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JNCLEX-RM (Jordan) study materials
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JNCLEX-RM (Jordan) practice questions

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Question 1Antenatal Care and Midwifery Assessment

At the first antenatal visit, which calculation gives the estimated date of delivery using Naegele's rule for a woman with a regular 28-day cycle?

  1. Add 7 months and 9 days to the last day of the last menstrual period
  2. Add 280 days to the day of assumed conception
  3. Subtract 3 months and add 14 days to the first day of the last menstrual period
  4. Add 9 months and 7 days to the first day of the last menstrual period Correct answer.

Explanation

Naegele's rule estimates delivery by taking the first day of the last menstrual period, subtracting 3 months, and adding 7 days and 1 year, which is equivalent to adding 9 months and 7 days. The calculation is anchored to the first day of bleeding, not the last day or the conception date, because the LMP is the reliably reported landmark.

Question 2Antenatal Care and Midwifery Assessment

A pregnant woman at 10 weeks' gestation reports mild nausea with vomiting once or twice daily but is keeping fluids down and has stable weight. What is the most appropriate midwifery response?

  1. Arrange immediate ultrasound to exclude hydatidiform mole
  2. Refer urgently for inpatient intravenous rehydration and antiemetic therapy
  3. Advise her to stop taking folic acid until the vomiting settles
  4. Reassure that nausea and vomiting of pregnancy is common and give dietary and hydration advice with safety-netting Correct answer.

Explanation

Mild nausea and vomiting with preserved oral intake and stable weight is typical of nausea and vomiting of pregnancy and is managed with reassurance, small frequent meals, ginger, and clear safety-netting advice. Escalation is reserved for signs such as dehydration, ketonuria, weight loss, or inability to keep fluids down.

Question 3Antenatal Care and Midwifery Assessment

Which supplement is recommended routinely from before conception through the first trimester to reduce the risk of neural tube defects?

  1. Calcium carbonate 1 gram daily
  2. Folic acid 400 micrograms daily Correct answer.
  3. Ferrous sulfate 200 milligrams daily
  4. Vitamin A 10,000 international units daily

Explanation

Periconceptional folic acid at 400 micrograms daily reduces the incidence of neural tube defects, and higher doses are used for women with additional risk factors. Iron and calcium are commonly started later for anaemia and bone health, and high-dose vitamin A is avoided because of teratogenicity.

Question 4Antenatal Care and Midwifery Assessment

During a routine antenatal visit at 24 weeks, a woman's blood pressure is 148/96 mmHg on two readings four hours apart, with no proteinuria and no symptoms. What is the most appropriate next step?

  1. Reassure her that isolated raised readings are normal in the second trimester and review in four weeks
  2. Advise bed rest at home and recheck blood pressure at the next scheduled visit
  3. Arrange same-day assessment for hypertensive disease of pregnancy including bloods and fetal monitoring Correct answer.
  4. Prescribe a thiazide diuretic and continue routine antenatal scheduling

Explanation

New hypertension at 24 weeks meets the threshold for hypertensive disease of pregnancy and requires prompt assessment with urinalysis, blood tests, and fetal surveillance to distinguish gestational hypertension from pre-eclampsia. Deferring review or treating empirically without assessment risks missing progressive disease.

Question 5Antenatal Care and Midwifery Assessment

A woman at 28 weeks reports a sudden gush of clear fluid and ongoing dampness. Which combination of assessments best confirms prelabour rupture of membranes?

  1. Maternal self-report of leakage combined with a urinary tract infection screen
  2. Transabdominal ultrasound measurement of amniotic fluid index alone
  3. Sterile speculum examination showing pooling of fluid with a positive nitrazine or ferning test Correct answer.
  4. Digital vaginal examination to palpate the membranes directly

Explanation

Sterile speculum examination demonstrating fluid pooling in the posterior fornix, supported by nitrazine or fern testing, is the standard bedside confirmation of membrane rupture. Digital vaginal examination is avoided because it introduces infection risk and shortens the latency period without adding diagnostic certainty.

Question 6Antenatal Care and Midwifery Assessment

Which finding on routine antenatal screening should prompt immediate referral for assessment of possible preterm labour at 30 weeks?

  1. Increased clear vaginal discharge without contractions
  2. A single episode of low backache relieved by paracetamol
  3. Braxton Hicks contractions that resolve with hydration and rest
  4. Regular painful contractions with progressive cervical change Correct answer.

Explanation

Regular painful contractions accompanied by progressive cervical dilatation or effacement define preterm labour and require urgent assessment for tocolysis, steroids, and magnesium sulfate neuroprotection. Irregular painless contractions and isolated symptoms without cervical change do not meet that threshold.

Question 7Antenatal Care and Midwifery Assessment

A woman at 34 weeks has a fundal height of 28 cm and a history of a previous small-for-gestational-age baby. What is the most appropriate midwifery action?

