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Midwifery Exam practice questions

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Question 1Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 28 weeks' gestation reports a sudden gush of clear fluid from the vagina. On speculum examination, fluid is seen pooling in the posterior fornix. Which finding best supports a diagnosis of premature rupture of membranes?

  1. Presence of glucose in the pooled fluid
  2. Alkaline pH of the pooled fluid on nitrazine testing Correct answer.
  3. Blood-tinged mucus at the cervical os
  4. Ferning pattern absent on dried fluid microscopy

Explanation

Amniotic fluid is alkaline, so nitrazine paper turns blue at a pH above approximately 6.5, which supports rupture of membranes. Ferning of dried amniotic fluid is a positive finding, not an absent one. Blood-tinged mucus is a normal cervical finding and does not confirm rupture.

Question 2Content areas determined by the most recent Task Analysis completed by the Research Committee

During the second stage of labor, a fetal heart rate tracing shows repetitive variable decelerations. Which initial intervention is most appropriate?

  1. Reposition the laboring person to a lateral or knee-chest position Correct answer.
  2. Place the client supine with the head of the bed elevated
  3. Increase the oxytocin infusion rate to shorten labor
  4. Ask the client to push more forcefully with each contraction

Explanation

Variable decelerations usually reflect umbilical cord compression, and maternal repositioning is the first-line maneuver to relieve pressure on the cord. Increasing oxytocin or encouraging stronger pushing would intensify contractions and worsen cord compression. A supine position can compress the vena cava and reduce placental perfusion.

Question 3Content areas determined by the most recent Task Analysis completed by the Research Committee

Which physiologic change of pregnancy increases a client's risk for developing iron-deficiency anemia?

  1. A decrease in glomerular filtration rate
  2. A 40 to 50 percent increase in maternal plasma volume Correct answer.
  3. Reduced production of erythropoietin
  4. Decreased cardiac output in the third trimester

Explanation

Plasma volume rises proportionally more than red cell mass, producing hemodilution and a lower hematocrit. Glomerular filtration rate increases rather than decreases in pregnancy, and erythropoietin production rises. Cardiac output increases throughout pregnancy.

Question 4Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 34 weeks' gestation presents with painless, bright red vaginal bleeding. Her uterus is soft and relaxed, and the fetal heart rate is reassuring. Which condition should be the primary concern?

  1. Vasa previa
  2. Abruptio placentae
  3. Uterine rupture
  4. Placenta previa Correct answer.

Explanation

Painless bright red bleeding with a soft, relaxed uterus is the classic presentation of placenta previa. Abruptio placentae typically produces painful bleeding with a tense, tender uterus. Uterine rupture and vasa previa have different presentations, including fetal compromise and bleeding at membrane rupture.

Question 5Content areas determined by the most recent Task Analysis completed by the Research Committee

Which immunization is recommended during pregnancy to prevent severe disease in the newborn from respiratory syncytial virus?

  1. Maternal RSV vaccine given at 32 to 36 weeks' gestation during RSV season Correct answer.
  2. Varicella vaccine given at 28 weeks' gestation
  3. Measles-mumps-rubella vaccine given postpartum before discharge
  4. Live attenuated influenza vaccine given in the first trimester

Explanation

The maternal RSV vaccine is recommended between 32 and 36 weeks' gestation when RSV season applies, so that antibody is transferred to the fetus. Live vaccines such as MMR and varicella are contraindicated during pregnancy. Live attenuated influenza vaccine is also not given in pregnancy.

Question 6Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 36 weeks' gestation has a blood pressure of 158/112 mmHg on two occasions four hours apart, a platelet count of 88,000/mm3, and a headache. Which diagnosis is most consistent with these findings?

