CERTIFIED NURSE MIDWIFE EXAMINATION WITH
CORRECT ACTUAL QUESTIONS AND CORRECTLY WELL
DEFINED ANSWERS LATEST ALREADY GRADED A+
(2025/2026)
Antepartum Care (1–25)
1. A 28-year-old primigravida at 10 weeks gestation has a positive urine pregnancy
test and mild vaginal spotting. Her vitals are stable, and abdominal exam is
unremarkable. What is the best next step?
A) Immediate transvaginal ultrasound
B) Serum quantitative β-hCG and repeat in 48 hours
C) Start methotrexate for presumed ectopic pregnancy
D) Reassure and discharge without testing
Answer: B
*Rationale: Serial quantitative β-hCG levels help distinguish a viable intrauterine
pregnancy from a failing pregnancy or ectopic pregnancy when ultrasound is not
yet diagnostic. At 10 weeks, transvaginal ultrasound should typically show an
intrauterine pregnancy; however, serial β-hCG is the appropriate next step if
viability is uncertain .*
2. A 35-year-old G2P1 with gestational diabetes controlled by diet has a fetus with
an estimated fetal weight at the 95th percentile at 38 weeks. What is the most
appropriate recommendation?
A) Immediate cesarean delivery
B) Elective induction of labor at 39 weeks with planned vaginal delivery if
favorable
,C) Expectant management until 41 weeks
D) Immediate administration of corticosteroids
Answer: B
*Rationale: For suspected macrosomia in diabetic patients, induction at 39 weeks
is often considered to reduce the risk of further fetal growth. Cesarean delivery is
reserved for obstetric indications, not solely for suspected macrosomia in a
patient with diet-controlled GDM .*
3. A patient at 20 weeks gestation presents with a blood pressure of 150/95 mm
Hg, proteinuria 1+ on dipstick, and mild edema. What is the most appropriate
immediate action?
A) Diagnose preeclampsia and plan immediate delivery
B) Repeat BP after 4 hours and obtain 24-hour urine protein and labs
C) Start labetalol and send home
D) Ignore edema and reassess at the next prenatal visit
Answer: B
*Rationale: The diagnosis of preeclampsia requires confirmation. Further
evaluation, including BP trends, quantitative protein assessment (24-hour urine or
protein/creatinine ratio), and laboratory studies (platelets, creatinine, LFTs), is
needed before definitive management .*
4. A woman at 28 weeks gestation presents with new-onset pruritus that is worse
at night and elevated bile acids. What is the most likely diagnosis, and what is the
key fetal risk?
A) Intrahepatic cholestasis of pregnancy — risk of fetal distress/stillbirth
B) Preeclampsia — risk of maternal seizure
C) HELLP syndrome — risk of maternal hepatic rupture
D) Atopic dermatitis — no fetal risk
Answer: A
Rationale: Pruritus with elevated bile acids indicates intrahepatic cholestasis of
,pregnancy, which is associated with fetal risks, including stillbirth, and requires
close monitoring with possible early delivery .
5. A woman at 28 weeks gestation presents with severe pruritus on her palms and
soles. Lab tests reveal elevated bile acids. What is the most likely diagnosis?
A) Preeclampsia
B) Acute fatty liver of pregnancy
C) Intrahepatic cholestasis of pregnancy
D) HELLP syndrome
Answer: C
Rationale: Pruritus on the palms and soles with elevated bile acids is characteristic
of intrahepatic cholestasis of pregnancy. This condition requires monitoring of bile
acid levels and may necessitate early delivery to prevent stillbirth .
6. A 32-year-old G2P1 with a history of a prior cesarean section desires a trial of
labor after cesarean (TOLAC). She is currently 38 weeks with an unfavorable
cervix. What is the most important factor in counseling her?
A) Her age is a contraindication to TOLAC
B) Prior uterine incision type and the reason for the prior cesarean
C) Fetal weight is the only predictor of success
D) TOLAC is never recommended after one cesarean
Answer: B
Rationale: The type of prior uterine incision (low transverse is favorable; classical
or T-shaped increases rupture risk) and the indication for the prior cesarean (e.g.,
arrest disorders vs. malpresentation) are critical predictors of TOLAC success and
safety. A prior low transverse incision is not an absolute contraindication to
TOLAC .
, 7. A 26-year-old G1P0 at 32 weeks presents with a blood pressure of 110/70 mm
Hg, mild ankle edema, and weight gain of 1 kg in the past week. What is the most
appropriate management?
A) Diagnose preeclampsia and admit for delivery
B) Reassure that this is a normal finding in pregnancy
C) Start magnesium sulfate immediately
D) Administer labetalol and schedule a repeat BP in 1 week
Answer: B
Rationale: Mild ankle edema and modest weight gain are common in normal
pregnancy due to increased plasma volume and venous stasis. Without
hypertension or proteinuria, these findings do not indicate preeclampsia .
8. A 32-week pregnant woman presents with painless vaginal bleeding. What is
the most likely cause?
A) Placenta previa
B) Abruptio placentae
C) Vasa previa
D) Cervical insufficiency
Answer: A
Rationale: Painless vaginal bleeding in the third trimester is most commonly
associated with placenta previa, where the placenta partially or completely covers
the cervical os. Abruptio placentae typically presents with painful bleeding .
9. A 28-year-old primigravida at 34 weeks gestation presents with painless vaginal
bleeding. Which is the most likely diagnosis?
