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Midwifery Licensing practice questions

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Question 1Antepartum Care and Prenatal Assessment

At what gestational age, counted from the first day of the last menstrual period, does the fetal heart first become detectable by transvaginal ultrasound in an uncomplicated pregnancy?

  1. Around 10 weeks
  2. Around 20 weeks
  3. Around 6 weeks Correct answer.
  4. Around 14 weeks

Explanation

Cardiac activity can normally be seen by transvaginal ultrasound from about 6 weeks of gestation, when the embryo measures only a few millimeters. Waiting until 10 weeks or later would delay confirmation of viability well beyond the period when this sign is reliably present.

Question 2Antepartum Care and Prenatal Assessment

A client at 12 weeks' gestation reports mild nausea with occasional vomiting but is keeping fluids down and gaining weight appropriately. Which initial management is most appropriate?

  1. Admit her for intravenous rehydration and antiemetics
  2. Reassure her that this is expected and suggest small frequent bland meals Correct answer.
  3. Arrange immediate obstetric ultrasound to exclude molar pregnancy
  4. Prescribe a course of oral antibiotics

Explanation

Nausea and vomiting that does not interfere with hydration or nutrition is a normal feature of early pregnancy and responds to dietary measures such as small, frequent, low-fat meals. Escalation to admission or imaging is reserved for red flags such as dehydration, weight loss, or hyperemesis.

Question 3Antepartum Care and Prenatal Assessment

Which laboratory finding is most characteristic of physiologic anemia of pregnancy?

  1. A dilutional fall in hemoglobin with normal red cell indices Correct answer.
  2. A macrocytic anemia with low vitamin B12
  3. A hemolytic anemia with raised bilirubin
  4. A microcytic hypochromic picture with low ferritin

Explanation

Plasma volume expands proportionally more than red cell mass, producing a dilutional fall in hemoglobin concentration while red cell size and iron stores remain normal. This is why pregnancy-specific hemoglobin thresholds are lower than in non-pregnant adults.

Question 4Antepartum Care and Prenatal Assessment

Which immunization is routinely recommended during every pregnancy, regardless of prior vaccination history, to protect the newborn from pertussis?

  1. Varicella vaccine
  2. Live attenuated influenza vaccine
  3. Measles, mumps, and rubella vaccine
  4. Tetanus, diphtheria, and acellular pertussis vaccine Correct answer.

Explanation

Inactivated Tdap is recommended in each pregnancy, ideally between 27 and 36 weeks, so that maternal antibody crosses the placenta and protects the infant before the primary series begins. Live vaccines are avoided in pregnancy because of theoretical fetal risk.

Question 5Antepartum Care and Prenatal Assessment

A client's last menstrual period began on 3 March. Using Naegele's rule, what is her estimated date of delivery?

  1. 10 December Correct answer.
  2. 24 November
  3. 3 January
  4. 31 December

Explanation

Naegele's rule adds one year, subtracts three months, and adds seven days to the first day of the last menstrual period. Applying this to 3 March gives 10 December of the following year.

Question 6Antepartum Care and Prenatal Assessment

Which finding on a routine urinalysis at 28 weeks most strongly suggests preeclampsia rather than a urinary tract infection?

  1. Proteinuria accompanied by new hypertension Correct answer.
  2. Ketonuria after an overnight fast
  3. Glycosuria with a normal blood glucose
  4. Proteinuria accompanied by nitrites and leukocyte esterase

Explanation

Preeclampsia is defined by new hypertension arising after 20 weeks together with proteinuria or other end-organ signs, so proteinuria must be interpreted alongside blood pressure. Infection is suggested instead when nitrites, leukocyte esterase, and urinary symptoms are present.

Question 7Antepartum Care and Prenatal Assessment

Which supplement is recommended for all pregnant women from before conception through the first trimester to reduce the risk of neural tube defects?

  1. Iron 200 mg daily
  2. Vitamin A 10,000 IU daily
  3. Folic acid 400 micrograms daily Correct answer.
  4. Calcium 2 g daily

Explanation

Periconceptional folic acid at 400 micrograms daily lowers the incidence of neural tube defects, with higher doses reserved for women with a previous affected pregnancy or specific risk factors. High-dose vitamin A is teratogenic and should be avoided.

Question 8Antepartum Care and Prenatal Assessment

At what gestational age is a pregnant client typically first aware of fetal movements, assuming a first pregnancy and an anterior placenta?

  1. Around 18 to 22 weeks Correct answer.
  2. Around 10 to 12 weeks
  3. Around 32 to 34 weeks
  4. Around 26 to 28 weeks

Explanation

Quickening is usually perceived between about 18 and 22 weeks in a first pregnancy and may be earlier in later pregnancies. An anterior placenta can delay perception slightly because it cushions early movements.

Question 9Antepartum Care and Prenatal Assessment

A client at 34 weeks has a fundal height of 29 cm. Which action is most appropriate?

  1. Schedule induction of labor at 36 weeks
  2. Reassure her that fundal height is unrelated to gestational age
  3. Arrange ultrasound assessment of fetal growth Correct answer.
  4. Repeat the measurement only at 40 weeks

Explanation

Fundal height measured in centimeters should approximate gestational age in weeks between roughly 20 and 36 weeks, and a discrepancy of 3 cm or more warrants ultrasound to assess growth and amniotic fluid. A single lagging measurement is not itself an indication for early delivery.

Question 10Antepartum Care and Prenatal Assessment

A primigravida at 38 weeks has a blood pressure of 152/96 mmHg on two occasions four hours apart, with 2+ proteinuria and no symptoms. Which diagnosis best fits?

  1. Gestational hypertension
  2. Preeclampsia without severe features Correct answer.
  3. Eclampsia
  4. Chronic hypertension

Explanation

New hypertension after 20 weeks together with proteinuria defines preeclampsia, and the absence of severe-range pressures, symptoms, or laboratory abnormalities places it in the without-severe-features category. Gestational hypertension requires the absence of proteinuria and other end-organ signs.

Question 11Antepartum Care and Prenatal Assessment

A client at 28 weeks has a 1-hour 50 g glucose challenge result of 152 mg/dL. What is the next appropriate step?

  1. Advise no further testing because the result is normal
  2. Repeat the 50 g challenge in four weeks
  3. Perform a 3-hour 100 g oral glucose tolerance test Correct answer.
  4. Diagnose gestational diabetes and start insulin

Explanation

A screening value above the threshold, commonly 140 mg/dL, requires confirmation with a diagnostic 3-hour oral glucose tolerance test rather than immediate treatment. Diagnosis depends on the number of abnormal values on the diagnostic test.

Question 12Antepartum Care and Prenatal Assessment

Which pattern on a routine antenatal complete blood count most suggests iron deficiency anemia rather than thalassemia trait?

  1. Normal hemoglobin with isolated thrombocytopenia
  2. Low ferritin with microcytic hypochromic indices Correct answer.
  3. Normal ferritin with microcytosis and a normal red cell distribution width
  4. Raised ferritin with macrocytosis

Explanation

Depleted iron stores, reflected by low ferritin, combined with microcytic hypochromic red cells is the classic picture of iron deficiency. Thalassemia trait typically shows microcytosis with a normal ferritin and a normal or only mildly raised red cell distribution width.

Question 13Antepartum Care and Prenatal Assessment

A client at 36 weeks reports a sudden gush of clear fluid and ongoing leakage. Which assessment should be performed first?

  1. Sterile speculum examination to confirm rupture of membranes Correct answer.
  2. Transabdominal ultrasound to measure amniotic fluid only
  3. Digital vaginal examination to assess cervical dilation
  4. Urine culture to exclude urinary tract infection

Explanation

Sterile speculum examination allows direct visualization of fluid pooling or a positive ferning or nitrazine test and avoids introducing infection. Digital examination is avoided in suspected rupture before labor because it shortens the latency period and increases infection risk.

