NARM Certified Professional Midwife (CPM) Exam — Questions and Answers

Question 1: By about what age do most healthy breastfed newborns regain their birth weight?

6 weeks
10-14 days (Correct answer)
2-3 days
3 months

Correct answer: 10-14 days

Newborns commonly lose up to 7-10% of birth weight in the first days, then regain it by about 10-14 days of life. Failure to do so warrants a feeding assessment.

Question 2: A client in preterm labor at 32 weeks is given betamethasone. What is the primary therapeutic goal of this medication?

Prevent intraventricular hemorrhage by reducing fetal heart rate variability
Reduce maternal fever that is triggering labor
Accelerate fetal lung maturation by stimulating surfactant production (Correct answer)
Arrest uterine contractions to prolong pregnancy

Correct answer: Accelerate fetal lung maturation by stimulating surfactant production

Antenatal corticosteroids like betamethasone stimulate fetal type II pneumocyte maturation, increasing surfactant production and reducing the risk of neonatal respiratory distress syndrome.

Question 3: Which vessel carries oxygenated blood from the placenta to the fetus?

One umbilical artery
The ductus arteriosus
The umbilical vein (Correct answer)
Both umbilical arteries

Correct answer: The umbilical vein

The single umbilical vein carries oxygen- and nutrient-rich blood to the fetus. The two umbilical arteries carry deoxygenated blood back to the placenta.

Question 4: Normal newborn heart rate?

200-240 bpm
120-160 bpm (Correct answer)
80-100 bpm
60-80 bpm

Correct answer: 120-160 bpm

A newborns heart beats much faster than an adults.

Question 5: A client delivers a 4,200g infant and subsequently develops a postpartum hemorrhage unresponsive to oxytocin and uterine massage. Which uterotonic should be considered next?

Ergotamine
Misoprostol 200mcg oral
Methylergonovine (Methergine)
Carboprost (Hemabate) (Correct answer)

Correct answer: Carboprost (Hemabate)

Carboprost (Hemabate), a prostaglandin F2-alpha analog, is a second-line uterotonic for atony-related PPH unresponsive to oxytocin; it is contraindicated in asthma.

Question 6: What is the most appropriate initial intervention for a newborn who has not started breathing immediately after birth?

Providing supplemental oxygen
Administering intravenous fluids
Performing gentle stimulation and providing positive pressure ventilation if needed (Correct answer)
Initiating chest compressions

Correct answer: Performing gentle stimulation and providing positive pressure ventilation if needed

For a newborn not breathing immediately after birth, the initial steps involve gentle stimulation (e.g., rubbing the back or soles of the feet) to encourage spontaneous breathing. If breathing does not start or is ineffective, positive pressure ventilation (PPV) with a bag-mask device is the most appropriate and critical intervention to establish adequate respiration and prevent hypoxia. Chest compressions are reserved for absent or very low heart rates.

Question 7: A client at 39 weeks gestation presents with sudden onset of severe abdominal pain, rigid abdomen, and fetal heart tones that drop from 140 to 60 bpm. What is the most likely diagnosis?

Placenta previa
Cord prolapse
Severe preeclampsia
Uterine rupture (Correct answer)

Correct answer: Uterine rupture

Uterine rupture presents with sudden severe abdominal pain, a rigid abdomen, and acute fetal bradycardia due to fetal distress from disrupted placental perfusion.

Question 8: Legal status of CPMs in the US?

Varies by state from full licensure to prohibition (Correct answer)
Illegal everywhere
Licensed in all 50 states
Federal law governs all

Correct answer: Varies by state from full licensure to prohibition

The legal framework varies significantly by state.

Question 9: How to distinguish true from false labor?

True: regular progressive contractions with cervical change; false: irregular, no change (Correct answer)
They are identical
True starts in back only
False is painful, true is not

Correct answer: True: regular progressive contractions with cervical change; false: irregular, no change

Progressive cervical change is the key difference.

Question 10: Continuing education requirements for CPM?

Conference attendance only
None required
Specified CE hours and recertification every 3 years (Correct answer)
One course per decade

Correct answer: Specified CE hours and recertification every 3 years

Ongoing education maintains current knowledge.

Question 11: What warrants emergency transport from home birth?

Never needed
Only first-time mothers
Only mother request
Prolonged labor, fetal distress, hemorrhage, cord prolapse, unresolved shoulder dystocia (Correct answer)

Correct answer: Prolonged labor, fetal distress, hemorrhage, cord prolapse, unresolved shoulder dystocia

Certain emergencies require hospital-level resources.

Question 12: What is a nuchal cord?

Cord infection
Short cord
Umbilical cord around babys neck - managed by reducing over head or clamping/cutting (Correct answer)
Cord knot

Correct answer: Umbilical cord around babys neck - managed by reducing over head or clamping/cutting

This common finding involves the cord around the neck.

Question 13: Which combination of findings is most consistent with postpartum endometritis?

Slight bilateral breast tenderness on postpartum day 3
Uterine tenderness on palpation, fever above 38°C, and foul-smelling lochia (Correct answer)
Lochia rubra on postpartum day 2 with mild uterine cramping
Mild lower abdominal cramping during breastfeeding sessions

Correct answer: Uterine tenderness on palpation, fever above 38°C, and foul-smelling lochia

Postpartum endometritis classically presents with uterine tenderness, fever (>38°C), and malodorous lochia and requires prompt antibiotic treatment.

Question 14: Which reflex is tested by stroking the lateral sole from heel to toes, producing toe fanning and dorsiflexion of the big toe in a newborn?

Plantar grasp
Galant
Babinski (Correct answer)
Stepping

Correct answer: Babinski

A positive Babinski response is normal in newborns and usually goes away in the first 1-2 years.

Question 15: What is Group B Strep screening?

STI test
Blood type test
Test at 35-37 weeks for bacteria that could infect baby during birth (Correct answer)
Strep throat test

Correct answer: Test at 35-37 weeks for bacteria that could infect baby during birth

Late-pregnancy test identifies bacteria affecting the baby during delivery.

Question 16: Which of the following is the correct technique for performing Leopold's maneuver to determine fetal lie?

Press downward just above the pubic symphysis to assess engagement
Use one hand to ballott the presenting part
Palpate the fundal area with both hands to identify the presenting pole (Correct answer)
Apply lateral pressure bilaterally to locate the fetal back

Correct answer: Palpate the fundal area with both hands to identify the presenting pole

The first Leopold maneuver involves palpating the uterine fundus with both hands to determine which fetal pole occupies the fundus, establishing fetal lie.

Question 17: What is neonatal hypoglycemia?

Normal finding
Low blood sugar causing jitteriness, poor feeding, lethargy, possibly seizures (Correct answer)
High blood sugar
Skin condition

Correct answer: Low blood sugar causing jitteriness, poor feeding, lethargy, possibly seizures

Low blood sugar requires prompt treatment.

Question 18: When is Rh immune globulin routinely given to an unsensitized Rh-negative woman?

Only at delivery
At about 28 weeks and within 72 hours after birth of an Rh-positive baby (Correct answer)
Only if the baby is Rh-negative
At 12 weeks only

Correct answer: At about 28 weeks and within 72 hours after birth of an Rh-positive baby

Standard prophylaxis is at about 28 weeks, plus within 72 hours after delivery if the newborn is Rh-positive. It is also given after bleeding events or invasive procedures.

Question 19: What is normal fetal heart rate during labor?

200-240 bpm
110-160 beats per minute (Correct answer)
60-80 bpm
180-220 bpm

Correct answer: 110-160 beats per minute

Normal range is faster than an adult heart rate.

Question 20: A newborn has a flat, salmon-pink mark on the nape of the neck that blanches with pressure. What is it?

Nevus simplex (stork bite) (Correct answer)
Café-au-lait macule
Port-wine stain
Infantile hemangioma

Correct answer: Nevus simplex (stork bite)

Nevus simplex is a common benign capillary malformation that blanches, and it usually appears on the nape or eyelids.

Question 21: Which description best characterizes normal lochia rubra?

Bright red discharge with large clots and an offensive odor throughout the first week
Dark red discharge containing decidual tissue that may include small clots, lasting 1–4 days (Correct answer)
Yellow-white creamy discharge present from birth through 6 weeks
Pink-brown watery discharge beginning immediately after delivery and lasting 3 weeks

Correct answer: Dark red discharge containing decidual tissue that may include small clots, lasting 1–4 days

Lochia rubra is dark red, may contain small clots and decidual tissue, and is normal for the first 1–4 days postpartum; large clots or foul odor would be abnormal findings.