  1. Arrange ultrasound biometry and umbilical artery Doppler assessment Correct answer.
  2. Advise a high-calorie diet to accelerate fetal growth
  3. Recommend increased maternal bed rest to improve placental perfusion
  4. Reassure that fundal height varies and repeat measurement in four weeks

Explanation

A fundal height more than 3 cm below gestation with a prior small-for-gestational-age infant raises concern for fetal growth restriction and warrants ultrasound biometry with umbilical artery Doppler. Serial measurement alone delays diagnosis, and bed rest or increased calories do not treat uteroplacental insufficiency.

Question 8Antenatal Care and Midwifery Assessment

When should a woman with an uncomplicated singleton pregnancy first feel fetal movements, and what advice should the midwife give about monitoring them?

  1. Around 28 weeks, with advice to perform kick counts only if bleeding occurs
  2. Around 12 weeks, with advice to count ten movements every hour from 16 weeks
  3. Around 24 weeks, with advice to use a home Doppler daily
  4. Around 18 to 20 weeks, with advice to be aware of her baby's individual pattern from the third trimester Correct answer.

Explanation

Most women first perceive movements between 18 and 20 weeks, and from the third trimester they should be aware of their baby's individual movement pattern. Reduced or changed movements should prompt same-day assessment; routine kick charts and home Dopplers are not recommended because they give false reassurance.

Question 9Antenatal Care and Midwifery Assessment

A woman at 26 weeks has a random plasma glucose of 11.4 mmol/L and symptoms of polyuria and thirst. What is the correct interpretation and action?

  1. This should be ignored until the routine 28-week oral glucose tolerance test
  2. This indicates pre-existing type 1 diabetes and requires insulin before any further testing
  3. This meets diagnostic criteria for gestational diabetes and requires immediate referral for management Correct answer.
  4. This is normal in pregnancy because fasting glucose falls and random values rise

Explanation

A random plasma glucose of 11.1 mmol/L or higher with classic symptoms is diagnostic of diabetes in pregnancy and requires prompt referral for dietary and pharmacological management. Waiting for the routine test or attributing the value to normal physiology risks maternal and fetal harm.

Question 10Antenatal Care and Midwifery Assessment

Which woman should be offered anti-D immunoglobulin during pregnancy according to standard prophylaxis?

  1. An RhD-negative woman whose baby is confirmed RhD-negative by cell-free DNA
  2. An RhD-positive woman with a negative antibody screen
  3. An RhD-negative woman with no anti-D antibodies at 28 weeks Correct answer.
  4. An RhD-negative woman who already has immune anti-D antibodies

Explanation

Routine antenatal anti-D prophylaxis is offered to RhD-negative women who are not already sensitised, typically around 28 weeks, plus after sensitising events. Once immune anti-D antibodies are present, prophylaxis is no longer useful, and it is unnecessary if the fetus is known to be RhD-negative.

Question 11Antenatal Care and Midwifery Assessment

At 36 weeks, a woman's fetus is found to be in a frank breech presentation. Which statement about her options is most accurate?

  1. Breech presentation at 36 weeks always requires immediate caesarean section before labour
  2. External cephalic version can be offered after 37 weeks in the absence of contraindications Correct answer.
  3. Vaginal breech birth is contraindicated in all circumstances
  4. Moxibustion has strong evidence supporting routine use for breech version

Explanation

External cephalic version is typically offered from 37 weeks to women with breech presentation and no contraindications, with success in roughly half of attempts. Many breeches turn spontaneously before term, and planned vaginal breech birth remains possible in selected cases with experienced support.

Question 12Antenatal Care and Midwifery Assessment

A woman at 38 weeks reports a severe constant abdominal pain with a board-like uterus and vaginal bleeding. What is the priority midwifery action?

  1. Arrange an outpatient ultrasound for the following morning
  2. Give oral analgesia and reassess in one hour
  3. Call for emergency obstetric review and prepare for immediate caesarean section Correct answer.
  4. Perform a digital vaginal examination to assess cervical dilatation

Explanation

Painful bleeding with a rigid, tender uterus suggests placental abruption, an obstetric emergency requiring immediate senior review, maternal stabilisation, and often expedited delivery. Digital examination is avoided because it may worsen bleeding, especially if placenta praevia coexists.

Question 13Antenatal Care and Midwifery Assessment

Which combination of maternal observations is most consistent with severe pre-eclampsia requiring urgent escalation?

  1. Blood pressure 142/88 mmHg with negative proteinuria and normal reflexes
  2. Blood pressure 132/84 mmHg with trace proteinuria and no symptoms
  3. Blood pressure 168/112 mmHg with 3+ proteinuria and new frontal headache Correct answer.
  4. Blood pressure 118/70 mmHg with 1+ proteinuria and mild ankle oedema

Explanation

Severe hypertension with heavy proteinuria and neurological symptoms such as frontal headache indicates severe pre-eclampsia and warrants urgent escalation for antihypertensives, magnesium sulfate, and delivery planning. The other profiles lack the severity criteria of markedly raised pressure with symptoms.

