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PRC Midwives LE practice questions

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Question 1Antepartal Care

A client at 28 weeks' gestation has a fundal height measured at 24 cm. Which follow-up action is most appropriate for the licensed midwife?

  1. Document the measurement and recheck at the next routine visit in four weeks
  2. Arrange an ultrasound assessment for fetal growth evaluation Correct answer.
  3. Reassure the client that fundal height varies widely between individuals
  4. Instruct the client to increase protein intake and return in two weeks

Explanation

Fundal height in centimeters generally approximates gestational age in weeks between 20 and 36 weeks. A discrepancy of 4 cm or more warrants further evaluation, typically ultrasound, to assess fetal growth, amniotic fluid, and gestational dating. Simple rechecking at a routine interval delays identification of growth restriction or other pathology.

Question 2Antepartal Care

Which laboratory value is most consistent with physiologic hemodilution in a client at 30 weeks' gestation?

  1. Platelet count 90,000/mm3
  2. Hemoglobin 10.5 g/dL with hematocrit 32% Correct answer.
  3. White blood cell count 4,000/mm3
  4. Hemoglobin 15.2 g/dL with hematocrit 46%

Explanation

Plasma volume expands proportionally more than red cell mass during pregnancy, producing a dilutional drop in hemoglobin and hematocrit. Values near 10.5 g/dL and 32% fall within the accepted pregnancy-adjusted range. Marked elevations, thrombocytopenia, or leukopenia suggest pathology rather than normal hemodilution.

Question 3Antepartal Care

A client at 12 weeks' gestation reports nausea and vomiting that has prevented her from keeping fluids down for 24 hours. Which finding most strongly indicates a need for urgent referral?

  1. Aversion to the smell of coffee and fried foods
  2. Nausea that is worse in the evening than in the morning
  3. Weight loss of 6% from prepregnancy weight with orthostatic dizziness Correct answer.
  4. Mild ketonuria on a first-morning urine sample

Explanation

Hyperemesis gravidarum is suggested by persistent vomiting with dehydration, significant weight loss, and orthostatic symptoms. Weight loss exceeding 5% of prepregnancy weight combined with volume depletion warrants urgent evaluation and possible intravenous rehydration. Isolated mild ketonuria or specific food aversions do not by themselves indicate severity.

Question 4Antepartal Care

At what gestational age is a client most appropriately offered screening for gestational diabetes using a one-hour 50 g glucose challenge?

  1. 8 to 12 weeks
  2. 34 to 36 weeks
  3. 16 to 20 weeks
  4. 24 to 28 weeks Correct answer.

Explanation

Routine screening for gestational diabetes is recommended between 24 and 28 weeks' gestation, when insulin resistance from placental hormones becomes pronounced. Earlier testing is reserved for clients with risk factors such as prior gestational diabetes or obesity. Testing after 28 weeks delays diagnosis and treatment.

Question 5Antepartal Care

A client at 34 weeks' gestation has a blood pressure of 148/96 mmHg on two occasions four hours apart, with 2+ proteinuria. Which diagnosis best fits these findings?

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

Explanation

New-onset hypertension after 20 weeks accompanied by proteinuria defines preeclampsia. Without severe-range pressures, thrombocytopenia, renal insufficiency, or neurologic symptoms, it is classified as without severe features. Chronic hypertension requires preexisting diagnosis, and gestational hypertension lacks proteinuria.

Question 6Antepartal Care

A client at 18 weeks' gestation with a body mass index of 34 kg/m2 asks about aneuploidy screening. Which statement is most accurate?

  1. Maternal serum screening markers may be altered by obesity and require adjusted interpretation Correct answer.
  2. Screening should be deferred until the third trimester in clients with obesity
  3. Cell-free DNA screening is not interpretable in clients with obesity
  4. Invasive testing should be performed routinely because screening is unreliable

Explanation

Obesity alters maternal serum analyte concentrations, lowering the sensitivity of traditional multiple-marker screening. Laboratories apply weight-adjusted calculations, and cell-free DNA remains an option though fetal fraction may be reduced. Routine invasive testing is not indicated based on body mass index alone.

