NARM Emergency and Complication Management 3

Question 1

A client has a shoulder dystocia with the anterior shoulder impacted behind the pubic symphysis. After McRoberts maneuver and suprapubic pressure fail, what is the next maneuver?

Accepted Answer

Rubin II or Woods screw maneuver

Answer

Rubin II (internal rotation of the anterior shoulder toward the fetal chest) or the Woods screw maneuver (rotating the posterior shoulder) are the recommended next steps after McRoberts and suprapubic pressure fail.

Question 2

When managing a third-degree perineal laceration, which structure differentiates a third-degree from a second-degree tear?

Accepted Answer

External anal sphincter

Answer

A third-degree laceration involves the external anal sphincter, distinguishing it from a second-degree tear which involves the perineal muscles but not the sphincter.

Question 3

A newborn at 5 minutes of life has a heart rate of 105 bpm, weak cry, some flexion, grimace response to stimulation, and pink body with blue extremities. What is the Apgar score?

Accepted Answer

7

Answer

Scoring: HR >100 (2) + weak cry (1) + some flexion (1) + grimace (1) + pink body/blue extremities (1) = 7.

Question 4

During a water birth, the midwife observes the infant born completely submerged and limp. What is the first action after lifting the infant from the water?

Accepted Answer

Stimulate by rubbing the back and assess breathing

Answer

Initial newborn resuscitation begins with drying, stimulation, and assessment of breathing and heart rate before escalating to more aggressive interventions.

Question 5

A client develops sudden onset shortness of breath, hypotension, and altered mental status immediately following rupture of membranes at 38 weeks. What rare but catastrophic complication should be suspected?

Accepted Answer

Amniotic fluid embolism

Answer

Amniotic fluid embolism (AFE) classically presents with sudden cardiovascular collapse, respiratory distress, and DIC following amniotomy or ROM, and has high maternal mortality.

(NARM) North American Registry of Midwives Practice Test

(NARM) North American Registry of Midwives Practice Test

NARM Emergency and Complication Management 3