Ethiopian Midwifery University Exit Exam Practice Questions (50 Items)

Part 4: Neonatal Care (Newborn Management)

Q51. A midwife evaluates a newborn infant exactly 1 minute after birth. The infant has a heart rate of 95 beats per minute, a weak cry with irregular respirations, some flexion of the extremities, grimaces when suctioned, and a pink body with blue extremities. What is the computed APGAR score for this infant? A) 4 B) 5 C) 6 D) 7

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• Correct Answer: B
• Rationale: The APGAR score components are: Heart rate <100 (1 point); weak/irregular respirations (1 point); flexion of extremities (1 point); grimace (1 point); acrocyanosis (1 point). Total = 1+1+1+1+1=5.

Q52. A newborn infant is delivered at 35 weeks of gestation. Within 30 minutes of birth, the neonate develops tachypnea (respiratory rate of 75 breaths/minute), audible expiratory grunting, intercostal retractions, and nasal flaring. What is the most likely underlying pathophysiology? A) Meconium aspiration syndrome B) Congenital diaphragmatic hernia C) Surfactant deficiency leading to Respiratory Distress Syndrome (RDS) D) Transient tachypnea of the newborn

• Correct Answer: C
• Rationale: RDS occurs primarily in preterm infants due to a deficiency in pulmonary surfactant, which causes widespread alveolar collapse, micro-atelectasis, and progressive respiratory distress.

Q53. According to the national Neonatal Resuscitation Guidelines, if a newborn baby does not establish spontaneous breathing after thorough drying, stimulating, and clearing the airway, what is the immediate next step within the “Golden Minute”? A) Administer intravenous Epinephrine via the umbilical vein B) Initiate positive pressure ventilation (PPV) using a bag-and-mask device C) Start external chest compressions at a 3:1 ratio D) Place the infant under a radiant warmer and observe for 5 minutes

• Correct Answer: B
• Rationale: If an infant remains apneic or has a heart rate <100 bpm after initial stimulation, positive pressure ventilation (PPV) is the single most critical step in neonatal resuscitation and must be started within the first minute of life.

Q54. A midwife notices that a 36-hour-old term infant has developed a yellowish discoloration of the face and sclera. A serum bilirubin test confirms a level of 6 mg/dL. The infant is alert, feeding well, and has normal stool and urine. How should this jaundice be classified? A) Pathological Jaundice B) Physiological Jaundice C) Breast milk jaundice D) Biliary atresia jaundice

• Correct Answer: B
• Rationale: Physiological jaundice appears after 24 hours of life, peaks between days 3–5, involves low to moderate bilirubin levels, and resolves spontaneously as the newborn’s liver matures. Jaundice within the first 24 hours is always pathological.

Q55. To prevent ophthalmia neonatorum (neonatal conjunctivitis) caused by maternal Neisseria gonorrhoeae or Chlamydia trachomatis, which prophylactic medication should the midwife apply to the newborn’s eyes universally within 1 hour of birth? A) 1% Tetracycline hydrochloride eye ointment B) 0.5% Hydrocortisone drops C) 10% Silver nitrate solution D) 2% Amoxicillin wash

• Correct Answer: A
• Rationale: Universal application of 1% Tetracycline eye ointment (or Erythromycin) into the conjunctival sac within 1 hour of birth is the recommended protocol to prevent neonatal blindness from birth canal infections.

Q56. A midwife performs a physical assessment on a term newborn. When the midwife taps the glabella or bridge of the nose, the infant blinks repeatedly. When the infant’s palms are touched, the fingers curl tightly around the midwife’s finger. What are these neurological findings? A) Abnormal hyper-reflexive states B) Normal primitive neonatal reflexes (Moro and Babinski) C) Normal primitive neonatal reflexes (Glabellar and Palmar grasp reflexes) D) Signs of neonatal abstinence syndrome

• Correct Answer: C
• Rationale: The glabellar tap reflex (blinking in response to tapping the forehead) and the palmar grasp reflex are normal primitive reflexes that indicate central nervous system integrity in the newborn.