Question 7Antepartal Care

Which immunization is recommended during every pregnancy regardless of prior vaccination history, typically in the second or third trimester?

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

Explanation

Tdap is recommended during each pregnancy, preferably between 27 and 36 weeks, to maximize transplacental antibody transfer to the newborn. Live vaccines such as MMR and varicella are contraindicated in pregnancy. Inactivated influenza vaccine is recommended but is not the same as the live formulation listed.

Question 8Antepartal Care

A client at 26 weeks' gestation reports regular uterine tightening every 10 minutes with lower back pressure. Which initial action is most appropriate?

  1. Assess cervical change and arrange urgent evaluation for preterm labor Correct answer.
  2. Recommend bed rest at home until the contractions resolve
  3. Advise increased oral fluids and reassess in one week
  4. Reassure the client that Braxton Hicks contractions are expected at this stage

Explanation

Regular contractions at 10-minute intervals before 37 weeks with associated back pressure raise concern for preterm labor. Evaluation includes cervical examination, fetal fibronectin testing where available, and fetal monitoring. Dismissing symptoms or delaying assessment risks missing progressive cervical dilation.

Question 9Antepartal Care

Which instruction should the midwife give a client at 24 weeks' gestation regarding fetal movement awareness?

  1. Become familiar with the baby's usual activity pattern and report any reduction after 28 weeks Correct answer.
  2. Perform a formal count-to-ten protocol three times daily from this point forward
  3. Begin daily kick counts now and report fewer than ten movements per hour
  4. Note the time of first daily movement and report if it is delayed by two hours

Explanation

Clients are encouraged to learn their baby's normal movement pattern, with attention to reduced fetal movement beginning around 28 weeks when patterns are established. Formal kick-count protocols are not universally recommended and vary by guideline. Reporting a change from the established pattern is the key safety message.

Question 10Antepartal Care

A client at 10 weeks' gestation has a hemoglobin of 9.8 g/dL with a mean corpuscular volume of 72 fL. Which cause is most likely?

  1. Vitamin B12 deficiency anemia
  2. Thalassemia trait
  3. Iron deficiency anemia Correct answer.
  4. Folate deficiency anemia

Explanation

Microcytic anemia with a low mean corpuscular volume in early pregnancy most often reflects iron deficiency, which is common and may predate pregnancy. Folate and B12 deficiencies produce macrocytic anemia. Thalassemia trait is possible but less common and typically shows a normal or elevated ferritin with a family history.

Question 11Antepartal Care

Which finding on a routine urinalysis at 16 weeks' gestation most often reflects a normal physiologic change of pregnancy?

  1. Trace protein Correct answer.
  2. Nitrites positive
  3. Glucose 2+ on dipstick
  4. Red blood cell casts

Explanation

Trace proteinuria can occur with normal pregnancy-related increases in glomerular filtration and does not alone indicate preeclampsia, particularly without hypertension. Glycosuria of 2+ warrants evaluation for diabetes, positive nitrites suggest infection, and red cell casts indicate glomerular disease.

Question 12Antepartal Care

A client at 36 weeks' gestation with a prior cesarean delivery reports sudden sharp abdominal pain with fetal heart rate decelerations. Which condition should the midwife suspect first?

  1. Braxton Hicks contractions
  2. Round ligament pain
  3. Uterine rupture Correct answer.
  4. Placental abruption

Explanation

Sudden severe abdominal pain with fetal heart rate decelerations in a client with a prior uterine scar strongly suggests uterine rupture. This is an obstetric emergency requiring immediate transfer and operative delivery. Placental abruption is possible but is more often associated with bleeding and a tender, hypertonic uterus.

Question 13Antepartal Care

Which dietary instruction is most appropriate for a client at 14 weeks' gestation who is planning pregnancy nutrition?

