NARM Practice Exam 600 Questions - (121-270) Prenatal Flashcards
121 . Which of the following would not cause hematocrit to be reduced?
a) Hemorrhage, with the blood draw done immediately after it occurred.
b) Vitamin or mineral deficiency (e.g. iron, B12, B6)
c) Hemolysis
d) Overhydration
A
122 . You’re attempting to assess fetal flexion by performing Leopold’s Maneuvers. Which of these statements is not true?
a) If the cephalic prominence is on the same side as the fetal back, the fetal head is extended, and the fetus has either brow or face presentation.
b) If no cephalic prominence is felt, there is neither flexion nor extension, and the fetus is in military position.
c) If the cephalic prominence is on the same side as the small parts, the fetus is well-flexed and the fetus is in vertex position.
d) The third maneuver (or Pawlick’s grip) is used to ascertain fetal flexion, whereby the thumb and fingers of the dominant hand are placed just above the pubic symphysis and the presenting part is grasped.
D
123 . Melissa admits to you at 16 weeks that she’s started smoking again, and asks what the risks to the baby are. You tell her that it exposes the baby to toxins such as lead, cadmium, cyanide, nicotine and carbon monoxide, that the baby’s blood flow is reduced, limiting the delivery of oxygen and nutrients, resulting in impaired growth and development. It significantly increases the risk of miscarriage, stillbirth, abnormalities with the placenta, IUGR and neonatal death. Which of the following did you forget?
a) Post term delivery
b) Low birth weight
c) Macrosomia
d) Preterm delivery
D
124 . Molly called you last week to enquire about your services, as she’d just discovered that she was pregnant. Today, she calls you to tell you she has menstrual-like cramps, spotting, nausea, and, probably unrelated, pain in her shoulder. Since she’s not yet a client, you explain that you can’t treat her, but you feel compelled to tell her what?
a) She’s having a threatened miscarriage. She should wait to see what happens, as there’s nothing that can be done at this stage.
b) She is having an inevitable spontaneous abortion. She can wait to pass the products of conception naturally or see a physician for uterine evacuation.
c) She may be experiencing an ectopic pregnancy, and should see a physician as soon as possible.
d) She’s showing symptoms of appendicitis, and should see her primary care provider as soon as possible.
C
125 . At 28 weeks, Lydia complained of varicose veins, and you told her of various ways she could help mitigate them. Lydia chose to exercise more, has been trying to avoid standing for prolonged periods of time, and has been taking Vitamin E. She decided not to use compression socks because it was too hot. Today, you want to go through signs and symptoms of thrombophlebitis with her. Which of these will you not tell her to look out for?
a) Fever, racing heart, severe pain in the leg that starts suddenly.
b) Heat, pain, swelling and/or a knot or cord you can feel (but don’t massage it or poke it too much!)
c) Swelling across your body, pain if you touch one area of the calf, tenderness along the length of the vein.
d) Flex your foot (lift towards your leg) to see if there’s sharp pain in the leg. (Think of embolization.)
D
126 . At 29 weeks, Laocadia calls you to report bleeding. She had intercourse and then a little cramping, and is worried she’s starting labor. Which one of these should you avoid doing?
a) Reassure her that it’s very unlikely she’s in labor - a little cramping after intercourse is normal, and the bleeding is probably from a sensitive cervix or a polyp or fibroid.
b) Ask Laocadia to come in so you can take her vital signs and listen to the baby’s heart.
c) Do a vaginal exam to check for cervical change so you can determine the appropriate care.
d) Refer her to a physician to hopefully rule out premature labor, placenta previa or placental abruption.
C
127 . Kamille is 36 weeks pregnant, and has moderate pitting edema in both of her lower legs. She reports that it tends to worsen during the day and is quite uncomfortable by bedtime. What do you do?
a) Explain that this can be an early sign of preeclampsia, and Kamille needs to keep an eye on it. If it spreads to her hands and face, she should call you immediately.
b) Explain that while this is no cause for concern, Kamille can make changes to help ease the symptoms, including wearing compression socks, elevating her feet, adding salt ‘to taste’ to her food, hydrating well and eating a healthful diet with plenty of protein.
c) Explain that this is due to fluid from the blood seeping into spaces around cells, reducing the blood volume, which can cause problems like premature labor.
d) Explain that this is normal and is because of hormonal changes, and it shows that her blood volume is well-expanded.
B
128 . Which of the following has inaccurate information on possible methods for stimulating the start of labor in a post-dates client (with intact membranes)?
a) Having the client take: Castrol oil, blue/black cohosh, red raspberry leaf, evening primrose oil (orally or internally), cimicifuga, and/or caulophyllum.
b) Chiropractic adjustment or acupuncture.
c) Stripping membranes (using sterile technique), amniotomy (with a fetus that is well-engaged) or attempting to reposition a malpositioned fetus.
d) Sexual intercourse (unprotected), nipple stimulation, and discussing emotional blockages that may be interfering.
