Certified Midwife Exam Prep Risk Assessment & Management 4 — Questions and Answers
Question 1: A laboring client at 8 cm dilation suddenly experiences severe abdominal pain, board-like uterine rigidity, and FHR bradycardia. What is the most likely diagnosis?
- Uterine hyperstimulation from oxytocin
- Placental abruption with uterine tetany (Correct answer)
- Cord prolapse
- Precipitous labor
Correct answer: Placental abruption with uterine tetany
Sudden severe abdominal pain, board-like rigidity, and fetal bradycardia together are classic signs of severe placental abruption requiring emergency cesarean.
Question 2: A client at 36 weeks is found to have oligohydramnios (AFI 4 cm) at a routine visit. She reports decreased fetal movement. What is the first priority assessment?
- Schedule a follow-up ultrasound in one week
- Perform a non-stress test immediately (Correct answer)
- Advise increased fluid intake and recheck AFI tomorrow
- Order maternal urinalysis to rule out dehydration
Correct answer: Perform a non-stress test immediately
Oligohydramnios combined with decreased fetal movement requires immediate fetal surveillance via NST to assess for fetal compromise.
Question 3: Which postpartum client is at highest risk for deep vein thrombosis (DVT) and requires thromboprophylaxis discussion?
- G2P2, vaginal birth, ambulatory within 2 hours, no risk factors
- G1P1, cesarean birth, BMI 38, varicose veins, smoker (Correct answer)
- G3P3, vaginal birth with second-degree laceration, breastfeeding
- G2P1, elective cesarean at 39 weeks, BMI 24, no comorbidities
Correct answer: G1P1, cesarean birth, BMI 38, varicose veins, smoker
Cesarean birth combined with obesity, varicose veins, and smoking represents multiple VTE risk factors making thromboprophylaxis strongly indicated.
Question 4: During a home birth, the client delivers a vigorous infant but the placenta has not delivered after 60 minutes. What is the risk management priority?
- Continue expectant management for another 30 minutes
- Attempt manual placenta removal at home
- Arrange urgent transfer to hospital for retained placenta management (Correct answer)
- Administer a second dose of oxytocin and wait
Correct answer: Arrange urgent transfer to hospital for retained placenta management
Retained placenta beyond 60 minutes at a home birth exceeds safe management capacity and requires urgent transfer for manual removal under controlled hospital conditions.
Question 5: A client with a history of postpartum hemorrhage (PPH) in a prior delivery is now at 38 weeks. Which active management strategy is MOST important to implement at delivery?
- Routine oxytocin administration only if bleeding exceeds 500 mL
- Prophylactic oxytocin immediately after delivery of the anterior shoulder (Correct answer)
- Delayed cord clamping for 5 minutes regardless of maternal status
- Waiting for spontaneous placental expulsion before any uterotonic
Correct answer: Prophylactic oxytocin immediately after delivery of the anterior shoulder
In clients with prior PPH history, prophylactic oxytocin administration upon delivery of the anterior shoulder is the cornerstone of active management of the third stage.
Question 6: A client at 30 weeks presents with a blood pressure of 148/96 mmHg on two readings 4 hours apart. She has no proteinuria. What is the correct risk classification?
- Chronic hypertension
- Gestational hypertension (Correct answer)
- Preeclampsia without severe features
- White coat hypertension requiring no action
Correct answer: Gestational hypertension
New-onset hypertension after 20 weeks without proteinuria or other preeclampsia features is classified as gestational hypertension requiring close monitoring.
Question 7: A client in labor receives oxytocin augmentation. The tocometer shows contractions every 90 seconds lasting 90 seconds with incomplete uterine relaxation. What is the appropriate intervention?
- Increase oxytocin to improve labor progress
- Decrease or discontinue oxytocin to treat tachysystole (Correct answer)
- Administer terbutaline and continue current oxytocin dose
- Document the finding and reassess in 30 minutes
Correct answer: Decrease or discontinue oxytocin to treat tachysystole
More than 5 contractions in 10 minutes (tachysystole) with incomplete relaxation requires immediate oxytocin reduction or discontinuation to prevent fetal hypoxia.
Certified Midwife Exam Prep Risk Assessment & Management 4
A laboring client at 8 cm dilation suddenly experiences severe abdominal pain, board-like uterine rigidity, and FHR bradycardia.
What is the most likely diagnosis?