Certified Midwife Exam Prep Risk Assessment & Management 5 — Questions and Answers
Question 1: A newborn delivered at 38 weeks has an Apgar score of 4 at 1 minute and 6 at 5 minutes. Which risk management action is indicated at the 5-minute assessment?
- Transfer immediately to NICU without further Apgar scoring
- Continue resuscitation efforts and assign a 10-minute Apgar score (Correct answer)
- Document and discharge to mother with routine monitoring
- Administer epinephrine if score does not reach 7 by 10 minutes
Correct answer: Continue resuscitation efforts and assign a 10-minute Apgar score
An Apgar score below 7 at 5 minutes requires continued resuscitation and a 10-minute Apgar score to guide further management per NRP guidelines.
Question 2: Which prenatal screening result requires immediate genetic counseling referral and risk stratification in the first trimester?
- Cell-free fetal DNA showing trisomy 21 risk 1:200
- Nuchal translucency of 3.8 mm (Correct answer)
- Maternal serum PAPP-A at the 10th percentile
- Positive quad screen with AFP below normal range
Correct answer: Nuchal translucency of 3.8 mm
Nuchal translucency at or above 3.5 mm is associated with chromosomal abnormalities and structural cardiac defects, requiring urgent genetic counseling and diagnostic testing.
Question 3: A client with sickle cell disease (HbSS) is 24 weeks pregnant. Which complication requires the most vigilant antepartum surveillance?
- Gestational diabetes
- Fetal growth restriction and preterm birth (Correct answer)
- Placenta previa
- Group B Streptococcus colonization
Correct answer: Fetal growth restriction and preterm birth
Sickle cell disease is strongly associated with placental insufficiency leading to fetal growth restriction and preterm birth, requiring serial growth ultrasounds.
Question 4: A client at 39 weeks reports a sudden gush of clear fluid but labor has not started. GBS status is positive. What is the risk-appropriate management?
- Expectant management at home for 24 hours before induction
- Immediate induction of labor with GBS prophylaxis (Correct answer)
- Cesarean section without trial of labor
- Apply digital exam to confirm membrane rupture and check Bishop score
Correct answer: Immediate induction of labor with GBS prophylaxis
GBS-positive clients with PROM at term should receive immediate induction plus antibiotic prophylaxis to reduce neonatal sepsis risk.
Question 5: During the second stage of labor, an episiotomy is being considered. Which maternal risk factor most strongly supports this decision?
- Primigravida with normal progress
- Imminent severe perineal tear with fetal bradycardia requiring expedited delivery (Correct answer)
- Desire to prevent any perineal laceration
- Epidural analgesia limiting pushing effectiveness
Correct answer: Imminent severe perineal tear with fetal bradycardia requiring expedited delivery
Episiotomy is supported when fetal bradycardia requires expedited delivery and obstruction by perineal tissue would otherwise delay birth.
Question 6: A client presents at 10 weeks with a history of three consecutive first-trimester losses. Which evaluation is MOST appropriate to assess recurrent pregnancy loss risk?
- Hysterosalpingography only
- Karyotyping of both parents, thrombophilia panel, uterine evaluation (Correct answer)
- Maternal thyroid function tests alone
- Chromosomal microarray of the client only
Correct answer: Karyotyping of both parents, thrombophilia panel, uterine evaluation
Recurrent pregnancy loss evaluation requires a comprehensive workup including parental karyotyping, antiphospholipid antibody panel, thrombophilia screen, and uterine anatomy assessment.
Question 7: A laboring client with preeclampsia is receiving magnesium sulfate. The nurse reports absent deep tendon reflexes (DTRs) and a respiratory rate of 10/min. What is the priority intervention?
- Reduce magnesium infusion rate by 50%
- Discontinue magnesium immediately and administer calcium gluconate (Correct answer)
- Increase IV fluid rate to flush magnesium
- Recheck DTRs in 15 minutes before acting
Correct answer: Discontinue magnesium immediately and administer calcium gluconate
Absent DTRs with respiratory depression indicate magnesium toxicity requiring immediate infusion discontinuation and calcium gluconate administration as the antidote.
Certified Midwife Exam Prep Risk Assessment & Management 5
A newborn delivered at 38 weeks has an Apgar score of 4 at 1 minute and 6 at 5 minutes.
Which risk management action is indicated at the 5-minute assessment?