Certified Midwife Exam Prep Risk Assessment & Management 4

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?

Accepted Answer

Placental abruption with uterine tetany

Answer

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?

Accepted Answer

Perform a non-stress test immediately

Answer

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?

Accepted Answer

G1P1, cesarean birth, BMI 38, varicose veins, smoker

Answer

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?

Accepted Answer

Arrange urgent transfer to hospital for retained placenta management

Answer

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?

Accepted Answer

Prophylactic oxytocin immediately after delivery of the anterior shoulder

Answer

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.

Certified Midwife Exam Prep Practice Test

Certified Midwife Exam Prep Practice Test

Certified Midwife Exam Prep Risk Assessment & Management 4