CNM (Certified Nurse-Midwife) Certification Exam
Practice Questions 100 Multiple-Choice Questions
with Answers and Rationales ALL IN ONE PAPER
ALREADY GRADED A+
SECTION 1: ANTEPARTUM CARE (Questions 1–25)
Question 1
A 28-year-old G1P0 at 39 weeks gestation presents for a routine prenatal visit. Which of the
following is the MOST accurate method for calculating the estimated date of delivery (EDD)?
A) Add 7 days to the first day of the last menstrual period and subtract 3 months
B) Add 14 days to the first day of the last menstrual period
C) Subtract 7 days from the first day of the last menstrual period and add 9 months
D) Add 9 months to the first day of the last menstrual period
Correct Answer: A
Rationale: Naegele's rule calculates EDD by adding 7 days to the first day of the last menstrual
period (LMP) and subtracting 3 months. This is the standard method for estimating due date in
a woman with regular 28-day cycles.
Question 2
A pregnant client at 32 weeks gestation presents with painless vaginal bleeding. What is the
MOST important differential diagnosis to consider?
A) Placenta previa
B) Placental abruption
C) Preterm labor
D) Cervical insufficiency
Correct Answer: A
1
, Rationale: Painless vaginal bleeding in the third trimester is the classic presentation of placenta
previa. This condition requires immediate evaluation and is a contraindication to vaginal
examination.
Question 3
A 25-year-old G2P1 at 10 weeks gestation presents with nausea, vomiting, and weight loss of 5
pounds over 2 weeks. Which of the following is the MOST appropriate initial management?
A) Hospital admission for IV fluids
B) Oral antiemetics and dietary modifications
C) Total parenteral nutrition
D) Immediate termination of pregnancy
Correct Answer: B
Rationale: Hyperemesis gravidarum is initially managed with conservative measures including
dietary modifications, small frequent meals, and oral antiemetics. Hospitalization is reserved for
severe cases with dehydration or electrolyte imbalances.
Question 4
Which of the following immunizations is routinely recommended during pregnancy?
A) Measles, mumps, rubella (MMR)
B) Varicella
C) Tdap (tetanus, diphtheria, pertussis)
D) Human papillomavirus (HPV)
Correct Answer: C
Rationale: Tdap is recommended during each pregnancy, ideally between 27-36 weeks
gestation, to provide passive immunity to the newborn. MMR and varicella are live vaccines and
are contraindicated during pregnancy.
Question 5
A 30-year-old G3P2 at 28 weeks gestation presents with a blood pressure of 148/92 mmHg and
2+ protein on urine dipstick. What is the MOST likely diagnosis?
A) Gestational hypertension
B) Preeclampsia
2
, C) Chronic hypertension
D) Eclampsia
Correct Answer: B
Rationale: Preeclampsia is defined as new-onset hypertension (≥140/90 mmHg) and proteinuria
(≥300 mg/24 hours) after 20 weeks gestation. This patient meets the criteria.
Question 6
A pregnant client at 35 weeks gestation reports decreased fetal movement. What is the MOST
appropriate next step?
A) Reassure the patient and send home
B) Perform a non-stress test (NST) or biophysical profile (BPP)
C) Schedule a cesarean section
D) Order a pelvic ultrasound
Correct Answer: B
Rationale: Decreased fetal movement is a concerning sign that warrants further evaluation. A
non-stress test or biophysical profile assesses fetal well-being and guides further management.
Question 7
Which of the following supplements is recommended to prevent neural tube defects?
A) Vitamin C
B) Vitamin D
C) Folic acid
D) Vitamin K
Correct Answer: C
Rationale: Folic acid supplementation (400-800 mcg daily) before conception and during early
pregnancy significantly reduces the risk of neural tube defects such as spina bifida.
Question 8
A 22-year-old G1P0 at 16 weeks gestation presents with a positive quad screen showing
elevated alpha-fetoprotein (AFP). What is the MOST likely association?
3
, A) Down syndrome
B) Neural tube defect
C) Trisomy 18
D) Normal variant
Correct Answer: B
Rationale: Elevated maternal serum AFP is associated with open neural tube defects (e.g., spina
bifida, anencephaly). Low AFP is associated with Down syndrome and trisomy 18.
Question 9
Which of the following is a sign of true labor?
A) Irregular contractions
B) Contractions that stop with rest
C) Progressive cervical dilation and effacement
D) Pain localized to the lower back only
Correct Answer: C
Rationale: True labor is characterized by regular contractions that produce progressive cervical
change (dilation and effacement).
Question 10
A pregnant client at 24 weeks gestation has a 1-hour glucose challenge test result of 155 mg/dL.
What is the MOST appropriate next step?
A) Diagnose gestational diabetes
B) Order a 3-hour glucose tolerance test
C) Repeat the 1-hour test in 2 weeks
D) No further action needed
Correct Answer: B
Rationale: A 1-hour glucose challenge test result ≥140 mg/dL warrants a 3-hour diagnostic
glucose tolerance test. Gestational diabetes is diagnosed based on 3-hour GTT results.
