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

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:

Accepted Answer

Reposition client to lateral decubitus and administer IV fluid bolus

Answer

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:

Accepted Answer

Bladder distension

Answer

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?

Accepted Answer

Respiratory rate of 72 breaths per minute with nasal flaring

Answer

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:

Accepted Answer

Order an ultrasound to evaluate for intrauterine growth restriction

Answer

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.

(NARM) North American Registry of Midwives Practice Test

(NARM) North American Registry of Midwives Practice Test

NARM Clinical Knowledge and Skills 3