NARM Clinical Knowledge and Skills 3

Question 1

A laboring client's membranes rupture spontaneously and you note green-stained fluid with thick particulate matter. Your immediate priority is:

Accepted Answer

Assess fetal heart rate and prepare for possible neonatal resuscitation

Answer

Place client in Trendelenburg position

Answer

Perform an immediate vaginal exam to check for cord prolapse

Answer

Administer oxygen at 10 L/min via non-rebreather mask

Question 2

During active labor, late decelerations are observed on the fetal monitor with each contraction. The initial nursing/midwifery intervention is to:

Accepted Answer

Reposition client to lateral decubitus and administer IV fluid bolus

Answer

Prepare for immediate cesarean delivery

Answer

Increase oxytocin infusion rate

Answer

Perform amnioinfusion

Question 3

A postpartum client has a boggy uterus displaced to the right of midline 30 minutes after delivery. The most likely cause is:

Accepted Answer

Bladder distension

Answer

Uterine atony secondary to retained placental fragments

Answer

Normal uterine involution pattern

Answer

Subinvolution

Question 4

Which finding on newborn assessment at one hour of life requires the most urgent follow-up?

Accepted Answer

Respiratory rate of 72 breaths per minute with nasal flaring

Answer

Acrocyanosis of hands and feet

Answer

Vernix caseosa in skin folds

Answer

Molding of the skull with overriding sutures

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:

Accepted Answer

Order an ultrasound to evaluate for intrauterine growth restriction

Answer

Increase caloric intake recommendations and recheck in 2 weeks

Answer

Refer for biophysical profile immediately

Answer

Schedule non-stress test weekly until delivery

Question 6

Which laboratory value is most consistent with HELLP syndrome in a 38-week client presenting with epigastric pain and malaise?

Accepted Answer

Platelet count of 85,000/µL with elevated AST and LDH

Answer

Hemoglobin of 10.2 g/dL with normal platelets

Answer

Proteinuria 2+ with normal liver enzymes

Answer

Elevated creatinine with normal platelets and liver enzymes

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:

Accepted Answer

Perform a non-stress test and consider biophysical profile if non-reactive

Answer

Reassure the client that 4 movements in 2 hours is within normal limits

Answer

Schedule a routine visit in 3 days

Answer

Advise increased maternal caloric intake and recount tomorrow