Question 14Antepartum Care and Prenatal Assessment

A client at 26 weeks is found to have a closed cervix, no contractions, and a cervical length of 18 mm on transvaginal ultrasound. Which management is most appropriate?

  1. Reassure her that cervical length has no predictive value
  2. Refer for consideration of cervical cerclage and discuss progesterone Correct answer.
  3. Advise bed rest until 37 weeks
  4. Schedule elective delivery at 34 weeks

Explanation

A short cervix below 25 mm before 34 weeks is a recognized predictor of preterm birth, and cerclage or vaginal progesterone may be offered depending on history and findings. Bed rest has not been shown to be effective and carries its own risks.

Question 15Antepartum Care and Prenatal Assessment

Which finding on a midtrimester ultrasound most strongly suggests an increased risk of aneuploidy and warrants offering diagnostic testing?

  1. A low-lying placenta at 20 weeks
  2. A single umbilical artery with normal growth
  3. Mild pyelectasis in isolation
  4. A thickened nuchal fold with a cardiac echogenic focus Correct answer.

Explanation

Soft markers raise risk most when several are present together, and a thickened nuchal fold is among the stronger markers. Isolated minor findings such as pyelectasis or a single umbilical artery carry much lower significance and are often followed with ultrasound alone.

Question 16Antepartum Care and Prenatal Assessment

Which statement about the quadruple marker screen is correct?

  1. It is performed at 10 to 13 weeks together with nuchal translucency
  2. It is performed between 15 and 22 weeks and reports a risk estimate rather than a diagnosis Correct answer.
  3. It measures fetal DNA directly from maternal plasma
  4. It replaces the need for diagnostic testing in all cases

Explanation

The quadruple test uses maternal serum markers drawn in the second trimester to calculate a probability of aneuploidy or neural tube defects. A high-risk result is an indication for diagnostic testing, not a diagnosis in itself.

Question 17Antepartum Care and Prenatal Assessment

A client at 30 weeks has a hemoglobin of 9.2 g/dL with low ferritin despite oral iron. Which management is most appropriate?

  1. Consider intravenous iron infusion Correct answer.
  2. Increase oral iron to three times daily without further assessment
  3. Transfuse packed red cells immediately
  4. Reassure her that this is normal hemodilution

Explanation

Iron deficiency anemia that does not respond to oral therapy, often because of poor absorption or intolerance, is an indication to consider intravenous iron. Transfusion is reserved for severe or symptomatic anemia near delivery.

Question 18Antepartum Care and Prenatal Assessment

A client with a body mass index of 34 kg/m2 at her first visit asks about early pregnancy care. Which recommendation is most appropriate?

  1. Reassure her that obesity carries no additional antenatal risk
  2. Recommend a very low calorie diet until 20 weeks
  3. Advise weight loss of 10 kg during pregnancy
  4. Offer early screening for gestational diabetes and counsel on appropriate gestational weight gain Correct answer.

Explanation

Obesity increases the risk of gestational diabetes, hypertensive disorders, and macrosomia, so early screening and individualized weight-gain counseling are recommended. Weight loss during pregnancy is not advised because of concerns about fetal nutrition.

Question 19Antepartum Care and Prenatal Assessment

A client with a history of deep vein thrombosis reports unilateral calf pain and swelling at 24 weeks. Which diagnostic approach is most appropriate?

  1. D-dimer testing alone to exclude thrombosis
  2. Empiric antibiotics for cellulitis
  3. Compression ultrasound of the affected leg Correct answer.
  4. Reassurance that thrombosis is rare in pregnancy

Explanation

Compression ultrasound is the first-line imaging test for suspected deep vein thrombosis and is safe in pregnancy. D-dimer is not reliable because it rises physiologically in pregnancy and a negative result does not exclude thrombosis.