A
129 . Which of these FHR is outside the normal range?
a) 162 bpm at 10 weeks
b) 148 bpm at 16 weeks
c) 134 bpm at 36 weeks
d) 170 bpm at 28 weeks
D
130 . You’re explaining to your student how to identify breech presentation. Which of the following is the best advice when the student is moving through the Leopold maneuvers?
a) If the pregnant person reports fetal movement near the cervix or a hard ball in the ribs, it is likely that the fetus is breech.
b) Listen for the fetal heart tones. If they’re high in the abdomen, it is likely that the fetus is breech.
c) Palpate gently but deep into the abdomen so that you can feel the fetus well.
d) Never assume that a fetus is cephalic. Keep searching until you are certain you have felt a head - a hard ball that moves independently of the trunk. If you can’t find it, you can’t be certain of fetal position.
D
131 . At her 34-week appointment with Lavender, you decide to do a fluid thrill test, and tap on one side of the uterus and feel for a fluid thrill on the other side. Which scenario led you to perform this test?
a) Positive GTT results.
b) Placental souffle heard in the lower part of the uterus.
c) Difficult to palpate fetus. Fundal height 37 cm.
d) Fetal head felt in the fundus, but unable to determine if fetal buttocks or legs are presenting.
C
132 . Lindy’s fundal height measurements for the last few appointments have been: 20 weeks: 20 cm, 24 weeks: 25 cm, 28 weeks: 30 cm, 30 weeks: 33 cm. When you measure her today, at 32 weeks and 4 days, fundal height is 36 cm. Which of these is not a likely explanation for the high fundal height measurements?
a) Gestational diabetes
b) Incorrect dates
c) Polyhydramnios
d) Multiples
B
133 . Landry tells you she’s been feeling a lot of tingling and numbness in her thumb, index finger and middle finger. You ask her to bend her wrists and put her hands together, back-to-back. Within 30 seconds, she tells you she feels the tingling and numbness and also discomfort. Which of these is not a good recommendation for Landry?
a) When doing nerve gliding exercises, apply crushed ice to the hand for 20 minutes prior to the exercise, and apply heat to the hand afterwards.
b) Wear a wrist splint at night to place the wrist in a neutral position
c) Drink skullcap and take a B-complex supplement
d) Hand and wrist exercises, like fist to stop sign, fist to fan, thumb touches and gentle wrist stretches.
A
134 . At a prenatal appointment, you ask Judith to look at your pen point as you hold it about 2 feet from her face. You then move it towards her nose, carefully watching her eyes. What are you doing, and why?
a) Watching for the convergence of the eyes and contraction of pupils as she looks at the object closer to her - one sign of accommodation. If absent, there are many causes, including trauma and pharmacological agents, so you’d need to investigate further.
b) Watching for the divergence of the eyes and dilation of pupils as she looks at the object closer to her - one sign of accommodation. If absent, there are many causes, including trauma and pharmacological agents, so you’d need to investigate further.
c) Watching for the convergence of the eyes and dilation of irises as she looks at the object closer to her - one sign of accommodation. If absent, there are many causes, including trauma and pharmacological agents, so you’d need to investigate further.
d) Watching for the divergence of the eyes and contraction of irises as she looks at the object closer to her - one sign of accommodation. If absent, there are many causes, including trauma and pharmacological agents, so you’d need to investigate further.
A
135 . Which of the following would not be a reasonable possible interpretation of cloudy urine?
a) Protein is present in the sample
b) Holding for long periods of time, leading to formation of sediment
c) Vaginal discharge is present in the sample
d) Overhydration
D
136 . Leanne has symptoms of a vaginal yeast infection, but has declined allopathic treatment. Which of these would you not recommend to her?
a) Taking garlic (in food, ideally not heavily cooked, or in tablet or capsule form), or even inserting a whole, un-nicked clove vaginally may help. Remove a clove from the vagina if it causes a burning sensation, and change 3 times a day if not.
b) Wear cotton underwear, or no underwear at all. If wearing a pantyliner, get a breathable one and change it regularly.
c) Try inserting boric acid suppositories, which prevent candida fungi from growing, or taking oral fluconazole.
d) Take a high-quality probiotic such as Lactobacillus rhamnosus or Lactobacillus acidophilus.
C
137 . You’ve carefully researched and written practice protocols, including those for emergency transfer of care. Today, one of your favorite clients is in a situation that would normally trigger emergency transfer, but she begs you to try a few more things before activating the protocol. What do you do?
a) If you list all the risks and benefits of the decision and your client gives informed consent, you can choose not to follow the protocols on this occasion.
b) Follow your protocol. You used your best clinical judgement to write the protocols without emotion influencing them, and so the safest thing to do for your client is to follow them now.
c) Follow your protocol. You would get a bad reputation if you displayed favoritism to one client.
d) If you feel that you can try the extra steps before transfer without putting the client or her baby at significant risk, you should follow her request.
