NARM CERTIFIED PROFESSIONAL MIDWIFE (CPM)
EXAM PRACTICE QUESTIONS 300 MULTIPLE-CHOICE
QUESTIONS WITH CORRECT ANSWERS AND
RATIONALES
---
SECTION 1: PRENATAL CARE (Questions 1-75)
1. A client at 28 weeks gestation presents with a blood pressure of 148/92 mmHg
and 2+ proteinuria. Which of the following is the most appropriate next step?
A) Recheck blood pressure in 30 minutes
B) Recommend bed rest at home
C) Refer for immediate obstetric consultation
D) Increase fluid intake to 3 liters daily
Correct Answer: C
Rationale: Blood pressure ≥140/90 with proteinuria at or after 20 weeks suggests
preeclampsia. This requires prompt obstetric evaluation for possible management
including antihypertensives, seizure prophylaxis, and delivery planning. Delaying
care with bed rest or fluids is inadequate for this potentially life-threatening
condition.
,---
2. At what gestational age is a routine anatomy scan typically performed?
A) 10-12 weeks
B) 16-18 weeks
C) 18-22 weeks
D) 24-28 weeks
Correct Answer: C
Rationale: The detailed fetal anatomy survey is optimally performed between 18-
22 weeks gestation. This timing allows for adequate fetal size to visualize
structures while still allowing for pregnancy management options if anomalies are
detected.
---
3. A G3P2 client at 36 weeks gestation reports decreased fetal movement over the
past 24 hours. What is the most appropriate initial assessment?
A) Schedule a non-stress test for next week
B) Instruct client to perform a kick count for 2 hours
,C) Send client to labor and delivery for immediate evaluation
D) Reassure the client that decreased movement is normal at 36 weeks
Correct Answer: C
Rationale: Decreased fetal movement after 28 weeks requires immediate
evaluation with a non-stress test or biophysical profile. Fetal movement is a key
indicator of fetal wellbeing, and decreased movement may indicate fetal
compromise. Home kick counts are not sufficient when the mother reports
decreased movement.
---
4. Which of the following is a normal finding in a first-trimester ultrasound?
A) Crown-rump length of 45 mm at 12 weeks
B) Absence of cardiac activity
C) Gestational sac without a yolk sac at 7 weeks
D) Fetal heart rate of 180 bpm
Correct Answer: A
Rationale: A crown-rump length (CRL) of 45 mm is consistent with a 12-week
gestation. Normal first-trimester findings include cardiac activity (not absence),
, presence of a yolk sac by 6 weeks, and fetal heart rate between 110-160 bpm (180
would be tachycardic).
---
5. A client's rubella titer shows IgG positive, IgM negative. This indicates:
A) Active rubella infection
B) Immunity to rubella
C) Need for rubella vaccination
D) Recent infection within the past month
Correct Answer: B
Rationale: IgG positive with IgM negative indicates prior infection or vaccination
with immunity. This is a reassuring finding during pregnancy as rubella infection in
pregnancy, especially in the first trimester, can cause congenital rubella syndrome.
---
6. The fundal height at 32 weeks gestation should approximately measure:
A) 28 cm
B) 30 cm
EXAM PRACTICE QUESTIONS 300 MULTIPLE-CHOICE
QUESTIONS WITH CORRECT ANSWERS AND
RATIONALES
---
SECTION 1: PRENATAL CARE (Questions 1-75)
1. A client at 28 weeks gestation presents with a blood pressure of 148/92 mmHg
and 2+ proteinuria. Which of the following is the most appropriate next step?
A) Recheck blood pressure in 30 minutes
B) Recommend bed rest at home
C) Refer for immediate obstetric consultation
D) Increase fluid intake to 3 liters daily
Correct Answer: C
Rationale: Blood pressure ≥140/90 with proteinuria at or after 20 weeks suggests
preeclampsia. This requires prompt obstetric evaluation for possible management
including antihypertensives, seizure prophylaxis, and delivery planning. Delaying
care with bed rest or fluids is inadequate for this potentially life-threatening
condition.
,---
2. At what gestational age is a routine anatomy scan typically performed?
A) 10-12 weeks
B) 16-18 weeks
C) 18-22 weeks
D) 24-28 weeks
Correct Answer: C
Rationale: The detailed fetal anatomy survey is optimally performed between 18-
22 weeks gestation. This timing allows for adequate fetal size to visualize
structures while still allowing for pregnancy management options if anomalies are
detected.
---
3. A G3P2 client at 36 weeks gestation reports decreased fetal movement over the
past 24 hours. What is the most appropriate initial assessment?
A) Schedule a non-stress test for next week
B) Instruct client to perform a kick count for 2 hours
,C) Send client to labor and delivery for immediate evaluation
D) Reassure the client that decreased movement is normal at 36 weeks
Correct Answer: C
Rationale: Decreased fetal movement after 28 weeks requires immediate
evaluation with a non-stress test or biophysical profile. Fetal movement is a key
indicator of fetal wellbeing, and decreased movement may indicate fetal
compromise. Home kick counts are not sufficient when the mother reports
decreased movement.
---
4. Which of the following is a normal finding in a first-trimester ultrasound?
A) Crown-rump length of 45 mm at 12 weeks
B) Absence of cardiac activity
C) Gestational sac without a yolk sac at 7 weeks
D) Fetal heart rate of 180 bpm
Correct Answer: A
Rationale: A crown-rump length (CRL) of 45 mm is consistent with a 12-week
gestation. Normal first-trimester findings include cardiac activity (not absence),
, presence of a yolk sac by 6 weeks, and fetal heart rate between 110-160 bpm (180
would be tachycardic).
---
5. A client's rubella titer shows IgG positive, IgM negative. This indicates:
A) Active rubella infection
B) Immunity to rubella
C) Need for rubella vaccination
D) Recent infection within the past month
Correct Answer: B
Rationale: IgG positive with IgM negative indicates prior infection or vaccination
with immunity. This is a reassuring finding during pregnancy as rubella infection in
pregnancy, especially in the first trimester, can cause congenital rubella syndrome.
---
6. The fundal height at 32 weeks gestation should approximately measure:
A) 28 cm
B) 30 cm
