perform fetal scalp stimulation
- Prepare for operative delivery (Correct answer)
- Administer IV fluid bolus only
Correct answer: Prepare for operative delivery
Persistent late decelerations with reduced variability despite conservative measures indicates Category III tracing requiring prompt delivery.
Question 5: A multigravida presents at 32 weeks with painless vaginal bleeding. Placenta previa is confirmed by ultrasound. Which action is CONTRAINDICATED?
- Administering betamethasone
- Performing a digital cervical exam (Correct answer)
- Placing two large-bore IV lines
- Typing and cross-matching blood
Correct answer: Performing a digital cervical exam
Digital cervical examination is absolutely contraindicated with placenta previa due to the risk of precipitating catastrophic hemorrhage.
Question 6: Which laboratory finding in a client with severe preeclampsia most warrants immediate delivery regardless of gestational age?
- Proteinuria of 500 mg/24 hours
- Platelet count of 95,000/μL
- Platelet count below 100,000/μL with rising creatinine (Correct answer)
- Blood pressure 155/105 mmHg
Correct answer: Platelet count below 100,000/μL with rising creatinine
HELLP syndrome features (thrombocytopenia with renal impairment) indicate severe maternal end-organ damage requiring delivery at any gestational age.
Question 7: A client at 41+2 weeks declines induction of labor. What is the midwife's primary risk communication obligation?
- Document refusal and proceed with client wishes without further discussion
- Inform the client that the risk of stillbirth increases significantly beyond 41 weeks (Correct answer)
- Transfer care to an obstetrician immediately
- Offer only twice-weekly NST without discussing risks
Correct answer: Inform the client that the risk of stillbirth increases significantly beyond 41 weeks
Informed refusal requires that clients receive complete information about increased stillbirth risk beyond 41 weeks, enabling true autonomous decision-making.
Certified Midwife Exam Prep Risk Assessment & Management 2
A 34-year-old primigravida at 38 weeks has a BMI of 42.
Which intrapartum complication should the midwife prioritize in the risk plan?