NARM Practice Exam 600 Questions - (31-60) General healthcare skills Flashcards
31 . For which of these antepartum screening(s) would RhoGAM be recommended for an Rh-negative client?
a) Nuchal translucency screen
b) Chorionic villus sampling, amniocentesis, cordocentesis
c) Triple screen and quad screen
d) Nuchal translucency, triple and quad screens
B
32 . You’re saying farewell to Faith at her 6-week appointment, and give her one final reminder about considering getting a rubella vaccination at least 3 months prior to her next pregnancy. What is your rationale?
a) Faith’s antibody screen was <1:10, indicating she was not immune to rubella. Risks of rubella infection during pregnancy include a 20% risk of congenital malformations such as cataracts, cardiac defects or deafness if contracted in the first trimester. There is also a risk of fetal demise.
b) Faith experienced a low-grade fever, drowsiness, sore throat, rash and swollen neck glands during pregnancy, leading you to suspect that she was infected with rubella. The risks to a fetus include congenital malformations, miscarriage and fetal demise.
c) Faith had the German Measles vaccine as a teen, but has not had the rubella vaccine, so she is at risk of contracting Rubella during a subsequent pregnancy. Risks to the baby are highest if contracted in the first trimester, with possibly as high as 50% transmission and a 20% risk of significant fetal malformation or even fetal demise.
d) Faith’s antibody screen was >1:64, indicating she was not immune to rubella. Risks of rubella infection during pregnancy include a 20% risk of congenital malformations such as cataracts, cardiac defects or deafness if contracted in the first trimester. There is also a risk of fetal demise.
A
33 . You’re preparing for a sterile procedure. What are the steps you take?
a) Ensure you have all supplies ready. Sterilize your hands with hand sanitizer. Open sterile glove packet and discard outer bag. Unfold sterile wrapping without touching gloves or inner side of the paper. Grasping a glove by the folded cuff, put it on the other hand. With fingers in the inner fold of the cuff, repeat, ensuring you do not touch your skin with the gloved hand. Have your assistant open equipment and carefully drop it into the sterile field of the glove paper.
b) Gather supplies and wash your hands thoroughly. Open the sterile gloves, throw the outer wrapper away and open the inner paper. Put on gloves by grasping cuffs with the opposite hand and ensuring you don’t touch the outer side of the glove with your skin. Open the other equipment you’ll need and carefully arrange them on the sterile field.
c) Ensure you have all supplies ready. Wash hands with soap and water for at least 60 seconds. Open sterile glove packet and discard outer bag. Unfold sterile wrapping without touching gloves or inner side of the paper. Grasping a glove by the folded cuff, put it on the other hand. With fingers in the inner fold of the cuff, repeat, ensuring you do not touch your skin with the gloved hand. Have your assistant open equipment and carefully drop it into the sterile field of the glove paper.
d) Wash your hands thoroughly and gather supplies. Open sterile glove packet and discard and then open out inner paper, smoothing it thoroughly before putting on the gloves. Grasp the first glove by the cuff and put it on your other hand. Repeat with the second, ensuring your gloved hand does not touch the outer surface of the second glove. Have your assistant open equipment and carefully drop it into the sterile field created by the glove wrapping.
C
34 . Elizabeth is Rh negative and her husband is known to be Rh positive. You’ve just explained the action of RhoGAM to her, but have not yet described risks and benefits of it when she tells you that her religion does not allow her to have RhoGAM because it is a blood product. How might you accurately counsel her?
a) Since Elizabeth is Rh negative, she is not at risk of isoimmunization, and hence RhoGAM is not an appropriate medication to be offering her.
b) RhoGAM is a plasma derivative, and so she is correct that it is a blood product. If she changes her mind at any stage, you are happy to revisit the topic with her without any judgement. If she does not have RhoGAM administered, your recommendation is that she be tested for isoimmunization prior to any pregnancies so that she can make an informed choice over the risks involved.
c) RhoGAM is indeed a blood product. While you respect her decision, you do still want to tell her the risks and benefits so she fully understands the risks involved. When administered correctly, it reduces the risk of isoimmunization to 1-2%. It does carry the theoretical risk of transmission of a virus.
d) RhoGAM is a plasma derivative, not a blood product, and so she does not need to decline it on religious grounds. You explain this to her and then tell her of the risks and benefits of RhoGAM and of refusing it.