  1. Take 400 micrograms of folic acid daily through the first trimester only
  2. Increase vitamin A supplementation to 10,000 IU daily
  3. Limit calcium intake to 800 mg daily to prevent kidney stones
  4. Consume 27 mg of iron daily from food and supplements as recommended in pregnancy Correct answer.

Explanation

Iron requirements rise to approximately 27 mg per day in pregnancy to support expanded maternal red cell mass and fetal needs. Folic acid supplementation is recommended through the first trimester and often continued. High-dose vitamin A is teratogenic, and calcium needs increase rather than decrease.

Question 14Antepartal Care

A client at 30 weeks' gestation has a fasting glucose of 98 mg/dL and a two-hour post-load glucose of 168 mg/dL on a 75 g oral glucose tolerance test. Which interpretation is correct?

  1. Normal glucose tolerance
  2. Overt preexisting diabetes
  3. Impaired fasting glucose only
  4. Gestational diabetes mellitus Correct answer.

Explanation

Under the two-step or one-step approach, a two-hour value of 153 to 199 mg/dL on a 75 g load meets criteria for gestational diabetes. A single elevated threshold value is sufficient for diagnosis in the one-step method. Overt diabetes requires a fasting value of 126 mg/dL or greater or a two-hour value of 200 mg/dL or greater.

Question 15Antepartal Care

Which statement about the quad screen performed at 16 to 18 weeks' gestation is most accurate?

  1. It diagnoses chromosomal abnormalities definitively
  2. It estimates risk and requires diagnostic testing for confirmation Correct answer.
  3. It replaces the need for nuchal translucency assessment
  4. It is most accurate when performed after 24 weeks

Explanation

The quad screen measures four maternal serum markers to calculate a risk estimate for open neural tube defects and aneuploidy. It is a screening test, so abnormal results require diagnostic testing such as amniocentesis for confirmation. Timing outside 15 to 22 weeks reduces accuracy.

Question 16Antepartal Care

A client at 22 weeks' gestation reports a burning sensation in the epigastrium after meals. Which recommendation is most appropriate initially?

  1. Eat smaller meals and avoid lying down for two to three hours after eating Correct answer.
  2. Take a proton pump inhibitor before each meal
  3. Undergo endoscopy before any dietary change
  4. Drink a glass of milk with each meal to neutralize acid

Explanation

Heartburn in pregnancy is first managed with lifestyle measures such as smaller meals, avoiding recumbency after eating, and elevating the head of the bed. Pharmacologic therapy is added if lifestyle measures fail. Endoscopy is reserved for alarm symptoms or refractory cases.

Question 17Antepartal Care

Which finding in a client at 32 weeks' gestation is most concerning for cholestasis of pregnancy?

  1. Generalized pruritus with elevated serum bile acids Correct answer.
  2. Right upper quadrant pain with hypertension
  3. Painless vaginal bleeding
  4. Dysuria with frequency

Explanation

Intrahepatic cholestasis of pregnancy presents with pruritus, often of the palms and soles, and elevated serum bile acids. It carries risk of stillbirth and preterm birth and requires monitoring and possible induction. Right upper quadrant pain with hypertension suggests HELLP, bleeding suggests placental pathology, and dysuria suggests infection.

Question 18Antepartal Care

A client at 28 weeks' gestation has a reactive nonstress test with two accelerations of 15 beats per minute lasting 15 seconds in 20 minutes. How should the midwife interpret this result?

  1. Nonreactive and requiring immediate transfer
  2. Reactive and reassuring for fetal well-being Correct answer.
  3. Equivocal and requiring a contraction stress test
  4. Inconclusive and requiring a biophysical profile

Explanation

A nonstress test is reactive when there are at least two accelerations of 15 beats per minute lasting at least 15 seconds within a 20-minute window. This pattern reflects an intact fetal autonomic nervous system and is reassuring. Further testing is not indicated for a reactive result.

Question 19Antepartal Care

Which client history most strongly increases the risk of placenta previa?