Question 20Antepartum Care and Prenatal Assessment

A client with a known history of gestational diabetes in a previous pregnancy is now at 12 weeks. Which statement about early testing is correct?

  1. Early testing is recommended because of the history of gestational diabetes Correct answer.
  2. Early testing is only for clients with type 1 diabetes
  3. No testing is needed if the previous pregnancy ended in a normal delivery
  4. Testing should be deferred until 28 weeks regardless of history

Explanation

A history of gestational diabetes is a risk factor that warrants early glucose testing, and the result guides whether testing is repeated later in pregnancy. Universal screening at 24 to 28 weeks still applies to those with a normal early result.

Question 21Antepartum Care and Prenatal Assessment

A client at 22 weeks has a blood pressure of 138/88 mmHg and a history of preeclampsia in a previous pregnancy. Which preventive measure should be discussed?

  1. Strict bed rest for the remainder of pregnancy
  2. Elective delivery at 34 weeks
  3. Low-dose aspirin started before 16 weeks Correct answer.
  4. Prophylactic magnesium sulfate infusion

Explanation

Low-dose aspirin started before 16 weeks reduces the risk of preeclampsia in women with a history of the disease or other high-risk factors. Bed rest and prophylactic magnesium are not used for prevention, and early delivery is reserved for severe disease.

Question 22Antepartum Care and Prenatal Assessment

A client at 32 weeks reports a sudden reduction in fetal movements over the past day. Which action is most appropriate?

  1. Advise her to drink cold water and wait 48 hours
  2. Reassure her that fetal movement patterns vary and review at the next visit
  3. Arrange immediate fetal assessment with cardiotocography and ultrasound Correct answer.
  4. Schedule a routine visit in one week

Explanation

Reduced fetal movements after 28 weeks require prompt assessment with cardiotocography and ultrasound to exclude fetal compromise. Deferring evaluation risks missing hypoxia or growth restriction.

Question 23Antepartum Care and Prenatal Assessment

A client at 18 weeks has a fundal height of 24 cm and a history of a previous cesarean. Which diagnosis should be considered first?

  1. Intrauterine growth restriction
  2. Multiple gestation or inaccurate dating Correct answer.
  3. Oligohydramnios
  4. Cervical insufficiency

Explanation

A fundal height larger than expected for dates suggests multiple gestation, polyhydramnios, or incorrect dating, and ultrasound is needed to clarify. A previous cesarean does not explain a large uterus but is relevant to later delivery planning.

Question 24Antepartum Care and Prenatal Assessment

A client at 14 weeks has a positive first-trimester screen with an increased risk of trisomy 21. She asks what the result means. Which response is most accurate?

  1. The result requires immediate termination of pregnancy
  2. The result indicates increased probability and diagnostic testing is offered to confirm Correct answer.
  3. The result confirms that the fetus has trisomy 21
  4. The result means the pregnancy is not viable

Explanation

Screening tests estimate probability and cannot establish a diagnosis, so an increased-risk result should prompt a discussion of diagnostic testing such as chorionic villus sampling or amniocentesis. Counseling must remain non-directive about the options that follow.

Question 25Antepartum Care and Prenatal Assessment

A client at 24 weeks with a history of preterm birth at 30 weeks now has a cervical length of 20 mm. Which combination is most supported by evidence?

  1. Serial digital cervical examinations every week
  2. Elective delivery at 34 weeks
  3. Routine antibiotics until 37 weeks
  4. Vaginal progesterone and consideration of cerclage given the prior preterm birth Correct answer.

Explanation

A history of spontaneous preterm birth combined with a short cervix identifies a woman who may benefit from vaginal progesterone and cerclage. Routine antibiotics and serial digital examinations have not been shown to prevent preterm birth and may introduce infection risk.

Question 26Antepartum Care and Prenatal Assessment

A client at 10 weeks' gestation reports nausea and vomiting that has caused a 4 kg weight loss and ketonuria. Which term describes this presentation?

  1. Morning sickness of pregnancy
  2. Physiologic anemia of pregnancy
  3. Gastroesophageal reflux disease
  4. Hyperemesis gravidarum Correct answer.

Explanation

Hyperemesis gravidarum is persistent vomiting in pregnancy associated with weight loss (commonly defined as more than 5% of prepregnancy weight), dehydration, and ketonuria. Ordinary morning sickness does not produce significant weight loss or ketonuria.

Question 27Antepartum Care and Prenatal Assessment

At a first prenatal visit at 9 weeks, which laboratory test is recommended for all pregnant clients to identify asymptomatic bacteriuria?

  1. 24-hour urine protein collection
  2. Urine culture Correct answer.
  3. Renal ultrasound
  4. Serum creatinine

Explanation

A clean-catch urine culture is the recommended screening test for asymptomatic bacteriuria in early pregnancy because untreated infection raises the risk of pyelonephritis and preterm birth. Dipstick testing is insufficiently sensitive, so culture is the standard.

Question 28Antepartum Care and Prenatal Assessment

A client at 12 weeks asks how her estimated date of delivery will be determined. Her last menstrual period was 10 weeks ago and a crown-rump length measurement is available. Which method is most reliable?

  1. Quickening date
  2. First-trimester ultrasound crown-rump length Correct answer.
  3. Fundal height measurement
  4. Last menstrual period alone

Explanation

First-trimester ultrasound dating by crown-rump length is the most accurate method and takes precedence over the last menstrual period when the two disagree by more than about five to seven days. Later clinical markers such as fundal height and quickening are far less precise.

Question 29Antepartum Care and Prenatal Assessment

A client at 16 weeks reports a thin, watery vaginal discharge and asks whether it is normal. Which characteristic of normal physiologic leukorrhea should the midwife expect?

  1. Blood-tinged with cramping
  2. Yellow-green and frothy with vulvar itching
  3. Gray with a fishy odor
  4. Clear to white, nonirritating, and without odor Correct answer.

Explanation

Physiologic leukorrhea of pregnancy is increased clear or white mucus that is nonirritating and essentially odorless. Colored, frothy, malodorous, or bloody discharge suggests infection or another complication requiring evaluation.

Question 30Antepartum Care and Prenatal Assessment

A client at 28 weeks has a blood pressure of 108/64 mmHg, 1+ dependent edema, and a uterus that measures 27 cm. She feels well and fetal heart tones are 140 beats per minute. What is the most appropriate interpretation?

  1. Findings suggest polyhydramnios
  2. Findings are within normal limits for gestational age Correct answer.
  3. Findings indicate mild preeclampsia
  4. Findings suggest intrauterine growth restriction requiring immediate delivery

Explanation

At 28 weeks a fundal height within 2 to 3 cm of gestational age, normal blood pressure, mild dependent edema, and a normal fetal heart rate are expected findings. Fundal height between 24 and 34 weeks normally approximates gestational age in centimeters within a few centimeters.

Question 31Antepartum Care and Prenatal Assessment

A client at 20 weeks reports burning epigastric pain that worsens after meals and at night. Which initial intervention is most appropriate?

  1. Small frequent meals and elevating the head of the bed Correct answer.
  2. Discontinuation of all prenatal vitamins
  3. Oral antibiotics for Helicobacter pylori
  4. Immediate endoscopy

Explanation

Reflux and dyspepsia in pregnancy are first managed with lifestyle measures such as smaller meals, avoiding late meals, and elevating the head of the bed, followed by antacids if needed. Invasive testing and empiric antibiotic therapy are not first-line in uncomplicated pregnancy dyspepsia.