  1. Preeclampsia with severe features Correct answer.
  2. Gestational hypertension
  3. HELLP syndrome without preeclampsia
  4. Chronic hypertension

Explanation

Severe-range blood pressure after 20 weeks plus thrombocytopenia and a headache meets criteria for preeclampsia with severe features. Gestational hypertension requires elevated blood pressure without proteinuria or severe features. HELLP syndrome occurs as a variant of preeclampsia and requires evidence of hemolysis and elevated liver enzymes as well.

Question 7Content areas determined by the most recent Task Analysis completed by the Research Committee

Which finding on a newborn examination is most suggestive of congenital hip dysplasia?

  1. Caput succedaneum over the presenting part
  2. Palmar grasp reflex present bilaterally
  3. Moro reflex present and symmetric
  4. Asymmetric thigh skin folds with a positive Ortolani sign Correct answer.

Explanation

Asymmetric skin folds and a positive Ortolani or Barlow maneuver suggest developmental dysplasia of the hip. A symmetric Moro reflex and palmar grasp are normal newborn findings. Caput succedaneum is a common birth-related scalp finding unrelated to hip dysplasia.

Question 8Content areas determined by the most recent Task Analysis completed by the Research Committee

Which instruction should be given to a client at 12 weeks' gestation who is prescribed folic acid supplementation?

  1. Begin supplementation only in the third trimester
  2. Discontinue supplementation once pregnancy is confirmed
  3. Take 400 micrograms daily to reduce the risk of neural tube defects Correct answer.
  4. Take 4 milligrams daily regardless of prior pregnancy history

Explanation

A daily folic acid intake of 400 micrograms is recommended for most pregnant clients to reduce the risk of neural tube defects. Higher doses of 4 milligrams are reserved for clients with a prior affected pregnancy or other high-risk factors. Supplementation is most important in early pregnancy, when the neural tube forms.

Question 9Content areas determined by the most recent Task Analysis completed by the Research Committee

A client in active labor at 6 cm dilation requests epidural analgesia. Which assessment finding is most important to obtain before placement?

  1. Blood glucose level
  2. Fundal height measurement
  3. Platelet count and coagulation status Correct answer.
  4. Urine specific gravity

Explanation

Neuraxial anesthesia carries a risk of epidural hematoma, so platelet count and coagulation status should be verified before placement. Blood glucose, urine specific gravity, and fundal height do not directly determine safety of epidural placement.

Question 10Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 10 weeks' gestation with a confirmed intrauterine pregnancy reports cramping and vaginal bleeding. The cervix is closed and no tissue has passed. Which diagnosis is most likely?

  1. Inevitable miscarriage
  2. Complete miscarriage
  3. Septic abortion
  4. Threatened miscarriage Correct answer.

Explanation

A threatened miscarriage presents with bleeding and cramping while the cervix remains closed and the pregnancy is still viable. An inevitable miscarriage involves cervical dilation. A complete miscarriage has passage of all tissue, and septic abortion includes signs of infection such as fever.

Question 11Content areas determined by the most recent Task Analysis completed by the Research Committee

Which instruction is most appropriate for a client at 30 weeks' gestation who is asked to perform daily fetal movement counting?

  1. Perform counts only when contractions begin
  2. Count only during active exercise
  3. Count fetal movements at about the same time each day and report a marked decrease Correct answer.
  4. Report only if no movement occurs for 24 hours

Explanation

Daily fetal movement counting is most useful when done at a consistent time each day, with prompt reporting of a significant decrease in movements. Waiting 24 hours or waiting for contractions delays evaluation of possible fetal compromise. Movement counting is done at rest, not during exercise.

Question 12Content areas determined by the most recent Task Analysis completed by the Research Committee

Which statement about group B streptococcus prophylaxis in labor is accurate?

  1. A positive screen requires cesarean birth
  2. Oral antibiotics are given at 20 weeks to eradicate colonization
  3. Intravenous penicillin is given in labor to clients with a positive prenatal screen Correct answer.
  4. Prophylaxis is indicated only after rupture of membranes for more than 24 hours

Explanation

Intrapartum intravenous penicillin is the standard prophylaxis for clients colonized with group B streptococcus to reduce neonatal early-onset disease. Treating earlier in pregnancy does not reliably eradicate colonization. Cesarean birth is not indicated solely for colonization.