Question 14Antenatal Care and Midwifery Assessment

A woman with a body mass index of 38 kg/m2 books at 9 weeks. Which antenatal plan best reflects current guidance?

  1. Advice to limit weight gain to under 2 kg for the whole pregnancy
  2. Routine thromboprophylaxis with low molecular weight heparin for all obese women
  3. Routine midwifery-led care with no additional screening
  4. Referral for specialist obstetric-led care with early screening for diabetes and anaemia Correct answer.

Explanation

A booking BMI of 35 kg/m2 or more warrants consultant-led care and enhanced screening, including early glucose testing and attention to anaemia, hypertension, and thromboembolic risk. Universal heparin prophylaxis and severe caloric restriction are not recommended.

Question 15Antenatal Care and Midwifery Assessment

Which screening approach is standard for detecting asymptomatic bacteriuria in pregnancy?

  1. Screening only if the woman reports dysuria
  2. Urine culture at booking and at least once later in pregnancy Correct answer.
  3. Urine microscopy for casts at 36 weeks
  4. Dipstick testing for nitrites at every visit only

Explanation

Urine culture is the standard because asymptomatic bacteriuria is common in pregnancy and, if untreated, predisposes to pyelonephritis and preterm birth. Dipstick testing alone is insufficiently sensitive, and symptom-triggered testing misses the asymptomatic cases that screening aims to find.

Question 16Antenatal Care and Midwifery Assessment

A woman at 16 weeks reports vaginal bleeding and passage of grape-like tissue, and her uterus is larger than dates. Which diagnosis should the midwife prioritise when escalating?

  1. Cervical ectropion
  2. Placenta praevia
  3. Gestational trophoblastic disease such as hydatidiform mole Correct answer.
  4. Threatened miscarriage of a normal intrauterine pregnancy

Explanation

Vaginal bleeding with grape-like vesicles and a uterus large for dates is classic for hydatidiform mole, which requires urgent ultrasound, hCG measurement, and referral to a trophoblastic centre. Placenta praevia causes painless bleeding later in pregnancy without vesicular tissue.

Question 17Antenatal Care and Midwifery Assessment

A woman at 12 weeks has a haemoglobin of 104 g/L with a normal mean cell volume. What is the most appropriate interpretation and plan?

  1. Immediate blood transfusion is required
  2. No action is needed because haemoglobin falls in all pregnancies without consequence
  3. This confirms beta-thalassaemia major
  4. Physiological haemodilution is likely, but iron stores should be assessed and diet reviewed with recheck Correct answer.

Explanation

Plasma volume expansion lowers haemoglobin in pregnancy, so a value of 104 g/L at 12 weeks is common, but iron status should still be checked and dietary advice given with a planned recheck. Transfusion is reserved for severe symptomatic anaemia, and a normal MCV does not suggest thalassaemia major.

Question 18Antenatal Care and Midwifery Assessment

Which vaccine is routinely recommended in every pregnancy, regardless of trimester, to protect the newborn?

  1. Live attenuated measles, mumps, and rubella vaccine
  2. Live attenuated varicella vaccine
  3. Human papillomavirus vaccine
  4. Tetanus, diphtheria, and acellular pertussis vaccine Correct answer.

Explanation

Pertussis-containing vaccine is recommended in every pregnancy, usually in the second or third trimester, so that maternal antibodies cross the placenta and protect the infant before immunisation begins. Live vaccines such as varicella and MMR are contraindicated in pregnancy.

Question 19Antenatal Care and Midwifery Assessment

A woman at 20 weeks reports a persistent low mood, anhedonia, and poor sleep for the past month. What is the most appropriate midwifery approach?

  1. Advise her to stop any antidepressant immediately without specialist input
  2. Defer any discussion of mood until the postnatal period
  3. Explore her mental health sensitively, use a validated tool such as the Edinburgh Postnatal Depression Scale, and refer as indicated Correct answer.
  4. Reassure her that low mood is a normal pregnancy symptom and review at 28 weeks

Explanation

Persistent low mood and anhedonia in pregnancy should be explored with a validated screening tool and, where indicated, referred for psychological or psychiatric care. Perinatal depression is common and treatable, and abrupt cessation of antidepressants without specialist advice risks relapse.

Question 20Antenatal Care and Midwifery Assessment

A woman at 34 weeks has an obstetric history of one previous caesarean section and now has a singleton cephalic pregnancy with no other risk factors. What is the most accurate counselling point?

