Certified Midwife Exam Prep Certified Nurse Midwife 5

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?

Accepted Answer

Encourage continued pushing; extended second stage is acceptable with epidural and reassuring FHR

Answer

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?

Accepted Answer

Folic acid 400–800 mcg daily

Answer

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?

Accepted Answer

Umbilical cord compression

Answer

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?

Accepted Answer

To accelerate fetal lung maturity and reduce neonatal complications

Answer

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?

Accepted Answer

Refer immediately for pelvic ultrasound and gynecologic oncology consultation

Answer

A fixed, non-tender adnexal mass in a postmenopausal woman raises significant concern for ovarian malignancy and requires urgent ultrasound and specialist referral.

Certified Midwife Exam Prep Practice Test

Certified Midwife Exam Prep Practice Test

Certified Midwife Exam Prep Certified Nurse Midwife 5