NARM Clinical Knowledge and Skills 3 — Questions and Answers
Question 1: A laboring client's membranes rupture spontaneously and you note green-stained fluid with thick particulate matter. Your immediate priority is:
- Assess fetal heart rate and prepare for possible neonatal resuscitation (Correct answer)
- Place client in Trendelenburg position
- Perform an immediate vaginal exam to check for cord prolapse
- Administer oxygen at 10 L/min via non-rebreather mask
Correct answer: Assess fetal heart rate and prepare for possible neonatal resuscitation
Thick meconium-stained amniotic fluid signals fetal stress; the priority is continuous FHR monitoring and alerting the neonatal team for potential airway suctioning and resuscitation.
Question 2: During active labor, late decelerations are observed on the fetal monitor with each contraction. The initial nursing/midwifery intervention is to:
- Reposition client to lateral decubitus and administer IV fluid bolus (Correct answer)
- Prepare for immediate cesarean delivery
- Increase oxytocin infusion rate
- Perform amnioinfusion
Correct answer: Reposition client to lateral decubitus and administer IV fluid bolus
Late decelerations suggest uteroplacental insufficiency; repositioning improves uterine perfusion and IV fluids increase maternal cardiac output as first-line interventions.
Question 3: A postpartum client has a boggy uterus displaced to the right of midline 30 minutes after delivery. The most likely cause is:
- Bladder distension (Correct answer)
- Uterine atony secondary to retained placental fragments
- Normal uterine involution pattern
- Subinvolution
Correct answer: Bladder distension
A full bladder displaces the uterus laterally (most often to the right) and prevents effective uterine contraction, causing apparent uterine atony.
Question 4: Which finding on newborn assessment at one hour of life requires the most urgent follow-up?
- Respiratory rate of 72 breaths per minute with nasal flaring (Correct answer)
- Acrocyanosis of hands and feet
- Vernix caseosa in skin folds
- Molding of the skull with overriding sutures
Correct answer: Respiratory rate of 72 breaths per minute with nasal flaring
A respiratory rate above 60 breaths per minute with nasal flaring indicates respiratory distress and requires urgent evaluation for transient tachypnea, pneumonia, or other pulmonary pathology.
Question 5: During a prenatal visit at 36 weeks, fundal height measures 30 cm. After ruling out inaccurate dating, the next most appropriate step is:
- Order an ultrasound to evaluate for intrauterine growth restriction (Correct answer)
- Increase caloric intake recommendations and recheck in 2 weeks
- Refer for biophysical profile immediately
- Schedule non-stress test weekly until delivery
Correct answer: Order an ultrasound to evaluate for intrauterine growth restriction
A fundal height 3 cm or more below expected for gestational age raises concern for IUGR and warrants ultrasound evaluation of fetal growth and amniotic fluid.
Question 6: Which laboratory value is most consistent with HELLP syndrome in a 38-week client presenting with epigastric pain and malaise?
- Platelet count of 85,000/µL with elevated AST and LDH (Correct answer)
- Hemoglobin of 10.2 g/dL with normal platelets
- Proteinuria 2+ with normal liver enzymes
- Elevated creatinine with normal platelets and liver enzymes
Correct answer: Platelet count of 85,000/µL with elevated AST and LDH
HELLP syndrome is characterized by Hemolytic anemia, Elevated Liver enzymes, and Low Platelets; thrombocytopenia with elevated AST and LDH are hallmark findings.
Question 7: A client at 39 weeks reports decreased fetal movement. Kick count documentation shows 4 movements in 2 hours. The most appropriate response is:
- Perform a non-stress test and consider biophysical profile if non-reactive (Correct answer)
- Reassure the client that 4 movements in 2 hours is within normal limits
- Schedule a routine visit in 3 days
- Advise increased maternal caloric intake and recount tomorrow
Correct answer: Perform a non-stress test and consider biophysical profile if non-reactive
Fewer than 10 movements in 2 hours (or fewer than 6 in some protocols) is a threshold requiring electronic fetal monitoring to evaluate fetal status.
NARM Clinical Knowledge and Skills 3
A laboring client's membranes rupture spontaneously and you note green-stained fluid with thick particulate matter.
Your immediate priority is: