NARM Emergency and Complication Management 2 — Questions and Answers
Question 1: A client at 39 weeks gestation presents with sudden onset of severe abdominal pain, rigid abdomen, and fetal heart tones that drop from 140 to 60 bpm. What is the most likely diagnosis?
- Placenta previa
- Uterine rupture (Correct answer)
- Severe preeclampsia
- Cord prolapse
Correct answer: Uterine rupture
Uterine rupture presents with sudden severe abdominal pain, a rigid abdomen, and acute fetal bradycardia due to fetal distress from disrupted placental perfusion.
Question 2: During a home birth, the midwife notes the umbilical cord prolapsing past the presenting part with the cervix fully dilated and vertex at +2 station. What is the priority action?
- Reposition the cord manually back into the uterus
- Apply firm upward pressure on the presenting part while calling 911 (Correct answer)
- Place the client in Trendelenburg and transport immediately
- Administer oxygen and prepare for immediate delivery
Correct answer: Apply firm upward pressure on the presenting part while calling 911
With cord prolapse at +2 station, the most effective immediate action is to manually elevate the presenting part to relieve cord compression while arranging emergency transport.
Question 3: A newborn is born limp and apneic at 1 minute of life. After 30 seconds of positive pressure ventilation, heart rate is 55 bpm. What is the next step?
- Continue PPV alone for another 30 seconds
- Begin chest compressions at a 3:1 ratio with PPV (Correct answer)
- Administer epinephrine via umbilical vein
- Begin chest compressions at a 15:2 ratio
Correct answer: Begin chest compressions at a 3:1 ratio with PPV
A heart rate below 60 bpm despite adequate PPV requires initiation of chest compressions at a 3:1 compression-to-ventilation ratio per NRP guidelines.
Question 4: Which of the following is the FIRST-LINE treatment for eclamptic seizures in a laboring client?
- Diazepam IV push
- Magnesium sulfate 4-6g IV loading dose (Correct answer)
- Phenytoin 1000mg IV
- Labetalol 20mg IV
Correct answer: Magnesium sulfate 4-6g IV loading dose
Magnesium sulfate is the first-line anticonvulsant for eclampsia and also prevents recurrent seizures, making it the preferred treatment over benzodiazepines or phenytoin.
Question 5: A client delivers a 4,200g infant and subsequently develops a postpartum hemorrhage unresponsive to oxytocin and uterine massage. Which uterotonic should be considered next?
- Ergotamine
- Methylergonovine (Methergine)
- Carboprost (Hemabate) (Correct answer)
- Misoprostol 200mcg oral
Correct answer: Carboprost (Hemabate)
Carboprost (Hemabate), a prostaglandin F2-alpha analog, is a second-line uterotonic for atony-related PPH unresponsive to oxytocin; it is contraindicated in asthma.
Question 6: During auscultation of fetal heart tones in active labor, the midwife hears a rate of 180 bpm persisting for 15 minutes. What is the most common cause of fetal tachycardia in labor?
- Fetal anemia
- Maternal fever and chorioamnionitis (Correct answer)
- Fetal cardiac arrhythmia
- Umbilical cord compression
Correct answer: Maternal fever and chorioamnionitis
Maternal fever from chorioamnionitis is the most common cause of fetal tachycardia in labor, as the elevated maternal temperature directly increases fetal heart rate.
Question 7: A client at 36 weeks presents with painless bright red vaginal bleeding without contractions. Fetal heart tones are 145 bpm. What should the midwife do FIRST?
- Perform a sterile vaginal exam to assess cervical dilation
- Assess vital signs and call for emergency transport (Correct answer)
- Apply fundal pressure to determine placental location
- Administer 500mL IV fluid bolus
Correct answer: Assess vital signs and call for emergency transport
Painless bright red bleeding at 36 weeks is a classic presentation of placenta previa; digital vaginal examination must be avoided and emergency transport is the priority action.
NARM Emergency and Complication Management 2
A client at 39 weeks gestation presents with sudden onset of severe abdominal pain, rigid abdomen, and fetal heart tones that drop from 140 to 60 bpm.
What is the most likely diagnosis?