NARM Clinical Knowledge and Skills 1 — Questions and Answers
Question 1: What is the primary purpose of conducting a non-stress test (NST) in the third trimester of pregnancy?
- To assess fetal lung maturity
- To evaluate fetal heart rate patterns in response to fetal movements (Correct answer)
- To determine the mother’s blood glucose levels
- To measure the size of the fetal head
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 2: What is the primary management goal during the active phase of labor?
- Inducing labor if it is progressing slowly
- Providing continuous electronic fetal monitoring
- Ensuring cervical dilation progresses at an appropriate rate (Correct answer)
- Administering intravenous fluids to the mother
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 3: Which of the following is a common sign of postpartum hemorrhage?
- Temperature of 101°F (38.3°C)
- Persistent, severe headache
- A decrease in hematocrit levels (Correct answer)
- Elevated blood pressure
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 4: 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?
- Heart rate
- Respiratory effort
- 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 5: What is the most appropriate initial intervention for a newborn who has not started breathing immediately after birth?
- Administering intravenous fluids
- Providing supplemental oxygen
- 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.
NARM Clinical Knowledge and Skills 1
What is the primary purpose of conducting a non-stress test (NST) in the third trimester of pregnancy?