Certified Midwife Exam Prep Certified Professional Midwife 5 — Questions and Answers
Question 1: A newborn born at home fails to establish spontaneous respirations after thorough drying and stimulation for 30 seconds. The heart rate is 80 bpm. What is the IMMEDIATE next step according to NRP guidelines?
- Administer epinephrine via umbilical vein
- Begin positive pressure ventilation with a bag-mask (Correct answer)
- Start chest compressions at a 3:1 ratio
- Initiate transport and do nothing further at home
Correct answer: Begin positive pressure ventilation with a bag-mask
Per NRP, if a newborn is apneic or has a heart rate <100 bpm after initial steps, positive pressure ventilation is the immediate and most critical intervention.
Question 2: Which of the following is a contraindication to planned out-of-hospital birth that falls under the MANA Standards and Qualifications?
- History of one prior uncomplicated cesarean section (VBAC candidate)
- Gestational age of 39 weeks with a singleton vertex presentation
- Active herpes simplex virus lesion at onset of labor (Correct answer)
- BMI of 30 at the onset of pregnancy
Correct answer: Active herpes simplex virus lesion at onset of labor
Active genital herpes lesions at onset of labor require cesarean delivery; planned vaginal birth in any setting is contraindicated due to neonatal transmission risk.
Question 3: A client is 5 days postpartum and calls reporting a temperature of 38.8°C (101.8°F), foul-smelling lochia, and uterine tenderness. What is the MOST likely diagnosis?
- Normal postpartum involution
- Mastitis
- Endometritis (Correct answer)
- Urinary tract infection
Correct answer: Endometritis
Postpartum fever with uterine tenderness and malodorous lochia after the first 24 hours is endometritis until proven otherwise, requiring antibiotic treatment.
Question 4: What does the term 'physiologic management of the third stage of labor' include?
- Immediate cord clamping, controlled cord traction, and oxytocin injection
- Delayed cord clamping, avoiding cord traction, and allowing placenta to deliver spontaneously (Correct answer)
- Fundal massage, controlled cord traction, and IV oxytocin infusion
- Manual exploration of the uterine cavity after placental delivery
Correct answer: Delayed cord clamping, avoiding cord traction, and allowing placenta to deliver spontaneously
Physiologic (expectant) management allows the placenta to separate and deliver spontaneously without oxytocics or cord traction, with the cord clamped only after pulsation stops.
Question 5: A client at 36 weeks gestation has an ultrasound showing an anterior placenta covering the internal os. She presents with painless, bright-red vaginal bleeding. What should the CPM do?
- Perform a sterile vaginal exam to assess cervical dilation
- Initiate immediate transport to a hospital (Correct answer)
- Apply continuous external fetal monitoring and wait
- Administer a tocolytic to stop uterine contractions
Correct answer: Initiate immediate transport to a hospital
Placenta previa with active bleeding is a life-threatening obstetric emergency requiring immediate hospital transport for possible cesarean delivery; vaginal exams are strictly contraindicated.
Question 6: Which vitamin/mineral supplementation is specifically recommended to begin BEFORE conception to reduce the risk of neural tube defects?
- Iron 27 mg daily
- Calcium 1000 mg daily
- Folic acid 400–800 mcg daily (Correct answer)
- Vitamin D 600 IU daily
Correct answer: Folic acid 400–800 mcg daily
Folic acid supplementation starting at least one month before conception and through the first trimester reduces neural tube defect risk by up to 70%.
Question 7: A client at 41+3 weeks gestation has an unfavorable cervix (Bishop score 3). She is declining induction and wishes to continue expectant management. Which assessment is MOST important to perform at each prenatal visit going forward?
- Weekly pelvic exams to assess cervical change
- Biophysical profile and non-stress testing twice weekly (Correct answer)
- Daily urine dipstick for protein
- Fundal height measurement at each visit
Correct answer: Biophysical profile and non-stress testing twice weekly
Post-term surveillance with biophysical profile and non-stress testing twice weekly monitors for uteroplacental insufficiency, the primary risk of post-term pregnancy.
Certified Midwife Exam Prep Certified Professional Midwife 5
A newborn born at home fails to establish spontaneous respirations after thorough drying and stimulation for 30 seconds.
The heart rate is 80 bpm.
What is the IMMEDIATE next step according to NRP guidelines?