Question 13Content areas determined by the most recent Task Analysis completed by the Research Committee

A client who is 24 hours postpartum after a spontaneous vaginal birth reports perineal pain and has a firm, midline uterus at the umbilicus. Which action is most appropriate?

  1. Perform vigorous fundal massage
  2. Administer methylergonovine
  3. Inspect the perineum for hematoma and apply an ice pack Correct answer.
  4. Encourage ambulation without further assessment

Explanation

A firm uterus with significant perineal pain raises concern for a vulvar or vaginal hematoma, which requires inspection. Vigorous massage is not indicated when the uterus is already firm. Methylergonovine treats uterine atony, not hematoma.

Question 14Content areas determined by the most recent Task Analysis completed by the Research Committee

Which finding is most consistent with postpartum endometritis?

  1. Unilateral calf pain and swelling
  2. Bilateral breast engorgement on day three
  3. Painless vaginal bleeding with a firm uterus
  4. Fever, uterine tenderness, and foul-smelling lochia Correct answer.

Explanation

Postpartum endometritis presents with fever, uterine tenderness, and malodorous lochia, often after cesarean birth or prolonged rupture of membranes. Painless bleeding with a firm uterus suggests another cause such as retained placenta. Breast engorgement and calf pain suggest different conditions.

Question 15Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 18 weeks' gestation reports nausea and vomiting that has worsened, with inability to keep fluids down for two days. Which finding would most strongly indicate a need for intravenous rehydration?

  1. Hemoglobin of 11.5 g/dL
  2. Urine specific gravity of 1.030 with ketonuria Correct answer.
  3. Blood pressure of 118/72 mmHg
  4. Fetal heart tones of 150 beats per minute

Explanation

Concentrated urine with ketonuria suggests dehydration and inadequate caloric intake, supporting the need for intravenous fluids. A normal blood pressure, hemoglobin, and fetal heart rate do not by themselves indicate dehydration. Clinical assessment of hydration status guides fluid replacement.

Question 16Content areas determined by the most recent Task Analysis completed by the Research Committee

Which instruction about breastfeeding is most accurate for a client with a healthy term newborn?

  1. Give supplemental water between feeds
  2. Restrict night feedings until milk comes in
  3. Limit feeds to five minutes per breast
  4. Feed on demand, at least eight to twelve times in 24 hours Correct answer.

Explanation

Frequent feeding on demand, about eight to twelve times daily, supports milk production and prevents engorgement. Restricting night feeds or limiting feed duration can reduce supply. Supplemental water is unnecessary for breastfed newborns and can interfere with intake.

Question 17Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 39 weeks' gestation is in the latent phase of labor with contractions every five minutes. Which finding indicates that she is progressing appropriately?

  1. Cervical dilation that remains at 2 cm for eight hours
  2. Cervical change from 2 cm to 4 cm over several hours Correct answer.
  3. Contractions that stop when she changes position
  4. Fetal station moving from minus two to minus three

Explanation

Progressive cervical dilation and effacement over time indicate true labor progress. Contractions that stop with position change suggest false labor. Prolonged arrest at 2 cm or upward movement of the fetal station does not indicate normal progress.

Question 18Content areas determined by the most recent Task Analysis completed by the Research Committee

Which method is most reliable for confirming that the placenta has been completely delivered?

  1. Palpate the uterine fundus for firmness
  2. Count the umbilical vessels
  3. Inspect the maternal and fetal surfaces for missing cotyledons and intact membranes Correct answer.
  4. Weigh the placenta and record the result

Explanation

Visual inspection of both placental surfaces and membranes is the standard method for identifying retained fragments. Weighing the placenta does not confirm completeness. Fundal firmness and vessel counts do not reveal retained tissue.

