Maternity CJE ACTUAL EXAM QUESTIONS AND
CORRECT ANSWERS - 247 Questions
This examination assesses advanced knowledge of antepartum care and complications, including screening,
diagnosis, management, and pathophysiology of conditions such as preeclampsia, gestational diabetes, preterm
labor, and placental abnormalities. Questions require integration of evidence-based guidelines and clinical
reasoning. It contains 247 multiple-choice questions, each with four distractors and a fully worked rationale that
explains why the keyed answer is correct. Content is organized into 10 focused sections: Antepartum Care and
Complications, Intrapartum Care and Complications, Postpartum Care and Complications, Newborn Assessment
and Care, Newborn Complications and Resuscitation, Maternal and Fetal Assessment, Pharmacological
Therapies in Maternity, Psychosocial and Cultural Considerations, Family Planning and Contraception,
Lactation and Breastfeeding. Targeted learning outcomes include: Differentiate between normal and pathological
findings in antepartum assessment.; Apply evidence-based screening and diagnostic criteria for common
antepartum complications.; Formulate management plans for high-risk pregnancies based on current guidelines.;
Interpret diagnostic tests and imaging in the context of antepartum care.. Every item has been reviewed for
clinical accuracy, current guidelines, and clarity so that students can study with confidence and self-correct as
they work through the bank. Use it as a high-yield review immediately before the exam, or as a structured practice
tool during the unit - the rationales double as concise teaching notes. The recommended writing time is 3 hours,
Section 1: Antepartum Care and Complications (Questions 1-25)
1 A pregnant individual at 28 weeks gestation presents with a blood pressure
of 155/95 mmHg and 2+ proteinuria on dipstick. Which laboratory finding is
most concerning for severe preeclampsia?
A) Platelet count 120,000/mm³
B) Serum creatinine 1.2 mg/dL
C) AST 70 U/L
D) Lactate dehydrogenase 600 U/L
Answer: D
Rationale: Severe preeclampsia is defined by features such as thrombocytopenia
(<100,000), elevated creatinine (>1.1), elevated liver enzymes (AST >70), and
LDH >600. Among the options, LDH 600 U/L meets the threshold for severe
disease, while the other values are borderline or less specific.
2 A patient at 24 weeks gestation has a 50-gram glucose challenge test result
of 145 mg/dL. What is the most appropriate next step?
A) Diagnose gestational diabetes and start insulin
B) Perform a 100-gram oral glucose tolerance test
C) Repeat the 50-gram test in 2 weeks
D) Obtain a fasting blood glucose level
,Answer: B
Rationale: A 50-gram glucose challenge test result of 145 mg/dL meets the
threshold for a positive screen (typically 130-140). The recommended next step
is a diagnostic 100-gram OGTT. Diagnosis and management should not be
based on the screening test alone.
3 A patient at 32 weeks gestation with a history of preterm birth presents with
regular uterine contractions and cervical dilation of 2 cm. Fetal fibronectin
testing is negative. What is the most likely implication?
A) High risk of delivery within 7 days
B) Low risk of delivery within 7 days
C) Need for immediate administration of corticosteroids
D) Presence of intra-amniotic infection
Answer: B
Rationale: A negative fetal fibronectin test has a high negative predictive value
for preterm delivery within 7 days, especially in symptomatic patients. It
suggests that preterm birth is unlikely in the near term, reducing the need for
immediate interventions like corticosteroids.
4 Which of the following is the primary mechanism by which low-dose aspirin
reduces the risk of preeclampsia?
A) Inhibition of thromboxane A2 synthesis
B) Vasodilation via nitric oxide release
C) Reduction of angiotensin II sensitivity
D) Blockade of calcium channels
Answer: A
Rationale: Low-dose aspirin (81 mg daily) selectively inhibits
cyclooxygenase-1, reducing thromboxane A2 production more than
prostacyclin. This shifts the balance toward vasodilation and anti-platelet
aggregation, which is thought to prevent the placental ischemia that leads to
preeclampsia.