Question 32Antepartum Care and Prenatal Assessment

A client at 24 weeks has a body mass index of 31 kg/m2 and a normal 1-hour glucose challenge. She asks about future screening. Which statement is correct?

  1. She should be screened for gestational diabetes later in pregnancy despite the normal early test Correct answer.
  2. Screening should be deferred until after delivery
  3. She should have a repeat screen only if she develops symptoms
  4. A normal early screen means no further glucose testing is needed

Explanation

A normal early glucose test in a client with obesity does not exclude later gestational diabetes, so repeat screening at 24 to 28 weeks is recommended. Early screening identifies preexisting diabetes, while later testing detects gestational diabetes arising with placental growth.

Question 33Antepartum Care and Prenatal Assessment

A client at 30 weeks reports intense vulvar itching and thick white cottage-cheese discharge. Which management is most appropriate?

  1. Topical corticosteroid cream
  2. Oral metronidazole
  3. Reassurance without treatment
  4. Topical azole antifungal therapy Correct answer.

Explanation

The described discharge and itching are typical of vulvovaginal candidiasis, which is treated with a topical imidazole such as clotrimazole or miconazole. Metronidazole treats trichomoniasis and bacterial vaginosis, not candidiasis.

Question 34Antepartum Care and Prenatal Assessment

A client at 34 weeks reports new-onset severe itching of the palms and soles without a rash, worse at night. Which condition should be suspected first?

  1. Pruritic urticarial papules and plaques of pregnancy
  2. Contact dermatitis
  3. Intrahepatic cholestasis of pregnancy Correct answer.
  4. Scabies infestation

Explanation

Pruritus of the palms and soles without a primary rash, especially with nocturnal worsening, is characteristic of intrahepatic cholestasis of pregnancy, which requires bile acid testing. PUPPP presents with an urticarial rash usually beginning on the abdominal striae.

Question 35Antepartum Care and Prenatal Assessment

A client at 36 weeks has a fundal height of 41 cm and a history of gestational diabetes. Ultrasound shows an estimated fetal weight above the 95th percentile. Which complication should the midwife anticipate?

  1. Intrauterine growth restriction
  2. Oligohydramnios
  3. Shoulder dystocia at delivery Correct answer.
  4. Placental abruption

Explanation

Fetal macrosomia, often associated with gestational diabetes, increases the risk of shoulder dystocia because the fetal shoulders may not pass beneath the symphysis pubis after the head delivers. Oligohydramnios and growth restriction are not typical of this presentation.

Question 36Antepartum Care and Prenatal Assessment

A client at 22 weeks has a blood pressure of 128/78 mmHg and a history of chronic hypertension treated with labetalol. She asks about aspirin prophylaxis. Which statement is correct?

  1. Low-dose aspirin started before 16 weeks reduces the risk of preeclampsia in clients at high risk Correct answer.
  2. Aspirin is contraindicated in pregnancy at any dose
  3. Aspirin should be started only after 36 weeks
  4. Aspirin replaces antihypertensive therapy

Explanation

Low-dose aspirin, typically 81 to 150 mg daily, begun before 16 weeks' gestation reduces the incidence of preeclampsia in clients at high risk, including those with chronic hypertension. It is not a substitute for antihypertensive medication.

Question 37Antepartum Care and Prenatal Assessment

A client at 26 weeks is Rh-negative and unsensitized. She reports no prior pregnancy complications. What is the standard plan for anti-D immune globulin?

  1. Administer a dose at about 28 weeks and again within 72 hours after delivery if the infant is Rh-positive Correct answer.
  2. Withhold anti-D because sensitization cannot occur before 28 weeks
  3. Administer a dose only after delivery regardless of infant blood type
  4. Administer a dose at conception

Explanation

Routine antenatal anti-D immune globulin is given at about 28 weeks to unsensitized Rh-negative clients, with a postpartum dose within 72 hours of delivery if the newborn is Rh-positive. Additional doses are given after events such as amniocentesis or bleeding.

