NARM Emergency and Complication Management 2

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?

Accepted Answer

Uterine rupture

Answer

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?

Accepted Answer

Apply firm upward pressure on the presenting part while calling 911

Answer

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?

Accepted Answer

Begin chest compressions at a 3:1 ratio with PPV

Answer

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?

Accepted Answer

Magnesium sulfate 4-6g IV loading dose

Answer

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?

Accepted Answer

Carboprost (Hemabate)

Answer

Carboprost (Hemabate), a prostaglandin F2-alpha analog, is a second-line uterotonic for atony-related PPH unresponsive to oxytocin; it is contraindicated in asthma.

(NARM) North American Registry of Midwives Practice Test

(NARM) North American Registry of Midwives Practice Test

NARM Emergency and Complication Management 2