NARM Clinical Knowledge and Skills 4

Question 1

When managing a shoulder dystocia, which maneuver is performed first after standard McRoberts positioning and suprapubic pressure fail?

Accepted Answer

Rubin II maneuver (internal rotation of anterior shoulder)

Answer

Delivery of the posterior arm

Answer

Zavanelli maneuver (cephalic replacement)

Answer

Deliberate clavicle fracture

Question 2

A client at 32 weeks gestation is at risk for preterm labor. Which tocolytic agent is contraindicated in clients with cardiac disease?

Accepted Answer

Terbutaline (beta-agonist)

Answer

Indomethacin

Answer

Nifedipine

Answer

Magnesium sulfate

Question 3

Which clinical finding best differentiates true labor from Braxton Hicks contractions?

Accepted Answer

Progressive cervical dilation with contractions that increase in frequency and intensity

Answer

Contraction duration greater than 30 seconds

Answer

Maternal report of lower backache

Answer

Onset of contractions before 37 weeks gestation

Question 4

A newborn's blood glucose at 1 hour of life is 38 mg/dL and the infant is asymptomatic. The best initial management is:

Accepted Answer

Early breastfeeding or formula feeding followed by glucose recheck in 30–60 minutes

Answer

Immediate IV dextrose infusion

Answer

Transfer to NICU for continuous glucose monitoring

Answer

Administer glucagon IM and recheck in 2 hours

Question 5

During a vaginal exam in labor you palpate the posterior fontanelle in the left occiput posterior (LOP) position. Which fetal movement would most likely result in spontaneous rotation to occiput anterior?

Accepted Answer

Long arc rotation of 135 degrees from LOP to OA

Answer

Short arc rotation of 45 degrees to direct occiput posterior

Answer

Extension of the fetal head

Answer

Asynclitism of the parietal bones

Question 6

Which of the following represents the correct order of cardinal movements of labor?

Accepted Answer

Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion

Answer

Engagement, flexion, descent, internal rotation, extension, external rotation, expulsion

Answer

Descent, engagement, flexion, extension, internal rotation, external rotation, expulsion

Answer

Engagement, descent, internal rotation, flexion, extension, external rotation, expulsion

Question 7

A client at 20 weeks is found to have a fundal height of 24 cm and a single fetus on ultrasound. Which condition should be ruled out first?

Accepted Answer

Polyhydramnios

Answer

Placenta previa

Answer

Fetal macrosomia

Answer

Uterine fibroids