Question 19Content areas determined by the most recent Task Analysis completed by the Research Committee

A client using combined oral contraceptives reports missing one pill. Which instruction is most appropriate?

  1. Stop the pack and wait for menses
  2. Take the missed pill as soon as remembered and continue the pack Correct answer.
  3. Use no backup method
  4. Double the dose for the rest of the pack

Explanation

For a single missed combined pill, the client should take it as soon as remembered and continue the remaining pills on schedule. Backup contraception is generally advised if the missed pill is late enough or if multiple pills are missed. Stopping the pack or doubling doses is not recommended.

Question 20Content areas determined by the most recent Task Analysis completed by the Research Committee

Which screening test is recommended for all pregnant clients at the first prenatal visit to detect asymptomatic bacteriuria?

  1. Renal ultrasound
  2. Urinalysis with dipstick only
  3. Urine culture Correct answer.
  4. 24-hour urine collection

Explanation

A urine culture is the recommended screening test because asymptomatic bacteriuria is common in pregnancy and can lead to pyelonephritis if untreated. Dipstick urinalysis is not sensitive enough for screening. A 24-hour collection and renal ultrasound are not screening tools for bacteriuria.

Question 21Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 41 weeks' gestation has a reactive nonstress test but reports decreased fetal movement. Which next step is most appropriate?

  1. Reassure the client and schedule a visit in one week
  2. Repeat the nonstress test in 48 hours
  3. Perform an ultrasound to assess amniotic fluid volume Correct answer.
  4. Induce labor immediately without further testing

Explanation

Decreased fetal movement near term warrants further evaluation, including amniotic fluid assessment, because oligohydramnios is associated with placental insufficiency. Waiting a week or 48 hours delays necessary evaluation. Immediate induction without further assessment is not the first step.

Question 22Content areas determined by the most recent Task Analysis completed by the Research Committee

Which finding during a newborn assessment should prompt immediate further evaluation?

  1. A heart murmur accompanied by cyanosis Correct answer.
  2. Mild acrocyanosis at one hour of life
  3. A single palmar crease
  4. Molding of the head after vaginal birth

Explanation

A murmur with cyanosis may indicate a critical congenital heart defect and requires urgent evaluation. Mild acrocyanosis and molding are common transitional findings. A single palmar crease can be a normal variant and does not alone require emergency evaluation.

Question 23Content areas determined by the most recent Task Analysis completed by the Research Committee

Which statement about the use of oxytocin for labor augmentation is correct?

  1. It is administered as an intravenous bolus
  2. The infusion rate is titrated to contraction frequency and fetal response Correct answer.
  3. It is continued at a fixed rate regardless of contraction pattern
  4. It requires no fetal monitoring once started

Explanation

Oxytocin is titrated to achieve adequate contractions while monitoring fetal status and uterine resting tone to avoid tachysystole. It is given as a controlled infusion, not a bolus. Continuous fetal monitoring is required during augmentation.

Question 24Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 36 weeks' gestation with preeclampsia is receiving magnesium sulfate. Which assessment finding indicates possible magnesium toxicity?

  1. Blood pressure of 140/90 mmHg
  2. Loss of deep tendon reflexes Correct answer.
  3. Urine output of 50 mL per hour
  4. Respiratory rate of 18 breaths per minute

Explanation

Loss of deep tendon reflexes is an early sign of magnesium toxicity and should prompt stopping the infusion and notifying the provider. Blood pressure, adequate urine output, and a normal respiratory rate do not indicate toxicity. Respiratory depression occurs with more severe toxicity.

Question 25Content areas determined by the most recent Task Analysis completed by the Research Committee

Which intervention best supports a client's perineal comfort and healing after a second-degree laceration repair?