  1. Uterine rupture risk makes any trial of labour unacceptable
  2. Induction of labour with misoprostol is the preferred method if delivery is needed
  3. Elective repeat caesarean is mandatory after any previous caesarean
  4. Planned vaginal birth after caesarean is a reasonable option with continuous fetal monitoring in labour Correct answer.

Explanation

For most women with one previous caesarean and no contraindications, planned vaginal birth is a reasonable and often appropriate choice, provided labour is monitored and the unit can perform emergency caesarean. Repeat caesarean is an option rather than a mandate, and prostaglandin induction carries higher rupture risk.

Question 21Antenatal Care and Midwifery Assessment

At 32 weeks, a woman with a twin pregnancy asks about birth planning. Which statement best reflects evidence-based counselling?

  1. Vaginal birth is contraindicated for all twin pregnancies
  2. Twin pregnancies require no additional fetal surveillance beyond routine care
  3. All twin pregnancies should be delivered by 30 weeks
  4. Planned caesarean is generally recommended for twins where the first twin is not cephalic Correct answer.

Explanation

For twins with a non-cephalic first twin, planned caesarean reduces the risk of intrapartum complications and is generally recommended, whereas cephalic first twins may be suitable for vaginal birth. Twins also require more intensive surveillance and are usually delivered nearer term, not at 30 weeks.

Question 22Antenatal Care and Midwifery Assessment

Which finding on a routine antenatal visit at 28 weeks most strongly suggests a need for urgent assessment for venous thromboembolism?

  1. Bilateral mild ankle oedema after a long day standing
  2. Generalised pruritus without rash
  3. Unilateral calf swelling with pain on dorsiflexion Correct answer.
  4. Varicose veins with mild aching in both legs

Explanation

Unilateral leg swelling with calf pain raises suspicion of deep vein thrombosis, which is more common in pregnancy and requires urgent compression ultrasound and anticoagulation assessment. Bilateral dependent oedema and varicose veins are common physiological findings, and generalised itching suggests cholestasis rather than thrombosis.

Question 23Antenatal Care and Midwifery Assessment

Which is the recommended initial management for a woman at 34 weeks with confirmed prelabour rupture of membranes and no signs of infection?

  1. Digital vaginal examinations every four hours to assess progress
  2. Admission for observation with antibiotics and antenatal corticosteroids, planning delivery around 37 weeks Correct answer.
  3. Discharge home with no follow-up until 40 weeks
  4. Immediate caesarean section regardless of fetal status

Explanation

For preterm prelabour rupture of membranes remote from term, expectant management with antibiotics, corticosteroids, and close monitoring for chorioamnionitis is standard, with delivery usually planned around 37 weeks if the course remains uncomplicated. Serial digital examinations increase infection risk and are avoided.

Question 24Antenatal Care and Midwifery Assessment

What is the purpose of the mid-stream urine sample collected at the first antenatal visit?

  1. To detect asymptomatic bacteriuria and proteinuria that may indicate renal or hypertensive disease Correct answer.
  2. To screen for group B streptococcus colonisation
  3. To measure gestational diabetes using a glucose load
  4. To determine fetal rhesus status

Explanation

The booking urine sample is cultured to detect asymptomatic bacteriuria and tested for protein, which can signal renal disease or hypertensive disorders. Diabetes screening uses specific glucose tests, fetal rhesus status uses maternal antibody testing or cell-free DNA, and group B streptococcus screening is not done by routine culture at booking.

Question 25Antenatal Care and Midwifery Assessment

A woman at 30 weeks is found to have a low-lying placenta on ultrasound. Which counselling is most appropriate?

  1. She should be booked for elective caesarean at 32 weeks
  2. Repeat ultrasound later in pregnancy is needed, and she should report any painless bleeding immediately Correct answer.
  3. Vaginal delivery is now permanently contraindicated regardless of later imaging
  4. She can be reassured the placenta will never move

Explanation

Most low-lying placentas apparent in the second trimester resolve as the uterus grows, so a repeat scan in the third trimester is arranged, with advice to report painless bleeding urgently. Delivery planning depends on the follow-up finding, and a persistent placenta praevia would require caesarean.

Question 26Antenatal Care and Midwifery Assessment

A woman books for antenatal care at 9 weeks of gestation. Which formula correctly calculates her estimated date of delivery (EDD) using Naegele's rule?

  1. Add 9 months and 7 days to the first day of her last menstrual period Correct answer.
  2. Add 7 months and 9 days to the first day of her last menstrual period
  3. Add 280 days to the date of her first positive pregnancy test
  4. Add 266 days to the date of her first ultrasound scan

Explanation

Naegele's rule estimates the EDD by adding 9 calendar months and 7 days to the first day of the last menstrual period (LMP), which corresponds to 280 days or 40 weeks. This assumes a regular 28-day cycle with ovulation on day 14; if the cycle is irregular or longer, ultrasound dating in the first trimester is more accurate. The rule uses the LMP, not the date of a pregnancy test or scan.