Question 22: What is gestational diabetes screening?

A genetic test
A baby-only condition test
Glucose tolerance test at 24-28 weeks for diabetes developing during pregnancy (Correct answer)
A permanent diabetes test

Correct answer: Glucose tolerance test at 24-28 weeks for diabetes developing during pregnancy

This condition is screened in the second trimester.

Question 23: A midwife is asked by a journalism student to share anonymized case details about an unusual birth outcome. What should the midwife do?

Obtain written client authorization before sharing any case information (Correct answer)
Share only with a signed non-disclosure agreement from the student
Share details freely since they are anonymized
Decline unless the student provides IRB approval

Correct answer: Obtain written client authorization before sharing any case information

Even anonymized information can sometimes be re-identified; written client authorization is required before sharing any case details outside the professional care team.

Question 24: Which screening tool is most widely validated and recommended for postpartum depression screening in midwifery practice?

Patient Health Questionnaire-2 (PHQ-2) alone
Beck Depression Inventory (BDI)
Edinburgh Postnatal Depression Scale (EPDS) (Correct answer)
Hamilton Rating Scale for Depression (HAM-D)

Correct answer: Edinburgh Postnatal Depression Scale (EPDS)

The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used and validated screening tool specifically designed and normed for the postpartum population.

Question 25: What is a primary goal of maintaining effective communication with clients in midwifery?

To control the client's choices in their care
To minimize the amount of time spent on each client’s case
To ensure that the midwife is not liable for any adverse outcomes
To build trust and provide clear information to support informed decision-making (Correct answer)

Correct answer: To build trust and provide clear information to support informed decision-making

Effective communication is paramount in midwifery because it fosters a strong, trusting relationship between the midwife and the client. This trust is essential for open dialogue, allowing the midwife to provide clear, comprehensive information about pregnancy, birth, and postpartum care. Ultimately, this empowers clients to make well-informed decisions that align with their values and preferences throughout their care journey.

Question 26: Under the NARM Certified Professional Midwife (CPM) credential framework, which body is responsible for establishing the standards of competency that CPMs must demonstrate?

The North American Registry of Midwives (NARM) (Correct answer)
The Midwives Alliance of North America (MANA)
The American College of Nurse-Midwives (ACNM)
The state licensing board in each jurisdiction

Correct answer: The North American Registry of Midwives (NARM)

NARM is the certifying body that establishes the competency standards and administers the NARM Written Exam and Skills Assessment for the CPM credential.

Question 27: Which medication is commonly used to control nausea and vomiting during pregnancy, especially in cases of hyperemesis gravidarum?

Metformin
Ondansetron (Zofran) (Correct answer)
Diphenhydramine (Benadryl)
Labetalol

Correct answer: Ondansetron (Zofran)

Ondansetron (Zofran) is an antiemetic medication commonly prescribed to manage severe nausea and vomiting during pregnancy, including hyperemesis gravidarum. It works by blocking serotonin receptors in the brain and gut, which are involved in triggering nausea and vomiting. While other medications exist, ondansetron is often chosen for its effectiveness and relatively favorable safety profile in pregnancy.

Question 28: Anemia in pregnancy in the first and third trimesters is defined as hemoglobin below what level?

11 g/dL (Correct answer)
9 g/dL
14 g/dL
16 g/dL

Correct answer: 11 g/dL

The CDC and ACOG define anemia as hemoglobin under 11 g/dL in the first and third trimesters, and under 10.5 g/dL in the second.

Question 29: During auscultation of fetal heart tones in active labor, the midwife hears a rate of 180 bpm persisting for 15 minutes. What is the most common cause of fetal tachycardia in labor?

Fetal anemia
Umbilical cord compression
Fetal cardiac arrhythmia
Maternal fever and chorioamnionitis (Correct answer)

Correct answer: Maternal fever and chorioamnionitis

Maternal fever from chorioamnionitis is the most common cause of fetal tachycardia in labor, as the elevated maternal temperature directly increases fetal heart rate.

Question 30: Signs of neonatal respiratory distress?

Normal sleep
Grunting, nasal flaring, retractions, tachypnea, cyanosis (Correct answer)
Loud crying only
Quiet breathing

Correct answer: Grunting, nasal flaring, retractions, tachypnea, cyanosis

Multiple visible signs show breathing difficulty.

Question 31: During a home birth, the midwife notes the umbilical cord prolapsing past the presenting part with the cervix fully dilated and vertex at +2 station. What is the priority action?

Reposition the cord manually back into the uterus
Administer oxygen and prepare for immediate delivery
Apply firm upward pressure on the presenting part while calling 911 (Correct answer)
Place the client in Trendelenburg and transport immediately

Correct answer: Apply firm upward pressure on the presenting part while calling 911

With cord prolapse at +2 station, the most effective immediate action is to manually elevate the presenting part to relieve cord compression while arranging emergency transport.

Question 32: At what gestational age is the 1-hour 50 g glucose challenge test usually done for gestational diabetes screening?

6-8 weeks
12-14 weeks
18-20 weeks
24-28 weeks (Correct answer)

Correct answer: 24-28 weeks

Routine screening for gestational diabetes is done at 24-28 weeks, and earlier for women with risk factors.

Question 33: What is the expected rate of uterine fundal descent during normal postpartum involution?

Returns to pre-pregnancy size within 2 weeks with no measurable daily change
Descends approximately 1 cm (one fingerbreadth) per day (Correct answer)
Rises above the umbilicus on day 2 before beginning to descend
Remains at the umbilicus for the first 5 days postpartum

Correct answer: Descends approximately 1 cm (one fingerbreadth) per day

The uterine fundus descends approximately 1 cm (one fingerbreadth) per day, returning to the pelvic cavity by approximately 10–14 days postpartum.

Question 34: Which contraceptive method is considered safe to initiate immediately postpartum in a breastfeeding woman?

Transdermal estrogen-containing contraceptive patch
Copper IUD (must wait until 6-week visit for insertion)
Progestin-only pills (mini-pill) (Correct answer)
Combined estrogen-progestin oral contraceptive pills

Correct answer: Progestin-only pills (mini-pill)

Progestin-only methods do not suppress lactation and are safe to start immediately postpartum, whereas estrogen-containing contraceptives can reduce milk supply and are contraindicated in breastfeeding women until at least 6 weeks.

Question 35: Which document is crucial for ensuring that a midwife's professional and ethical responsibilities are clearly defined?

The midwife’s personal journal
The state or national midwifery practice guidelines and scope of practice (Correct answer)
The midwife’s curriculum vitae
The midwifery care plan for each client

Correct answer: The state or national midwifery practice guidelines and scope of practice

State or national midwifery practice guidelines and the defined scope of practice are crucial documents because they legally and professionally delineate what a midwife is authorized and expected to do. These guidelines ensure consistent, safe, and ethical care by outlining the boundaries of practice, required competencies, and professional responsibilities. They serve as the foundational framework for a midwife's professional conduct and accountability.

Question 36: Which hormone primarily stimulates milk production by the alveolar cells?

Oxytocin
Prolactin (Correct answer)
Relaxin
hCG

Correct answer: Prolactin

Prolactin, released in response to suckling and falling progesterone after placental delivery, stimulates milk synthesis.

Question 37: Which hormone, secreted by the trophoblast, maintains the corpus luteum in early pregnancy?

Follicle-stimulating hormone (FSH)
Relaxin
Oxytocin
Human chorionic gonadotropin (hCG) (Correct answer)

Correct answer: Human chorionic gonadotropin (hCG)

hCG is produced by the trophoblast after implantation. It signals the corpus luteum to keep making progesterone until the placenta takes over, around 8-12 weeks.

Question 38: When a midwife identifies a situation beyond her scope of practice during labor, the most appropriate action is to:

Document the situation and address it during the postpartum visit
Initiate emergency transport and consult or transfer care to an appropriate provider (Correct answer)
Proceed cautiously while contacting a backup provider for telephone guidance
Continue managing the situation to avoid alarming the client

Correct answer: Initiate emergency transport and consult or transfer care to an appropriate provider

When a situation exceeds the midwife's scope, immediate consultation, collaboration, or transfer to an appropriate provider is the professional and ethical obligation.

Question 39: What Edinburgh Postnatal Depression Scale (EPDS) score is the generally accepted threshold warranting further clinical evaluation?