A) Placenta previa
B) Placental abruption
C) Vasa previa
D) Uterine rupture
CORRECT ACTUAL QUESTIONS AND CORRECTLY WELL
DEFINED ANSWERS LATEST ALREADY GRADED A+
(2025/2026)
Antepartum Care (1–25)
1. A 28-year-old primigravida at 10 weeks gestation has a positive urine pregnancy
test and mild vaginal spotting. Her vitals are stable, and abdominal exam is
unremarkable. What is the best next step?
A) Immediate transvaginal ultrasound
B) Serum quantitative β-hCG and repeat in 48 hours
C) Start methotrexate for presumed ectopic pregnancy
D) Reassure and discharge without testing
Answer: B
*Rationale: Serial quantitative β-hCG levels help distinguish a viable intrauterine
pregnancy from a failing pregnancy or ectopic pregnancy when ultrasound is not
yet diagnostic. At 10 weeks, transvaginal ultrasound should typically show an
intrauterine pregnancy; however, serial β-hCG is the appropriate next step if
viability is uncertain .*
2. A 35-year-old G2P1 with gestational diabetes controlled by diet has a fetus with
an estimated fetal weight at the 95th percentile at 38 weeks. What is the most
appropriate recommendation?
A) Immediate cesarean delivery
B) Elective induction of labor at 39 weeks with planned vaginal delivery if
favorable
,C) Expectant management until 41 weeks
D) Immediate administration of corticosteroids
Answer: B
*Rationale: For suspected macrosomia in diabetic patients, induction at 39 weeks
is often considered to reduce the risk of further fetal growth. Cesarean delivery is
reserved for obstetric indications, not solely for suspected macrosomia in a
patient with diet-controlled GDM .*
3. A patient at 20 weeks gestation presents with a blood pressure of 150/95 mm
Hg, proteinuria 1+ on dipstick, and mild edema. What is the most appropriate
immediate action?
A) Diagnose preeclampsia and plan immediate delivery
B) Repeat BP after 4 hours and obtain 24-hour urine protein and labs
C) Start labetalol and send home
D) Ignore edema and reassess at the next prenatal visit
Answer: B
*Rationale: The diagnosis of preeclampsia requires confirmation. Further
evaluation, including BP trends, quantitative protein assessment (24-hour urine or
protein/creatinine ratio), and laboratory studies (platelets, creatinine, LFTs), is
needed before definitive management .*
4. A woman at 28 weeks gestation presents with new-onset pruritus that is worse
at night and elevated bile acids. What is the most likely diagnosis, and what is the
key fetal risk?
A) Intrahepatic cholestasis of pregnancy — risk of fetal distress/stillbirth
B) Preeclampsia — risk of maternal seizure
C) HELLP syndrome — risk of maternal hepatic rupture
D) Atopic dermatitis — no fetal risk
Answer: A
Rationale: Pruritus with elevated bile acids indicates intrahepatic cholestasis of
,pregnancy, which is associated with fetal risks, including stillbirth, and requires
close monitoring with possible early delivery .
5. A woman at 28 weeks gestation presents with severe pruritus on her palms and
soles. Lab tests reveal elevated bile acids. What is the most likely diagnosis?
A) Preeclampsia
B) Acute fatty liver of pregnancy
C) Intrahepatic cholestasis of pregnancy
D) HELLP syndrome
Answer: C
Rationale: Pruritus on the palms and soles with elevated bile acids is characteristic
of intrahepatic cholestasis of pregnancy. This condition requires monitoring of bile
acid levels and may necessitate early delivery to prevent stillbirth .
6. A 32-year-old G2P1 with a history of a prior cesarean section desires a trial of
labor after cesarean (TOLAC). She is currently 38 weeks with an unfavorable
cervix. What is the most important factor in counseling her?
A) Her age is a contraindication to TOLAC
B) Prior uterine incision type and the reason for the prior cesarean
C) Fetal weight is the only predictor of success
D) TOLAC is never recommended after one cesarean
Answer: B
Rationale: The type of prior uterine incision (low transverse is favorable; classical
or T-shaped increases rupture risk) and the indication for the prior cesarean (e.g.,
arrest disorders vs. malpresentation) are critical predictors of TOLAC success and
safety. A prior low transverse incision is not an absolute contraindication to
TOLAC .
, 7. A 26-year-old G1P0 at 32 weeks presents with a blood pressure of 110/70 mm
Hg, mild ankle edema, and weight gain of 1 kg in the past week. What is the most
appropriate management?
A) Diagnose preeclampsia and admit for delivery
B) Reassure that this is a normal finding in pregnancy
C) Start magnesium sulfate immediately
D) Administer labetalol and schedule a repeat BP in 1 week
Answer: B
Rationale: Mild ankle edema and modest weight gain are common in normal
pregnancy due to increased plasma volume and venous stasis. Without
hypertension or proteinuria, these findings do not indicate preeclampsia .
8. A 32-week pregnant woman presents with painless vaginal bleeding. What is
the most likely cause?
A) Placenta previa
B) Abruptio placentae
C) Vasa previa
D) Cervical insufficiency
Answer: A
Rationale: Painless vaginal bleeding in the third trimester is most commonly
associated with placenta previa, where the placenta partially or completely covers
the cervical os. Abruptio placentae typically presents with painful bleeding .
9. A 28-year-old primigravida at 34 weeks gestation presents with painless vaginal
bleeding. Which is the most likely diagnosis?
A) Placenta previa
B) Placental abruption
C) Vasa previa
D) Uterine rupture
