(AMCB) Certified Nurse-Midwife (CNM) Certification
Questions and correct Answers (Verified Answers) with
Rationales 2024
1. A 28-year-old pregnant woman 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
Answer: a) Placenta previa
Rationale: Placenta previa typically presents as painless vaginal bleeding in the
third trimester due to the placenta partially or completely covering the cervical
os. Placental abruption causes painful bleeding. Vasa previa presents with fetal
distress and bleeding. Uterine rupture is rare and usually painful.
2. During labor, a fetal heart rate tracing shows late decelerations. What is the
best initial nursing-midwifery intervention?
a) Administer oxygen to the mother
b) Increase oxytocin infusion
c) Encourage maternal pushing
d) Perform immediate cesarean delivery
,Answer: a) Administer oxygen to the mother
Rationale: Late decelerations indicate uteroplacental insufficiency and fetal
hypoxia. The initial intervention is to improve oxygen delivery by administering
maternal oxygen, repositioning the mother, and ensuring adequate hydration.
Oxytocin should not be increased as it may worsen hypoxia.
3. A postpartum patient is breastfeeding and reports breast engorgement on
day 4 after delivery. What advice should the midwife give?
a) Use warm compresses and feed frequently
b) Avoid breastfeeding to allow engorgement to resolve
c) Apply ice packs and pump every 4 hours
d) Use a tight bra and avoid nipple stimulation
Answer: a) Use warm compresses and feed frequently
Rationale: Breast engorgement results from milk accumulation and edema.
Warm compresses before feeding help soften the breasts, and frequent feeding
promotes milk removal, relieving engorgement. Avoiding breastfeeding worsens
engorgement.
4. Which of the following is the best contraceptive method for a breastfeeding
mother at 6 weeks postpartum?
a) Combined oral contraceptive pill
b) Progestin-only pill
, c) Copper IUD
d) Diaphragm
Answer: b) Progestin-only pill
Rationale: Progestin-only pills are preferred during breastfeeding because they
do not affect milk production. Combined estrogen-progestin pills may reduce
milk supply, especially in the early postpartum period.
5. A pregnant woman with a history of type 1 diabetes has an HbA1c of 7.8%
at 20 weeks gestation. What is the best next step?
a) Continue current management and retest in 12 weeks
b) Initiate insulin therapy or adjust insulin regimen
c) Advise dietary management only
d) Schedule delivery at 34 weeks
Answer: b) Initiate insulin therapy or adjust insulin regimen
Rationale: An HbA1c above 6.5% in pregnancy indicates poor glycemic control.
Tight glucose control is essential to reduce fetal risks. Insulin therapy or
adjustment is indicated to optimize maternal-fetal outcomes.
6. Which finding suggests preeclampsia in a pregnant woman at 32 weeks?
a) Blood pressure 120/80 mm Hg, 1+ proteinuria
b) Blood pressure 140/90 mm Hg, no proteinuria
c) Blood pressure 150/100 mm Hg, 3+ proteinuria
d) Blood pressure 130/85 mm Hg, mild edema
Questions and correct Answers (Verified Answers) with
Rationales 2024
1. A 28-year-old pregnant woman 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
Answer: a) Placenta previa
Rationale: Placenta previa typically presents as painless vaginal bleeding in the
third trimester due to the placenta partially or completely covering the cervical
os. Placental abruption causes painful bleeding. Vasa previa presents with fetal
distress and bleeding. Uterine rupture is rare and usually painful.
2. During labor, a fetal heart rate tracing shows late decelerations. What is the
best initial nursing-midwifery intervention?
a) Administer oxygen to the mother
b) Increase oxytocin infusion
c) Encourage maternal pushing
d) Perform immediate cesarean delivery
,Answer: a) Administer oxygen to the mother
Rationale: Late decelerations indicate uteroplacental insufficiency and fetal
hypoxia. The initial intervention is to improve oxygen delivery by administering
maternal oxygen, repositioning the mother, and ensuring adequate hydration.
Oxytocin should not be increased as it may worsen hypoxia.
3. A postpartum patient is breastfeeding and reports breast engorgement on
day 4 after delivery. What advice should the midwife give?
a) Use warm compresses and feed frequently
b) Avoid breastfeeding to allow engorgement to resolve
c) Apply ice packs and pump every 4 hours
d) Use a tight bra and avoid nipple stimulation
Answer: a) Use warm compresses and feed frequently
Rationale: Breast engorgement results from milk accumulation and edema.
Warm compresses before feeding help soften the breasts, and frequent feeding
promotes milk removal, relieving engorgement. Avoiding breastfeeding worsens
engorgement.
4. Which of the following is the best contraceptive method for a breastfeeding
mother at 6 weeks postpartum?
a) Combined oral contraceptive pill
b) Progestin-only pill
, c) Copper IUD
d) Diaphragm
Answer: b) Progestin-only pill
Rationale: Progestin-only pills are preferred during breastfeeding because they
do not affect milk production. Combined estrogen-progestin pills may reduce
milk supply, especially in the early postpartum period.
5. A pregnant woman with a history of type 1 diabetes has an HbA1c of 7.8%
at 20 weeks gestation. What is the best next step?
a) Continue current management and retest in 12 weeks
b) Initiate insulin therapy or adjust insulin regimen
c) Advise dietary management only
d) Schedule delivery at 34 weeks
Answer: b) Initiate insulin therapy or adjust insulin regimen
Rationale: An HbA1c above 6.5% in pregnancy indicates poor glycemic control.
Tight glucose control is essential to reduce fetal risks. Insulin therapy or
adjustment is indicated to optimize maternal-fetal outcomes.
6. Which finding suggests preeclampsia in a pregnant woman at 32 weeks?
a) Blood pressure 120/80 mm Hg, 1+ proteinuria
b) Blood pressure 140/90 mm Hg, no proteinuria
c) Blood pressure 150/100 mm Hg, 3+ proteinuria
d) Blood pressure 130/85 mm Hg, mild edema
