Oregon Certified Nurse Midwife Exam
Practice Questions And Correct Answers
(Verified Answers) Plus Rationale 2027
Q&A| Instant Download Pdf.
1. Which finding in a pregnant patient most strongly suggests
preeclampsia with severe features and requires prompt evaluation
and management?
A. Blood pressure of 132/82 mm Hg with trace proteinuria
B. Mild dependent edema after prolonged standing
C. Persistent blood pressure of 160/110 mm Hg or higher
D. Heartburn relieved by dietary modification
Rationale: Persistent severe-range blood pressure, defined as systolic
pressure of at least 160 mm Hg or diastolic pressure of at least 110 mm Hg,
is a severe feature of preeclampsia and increases the risk of maternal
stroke, placental complications, and other serious morbidity.
2. A pregnant patient at 30 weeks reports painless bright-red vaginal
bleeding. The uterus is soft and nontender, and fetal heart rate is
reassuring. Which condition should the certified nurse midwife
suspect first?
A. Placental abruption
B. Uterine rupture
C. Preterm labor
D. Placenta previa
,Rationale: Painless, bright-red vaginal bleeding in the second half of
pregnancy, particularly with a soft and nontender uterus, is characteristic
of placenta previa; digital vaginal examination should be avoided until
placenta previa has been excluded.
3. A patient in active labor develops recurrent late fetal heart rate
decelerations. Which nursing-midwifery intervention should be
initiated first?
A. Encourage maternal pushing
B. Reposition the patient laterally and assess for reversible causes of
uteroplacental insufficiency
C. Perform immediate amniotomy
D. Increase the oxytocin infusion
Rationale: Recurrent late decelerations indicate impaired uteroplacental
oxygen exchange, and initial management includes maternal repositioning
and correction of reversible contributors such as excessive uterine activity
or maternal hypotension.
4. Which assessment finding is most consistent with true labor rather
than false labor?
A. Contractions that disappear with hydration
B. Irregular contractions without cervical change
C. Contractions primarily occurring in the upper abdomen
D. Progressive cervical dilation and effacement accompanied by regular
contractions
Rationale: True labor produces coordinated uterine contractions that result
in progressive cervical effacement and dilation, whereas false labor
generally does not produce progressive cervical change.
5. A pregnant patient with Rh-negative blood type has no detectable
anti-D antibodies. Which intervention is generally appropriate during
pregnancy?
,A. Administer Rh immune globulin only after delivery
B. Administer anti-D immune globulin only if anemia develops
C. Administer prophylactic Rh immune globulin at approximately 28 weeks
and again postpartum when indicated
D. Avoid all invasive procedures regardless of clinical circumstances
Rationale: Unsensitized Rh-negative patients are commonly offered
routine antenatal Rh immune globulin around 28 weeks and postpartum
when the newborn is Rh-positive or Rh status is otherwise clinically
indicated.
6. A patient receiving magnesium sulfate for severe preeclampsia
develops absent deep tendon reflexes and respiratory depression.
What is the priority intervention?
A. Increase the magnesium infusion
B. Administer additional oxytocin
C. Stop magnesium sulfate and prepare to administer calcium gluconate
D. Place the patient in Trendelenburg position
Rationale: Loss of reflexes and respiratory depression are signs of
magnesium toxicity; the infusion should be stopped and calcium gluconate
should be available as the antidote.
7. Which medication is commonly used for cervical ripening and
induction of labor in an appropriate candidate?
A. Terbutaline
B. Misoprostol
C. Methylergonovine
D. Magnesium sulfate
Rationale: Misoprostol, a prostaglandin E1 analogue, can promote cervical
ripening and uterine contractions and is commonly used for labor induction
when clinically appropriate.
, 8. A patient at 39 weeks has spontaneous rupture of membranes
followed by a fetal heart rate suddenly falling to 70 beats/minute.
Which complication should be considered urgently?
A. Maternal hypoglycemia
B. Umbilical cord prolapse
C. Normal fetal sleep cycle
D. Placenta accreta
Rationale: Acute fetal bradycardia immediately after rupture of
membranes raises concern for umbilical cord prolapse, which can cause
acute fetal hypoxia and requires emergency evaluation and intervention.
9. Which finding is most characteristic of chorioamnionitis?
A. Maternal bradycardia and hypothermia
B. Painless vaginal bleeding with a soft uterus
C. Maternal fever with uterine tenderness and fetal or maternal
tachycardia
D. Isolated maternal hypertension without fever
Rationale: Intraamniotic infection commonly presents with maternal fever
accompanied by uterine tenderness, maternal tachycardia, fetal
tachycardia, and sometimes malodorous amniotic fluid.
10. During a vaginal examination, the presenting fetal part is
palpated at the level of the maternal ischial spines. How should the
fetal station be documented?
A. −2
B. −1
C. 0
D. +3
Rationale: Station 0 indicates that the presenting fetal part is at the level
of the maternal ischial spines, which is used as the reference point for
assessing fetal descent.