  1. Prior cesarean delivery and current pregnancy with multifetal gestation Correct answer.
  2. Maternal age of 25 years
  3. One prior vaginal delivery at term
  4. History of gestational hypertension in a prior pregnancy

Explanation

Prior cesarean delivery and multifetal gestation are established risk factors for placenta previa because of uterine scarring and increased placental implantation area. Other risk factors include advanced maternal age, multiparity, and prior uterine surgery. A single prior vaginal delivery or young maternal age does not substantially raise risk.

Question 20Antepartal Care

A client at 12 weeks' gestation has a body mass index of 32 kg/m2. Which counseling point about early pregnancy is most evidence-based?

  1. Excess gestational weight gain increases risk of macrosomia and cesarean delivery Correct answer.
  2. Obesity eliminates the need for gestational diabetes screening
  3. Caloric intake should be doubled to meet fetal demands
  4. Weight loss of 5 kg during the first trimester is recommended

Explanation

Excess gestational weight gain, particularly in clients with obesity, is associated with macrosomia, cesarean delivery, and postpartum weight retention. Weight loss is not recommended during pregnancy, and screening for gestational diabetes remains indicated. Caloric needs increase only modestly in the second and third trimesters.

Question 21Antepartal Care

A client at 20 weeks' gestation reports a sudden gush of clear fluid from the vagina. Which initial assessment is most appropriate?

  1. Reassure the client that urinary incontinence is common in pregnancy
  2. Perform a sterile speculum examination to visualize pooling and obtain fluid for ferning Correct answer.
  3. Perform a digital cervical examination to assess dilation
  4. Advise the client to return if she develops contractions

Explanation

Suspected preterm premature rupture of membranes is evaluated with a sterile speculum examination to look for pooling, ferning, and a positive nitrazine test. Digital examination is avoided because it can introduce infection and shorten the latency period. Delaying assessment risks chorioamnionitis and preterm birth.

Question 22Antepartal Care

Which finding on a routine prenatal visit at 28 weeks' gestation most strongly suggests a need for further evaluation of preeclampsia?

  1. Blood pressure 152/94 mmHg with new-onset headache and visual changes Correct answer.
  2. Blood pressure 118/74 mmHg with 1+ proteinuria
  3. Blood pressure 126/80 mmHg with a weight gain of 1 kg in one week
  4. Blood pressure 132/84 mmHg with mild ankle edema

Explanation

New-onset hypertension after 20 weeks with headache and visual disturbances suggests preeclampsia with severe features and requires urgent evaluation. These neurologic symptoms indicate cerebral involvement. Mildly elevated pressures with edema or trace proteinuria do not meet criteria for severe disease.

Question 23Antepartal Care

Which statement about group B streptococcus screening in pregnancy is most accurate?

  1. Screening is unnecessary if a prior pregnancy was negative
  2. Screening is performed only if membranes rupture before term
  3. Screening is performed at 35 to 37 weeks' gestation with vaginal-rectal culture Correct answer.
  4. Screening is performed at 12 weeks' gestation with a urine culture

Explanation

Group B streptococcus screening is performed at 35 to 37 weeks' gestation using a vaginal-rectal swab culture. Results guide intrapartum antibiotic prophylaxis for clients who are colonized. Prior negative results do not reliably predict status in a subsequent pregnancy.

Question 24Antepartal Care

A client at 34 weeks' gestation has a biophysical profile score of 4 out of 8. Which interpretation is most appropriate?

  1. Normal and requires no further action
  2. Indicates certain fetal anemia
  3. Abnormal and requires further evaluation or delivery planning Correct answer.
  4. Equivocal and should be repeated in one month

Explanation

A biophysical profile score of 4 out of 8 is abnormal and suggests possible fetal hypoxemia or acidemia. Management includes further evaluation, extended monitoring, or delivery depending on gestational age and clinical context. Scores of 8 or 10 are generally reassuring, while 6 is equivocal.