Q57. A preterm infant born at 32 weeks of gestation is admitted to the neonatal care unit. The midwife must protect the baby against hypothermia. Which method is most effective for stable thermal regulation and promoting early breastfeeding for stable low-birth-weight infants? A) Placing the baby in an open crib next to a window B) Continuous Kangaroo Mother Care (KMC) providing skin-to-skin contact C) Wrapping the infant in thick blankets and keeping them under an electric fan D) Keeping the baby in a dry towel under a 100-watt domestic bulb

• Correct Answer: B
• Rationale: Kangaroo Mother Care (skin-to-skin contact) is an evidence-based approach that stabilizes newborn temperature, regulates heart and respiratory rates, and encourages successful breastfeeding, especially in low-birth-weight and preterm infants.

Q58. A midwife is assessing a 3-day-old infant brought to the clinic. The mother states the baby is “not feeding well.” The midwife observes a temperature of 35.5°C, lethargy, poor sucking reflex, tachypnea, and a red, swollen umbilicus with a foul discharge. What condition do these signs indicate? A) Neonatal tetanus B) Neonatal Sepsis C) Infant botulism D) Congenital cardiac anomaly

• Correct Answer: B
• Rationale: Signs of neonatal sepsis can be subtle and include hypothermia or fever, lethargy, poor feeding, respiratory distress, and localized infections like omphalitis (inflamed umbilicus).

Q59. Within 1 hour of a healthy term delivery, the midwife administers an intramuscular injection of 1 mg Vitamin K1 (Phytomenadione) into the infant’s anterolateral thigh. What is the physiological rationale for this intervention? A) To stimulate rapid bone mineralization B) To prevent Vitamin K Deficiency Bleeding (Hemorrhagic Disease of the Newborn) C) To boost the infant’s active immune response against tetanus D) To colonize the gastrointestinal tract with lactobacillus

• Correct Answer: B
• Rationale: Newborns are born with low Vitamin K levels due to minimal placental transfer and a sterile gut tract that cannot synthesize it. Vitamin K prophylaxis prevents life-threatening early or late bleeding episodes.

Q60. A midwife examines a newborn delivered via a difficult prolonged vacuum-assisted extraction. The midwife notes a soft swelling on the infant’s scalp that does not cross the cranial suture lines and increases in size over the first 24 hours. What is this swelling? A) Caput succedaneum B) Cephalohematoma C) Subgaleal hematoma D) Intracranial hydrocephalus

• Correct Answer: B
• Rationale: A cephalohematoma is a collection of blood between the skull bone and the periosteum caused by ruptured blood vessels during labor. Because it is bound by the periosteum, the swelling is strictly contained within suture lines. Caput succedaneum crosses suture lines.

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Part 5: Gynecology

Q61. A 32-year-old female patient presents with a history of lower abdominal pain, high fever (38.8∘C), and a foul-smelling purulent cervical discharge. On bimanual pelvic examination, the midwife notes severe cervical motion tenderness (chandelier sign) and bilateral adnexal tenderness. What is the most likely diagnosis? A) Endometriosis B) Pelvic Inflammatory Disease (PID) C) Ectopic Pregnancy D) Ovarian cyst torsion

• Correct Answer: B
• Rationale: PID is an upper genital tract infection that typically presents with lower abdominal pain, fever, cervical discharge, and characteristic cervical motion and adnexal tenderness on bimanual exam.

Q62. A 24-year-old sexually active woman presents with missing her last menstrual period 6 weeks ago, sharp unilateral lower abdominal pain, and light vaginal bleeding. On examination, she is hemodynamically stable but has marked adnexal tenderness. What life-threatening condition must be ruled out first? A) Acute appendicitis B) Ruptured or expanding Ectopic Pregnancy C) Threatened abortion D) Follicular ovarian cyst rupture

• Correct Answer: B
• Rationale: Any woman of reproductive age presenting with amenorrhea, abdominal pain, and vaginal bleeding must be evaluated for an ectopic pregnancy to prevent tubal rupture and severe intra-abdominal hemorrhage.

