Barkley CNM Exam Practice Questions 200 Questions
with Verified Answers & Detailed Rationales Certified
Nurse-Midwife (CNM) Certification Review | Latest
2026/2027 Edition | AMCB Exam Blueprint | Grade A+
EXAM OVERVIEW
Component Details
Exam AMCB Certified Nurse-Midwife (CNM) Certification Exam
Content Antepartum Care, Intrapartum Care, Postpartum Care, Newborn Care,
Areas Well-Woman GYN, Primary Care, Professional Issues
SECTION 1: ANTEPARTUM CARE (Questions 1-75)
Question 1
A 28-year-old G1P0 at 8 weeks gestation presents with first-trimester bleeding and
cramping. Transvaginal ultrasound reveals an intrauterine pregnancy with fetal cardiac
activity, but a subchorionic hemorrhage is noted. Which management is most
appropriate?
A) Immediate dilation and curettage
B) Bed rest with pelvic rest and reassurance
C) Administration of Rh immunoglobulin if Rh-negative
D) Serial hCG monitoring and repeat ultrasound in 1 week
Correct Answer: B
Rationale: A subchorionic hemorrhage in the presence of a viable intrauterine
pregnancy with fetal cardiac activity is typically managed conservatively with pelvic rest
and reassurance . The majority resolve spontaneously. Rh immunoglobulin should be
,administered if the patient is Rh-negative, but this is not the primary management.
Immediate D&C is not indicated without signs of inevitable miscarriage.
Question 2
A 32-year-old G3P2 at 12 weeks gestation presents for her first prenatal visit. Her BMI is
32 kg/m². Which of the following is the most appropriate recommendation regarding
weight gain?
A) 11-20 pounds
B) 15-25 pounds
C) 25-35 pounds
D) 28-40 pounds
Correct Answer: A
Rationale: According to IOM guidelines, women with a pre-pregnancy BMI ≥30 kg/m²
should gain 11-20 pounds (5-9 kg) during pregnancy . This patient's BMI of 32 kg/m²
places her in the obese category. Nutritional counseling and monitoring of weight gain
patterns are essential.
Question 3
A 35-year-old G2P1 at 16 weeks gestation is Rh-negative with an Rh-positive partner.
Her antibody screen is negative. When should Rh immunoglobulin be administered?
A) At 28 weeks gestation
B) Immediately at the first visit
C) At 36 weeks gestation
D) Only at delivery
Correct Answer: A
Rationale: For Rh-negative women with negative antibody screens, Rh immunoglobulin
is routinely administered at 28 weeks gestation and within 72 hours of delivery if the
infant is Rh-positive . Additional doses are indicated after any potentially sensitizing
events (amniocentesis, vaginal bleeding, abdominal trauma).
,Question 4
During a 20-week prenatal visit, a patient reports increased fetal movement and
occasional Braxton-Hicks contractions. Which of the following is the most appropriate
response?
A) Refer for immediate ultrasound
B) Recommend bed rest
C) Reassure that these are normal findings
D) Administer tocolytic therapy
Correct Answer: C
Rationale: Increased fetal movement and Braxton-Hicks contractions are normal
findings in the second trimester . Patients should be counseled about normal physiology
of pregnancy, common discomforts, and self-care during pregnancy. No intervention is
required.
Question 5
A 29-year-old G1P0 at 10 weeks gestation presents with nausea and vomiting. She has
lost 3 pounds since her last visit. Which of the following is the most appropriate first-line
treatment?
A) Ondansetron 4 mg PO
B) Pyridoxine (vitamin B6) and doxylamine
C) Metoclopramide
D) Promethazine
Correct Answer: B
Rationale: Pyridoxine (vitamin B6) with doxylamine is the first-line treatment for nausea
and vomiting of pregnancy . It is FDA-approved for this indication and has a strong
safety profile. Ondansetron may be used for refractory cases but is not first-line.
Question 6
A 27-year-old G2P1 at 32 weeks gestation has a hemoglobin of 10.2 g/dL and
hematocrit of 31%. Which laboratory test should be ordered to confirm the diagnosis?
, A) Serum ferritin
B) Vitamin B12 level
C) Folate level
D) Reticulocyte count
Correct Answer: A
Rationale: Iron deficiency anemia is the most common anemia in pregnancy . Serum
ferritin is the most sensitive and specific test for iron deficiency anemia. A ferritin <30
ng/mL confirms the diagnosis. Iron supplementation should be initiated.
Question 7
A 34-year-old G3P2 at 18 weeks gestation has a positive syphilis screen. Which of the
following is the most appropriate next step?
A) Order a confirmatory treponemal test
B) Treat empirically with penicillin
C) Schedule a repeat test in 4 weeks
D) Refer to infectious disease
Correct Answer: A
Rationale: A positive syphilis screen should be confirmed with a treponemal test (e.g.,
FTA-ABS or TP-PA) . Confirmed syphilis in pregnancy requires treatment with penicillin
to prevent congenital syphilis. The confirmatory test should be ordered before
treatment.
Question 8
A 31-year-old G1P0 at 36 weeks gestation presents with a blood pressure of 148/92
mmHg and 1+ proteinuria. Which additional finding would confirm a diagnosis of
preeclampsia?