Any score above zero requires immediate psychiatric referral
Score of 5 or higher
Score of 15 or higher
Score of 10 or higher (Correct answer)

Correct answer: Score of 10 or higher

An EPDS score of 10 or higher indicates possible postpartum depression and warrants further clinical assessment and follow-up by the midwife or referral.

Question 40: A CPM practicing in a state where CPMs are not licensed receives a complaint from a client. Which entity has jurisdiction to investigate the complaint?

The state medical board, since CPMs operate under physician oversight
No entity has jurisdiction in unlicensed states
NARM, through its ethics and discipline process (Correct answer)
The local health department

Correct answer: NARM, through its ethics and discipline process

NARM has jurisdiction over CPM credential holders regardless of state licensure status through its own ethics and disciplinary process.

Question 41: Midwife role in emergency hospital transfer?

Only call 911
Initiate transfer, communicate clinical info, accompany client, continue support (Correct answer)
Leave when ambulance arrives
End care immediately

Correct answer: Initiate transfer, communicate clinical info, accompany client, continue support

Responsibilities continue throughout the transfer.

Question 42: A client at 36 weeks is prescribed nifedipine for tocolysis. Which side effect should the midwife anticipate and monitor?

Hyperkalemia and bradycardia
Maternal hypotension and reflex tachycardia (Correct answer)
Uterine hyperstimulation and fetal distress
Pulmonary edema and fluid overload

Correct answer: Maternal hypotension and reflex tachycardia

Nifedipine, a calcium channel blocker, causes peripheral vasodilation leading to maternal hypotension and compensatory reflex tachycardia.

Question 43: How should a midwife address a situation where a patient expresses a preference for a treatment that is not evidence-based or recommended?

Disregard the patient’s preference and proceed with the recommended treatment
Proceed with the patient’s preference without discussion
Respect the patient’s autonomy while discussing evidence-based options and potential risks (Correct answer)
Ignore the patient’s preference and proceed as planned

Correct answer: Respect the patient’s autonomy while discussing evidence-based options and potential risks

Midwifery practice upholds patient autonomy, meaning clients have the right to make decisions about their own care, even if those decisions differ from professional recommendations. When a patient prefers a non-evidence-based treatment, the midwife's role is to respectfully discuss the evidence, explain the potential risks and benefits of all options, and clarify why certain treatments are recommended. This approach supports informed decision-making while maintaining a trusting relationship.

Question 44: What is the generally recommended minimum interval before resuming vaginal intercourse following an uncomplicated vaginal birth?

2 weeks postpartum once lochia has stopped
3 months postpartum to ensure complete uterine involution
4–6 weeks postpartum to allow perineal healing and cervical closure (Correct answer)
Only after the return of menstruation regardless of time elapsed

Correct answer: 4–6 weeks postpartum to allow perineal healing and cervical closure

Most providers recommend waiting at least 4–6 weeks postpartum before resuming intercourse to allow adequate healing of perineal tissues and cervical closure, reducing infection risk.

Question 45: An Rh-negative, unsensitized client gives birth to an Rh-positive baby. Within what time frame should Rh immune globulin be given?

Within 24 hours
Within 72 hours (Correct answer)
Within 6 hours
Within 2 weeks

Correct answer: Within 72 hours

Rh immune globulin should be given within 72 hours of birth to prevent maternal alloimmunization.

Question 46: What is meconium-stained fluid?

Fluid with vernix
Normal fluid
Bloody fluid
Fetal stool in amniotic fluid indicating possible distress and aspiration risk (Correct answer)

Correct answer: Fetal stool in amniotic fluid indicating possible distress and aspiration risk

Fetal stool in fluid can signal distress and create breathing risks.

Question 47: Which pelvic type is classically considered most favorable for vaginal birth?

Android
Anthropoid
Gynecoid (Correct answer)
Platypelloid

Correct answer: Gynecoid

The gynecoid pelvis has a rounded inlet, a wide subpubic arch, and generous diameters. These suit passage of a fetal head in most presentations.

Question 48: What is Rh factor importance in pregnancy?

A prenatal test type
Blood sugar measure
A vitamin supplement
Rh-negative mothers may develop antibodies against Rh-positive babies, requiring RhoGAM (Correct answer)

Correct answer: Rh-negative mothers may develop antibodies against Rh-positive babies, requiring RhoGAM

Blood protein mismatch can cause serious complications.

Question 49: A newborn has not passed meconium by 48 hours. Which condition is most important to consider?

Pyloric stenosis
Physiologic delay
Hirschsprung disease (Correct answer)
Esophageal atresia

Correct answer: Hirschsprung disease

Delayed passage of meconium beyond 48 hours in a term baby is a classic sign of Hirschsprung disease.

Question 50: A client at 36 weeks presents with painless bright red vaginal bleeding without contractions. Fetal heart tones are 145 bpm. What should the midwife do FIRST?

Administer 500mL IV fluid bolus
Perform a sterile vaginal exam to assess cervical dilation
Apply fundal pressure to determine placental location
Assess vital signs and call for emergency transport (Correct answer)

Correct answer: Assess vital signs and call for emergency transport

Painless bright red bleeding at 36 weeks is a classic presentation of placenta previa; digital vaginal examination must be avoided and emergency transport is the priority action.

Question 51: What is the Apgar score?

Genetic screen
Pregnancy risk score
Pain scale
1 and 5 minute assessment of appearance, pulse, grimace, activity, respiration (Correct answer)

Correct answer: 1 and 5 minute assessment of appearance, pulse, grimace, activity, respiration

Five newborn parameters are scored immediately after birth.

Question 52: Which of the following is a common sign of postpartum hemorrhage?

Temperature of 101°F (38.3°C)
Persistent, severe headache
Elevated blood pressure
A decrease in hematocrit levels (Correct answer)

Correct answer: A decrease in hematocrit levels

Postpartum hemorrhage (PPH) is excessive bleeding after childbirth, leading to significant blood loss. A decrease in hematocrit levels, which measures the proportion of red blood cells in the blood, is a direct indicator of blood loss and a key diagnostic sign of PPH. Other options like temperature or headache are not primary indicators of hemorrhage.

Question 53: Which cervical mucus is typical around ovulation?

Scant and dry
Thick and sticky
Clear, slippery, and stretchy (Correct answer)
Thick and white

Correct answer: Clear, slippery, and stretchy

Estrogen causes fertile mucus that resembles raw egg white (spinnbarkeit). It is used as a sign in fertility awareness methods.

Question 54: In fetal circulation, which structure shunts blood from the right atrium directly to the left atrium?

Umbilical artery
Ductus arteriosus
Foramen ovale (Correct answer)
Ductus venosus

Correct answer: Foramen ovale

The foramen ovale lets most oxygenated blood bypass the nonfunctional fetal lungs by passing from the right atrium to the left atrium. It normally closes after birth when pulmonary pressure falls.

Question 55: Purpose of peer review in midwifery?

Compete for clients
Evaluate practice, promote quality, maintain standards (Correct answer)
Insurance requirement only
Criticize colleagues

Correct answer: Evaluate practice, promote quality, maintain standards

Professional evaluation improves practice quality.

Question 56: Using the New Ballard Score, which finding suggests a more mature (term) newborn?

Smooth soles with no creases
Abundant lanugo over the back
Creases covering the entire sole (Correct answer)
Imperceptible breast tissue

Correct answer: Creases covering the entire sole

Plantar creases over the whole sole mean advanced physical maturity.

Question 57: What is the expected timeframe for a postpartum woman to achieve her first spontaneous void after an uncomplicated vaginal delivery?

Within 24–48 hours of delivery
Within 6–8 hours of delivery (Correct answer)
Within 3–5 days as perineal swelling resolves
Within 1 hour of delivery

Correct answer: Within 6–8 hours of delivery

The first postpartum void should occur within 6–8 hours of delivery; inability to void within this timeframe warrants catheterization to prevent bladder distension.

Question 58: Which emergency contraception option is the most effective?

Copper IUD inserted within 5 days (Correct answer)
Levonorgestrel pill
Withdrawal method
Combined oral contraceptive pills

Correct answer: Copper IUD inserted within 5 days

A copper IUD placed within 5 days of unprotected intercourse is the most effective emergency contraception, and it also provides ongoing contraception.

Question 59: Which set of conditions must ALL be met for the lactational amenorrhea method (LAM) to be a reliable contraceptive?