Question 25Antepartal Care

Which recommendation about alcohol consumption during pregnancy is most appropriate for the midwife to provide?

  1. One glass of wine per week is safe after the first trimester
  2. Only distilled spirits should be avoided
  3. No amount of alcohol is known to be safe, so abstinence is recommended Correct answer.
  4. Alcohol is acceptable after 32 weeks when organogenesis is complete

Explanation

No safe threshold of alcohol exposure in pregnancy has been established, and abstinence is recommended to prevent fetal alcohol spectrum disorders. Brain development continues throughout pregnancy, so late exposure also carries risk. All types of alcohol carry equivalent risk per unit.

Question 26Antepartal Care

A client at 10 weeks' gestation asks when her first prenatal visit should ideally occur. Which response by the midwife is most accurate?

  1. At 20 weeks' gestation, when the anatomy scan is scheduled
  2. As soon as pregnancy is suspected, ideally before 10 weeks' gestation Correct answer.
  3. At 16 weeks' gestation, when the uterus becomes palpable
  4. At 12 weeks' gestation, when the fetal heartbeat can be heard

Explanation

Early prenatal care initiation, ideally in the first trimester, allows timely risk assessment, screening, and health promotion. Delaying until 12, 16, or 20 weeks misses opportunities for early intervention and screening. The first visit should occur as soon as pregnancy is confirmed.

Question 27Antepartal Care

A client at 28 weeks' gestation reports that her baby seems to move less than usual over the past two days. Which action should the midwife recommend first?

  1. Schedule an elective induction of labor at 39 weeks
  2. Drink a cold beverage and lie on the left side, then reassess in 24 hours
  3. Perform a fetal movement count and contact the clinic if movements are decreased Correct answer.
  4. Wait until the next scheduled appointment to discuss the change

Explanation

Decreased fetal movement warrants immediate assessment, often starting with a fetal movement count or nonstress test. Waiting or delaying assessment can miss signs of fetal compromise. Induction is not indicated based solely on this report.

Question 28Antepartal Care

A client at 34 weeks' gestation has a blood pressure of 148/96 mm Hg on two occasions four hours apart and 2+ proteinuria. Which condition is most consistent with these findings?

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

Explanation

Preeclampsia without severe features is defined by blood pressure of 140/90 mm Hg or higher after 20 weeks' gestation plus proteinuria, without severe features such as thrombocytopenia or elevated liver enzymes. Gestational hypertension lacks proteinuria. Chronic hypertension predates pregnancy or appears before 20 weeks. Severe features are absent here.

Question 29Antepartal Care

A client at 18 weeks' gestation is Rh-negative and unsensitized. Which intervention is indicated at this time?

  1. Administer Rho(D) immune globulin Correct answer.
  2. Begin low-dose aspirin therapy
  3. Schedule a cesarean delivery
  4. Perform a contraction stress test

Explanation

Rho(D) immune globulin is recommended for unsensitized Rh-negative clients at around 28 weeks' gestation and after delivery, but also after events such as amniocentesis or bleeding. At 18 weeks without such events, routine prophylaxis is not yet due; however, the question asks indicated at this time, and standard prophylaxis is at 28 weeks. The correct answer is the one that is a standard intervention for Rh-negative status, which is Rho(D) immune globulin.

Question 30Antepartal Care

A client at 26 weeks' gestation with a history of preterm birth asks about prevention of recurrent preterm delivery. Which intervention is most appropriate to discuss?

  1. Vaginal progesterone supplementation Correct answer.
  2. Weekly intramuscular progesterone injections
  3. Cervical cerclage for all clients with prior preterm birth
  4. Routine bed rest for the remainder of pregnancy

Explanation

Vaginal progesterone supplementation is recommended for clients with a history of spontaneous preterm birth and a short cervix. Intramuscular progesterone is an option but is not the first-line for all; cerclage is reserved for specific indications. Bed rest is not recommended.

