Certified Midwife Exam Prep Certified Professional Midwife 2 — Questions and Answers
Question 1: A client at 38 weeks gestation presents with a blood pressure of 160/110 mmHg and 3+ proteinuria. What is the most appropriate next step?
- Administer magnesium sulfate and arrange immediate transfer (Correct answer)
- Continue monitoring at home with daily BP checks
- Schedule a non-stress test for next week
- Recommend bed rest and reduced sodium intake
Correct answer: Administer magnesium sulfate and arrange immediate transfer
BP ≥160/110 with proteinuria meets criteria for severe preeclampsia requiring magnesium sulfate prophylaxis and urgent hospital transfer.
Question 2: Which fetal presentation is associated with the highest risk of cord prolapse?
- Occiput anterior
- Frank breech
- Footling breech (Correct answer)
- Occiput posterior
Correct answer: Footling breech
Footling (incomplete) breech presents with the foot or feet as the lowest part, leaving space for the umbilical cord to prolapse beside or below the presenting part.
Question 3: According to NARM standards, which of the following is within the CPM's scope of practice for newborn care?
- Administering IV antibiotics for suspected neonatal sepsis
- Performing a neonatal intubation for respiratory distress
- Administering vitamin K prophylaxis (Correct answer)
- Suturing a significant perineal laceration requiring general anesthesia
Correct answer: Administering vitamin K prophylaxis
Vitamin K prophylaxis (intramuscular injection) is a standard CPM newborn care procedure within scope of practice.
Question 4: A client in active labor at 41 weeks has meconium-stained amniotic fluid with thick, particulate consistency. The fetal heart rate is 100 bpm. What action should the CPM take?
- Continue monitoring and prepare for birth at home
- Perform amnioinfusion to dilute the meconium
- Initiate immediate transport to a hospital (Correct answer)
- Administer oxygen via face mask and recheck FHR in 15 minutes
Correct answer: Initiate immediate transport to a hospital
Thick meconium combined with fetal bradycardia (100 bpm) indicates fetal compromise requiring immediate hospital transfer for neonatal resuscitation capability.
Question 5: When performing a postpartum fundal assessment 1 hour after delivery, the midwife notes the uterus is boggy and displaced to the right. What is the most likely cause?
- Uterine atony alone
- A full bladder (Correct answer)
- Retained placental fragments
- Uterine inversion
Correct answer: A full bladder
A displaced, boggy uterus shortly postpartum is most commonly caused by a distended bladder pushing the uterus to the side.
Question 6: Which herbal supplement is contraindicated during pregnancy due to its uterotonic properties?
- Ginger root
- Red raspberry leaf
- Blue cohosh (Correct answer)
- Chamomile tea
Correct answer: Blue cohosh
Blue cohosh contains caulosaponin and caulophyllosaponin, which have documented uterotonic and potentially harmful vasoconstrictive effects on the fetus.
Question 7: A newborn at 1 minute of age has a heart rate of 90 bpm, weak cry, some flexion of extremities, grimace response to stimulation, and blue extremities with pink body. What is this infant's APGAR score?
- 5
- 6 (Correct answer)
- 7
- 4
Correct answer: 6
HR<100=1, weak cry=1, some flexion=1, grimace=1, acrocyanosis=1, totaling an APGAR score of 6.
Certified Midwife Exam Prep Certified Professional Midwife 2
A client at 38 weeks gestation presents with a blood pressure of 160/110 mmHg and 3+ proteinuria.
What is the most appropriate next step?