NARM Practice Exam 600 Questions - (1-30) Professional issues, knowledge and skills Flashcards
1 . At Abril’s 36-week appointment, you meet her husband for the first time and discover that he only speaks Spanish. Abril acts as translator throughout the appointment, which works well and you feel he’ll be a supportive birth partner. What do you need to do for him?
a) Arrange to have a bilingual assistant at the birth who can communicate with him directly so that conversations do not need to go through Abril when she’s in labor.
b) Encourage him to attend a birth class, as he’s not been attending prenatal appointments and so probably needs some childbirth education.
c) Encourage him by telling him you believe he’ll be a great help to Abril during labor and birth and you think he’ll make a great Dad.
d) Give him paperwork about labor, birth and the postpartum period in Spanish.
A
2 . In your practice, you’ve seen several clients who tested positive to COVID-19 during their pregnancy, and a high percentage of them had abnormal-looking placentas. What can you conclude from this?
a) This is anecdotal evidence. It is an interesting observation, worthy of further study, but it is not conclusive.
b) If you observed abnormalities in at least 50% more placentas in this group than in those not diagnosed with COVID-19, this would be considered definitive proof that COVID-19 increases the rate of placental abnormalities.
c) The research was not conducted by a scientist, and so the data cannot be used in a scientific study.
d) Since the placentas by nature were not aware of the diagnosis of COVID-19, it was a double-blind trial, and hence the data is of high quality.
A
3 . You move to a state that regulates midwifery. One law there states that you must transfer care to an obstetrician at 42.0 weeks. However, your Practice Guidelines state that you will provide care up to 42.6 weeks. What does this imply?
a) If a client goes beyond 42 weeks, they should go to a hotel across the state line once labor is active so that you can legally care for them during the birth.
b) You should lobby to change the state law to allow care through to 42.6 weeks, and should continue this practice in the interim to show that it is safe to do so.
c) The state laws supersede your Practice Guidelines and must be followed. You should update your guidelines to reflect the laws in this state.
d) Since you would be following your Practice Guidelines if you continued care through to 42.6 weeks, you are legally entitled to do so.
C
4 . At her very first appointment, Deborah tells you that she doesn’t want a vaginal exam under any circumstances during labor. What do you do?
a) Describe situations where a vaginal exam would be essential, and where you’d do one even without her consent.
b) State that this automatically risks her out of your care because she’s risking the life of her baby over her desire to avoid a simple exam.
c) Verbally agree to this, knowing that you’ll be able to convince her to change her mind during labor if you tell her that her baby’s wellbeing is at stake.
d) Explain the situations when you might feel the need to perform a vaginal exam during labor, and that there is the possibility that not being able to do a vaginal exam might require you to transfer care in a situation where this could have been avoided if you’d done one.
D
5 . Your client has told you she’s made a decision about her treatment for a specific part of her care, and you believe she’s made the wrong decision. What do you do?
a) Ensure she’s fully understood the risks of the treatment she’s chosen and the benefits of the one you recommend.
b) Discuss risks and benefits of the treatment she’s chosen, of alternative treatments and of doing nothing. Regardless of her decision, follow the treatment she has chosen.
c) Ensure you’ve discussed the risks and benefits of the plan she’s chosen and of all reasonable alternative plans, and that she’s understood what you’ve told her. Then follow her decision, unless you feel this risks her out of your care, in which case begin the process of transferring care, explaining why you feel this is appropriate.
d) Tell your client of the risks and benefits of all of the different alternatives and ensure she’s understood. Regardless of her decision, you’re the midwife with the training to make the best decisions in these situations, so follow the treatment that you prefer.
C
6 . You have a student beginning phase 3/primary midwife under supervision who needs a continuity of care client. You tell him about a repeat client who you just heard is pregnant again, giving details of her previous pregnancy and birth. Your student is excited to meet her when she makes an appointment for the following week. What did you do wrong?
a) You should have waited to discuss the previous pregnancy until after your student had collected the initial history.
b) You should have obtained your client’s permission before disclosing details of her previous care with your student.
c) You should have waited until after the client had booked the appointment with you to discuss her with your student, as the records should have remained confidential until she was once again a client.
d) You should have had your student read through the records himself so that he could form an unbiased opinion of her.
B
7 . A local OB approaches you about a patient and her husband, who have requested that he perform a female circumcision on their neonate. The OB asks you whether he should agree to the procedure since it is in keeping with their cultural heritage. Which is the best response?
a) Whilst it is important to respect the culture of clients, Female Genital Mutilation can cause severe complications, including death. You recommend that the OB explain that he is unwilling to perform the surgery because of these risks, but without shaming the parents.
b) Explain that there are religious reasons for performing male circumcisions, but not for performing female circumcision, and so he is not obliged to perform the surgery.
c) State that parents have the right to choose whether their children are circumcised, regardless of the sex of the child, and that he should perform the surgery, even if he has concerns about the safety.
d) State that neonates are people in their own right, and the parents should not be allowed to make medical decisions on their behalf. It should be up to the doctor to make the decisions, and if he does not feel the surgery is safe, he should not perform it.
A
8 . You’re at a homebirth, covering for a midwife who lives in a town an hour from you when a complication arises. You call 911 and request an ambulance, and then ask the client’s partner for the phone number for the nearest hospital so you can call to make report. What have you done wrong?
a) After calling the ambulance, you should have called the midwife you’re covering for to ask for the contact details for the hospital, as it is not professional to ask the client this information.
b) You should not have agreed to cover for a homebirth with a client who lives so far away from you that you don’t know the contact details for the nearest hospital.
c) A midwife must be prepared for emergencies, including for transport, and even when covering for another midwife. You should have already had the contact details for the nearest hospital.
d) You should have called the hospital to make report before you called for the ambulance.