Q63. A 48-year-old woman presents to the outpatient clinic complaining of heavy, prolonged menstrual bleeding (menorrhagia) over the past 6 months. A pelvic ultrasound reveals well-circumscribed, non-cancerous benign smooth muscle tumors within the myometrium of the uterus. How should these be documented? A) Endometrial polyps B) Uterine Leiomyomas (Fibroids) C) Cervical carcinomas D) Ovarian teratomas

• Correct Answer: B
• Rationale: Leiomyomas, or uterine fibroids, are benign monoclonal tumors arising from smooth muscle cells in the myometrium. They are the most common benign tumors in women of reproductive age and frequently cause heavy menstrual bleeding.

Q64. A 22-year-old female client presents with an intensive, frothy, yellowish-green, foul-smelling vaginal discharge accompanied by severe vulvar pruritus and burning. On speculum examination, the midwife notes diffuse petechiae on the cervix (“strawberry cervix”). What is the causative pathogen? A) Candida albicans B) Gardnerella vaginalis C) Trichomonas vaginalis D) Chlamydia trachomatis

• Correct Answer: C
• Rationale: Trichomoniasis, caused by the protozoan Trichomonas vaginalis, classically presents with a frothy, yellowish-green discharge, vulvar irritation, and a characteristic “strawberry cervix” due to punctate hemorrhages.

Q65. A 52-year-old woman presents with complaints of irregular menstrual cycles, hot flashes, night sweats, mood swings, and vaginal dryness. She states she has not had a menstrual period for 6 months. How should the midwife classify her current reproductive transition stage? A) Post-menopause B) Perimenopause (Climacteric) C) Premature ovarian failure D) Secondary amenorrhea

• Correct Answer: B
• Rationale: Perimenopause is the transitional phase leading up to menopause, characterized by irregular menstrual cycles and vasomotor symptoms like hot flashes and night sweats. True menopause is diagnosed after 12 consecutive months of amenorrhea.

Q66. A 60-year-old multiparous woman presents with complaints of a feeling of fullness and heaviness in her pelvic region. She states, “I feel like something is dropping out of my vagina when I lift heavy objects.” On inspection, the cervix is visible protruding outside the vaginal introitus. What is this condition? A) Cystocele B) Rectocele C) Uterine Prolapse D) Vaginal vault eversion

• Correct Answer: C
• Rationale: Uterine prolapse is the descent of the uterus into or through the vagina due to weakness in the supporting pelvic floor muscles and ligaments, often associated with high multiparity and chronic pelvic pressure.

Q67. A 28-year-old woman presents with severe dysmenorrhea, deep dyspareunia, and chronic pelvic pain that worsens during menstruation. She has been trying to conceive for 3 years without success. A laparoscopy reveals dark, “chocolate-colored” cysts on her ovaries and blue-black endometrial-like implants across the pelvic peritoneum. What is the diagnosis? A) Polycystic Ovary Syndrome (PCOS) B) Endometriosis C) Adenomyosis D) Chronic pelvic inflammatory disease

• Correct Answer: B
• Rationale: Endometriosis is characterized by the presence of functional endometrial tissue outside the uterine cavity. This tissue responds to cyclic hormonal changes, causing chronic inflammation, pain, scarring, and characteristic ovarian “chocolate cysts.”

Q68. A 45-year-old woman presents for a routine gynecological screening. The midwife performs a Papanicolaou (Pap) smear. What is the primary clinical purpose of a Pap smear test? A) To diagnose acute pelvic inflammatory disease B) To detect pre-cancerous cellular changes and screen for Cervical Cancer C) To evaluate the patency of the fallopian tubes D) To confirm a suspected pregnancy

• Correct Answer: B
• Rationale: The Pap smear is an effective cytological screening tool designed to detect pre-malignant or malignant transformations in the transformation zone of the cervix, allowing for early intervention against cervical cancer.