B
138 . You’re practicing in a state where midwives can attend births from 37.0 weeks. Moira (G1P0000) calls you at 36.5 weeks to tell you she’s had menstrual-like cramps on and off for a couple of hours, and had diarrhea earlier today. You suspect she may be in early labor. What should you do?
a) Suggest that Moira drink plenty of water, take a warm bath with lavender oil and epsom salts, and then lie down on her left side.
b) Since this is Moira’s first labor, it’s likely it will take a long time, so you decide to let it take its course. At worst, the baby will be born at 36.6, and no-one will care about you attending a birth 1 day early!
c) Suggest that Moira drink some cayenne tea and then go for a walk for an hour or so.
d) Suggest that Moira take a Benadryl and some calcium and then try to sleep.
A
139 . When Jaqueline’s baby is born, she comments on the shape of his head, worried that he might be brain damaged. Which is most accurate?
a) During labor and birth, the baby’s head normally ‘molds’ to the shape of the passageway, and this doesn’t cause any damage to the brain. In fact, the bones of a baby’s skull are designed to do this: they can overlap slightly, making the head smaller in certain places so that it can better fit through the pelvis.
b) During labor and birth, the baby’s head often ‘molds’ to the shape of the passageway, and this doesn’t cause any damage to the brain. It’s called a caput succedaneum, and will disappear in a couple of days with no lasting damage.
c) During labor and birth, the baby’s head normally ‘molds’ to the shape of the passageway, and this doesn’t cause any damage to the brain. In fact, the bones of a baby’s skull are designed to do this: they can move slightly without having any negative impact on the brain.
d) During labor and birth, the baby’s head normally ‘molds’ to the shape of the passageway, and this doesn’t cause any damage to the brain. In fact, the bones of a baby’s skull are designed to do this: they can separate slightly as they are pushed out of place by the bony pelvis.
A
140 . Janiya, 20 weeks pregnant, recently moved to the USA and just called to enquire about hiring you as her midwife. What is one concern about her care that you want to address the first time you meet with her, and then revisit periodically?
a) What social support system she has in place.
b) Whether she’s in the country legally.
c) Whether she can afford to pay you.
d) What prenatal care she had before moving to the US.
A
141 . Jo sheepishly tells you she’s been craving laundry detergent, and has had to ask her partner to do all the laundry so she can avoid temptation. What should you say to Jo?
a) Explain that this is fairly common in pregnancy and is called ‘pica’. It’s not always a craving for laundry detergent, but for any non-nutritive item, like ice chips, dirt or clay. Be non-judgmental in your response, but agree that she is right that she needs to fight this temptation. It’s not known for certain, but it’s thought that pica is caused by something missing in the diet, such as iron or other minerals. Discuss how you might address this with diet, supplements and possibly testing to help identify the source of the problem.
b) Explain that this is called ‘pica’, and it’s very common, where people crave non-food items like dirt. Tell Jo what effect laundry detergent might have on her and on the baby and stress the importance that she continue to fight the temptation.
c) Without any judgement, tell Jo that this is called ‘pica’ and is a sign that she’s not getting enough iron in her diet. Explore with her ways in which she could increase iron intake, including with diet, cooking in cast iron pans and/or supplements such as floradix.
d) Tell Jo this is bordering on child abuse, as the laundry detergent could kill her unborn child, and make it clear to her that if she admits to you that she’s followed through on her craving, you’ll have no choice but to call CPS to help protect her baby.
A
142 . Which of these statements about estimating fetal weight is not accurate?
a) Research shows that weight estimates from palpation are generally overestimated.
b) Research shows that weight estimates from sonograms are generally underestimated.
c) Fetal weight estimation needs considerable ‘calibration’, wherein the provider records estimated weights and then weighs the neonates in order to determine accuracy, and updates methods as appropriate.
d) Fetal weight estimation is least accurate for macrosomic babies.
D
143 . At 38 weeks, you discover that Lee’s fetus is ROP. Which of these is not a technique you should encourage her to try in order to help with rotation to the anterior?
a) Straddle an armless chair, facing its back, and rest your arms on the chair’s back. Move your bottom back to the edge of the seat and lean forwards so your belly hangs low. Relax your abdominal muscles and maintain this for 20 minutes 4 to 6 times a day.
b) See a chiropractor for an adjustment.
c) Do pelvic rocks (cat-cows) for 10 minutes 6 to 8 times a day.
d) Lie on your back, head down, on a plank or ironing board propped up on a sofa. Do this for up to 20 minutes 1-3 times a day.
D
144 . Which of these are not all symptoms or signs of a uterine rupture?
a) Abrupt bradycardia/recurrent decelerations that become deeper, easily palpable fetus
b) Sudden loss of fetal station, vaginal bleeding
c) Uterine tachysystole
d) Maternal anxiety, abdominal pain/uterine guarding
C