CNM Certification ACTUAL EXAM ALL
QUESTIONS AND ANSWERS ALREADY GRADED
A+. 100% VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | GRADED A+
Domain 1: Antepartum Care (21%)
Question 1
A 32-year-old primigravida at 28 weeks gestation presents with a blood pressure of 155/102
mmHg and 2+ proteinuria. She reports a severe headache and visual changes. Which of the
following is the priority intervention?
A) Schedule a follow-up appointment in 1 week
B) Admit the patient for observation and management of preeclampsia with severe features
C) Prescribe oral antihypertensive medication and discharge
D) Recommend bed rest at home
Answer: B) Admit the patient for observation and management of preeclampsia with severe
features
Rationale: This patient is presenting with preeclampsia with severe features, characterized by
severe hypertension (≥160/110 mmHg) and symptoms of end-organ dysfunction (headache,
visual changes). This is a medical emergency requiring immediate admission for monitoring,
antihypertensive therapy, and possible delivery planning.
Question 2
A pregnant patient at 36 weeks gestation has a hemoglobin A1c of 8.5%. The patient has been
diagnosed with gestational diabetes. Which of the following fetal complications is most
associated with this condition?
A) Intrauterine growth restriction (IUGR)
B) Macrosomia
C) Oligohydramnios
D) Preterm birth only
,Answer: B) Macrosomia
Rationale: Poorly controlled gestational diabetes (elevated A1c) is strongly associated with fetal
macrosomia (estimated fetal weight > 4,000-4,500 grams). Maternal hyperglycemia leads to
fetal hyperinsulinemia, which promotes excessive fetal growth. Other complications include
neonatal hypoglycemia, polyhydramnios, and respiratory distress syndrome.
Question 3
A 25-year-old G2P1 patient at 32 weeks gestation presents with painless, bright red vaginal
bleeding. She reports no trauma, no contractions, and the fetal heart rate is reassuring. Which
condition should the nurse-midwife suspect?
A) Placental abruption
B) Placenta previa
C) Preterm labor
D) Cervical insufficiency
Answer: B) Placenta previa
Rationale: Painless, bright red vaginal bleeding in the third trimester is the classic presentation
of placenta previa. Placental abruption typically presents with painful, dark bleeding and uterine
tenderness.
Question 4
A patient at 35 weeks gestation is diagnosed with intrahepatic cholestasis of pregnancy. Which
symptom is most consistent with this condition?
A) Severe headache and visual changes
B) Pruritus (itching), particularly on the palms and soles
C) Epigastric pain and nausea
D) Right upper quadrant pain and hypertension
Answer: B) Pruritus (itching), particularly on the palms and soles
Rationale: Intrahepatic cholestasis of pregnancy is characterized by pruritus, particularly on the
palms and soles, due to elevated bile acids. It is associated with increased risk of fetal distress
and stillbirth. The other options are more consistent with preeclampsia or HELLP syndrome.
,Question 5
A patient at 24 weeks gestation has a 1-hour glucose tolerance test result of 185 mg/dL. Which
is the appropriate next step?
A) Diagnosis of gestational diabetes
B) 3-hour oral glucose tolerance test (OGTT) for confirmation
C) Immediate insulin therapy
D) Dietary counseling only
Answer: B) 3-hour oral glucose tolerance test (OGTT) for confirmation
Rationale: A 1-hour glucose tolerance test result ≥ 140-180 mg/dL (depending on institutional
cutoff) requires confirmation with a 3-hour OGTT. Gestational diabetes is diagnosed if two or
more values are elevated on the 3-hour test.
Question 6
A patient at 12 weeks gestation with a history of cervical insufficiency and prior second-
trimester loss is being evaluated. Which intervention is indicated for cervical insufficiency?
A) Cerclage placement
B) Progesterone supplementation only
C) Bed rest only
D) Betamethasone administration
Answer: A) Cerclage placement
Rationale: Cervical insufficiency is managed with cerclage (surgical placement of a suture
around the cervix) in patients with a history of second-trimester loss. Progesterone
supplementation may be used, but cerclage is the definitive surgical intervention.
Question 7
A patient at 30 weeks gestation presents with painless, bright red vaginal bleeding. The nurse-
midwife should suspect which condition?
A) Placenta previa
B) Placental abruption
C) Preterm labor
D) Cervical insufficiency
Answer: A) Placenta previa
, Rationale: Painless, bright red vaginal bleeding in the third trimester is classic for placenta
previa. Placental abruption typically presents with painful, dark bleeding and uterine
tenderness.
Question 8
A patient at 34 weeks gestation presents with right upper quadrant pain, nausea, and elevated
liver enzymes. The patient has a diagnosis of HELLP syndrome. Which laboratory finding is
consistent with this diagnosis?
A) Elevated platelet count
B) Elevated liver enzymes
C) Decreased hemoglobin
D) Elevated creatinine
Answer: B) Elevated liver enzymes
Rationale: HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is characterized
by elevated liver enzymes (AST, ALT) and low platelets. It is a complication of preeclampsia
requiring prompt recognition and management.
Question 9
A patient at 37 weeks gestation is diagnosed with intrahepatic cholestasis of pregnancy. Which
symptom is most consistent with this condition?
A) Severe headache
B) Visual disturbances
C) Pruritus (itching), particularly on palms and soles
D) Epigastric pain
Answer: C) Pruritus (itching), particularly on palms and soles
Rationale: Intrahepatic cholestasis of pregnancy is characterized by pruritus, particularly on the
palms and soles, due to elevated bile acids. It is associated with increased risk of fetal distress
and stillbirth.
Question 10
A patient at 39 weeks gestation is being evaluated for post-term pregnancy. Which fetal
complication is associated with post-term pregnancy?