Q69. A 30-year-old woman presents with a history of amenorrhea for 9 months. Her pregnancy tests are consistently negative. She reports having had a vigorous dilation and curettage (D&C) procedure for a severe postpartum hemorrhage 1 year ago. What condition should be suspected? A) Sheehan’s Syndrome B) Asherman’s Syndrome (Intrauterine adhesions) C) Polycystic Ovary Syndrome D) Prolactinoma

• Correct Answer: B
• Rationale: Asherman’s syndrome involves the formation of intrauterine adhesions or scar tissue, often following over-aggressive curettage after a miscarriage or delivery, which destroys the endometrial basalis layer and causes secondary amenorrhea.

Q70. A client presents with a complaint of a thick, white, curd-like (cottage cheese-appearance) vaginal discharge accompanied by intense vulvovaginal pruritus and erythema. The vaginal pH is 4.2. Microscopic examination of a wet mount reveals pseudohyphae. What is the diagnosis and appropriate treatment? A) Bacterial vaginosis; Oral Metformin B) Vulvovaginal Candidiasis; Topical or oral Antifungal (e.g., Clotrimazole or Fluconazole) C) Trichomoniasis; Oral Metronidazole D) Gonorrhea; Ceftriaxone injection

• Correct Answer: B
• Rationale: Vulvovaginal candidiasis is a fungal infection caused by Candida albicans, presenting with intense itching, thick curd-like discharge, and pseudohyphae on a wet mount, typically managed with antifungal therapy.

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Part 6: Family Planning and Contraception

Q71. A 24-year-old lactating mother who delivered 6 weeks ago requests a highly effective contraceptive method. She intends to breastfeed for at least 1 year. According to the Medical Eligibility Criteria (MEC), which contraceptive method is preferred over combined hormonal options during early lactation? A) Combined Oral Contraceptive Pill (COCP) B) Progestogen-Only Pill (POP) or Progestogen-only Injectable (DMPA) C) Combined Contraceptive Vaginal Ring D) High-dose Estrogen patch

• Correct Answer: B
• Rationale: Estrogen-containing contraceptives can suppress breast milk production in the early postpartum period. Progestogen-only methods (like POPs, implants, or DMPA) do not affect lactation and are safe for use starting 6 weeks postpartum.

Q72. A woman attends the family planning clinic for the insertion of a Copper-bearing Intrauterine Contraceptive Device (IUCD). What is the primary mechanism of action of the copper IUCD? A) Suppression of ovulation via negative feedback on the hypothalamus B) Thickening of the cervical mucus to block sperm penetration C) Inducing a localized sterile inflammatory reaction in the endometrium that is toxic to spermatozoa and prevents fertilization D) Causing temporary chemical occlusion of both fallopian tubes

• Correct Answer: C
• Rationale: The copper IUCD releases copper ions that create a localized, sterile inflammatory response in the uterine and tubal fluids. This environment is toxic to sperm, impairing their motility and viability to prevent fertilization.

Q73. A 19-year-old client comes to the clinic stating she had unprotected sexual intercourse 48 hours ago and wishes to avoid pregnancy. Which of the following is the most appropriate oral Emergency Contraceptive method to recommend, and within what maximum timeframe must it be taken? A) Combined Oral Pill within 14 days B) Levonorgestrel 1.5 mg single dose within 72 to 120 hours C) Mifepristone daily for 7 days D) High-dose Aspirin immediately

• Correct Answer: B
• Rationale: Oral emergency contraception with a single dose of 1.5 mg Levonorgestrel is highly effective at preventing pregnancy by delaying or inhibiting ovulation if taken within 72 to 120 hours of unprotected intercourse.