Question 38Antepartum Care and Prenatal Assessment

A client at 38 weeks reports a sudden gush of fluid and a pulsating sensation at the introitus with a palpable cord. Which action should the midwife take first?

  1. Place the client in Trendelenburg or knee-chest position and arrange emergency transfer Correct answer.
  2. Attempt to replace the cord into the vagina
  3. Clamp the visible cord
  4. Perform a vaginal examination to confirm dilation

Explanation

Visible umbilical cord prolapse is an obstetric emergency; the priority is relieving cord compression by positioning the client head-down or knee-chest while arranging immediate delivery. Handling or clamping the cord worsens spasm and compression.

Question 39Antepartum Care and Prenatal Assessment

A client at 32 weeks has a blood pressure of 158/104 mmHg and a platelet count of 88,000/mm3 but no proteinuria. Which diagnosis should be considered?

  1. Preeclampsia with severe features based on thrombocytopenia and severe-range blood pressure Correct answer.
  2. Chronic hypertension alone
  3. Gestational hypertension alone
  4. Normal pregnancy blood pressure

Explanation

Preeclampsia with severe features can be diagnosed without proteinuria when there is severe-range blood pressure plus thrombocytopenia below 100,000/mm3, renal or hepatic dysfunction, pulmonary edema, or visual symptoms. Gestational hypertension requires elevated blood pressure without these features.

Question 40Antepartum Care and Prenatal Assessment

A client at 18 weeks reports pelvic pressure and a low backache. On speculum examination the membranes bulge into the cervical os and the cervix is 2 cm dilated. Which diagnosis should be considered?

  1. Cervical insufficiency with bulging membranes Correct answer.
  2. Placenta previa
  3. Round ligament pain
  4. Physiologic cervical softening of pregnancy

Explanation

Painless cervical dilation with bulging membranes in the second trimester is characteristic of cervical insufficiency, which may require cerclage or other intervention. Round ligament pain and normal cervical softening do not cause membrane bulging or progressive dilation.

Question 41Intrapartum Care and Labor Management

During the active phase of the first stage of labor, which cervical change defines adequate progress in a nulliparous woman according to standard labor curves?

  1. Dilation of at least 1.2 cm per hour Correct answer.
  2. Dilation of at least 2.5 cm per hour
  3. Dilation of at least 0.5 cm per hour
  4. Dilation of at least 0.2 cm per hour

Explanation

Contemporary labor guidelines (such as the ACOG/SMFM safe-labor consensus) use a minimum normal dilation rate of about 1.2 cm/hour for nulliparas in active labor. Slower progress prompts evaluation for adequate contractions, cephalopelvic disproportion, or fetal malposition rather than immediate cesarean.

Question 42Intrapartum Care and Labor Management

A laboring woman at 6 cm dilation has a category II fetal heart rate tracing with recurrent variable decelerations. Which initial intrauterine resuscitation measure is most appropriate?

  1. Repositioning the mother and giving an intravenous fluid bolus Correct answer.
  2. Increasing oxytocin to shorten labor
  3. Performing an immediate cesarean delivery
  4. Administering a tocolytic such as terbutaline

Explanation

Recurrent variable decelerations usually reflect umbilical cord compression, so maternal repositioning (especially lateral or knee-chest) and an IV fluid bolus are first-line measures. These improve uteroplacental perfusion and relieve cord compression before more invasive steps are considered.

Question 43Intrapartum Care and Labor Management

Which finding best confirms that a woman has entered the second stage of labor?

  1. Rupture of membranes
  2. Regular contractions every 3 minutes
  3. Spontaneous urge to bear down with complete dilation
  4. Complete cervical dilation with the presenting part at station 0 Correct answer.

Explanation

The second stage begins at full cervical dilation and ends with delivery of the newborn. Complete dilation with descent of the presenting part is the defining criterion, though an urge to push often accompanies it.

