Certified Midwife Exam Prep Certified Nurse Midwife 4 — Questions and Answers
Question 1: A patient with a BMI of 32 at her first prenatal visit asks how much weight she should gain during pregnancy. What is the IOM-recommended range?
- 11–20 lbs (5–9 kg)
- 15–25 lbs (7–11 kg) (Correct answer)
- 25–35 lbs (11–16 kg)
- 28–40 lbs (13–18 kg)
Correct answer: 15–25 lbs (7–11 kg)
The Institute of Medicine recommends a gestational weight gain of 15–25 lbs for women with a pre-pregnancy BMI of 30–39.9 (obese class I and II).
Question 2: Which intrapartum intervention is most strongly associated with reducing the risk of group B Streptococcus (GBS) transmission to the neonate?
- Cesarean delivery before labor onset
- Intrapartum IV penicillin G given at least 4 hours before delivery (Correct answer)
- Chlorhexidine vaginal wash at admission
- Prophylactic neonatal ampicillin after birth
Correct answer: Intrapartum IV penicillin G given at least 4 hours before delivery
IV penicillin G given at least 4 hours before delivery is the gold standard for intrapartum GBS prophylaxis and most effectively reduces vertical transmission.
Question 3: A patient at 32 weeks presents with painless loss of fluid per vagina. Ferning on microscopy and pooling are positive. What is the most likely diagnosis?
- Urinary incontinence
- Increased vaginal discharge
- Premature rupture of membranes (PROM) (Correct answer)
- Bloody show
Correct answer: Premature rupture of membranes (PROM)
Ferning (arborization pattern on drying) and pooling of fluid in the posterior fornix are classic clinical signs confirming premature rupture of membranes.
Question 4: Which approach to pain management is most consistent with a CNM's midwifery philosophy during an uncomplicated labor?
- Routine epidural placement upon active labor diagnosis
- Informing the patient of all pain management options and supporting her informed choice (Correct answer)
- Discouraging pharmacologic analgesia to preserve a 'natural birth'
- Delaying pain management discussion until transition phase
Correct answer: Informing the patient of all pain management options and supporting her informed choice
The CNM role centers on informed consent and shared decision-making; supporting the patient's autonomous choice — whether pharmacologic or non-pharmacologic — is foundational.
Question 5: A patient at 16 weeks gestation is found to have a hemoglobin of 9.8 g/dL and a mean corpuscular volume (MCV) of 72 fL. What is the most likely diagnosis?
- Megaloblastic anemia
- Anemia of chronic disease
- Iron-deficiency anemia (Correct answer)
- Sickle cell trait
Correct answer: Iron-deficiency anemia
Microcytic anemia (low MCV) in a pregnant patient is most commonly caused by iron deficiency, which is the leading cause of anemia in pregnancy.
Question 6: During a newborn assessment, the CNM notes a flat, salmon-colored patch on the nape of the neck that blanches with pressure. What is this finding?
- Port wine stain (nevus flammeus)
- Mongolian spot
- Nevus simplex (stork bite) (Correct answer)
- Café-au-lait macule
Correct answer: Nevus simplex (stork bite)
A nevus simplex (also called stork bite or angel kiss) is a flat, salmon-colored, blanchable vascular malformation commonly seen on the nape of the neck and eyelids of newborns.
Question 7: A patient at 26 weeks has a 1-hour glucose challenge test result of 152 mg/dL. What is the next appropriate step?
- Diagnose gestational diabetes and begin insulin therapy
- Repeat the 1-hour GCT in two weeks
- Perform a 3-hour 100 g oral glucose tolerance test (Correct answer)
- Begin dietary modifications and recheck fasting glucose
Correct answer: Perform a 3-hour 100 g oral glucose tolerance test
A 1-hour GCT value ≥140 mg/dL (some use ≥130 mg/dL as a cutoff) is a screen-positive result that requires a confirmatory 3-hour 100 g OGTT for diagnosis.
Certified Midwife Exam Prep Certified Nurse Midwife 4
A patient with a BMI of 32 at her first prenatal visit asks how much weight she should gain during pregnancy.
What is the IOM-recommended range?