Q74. A client has been using Depot Medroxyprogesterone Acetate (DMPA / Depo-Provera) injections for contraception for 1 year. She presents for her scheduled injection and complains of amenorrhea. What is the most appropriate action by the midwife? A) Discontinue the method immediately and refer her for a laparatomy B) Reassure her that amenorrhea is a common, benign side effect of DMPA due to endometrial atrophy, and administer the injection if pregnancy is ruled out C) Switch her immediately to a high-dose combined oral pill to force withdrawal bleeding D) Administer a high-dose estrogen injection to trigger menses

• Correct Answer: B
• Rationale: Amenorrhea is an expected, harmless side effect of prolonged DMPA use, driven by progestogen-induced endometrial thinning. Counseling and reassurance are key to maintaining client compliance.

Q75. A 35-year-old woman requests a contraceptive method. She smokes 20 cigarettes a day and has a history of mild hypertension. According to the WHO Medical Eligibility Criteria (MEC), which method is classified as MEC Category 4 (absolute contraindication) for this client? A) Copper-T Intrauterine Device B) Combined Oral Contraceptive Pills (COCPs) C) Levonorgestrel Implants (Jadelle) D) Condoms

• Correct Answer: B
• Rationale: Estrogen-containing contraceptives (like COCPs) significantly increase the risk of myocardial infarction, stroke, and thromboembolism in women over 35 who smoke heavily, making them an absolute contraindication (MEC 4).

Q76. A couple wants to use a natural family planning approach and requests information on the Standard Days Method (SDM). The midwife explains that this method uses a color-coded string of beads (CycleBeads) to identify fertile days. For women with cycles lasting between 26 and 32 days, which specific cycle days are considered fertile and require avoidance of unprotected intercourse? A) Days 1 to 5 B) Days 8 to 19 C) Days 20 to 28 D) Days 14 only

• Correct Answer: B
• Rationale: The Standard Days Method identifies days 8 through 19 of a woman’s menstrual cycle as her potentially fertile window, during which she should avoid unprotected sex to prevent pregnancy.

Q77. A client undergoes surgical bilateral tubal ligation for permanent contraception. She asks the midwife how this procedure prevents pregnancy. What is the correct explanation? A) It halts the maturation and release of ova from the ovaries completely B) It mechanically disrupts the fallopian tubes, preventing the sperm from meeting and fertilizing the ovum C) It causes rapid regression of the uterine lining D) It alters systemic hormone balances to prevent implantation

• Correct Answer: B
• Rationale: Bilateral tubal ligation is a permanent contraceptive method where the fallopian tubes are cut, tied, or clipped. This blocks the passage of sperm, preventing it from reaching the ovum.

Q78. A family planning client chooses a subdermal contraceptive implant system (e.g., Implanon or Jadelle). What is the standard duration of contraceptive protection provided by a single-rod Implanon implant? A) 1 year B) 3 years C) 5 years D) 10 years

• Correct Answer: B
• Rationale: The single-rod etonogestrel implant (Implanon/Implanon NXT) provides reliable, highly effective contraception for up to 3 years before requiring replacement. The two-rod system (Jadelle) lasts for 5 years.

Q79. A client returned from an outpatient clinic after having a copper IUCD inserted 2 weeks ago. She presents complaining of mild intermenstrual spotting and light lower abdominal cramping. On examination, the IUCD strings are visible at the external cervical os, and her vital signs are normal. What is the appropriate midwifery action? A) Perform an emergency removal of the IUCD immediately B) Reassure her that mild cramping and spotting are common, expected side effects during the first few months after IUCD insertion, and offer a short course of NSAIDs C) Initiate broad-spectrum intravenous antibiotic therapy for pelvic abscess D) Schedule her for an emergency diagnostic laparoscopy

• Correct Answer: B
• Rationale: Intermenstrual spotting, increased menstrual flow, and mild cramping are well-documented side effects during the first 3–6 months of copper IUCD use. Reassurance and simple analgesics are the standard management.