  1. Perform vigorous perineal massage in the first 24 hours
  2. Avoid all perineal hygiene until the sutures dissolve
  3. Apply ice packs in the first 24 hours and perform perineal hygiene after voiding Correct answer.
  4. Use a sitz bath with very hot water several times daily

Explanation

Ice packs reduce early edema, and gentle perineal hygiene after voiding helps prevent infection. Avoiding hygiene increases infection risk. Very hot water and vigorous massage can irritate healing tissue.

Question 26Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 28 weeks' gestation has a 1-hour glucose challenge test result of 152 mg/dL. Which action should the midwife anticipate next?

  1. Begin insulin therapy immediately
  2. Repeat the 1-hour glucose challenge test in one week
  3. Schedule a 3-hour oral glucose tolerance test Correct answer.
  4. Reassure the client that no further testing is needed

Explanation

A 1-hour glucose challenge result of 140 mg/dL or higher is generally considered a positive screen and requires diagnostic confirmation with a 3-hour oral glucose tolerance test. The challenge test is a screening tool only and cannot by itself diagnose gestational diabetes. Insulin is not started on the basis of a screening result alone.

Question 27Content areas determined by the most recent Task Analysis completed by the Research Committee

Which immunization is recommended during pregnancy specifically to prevent severe pertussis in the newborn?

  1. Measles, mumps, and rubella vaccine
  2. Tetanus, diphtheria, and acellular pertussis vaccine Correct answer.
  3. Varicella vaccine
  4. Human papillomavirus vaccine

Explanation

The tetanus, diphtheria, and acellular pertussis (Tdap) vaccine is recommended during each pregnancy, ideally between 27 and 36 weeks' gestation, so that maternal antibodies transfer to the fetus. This provides passive protection against pertussis during the vulnerable newborn period. The other listed vaccines are live or not indicated during pregnancy for this purpose.

Question 28Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 34 weeks' gestation reports a sudden gush of clear fluid from the vagina. Which assessment should the midwife perform first to evaluate for rupture of membranes?

  1. Sterile speculum examination to visualize pooling of fluid Correct answer.
  2. Urine dipstick testing for protein
  3. Digital cervical examination to assess dilation
  4. Transabdominal ultrasound to measure amniotic fluid volume

Explanation

A sterile speculum examination allows direct visualization of amniotic fluid pooling in the posterior fornix and permits collection of fluid for ferning and pH testing. Digital cervical examination is avoided before rupture is confirmed because of infection risk. Ultrasound and urine testing do not directly confirm membrane rupture.

Question 29Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 8 weeks' gestation reports severe unilateral pelvic pain with vaginal spotting. On assessment, the midwife notes shoulder pain and a positive pregnancy test. Which condition should be suspected?

  1. Threatened miscarriage
  2. Urinary tract infection
  3. Ectopic pregnancy Correct answer.
  4. Round ligament pain

Explanation

Unilateral pelvic pain with vaginal bleeding in early pregnancy, especially with shoulder tip pain suggesting hemoperitoneum, is highly suggestive of ectopic pregnancy. This is a medical emergency requiring immediate evaluation. Threatened miscarriage typically presents with midline cramping and bleeding without shoulder pain.

Question 30Content areas determined by the most recent Task Analysis completed by the Research Committee

Which finding is most characteristic of placenta previa?

  1. A uterus that is tender to palpation between contractions
  2. Bleeding accompanied by fetal heart rate decelerations during contractions
  3. Painless bright red vaginal bleeding in the third trimester Correct answer.
  4. Painful dark vaginal bleeding with a firm uterus

Explanation

Placenta previa typically presents with painless, bright red vaginal bleeding in the late second or third trimester. The bleeding is often sudden and the uterus remains soft and nontender. Painful bleeding with a firm uterus suggests placental abruption instead.

Question 31Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 32 weeks' gestation is diagnosed with placenta previa. Which instruction is most important for the midwife to provide?

  1. Use tampons to manage light spotting
  2. Schedule a digital cervical examination each week
  3. Avoid vaginal intercourse and report any bleeding immediately Correct answer.
  4. Perform daily vigorous exercise to maintain fitness

Explanation

Clients with placenta previa should avoid vaginal intercourse and any vaginal manipulation because these can provoke hemorrhage. They should report any bleeding promptly. Digital examinations and tampon use are contraindicated because they may disrupt the placenta and cause severe bleeding.

Question 32Content areas determined by the most recent Task Analysis completed by the Research Committee

Which assessment finding should the midwife report immediately in a client receiving magnesium sulfate for preeclampsia?

  1. Blood pressure of 138/88 mmHg
  2. Respiratory rate of 10 breaths per minute Correct answer.
  3. Urine output of 60 mL per hour
  4. Deep tendon reflexes of 2+

Explanation

A respiratory rate of 10 breaths per minute or lower suggests magnesium toxicity and requires immediate intervention, including stopping the infusion and notifying the provider. Therapeutic magnesium sulfate should not depress respirations below 12 to 16 per minute. The other findings are within acceptable ranges.

Question 33Content areas determined by the most recent Task Analysis completed by the Research Committee

A client in the second stage of labor has a fetal heart rate tracing showing recurrent late decelerations. Which action should the midwife take first?

  1. Increase the oxytocin infusion rate
  2. Reposition the client to a lateral position and administer oxygen Correct answer.
  3. Perform a fundal pressure maneuver
  4. Instruct the client to push more forcefully

Explanation

Recurrent late decelerations suggest uteroplacental insufficiency. Initial intrauterine resuscitation includes repositioning to a lateral position, administering oxygen, and stopping any oxytocin. Pushing harder, increasing oxytocin, or applying fundal pressure would worsen fetal oxygenation.

Question 34Content areas determined by the most recent Task Analysis completed by the Research Committee

Which finding suggests that a client is in the second stage of labor?

  1. Bloody show with cervical dilation of 2 cm
  2. Complete cervical dilation with the urge to bear down Correct answer.
  3. Rupture of membranes with a station of minus two
  4. Contractions every five minutes with cervical dilation of 4 cm

Explanation

The second stage of labor begins at complete cervical dilation and ends with birth of the newborn. An urge to bear down commonly accompanies complete dilation. The other findings describe earlier phases of labor.

Question 35Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 20 weeks' gestation reports a headache and visual disturbances and has a blood pressure of 146/96 mmHg. Which diagnosis should the midwife consider?

  1. Gestational hypertension without proteinuria
  2. Preeclampsia with severe features Correct answer.
  3. Normal pregnancy changes
  4. Chronic hypertension

Explanation

Headache and visual disturbances are severe features that, when accompanied by elevated blood pressure after 20 weeks' gestation, suggest preeclampsia with severe features. Gestational hypertension lacks these severe symptoms. Chronic hypertension would have been present before 20 weeks.

Question 36Content areas determined by the most recent Task Analysis completed by the Research Committee

Which contraceptive method is most appropriate for a client who is breastfeeding a 6-week-old infant and wishes to start contraception?

  1. Combined vaginal ring
  2. Progestin-only pill Correct answer.
  3. Combined contraceptive patch
  4. Combined oral contraceptive

Explanation

Progestin-only methods are preferred during breastfeeding because they do not contain estrogen, which can reduce milk supply. Combined estrogen-progestin methods are generally avoided in the early postpartum breastfeeding period. The progestin-only pill is safe and effective.

Question 37Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 16 weeks' gestation asks about the purpose of maternal serum alpha-fetoprotein screening. Which response by the midwife is accurate?

  1. It determines the fetal blood type
  2. It confirms the presence of gestational diabetes
  3. It diagnoses Down syndrome definitively
  4. It screens for neural tube defects and certain chromosomal conditions Correct answer.

Explanation

Maternal serum alpha-fetoprotein screening is used to identify pregnancies at increased risk for neural tube defects and some chromosomal abnormalities. It is a screening test, not a diagnostic test, and abnormal results require further evaluation. It does not determine fetal blood type or diagnose diabetes.

Question 38Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 12 weeks' gestation reports that she has not been vaccinated against rubella. Which instruction is most appropriate?

  1. Receive the rubella vaccine after delivery Correct answer.
  2. Undergo an immediate termination of pregnancy
  3. Receive the rubella vaccine now
  4. Avoid all contact with children

Explanation

The rubella vaccine is a live vaccine and is contraindicated during pregnancy. Clients who are not immune should be vaccinated in the postpartum period, ideally before discharge. Avoiding children or terminating the pregnancy is not indicated.

Question 39Content areas determined by the most recent Task Analysis completed by the Research Committee

Which sign indicates the onset of the third stage of labor?

  1. Complete cervical dilation
  2. Rupture of membranes
  3. Delivery of the newborn Correct answer.
  4. Full effacement of the cervix

Explanation

The third stage of labor begins with the birth of the newborn and ends with delivery of the placenta. Complete dilation marks the start of the second stage. Rupture of membranes and effacement occur earlier in labor.

Question 40Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 38 weeks' gestation is in active labor and reports sudden severe abdominal pain with a board-like uterus and fetal bradycardia. Which condition should the midwife suspect?

  1. Cord prolapse
  2. Chorioamnionitis
  3. Placental abruption Correct answer.
  4. Uterine rupture

Explanation

Sudden severe abdominal pain with a rigid, board-like uterus and fetal bradycardia is characteristic of placental abruption. Uterine rupture also causes acute pain but is more often associated with a prior uterine scar and loss of station. Chorioamnionitis presents with fever and uterine tenderness, and cord prolapse causes sudden bradycardia without the board-like uterus.

Question 41Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 30 weeks' gestation with a history of preterm birth is prescribed progesterone supplementation. Which statement about this therapy is accurate?

  1. It is contraindicated in clients with a prior preterm birth
  2. It is given to treat active preterm labor
  3. It reduces the risk of recurrent preterm birth Correct answer.
  4. It replaces the need for cervical length monitoring

Explanation

Progesterone supplementation is used in clients with a history of spontaneous preterm birth to reduce the risk of recurrence. It is not used to treat active preterm labor. It does not eliminate the need for ongoing assessment such as cervical length monitoring.

Question 42Content areas determined by the most recent Task Analysis completed by the Research Committee

Which finding on a newborn examination should prompt immediate further evaluation?

  1. A heart rate of 130 beats per minute at 1 hour of life
  2. A heart rate of 90 beats per minute at 30 minutes of life Correct answer.
  3. A respiratory rate of 50 breaths per minute at 1 hour of life
  4. A temperature of 36.8 degrees Celsius at 1 hour of life

Explanation

A newborn heart rate below 100 beats per minute after the first minutes of life may indicate distress and requires immediate evaluation. Normal newborn heart rates are typically 110 to 160 beats per minute. The other listed values fall within acceptable ranges.

Question 43Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 26 weeks' gestation reports decreased fetal movement over the past 24 hours. Which action should the midwife recommend?

  1. Perform a focused fetal movement count and contact the provider if movement remains reduced Correct answer.
  2. Assume the decrease is normal because the fetus is still small
  3. Wait until the next scheduled prenatal visit
  4. Increase caffeine intake to stimulate fetal activity

Explanation

Reduced fetal movement should be evaluated promptly because it may indicate fetal compromise. A focused movement count followed by provider contact if movement remains reduced is appropriate. Waiting, using caffeine, or assuming the change is normal delays necessary assessment.

Question 44Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 40 weeks' gestation is in the first stage of labor and has a cervical examination showing 8 cm dilation, 100 percent effacement, and station zero. Which phase of labor is this client in?

