Certified Midwife Exam Prep Certified Nurse Midwife 5 — Questions and Answers
Question 1: A CNM is caring for a patient in the second stage of labor for 3 hours with an epidural. Fetal heart tones are Category I and the fetal head is at +2 station. What is the most appropriate management?
- Proceed immediately to cesarean delivery
- Encourage continued pushing; extended second stage is acceptable with epidural and reassuring FHR (Correct answer)
- Administer oxytocin bolus to hasten delivery
- Apply vacuum or forceps immediately
Correct answer: Encourage continued pushing; extended second stage is acceptable with epidural and reassuring FHR
ACOG guidelines allow extended second-stage duration with an epidural (up to 3 hours for nulliparas, 2 hours for multiparas) when maternal and fetal status are reassuring.
Question 2: Which vitamin supplement is MOST critical to recommend before conception and in the first trimester to reduce neural tube defects?
- Vitamin D 2000 IU daily
- Iron 27 mg daily
- Folic acid 400–800 mcg daily (Correct answer)
- Calcium 1200 mg daily
Correct answer: Folic acid 400–800 mcg daily
Folic acid supplementation of at least 400 mcg daily starting before conception and continuing through the first trimester significantly reduces the risk of neural tube defects.
Question 3: A CNM notes a variable deceleration pattern that returns to baseline within 30 seconds during active labor. Which is the most likely cause?
- Uteroplacental insufficiency
- Umbilical cord compression (Correct answer)
- Fetal head compression
- Maternal hypotension
Correct answer: Umbilical cord compression
Variable decelerations result from transient umbilical cord compression, which causes a rapid drop and return in the fetal heart rate that varies in timing, shape, and duration.
Question 4: A patient at 34 weeks with preterm labor is receiving betamethasone. What is the primary rationale for this treatment?
- To stop uterine contractions and prolong pregnancy
- To accelerate fetal lung maturity and reduce neonatal complications (Correct answer)
- To prevent maternal infection during preterm birth
- To increase uteroplacental blood flow
Correct answer: To accelerate fetal lung maturity and reduce neonatal complications
Antenatal corticosteroids such as betamethasone accelerate fetal lung surfactant production, reducing rates of respiratory distress syndrome, intraventricular hemorrhage, and neonatal mortality.
Question 5: A CNM performs a routine pelvic exam and notes a firm, non-tender, fixed adnexal mass in a 52-year-old postmenopausal patient. What is the most appropriate next step?
- Reassure the patient and recheck in 6 months
- Refer immediately for pelvic ultrasound and gynecologic oncology consultation (Correct answer)
- Prescribe a short course of oral contraceptives to observe for regression
- Order a Pap smear and recheck at annual visit
Correct answer: Refer immediately for pelvic ultrasound and gynecologic oncology consultation
A fixed, non-tender adnexal mass in a postmenopausal woman raises significant concern for ovarian malignancy and requires urgent ultrasound and specialist referral.
Question 6: During a well-woman visit, a 35-year-old patient reports difficulty sleeping, night sweats, and irregular periods for the past 8 months. FSH is 42 mIU/mL. What is the most likely diagnosis?
- Hypothyroidism
- Hyperprolactinemia
- Perimenopause (Correct answer)
- Polycystic ovary syndrome (PCOS)
Correct answer: Perimenopause
Elevated FSH (>25 mIU/mL), irregular menses, vasomotor symptoms (night sweats), and the patient's age are classic indicators of perimenopause.
Question 7: A CNM is attending a birth when the baby's head delivers but the shoulders do not follow with the next push, and the head retracts against the perineum. What maneuver should be attempted FIRST?
- Zavanelli maneuver
- McRoberts maneuver with suprapubic pressure (Correct answer)
- Fundal pressure
- Internal podalic version
Correct answer: McRoberts maneuver with suprapubic pressure
McRoberts maneuver (hyperflexion of maternal thighs) combined with suprapubic pressure is the recommended first-line intervention for shoulder dystocia as it flattens the lumbar lordosis and frees the anterior shoulder.
Certified Midwife Exam Prep Certified Nurse Midwife 5
A CNM is caring for a patient in the second stage of labor for 3 hours with an epidural.
Fetal heart tones are Category I and the fetal head is at +2 station.
What is the most appropriate management?