Question 27Antenatal Care and Midwifery Assessment

At the first antenatal visit, a woman at 10 weeks is offered routine screening. Which set of investigations is recommended for all pregnant women in Jordan at booking?

  1. Full blood count, blood group and antibodies, rubella immunity, and hepatitis B surface antigen Correct answer.
  2. Full blood count, blood group and antibodies, thyroid function tests, and vitamin D level
  3. Full blood count, blood group and antibodies, HIV test, and syphilis serology
  4. Full blood count, blood group and antibodies, random blood glucose, and urine culture

Explanation

Routine booking investigations include a full blood count to detect anaemia, blood group and antibody screen to identify Rh negativity and atypical antibodies, rubella immunity to identify women who need postnatal vaccination, and hepatitis B surface antigen to plan newborn immunoprophylaxis. HIV and syphilis screening are also recommended in many programmes, but the option that lists rubella and hepatitis B together with FBC and blood group is the standard core set. Random blood glucose, thyroid function, and vitamin D are not universal booking tests.

Question 28Antenatal Care and Midwifery Assessment

A woman at 28 weeks of gestation has a haemoglobin of 95 g/L with a mean cell volume of 72 fL. She reports fatigue and follows a diet low in red meat. What is the most appropriate initial management?

  1. Prescribe oral iron supplementation and advise dietary iron-rich foods, then recheck in 4 weeks Correct answer.
  2. Request haemoglobin electrophoresis before starting any iron treatment
  3. Reassure her that haemodilution causes low haemoglobin in pregnancy and recheck at 36 weeks
  4. Arrange urgent blood transfusion and admit for intravenous iron therapy

Explanation

A haemoglobin of 95 g/L with a microcytic MCV of 72 fL in a woman with low dietary iron intake strongly suggests iron-deficiency anaemia, which is common in pregnancy. The initial management is oral iron supplementation with dietary advice, followed by a repeat full blood count in about 4 weeks to assess response. Transfusion is reserved for severe symptomatic anaemia, and haemoglobin electrophoresis is considered if the MCV remains low despite iron therapy or if thalassaemia is suspected.

Question 29Antenatal Care and Midwifery Assessment

A woman at 18 weeks of gestation asks about the mid-trimester ultrasound scan. Which statement best describes the main purpose of the anomaly scan performed at 18–22 weeks?

  1. It determines the fetal sex for social reasons and assesses amniotic fluid volume only
  2. It screens for gestational diabetes by measuring fetal abdominal circumference
  3. It detects major fetal structural anomalies and assesses fetal growth and placental position Correct answer.
  4. It confirms the estimated date of delivery with the greatest accuracy

Explanation

The mid-trimester anomaly scan at 18–22 weeks is performed to detect major structural fetal anomalies, assess fetal biometry and growth, and locate the placenta. It is not the most accurate method for dating; first-trimester ultrasound is more precise. Fetal sex may be visualised but is not the primary purpose, and gestational diabetes is screened with blood tests, not ultrasound.

Question 30Antenatal Care and Midwifery Assessment

A woman at 24 weeks of gestation has a blood pressure of 148/96 mmHg on two occasions 4 hours apart. She has no headache, visual disturbance, or epigastric pain, and her urine dipstick shows no protein. What is the most appropriate next step in her antenatal management?

  1. Reassure her that isolated hypertension at 24 weeks is normal and review at the next routine visit
  2. Prescribe bed rest at home and repeat the blood pressure in 2 weeks
  3. Start antihypertensive treatment and arrange close monitoring with twice-weekly blood pressure checks and pre-eclampsia bloods Correct answer.
  4. Admit for immediate delivery because the blood pressure is above 140/90 mmHg

Explanation

A blood pressure of 148/96 mmHg at 24 weeks meets the definition of hypertension in pregnancy and requires assessment for pre-eclampsia, including blood tests and urine protein quantification. Antihypertensive treatment is usually started when blood pressure is persistently 140/90 mmHg or higher to reduce the risk of severe hypertension. Delivery at 24 weeks would only be considered for severe maternal or fetal compromise, which is not present here.

Question 31Antenatal Care and Midwifery Assessment

A woman at 32 weeks of gestation reports a sudden onset of severe constant abdominal pain, a tense and tender uterus, and reduced fetal movements. Her blood pressure is 90/50 mmHg and she looks pale. What is the most likely diagnosis?

  1. Round ligament pain
  2. Uterine rupture
  3. Placental abruption Correct answer.
  4. Acute chorioamnionitis

Explanation

Severe constant abdominal pain with a tense, tender uterus, reduced fetal movements, and maternal hypotension and pallor at 32 weeks is the classic presentation of placental abruption. The pain is due to bleeding into the decidua, and the hypotension reflects concealed or revealed blood loss. Uterine rupture usually occurs in labour or after previous uterine surgery and is associated with loss of station and fetal bradycardia.

