CNM – Certified Nurse-Midwife | Comprehensive Study
Guide, Practice Exam, Questions & Answers, Midwifery
Certification Exam Prep, Women's Health, Prenatal
Care, Labor & Delivery, Postpartum Care, Newborn
Assessment, High-Risk Obstetrics, Fetal Monitoring,
Clinical Judgment, Detailed Rationales, Complete
Review
Question 1: A 32-year-old primigravida at 28 weeks gestation presents with
new-onset hypertension (BP 148/92 mmHg) and 1+ proteinuria on dipstick.
Which laboratory finding would be most indicative of severe preeclampsia
with features of hemolysis, elevated liver enzymes, and low platelet count
(HELLP syndrome)?
A. Elevated serum creatinine and BUN
B. Elevated liver transaminases (AST and ALT)
C. Elevated serum uric acid
D. Thrombocytopenia with a platelet count of 80,000/µL
CORRECT ANSWER: D. Thrombocytopenia with a platelet count of 80,000/µL
Rationale: HELLP syndrome is a severe form of preeclampsia characterized by
Hemolysis, Elevated Liver enzymes, and Low Platelet count. A platelet count
<100,000/µL is a key diagnostic criterion for HELLP, making thrombocytopenia the
most definitive marker among the options provided. While elevated liver transaminases
and renal impairment are also features, the hallmark of HELLP involves the triad of
hemolysis, liver dysfunction, and thrombocytopenia. A platelet count of 80,000/µL
directly reflects the "LP" component and indicates a critical level requiring immediate
intervention, often delivery .
Question 2: A patient at 39 weeks gestation is admitted for induction of labor.
Her Bishop score is 4. What is the most appropriate initial step to promote a
successful vaginal delivery?
A. Immediate administration of oxytocin infusion
B. Artificial rupture of membranes (AROM)
C. Cervical ripening with a prostaglandin agent
D. Initiation of an amnioinfusion
CORRECT ANSWER: C. Cervical ripening with a prostaglandin agent
Rationale: A Bishop score of 4 indicates an unfavorable cervix. Directly initiating
oxytocin or AROM in this context is associated with a higher risk of failed induction and
cesarean delivery. Cervical ripening, typically using prostaglandin E2 (dinoprostone) or
misoprostol, is the standard initial intervention to prepare the cervix for induction,
improving the likelihood of a successful vaginal delivery .
,Question 3: A newborn is delivered at 39 weeks via spontaneous vaginal
delivery. The mother is Group B Streptococcus (GBS) positive and received her
first dose of intrapartum penicillin G 1 hour prior to delivery. What is the most
appropriate management for this asymptomatic newborn?
A. Routine newborn care with discharge at 24 hours
B. Admission to the NICU for empirical intravenous antibiotics
C. Obtain a complete blood count (CBC) and blood culture, and observe for 48 hours
D. Immediate administration of intramuscular penicillin
CORRECT ANSWER: C. Obtain a complete blood count (CBC) and blood
culture, and observe for 48 hours
Rationale: Neonates born to GBS-positive mothers who receive less than 4 hours of
adequate intrapartum antibiotic prophylaxis are considered at increased risk for early-
onset sepsis. The standard of care is to initiate laboratory evaluation (CBC and blood
culture) and observe the infant for at least 48 hours for signs of infection. Empirical
antibiotics are reserved for symptomatic infants or those with significant risk factors and
clinical findings .
Question 4: A 34-year-old woman at 8 weeks gestation presents with
significant nausea, vomiting, and a 5% weight loss from her pre-pregnancy
weight. She has ketones in her urine. This clinical presentation is most
consistent with which diagnosis?
A. Normal pregnancy-related nausea
B. Gastroesophageal reflux disease
C. Hyperemesis gravidarum
D. Gastroenteritis
CORRECT ANSWER: C. Hyperemesis gravidarum
Rationale: Hyperemesis gravidarum is characterized by severe nausea and vomiting
that leads to weight loss, dehydration, ketonuria, and electrolyte disturbances, typically
occurring in the first trimester. This presentation goes beyond typical "morning
sickness" and requires medical intervention to prevent complications like metabolic
alkalosis and nutritional deficiencies .
