Louisiana Certified Nurse Midwife Exam
Practice Questions And Correct Answers
(Verified Answers) Plus Rationale Q&A
1. A laboring patient at 41 weeks gestation has a Category II fetal heart tracing with
repetitive variable decelerations and minimal variability. Which intervention is most
appropriate as the first-line intrauterine resuscitation measure?
A. Administer terbutaline 0.25 mg subcutaneously
B. Perform amnioinfusion with warmed normal saline
C. Reposition to left lateral and administer oxygen
D. Prepare for immediate cesarean delivery
Answer: C. Reposition to left lateral and administer oxygen
Rationale: Repositioning to left lateral improves uteroplacental perfusion and oxygen
administration addresses potential hypoxia, making it the first-line measure for variable
decelerations. Terbutaline is used for tachysystole, amnioinfusion is considered for
recurrent variables after initial measures, and cesarean is reserved for non-reassuring
patterns unresponsive to resuscitation.
2. Which laboratory finding best distinguishes preeclampsia with severe features from
gestational hypertension?
A. Platelet count 120,000/µL
B. Blood pressure 150/95 mm Hg
C. Urine protein 280 mg/24 hours
D. Serum creatinine 0.9 mg/dL
Answer: A. Platelet count 120,000/µL
Rationale: Thrombocytopenia (<100,000/µL) is a severe feature of preeclampsia, whereas
gestational hypertension lacks proteinuria or severe features. BP 150/95 may be seen in
both, proteinuria 280 mg/24h is below the 300 mg threshold for preeclampsia, and
creatinine 0.9 mg/dL is within normal limits.
Page 1 of 78
,3. A postpartum patient reports unilateral calf pain and swelling. Which diagnostic
strategy is most appropriate to confirm deep vein thrombosis while minimizing risk?
A. D-dimer assay alone
B. Compression ultrasound of the lower extremity
C. Contrast venography
D. Magnetic resonance venography
Answer: B. Compression ultrasound of the lower extremity
Rationale: Compression ultrasound is the preferred noninvasive test for suspected DVT in
pregnancy/postpartum, with high sensitivity for proximal clots. D-dimer is unreliable due
to physiologic elevation, venography is invasive and involves radiation/contrast, and MRV
is reserved for inconclusive ultrasound.
4. Which medication is contraindicated during breastfeeding due to risk of infant
sedation and respiratory depression?
A. Ibuprofen
B. Acetaminophen
C. Codeine
D. Penicillin
Answer: C. Codeine
Rationale: Codeine is a prodrug metabolized to morphine; ultrarapid metabolizers can
transfer high morphine levels into breast milk, causing infant sedation and respiratory
depression. Ibuprofen, acetaminophen, and penicillin are generally compatible with
breastfeeding.
Page 2 of 78
,5. A patient at 28 weeks gestation presents with a fundal height of 24 cm. Which
condition should be prioritized in the differential diagnosis?
A. Polyhydramnios
B. Fetal macrosomia
C. Intrauterine growth restriction
D. Multiple gestation
Answer: C. Intrauterine growth restriction
Rationale: A fundal height 4 cm less than expected gestational age suggests intrauterine
growth restriction or oligohydramnios. Polyhydramnios and macrosomia would typically
present with larger-than-expected fundal height, and multiple gestation often causes a
larger fundal height.
6. Which statement best reflects the mechanism of action of combined oral
contraceptives?
A. They primarily inhibit ovulation by suppressing gonadotropin release.
B. They create a hostile endometrial environment for implantation.
C. They thicken cervical mucus to block sperm transport.
D. They directly inhibit sperm capacitation in the fallopian tube.
Answer: A. They primarily inhibit ovulation by suppressing gonadotropin release.
Rationale: Combined oral contraceptives primarily prevent ovulation via negative feedback
on the hypothalamus-pituitary axis, reducing FSH and LH surge. While they also thicken
cervical mucus and alter endometrium, ovulation suppression is the dominant mechanism.
Page 3 of 78
, 7. Which finding on a newborn assessment requires immediate further evaluation?
A. Mongolian spots on the buttocks
B. Caput succedaneum crossing suture lines
C. Single umbilical artery
D. Harlequin color change
Answer: C. Single umbilical artery
Rationale: A single umbilical artery is associated with congenital anomalies, especially
renal and cardiac, and warrants further investigation. Mongolian spots are benign, caput
succedaneum crosses sutures and resolves, and harlequin color change is a benign
transient phenomenon.
8. A patient at 36 weeks gestation presents with ruptured membranes and is group B
streptococcus positive. She has a penicillin allergy with anaphylaxis history. Which
antibiotic is recommended for intrapartum prophylaxis?
A. Cefazolin
B. Clindamycin
C. Erythromycin
D. Vancomycin
Answer: B. Clindamycin
Rationale: For GBS prophylaxis in penicillin-allergic patients with anaphylaxis,
clindamycin is recommended if the isolate is susceptible. Cefazolin is contraindicated due
to cross-reactivity risk, erythromycin is not recommended due to high resistance, and
vancomycin is reserved for clindamycin-resistant strains.