Practice Questions And Correct Answers
(Verified Answers) Plus Rationale 2027
Q&A| Instant Download Pdf.
1. Which finding in a pregnant patient most strongly suggests
preeclampsia with severe features and requires prompt evaluation
and management?
A. Blood pressure of 132/82 mm Hg with trace proteinuria
B. Mild dependent edema after prolonged standing
C. Persistent blood pressure of 160/110 mm Hg or higher
D. Heartburn relieved by dietary modification
Rationale: Persistent severe-range blood pressure, defined as systolic
pressure of at least 160 mm Hg or diastolic pressure of at least 110 mm Hg,
is a severe feature of preeclampsia and increases the risk of maternal
stroke, placental complications, and other serious morbidity.
2. A pregnant patient at 30 weeks reports painless bright-red vaginal
bleeding. The uterus is soft and nontender, and fetal heart rate is
reassuring. Which condition should the certified nurse midwife
suspect first?
A. Placental abruption
B. Uterine rupture
C. Preterm labor
D. Placenta previa
,Rationale: Painless, bright-red vaginal bleeding in the second half of
pregnancy, particularly with a soft and nontender uterus, is characteristic
of placenta previa; digital vaginal examination should be avoided until
placenta previa has been excluded.
3. A patient in active labor develops recurrent late fetal heart rate
decelerations. Which nursing-midwifery intervention should be
initiated first?
A. Encourage maternal pushing
B. Reposition the patient laterally and assess for reversible causes of
uteroplacental insufficiency
C. Perform immediate amniotomy
D. Increase the oxytocin infusion
Rationale: Recurrent late decelerations indicate impaired uteroplacental
oxygen exchange, and initial management includes maternal repositioning
and correction of reversible contributors such as excessive uterine activity
or maternal hypotension.
4. Which assessment finding is most consistent with true labor rather
than false labor?
A. Contractions that disappear with hydration
B. Irregular contractions without cervical change
C. Contractions primarily occurring in the upper abdomen
D. Progressive cervical dilation and effacement accompanied by regular
contractions
Rationale: True labor produces coordinated uterine contractions that result
in progressive cervical effacement and dilation, whereas false labor
generally does not produce progressive cervical change.
5. A pregnant patient with Rh-negative blood type has no detectable
anti-D antibodies. Which intervention is generally appropriate during
pregnancy?
,A. Administer Rh immune globulin only after delivery
B. Administer anti-D immune globulin only if anemia develops
C. Administer prophylactic Rh immune globulin at approximately 28 weeks
and again postpartum when indicated
D. Avoid all invasive procedures regardless of clinical circumstances
Rationale: Unsensitized Rh-negative patients are commonly offered
routine antenatal Rh immune globulin around 28 weeks and postpartum
when the newborn is Rh-positive or Rh status is otherwise clinically
indicated.
6. A patient receiving magnesium sulfate for severe preeclampsia
develops absent deep tendon reflexes and respiratory depression.
What is the priority intervention?
A. Increase the magnesium infusion
B. Administer additional oxytocin
C. Stop magnesium sulfate and prepare to administer calcium gluconate
D. Place the patient in Trendelenburg position
Rationale: Loss of reflexes and respiratory depression are signs of
magnesium toxicity; the infusion should be stopped and calcium gluconate
should be available as the antidote.
7. Which medication is commonly used for cervical ripening and
induction of labor in an appropriate candidate?
A. Terbutaline
B. Misoprostol
C. Methylergonovine
D. Magnesium sulfate
Rationale: Misoprostol, a prostaglandin E1 analogue, can promote cervical
ripening and uterine contractions and is commonly used for labor induction
when clinically appropriate.
, 8. A patient at 39 weeks has spontaneous rupture of membranes
followed by a fetal heart rate suddenly falling to 70 beats/minute.
Which complication should be considered urgently?
A. Maternal hypoglycemia
B. Umbilical cord prolapse
C. Normal fetal sleep cycle
D. Placenta accreta
Rationale: Acute fetal bradycardia immediately after rupture of
membranes raises concern for umbilical cord prolapse, which can cause
acute fetal hypoxia and requires emergency evaluation and intervention.
9. Which finding is most characteristic of chorioamnionitis?
A. Maternal bradycardia and hypothermia
B. Painless vaginal bleeding with a soft uterus
C. Maternal fever with uterine tenderness and fetal or maternal
tachycardia
D. Isolated maternal hypertension without fever
Rationale: Intraamniotic infection commonly presents with maternal fever
accompanied by uterine tenderness, maternal tachycardia, fetal
tachycardia, and sometimes malodorous amniotic fluid.
10. During a vaginal examination, the presenting fetal part is
palpated at the level of the maternal ischial spines. How should the
fetal station be documented?
A. −2
B. −1
C. 0
D. +3
Rationale: Station 0 indicates that the presenting fetal part is at the level
of the maternal ischial spines, which is used as the reference point for
assessing fetal descent.