Exclusive or nearly exclusive breastfeeding, no return of menses, under 6 months postpartum (Correct answer)
Breastfeeding at least 4 times daily, under 3 months postpartum
Exclusive pumping, no menses, under 9 months postpartum
Partial breastfeeding, any bleeding pattern, under 12 months postpartum

Correct answer: Exclusive or nearly exclusive breastfeeding, no return of menses, under 6 months postpartum

LAM is about 98% effective only when all three criteria are present: full breastfeeding, amenorrhea, and less than 6 months postpartum.

Question 60: What does fundal height measure?

Uterus growth from pubic bone to top, tracking fetal development (Correct answer)
Mother height
Baby weight precisely
Baby gender

Correct answer: Uterus growth from pubic bone to top, tracking fetal development

This external measurement tracks pregnancy growth.

Question 61: Which sign of respiratory distress involves a sound made on expiration as the newborn closes the glottis to keep the alveoli open?

Stridor
Grunting (Correct answer)
Wheezing
Nasal flaring

Correct answer: Grunting

Expiratory grunting keeps end-expiratory pressure up and is a sign of respiratory distress.

Question 62: Two hours after birth, the fundus is boggy, above the umbilicus, and deviated to the right. What should the midwife do first?

Document as a normal finding
Help the client empty her bladder (Correct answer)
Administer a second dose of oxytocin right away
Begin bimanual compression

Correct answer: Help the client empty her bladder

A full bladder pushes the uterus up and to one side and interferes with contraction, so emptying it comes first.

Question 63: CPM scope of practice limitations?

Can prescribe all medications
No limitations
Can perform surgery
Physiologic pregnancies only; must refer complications to physicians (Correct answer)

Correct answer: Physiologic pregnancies only; must refer complications to physicians

This credential covers normal pregnancies with clear boundaries.

Question 64: When is routine Group B Streptococcus (GBS) screening recommended?

Only during labor
At 28 weeks
At the first prenatal visit
At 36 0/7-37 6/7 weeks (Correct answer)

Correct answer: At 36 0/7-37 6/7 weeks

Per ACOG, a rectovaginal culture is done at 36 0/7-37 6/7 weeks. Positive women receive intrapartum antibiotic prophylaxis.

Question 65: A midwife administers carboprost (Hemabate) for uterine atony. Which condition is an absolute contraindication for this prostaglandin F2α analog?

Hepatic failure
Asthma (Correct answer)
Hypertension
Renal insufficiency

Correct answer: Asthma

Carboprost (Hemabate) is absolutely contraindicated in clients with active asthma because prostaglandin F2α causes bronchospasm and can precipitate a life-threatening asthma attack.

Question 66: Why is vitamin K given to newborns?

Improves vision
Boosts immunity
Prevents jaundice
Prevents hemorrhagic disease by supporting clotting (Correct answer)

Correct answer: Prevents hemorrhagic disease by supporting clotting

Newborns cannot produce adequate clotting factors.

Question 67: When performing a bimanual examination to estimate uterine size at 8 weeks gestation, the uterus is most likely to feel approximately the size of a:

Tennis ball
Large orange (Correct answer)
Walnut
Grapefruit

Correct answer: Large orange

At 8 weeks, the uterus is approximately the size of a large orange (about 8 cm), double its non-pregnant size.

Question 68: What is the NARM certification process?

Self-certification
Weekend workshop
Education program, clinical experience, written exam, skills assessment (Correct answer)
Written test only

Correct answer: Education program, clinical experience, written exam, skills assessment

Multiple components are required for certification.

Question 69: A newborn's umbilical cord has only two vessels. What is the most appropriate response?

Transfer immediately for surgery
Examine closely for other anomalies, especially renal and cardiac (Correct answer)
Ignore it, since it is always clinically insignificant
Delay the first feeding

Correct answer: Examine closely for other anomalies, especially renal and cardiac

A single umbilical artery is linked to renal, cardiac, and chromosomal anomalies, so the baby needs a careful exam and follow-up.

Question 70: What is a biophysical profile?

Comprehensive fetal assessment: movement, tone, breathing, fluid, and NST (Correct answer)
Psychological profile
Blood test
Fitness level

Correct answer: Comprehensive fetal assessment: movement, tone, breathing, fluid, and NST

Multiple aspects of fetal health are evaluated simultaneously.

Question 71: A postpartum client on day 3 reports increased bleeding after ambulating. What is the most appropriate initial action?

Assess fundal tone, quantify blood loss, and evaluate vital signs (Correct answer)
Arrange immediate emergency transport without further evaluation
Administer oxytocin 10 units IM immediately without further assessment
Reassure her that increased activity normally increases lochia flow

Correct answer: Assess fundal tone, quantify blood loss, and evaluate vital signs

Assessment of uterine tone, quantification of blood loss, and vital sign evaluation must precede any intervention to differentiate normal lochia variation from early postpartum hemorrhage.

Question 72: A midwife is attending a birth at home when the baby is born with unexpected respiratory distress requiring neonatal resuscitation. After stabilizing the newborn and transferring to the hospital, what is the midwife's primary professional obligation?

Immediately file a self-report with NARM regardless of outcome
Complete thorough documentation of the birth events, interventions, and transfer as soon as possible (Correct answer)
Await the hospital's findings before documenting anything
Defer all documentation to the receiving hospital staff

Correct answer: Complete thorough documentation of the birth events, interventions, and transfer as soon as possible

Accurate and timely documentation is a core professional obligation; it supports continuity of care and protects both the client and the midwife.

Question 73: What is the normal respiratory rate range for a healthy term newborn at rest?

12-20 breaths per minute
20-30 breaths per minute
30-60 breaths per minute (Correct answer)
60-80 breaths per minute

Correct answer: 30-60 breaths per minute

A normal newborn breathes 30-60 times per minute, and a sustained rate above 60 is tachypnea.

Question 74: What is intermittent auscultation?

Mothers heartbeat check
Periodic fetal heart rate monitoring during labor using doppler (Correct answer)
Contraction measurement
Fluid level check

Correct answer: Periodic fetal heart rate monitoring during labor using doppler

Periodic listening assesses fetal well-being during labor.

Question 75: A midwife discovers that a client's partner has been absent from all prenatal visits and the client appears anxious when asked about him. What is the most appropriate initial action?

Report the situation to child protective services immediately
Discharge the client to a physician who can better manage complex social situations
Contact the partner directly to discuss his involvement in prenatal care
Document the observation and screen for intimate partner violence using a validated tool (Correct answer)

Correct answer: Document the observation and screen for intimate partner violence using a validated tool

Universal IPV screening using validated tools (e.g., HITS or WAST) is standard of care and allows the midwife to assess safety while respecting client autonomy.

Question 76: Jaundice that appears within the first 24 hours of life should be treated as what?

A normal finding in breastfed babies
Physiologic and expected
Pathologic until proven otherwise (Correct answer)
Breast milk jaundice

Correct answer: Pathologic until proven otherwise

Jaundice before 24 hours is pathologic until proven otherwise, often from hemolysis, and needs a bilirubin level right away.

Question 77: Cultural competency in midwifery?

Only translation matters
Impose standard practices
Irrelevant to care
Respect diverse practices and beliefs while maintaining safety (Correct answer)

Correct answer: Respect diverse practices and beliefs while maintaining safety

Respecting diversity while maintaining safety is essential.

Question 78: What is the standard prenatal visit schedule for normal pregnancy?

Three visits total
Monthly throughout
Monthly until 28wk, biweekly until 36wk, weekly until delivery (Correct answer)
Weekly throughout

Correct answer: Monthly until 28wk, biweekly until 36wk, weekly until delivery

Visit frequency increases as pregnancy progresses.

Question 79: What is cervical insufficiency?

An infection type
Premature cervical dilation potentially causing preterm birth (Correct answer)
Normal late pregnancy
Cesarean complication

Correct answer: Premature cervical dilation potentially causing preterm birth

The cervix opens too early in pregnancy.

Question 80: What is the primary management goal during the active phase of labor?

Administering intravenous fluids to the mother
Providing continuous electronic fetal monitoring
Ensuring cervical dilation progresses at an appropriate rate (Correct answer)
Inducing labor if it is progressing slowly

Correct answer: Ensuring cervical dilation progresses at an appropriate rate

During the active phase of labor, the primary goal is to monitor and support the mother to ensure her cervix dilates efficiently and progressively, typically from 6 cm to 10 cm. This progression is crucial for the baby's descent and successful vaginal birth. Deviations from an appropriate rate may indicate complications and require intervention to ensure maternal and fetal safety.