Q80. A midwife is counseling a client on the use of the male condom. Beyond its contraceptive efficacy, what is the primary unique public health advantage of consistent and correct condom use? A) It provides the longest duration of permanent contraception available B) It offers dual protection by preventing unintended pregnancies and reducing the transmission of Sexually Transmitted Infections (STIs), including HIV C) It completely eliminates the risk of cervical fibroids D) It regulates irregular menstrual cycles

• Correct Answer: B
• Rationale: Condoms serve as a mechanical barrier that prevents the exchange of bodily fluids and exposure to lesions, offering dual protection against both pregnancy and STIs/HIV.

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Part 7: Midwifery Management, Ethics, and Professional Development

Q81. A midwife manager is designing a clinical quality improvement project to reduce institutional maternal mortality from postpartum hemorrhage. What is the first foundational step in the quality improvement loop? A) Implementing widespread punitive measures for staff errors B) Identifying the specific problem, reviewing baseline data, and establishing a measurable goal C) Ordering expensive high-tech surgical equipment immediately D) Rewriting the entire hospital budget allocation

• Correct Answer: B
• Rationale: Quality improvement cycles must begin by clearly defining the clinical issue, analyzing current data, and setting specific, measurable milestones before executing targeted interventions.

Q82. A midwife is caring for a woman in labor whose condition deteriorates, requiring an urgent emergency operative delivery to save the fetus. The woman is fully conscious and competent but refuses to consent to the procedure due to deep personal beliefs. The midwife respects her decision and continues supportive care. Which ethical principle is the midwife upholding? A) Beneficence B) Non-maleficence C) Autonomy D) Justice

• Correct Answer: C
• Rationale: The principle of autonomy states that a competent individual has the moral and legal right to make decisions about their own healthcare, including the right to refuse life-saving interventions.

Q83. A staff midwife makes a medication error by administering an incorrect dose of Oxytocin to a patient. Upon realizing the mistake, the midwife assesses the patient for adverse reactions, implements safety measures, notifies the team lead, and fills out an incident report. What professional value does this action demonstrate? A) Paternalism B) Accountability C) Veracity D) Fidelity

• Correct Answer: B
• Rationale: Accountability means taking ownership of one’s professional actions, decisions, and errors, which includes transparent reporting and taking immediate steps to protect patient safety.

Q84. A midwife manager wants to optimize staff scheduling and tasks in a busy labor ward. The manager allocates specific duties to team members based on their roles: one midwife performs all admissions, another monitors active labor, and a third manages deliveries. Which care delivery model does this represent? A) Functional Midwifery Care B) Team Midwifery Care C) Primary Midwifery Care D) Total Client Care

• Correct Answer: A
• Rationale: Functional care models distribute specific tasks or functions to various staff members rather than assigning one midwife to provide comprehensive care for a single patient.

Q85. During a delivery, a midwife notes that a patient is from a cultural background that practices specific non-harmful traditions, such as keeping the placenta in a traditional cloth. The midwife accommodates this request safely. What concept does this midwifery intervention reflect? A) Cultural Imperialism B) Ethnocentrism C) Culturally Competent and Respectful Maternity Care (RMC) D) Institutional paternalism

• Correct Answer: C
• Rationale: Respectful Maternity Care involves recognizing, respecting, and accommodating a patient’s safe cultural practices and preferences during childbirth, which enhances trust and patient satisfaction.

Q86. A midwife researcher wants to study the lived experiences of rural Ethiopian mothers who survived near-miss maternal complications. The researcher plans to conduct in-depth interviews with a small group of participants. Which research methodology is most appropriate? A) Quantitative randomized trial B) Qualitative phenomenological study C) Retrospective case-control study D) Double-blind experimental design

• Correct Answer: B
• Rationale: Qualitative phenomenology is ideal for investigating, understanding, and describing the deep, authentic “lived experiences” and meanings that individuals attach to specific life events.

Q87. A midwife manager uses a leadership style that involves staff members in creating ward policies, encourages open feedback, and seeks group consensus before introducing changes to the delivery unit. What leadership style is this? A) Autocratic leadership B) Bureaucratic leadership C) Democratic (Participative) leadership D) Laissez-faire leadership

• Correct Answer: C
• Rationale: Democratic leadership facilitates open communication, shares decision-making responsibilities, and values input from team members, which can improve staff morale and collaboration.