4
Practice Questions 100 Multiple-Choice Questions
with Answers and Rationales ALL IN ONE PAPER
ALREADY GRADED A+
SECTION 1: ANTEPARTUM CARE (Questions 1–25)
Question 1
A 28-year-old G1P0 at 39 weeks gestation presents for a routine prenatal visit. Which of the
following is the MOST accurate method for calculating the estimated date of delivery (EDD)?
A) Add 7 days to the first day of the last menstrual period and subtract 3 months
B) Add 14 days to the first day of the last menstrual period
C) Subtract 7 days from the first day of the last menstrual period and add 9 months
D) Add 9 months to the first day of the last menstrual period
Correct Answer: A
Rationale: Naegele's rule calculates EDD by adding 7 days to the first day of the last menstrual
period (LMP) and subtracting 3 months. This is the standard method for estimating due date in
a woman with regular 28-day cycles.
Question 2
A pregnant client at 32 weeks gestation presents with painless vaginal bleeding. What is the
MOST important differential diagnosis to consider?
A) Placenta previa
B) Placental abruption
C) Preterm labor
D) Cervical insufficiency
Correct Answer: A
1
, Rationale: Painless vaginal bleeding in the third trimester is the classic presentation of placenta
previa. This condition requires immediate evaluation and is a contraindication to vaginal
examination.
Question 3
A 25-year-old G2P1 at 10 weeks gestation presents with nausea, vomiting, and weight loss of 5
pounds over 2 weeks. Which of the following is the MOST appropriate initial management?
A) Hospital admission for IV fluids
B) Oral antiemetics and dietary modifications
C) Total parenteral nutrition
D) Immediate termination of pregnancy
Correct Answer: B
Rationale: Hyperemesis gravidarum is initially managed with conservative measures including
dietary modifications, small frequent meals, and oral antiemetics. Hospitalization is reserved for
severe cases with dehydration or electrolyte imbalances.
Question 4
Which of the following immunizations is routinely recommended during pregnancy?
A) Measles, mumps, rubella (MMR)
B) Varicella
C) Tdap (tetanus, diphtheria, pertussis)
D) Human papillomavirus (HPV)
Correct Answer: C
Rationale: Tdap is recommended during each pregnancy, ideally between 27-36 weeks
gestation, to provide passive immunity to the newborn. MMR and varicella are live vaccines and
are contraindicated during pregnancy.
Question 5
A 30-year-old G3P2 at 28 weeks gestation presents with a blood pressure of 148/92 mmHg and
2+ protein on urine dipstick. What is the MOST likely diagnosis?
A) Gestational hypertension
B) Preeclampsia
2
, C) Chronic hypertension
D) Eclampsia
Correct Answer: B
Rationale: Preeclampsia is defined as new-onset hypertension (≥140/90 mmHg) and proteinuria
(≥300 mg/24 hours) after 20 weeks gestation. This patient meets the criteria.
Question 6
A pregnant client at 35 weeks gestation reports decreased fetal movement. What is the MOST
appropriate next step?
A) Reassure the patient and send home
B) Perform a non-stress test (NST) or biophysical profile (BPP)
C) Schedule a cesarean section
D) Order a pelvic ultrasound
Correct Answer: B
Rationale: Decreased fetal movement is a concerning sign that warrants further evaluation. A
non-stress test or biophysical profile assesses fetal well-being and guides further management.
Question 7
Which of the following supplements is recommended to prevent neural tube defects?
A) Vitamin C
B) Vitamin D
C) Folic acid
D) Vitamin K
Correct Answer: C
Rationale: Folic acid supplementation (400-800 mcg daily) before conception and during early
pregnancy significantly reduces the risk of neural tube defects such as spina bifida.
Question 8
A 22-year-old G1P0 at 16 weeks gestation presents with a positive quad screen showing
elevated alpha-fetoprotein (AFP). What is the MOST likely association?
3
, A) Down syndrome
B) Neural tube defect
C) Trisomy 18
D) Normal variant
Correct Answer: B
Rationale: Elevated maternal serum AFP is associated with open neural tube defects (e.g., spina
bifida, anencephaly). Low AFP is associated with Down syndrome and trisomy 18.
Question 9
Which of the following is a sign of true labor?
A) Irregular contractions
B) Contractions that stop with rest
C) Progressive cervical dilation and effacement
D) Pain localized to the lower back only
Correct Answer: C
Rationale: True labor is characterized by regular contractions that produce progressive cervical
change (dilation and effacement).
Question 10
A pregnant client at 24 weeks gestation has a 1-hour glucose challenge test result of 155 mg/dL.
What is the MOST appropriate next step?
A) Diagnose gestational diabetes
B) Order a 3-hour glucose tolerance test
C) Repeat the 1-hour test in 2 weeks
D) No further action needed
Correct Answer: B
Rationale: A 1-hour glucose challenge test result ≥140 mg/dL warrants a 3-hour diagnostic
glucose tolerance test. Gestational diabetes is diagnosed based on 3-hour GTT results.
4