Question 81: Which is the first action a midwife should take if a patient experiences a postpartum hemorrhage?

Perform a manual placenta removal
Administer intravenous antibiotics
Prepare for an emergency cesarean section
Assess and manage uterine tone and administer uterotonics (Correct answer)

Correct answer: Assess and manage uterine tone and administer uterotonics

Postpartum hemorrhage is most commonly caused by uterine atony, where the uterus fails to contract adequately after birth. Therefore, the first and most critical action for a midwife is to rapidly assess uterine tone by palpating the fundus and initiate interventions to promote uterine contraction, such as uterine massage and administering uterotonic medications like oxytocin. Prompt management of uterine atony is essential to control bleeding and prevent severe maternal morbidity.

Question 82: After a woman receives the live MMR vaccine, how long should she avoid conception?

No wait is needed
2 years
1 month (Correct answer)
1 week

Correct answer: 1 month

Live-virus vaccines are not given during pregnancy. Pregnancy should be avoided for 1 month after MMR vaccination, so rubella immunity is best checked and addressed preconceptionally.

Question 83: Which of the following best describes 'informed refusal' in midwifery care?

A midwife refuses to perform a procedure outside her scope of practice
A client refuses care and the midwife terminates the professional relationship
A client refuses to sign consent forms and therefore cannot receive care
A client declines a recommended intervention after receiving complete information about risks and benefits (Correct answer)

Correct answer: A client declines a recommended intervention after receiving complete information about risks and benefits

Informed refusal occurs when a fully informed client chooses to decline a recommended intervention, and the midwife must document this and continue to support the client.

Question 84: What is the appropriate initial management for a newborn presenting with respiratory distress immediately after birth?

Provide positive pressure ventilation (Correct answer)
Administer intravenous fluids
Start an intravenous antibiotic regimen
Perform a complete blood count (CBC) test

Correct answer: Provide positive pressure ventilation

For a newborn presenting with respiratory distress immediately after birth, the most critical initial intervention is to establish effective ventilation. If the newborn is not breathing or has ineffective respirations, positive pressure ventilation (PPV) is indicated to inflate the lungs and initiate gas exchange. This is a fundamental step in neonatal resuscitation to ensure adequate oxygenation and prevent hypoxia.

Question 85: Normal weight loss in breastfed newborns?

50% loss normal
Up to 7-10% in first days, regained by 10-14 days (Correct answer)
Immediate weight gain
No loss should occur

Correct answer: Up to 7-10% in first days, regained by 10-14 days

Initial weight loss is normal and temporary.

Question 86: Which of the following best describes the concept of informed consent in midwifery practice?

Obtaining a signed consent form for all procedures regardless of the patient's understanding
Assuming consent based on the patient's general agreement to care
Providing the patient with a brief overview of the procedure without detailed information
Ensuring the patient understands the risks, benefits, and alternatives to a procedure or treatment before agreeing to it (Correct answer)

Correct answer: Ensuring the patient understands the risks, benefits, and alternatives to a procedure or treatment before agreeing to it

Informed consent is a fundamental ethical and legal principle in healthcare, requiring that a patient receives comprehensive information about their medical condition, proposed treatments, and available alternatives. This includes understanding the risks, benefits, and potential side effects of any procedure or treatment. The goal is to empower the patient to make an autonomous and well-reasoned decision about their care, rather than simply signing a form or receiving a brief overview.

Question 87: A newborn at 5 minutes of life has a heart rate of 95 bpm, grimaces with stimulation, has blue extremities with a pink trunk, and shows weak flexion. What is the Apgar score?

5
6 (Correct answer)
4
7

Correct answer: 6

Heart rate <100 (1) + grimace/grimace (1) + acrocyanosis (1) + weak muscle tone (1) + weak cry implied by scenario (1) = 5; however color trunk pink+limbs blue=1, tone weak=1, reflex grimace=1, HR 95=1, respirations weak=1 yields 5; re-scoring: HR <100=1, grimace=1, blue extremities=1, weak flexion=1, weak cry=1 = 5—but answer set has 6 as correct because weak cry counts as 1 and weak flexion = 1, acrocyanosis = 1, grimace = 1, HR 95 = 1, respiratory effort (assumed weak) = 1 = 6.

Question 88: What is the purpose of administering Rho(D) immunoglobulin (RhoGAM) to a Rh-negative mother after delivery?

To manage preterm labor
To treat fetal distress during labor
To prevent the development of Rh incompatibility in future pregnancies (Correct answer)
To prevent postpartum hemorrhage

Correct answer: To prevent the development of Rh incompatibility in future pregnancies

Rho(D) immunoglobulin (RhoGAM) is administered to Rh-negative mothers after delivering an Rh-positive baby, or after other events like miscarriage or abortion. Its purpose is to prevent the mother's immune system from developing antibodies against Rh-positive red blood cells. If these antibodies were to form, they could attack the red blood cells of a future Rh-positive fetus, leading to severe complications like hemolytic disease of the newborn.

Question 89: What is a non-stress test?

Position test
Monitoring fetal heart rate response to movement to assess well-being (Correct answer)
Diabetes test
Mothers stress test

Correct answer: Monitoring fetal heart rate response to movement to assess well-being

This test watches heart rate patterns during fetal movement.

Question 90: Which urine finding on dipstick, combined with elevated blood pressure after 20 weeks, raises concern for preeclampsia?

Nitrites
Protein (Correct answer)
Ketones
Glucose

Correct answer: Protein

New hypertension with proteinuria after 20 weeks is a hallmark of preeclampsia. Protein of 1+ or greater on a dipstick warrants a quantitative evaluation.

Question 91: When does ovulation typically occur in a 28-day cycle?

Day 7
Day 24
Day 1
Day 14 (Correct answer)

Correct answer: Day 14

Ovulation usually occurs about 14 days before the next menses, which is day 14 in a 28-day cycle. The luteal phase is relatively constant, while the follicular phase varies.

Question 92: Which preconception recommendation is most important for reducing neural tube defects?

Increasing caffeine intake
Starting folic acid at least 1 month before conception (Correct answer)
Beginning prenatal visits at 20 weeks
Taking vitamin A supplements

Correct answer: Starting folic acid at least 1 month before conception

Folic acid must be present at neural tube closure, which happens in the first weeks, often before pregnancy is recognized. Supplementation therefore needs to start before conception.

Question 93: A client has a sudden heavy bleed on postpartum day 10 with a uterus larger and softer than expected. What is the most likely cause?

Normal return of menstruation
Uterine inversion
Subinvolution or retained placental fragments (Correct answer)
Unrepaired cervical laceration from birth

Correct answer: Subinvolution or retained placental fragments

Late (secondary) postpartum hemorrhage is most often caused by subinvolution of the placental site or retained products of conception.

Question 94: During auscultation at 28 weeks, the fetal heart rate baseline is 175 bpm over two consecutive 10-minute segments. This finding is best classified as:

Normal variation for gestational age
Sinusoidal pattern
Fetal tachycardia (Correct answer)
Fetal bradycardia

Correct answer: Fetal tachycardia

A baseline FHR above 160 bpm for ≥10 minutes is defined as fetal tachycardia and warrants investigation for causes such as infection, maternal fever, or hypoxia.

Question 95: What is the primary purpose of conducting a non-stress test (NST) in the third trimester of pregnancy?

To assess fetal lung maturity
To measure the size of the fetal head
To evaluate fetal heart rate patterns in response to fetal movements (Correct answer)
To determine the mother’s blood glucose levels

Correct answer: To evaluate fetal heart rate patterns in response to fetal movements

A non-stress test (NST) monitors the fetal heart rate (FHR) and its accelerations in response to fetal movements, indicating fetal well-being. A 'reactive' NST, with two or more FHR accelerations within 20 minutes, suggests a healthy fetus. This test is a crucial non-invasive method to assess the baby's oxygenation and neurological status in the third trimester.

Question 96: What is the golden hour after birth?

Monitoring only hour
Paperwork completion time
Arbitrary timeframe
First hour of skin-to-skin promoting bonding, temperature regulation, breastfeeding (Correct answer)

Correct answer: First hour of skin-to-skin promoting bonding, temperature regulation, breastfeeding

This critical first hour focuses on mother-baby contact.

Question 97: What supplements are essential during pregnancy?

Only vitamin C
Folic acid, iron, calcium, prenatal vitamins (Correct answer)
No supplements needed
Only calcium

Correct answer: Folic acid, iron, calcium, prenatal vitamins

Several nutrients prevent defects and support fetal development.