Q88. A midwife accidentally shares confidential medical information about a high-profile maternity patient with an unauthorized individual outside the care team. This breach violates which legal and ethical duty? A) Informed consent B) Confidentiality and Privacy protection C) Justice allocation D) Professional beneficence

• Correct Answer: B
• Rationale: Confidentiality is a fundamental ethical and legal obligation that requires healthcare providers to protect patient privacy by not disclosing medical information without explicit patient authorization.

Q89. In a healthcare center, the team is conducting a maternal death audit to determine the systemic factors that contributed to a recent maternal demise. This process is designed to serve what primary public health function? A) To find and punish the specific individual who made a mistake B) To analyze systemic errors and delays (Three Delays model) to prevent future maternal deaths C) To reduce the hospital’s financial liability D) To eliminate the need for future emergency surgical care

• Correct Answer: B
• Rationale: Maternal death audits analyze the clinical and systemic factors surrounding a mortality event to identify gaps in care, address delays, and implement improvements to prevent future tragedies.

Q90. A midwife manager is rolling out a new electronic partograph tracking system. Anticipating resistance to this change among staff, the manager uses Kurt Lewin’s Change Theory. The initial phase of preparing the team, breaking down old habits, and highlighting the benefits of the new system is known as what? A) Unfreezing stage B) Moving stage C) Refreezing stage D) Stabilizing stage

• Correct Answer: A
• Rationale: Kurt Lewin’s change theory includes three stages: Unfreezing (preparing the organization for change and addressing resistance), Moving (executing the change), and Refreezing (solidifying the new practices into standard routines).

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Part 8: Core Fundamentals and Basic Skills in Midwifery

Q91. A midwife is preparing to insert an intravenous cannula for a patient experiencing a postpartum hemorrhage. To maximize fluid resuscitation efficiency, what size (gauge) cannula should the midwife choose? A) 22 Gauge (Blue) B) 24 Gauge (Yellow) C) 16 or 18 Gauge (Gray or Green – Large-bore) D) 26 Gauge (Purple)

• Correct Answer: C
• Rationale: Managing a hemorrhage requires rapid volume replacement. Large-bore cannulas (16G or 18G) allow for the swift infusion of crystalloids, colloids, and blood products with minimal resistance.

Q92. A midwife needs to perform a sterile vaginal examination on a patient with ruptured membranes. Which level of asepsis is mandatory to prevent introducing pathogenic micro-organisms into the birth canal? A) Medical asepsis (Clean technique) B) Surgical asepsis (Sterile technique using sterile gloves and drapes) C) Basic localized disinfection wash D) Prophylactic systemic antibiotic administration only

• Correct Answer: B
• Rationale: Once membranes have ruptured, the protective barrier against ascending infections is compromised. Strict surgical asepsis using sterile gloves and instruments is required to protect against chorioamnionitis.

Q93. A midwife checks the vital signs of an adult client admitted to the antepartum ward and records a blood pressure of 120/80 mmHg, a respiratory rate of 18 breaths/minute, and a pulse rate of 115 beats per minute. How should the pulse rate be documented? A) Bradycardia B) Tachycardia C) Normal resting heart rate D) Arrhythmia

• Correct Answer: B
• Rationale: A normal resting adult pulse rate ranges between 60 and 100 beats per minute. A rate above 100 beats per minute is classified as tachycardia.

Q94. A midwife is preparing to administer an intramuscular injection of an antiemetic to a pregnant woman. Which muscle site is preferred for deep, large-volume intramuscular injections in adults due to its low risk of major nerve or vascular injury? A) Deltoid muscle B) Ventrogluteal site C) Dorsogluteal site D) Rectus femoris

• Correct Answer: B
• Rationale: The ventrogluteal site is the safest choice for intramuscular injections in adults because it offers a large muscle mass and lacks major overlying nerves or blood vessels.

