CMRE Sample Questions

1.

Sample Scenario #1 (Questions 1 to 5)

A 32-year-old G3P2 client at 40+5 weeks gestation presents to the birthing unit in active labour. She reports strong contractions every 3 minutes, lasting 60 seconds. She denies vaginal bleeding or rupture of membranes. On admission, her vital signs are stable (BP 122/78 mmHg, HR 88 bpm), and fetal heart rate (FHR) is 145 bpm with moderate variability and no decelerations. A cervical exam reveals 7 cm dilation, 100% effacement, and a fetal station of 0. However, during the next contraction, the midwife observes prolonged fetal heart rate deceleration (85 bpm lasting 2 minutes) before returning to baseline.

What is the most critical next step for the midwife after observing a prolonged fetal heart rate deceleration?

2.

Sample Scenario #1 (Questions 1 to 5)

A 32-year-old G3P2 client at 40+5 weeks gestation presents to the birthing unit in active labour. She reports strong contractions every 3 minutes, lasting 60 seconds. She denies vaginal bleeding or rupture of membranes. On admission, her vital signs are stable (BP 122/78 mmHg, HR 88 bpm), and fetal heart rate (FHR) is 145 bpm with moderate variability and no decelerations. A cervical exam reveals 7 cm dilation, 100% effacement, and a fetal station of 0. However, during the next contraction, the midwife observes prolonged fetal heart rate deceleration (85 bpm lasting 2 minutes) before returning to baseline.

What would be the next critical step the midwife would need to perform?

3.

Sample Scenario #1 (Questions 1 to 5)

A 32-year-old G3P2 client at 40+5 weeks gestation presents to the birthing unit in active labour. She reports strong contractions every 3 minutes, lasting 60 seconds. She denies vaginal bleeding or rupture of membranes. On admission, her vital signs are stable (BP 122/78 mmHg, HR 88 bpm), and fetal heart rate (FHR) is 145 bpm with moderate variability and no decelerations. A cervical exam reveals 7 cm dilation, 100% effacement, and a fetal station of 0. However, during the next contraction, the midwife observes prolonged fetal heart rate deceleration (85 bpm lasting 2 minutes) before returning to baseline.

During the sterile vaginal exam, the midwife detects a prolapsed umbilical cord. What is the most critical immediate action?

4.

Sample Scenario #1 (Questions 1 to 5)

A 32-year-old G3P2 client at 40+5 weeks gestation presents to the birthing unit in active labour. She reports strong contractions every 3 minutes, lasting 60 seconds. She denies vaginal bleeding or rupture of membranes. On admission, her vital signs are stable (BP 122/78 mmHg, HR 88 bpm), and fetal heart rate (FHR) is 145 bpm with moderate variability and no decelerations. A cervical exam reveals 7 cm dilation, 100% effacement, and a fetal station of 0. However, during the next contraction, the midwife observes prolonged fetal heart rate deceleration (85 bpm lasting 2 minutes) before returning to baseline.

What is the most critical intervention the midwife should implement while awaiting an emergency cesarean section?

5.

Sample Scenario #1 (Questions 1 to 5)

A 32-year-old G3P2 client at 40+5 weeks gestation presents to the birthing unit in active labour. She reports strong contractions every 3 minutes, lasting 60 seconds. She denies vaginal bleeding or rupture of membranes. On admission, her vital signs are stable (BP 122/78 mmHg, HR 88 bpm), and fetal heart rate (FHR) is 145 bpm with moderate variability and no decelerations. A cervical exam reveals 7 cm dilation, 100% effacement, and a fetal station of 0. However, during the next contraction, the midwife observes prolonged fetal heart rate deceleration (85 bpm lasting 2 minutes) before returning to baseline.

The client is visibly distressed and expressing fear about the emergency cesarean section. As an advocate, what is the most appropriate action for the midwife?

