Certified Midwife Exam Prep Certified Professional Midwife 4 — Questions and Answers
Question 1: Leopold's maneuvers are performed to assess fetal position. Which maneuver identifies fetal lie by palpating the uterine fundus?
- First maneuver (Correct answer)
- Second maneuver
- Third maneuver
- Fourth maneuver
Correct answer: First maneuver
The first Leopold's maneuver involves palpating the fundal area to determine which fetal pole (head or breech) occupies the fundus, establishing fetal lie.
Question 2: A laboring client at 8 cm dilation suddenly reports severe, constant abdominal pain with a rigid, board-like uterus and heavy vaginal bleeding. FHR shows late decelerations. What is the MOST likely diagnosis?
- Placenta previa
- Placental abruption (Correct answer)
- Uterine rupture
- Vasa previa
Correct answer: Placental abruption
Sudden severe abdominal pain, rigid uterus, vaginal bleeding, and late decelerations are classic signs of placental abruption requiring immediate transport.
Question 3: What is the BEST clinical indicator that the placenta has separated and is ready for delivery?
- 30 minutes have elapsed since birth
- The umbilical cord lengthens at the introitus (Correct answer)
- Maternal urge to push returns
- Fundal height rises above the umbilicus
Correct answer: The umbilical cord lengthens at the introitus
Cord lengthening at the vulva (Brandt-Andrews sign) occurs as the separated placenta descends into the lower uterine segment, indicating readiness for delivery.
Question 4: A client at 28 weeks gestation with Rh-negative blood type has a minor car accident with no apparent injuries. What intervention is indicated?
- No intervention; wait until delivery to administer RhoGAM
- Administer 300 mcg RhoGAM within 72 hours (Correct answer)
- Administer 50 mcg RhoGAM within 72 hours
- Order a Kleihauer-Betke test only if symptoms develop
Correct answer: Administer 300 mcg RhoGAM within 72 hours
Any potentially sensitizing event after 12 weeks in an Rh-negative client warrants the standard 300 mcg RhoGAM dose within 72 hours to prevent Rh isoimmunization.
Question 5: When assessing a client's pelvis using clinical pelvimetry, which measurement is MOST predictive of the ability of the fetal head to pass through?
- Obstetric conjugate
- Diagonal conjugate (Correct answer)
- Transverse diameter of the outlet
- Bi-ischial diameter
Correct answer: Diagonal conjugate
The diagonal conjugate is the clinically measurable AP diameter; subtracting 1.5–2 cm estimates the obstetric conjugate, the true narrowest inlet measurement.
Question 6: Which of the following laboratory values is MOST concerning in a client at 32 weeks gestation?
- Hemoglobin of 10.5 g/dL
- Platelet count of 95,000/μL (Correct answer)
- White blood cell count of 12,000/μL
- Serum ferritin of 15 ng/mL
Correct answer: Platelet count of 95,000/μL
A platelet count of 95,000/μL indicates thrombocytopenia, which could signal HELLP syndrome, ITP, or another serious condition requiring immediate evaluation.
Question 7: Under NARM's Midwifery Bridge Certificate program, a Certified Nurse-Midwife seeking a CPM credential is primarily required to demonstrate competency in:
- Pharmacology for obstetric emergencies
- Out-of-hospital birth skills and newborn resuscitation (Correct answer)
- Hospital-based fetal monitoring interpretation
- Surgical assisting for cesarean sections
Correct answer: Out-of-hospital birth skills and newborn resuscitation
The Bridge Certificate validates skills specific to out-of-hospital practice—newborn resuscitation, physiologic birth management—not the hospital-focused competencies CNMs already hold.
Certified Midwife Exam Prep Certified Professional Midwife 4
Leopold's maneuvers are performed to assess fetal position.
Which maneuver identifies fetal lie by palpating the uterine fundus?