C
9 . You’re delighted to be invited to a Christmas party with labor and Delivery staff from the local hospital. At the party, one of the nurses starts loudly discussing a client you transferred to them in derogatory terms. Do you…?
a) Laugh along with the nurse to show you’re part of the team, but talk to her the next day to explain that you felt it was inappropriate.
b) Quietly but forcefully request that the nurse stop talking about this. Not only is it inappropriate and unprofessional to discuss patients in this way, but it’s also a breach of patient confidentiality.
c) Ask the nurse to please stop discussing this. It paints your client in a very unfavorable light, which isn’t kind.
d) Tell the nurse to stop talking about your client in such a way: it’s unprofessional and unkind. If she wants to continue telling others about the patient, she should say only positive things about her.
B
10 . You’re caring for Caroline, a client from a religious group that you’ve never heard of. Caroline explains to you that women are considered ‘unclean’ for 30 days after birth and are not allowed in the presence of men during this time. Which of these is the best response you could give her?
a) You understand what she’s saying to you, and will look more into the religious beliefs and practices so that you can do your best to follow them when caring for her. If you do misstep, apologize and learn from the mistake.
b) You should invite her to attend your church on Sunday so that you can introduce her to a more loving religion.
c) You understand what she’s saying to you, but she’s wrong. Women are blessed and beautiful after birth, and she should not be following such outdated religious regulations.
d) You understand what she’s saying to you, and respect her beliefs. You will arrange to meet her husband in another room postpartum to discuss any concerns he may have.
A
11 . An article has just been published in a peer-reviewed journal, proposing a ‘novel’ approach to something, but you’ve actually been doing this for many years and had been keeping track of the results with the thought of possibly publishing a paper on it yourself one day. You have a similar number of data points to the published study, but your results are very different to those reported, and you suspect a flaw in their work. What should you do?
a) Write your own paper on the subject and submit it to the main rival of the first journal, hoping you might manage to write it and have it published within 18 months.
b) Pay to have your research printed in a non-peer-reviewed journal so that you can get your data out as quickly as possible.
c) Contact the editor of the journal and tell them of your own data and your suspicions that there may be an error in the published work.
d) Change your data to match the research, as it was printed in a peer-reviewed journal, and so it must be correct.
C
12 . At your 36-week home visit with Christa, you notice that the house is perfectly clean and the fridge is well-stocked. You help make up the spare bed for the birth, inflate her pool to check it, and connect the hot water tap to the hose. You’re happy for the physical work as it’s chilly in the house and there’s no heating. What do you still need to discuss?
a) Tell Christa that it’s nice to see a clean house because most of your recent appointments have been postpartum, and those clients had ‘let things slip’ a little!
b) Ensure that Christa has music planned for listening to during labor. A selection of calm and powerful songs would be ideal.
c) Explain to Christa that it’s very important that the birth room be warm when the baby arrives, and ensure she has a heater there by 37 weeks.
d) Explain that Christa’s partner will need to set up the birth pool and fill it on the day of the birth, because you’ll need to conserve your energy.
C
13 . At your 36-week appointment with Cho, you notice that her husband has several bruises, avoids eye contact with you, and agrees with everything Cho says. You think of domestic partner violence.
a) Domestic partner violence by women is rarely of concern, and so you don’t need to act on this.
b) Domestic partner violence is perpetuated against all genders by all genders. You need to think carefully about how to approach this issue to ensure the safety of all.
c) Domestic partner violence is only perpetuated by men, and so this is not occurring here.
d) Domestic partner violence is perpetuated against all genders by all genders. However, Cho’s husband is not your client, and so this is none of your business.
B
14 . A local midwife posts in a closed group to “warn everyone” that a woman who claims to be a man approached her for midwifery care. Which is the best response to her?
a) As midwives, our job is to care for pregnant people, not condemn them. If she is not comfortable caring for this client, that is her prerogative, however, she should treat everyone with respect, even if she does not ‘approve’ of their lifestyle. Suggest that she look into CEUs on being inclusive.
b) This attitude is outdated and offensive. Midwives who are bigots should not be in practice.
c) Insist that the midwife take on this client so that she can learn some tolerance from him.
d) Agree that a transgender man would not be appropriate for an out of hospital birth because of the hormones they take.
A
15 . You’re collecting data on maternal mortality in your state in order to look for any recurring causes. For your first figure, you want to divide causes into ‘direct’ and ‘indirect’. Which of the following is the most accurate grouping?
a) Direct: Seizure following cessation during pregnancy of epileptic medications, asthma, COVID-19, cardiomyopathy. Indirect: PPH, eclampsia, sepsis from infection of cesarean wound, pulmonary embolism.
b) Direct: PPH in grand multipara, eclampsia in a patient carrying triplets, sepsis from injury at work, pulmonary embolism. Indirect: Seizure following cessation during pregnancy of epileptic medications, asthma, COVID-19, cardiomyopathy.
c) Direct: PPH, eclampsia, sepsis from infection of cesarean wound, pulmonary embolism. Indirect: Seizure following cessation during pregnancy of epileptic medications, asthma, COVID-19, cardiomyopathy
d) Direct: Seizure due to eclampsia, asthma attack in labor, COVID-19 contracted at OB visit, cardiomyopathy. Indirect: PPH, eclampsia, sepsis from infection of cesarean wound, pulmonary embolism.
C