Question 5: During an intrapartum fetal monitoring tracing, you observe late
decelerations with a loss of baseline variability. What is the most appropriate
immediate nursing intervention?
A. Apply a fetal scalp electrode to obtain a more accurate tracing
B. Administer a fluid bolus and prepare for immediate operative delivery
,C. Perform a vaginal exam to assess cervical dilation
D. Turn the patient to the left lateral position and administer oxygen
CORRECT ANSWER: D. Turn the patient to the left lateral position and
administer oxygen
Rationale: Late decelerations with loss of variability are concerning for fetal hypoxia
and uteroplacental insufficiency. The initial management includes intrauterine
resuscitation maneuvers: changing the mother's position to the left lateral (to relieve
aortocaval compression), increasing intravenous fluids, and administering oxygen. If
these measures do not resolve the pattern, operative delivery may become necessary .
Question 6: A 22-year-old nulliparous patient is in the active phase of labor.
The electronic fetal monitor shows a category II tracing with recurrent
variable decelerations. What is the most likely cause of this fetal heart rate
pattern?
A. Fetal head compression
B. Uteroplacental insufficiency
C. Umbilical cord compression
D. Maternal hypotension
CORRECT ANSWER: C. Umbilical cord compression
Rationale: Variable decelerations are characterized by a rapid fall and return of the fetal
heart rate and are most commonly associated with umbilical cord compression. This can
occur due to a nuchal cord, oligohydramnios, or the cord being compressed between the
fetus and the maternal pelvis. Early decelerations are associated with head compression,
and late decelerations indicate uteroplacental insufficiency .
Question 7: A postpartum patient at 6 weeks is screened for depression using
the Edinburgh Postnatal Depression Scale (EPDS). A score of 12 indicates the
need for:
A. Reassurance and routine follow-up at the 6-month visit
B. A repeat screening in 2 weeks
C. Immediate referral for psychiatric evaluation and treatment
D. Initiation of a selective serotonin reuptake inhibitor (SSRI)
CORRECT ANSWER: C. Immediate referral for psychiatric evaluation and
treatment
Rationale: The Edinburgh Postnatal Depression Scale (EPDS) is a validated screening
tool for postpartum depression. A score of 10 or higher typically suggests the presence
of depressive symptoms requiring further assessment and referral. A score of 12
, warrants a mental health evaluation to confirm the diagnosis and initiate appropriate
treatment, which may include counseling or antidepressant therapy .
Question 8: A 29-year-old woman is evaluated for a new Pap smear result of
ASC-US (Atypical Squamous Cells of Undetermined Significance). The patient
is 30 years old. What is the next step in her management according to current
guidelines?
A. Repeat Pap smear in 12 months
B. Immediate colposcopy
C. Reflex HPV (Human Papillomavirus) testing
D. No further follow-up is needed
CORRECT ANSWER: C. Reflex HPV (Human Papillomavirus) testing
Rationale: The standard of care for managing an ASC-US Pap result in women aged 30
and older is to perform reflex HPV testing on the same cytology sample. If the HPV test
is negative, the patient can be followed up with routine co-testing in 3 to 5 years. If the
HPV test is positive for high-risk HPV types, colposcopy is then indicated .
Question 9: A patient at 32 weeks gestation presents with the acute onset of
painless, bright red vaginal bleeding. Which condition should be at the top of
the differential diagnosis?
A. Placental abruption
B. Labor
C. Placenta previa
D. Vasa previa
CORRECT ANSWER: C. Placenta previa
Rationale: Painless, bright red vaginal bleeding in the second or third trimester is the
classic presentation of placenta previa, a condition where the placenta partially or
completely covers the cervical os. Placental abruption typically presents with painful
bleeding and abdominal pain. Vasa previa is very rare and involves fetal vessels running
over the cervical os. A digital pelvic exam should be avoided until ultrasound confirms
the placental location to prevent catastrophic hemorrhage .
Question 10: A patient at 35 weeks gestation with severe preeclampsia is being
prepared for delivery. Which medication is most important to administer to
prevent maternal seizures?
A. Nifedipine
B. Labetalol
Guide, Practice Exam, Questions & Answers, Midwifery
Certification Exam Prep, Women's Health, Prenatal
Care, Labor & Delivery, Postpartum Care, Newborn
Assessment, High-Risk Obstetrics, Fetal Monitoring,
Clinical Judgment, Detailed Rationales, Complete
Review
Question 1: A 32-year-old primigravida at 28 weeks gestation presents with
new-onset hypertension (BP 148/92 mmHg) and 1+ proteinuria on dipstick.
Which laboratory finding would be most indicative of severe preeclampsia
with features of hemolysis, elevated liver enzymes, and low platelet count
(HELLP syndrome)?
A. Elevated serum creatinine and BUN
B. Elevated liver transaminases (AST and ALT)
C. Elevated serum uric acid
D. Thrombocytopenia with a platelet count of 80,000/µL
CORRECT ANSWER: D. Thrombocytopenia with a platelet count of 80,000/µL
Rationale: HELLP syndrome is a severe form of preeclampsia characterized by
Hemolysis, Elevated Liver enzymes, and Low Platelet count. A platelet count
<100,000/µL is a key diagnostic criterion for HELLP, making thrombocytopenia the
most definitive marker among the options provided. While elevated liver transaminases
and renal impairment are also features, the hallmark of HELLP involves the triad of
hemolysis, liver dysfunction, and thrombocytopenia. A platelet count of 80,000/µL
directly reflects the "LP" component and indicates a critical level requiring immediate
intervention, often delivery .
Question 2: A patient at 39 weeks gestation is admitted for induction of labor.
Her Bishop score is 4. What is the most appropriate initial step to promote a
successful vaginal delivery?
A. Immediate administration of oxytocin infusion
B. Artificial rupture of membranes (AROM)
C. Cervical ripening with a prostaglandin agent
D. Initiation of an amnioinfusion
CORRECT ANSWER: C. Cervical ripening with a prostaglandin agent
Rationale: A Bishop score of 4 indicates an unfavorable cervix. Directly initiating
oxytocin or AROM in this context is associated with a higher risk of failed induction and
cesarean delivery. Cervical ripening, typically using prostaglandin E2 (dinoprostone) or
misoprostol, is the standard initial intervention to prepare the cervix for induction,
improving the likelihood of a successful vaginal delivery .
,Question 3: A newborn is delivered at 39 weeks via spontaneous vaginal
delivery. The mother is Group B Streptococcus (GBS) positive and received her
first dose of intrapartum penicillin G 1 hour prior to delivery. What is the most
appropriate management for this asymptomatic newborn?
A. Routine newborn care with discharge at 24 hours
B. Admission to the NICU for empirical intravenous antibiotics
C. Obtain a complete blood count (CBC) and blood culture, and observe for 48 hours
D. Immediate administration of intramuscular penicillin
CORRECT ANSWER: C. Obtain a complete blood count (CBC) and blood
culture, and observe for 48 hours
Rationale: Neonates born to GBS-positive mothers who receive less than 4 hours of
adequate intrapartum antibiotic prophylaxis are considered at increased risk for early-
onset sepsis. The standard of care is to initiate laboratory evaluation (CBC and blood
culture) and observe the infant for at least 48 hours for signs of infection. Empirical
antibiotics are reserved for symptomatic infants or those with significant risk factors and
clinical findings .
Question 4: A 34-year-old woman at 8 weeks gestation presents with
significant nausea, vomiting, and a 5% weight loss from her pre-pregnancy
weight. She has ketones in her urine. This clinical presentation is most
consistent with which diagnosis?
A. Normal pregnancy-related nausea
B. Gastroesophageal reflux disease
C. Hyperemesis gravidarum
D. Gastroenteritis
CORRECT ANSWER: C. Hyperemesis gravidarum
Rationale: Hyperemesis gravidarum is characterized by severe nausea and vomiting
that leads to weight loss, dehydration, ketonuria, and electrolyte disturbances, typically
occurring in the first trimester. This presentation goes beyond typical "morning
sickness" and requires medical intervention to prevent complications like metabolic
alkalosis and nutritional deficiencies .