6. A midwife attends a hospital birth complicated by postpartum hemorrhage, requiring urgent obstetric and nursing intervention. After the client is stabilized, the hospital team begins planning discharge without consulting the midwifery team. The midwife remains the primary care provider and is responsible for postpartum follow-up. What is the most appropriate leadership action to ensure continuity of care across disciplines?

7. A midwife with five years of experience in full-scope practice is reflecting on how to enhance her professional role and meet community needs. According to CMRC competencies, which additional skillset would best align with the midwife’s responsibility as a lifelong learner to promote client-centred, evolving care?

8.

Sample Scenario #2 (Questions 8 to 12)

At 5 days postpartum, the midwife visits her client, Amina, at home for a scheduled postnatal check. Amina is a first-time parent and has been exclusively breastfeeding, but she expresses that it has been “harder than expected.” She describes difficulty getting the baby to latch properly and reports that feedings often end in frustration and tears. Amina also shares that she has been crying frequently, feels overwhelmed, and sometimes questions her ability to care for her baby. She has been sleeping poorly, even when the baby sleeps, and reports feeling emotionally “up and down.” The baby has regained some birth weight and is producing an appropriate number of wet and dirty diapers. The midwife begins to assess whether Amina's experience is consistent with postpartum blues or if further mental health assessment is needed.

Which of the following assessment findings most strongly supports the midwife’s working diagnosis of postpartum blues rather than postpartum depression?

9.

Sample Scenario #2 (Questions 8 to 12)

At 5 days postpartum, the midwife visits her client, Amina, at home for a scheduled postnatal check. Amina is a first-time parent and has been exclusively breastfeeding, but she expresses that it has been “harder than expected.” She describes difficulty getting the baby to latch properly and reports that feedings often end in frustration and tears. Amina also shares that she has been crying frequently, feels overwhelmed, and sometimes questions her ability to care for her baby. She has been sleeping poorly, even when the baby sleeps, and reports feeling emotionally “up and down.” The baby has regained some birth weight and is producing an appropriate number of wet and dirty diapers. The midwife begins to assess whether Amina's experience is consistent with postpartum blues or if further mental health assessment is needed.

What is the most appropriate initial action the midwife should take in supporting Amina with postpartum blues and latching difficulties?

10.

Sample Scenario #2 (Questions 8 to 12)

At 5 days postpartum, the midwife visits her client, Amina, at home for a scheduled postnatal check. Amina is a first-time parent and has been exclusively breastfeeding, but she expresses that it has been “harder than expected.” She describes difficulty getting the baby to latch properly and reports that feedings often end in frustration and tears. Amina also shares that she has been crying frequently, feels overwhelmed, and sometimes questions her ability to care for her baby. She has been sleeping poorly, even when the baby sleeps, and reports feeling emotionally “up and down.” The baby has regained some birth weight and is producing an appropriate number of wet and dirty diapers. The midwife begins to assess whether Amina's experience is consistent with postpartum blues or if further mental health assessment is needed.

If Amina’s emotional symptoms persist beyond two weeks postpartum and begin to interfere with bonding and daily functioning, when should the midwife initiate a referral for further mental health assessment?

11.

Sample Scenario #2 (Questions 8 to 12)

At 5 days postpartum, the midwife visits her client, Amina, at home for a scheduled postnatal check. Amina is a first-time parent and has been exclusively breastfeeding, but she expresses that it has been “harder than expected.” She describes difficulty getting the baby to latch properly and reports that feedings often end in frustration and tears. Amina also shares that she has been crying frequently, feels overwhelmed, and sometimes questions her ability to care for her baby. She has been sleeping poorly, even when the baby sleeps, and reports feeling emotionally “up and down.” The baby has regained some birth weight and is producing an appropriate number of wet and dirty diapers. The midwife begins to assess whether Amina's experience is consistent with postpartum blues or if further mental health assessment is needed.

Following a discussion with Amina about her persistent low mood and the decision to refer her for mental health support, what is the most appropriate documentation the midwife should include in the clinical record?

12.