5 A patient at 20 weeks gestation is diagnosed with a complete placenta previa.
Which management recommendation is most appropriate?
A) Schedule cesarean delivery at 36 weeks
B) Advise pelvic rest and serial ultrasound surveillance
,C) Administer corticosteroids for fetal lung maturity
D) Perform amniocentesis to assess fetal lung maturity
Answer: B
Rationale: For asymptomatic placenta previa diagnosed in the second trimester,
management includes pelvic rest (avoid intercourse, douching) and serial
ultrasound to monitor placental location, as many resolve by term. Cesarean
delivery is planned only if previa persists near term, typically at 36-37 weeks if
symptomatic.
6 A pregnant patient with type 2 diabetes on insulin has a hemoglobin A1c of
9.2% at 10 weeks gestation. What is the most significant risk for the fetus?
A) Fetal macrosomia
B) Neural tube defect
C) Preterm birth
D) Neonatal hypoglycemia
Answer: B
Rationale: Poor glycemic control in the first trimester (elevated A1c) is strongly
associated with an increased risk of congenital anomalies, particularly neural
tube defects and cardiac defects. Macrosomia and neonatal hypoglycemia are
more related to third-trimester control.
7 Which of the following findings is most indicative of chorioamnionitis in a
patient with preterm premature rupture of membranes at 30 weeks?
A) Maternal white blood cell count 12,000/mm³
B) Fetal heart rate baseline 150 bpm with moderate variability
C) Amniotic fluid glucose 10 mg/dL
D) Positive nitrazine test on vaginal fluid
Answer: C
Rationale: Low amniotic fluid glucose (<15 mg/dL) is a sensitive marker for
chorioamnionitis, as bacteria consume glucose. Maternal leukocytosis is
non-specific, a normal fetal heart rate is reassuring, and nitrazine positivity
confirms ROM but not infection.
8 A patient at 34 weeks gestation with severe preeclampsia is started on
magnesium sulfate. Which of the following is the most important parameter
to monitor during infusion?
, A) Blood pressure every 15 minutes
B) Deep tendon reflexes
C) Urine output every hour
D) Respiratory rate every 4 hours
Answer: B
Rationale: Magnesium sulfate toxicity first manifests as loss of deep tendon
reflexes at serum levels of 9-12 mg/dL. Monitoring reflexes allows early
detection before respiratory depression or cardiac arrest occurs. Blood pressure
and urine output are important but not the most critical for toxicity.
9 A patient at 28 weeks gestation presents with acute onset of severe
abdominal pain and vaginal bleeding. Ultrasound shows a retroplacental
hematoma. What is the priority intervention?
A) Administer terbutaline for tocolysis
B) Prepare for emergency cesarean delivery
C) Obtain coagulation studies and type and crossmatch
D) Administer corticosteroids and betamethasone
Answer: C
Rationale: This presentation is concerning for placental abruption, which can
lead to disseminated intravascular coagulation. Immediate evaluation of
coagulation status and blood product preparation is critical. Delivery is
indicated if maternal or fetal compromise occurs, but initial stabilization
includes labs and IV access.
10 A patient at 16 weeks gestation is found to have a uterine fibroid that has
increased in size since her first trimester ultrasound. She reports mild pelvic
pressure. What is the most appropriate management?
A) Schedule myomectomy at 20 weeks
B) Prescribe nonsteroidal anti-inflammatory drugs
C) Reassure and monitor with serial ultrasounds
D) Administer gonadotropin-releasing hormone agonist
Answer: C
Rationale: Most fibroids remain stable or regress during pregnancy.