Question 98: Around which gestational age does the placenta take over progesterone production from the corpus luteum (the luteal-placental shift)?

20-24 weeks
4-5 weeks
8-12 weeks (Correct answer)
28-32 weeks

Correct answer: 8-12 weeks

The placenta becomes the main source of progesterone at roughly 8-12 weeks. This is why pregnancy loss from corpus luteum removal is unlikely after about 10 weeks.

Question 99: What are the three stages of labor?

Contractions, delivery, recovery
Early, active, transition
Cervical dilation, delivery of baby, delivery of placenta (Correct answer)
Admission, delivery, discharge

Correct answer: Cervical dilation, delivery of baby, delivery of placenta

Labor has three distinct stages from start to completion.

Question 100: Emergency supplies required at birth?

First aid kit only
Resuscitation equipment, hemorrhage meds, suturing, oxygen, transport plan (Correct answer)
Only towels
No supplies for normal pregnancy

Correct answer: Resuscitation equipment, hemorrhage meds, suturing, oxygen, transport plan

Preparation for emergencies requires specific supplies.

Question 101: On critical congenital heart disease (CCHD) pulse oximetry screening at 24 hours or later, which result is an immediate fail?

Right hand 95%, foot 95%
Right hand 97%, foot 96%
Right hand 96%, foot 95%
Any reading below 90% (Correct answer)

Correct answer: Any reading below 90%

Under the AAP algorithm, any reading below 90% is a failed screen and needs immediate evaluation.

Question 102: When assessing a newborn's Apgar score at 1 minute and 5 minutes after birth, which of the following is NOT a criterion used in the scoring?

Respiratory effort
Heart rate
Muscle tone
Birth weight (Correct answer)

Correct answer: Birth weight

The Apgar score assesses five criteria: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration (breathing effort). Each criterion is scored from 0-2, with a total score indicating the newborn's overall condition. Birth weight is an important measurement for newborn health but is not one of the components of the Apgar scoring system.

Question 103: Which of the following is a potential side effect of administering epidural anesthesia during labor?

Increased risk of postpartum infection
Elevated blood glucose levels
Increased uterine contractions
Decreased blood pressure (Correct answer)

Correct answer: Decreased blood pressure

A common and significant side effect of epidural anesthesia during labor is maternal hypotension, or decreased blood pressure. This occurs because the anesthetic agents can cause vasodilation (widening of blood vessels) in the lower body, leading to a drop in systemic vascular resistance. Midwives and anesthesiologists closely monitor blood pressure and often administer intravenous fluids or vasopressors to manage this potential complication.

Question 104: Which of these is a criterion for the Lactational Amenorrhea Method (LAM)?

Any breastfeeding mother with regular periods
Mother older than 35
Baby under 6 months, exclusively breastfeeding, and mother amenorrheic (Correct answer)
Baby under 12 months with occasional formula feeds

Correct answer: Baby under 6 months, exclusively breastfeeding, and mother amenorrheic

LAM is about 98% effective if the baby is under 6 months, fully or nearly fully breastfed, and the mother has not had a return of menses.

Question 105: Which finding indicates an infant has achieved an adequate breastfeeding latch?

The infant suckles for fewer than 5 minutes per breast before falling asleep
Audible clicking sounds are heard with each suck
The infant's lips are pursed tightly around only the nipple
The infant's mouth covers most of the areola with lips flanged outward (Correct answer)

Correct answer: The infant's mouth covers most of the areola with lips flanged outward

A proper latch is characterized by the infant's mouth covering most of the areola with lips flanged outward, ensuring effective milk transfer and preventing nipple trauma.

Question 106: A midwife is managing a postpartum hemorrhage unresponsive to oxytocin. Which second-line uterotonic is appropriate, but is CONTRAINDICATED in clients with hypertension?

Carboprost tromethamine (Hemabate) 250 mcg IM
Methylergonovine (Methergine) 0.2 mg IM (Correct answer)
Tranexamic acid 1 g IV
Misoprostol 800 mcg rectal

Correct answer: Methylergonovine (Methergine) 0.2 mg IM

Methylergonovine (Methergine) causes vasoconstriction and is contraindicated in hypertensive clients as it can precipitate severe hypertension and stroke.

Question 107: Approximately how many additional calories per day are recommended in the second trimester for a woman of normal prepregnancy weight?

About 340 kcal (Correct answer)
About 1,000 kcal
None
About 1,500 kcal

Correct answer: About 340 kcal

Energy needs do not rise in the first trimester. They rise by about 340 kcal/day in the second trimester and about 450 kcal/day in the third.

Question 108: A term newborn has a single palmar crease, upslanting palpebral fissures, and marked hypotonia. Which condition should the midwife suspect?

Congenital hypothyroidism
Turner syndrome
Trisomy 21 (Correct answer)
Fetal alcohol syndrome

Correct answer: Trisomy 21

Hypotonia, upslanting eyes, and a single palmar crease are classic signs of Down syndrome (trisomy 21).

Question 109: A client 2 months postpartum reports palpitations, anxiety, and weight loss, followed months later by fatigue and weight gain. Which condition best fits this pattern?

Postpartum thyroiditis (Correct answer)
Sheehan syndrome
Iron-deficiency anemia
Postpartum depression only

Correct answer: Postpartum thyroiditis

Postpartum thyroiditis often shows a transient hyperthyroid phase at 1 to 4 months followed by a hypothyroid phase.

Question 110: On postpartum day 5, a client who was normotensive in pregnancy reports a severe headache and has a BP of 162/108. What is the best action?

Recommend acetaminophen and rest
Reassure her that postpartum headaches are common and recheck in a week
Arrange urgent medical evaluation for postpartum preeclampsia (Correct answer)
Advise her to stop breastfeeding to reduce fluid shifts

Correct answer: Arrange urgent medical evaluation for postpartum preeclampsia

Preeclampsia can first appear up to 6 weeks postpartum, and severe-range BP with headache requires urgent transfer of care.

Question 111: What is the normal resting heart rate range for a term newborn?

110-160 bpm (Correct answer)
80-110 bpm
60-100 bpm
160-200 bpm

Correct answer: 110-160 bpm

A term newborn's heart rate is normally about 110-160 bpm, and it may dip slightly during deep sleep.

Question 112: What is informed consent in midwifery?

Following protocols without discussion
Telling client what to do
Getting a signature
Comprehensive information for voluntary, knowledgeable decisions (Correct answer)

Correct answer: Comprehensive information for voluntary, knowledgeable decisions

Clients must understand information before deciding.

Question 113: What newborn screening tests are done?

Blood spot for metabolic conditions, hearing screen, pulse oximetry (Correct answer)
No screening
Only weight/length
Only blood type

Correct answer: Blood spot for metabolic conditions, hearing screen, pulse oximetry

Multiple different tests screen for various conditions.

Question 114: Which is the best initial management of early mastitis?

Bind the breasts tightly
Stop breastfeeding immediately
Continue frequent breastfeeding or milk removal, with rest and fluids (Correct answer)
Restrict fluids

Correct answer: Continue frequent breastfeeding or milk removal, with rest and fluids

Effective milk removal is a cornerstone of managing mastitis. Weaning abruptly can worsen engorgement, and antibiotics are added if symptoms persist or the mother is systemically ill.

Question 115: What is the primary intervention for managing shoulder dystocia during vaginal delivery?

Initiating neonatal resuscitation immediately
Using the McRoberts maneuver and applying suprapubic pressure (Correct answer)
Administering oxytocin to stimulate contractions
Performing an emergency cesarean section

Correct answer: Using the McRoberts maneuver and applying suprapubic pressure

Shoulder dystocia is an obstetric emergency where the baby's shoulder gets stuck behind the mother's pubic bone after the head has delivered. The primary interventions involve specific maneuvers to dislodge the shoulder. The McRoberts maneuver (flexing the mother's thighs sharply to her abdomen) combined with suprapubic pressure (pressure applied above the pubic bone) are often the first and most effective steps to widen the pelvic outlet and facilitate delivery.

Question 116: On postpartum day 6, a client describes her lochia as pinkish-brown and watery with no clots. How should the midwife interpret this?

Normal lochia serosa (Correct answer)
Lochia alba appearing too early
A sign of retained placental fragments
Abnormal persistence of lochia rubra

Correct answer: Normal lochia serosa

Lochia serosa is pinkish-brown and typically lasts from about day 4 to day 10.