Q95. While evaluating a client’s continuous intravenous infusion line, the midwife observes that the skin around the insertion site is cool, pale, swollen, and painful to the touch. The infusion rate has slowed significantly. What complication has occurred? A) Phlebitis B) Intravenous Infiltration C) Thrombophlebitis D) Systemic fluid overload

• Correct Answer: B
• Rationale: Infiltration occurs when a non-vesicant fluid leaks into the surrounding subcutaneous tissue, causing local edema, coolness, and discomfort. Phlebitis typically presents with warmth and redness along the vein line.

Q96. To avoid medical errors and ensure patient safety, a midwife must verify the “Rights of Medication Administration” prior to giving any drug. What are the five core traditional rights? A) Right Patient, Right Drug, Right Dose, Right Route, and Right Time B) Right Room, Right Cost, Right Volume, Right Clinic, and Right Day C) Right Syringe, Right Outcome, Right Position, Right Equipment, and Right Form D) Right Assessment, Right Response, Right Diagnosis, Right Plan, and Right Record

• Correct Answer: A
• Rationale: The standard five rights of medication administration—right patient, right drug, right dose, right route, and right time—provide a systematic framework for reducing medication errors.

Q97. A midwife is interpreting the arterial blood gas (ABG) analysis of a pregnant client with severe preeclampsia. The values are: pH = 7.50, PaCO2​=28 mmHg, and HCO3−​=24 mEq/L. What is the correct interpretation? A) Uncompensated Metabolic Acidosis B) Uncompensated Respiratory Alkalosis C) Compensated Respiratory Acidosis D) Uncompensated Metabolic Alkalosis

• Correct Answer: B
• Rationale: A pH above 7.45 indicates alkalosis. The low PaCO2​ (<35 mmHg) matches the alkalotic pH trend, while the bicarbonate (HCO3−​) remains within the normal range (22–26 mEq/L), confirming an uncompensated respiratory alkalosis.

Q98. A client at 34 weeks of gestation is placed in a supine position flat on her back for a prolonged abdominal examination. She suddenly experiences dizziness, lightheadedness, nausea, and her blood pressure drops. What is the cause of these symptoms, and how should they be corrected? A) Hypoglycemia; Administer immediate oral glucose B) Supine Hypotensive Syndrome (Aortocaval compression); Turn the patient onto her left side C) Acute panic disorder; Administer a sedative D) Neurogenic shock; Place her in the high Fowler’s position

• Correct Answer: B
• Rationale: In the supine position, the heavy gravid uterus compresses the maternal inferior vena cava and aorta, reducing venous return to the heart and causing hypotension. Turning the patient onto her left side relieves this compression and restores blood flow.

Q99. A midwife is preparing to perform a urinary catheterization for a woman in labor who has a full bladder and is unable to void. What is the primary reason for emptying a distended bladder during labor? A) To speed up the rupture of membranes B) To prevent the bladder from mechanically blocking fetal descent and to reduce the risk of bladder trauma or postpartum atony C) To induce rapid cervical effacement D) To lower maternal core body temperature

• Correct Answer: B
• Rationale: A full bladder can obstruct the descent of the fetal presenting part through the pelvis, increase the risk of maternal bladder injury during delivery, and lead to postpartum uterine atony and subsequent hemorrhage.

Q100. A midwife is caring for a client who underwent an emergency Cesarean section 12 hours ago. Which of the following nursing interventions is most effective in preventing deep vein thrombosis (DVT) and pulmonary embolism during the immediate postoperative period? A) Maintaining strict, immobile bed rest for the first 3 postoperative days B) Encouraging early, frequent ambulation and active leg exercises in bed C) Restricting oral fluid intake to prevent fluid accumulation in the legs D) Administering continuous high-dose oral corticosteroids

• Correct Answer: B
• Rationale: Prolonged immobility post-surgery can cause venous stasis, a primary risk factor for DVT. Encouraging early ambulation and leg movement promotes blood flow and reduces thromboembolic risks.