Certified Midwife Exam Prep Certified Nurse Midwife 2 — Questions and Answers
Question 1: A laboring patient at 39 weeks gestation has a fetal heart rate baseline of 155 bpm with moderate variability and two accelerations in 20 minutes. How should the CNM interpret this tracing?
- Category I (normal) (Correct answer)
- Category II (indeterminate)
- Category III (abnormal)
- Non-reactive, requires biophysical profile
Correct answer: Category I (normal)
A baseline of 155 bpm with moderate variability and accelerations meets all criteria for a Category I (normal) fetal heart rate tracing.
Question 2: Which medication is the preferred first-line treatment for postpartum hemorrhage caused by uterine atony?
- Methylergonovine (Methergine)
- Oxytocin (Pitocin) (Correct answer)
- Carboprost tromethamine (Hemabate)
- Misoprostol
Correct answer: Oxytocin (Pitocin)
Oxytocin is the first-line uterotonic agent for postpartum hemorrhage due to its safety profile, effectiveness, and rapid onset.
Question 3: A newborn at 1 minute of life has a heart rate of 90 bpm, irregular respirations, grimace to stimulation, blue extremities, and flexed muscle tone. What is the Apgar score?
- 5
- 6 (Correct answer)
- 7
- 4
Correct answer: 6
Heart rate <100 (1) + irregular respirations (1) + grimace (1) + blue extremities/pink body (1) + flexed tone (1) = Apgar score of 6.
Question 4: A G2P1 patient at 28 weeks presents with painless bright red vaginal bleeding. Which condition should be highest on the differential?
- Placental abruption
- Placenta previa (Correct answer)
- Vasa previa
- Bloody show
Correct answer: Placenta previa
Painless bright red vaginal bleeding in the second or third trimester is the classic presentation of placenta previa.
Question 5: Under the Midwifery Model of Care, what is the primary role of the CNM when a patient has a normal, low-risk pregnancy?
- Manage all care independently without physician consultation
- Provide surveillance, support, and minimal intervention while promoting physiologic birth (Correct answer)
- Transfer all care to an obstetrician at 36 weeks
- Perform routine episiotomy to prevent perineal tears
Correct answer: Provide surveillance, support, and minimal intervention while promoting physiologic birth
The midwifery model emphasizes supporting physiologic processes, minimizing unnecessary interventions, and partnering with families in informed decision-making.
Question 6: A breastfeeding mother asks about contraception postpartum. Which method is CONTRAINDICATED before 6 months postpartum in a fully breastfeeding woman per the CDC MEC?
- Progestin-only pills
- Copper IUD
- Combined oral contraceptives (Correct answer)
- Lactational amenorrhea method (LAM)
Correct answer: Combined oral contraceptives
Combined hormonal contraceptives containing estrogen are CDC MEC Category 4 (contraindicated) before 30 days postpartum and Category 3 from 30 days to 6 months in breastfeeding women due to risk of reduced milk supply and infant exposure to estrogen.
Question 7: Which finding on a routine prenatal visit at 24 weeks warrants immediate further evaluation?
- Fundal height measuring 23 cm
- Blood pressure of 138/88 mmHg on two readings 4 hours apart (Correct answer)
- Fetal heart tones of 148 bpm
- Mild ankle edema at the end of the day
Correct answer: Blood pressure of 138/88 mmHg on two readings 4 hours apart
A BP ≥140/90 mmHg on two readings at ≥20 weeks gestation meets the diagnostic criteria for gestational hypertension or preeclampsia and requires immediate evaluation.
Certified Midwife Exam Prep Certified Nurse Midwife 2
A laboring patient at 39 weeks gestation has a fetal heart rate baseline of 155 bpm with moderate variability and two accelerations in 20 minutes.
How should the CNM interpret this tracing?