Question 5: During an intrapartum fetal monitoring tracing, you observe late
decelerations with a loss of baseline variability. What is the most appropriate
immediate nursing intervention?
A. Apply a fetal scalp electrode to obtain a more accurate tracing
B. Administer a fluid bolus and prepare for immediate operative delivery
,C. Perform a vaginal exam to assess cervical dilation
D. Turn the patient to the left lateral position and administer oxygen
CORRECT ANSWER: D. Turn the patient to the left lateral position and
administer oxygen
Rationale: Late decelerations with loss of variability are concerning for fetal hypoxia
and uteroplacental insufficiency. The initial management includes intrauterine
resuscitation maneuvers: changing the mother's position to the left lateral (to relieve
aortocaval compression), increasing intravenous fluids, and administering oxygen. If
these measures do not resolve the pattern, operative delivery may become necessary .
Question 6: A 22-year-old nulliparous patient is in the active phase of labor.
The electronic fetal monitor shows a category II tracing with recurrent
variable decelerations. What is the most likely cause of this fetal heart rate
pattern?
A. Fetal head compression
B. Uteroplacental insufficiency
C. Umbilical cord compression
D. Maternal hypotension
CORRECT ANSWER: C. Umbilical cord compression
Rationale: Variable decelerations are characterized by a rapid fall and return of the fetal
heart rate and are most commonly associated with umbilical cord compression. This can
occur due to a nuchal cord, oligohydramnios, or the cord being compressed between the
fetus and the maternal pelvis. Early decelerations are associated with head compression,
and late decelerations indicate uteroplacental insufficiency .
Question 7: A postpartum patient at 6 weeks is screened for depression using
the Edinburgh Postnatal Depression Scale (EPDS). A score of 12 indicates the
need for:
A. Reassurance and routine follow-up at the 6-month visit
B. A repeat screening in 2 weeks
C. Immediate referral for psychiatric evaluation and treatment
D. Initiation of a selective serotonin reuptake inhibitor (SSRI)
CORRECT ANSWER: C. Immediate referral for psychiatric evaluation and
treatment
Rationale: The Edinburgh Postnatal Depression Scale (EPDS) is a validated screening
tool for postpartum depression. A score of 10 or higher typically suggests the presence
of depressive symptoms requiring further assessment and referral. A score of 12
, warrants a mental health evaluation to confirm the diagnosis and initiate appropriate
treatment, which may include counseling or antidepressant therapy .
Question 8: A 29-year-old woman is evaluated for a new Pap smear result of
ASC-US (Atypical Squamous Cells of Undetermined Significance). The patient
is 30 years old. What is the next step in her management according to current
guidelines?
A. Repeat Pap smear in 12 months
B. Immediate colposcopy
C. Reflex HPV (Human Papillomavirus) testing
D. No further follow-up is needed
CORRECT ANSWER: C. Reflex HPV (Human Papillomavirus) testing
Rationale: The standard of care for managing an ASC-US Pap result in women aged 30
and older is to perform reflex HPV testing on the same cytology sample. If the HPV test
is negative, the patient can be followed up with routine co-testing in 3 to 5 years. If the
HPV test is positive for high-risk HPV types, colposcopy is then indicated .
Question 9: A patient at 32 weeks gestation presents with the acute onset of
painless, bright red vaginal bleeding. Which condition should be at the top of
the differential diagnosis?
A. Placental abruption
B. Labor
C. Placenta previa
D. Vasa previa
CORRECT ANSWER: C. Placenta previa
Rationale: Painless, bright red vaginal bleeding in the second or third trimester is the
classic presentation of placenta previa, a condition where the placenta partially or
completely covers the cervical os. Placental abruption typically presents with painful
bleeding and abdominal pain. Vasa previa is very rare and involves fetal vessels running
over the cervical os. A digital pelvic exam should be avoided until ultrasound confirms
the placental location to prevent catastrophic hemorrhage .
Question 10: A patient at 35 weeks gestation with severe preeclampsia is being
prepared for delivery. Which medication is most important to administer to
prevent maternal seizures?
A. Nifedipine
B. Labetalol