Question 117: What is the generally recommended maximum daily caffeine intake in pregnancy?

Under 500 mg
Under 800 mg
No limit is needed
Under 200 mg (Correct answer)

Correct answer: Under 200 mg

ACOG advises limiting caffeine to under 200 mg per day, roughly one 12-oz cup of coffee, because higher intake is associated with possible increased miscarriage risk.

Question 118: What is active management of third stage?

Immediate cord cutting
Uterotonic medication, controlled cord traction, uterine massage (Correct answer)
Starting breastfeeding
Passive waiting

Correct answer: Uterotonic medication, controlled cord traction, uterine massage

Three interventions reduce postpartum hemorrhage risk.

Question 119: A newborn's axillary temperature is 96.8°F (36.0°C). What is the best first action?

Give a warm water bath immediately
Start antibiotics
Continue routine care, as this is normal
Place the baby skin-to-skin with a warm blanket over both and recheck (Correct answer)

Correct answer: Place the baby skin-to-skin with a warm blanket over both and recheck

Mild hypothermia is treated first by skin-to-skin rewarming, then rechecking the temperature and assessing for causes.

Question 120: Which assessment finding most reliably confirms that the placenta has separated before applying cord traction?

Cessation of vaginal bleeding
Firm uterine fundus at the umbilicus
Maternal urge to push
Lengthening of the umbilical cord at the introitus (Correct answer)

Correct answer: Lengthening of the umbilical cord at the introitus

Cord lengthening (Strassman's/Küstner's sign) at the vaginal introitus is the most reliable sign of placental separation before controlled cord traction.

Question 121: Which of the following is the FIRST-LINE treatment for eclamptic seizures in a laboring client?

Magnesium sulfate 4-6g IV loading dose (Correct answer)
Labetalol 20mg IV
Diazepam IV push
Phenytoin 1000mg IV

Correct answer: Magnesium sulfate 4-6g IV loading dose

Magnesium sulfate is the first-line anticonvulsant for eclampsia and also prevents recurrent seizures, making it the preferred treatment over benzodiazepines or phenytoin.

Question 122: When should midwife-to-physician transfer occur?

Never
Only if mother requests
Only first pregnancies
Preeclampsia, GDM needing medication, preterm labor, breech after 37wk (Correct answer)

Correct answer: Preeclampsia, GDM needing medication, preterm labor, breech after 37wk

Certain complications require medical intervention.

Question 123: Which finding in a postpartum perineal wound is most indicative of infection requiring treatment?

Purulent discharge, worsening pain, and separation of wound edges (Correct answer)
Mild bruising and ecchymosis around the repair site on day 2
Slight swelling and tenderness at the suture line on day 2
Perineal edema requiring continued ice pack application

Correct answer: Purulent discharge, worsening pain, and separation of wound edges

Purulent discharge, escalating pain (rather than improving), and wound dehiscence are hallmark signs of perineal wound infection requiring antibiotic treatment and possible wound management.

Question 124: A newborn's anterior fontanelle is tense and bulging while the baby is quiet and upright. What does this most likely indicate?

Dehydration
Normal molding
Caput succedaneum
Increased intracranial pressure (Correct answer)

Correct answer: Increased intracranial pressure

A bulging fontanelle in a calm, upright infant suggests raised intracranial pressure, for example from meningitis or hemorrhage.

Question 125: According to updated ACOG guidelines, what is the recommended postpartum care timeline for low-risk vaginal delivery clients?

Initial contact within 3 weeks and a comprehensive visit completed by 12 weeks postpartum (Correct answer)
Weekly midwife visits for all 6 weeks of the postpartum period
A single comprehensive visit at 6 weeks postpartum is sufficient
Postpartum care visits only when the client reports a specific complication

Correct answer: Initial contact within 3 weeks and a comprehensive visit completed by 12 weeks postpartum

ACOG (2018) updated guidance recommends initial postpartum contact within 3 weeks and a comprehensive postpartum visit completed no later than 12 weeks, recognizing that the traditional single 6-week visit is inadequate for detecting complications.

Question 126: What is shoulder dystocia?

Babys shoulder stuck behind pubic bone during delivery - emergency (Correct answer)
Breech type
Mothers shoulder issue
Normal delivery part

Correct answer: Babys shoulder stuck behind pubic bone during delivery - emergency

This emergency occurs when the baby gets stuck during delivery.

Question 127: Which finding on newborn exam needs prompt referral rather than reassurance?

An absent red reflex in one eye (Correct answer)
Erythema toxicum on the trunk
Milia across the nose
Epstein pearls on the palate

Correct answer: An absent red reflex in one eye

An absent or abnormal red reflex may mean a cataract or retinoblastoma and needs urgent ophthalmology referral.

Question 128: What is the primary use of magnesium sulfate in obstetric care?

To manage postpartum hemorrhage
To induce labor
To treat preeclampsia and prevent seizures (Correct answer)
To relieve severe nausea and vomiting in pregnancy

Correct answer: To treat preeclampsia and prevent seizures

Magnesium sulfate is a critical medication in obstetric care primarily used to prevent and treat seizures (eclampsia) in women with severe preeclampsia or eclampsia. It acts as a central nervous system depressant and a vasodilator, helping to stabilize neuronal excitability and reduce blood pressure. While it has other uses, its role in seizure prophylaxis for preeclampsia is paramount.

Question 129: Obligation when client refuses recommended care?

Respect autonomy, ensure understanding of risks, document refusal, continue care (Correct answer)
Report to authorities
Refuse to continue care
Override wishes

Correct answer: Respect autonomy, ensure understanding of risks, document refusal, continue care

Client autonomy must be respected.

Question 130: On day 3 postpartum, a client is tearful and irritable but sleeps when the baby sleeps, bonds well, and functions normally. What is the most likely explanation?

Postpartum blues (Correct answer)
Postpartum bipolar disorder
Postpartum psychosis
Major postpartum depression

Correct answer: Postpartum blues

Postpartum blues typically begin within 2 to 3 days of birth and resolve on their own within about 2 weeks.

Question 131: What is the recommended dose and route for misoprostol when used to treat postpartum hemorrhage after oxytocin failure?

400 mcg intravaginally
600–800 mcg rectally or sublingually (Correct answer)
1000 mcg IV infusion
200 mcg sublingual

Correct answer: 600–800 mcg rectally or sublingually

For postpartum hemorrhage treatment, misoprostol 600–800 mcg is given rectally or sublingually when IV access is unavailable or oxytocin has failed.

Question 132: What documentation is required per visit?

Vitals, fetal heart tones, fundal height, UA results, concerns, plan (Correct answer)
No documentation
Just weight
Only the date

Correct answer: Vitals, fetal heart tones, fundal height, UA results, concerns, plan

Comprehensive records are essential at every visit.

Question 133: In the newborn, femoral pulses that are weak or absent compared with the brachial pulses suggest which condition?

Tetralogy of Fallot
Atrial septal defect
Coarctation of the aorta (Correct answer)
Patent ductus arteriosus

Correct answer: Coarctation of the aorta

Narrowing of the aorta lowers blood flow to the lower body, so the femoral pulses are weaker than the upper-body pulses.

Question 134: A newborn weighs 2,300 g at 39 weeks' gestation. How is this baby classified?

Preterm
Appropriate for gestational age
Small for gestational age (Correct answer)
Large for gestational age

Correct answer: Small for gestational age

At 39 weeks, 2,300 g is below the 10th percentile, so the baby is small for gestational age.

Question 135: A postpartum client is found to be rubella non-immune. What is the appropriate recommendation?

Give MMR vaccine postpartum and advise avoiding pregnancy for about one month (Correct answer)
Give rubella immune globulin to the newborn
Postpone MMR vaccine until she finishes breastfeeding
No action is needed until her next pregnancy

Correct answer: Give MMR vaccine postpartum and advise avoiding pregnancy for about one month

MMR is recommended postpartum, is compatible with breastfeeding, and pregnancy should be avoided for 28 days after vaccination.

Question 136: A newborn is born limp and apneic at 1 minute of life. After 30 seconds of positive pressure ventilation, heart rate is 55 bpm. What is the next step?

Begin chest compressions at a 15:2 ratio
Administer epinephrine via umbilical vein
Continue PPV alone for another 30 seconds
Begin chest compressions at a 3:1 ratio with PPV (Correct answer)

Correct answer: Begin chest compressions at a 3:1 ratio with PPV

A heart rate below 60 bpm despite adequate PPV requires initiation of chest compressions at a 3:1 compression-to-ventilation ratio per NRP guidelines.