  1. Fourth stage
  2. Active phase Correct answer.
  3. Latent phase
  4. Second stage

Explanation

The active phase of the first stage of labor is characterized by cervical dilation from about 6 cm to complete dilation, with rapid cervical change. A dilation of 8 cm with full effacement places the client in the active phase. The latent phase occurs at lower dilation, and the second stage begins at complete dilation.

Question 45Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 36 weeks' gestation is diagnosed with chorioamnionitis. Which finding is most consistent with this diagnosis?

  1. Maternal fever with uterine tenderness and foul-smelling amniotic fluid Correct answer.
  2. Sudden shoulder pain with vaginal spotting
  3. Painless vaginal bleeding with a soft uterus
  4. Decreased fetal movement with a normal maternal temperature

Explanation

Chorioamnionitis is an intra-amniotic infection characterized by maternal fever, uterine tenderness, and foul-smelling amniotic fluid. It may also cause maternal and fetal tachycardia. Painless bleeding and shoulder pain are not features of this condition.

Question 46Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 34 weeks' gestation is at risk for preterm birth. Which intervention has been shown to improve fetal outcomes when preterm birth is anticipated?

  1. Immediate induction of labor
  2. Administration of antenatal corticosteroids Correct answer.
  3. Routine amniotomy
  4. Administration of a live vaccine

Explanation

Antenatal corticosteroids given to clients at risk for preterm birth accelerate fetal lung maturity and reduce neonatal morbidity and mortality. Live vaccines, immediate induction, and routine amniotomy are not interventions used to improve preterm fetal outcomes.

Question 47Content areas determined by the most recent Task Analysis completed by the Research Committee

A client using a copper intrauterine device reports that she has missed a period and has a positive pregnancy test. Which action should the midwife take?

  1. Reassure the client that the device prevents ectopic pregnancy
  2. Advise the client to continue the pregnancy without evaluation
  3. Evaluate for ectopic pregnancy and arrange removal of the device Correct answer.
  4. Schedule a routine prenatal visit in four weeks

Explanation

Pregnancy with an intrauterine device in place carries an increased risk of ectopic pregnancy and requires prompt evaluation. If the pregnancy is intrauterine, removal of the device reduces the risk of complications such as sepsis and preterm birth. Reassurance or delayed evaluation is unsafe.

Question 48Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 28 weeks' gestation reports regular uterine contractions. Which assessment should the midwife perform to help distinguish true preterm labor from false labor?

  1. Fundal height measurement
  2. Cervical examination to assess change in dilation and effacement Correct answer.
  3. Urine dipstick testing for glucose
  4. Maternal blood pressure measurement

Explanation

Serial cervical examinations that show progressive dilation or effacement support a diagnosis of true preterm labor. False labor contractions do not produce cervical change. Blood pressure, urine glucose, and fundal height do not distinguish true from false labor.

Question 49Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 6 weeks postpartum reports feelings of sadness, tearfulness, and difficulty sleeping that have lasted for three weeks. Which condition should the midwife suspect?

  1. Postpartum depression Correct answer.
  2. Postpartum blues
  3. Postpartum psychosis
  4. Normal postpartum adjustment

Explanation

Postpartum depression is characterized by persistent sadness, tearfulness, and sleep disturbance lasting beyond two weeks after birth. Postpartum blues typically resolve within two weeks. Postpartum psychosis involves hallucinations or delusions and is a psychiatric emergency.

Question 50Content areas determined by the most recent Task Analysis completed by the Research Committee

A client at 24 weeks' gestation with a history of deep vein thrombosis asks about travel. Which recommendation is most appropriate?

  1. Remain seated for the entire flight
  2. Discontinue any prescribed anticoagulation before travel
  3. Avoid all travel until after delivery
  4. Ambulate frequently and use compression stockings during long trips Correct answer.

Explanation

Clients with a history of venous thromboembolism should ambulate frequently and use compression stockings during prolonged travel to reduce stasis. Remaining seated for the entire flight increases risk. Anticoagulation should be managed by the provider and not stopped without guidance.