Question 32Antenatal Care and Midwifery Assessment

A woman at 26 weeks of gestation with a singleton pregnancy is RhD negative and has no anti-D antibodies. She has not received anti-D prophylaxis yet. According to standard antenatal prophylaxis, when should she receive her first routine dose of anti-D immunoglobulin?

  1. At 20 weeks of gestation
  2. At 28 weeks of gestation Correct answer.
  3. At 34 weeks of gestation
  4. Only after delivery if the baby is RhD positive

Explanation

Routine antenatal anti-D prophylaxis is given at 28 weeks of gestation to RhD-negative women without anti-D antibodies, often followed by a second dose at 34 weeks depending on the regimen. This reduces the risk of sensitisation during the third trimester. Postnatal anti-D is given within 72 hours after delivery if the baby is RhD positive, but antenatal prophylaxis is also required.

Question 33Antenatal Care and Midwifery Assessment

A woman at 34 weeks of gestation presents with a history of a previous caesarean section and now has a singleton cephalic pregnancy. She asks about her options for birth. Which statement best reflects evidence-based counselling?

  1. A trial of labour is contraindicated after any caesarean section
  2. Induction of labour is always recommended at 39 weeks to avoid the risk of uterine rupture
  3. A trial of labour is a reasonable option with continuous fetal monitoring and immediate access to theatre Correct answer.
  4. A planned caesarean section is mandatory because of the previous scar

Explanation

For a woman with one previous caesarean section and a singleton cephalic pregnancy, a trial of labour is a reasonable option because most women achieve vaginal birth, and the risk of uterine rupture is low with continuous monitoring and access to emergency caesarean. Planned caesarean is an alternative, not mandatory. Induction of labour may be considered but is not universally recommended at 39 weeks solely to prevent rupture.

Question 34Antenatal Care and Midwifery Assessment

A woman at 36 weeks of gestation with a singleton pregnancy is found to have a fetus in a frank breech presentation on ultrasound. She has no other complications. Which statement about her options is most accurate?

  1. External cephalic version should be offered now at 36 weeks before labour begins
  2. She should be advised to have a vaginal breech birth because it is as safe as caesarean section for all babies
  3. External cephalic version is usually offered at 37 weeks or later, and she should be counselled about success rates and risks Correct answer.
  4. Breech presentation at 36 weeks always requires immediate caesarean section

Explanation

External cephalic version (ECV) is typically offered from 37 weeks of gestation to women with an uncomplicated singleton breech, because some fetuses turn spontaneously before then and ECV success is higher near term. Counselling should cover success rates, the small risk of complications, and the option of planned caesarean if ECV fails. Immediate caesarean at 36 weeks is not indicated, and vaginal breech birth is only considered in selected cases.

Question 35Antenatal Care and Midwifery Assessment

A woman at 38 weeks of gestation presents with a severe constant abdominal pain, a board-like uterus, and vaginal bleeding. Her blood pressure is 100/60 mmHg and her pulse is 110 beats per minute. What is the most appropriate immediate management?

  1. Give intravenous fluids, cross-match blood, and arrange urgent caesarean section Correct answer.
  2. Perform an ultrasound scan to locate the placenta before any intervention
  3. Give a tocolytic to relax the uterus and reassess in 1 hour
  4. Discharge her with analgesia and advise return if bleeding increases

Explanation

The presentation is consistent with placental abruption with maternal haemodynamic compromise, which is an obstetric emergency. Immediate management includes resuscitation with intravenous fluids, blood cross-matching, and urgent delivery, usually by caesarean section, to save the mother and fetus. Ultrasound is not required before acting when the clinical diagnosis is clear and the mother is unstable.

Question 36Antenatal Care and Midwifery Assessment

A woman at 28 weeks of gestation with a singleton pregnancy reports that she has not felt fetal movements for the past 12 hours. She has no bleeding or pain. What is the most appropriate next step?

  1. Arrange immediate assessment with auscultation of the fetal heart and cardiotocography Correct answer.
  2. Reassure her that fetal movements are often reduced at 28 weeks and ask her to monitor for another 24 hours
  3. Perform an ultrasound scan in 1 week to check fetal growth
  4. Advise her to drink cold water and lie on her left side, then reassess in 2 days

Explanation

Reduced fetal movements at 28 weeks require immediate assessment because they can be a sign of fetal compromise. The initial evaluation includes auscultation of the fetal heart and cardiotocography, with further ultrasound if indicated. Reassurance without assessment, delaying a scan for a week, or advising reassessment in 2 days risks missing fetal deterioration.

Question 37Antenatal Care and Midwifery Assessment

A woman at 26 weeks of gestation has a random plasma glucose of 11.4 mmol/L and symptoms of polyuria and thirst. What is the most appropriate next step?

