Certified Midwife Exam Prep Certified Nurse Midwife 3 — Questions and Answers
Question 1: A patient at 41+3 weeks gestation has a Bishop score of 4. Which management approach is most appropriate?
- Expectant management until 43 weeks
- Immediate cesarean section
- Cervical ripening followed by induction of labor (Correct answer)
- Membrane sweeping only, recheck in one week
Correct answer: Cervical ripening followed by induction of labor
An unfavorable cervix (Bishop score <6) at post-term gestation warrants cervical ripening with agents like misoprostol or Foley balloon prior to oxytocin augmentation.
Question 2: During a prenatal visit, a patient discloses that her partner monitors all her phone calls and controls access to money. What is the CNM's most appropriate initial response?
- Call law enforcement immediately
- Refer the patient to social work only
- Express concern, validate her experience, provide safety resources, and document (Correct answer)
- Advise her to leave the relationship before her next visit
Correct answer: Express concern, validate her experience, provide safety resources, and document
The CNM should respond with empathy, validate the patient's experience, provide information about local resources, create a safety plan, and document findings without mandating a specific course of action.
Question 3: Which maternal serum screening result pattern is most consistent with trisomy 18 (Edwards syndrome)?
- Elevated AFP, elevated hCG, elevated estriol
- Low AFP, elevated hCG, normal estriol
- Low AFP, low hCG, low estriol (Correct answer)
- Normal AFP, elevated hCG, low estriol
Correct answer: Low AFP, low hCG, low estriol
Trisomy 18 typically shows a triple-screen pattern of low AFP, low hCG, and low unconjugated estriol — the 'triple low' pattern.
Question 4: A patient at 38 weeks in active labor has a sudden onset of severe abdominal pain, rigid uterus, and fetal bradycardia after receiving oxytocin. What complication should the CNM suspect first?
- Placenta previa
- Uterine rupture
- Placental abruption (Correct answer)
- Umbilical cord prolapse
Correct answer: Placental abruption
Sudden severe abdominal pain, a rigid (board-like) uterus, and fetal distress in the context of oxytocin use are classic signs of placental abruption.
Question 5: The CNM is preparing to suture a second-degree perineal laceration. Which tissue layer must be repaired to achieve adequate hemostasis and support?
- Skin only
- Vaginal mucosa only
- Vaginal mucosa and perineal muscles (Correct answer)
- Perineal skin and rectal mucosa
Correct answer: Vaginal mucosa and perineal muscles
A second-degree laceration extends into the perineal muscles (bulbocavernosus, transverse perinei) and vaginal mucosa, and both layers must be repaired.
Question 6: A newborn is born at 35 weeks gestation, weighing 2,100 g. Which complication is this infant at HIGHEST risk for compared to a full-term infant?
- Physiologic jaundice resolving by day 3
- Respiratory distress syndrome (RDS) (Correct answer)
- Hypercalcemia
- Polycythemia
Correct answer: Respiratory distress syndrome (RDS)
Late preterm infants have immature lungs with insufficient surfactant, making respiratory distress syndrome the most significant immediate risk.
Question 7: According to the ACNM Scope of Practice, which situation requires the CNM to initiate consultation or transfer of care?
- Patient requests epidural analgesia during labor
- Patient has a prior uncomplicated cesarean section and desires TOLAC
- Patient develops severe preeclampsia with HELLP syndrome (Correct answer)
- Patient is GBS-positive and requires intrapartum antibiotics
Correct answer: Patient develops severe preeclampsia with HELLP syndrome
Severe preeclampsia with HELLP syndrome is a high-risk obstetric emergency that exceeds the CNM's independent scope and requires physician consultation and co-management or transfer.
Certified Midwife Exam Prep Certified Nurse Midwife 3
A patient at 41+3 weeks gestation has a Bishop score of 4.
Which management approach is most appropriate?