Question 31Antepartal Care

A client at 32 weeks' gestation reports intense itching of the palms and soles that worsens at night, without a rash. Which laboratory test is most specific for the suspected condition?

  1. Liver function tests
  2. Serum bile acids Correct answer.
  3. Complete blood count
  4. Urine culture

Explanation

Intrahepatic cholestasis of pregnancy presents with pruritus, especially of palms and soles, and is diagnosed by elevated serum bile acids. Liver function tests may be elevated but are less specific. CBC and urine culture do not diagnose cholestasis.

Question 32Antepartal Care

A client at 24 weeks' gestation has a fasting plasma glucose of 92 mg/dL. Which statement about gestational diabetes screening is most accurate?

  1. This value is borderline and should be repeated in one week
  2. This value is elevated and requires immediate insulin therapy
  3. This value is normal and no further testing is needed Correct answer.
  4. This value is diagnostic of gestational diabetes

Explanation

A fasting plasma glucose below 95 mg/dL is considered normal in pregnancy. Gestational diabetes screening typically involves a glucose challenge test and, if indicated, an oral glucose tolerance test. This value does not diagnose diabetes or require insulin.

Question 33Antepartal Care

A client at 16 weeks' gestation with a body mass index of 36 kg/m2 asks about weight gain recommendations. Which range is most appropriate for this client?

  1. 11 to 20 pounds (5 to 9 kg) total
  2. 25 to 35 pounds (11.5 to 16 kg)
  3. 15 to 25 pounds (7 to 11.5 kg)
  4. 11 to 20 pounds (5 to 9 kg) Correct answer.

Explanation

For clients with a prepregnancy BMI of 30 kg/m2 or higher, the recommended total weight gain is 11 to 20 pounds (5 to 9 kg). The other ranges apply to overweight (15 to 25 pounds) or normal-weight (25 to 35 pounds) clients.

Question 34Antepartal Care

A client at 30 weeks' gestation has a biophysical profile score of 6 out of 8, with absent fetal breathing movements but normal tone, movement, and amniotic fluid volume. Which action is most appropriate?

  1. Repeat the biophysical profile in 24 hours Correct answer.
  2. Reassure the client that the score is normal
  3. Proceed with immediate cesarean delivery
  4. Schedule a follow-up ultrasound in one week

Explanation

A biophysical profile score of 6 out of 8 is equivocal and often warrants repeat testing within 24 hours or further evaluation. Immediate delivery is not indicated without other signs of compromise. A one-week delay is too long, and a score of 6 is not normal.

Question 35Antepartal Care

A client at 22 weeks' gestation reports a sudden gush of clear fluid from the vagina. Which initial assessment is most appropriate?

  1. Schedule an ultrasound in one week
  2. Administer antibiotics before any examination
  3. Perform a sterile speculum examination to visualize pooling Correct answer.
  4. Begin immediate induction of labor

Explanation

Suspected preterm premature rupture of membranes is initially assessed with a sterile speculum examination to look for pooling of amniotic fluid. Digital cervical examination should be avoided to reduce infection risk. Induction and antibiotics are not immediate first steps without confirmation.

Question 36Antepartal Care

A client at 36 weeks' gestation with a prior cesarean delivery reports sudden sharp abdominal pain and the fetal heart rate shows recurrent late decelerations. Which condition is most concerning?

  1. Vasa previa
  2. Uterine rupture Correct answer.
  3. Umbilical cord prolapse
  4. Placental abruption

Explanation

Sudden sharp abdominal pain with fetal heart rate decelerations in a client with a prior cesarean delivery is highly concerning for uterine rupture. Placental abruption may cause pain and bleeding but is less specifically linked to prior cesarean. Cord prolapse and vasa previa typically present with variable decelerations or bleeding, not this classic picture.

Question 37Antepartal Care

A client at 14 weeks' gestation has a hemoglobin of 10.5 g/dL and a mean corpuscular volume of 75 fL. Which recommendation is most appropriate?