Page 4 of 78
Practice Questions And Correct Answers
(Verified Answers) Plus Rationale Q&A
1. A laboring patient at 41 weeks gestation has a Category II fetal heart tracing with
repetitive variable decelerations and minimal variability. Which intervention is most
appropriate as the first-line intrauterine resuscitation measure?
A. Administer terbutaline 0.25 mg subcutaneously
B. Perform amnioinfusion with warmed normal saline
C. Reposition to left lateral and administer oxygen
D. Prepare for immediate cesarean delivery
Answer: C. Reposition to left lateral and administer oxygen
Rationale: Repositioning to left lateral improves uteroplacental perfusion and oxygen
administration addresses potential hypoxia, making it the first-line measure for variable
decelerations. Terbutaline is used for tachysystole, amnioinfusion is considered for
recurrent variables after initial measures, and cesarean is reserved for non-reassuring
patterns unresponsive to resuscitation.
2. Which laboratory finding best distinguishes preeclampsia with severe features from
gestational hypertension?
A. Platelet count 120,000/µL
B. Blood pressure 150/95 mm Hg
C. Urine protein 280 mg/24 hours
D. Serum creatinine 0.9 mg/dL
Answer: A. Platelet count 120,000/µL
Rationale: Thrombocytopenia (<100,000/µL) is a severe feature of preeclampsia, whereas
gestational hypertension lacks proteinuria or severe features. BP 150/95 may be seen in
both, proteinuria 280 mg/24h is below the 300 mg threshold for preeclampsia, and
creatinine 0.9 mg/dL is within normal limits.
Page 1 of 78
,3. A postpartum patient reports unilateral calf pain and swelling. Which diagnostic
strategy is most appropriate to confirm deep vein thrombosis while minimizing risk?
A. D-dimer assay alone
B. Compression ultrasound of the lower extremity
C. Contrast venography
D. Magnetic resonance venography
Answer: B. Compression ultrasound of the lower extremity
Rationale: Compression ultrasound is the preferred noninvasive test for suspected DVT in
pregnancy/postpartum, with high sensitivity for proximal clots. D-dimer is unreliable due
to physiologic elevation, venography is invasive and involves radiation/contrast, and MRV
is reserved for inconclusive ultrasound.
4. Which medication is contraindicated during breastfeeding due to risk of infant
sedation and respiratory depression?
A. Ibuprofen
B. Acetaminophen
C. Codeine
D. Penicillin
Answer: C. Codeine
Rationale: Codeine is a prodrug metabolized to morphine; ultrarapid metabolizers can
transfer high morphine levels into breast milk, causing infant sedation and respiratory
depression. Ibuprofen, acetaminophen, and penicillin are generally compatible with
breastfeeding.
Page 2 of 78
,5. A patient at 28 weeks gestation presents with a fundal height of 24 cm. Which
condition should be prioritized in the differential diagnosis?
A. Polyhydramnios
B. Fetal macrosomia
C. Intrauterine growth restriction
D. Multiple gestation
Answer: C. Intrauterine growth restriction
Rationale: A fundal height 4 cm less than expected gestational age suggests intrauterine
growth restriction or oligohydramnios. Polyhydramnios and macrosomia would typically
present with larger-than-expected fundal height, and multiple gestation often causes a
larger fundal height.
6. Which statement best reflects the mechanism of action of combined oral
contraceptives?
A. They primarily inhibit ovulation by suppressing gonadotropin release.
B. They create a hostile endometrial environment for implantation.
C. They thicken cervical mucus to block sperm transport.
D. They directly inhibit sperm capacitation in the fallopian tube.
Answer: A. They primarily inhibit ovulation by suppressing gonadotropin release.
Rationale: Combined oral contraceptives primarily prevent ovulation via negative feedback
on the hypothalamus-pituitary axis, reducing FSH and LH surge. While they also thicken
cervical mucus and alter endometrium, ovulation suppression is the dominant mechanism.
Page 3 of 78
, 7. Which finding on a newborn assessment requires immediate further evaluation?
A. Mongolian spots on the buttocks
B. Caput succedaneum crossing suture lines
C. Single umbilical artery
D. Harlequin color change
Answer: C. Single umbilical artery
Rationale: A single umbilical artery is associated with congenital anomalies, especially
renal and cardiac, and warrants further investigation. Mongolian spots are benign, caput
succedaneum crosses sutures and resolves, and harlequin color change is a benign
transient phenomenon.
8. A patient at 36 weeks gestation presents with ruptured membranes and is group B
streptococcus positive. She has a penicillin allergy with anaphylaxis history. Which
antibiotic is recommended for intrapartum prophylaxis?
A. Cefazolin
B. Clindamycin
C. Erythromycin
D. Vancomycin
Answer: B. Clindamycin
Rationale: For GBS prophylaxis in penicillin-allergic patients with anaphylaxis,
clindamycin is recommended if the isolate is susceptible. Cefazolin is contraindicated due
to cross-reactivity risk, erythromycin is not recommended due to high resistance, and
vancomycin is reserved for clindamycin-resistant strains.
Page 4 of 78