A) Headache and visual disturbances
B) Elevated liver enzymes
C) Thrombocytopenia
D) Any of the above
with Verified Answers & Detailed Rationales Certified
Nurse-Midwife (CNM) Certification Review | Latest
2026/2027 Edition | AMCB Exam Blueprint | Grade A+
EXAM OVERVIEW
Component Details
Exam AMCB Certified Nurse-Midwife (CNM) Certification Exam
Content Antepartum Care, Intrapartum Care, Postpartum Care, Newborn Care,
Areas Well-Woman GYN, Primary Care, Professional Issues
SECTION 1: ANTEPARTUM CARE (Questions 1-75)
Question 1
A 28-year-old G1P0 at 8 weeks gestation presents with first-trimester bleeding and
cramping. Transvaginal ultrasound reveals an intrauterine pregnancy with fetal cardiac
activity, but a subchorionic hemorrhage is noted. Which management is most
appropriate?
A) Immediate dilation and curettage
B) Bed rest with pelvic rest and reassurance
C) Administration of Rh immunoglobulin if Rh-negative
D) Serial hCG monitoring and repeat ultrasound in 1 week
Correct Answer: B
Rationale: A subchorionic hemorrhage in the presence of a viable intrauterine
pregnancy with fetal cardiac activity is typically managed conservatively with pelvic rest
and reassurance . The majority resolve spontaneously. Rh immunoglobulin should be
,administered if the patient is Rh-negative, but this is not the primary management.
Immediate D&C is not indicated without signs of inevitable miscarriage.
Question 2
A 32-year-old G3P2 at 12 weeks gestation presents for her first prenatal visit. Her BMI is
32 kg/m². Which of the following is the most appropriate recommendation regarding
weight gain?
A) 11-20 pounds
B) 15-25 pounds
C) 25-35 pounds
D) 28-40 pounds
Correct Answer: A
Rationale: According to IOM guidelines, women with a pre-pregnancy BMI ≥30 kg/m²
should gain 11-20 pounds (5-9 kg) during pregnancy . This patient's BMI of 32 kg/m²
places her in the obese category. Nutritional counseling and monitoring of weight gain
patterns are essential.
Question 3
A 35-year-old G2P1 at 16 weeks gestation is Rh-negative with an Rh-positive partner.
Her antibody screen is negative. When should Rh immunoglobulin be administered?
A) At 28 weeks gestation
B) Immediately at the first visit
C) At 36 weeks gestation
D) Only at delivery
Correct Answer: A
Rationale: For Rh-negative women with negative antibody screens, Rh immunoglobulin
is routinely administered at 28 weeks gestation and within 72 hours of delivery if the
infant is Rh-positive . Additional doses are indicated after any potentially sensitizing
events (amniocentesis, vaginal bleeding, abdominal trauma).
,Question 4
During a 20-week prenatal visit, a patient reports increased fetal movement and
occasional Braxton-Hicks contractions. Which of the following is the most appropriate
response?
A) Refer for immediate ultrasound
B) Recommend bed rest
C) Reassure that these are normal findings
D) Administer tocolytic therapy
Correct Answer: C
Rationale: Increased fetal movement and Braxton-Hicks contractions are normal
findings in the second trimester . Patients should be counseled about normal physiology
of pregnancy, common discomforts, and self-care during pregnancy. No intervention is
required.
Question 5
A 29-year-old G1P0 at 10 weeks gestation presents with nausea and vomiting. She has
lost 3 pounds since her last visit. Which of the following is the most appropriate first-line
treatment?
A) Ondansetron 4 mg PO
B) Pyridoxine (vitamin B6) and doxylamine
C) Metoclopramide
D) Promethazine
Correct Answer: B
Rationale: Pyridoxine (vitamin B6) with doxylamine is the first-line treatment for nausea
and vomiting of pregnancy . It is FDA-approved for this indication and has a strong
safety profile. Ondansetron may be used for refractory cases but is not first-line.
Question 6
A 27-year-old G2P1 at 32 weeks gestation has a hemoglobin of 10.2 g/dL and
hematocrit of 31%. Which laboratory test should be ordered to confirm the diagnosis?
, A) Serum ferritin
B) Vitamin B12 level
C) Folate level
D) Reticulocyte count
Correct Answer: A
Rationale: Iron deficiency anemia is the most common anemia in pregnancy . Serum
ferritin is the most sensitive and specific test for iron deficiency anemia. A ferritin <30
ng/mL confirms the diagnosis. Iron supplementation should be initiated.
Question 7
A 34-year-old G3P2 at 18 weeks gestation has a positive syphilis screen. Which of the
following is the most appropriate next step?
A) Order a confirmatory treponemal test
B) Treat empirically with penicillin
C) Schedule a repeat test in 4 weeks
D) Refer to infectious disease
Correct Answer: A
Rationale: A positive syphilis screen should be confirmed with a treponemal test (e.g.,
FTA-ABS or TP-PA) . Confirmed syphilis in pregnancy requires treatment with penicillin
to prevent congenital syphilis. The confirmatory test should be ordered before
treatment.
Question 8
A 31-year-old G1P0 at 36 weeks gestation presents with a blood pressure of 148/92
mmHg and 1+ proteinuria. Which additional finding would confirm a diagnosis of
preeclampsia?
A) Headache and visual disturbances
B) Elevated liver enzymes
C) Thrombocytopenia
D) Any of the above