Question 44Intrapartum Care and Labor Management

A nulliparous woman in spontaneous labor has been fully dilated for 3 hours with adequate contractions, no descent of the fetal head, and a persistently reassuring tracing. What is the most appropriate next step?

  1. Perform amniotomy if membranes are already ruptured
  2. Augment with oxytocin despite adequate contractions
  3. Evaluate for cephalopelvic disproportion and consider operative delivery Correct answer.
  4. Continue pushing for another 3 hours without reassessment

Explanation

Prolonged second stage with arrested descent despite adequate contractions suggests cephalopelvic disproportion or malposition. Clinical assessment for disproportion and consideration of operative vaginal or cesarean delivery is warranted rather than continued expectant pushing.

Question 45Intrapartum Care and Labor Management

Which parameter is used to diagnose tachysystole during labor?

  1. More than three contractions in 10 minutes
  2. Contractions lasting longer than 60 seconds
  3. A resting uterine tone above 20 mm Hg
  4. More than five contractions in 10 minutes averaged over 30 minutes Correct answer.

Explanation

Tachysystole is defined as more than five contractions in 10 minutes averaged over a 30-minute window. It is described as present with or without associated fetal heart rate changes.

Question 46Intrapartum Care and Labor Management

A woman at 38 weeks presents in labor with a cord prolapse identified on vaginal examination. What is the priority immediate action?

  1. Replace the cord into the uterus and continue labor
  2. Administer oxytocin to expedite vaginal delivery
  3. Elevate the presenting part and prepare for emergency cesarean delivery Correct answer.
  4. Place the woman supine and observe the fetal tracing

Explanation

Cord prolapse is an obstetric emergency requiring relief of cord compression by elevating the presenting part while arranging immediate delivery, usually by cesarean. Manual elevation or filling the bladder can reduce compression until surgery.

Question 47Intrapartum Care and Labor Management

Which Bishop score component reflects cervical consistency?

  1. Dilation
  2. Consistency Correct answer.
  3. Effacement
  4. Position

Explanation

The Bishop score assesses dilation, effacement, station, consistency, and position of the cervix. Consistency is scored as firm, medium, or soft, with a softer cervix indicating greater readiness for labor.

Question 48Intrapartum Care and Labor Management

A woman receiving epidural analgesia develops hypotension 20 minutes after placement. Which intervention is most appropriate initially?

  1. Discontinuation of all fetal monitoring
  2. Rapid oxytocin augmentation
  3. Maternal left lateral positioning and intravenous fluid bolus Correct answer.
  4. Immediate administration of ephedrine without fluids

Explanation

Epidural-induced hypotension results from sympathetic blockade and reduced venous return. Left lateral positioning and an IV crystalloid bolus improve venous return and cardiac output; vasopressors are added if needed.

Question 49Intrapartum Care and Labor Management

Which description correctly characterizes the latent phase of the first stage of labor?

  1. Cervical dilation from 0 to about 5 cm with irregular contractions Correct answer.
  2. Cervical dilation from 6 to 10 cm with strong regular contractions
  3. Full dilation until delivery of the newborn
  4. Delivery of the placenta after the newborn

Explanation

The latent phase extends from the onset of labor to about 5 cm dilation, with slow cervical change and irregular contractions. The active phase follows, typically from 6 cm to full dilation.

Question 50Intrapartum Care and Labor Management

During a vaginal delivery, which maneuver is used to facilitate delivery of the anterior shoulder after the head is delivered?

  1. McRoberts maneuver with suprapubic pressure
  2. Gentle downward traction on the head Correct answer.
  3. Kristeller maneuver with abdominal pressure
  4. Fundal pressure applied during a contraction

Explanation

After restitution, gentle downward traction on the fetal head assists delivery of the anterior shoulder. The posterior shoulder follows with upward traction. Fundal pressure is not recommended.