  1. Arrange an oral glucose tolerance test to confirm gestational diabetes
  2. Repeat the random glucose in 2 weeks
  3. Diagnose gestational diabetes and start dietary advice and home glucose monitoring Correct answer.
  4. Reassure her that polyuria and thirst are normal in pregnancy

Explanation

A random plasma glucose of 11.4 mmol/L with symptoms of polyuria and thirst meets the diagnostic criteria for gestational diabetes, so further confirmatory testing is not required. Management should begin with dietary advice, home glucose monitoring, and referral to a diabetes team. An oral glucose tolerance test is unnecessary and would delay treatment.

Question 38Antenatal Care and Midwifery Assessment

A woman at 20 weeks of gestation reports a persistent low mood, anhedonia, and poor sleep for the past month. She has no thoughts of self-harm. What is the most appropriate initial response from the midwife?

  1. Advise her to stop taking any antenatal vitamins because they may be causing her symptoms
  2. Ask about suicidal ideation, use a validated screening tool such as the Edinburgh Postnatal Depression Scale, and refer for psychological support Correct answer.
  3. Prescribe an antidepressant immediately without further assessment
  4. Reassure her that mood changes are a normal part of pregnancy and review at 28 weeks

Explanation

Persistent low mood, anhedonia, and poor sleep for a month suggest antenatal depression and require formal assessment. The midwife should ask about suicidal ideation, use a validated screening tool such as the EPDS, and refer for psychological support or specialist mental health care as appropriate. Reassurance alone, immediate prescribing without assessment, or stopping vitamins are not appropriate.

Question 39Antenatal Care and Midwifery Assessment

A woman at 34 weeks of gestation has a body mass index of 38 kg/m2. She has no other medical conditions. Which antenatal plan best reflects current guidance for obesity in pregnancy?

  1. Perform a routine ultrasound scan at 32 weeks only to estimate fetal weight
  2. Offer a 75-g oral glucose tolerance test at 24–28 weeks and plan for anaesthetic review Correct answer.
  3. Schedule an early induction of labour at 37 weeks to prevent macrosomia
  4. Advise weight loss during pregnancy to reduce the risk of complications

Explanation

Women with a body mass index of 30 kg/m2 or more should be offered a 75-g oral glucose tolerance test at 24–28 weeks because of the increased risk of gestational diabetes. Anaesthetic review is also recommended for women with a BMI of 35 or more to plan analgesia and anaesthesia. Weight loss is not advised during pregnancy, and routine early induction is not recommended solely for obesity.

Question 40Antenatal Care and Midwifery Assessment

A woman at 30 weeks of gestation is found to have a low-lying placenta on ultrasound. She is asymptomatic. Which counselling is most appropriate?

  1. She should be advised to have a pelvic examination at the next visit to check for bleeding
  2. She should be booked for an immediate caesarean section at 32 weeks
  3. She should be reassured that the placenta will always move up and no follow-up is needed
  4. She should be advised to have a repeat ultrasound scan at 32–34 weeks to assess placental position Correct answer.

Explanation

A low-lying placenta at 30 weeks often resolves as the uterus grows, so a repeat ultrasound at 32–34 weeks is recommended to reassess placental position. If the placenta remains low at 36 weeks, further planning for delivery is needed. Immediate caesarean at 32 weeks is not indicated for an asymptomatic low-lying placenta, and pelvic examination should be avoided because it may provoke bleeding.

Question 41Intrapartum Care and Labour Management

A woman in active labour at 6 cm dilatation has a fetal heart rate baseline of 165 beats per minute sustained over 15 minutes. How is this pattern classified?

  1. Normal baseline variability
  2. Fetal tachycardia Correct answer.
  3. Baseline of 165 is uninterpretable without a contraction pattern
  4. Fetal bradycardia

Explanation

The normal fetal heart rate baseline lies between 110 and 160 beats per minute. A baseline above 160 sustained for at least 10 minutes is classified as fetal tachycardia and warrants evaluation for maternal fever, dehydration, infection, or fetal hypoxia.

Question 42Intrapartum Care and Labour Management

During the second stage of labour, which maternal action best supports spontaneous expulsion of the fetus while protecting the perineum?

  1. Pushing with an open glottis while exhaling during contractions Correct answer.
  2. Avoiding all pushing effort until the fetal head is visible
  3. Sustained closed-glottis pushing for the full length of each contraction
  4. Holding the breath and pushing as hard as possible at the start of each contraction

Explanation

Open-glottis pushing with exhalation distributes pressure more gradually, reduces Valsalva-related haemodynamic changes, and lowers the risk of perineal trauma compared with sustained breath-holding. Closed-glottis pushing raises intrathoracic pressure sharply and is associated with reduced maternal cardiac output and more perineal injury.

