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

After McRoberts and suprapubic pressure, internal rotational maneuvers such as Rubin II or Woods screw are the recommended next step before attempting posterior arm delivery.

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

Beta-agonists like terbutaline cause maternal tachycardia and cardiovascular stimulation, making them contraindicated in clients with significant cardiac disease.

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

True labor produces progressive cervical change (effacement and dilation) alongside regular, increasingly intense contractions, whereas Braxton Hicks contractions are irregular and non-progressive.

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

Asymptomatic neonatal hypoglycemia (glucose 36–45 mg/dL) in a term newborn is first managed with early feeding and recheck; IV glucose is reserved for symptomatic or severely hypoglycemic neonates.

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

LOP typically rotates via long arc (135°) to OA, which is the most favorable position for descent and delivery through the pelvic outlet.

(NARM) North American Registry of Midwives Practice Test

(NARM) North American Registry of Midwives Practice Test

NARM Clinical Knowledge and Skills 4