Asymptomatic or mildly symptomatic fibroids are managed conservatively
with observation. Myomectomy is avoided due to risk of hemorrhage and
preterm labor. NSAIDs are avoided in pregnancy, and GnRH agonists are
CORRECT ANSWERS - 247 Questions
This examination assesses advanced knowledge of antepartum care and complications, including screening,
diagnosis, management, and pathophysiology of conditions such as preeclampsia, gestational diabetes, preterm
labor, and placental abnormalities. Questions require integration of evidence-based guidelines and clinical
reasoning. It contains 247 multiple-choice questions, each with four distractors and a fully worked rationale that
explains why the keyed answer is correct. Content is organized into 10 focused sections: Antepartum Care and
Complications, Intrapartum Care and Complications, Postpartum Care and Complications, Newborn Assessment
and Care, Newborn Complications and Resuscitation, Maternal and Fetal Assessment, Pharmacological
Therapies in Maternity, Psychosocial and Cultural Considerations, Family Planning and Contraception,
Lactation and Breastfeeding. Targeted learning outcomes include: Differentiate between normal and pathological
findings in antepartum assessment.; Apply evidence-based screening and diagnostic criteria for common
antepartum complications.; Formulate management plans for high-risk pregnancies based on current guidelines.;
Interpret diagnostic tests and imaging in the context of antepartum care.. Every item has been reviewed for
clinical accuracy, current guidelines, and clarity so that students can study with confidence and self-correct as
they work through the bank. Use it as a high-yield review immediately before the exam, or as a structured practice
tool during the unit - the rationales double as concise teaching notes. The recommended writing time is 3 hours,
Section 1: Antepartum Care and Complications (Questions 1-25)
1 A pregnant individual at 28 weeks gestation presents with a blood pressure
of 155/95 mmHg and 2+ proteinuria on dipstick. Which laboratory finding is
most concerning for severe preeclampsia?
A) Platelet count 120,000/mm³
B) Serum creatinine 1.2 mg/dL
C) AST 70 U/L
D) Lactate dehydrogenase 600 U/L
Answer: D
Rationale: Severe preeclampsia is defined by features such as thrombocytopenia
(<100,000), elevated creatinine (>1.1), elevated liver enzymes (AST >70), and
LDH >600. Among the options, LDH 600 U/L meets the threshold for severe
disease, while the other values are borderline or less specific.
2 A patient at 24 weeks gestation has a 50-gram glucose challenge test result
of 145 mg/dL. What is the most appropriate next step?
A) Diagnose gestational diabetes and start insulin
B) Perform a 100-gram oral glucose tolerance test
C) Repeat the 50-gram test in 2 weeks
D) Obtain a fasting blood glucose level
,Answer: B
Rationale: A 50-gram glucose challenge test result of 145 mg/dL meets the
threshold for a positive screen (typically 130-140). The recommended next step
is a diagnostic 100-gram OGTT. Diagnosis and management should not be
based on the screening test alone.
3 A patient at 32 weeks gestation with a history of preterm birth presents with
regular uterine contractions and cervical dilation of 2 cm. Fetal fibronectin
testing is negative. What is the most likely implication?
A) High risk of delivery within 7 days
B) Low risk of delivery within 7 days
C) Need for immediate administration of corticosteroids
D) Presence of intra-amniotic infection
Answer: B
Rationale: A negative fetal fibronectin test has a high negative predictive value
for preterm delivery within 7 days, especially in symptomatic patients. It
suggests that preterm birth is unlikely in the near term, reducing the need for
immediate interventions like corticosteroids.
4 Which of the following is the primary mechanism by which low-dose aspirin
reduces the risk of preeclampsia?
A) Inhibition of thromboxane A2 synthesis
B) Vasodilation via nitric oxide release
C) Reduction of angiotensin II sensitivity
D) Blockade of calcium channels
Answer: A
Rationale: Low-dose aspirin (81 mg daily) selectively inhibits
cyclooxygenase-1, reducing thromboxane A2 production more than
prostacyclin. This shifts the balance toward vasodilation and anti-platelet
aggregation, which is thought to prevent the placental ischemia that leads to
preeclampsia.