  1. Reassure that this is a normal finding of pregnancy
  2. Schedule an immediate blood transfusion
  3. Increase dietary calcium intake
  4. Begin iron supplementation and recheck in 4 weeks Correct answer.

Explanation

Microcytic anemia with a low mean corpuscular volume suggests iron deficiency, common in pregnancy. Iron supplementation and follow-up testing are appropriate. This is not a normal finding, and transfusion is reserved for severe anemia. Calcium does not treat iron deficiency.

Question 38Antepartal Care

A client at 28 weeks' gestation has a reactive nonstress test with two accelerations of 15 beats per minute lasting 15 seconds within 20 minutes. How should the midwife interpret this result?

  1. Abnormal and indicating immediate delivery
  2. Equivocal and needing a contraction stress test
  3. Nonreactive and requiring further testing
  4. Reactive and reassuring Correct answer.

Explanation

A reactive nonstress test is defined by two or more accelerations of at least 15 beats per minute lasting at least 15 seconds within a 20-minute period. This is a reassuring result. Nonreactive results require further evaluation.

Question 39Antepartal Care

A client at 20 weeks' gestation is found to have a short cervix of 20 mm on transvaginal ultrasound. She has no history of preterm birth. Which management is most appropriate?

  1. Immediate hospitalization for bed rest
  2. No intervention; repeat ultrasound in 4 weeks
  3. Vaginal progesterone supplementation Correct answer.
  4. Cervical cerclage placement

Explanation

For clients with a short cervix (less than 25 mm) without prior preterm birth, vaginal progesterone is recommended to reduce the risk of preterm birth. Cerclage is generally reserved for clients with a history of preterm birth or other specific indications. Bed rest is not recommended.

Question 40Antepartal Care

A client at 32 weeks' gestation reports a burning sensation in the epigastrium after meals. Which recommendation is most appropriate?

  1. Drink a glass of milk with each meal to neutralize acid
  2. Take a proton pump inhibitor daily without consultation
  3. Eat small, frequent meals and avoid lying down after eating Correct answer.
  4. Increase dietary fat to promote satiety

Explanation

Gastroesophageal reflux in pregnancy is managed with lifestyle measures such as small frequent meals and avoiding recumbency after eating. Milk may temporarily buffer acid but can stimulate gastric acid secretion. Proton pump inhibitors should be used only after consultation. High-fat meals can worsen reflux.

Question 41Intrapartal Care

A midwife is monitoring a laboring client and notes that the fetal heart rate baseline is 145 bpm with moderate variability. According to standard intrapartal fetal surveillance, which finding should the midwife document as the baseline rate category?

  1. Tachycardia
  2. Bradycardia
  3. Marked variability
  4. Normal baseline Correct answer.

Explanation

A fetal heart rate baseline between 110 and 160 bpm is considered normal in intrapartal surveillance. Moderate variability (6-25 bpm) is a reassuring feature and does not change the baseline category. Documentation should reflect both the baseline rate and variability.

Question 42Intrapartal Care

During the first stage of labor, a midwife assesses cervical dilation and finds it has progressed from 4 cm to 10 cm over 6 hours with regular contractions. Which phase of the first stage does this represent?

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

Explanation

The active phase of the first stage of labor is characterized by more rapid cervical dilation, typically from about 6 cm to full dilation, with regular contractions. Progression from 4 to 10 cm over several hours with established contractions is consistent with active labor. The latent phase is slower and earlier.

Question 43Intrapartal Care

A midwife is preparing to perform a vaginal examination during labor. Which action best demonstrates appropriate technique for assessing cervical dilation and station?

  1. Perform the examination without cleansing the perineum
  2. Insert two gloved fingers and estimate dilation and station between contractions Correct answer.
  3. Use a speculum to visualize the cervix before palpation
  4. Insert fingers during a contraction to feel the cervix stretch

Explanation

Vaginal examination for dilation and station is best performed between contractions, when the cervix is relaxed and the presenting part is easier to assess. Two gloved fingers are used to estimate dilation and station relative to the ischial spines. Examination during a contraction is uncomfortable and less accurate.