Sample Scenario #2 (Questions 8 to 12)

At 5 days postpartum, the midwife visits her client, Amina, at home for a scheduled postnatal check. Amina is a first-time parent and has been exclusively breastfeeding, but she expresses that it has been “harder than expected.” She describes difficulty getting the baby to latch properly and reports that feedings often end in frustration and tears. Amina also shares that she has been crying frequently, feels overwhelmed, and sometimes questions her ability to care for her baby. She has been sleeping poorly, even when the baby sleeps, and reports feeling emotionally “up and down.” The baby has regained some birth weight and is producing an appropriate number of wet and dirty diapers. The midwife begins to assess whether Amina's experience is consistent with postpartum blues or if further mental health assessment is needed.

Which of the following population health factors most significantly increases the risk of prolonged postpartum blues or progression to postpartum depression?

13.

Sample Scenario #3 (Questions 13 to 16)

A 35-year-old G3P2 client at 28 weeks gestation presents for a routine prenatal visit. She reports occasional dizziness and fatigue, particularly in the mornings. She denies chest pain, shortness of breath, or syncope. On examination, her blood pressure is 110/70 mmHg, and her heart rate is 88 bpm. The midwife notes pale conjunctivae and mild pallor of the skin. The client’s fundal height is appropriate for gestational age, and the fetal heart rate is 140 bpm. The midwife performs an assessment to investigate the cause of the client’s symptoms.

What is the most critical diagnostic test the midwife should order to assess the cause of the client’s dizziness and fatigue?

14.

Sample Scenario #3 (Questions 13 to 16)

A 35-year-old G3P2 client at 28 weeks gestation presents for a routine prenatal visit. She reports occasional dizziness and fatigue, particularly in the mornings. She denies chest pain, shortness of breath, or syncope. On examination, her blood pressure is 110/70 mmHg, and her heart rate is 88 bpm. The midwife notes pale conjunctivae and mild pallor of the skin. The client’s fundal height is appropriate for gestational age, and the fetal heart rate is 140 bpm. The midwife performs an assessment to investigate the cause of the client’s symptoms.

If the CBC results reveal hemoglobin of 9.8 g/dL and hematocrit of 30%, what is the most appropriate next step in managing this client’s anemia?

15.

Sample Scenario #3 (Questions 13 to 16)

A 35-year-old G3P2 client at 28 weeks gestation presents for a routine prenatal visit. She reports occasional dizziness and fatigue, particularly in the mornings. She denies chest pain, shortness of breath, or syncope. On examination, her blood pressure is 110/70 mmHg, and her heart rate is 88 bpm. The midwife notes pale conjunctivae and mild pallor of the skin. The client’s fundal height is appropriate for gestational age, and the fetal heart rate is 140 bpm. The midwife performs an assessment to investigate the cause of the client’s symptoms.

What should the midwife include in the client’s care plan to address anemia and support maternal and fetal health?

16.

Sample Scenario #3 (Questions 13 to 16)

A 35-year-old G3P2 client at 28 weeks gestation presents for a routine prenatal visit. She reports occasional dizziness and fatigue, particularly in the mornings. She denies chest pain, shortness of breath, or syncope. On examination, her blood pressure is 110/70 mmHg, and her heart rate is 88 bpm. The midwife notes pale conjunctivae and mild pallor of the skin. The client’s fundal height is appropriate for gestational age, and the fetal heart rate is 140 bpm. The midwife performs an assessment to investigate the cause of the client’s symptoms.

How can the midwife best advocate for the client to address her anemia and promote health equity?

17. A midwife receives a last-minute call from a colleague asking to switch on-call coverage due to a personal emergency. Although the midwife had made non-urgent personal plans, no other coverage is available. What response best demonstrates professionalism?

18.

Scenario #4 (Questions 18 to 22)

A 32-year-old G2P2 client is 24 hours postpartum following a spontaneous vaginal delivery of a 3.4 kg infant at 39 weeks gestation. The client reports successful breastfeeding with feeds every 2-3 hours but mentions that the baby seems sleepier than expected during feeds. The infant has passed two wet diapers and one dark meconium stool. On examination, the newborn appears slightly jaundiced on the face, and capillary refill time is less than 3 seconds. The midwife performs an assessment to evaluate the baby’s condition and ensure appropriate management.