5 A patient at 20 weeks gestation is diagnosed with a complete placenta previa.
Which management recommendation is most appropriate?
A) Schedule cesarean delivery at 36 weeks
B) Advise pelvic rest and serial ultrasound surveillance
,C) Administer corticosteroids for fetal lung maturity
D) Perform amniocentesis to assess fetal lung maturity
Answer: B
Rationale: For asymptomatic placenta previa diagnosed in the second trimester,
management includes pelvic rest (avoid intercourse, douching) and serial
ultrasound to monitor placental location, as many resolve by term. Cesarean
delivery is planned only if previa persists near term, typically at 36-37 weeks if
symptomatic.
6 A pregnant patient with type 2 diabetes on insulin has a hemoglobin A1c of
9.2% at 10 weeks gestation. What is the most significant risk for the fetus?
A) Fetal macrosomia
B) Neural tube defect
C) Preterm birth
D) Neonatal hypoglycemia
Answer: B
Rationale: Poor glycemic control in the first trimester (elevated A1c) is strongly
associated with an increased risk of congenital anomalies, particularly neural
tube defects and cardiac defects. Macrosomia and neonatal hypoglycemia are
more related to third-trimester control.
7 Which of the following findings is most indicative of chorioamnionitis in a
patient with preterm premature rupture of membranes at 30 weeks?
A) Maternal white blood cell count 12,000/mm³
B) Fetal heart rate baseline 150 bpm with moderate variability
C) Amniotic fluid glucose 10 mg/dL
D) Positive nitrazine test on vaginal fluid
Answer: C
Rationale: Low amniotic fluid glucose (<15 mg/dL) is a sensitive marker for
chorioamnionitis, as bacteria consume glucose. Maternal leukocytosis is
non-specific, a normal fetal heart rate is reassuring, and nitrazine positivity
confirms ROM but not infection.
8 A patient at 34 weeks gestation with severe preeclampsia is started on
magnesium sulfate. Which of the following is the most important parameter
to monitor during infusion?
, A) Blood pressure every 15 minutes
B) Deep tendon reflexes
C) Urine output every hour
D) Respiratory rate every 4 hours
Answer: B
Rationale: Magnesium sulfate toxicity first manifests as loss of deep tendon
reflexes at serum levels of 9-12 mg/dL. Monitoring reflexes allows early
detection before respiratory depression or cardiac arrest occurs. Blood pressure
and urine output are important but not the most critical for toxicity.
9 A patient at 28 weeks gestation presents with acute onset of severe
abdominal pain and vaginal bleeding. Ultrasound shows a retroplacental
hematoma. What is the priority intervention?
A) Administer terbutaline for tocolysis
B) Prepare for emergency cesarean delivery
C) Obtain coagulation studies and type and crossmatch
D) Administer corticosteroids and betamethasone
Answer: C
Rationale: This presentation is concerning for placental abruption, which can
lead to disseminated intravascular coagulation. Immediate evaluation of
coagulation status and blood product preparation is critical. Delivery is
indicated if maternal or fetal compromise occurs, but initial stabilization
includes labs and IV access.
10 A patient at 16 weeks gestation is found to have a uterine fibroid that has
increased in size since her first trimester ultrasound. She reports mild pelvic
pressure. What is the most appropriate management?
A) Schedule myomectomy at 20 weeks
B) Prescribe nonsteroidal anti-inflammatory drugs
C) Reassure and monitor with serial ultrasounds
D) Administer gonadotropin-releasing hormone agonist
Answer: C
Rationale: Most fibroids remain stable or regress during pregnancy.
Asymptomatic or mildly symptomatic fibroids are managed conservatively
with observation. Myomectomy is avoided due to risk of hemorrhage and
preterm labor. NSAIDs are avoided in pregnancy, and GnRH agonists are