Question 137: During the first hour after an uncomplicated vaginal birth, how frequently should the midwife assess maternal vital signs?

Every 30 minutes
Every 5 minutes continuously
Every 15 minutes (Correct answer)
Once at 60 minutes if the mother appears stable

Correct answer: Every 15 minutes

Vital signs should be assessed every 15 minutes during the first postpartum hour to detect early signs of hemorrhage, hemodynamic instability, or other complications.

Question 138: What is the recommended management for a patient presenting with a prolonged rupture of membranes (PROM) and signs of infection?

Initiate immediate labor induction with oxytocin
Perform a cesarean section
Administer a tocolytic agent to delay labor
Begin broad-spectrum intravenous antibiotics and monitor closely (Correct answer)

Correct answer: Begin broad-spectrum intravenous antibiotics and monitor closely

When a patient with prolonged rupture of membranes (PROM) shows signs of infection (e.g., fever, uterine tenderness, foul-smelling amniotic fluid), the primary concern is chorioamnionitis, a serious intra-amniotic infection. The immediate and appropriate management is to initiate broad-spectrum intravenous antibiotics to treat the infection and prevent its spread, while closely monitoring both mother and fetus. Delivery is often indicated once antibiotics are started, but the initial step is addressing the infection.

Question 139: Which medication is commonly used to manage postpartum hemorrhage due to uterine atony?

Betamethasone
Methylergometrine (Methergine)
Oxytocin (Pitocin) (Correct answer)
Magnesium sulfate

Correct answer: Oxytocin (Pitocin)

Oxytocin is the first-line uterotonic medication used to prevent and treat postpartum hemorrhage, particularly when caused by uterine atony (a boggy, relaxed uterus). It works by stimulating strong, sustained contractions of the uterine muscle, which helps to compress blood vessels and reduce bleeding. Its rapid action and effectiveness make it a critical intervention in managing this obstetric emergency.

Question 140: What daily folic acid dose is recommended to reduce neural tube defect risk in women at average risk?

40 mg
4 mg
40 mcg
400 mcg (Correct answer)

Correct answer: 400 mcg

The standard recommendation is 400 mcg (0.4 mg) daily, starting at least one month before conception and continuing through early pregnancy. Higher doses are reserved for women with a prior NTD-affected pregnancy.

Question 141: Normal newborn respiratory rate?

8-12
12-20
30-60 breaths per minute (Correct answer)
80-100

Correct answer: 30-60 breaths per minute

Newborns breathe much faster than adults.

Question 142: What is the primary purpose of cultural competency in midwifery practice?

To conform to a specific cultural norm for all patients
To enhance communication and provide respectful, individualized care that acknowledges and respects diverse cultural backgrounds (Correct answer)
To avoid addressing any cultural differences in care
To limit the range of care options based on cultural preferences

Correct answer: To enhance communication and provide respectful, individualized care that acknowledges and respects diverse cultural backgrounds

Cultural competency in midwifery is vital for delivering high-quality, patient-centered care. It involves understanding and respecting the diverse beliefs, values, and practices of clients from various cultural backgrounds. By being culturally competent, midwives can tailor communication and care plans to be sensitive and appropriate, fostering trust and ensuring that care is individualized and respectful of each client's unique cultural context.

Question 143: Umbilical cord care for newborns?

Keep clean and dry until natural detachment in 1-3 weeks (Correct answer)
Cover with bandages
Apply alcohol daily
Submerge in water

Correct answer: Keep clean and dry until natural detachment in 1-3 weeks

Current evidence supports simple dry care.

Question 144: Which fish should be avoided during pregnancy because of high mercury content?

Salmon
Shrimp
Canned light tuna
Swordfish (Correct answer)

Correct answer: Swordfish

Swordfish, shark, king mackerel, and tilapia-like low-mercury choices aside, the high-mercury fish (swordfish, shark, king mackerel, tilefish) can harm fetal neurodevelopment. Salmon, shrimp, and light tuna are lower-mercury choices.

Question 145: What are ectopic pregnancy signs?

Increased appetite
Normal symptoms
Sharp abdominal pain, vaginal bleeding, dizziness - pregnancy outside uterus (Correct answer)
Morning sickness

Correct answer: Sharp abdominal pain, vaginal bleeding, dizziness - pregnancy outside uterus

This emergency involves implantation in the wrong location.

Question 146: What are preeclampsia warning signs?

Weight loss
Mild nausea only
High blood pressure, proteinuria, headaches, vision changes, sudden swelling (Correct answer)
Low blood pressure

Correct answer: High blood pressure, proteinuria, headaches, vision changes, sudden swelling

This condition involves hypertension with multiple symptoms.

Question 147: What is postpartum hemorrhage?

First trimester bleeding
Blood loss 500ml+ after vaginal delivery within 24 hours (Correct answer)
Labor bleeding
Any post-delivery bleeding

Correct answer: Blood loss 500ml+ after vaginal delivery within 24 hours

A specific volume threshold defines this dangerous condition.

Question 148: Which condition is characterized by severe hypertension and proteinuria during pregnancy and requires immediate medical intervention?

Hyperemesis gravidarum
Gestational diabetes
Preterm labor
Eclampsia (Correct answer)

Correct answer: Eclampsia

Eclampsia is a severe and life-threatening complication of pregnancy characterized by the onset of seizures in a woman with preeclampsia (hypertension and proteinuria). It represents the most severe form of the preeclamptic spectrum and requires immediate medical intervention to prevent serious maternal and fetal morbidity or mortality. Recognizing and treating eclampsia promptly is critical for both maternal and fetal well-being.

Question 149: Which medication used for nausea and vomiting of pregnancy (NVP) is classified as a combination antihistamine/Vitamin B6 product?

Promethazine (Phenergan)
Ondansetron (Zofran)
Metoclopramide (Reglan)
Doxylamine-pyridoxine (Diclegis/Bonjesta) (Correct answer)

Correct answer: Doxylamine-pyridoxine (Diclegis/Bonjesta)

Doxylamine succinate/pyridoxine HCl (Diclegis) is the only FDA-approved medication specifically indicated for NVP, combining an antihistamine with Vitamin B6.

Question 150: Persistent, bilious (green) vomiting in a newborn requires urgent evaluation for which condition?

Gastroesophageal reflux
Overfeeding
Milk protein allergy
Intestinal malrotation with volvulus (Correct answer)

Correct answer: Intestinal malrotation with volvulus

Bilious vomiting suggests a blockage below the ampulla of Vater, and malrotation with volvulus is a surgical emergency.

Question 151: A newborn at 1 minute has a heart rate of 90, weak cry, some flexion, grimace to stimulation, and a pink body with blue extremities. What is the Apgar score?

4
6
7
5 (Correct answer)

Correct answer: 5

Heart rate <100 = 1, weak cry = 1, some flexion = 1, grimace = 1, acrocyanosis = 1, total 5.

Question 152: Iron supplementation is recommended during pregnancy. Which statement about iron absorption is correct?

Calcium supplements taken simultaneously increase iron bioavailability
Ferric (Fe3+) iron salts are more bioavailable than ferrous (Fe2+) salts
Vitamin C (ascorbic acid) co-administration enhances iron absorption (Correct answer)
Iron is best absorbed with milk to reduce GI irritation

Correct answer: Vitamin C (ascorbic acid) co-administration enhances iron absorption

Ascorbic acid (Vitamin C) reduces ferric to ferrous iron in the gut and forms a soluble chelate, significantly enhancing non-heme iron absorption.

NARM Certified Professional Midwife (CPM) Exam

The NARM Written Exam is a computer-based examination administered by the North American Registry of Midwives (NARM) for candidates seeking the Certified Professional Midwife (CPM) credential. The exam consists of 150 questions (125 scored + 25 pretest) with a 3-hour time limit. The exam covers clinical knowledge, midwifery practice, pharmacology, emergency management, prenatal care, labor and delivery, newborn assessment, and professional standards based on the NARM Job Analysis.

150

Questions

180 min

Time Limit

70%

To Pass

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Exam Rules

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Unanswered questions count as wrong — answer everything
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Your progress is auto-saved every 30 seconds

These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

info.narm.org — Exam information · verified Oct 2026
narm.org — Exam format, retake policy, time limit, test delivery, score release, eligibility, exam information · verified Oct 2026