What is the most critical assessment the midwife should perform to evaluate the newborn’s slight jaundice and sleepiness?

19.

Scenario #4 (Questions 18 to 22)

A 32-year-old G2P2 client is 24 hours postpartum following a spontaneous vaginal delivery of a 3.4 kg infant at 39 weeks gestation. The client reports successful breastfeeding with feeds every 2-3 hours but mentions that the baby seems sleepier than expected during feeds. The infant has passed two wet diapers and one dark meconium stool. On examination, the newborn appears slightly jaundiced on the face, and capillary refill time is less than 3 seconds. The midwife performs an assessment to evaluate the baby’s condition and ensure appropriate management.

If the transcutaneous bilirubin (TcB) level is found to be approaching but not exceeding the phototherapy threshold for the newborn’s age in hours, what is the most appropriate next step in managing this infant?

20.

Scenario #4 (Questions 18 to 22)

A 32-year-old G2P2 client is 24 hours postpartum following a spontaneous vaginal delivery of a 3.4 kg infant at 39 weeks gestation. The client reports successful breastfeeding with feeds every 2-3 hours but mentions that the baby seems sleepier than expected during feeds. The infant has passed two wet diapers and one dark meconium stool. On examination, the newborn appears slightly jaundiced on the face, and capillary refill time is less than 3 seconds. The midwife performs an assessment to evaluate the baby’s condition and ensure appropriate management.

What should the midwife include in the care plan to support the newborn’s management of borderline bilirubin levels and prevent complications?

21.

Scenario #4 (Questions 18 to 22)

A 32-year-old G2P2 client is 24 hours postpartum following a spontaneous vaginal delivery of a 3.4 kg infant at 39 weeks gestation. The client reports successful breastfeeding with feeds every 2-3 hours but mentions that the baby seems sleepier than expected during feeds. The infant has passed two wet diapers and one dark meconium stool. On examination, the newborn appears slightly jaundiced on the face, and capillary refill time is less than 3 seconds. The midwife performs an assessment to evaluate the baby’s condition and ensure appropriate management.

What immediate intervention should the midwife implement to support the newborn’s bilirubin clearance and feeding efficiency?

22.

Scenario #4 (Questions 18 to 22)

A 32-year-old G2P2 client is 24 hours postpartum following a spontaneous vaginal delivery of a 3.4 kg infant at 39 weeks gestation. The client reports successful breastfeeding with feeds every 2-3 hours but mentions that the baby seems sleepier than expected during feeds. The infant has passed two wet diapers and one dark meconium stool. On examination, the newborn appears slightly jaundiced on the face, and capillary refill time is less than 3 seconds. The midwife performs an assessment to evaluate the baby’s condition and ensure appropriate management.

When the newborn’s TcB levels are approaching the phototherapy threshold and feeding challenges persist despite lactation support, what is the most appropriate collaborative action the midwife should take?

23. A 19-year-old client presents requesting birth control. She recently became sexually active and expresses concern about confidentiality, stating, “I don’t want my parents to find out.” She has no chronic health conditions, is not currently pregnant, and has irregular cycles. Which is the most appropriate next step in providing reproductive health care?

24.

A client at 28 weeks’ gestation with a history of a prior cesarean birth expresses strong interest in attempting a vaginal birth after cesarean (VBAC). There are no current obstetric complications, and the prior cesarean was for non-reassuring fetal heart rate in a term pregnancy. According to SOGC Guideline No. 155: Guidelines for Vaginal Birth After Previous Cesarean Birth, what is the most appropriate care planning approach?

25. During a collaborative birth, the attending physician suggests an episiotomy without discussing it with the client. The client has previously stated they prefer to avoid it unless medically necessary. What is the midwife’s best communication response?