Question 43Intrapartum Care and Labour Management

Which finding on vaginal examination confirms that the second stage of labour has begun?

  1. Regular contractions every 3 minutes lasting 60 seconds
  2. Full cervical dilatation with the presenting part at or below the ischial spines Correct answer.
  3. Rupture of membranes with clear liquor draining
  4. Cervical dilatation of 8 cm with a soft, anterior cervix

Explanation

The second stage is defined as the period from full dilatation of the cervix to delivery of the baby. Full dilatation alone is not always sufficient; progressive descent of the presenting part and maternal urge to push accompany the diagnosis.

Question 44Intrapartum Care and Labour Management

A labouring woman at 4 cm dilatation has a temperature of 38.4 degrees Celsius and a fetal baseline of 170 beats per minute. What is the most appropriate initial nursing action?

  1. Document the findings and reassess in 4 hours
  2. Increase the oxytocin infusion rate to shorten labour
  3. Reassure the woman that mild fever is expected in labour
  4. Notify the obstetric team and initiate investigations for maternal infection Correct answer.

Explanation

Maternal pyrexia in labour is associated with chorioamnionitis and with fetal tachycardia, and requires prompt medical review, cultures, and consideration of antibiotics and antipyretics. Delay risks maternal sepsis and fetal compromise.

Question 45Intrapartum Care and Labour Management

Which description correctly defines a category III fetal heart rate tracing according to standardised interpretation?

  1. Variable decelerations with moderate variability and a normal baseline
  2. Baseline of 115 with minimal variability and no accelerations
  3. Absent baseline variability with recurrent late decelerations or bradycardia Correct answer.
  4. Baseline of 150 with moderate variability and no decelerations

Explanation

Category III tracings are abnormal and include absent baseline variability combined with recurrent late or variable decelerations, bradycardia, or a sinusoidal pattern. They require immediate intrauterine resuscitation and expedited delivery assessment.

Question 46Intrapartum Care and Labour Management

What is the primary purpose of administering an oxytocin infusion in the first stage of labour?

  1. To soften the cervix before induction
  2. To prevent postpartum haemorrhage before delivery
  3. To augment inadequate uterine contractions when labour progress is slow Correct answer.
  4. To relieve pain during contractions

Explanation

Oxytocin is given intrapartum to augment or induce uterine contractions when they are inadequate for progress. It must be titrated with continuous fetal monitoring because of the risk of hyperstimulation.

Question 47Intrapartum Care and Labour Management

A woman receiving oxytocin has contractions lasting 95 seconds with less than 1 minute of rest between them and recurrent late decelerations. What is the priority action?

  1. Continue the infusion and document the decelerations
  2. Administer an opioid analgesic and reassess in 30 minutes
  3. Increase the oxytocin to complete cervical dilatation faster
  4. Stop the oxytocin infusion and reposition the woman in a left lateral position Correct answer.

Explanation

This pattern meets the definition of uterine tachysystole with associated fetal decelerations, requiring immediate discontinuation of oxytocin and intrauterine resuscitation. Repositioning improves uteroplacental perfusion while the team is summoned.

Question 48Intrapartum Care and Labour Management

Which assessment finding most strongly suggests that a woman has entered the latent phase of the first stage of labour?

  1. Contractions every 2 minutes with the fetal head visible at the introitus
  2. Third-stage placental separation with lengthening of the cord
  3. Full dilatation with the urge to bear down
  4. Regular painful contractions with cervical dilatation of 2 cm and progressive effacement Correct answer.

Explanation

The latent first stage extends from the onset of regular contractions to about 4 to 5 cm dilatation with progressive cervical effacement. The active first stage begins once dilatation advances more rapidly beyond that point.

Question 49Intrapartum Care and Labour Management

During a vaginal examination the midwife notes the fetal head is at station minus 2. What does this indicate?

  1. The leading edge of the presenting part is 2 cm above the ischial spines Correct answer.
  2. The fetal head is 2 cm below the ischial spines
  3. The cervix is 2 cm dilated
  4. The fetal head is at the pelvic outlet

Explanation

Station describes the level of the presenting part relative to the ischial spines, measured in centimetres. Negative values indicate the presenting part is above the spines, and positive values indicate descent below them.

Question 50Intrapartum Care and Labour Management

A woman in the active first stage has a cervical dilatation of 5 cm on examination and 5 cm again 4 hours later, with regular contractions and ruptured membranes. How should this be described?

  1. Prolonged active first stage requiring obstetric review Correct answer.
  2. Second stage of labour
  3. Obstructed labour requiring immediate caesarean section
  4. Normal progress because the latent phase can last 12 hours

Explanation

In the active first stage, dilatation of less than 0.5 cm per hour over 4 hours or more is considered slow progress and warrants review for causes such as inefficient contractions, malposition, or cephalopelvic disproportion. The finding is not automatically obstructed labour but must be assessed.