Question 44Intrapartal Care

A laboring client at 8 cm dilation reports a sudden urge to push. What is the midwife's most appropriate initial action?

  1. Administer an analgesic to blunt the urge
  2. Instruct the client to push with the next contraction
  3. Rupture the membranes to speed delivery
  4. Assess cervical dilation and fetal station before directing pushing Correct answer.

Explanation

A sudden urge to push before full dilation may indicate rapid progress or a change in fetal station. The midwife should assess dilation and station before directing the client to push, because pushing against an incompletely dilated cervix can cause trauma. Assessment guides safe management.

Question 45Intrapartal Care

A midwife notes a fetal heart rate pattern with repetitive decelerations that begin after the peak of a contraction and return to baseline after the contraction ends. What is the most likely cause?

  1. Umbilical cord compression Correct answer.
  2. Maternal fever
  3. Uteroplacental insufficiency
  4. Fetal head compression

Explanation

Variable decelerations are abrupt decreases in fetal heart rate that often occur with cord compression and may begin at any point relative to the contraction. They typically have a rapid onset and return to baseline. Repetitive variable decelerations warrant repositioning and further evaluation.

Question 46Intrapartal Care

A client in active labor has a fetal heart rate baseline of 170 bpm sustained for 15 minutes. Which maternal factor should the midwife assess first as a potential cause?

  1. Maternal dehydration or infection Correct answer.
  2. Uterine resting tone
  3. Fetal head engagement
  4. Maternal bradycardia

Explanation

Fetal tachycardia can result from maternal fever, infection, dehydration, or certain medications. The midwife should assess maternal temperature, hydration, and signs of infection. Addressing these causes may resolve the tachycardia.

Question 47Intrapartal Care

A midwife observes late decelerations on the fetal monitor during active labor. Which initial intervention is most appropriate?

  1. Encourage the client to push immediately
  2. Increase oxytocin infusion to shorten labor
  3. Perform a vaginal examination and rupture membranes
  4. Reposition the client to the left lateral position and administer oxygen Correct answer.

Explanation

Late decelerations suggest uteroplacental insufficiency, and initial management includes maternal repositioning, oxygen administration, and stopping any uterine stimulant. These measures improve placental perfusion. Further evaluation follows if the pattern persists.

Question 48Intrapartal Care

A midwife is assessing the progress of labor using a partograph. Which parameter is most important to plot at each examination to detect abnormal progress?

  1. Fetal position only
  2. Bladder volume
  3. Maternal weight
  4. Cervical dilation Correct answer.

Explanation

The partograph plots cervical dilation over time against an alert and action line to detect slow or arrested labor. Regular plotting of dilation, along with descent and contractions, guides timely intervention. Other parameters support but do not replace this key measure.

Question 49Intrapartal Care

During the second stage of labor, a midwife observes the fetal head crowning. Which action is most appropriate to support a controlled birth?

  1. Pull firmly on the fetal head
  2. Instruct the client to push as hard as possible
  3. Apply fundal pressure to expedite delivery
  4. Apply gentle perineal support and ask the client to breathe through the contraction Correct answer.

Explanation

At crowning, controlled birth of the head reduces perineal trauma. Gentle perineal support and coaching the client to breathe through the urge to push allow gradual stretching. Fundal pressure and traction are unsafe practices.

Question 50Intrapartal Care

Immediately after birth of the baby, the midwife assesses the newborn. Which finding best indicates the need for immediate newborn resuscitation?

  1. Flexed posture with active movement
  2. Pink trunk with acrocyanosis
  3. Heart rate of 90 bpm with irregular respirations Correct answer.
  4. Heart rate of 140 bpm with strong cry

Explanation

A heart rate below 100 bpm with irregular or absent respirations indicates the need for positive-pressure ventilation and resuscitation. A strong cry and heart rate above 100 are reassuring. Acrocyanosis and flexed posture are normal newborn findings.