QUESTIONS AND ANSWERS ALREADY GRADED
A+. 100% VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | GRADED A+
Domain 1: Antepartum Care (21%)
Question 1
A 32-year-old primigravida at 28 weeks gestation presents with a blood pressure of 155/102
mmHg and 2+ proteinuria. She reports a severe headache and visual changes. Which of the
following is the priority intervention?
A) Schedule a follow-up appointment in 1 week
B) Admit the patient for observation and management of preeclampsia with severe features
C) Prescribe oral antihypertensive medication and discharge
D) Recommend bed rest at home
Answer: B) Admit the patient for observation and management of preeclampsia with severe
features
Rationale: This patient is presenting with preeclampsia with severe features, characterized by
severe hypertension (≥160/110 mmHg) and symptoms of end-organ dysfunction (headache,
visual changes). This is a medical emergency requiring immediate admission for monitoring,
antihypertensive therapy, and possible delivery planning.
Question 2
A pregnant patient at 36 weeks gestation has a hemoglobin A1c of 8.5%. The patient has been
diagnosed with gestational diabetes. Which of the following fetal complications is most
associated with this condition?
A) Intrauterine growth restriction (IUGR)
B) Macrosomia
C) Oligohydramnios
D) Preterm birth only
,Answer: B) Macrosomia
Rationale: Poorly controlled gestational diabetes (elevated A1c) is strongly associated with fetal
macrosomia (estimated fetal weight > 4,000-4,500 grams). Maternal hyperglycemia leads to
fetal hyperinsulinemia, which promotes excessive fetal growth. Other complications include
neonatal hypoglycemia, polyhydramnios, and respiratory distress syndrome.
Question 3
A 25-year-old G2P1 patient at 32 weeks gestation presents with painless, bright red vaginal
bleeding. She reports no trauma, no contractions, and the fetal heart rate is reassuring. Which
condition should the nurse-midwife suspect?
A) Placental abruption
B) Placenta previa
C) Preterm labor
D) Cervical insufficiency
Answer: B) Placenta previa
Rationale: Painless, bright red vaginal bleeding in the third trimester is the classic presentation
of placenta previa. Placental abruption typically presents with painful, dark bleeding and uterine
tenderness.
Question 4
A patient at 35 weeks gestation is diagnosed with intrahepatic cholestasis of pregnancy. Which
symptom is most consistent with this condition?
A) Severe headache and visual changes
B) Pruritus (itching), particularly on the palms and soles
C) Epigastric pain and nausea
D) Right upper quadrant pain and hypertension
Answer: B) Pruritus (itching), particularly on the palms and soles
Rationale: Intrahepatic cholestasis of pregnancy is characterized by pruritus, particularly on the
palms and soles, due to elevated bile acids. It is associated with increased risk of fetal distress
and stillbirth. The other options are more consistent with preeclampsia or HELLP syndrome.
,Question 5
A patient at 24 weeks gestation has a 1-hour glucose tolerance test result of 185 mg/dL. Which
is the appropriate next step?
A) Diagnosis of gestational diabetes
B) 3-hour oral glucose tolerance test (OGTT) for confirmation
C) Immediate insulin therapy
D) Dietary counseling only
Answer: B) 3-hour oral glucose tolerance test (OGTT) for confirmation
Rationale: A 1-hour glucose tolerance test result ≥ 140-180 mg/dL (depending on institutional
cutoff) requires confirmation with a 3-hour OGTT. Gestational diabetes is diagnosed if two or
more values are elevated on the 3-hour test.
Question 6
A patient at 12 weeks gestation with a history of cervical insufficiency and prior second-
trimester loss is being evaluated. Which intervention is indicated for cervical insufficiency?
A) Cerclage placement
B) Progesterone supplementation only
C) Bed rest only
D) Betamethasone administration
Answer: A) Cerclage placement
Rationale: Cervical insufficiency is managed with cerclage (surgical placement of a suture
around the cervix) in patients with a history of second-trimester loss. Progesterone
supplementation may be used, but cerclage is the definitive surgical intervention.
Question 7
A patient at 30 weeks gestation presents with painless, bright red vaginal bleeding. The nurse-
midwife should suspect which condition?
A) Placenta previa
B) Placental abruption
C) Preterm labor
D) Cervical insufficiency
Answer: A) Placenta previa
, Rationale: Painless, bright red vaginal bleeding in the third trimester is classic for placenta
previa. Placental abruption typically presents with painful, dark bleeding and uterine
tenderness.
Question 8
A patient at 34 weeks gestation presents with right upper quadrant pain, nausea, and elevated
liver enzymes. The patient has a diagnosis of HELLP syndrome. Which laboratory finding is
consistent with this diagnosis?
A) Elevated platelet count
B) Elevated liver enzymes
C) Decreased hemoglobin
D) Elevated creatinine
Answer: B) Elevated liver enzymes
Rationale: HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is characterized
by elevated liver enzymes (AST, ALT) and low platelets. It is a complication of preeclampsia
requiring prompt recognition and management.
Question 9
A patient at 37 weeks gestation is diagnosed with intrahepatic cholestasis of pregnancy. Which
symptom is most consistent with this condition?
A) Severe headache
B) Visual disturbances
C) Pruritus (itching), particularly on palms and soles
D) Epigastric pain
Answer: C) Pruritus (itching), particularly on palms and soles
Rationale: Intrahepatic cholestasis of pregnancy is characterized by pruritus, particularly on the
palms and soles, due to elevated bile acids. It is associated with increased risk of fetal distress
and stillbirth.
Question 10
A patient at 39 weeks gestation is being evaluated for post-term pregnancy. Which fetal
complication is associated with post-term pregnancy?