B
35 . What is one reason the platelet count might be significant?
a) Thrombocytopenia raises the risk of hemorrhage.
b) There is a physiologic slight reduction in platelet count during pregnancy.
c) A high count due to reduced aggregation raises the risk of PPH.
d) A high count is one part of HELLP, a life-threatening complication.
A
36 . Emilia has a second-degree perineal tear, so you’re preparing to suture. What should you say to her?
a) You should explain the risks and benefits of suturing or leaving the tear unsutured, and of any medications or non-allopathic treatments you would suggest. Give your recommendation to Emilia, and seek informed consent. If Emilia wants to have lidocaine, check whether she has any known allergy to it. If so, do not use it and consider alternatives. Explain the procedure to her, including roughly how long it will take you.
b) You should explain the risks and benefits of suturing or leaving the tear unsutured, and of any medications or non-allopathic treatments you would suggest. Give your recommendation to Emilia, and seek informed consent. If Emilia wants to have lidocaine, check whether she has any known allergy to it. If so, have epinephrine ready to administer in case she has a reaction. Explain the procedure to her, including roughly how long it will take you.
c) You should explain the risks and benefits of suturing or leaving the tear unsutured, and of any medications or non-allopathic treatments you would suggest. Give your recommendation to Emilia, and seek informed consent. If Emilia wants to have lidocaine, check whether she has any known allergy to it. If so, don’t use it but don’t worry Emilia by telling her this. Explain the procedure to her, including roughly how long it will take you.
d) You should explain the risks and benefits of suturing or leaving the tear unsutured, and of any medications or non-allopathic treatments you would suggest. Give your recommendation to Emilia, and seek informed consent. If Emilia wants to have lidocaine, check whether she has any known allergy to it. If so, use Xylocaine (lidocaine with epinephrine) instead. Explain the procedure to her, including roughly how long it will take you.
A
37 . Which of the following lists appropriate use of instruments and equipment?
a) Amnihook: fetus is not engaged and amniotic fluid levels are high. Bulb syringe: Extra stimulation or suspected meconium aspiration, ensuring vagal response is not elicited. Delee tube: Not recommended for routine use. Use if there is excess fluid in the lungs. Lancets: For assessing hemoglobin level. Thermometer: Rectal is not recommended in a neonate because it may trigger a vagal response.
b) Thermometer: Axillary temperatures are approximately 1F cooler than oral temperatures, and temporal temperatures are approximately 1F higher than oral temperatures. Urinalysis strips: Ensure these are stored within the correct range of temperatures and not left in a very hot or cold car. Doppler and fetoscope: Used to detect fetal heartbeat, with Doppler picking it up approximately 8 weeks earlier but a fetoscope giving a more accurate sound of the heart beating. Pulse oximeter: Used to detect CCHD in neonates. Normally done within an hour of birth. To pass, neonate must have over 95% on left hand and foot, with less than 3% difference between the two.
c) Bag and mask resuscitator: neonatal heart rate is below 100bpm. Hemostats: To clamp an avulsed cord. Lancet: to assess neonatal glucose levels when hypoglycemia is suspected. Straight, in and out catheter: with sterile technique when client cannot empty their bladder. Sphygmomanometer: correctly sized to measure blood pressure.
d) Bulb syringe: Ensure you do not elicit a vagal response. Used as standard on the perineum. Hemostats: For clamping the cord prior to cutting. Nitrazine paper: To test for suspected ROM. Turns from yellow to deep blue in the presence of amniotic fluid. Scissors: Blunt-blunt are used for the emergency cutting of a nuchal cord. Suturing equipment: Sterile technique. Dissolvable sutures must be used.
C
38 . Which are normal readings for hematocrit and hemoglobin during pregnancy?
a) Early pregnancy: hematocrit over 31%, hemoglobin over 10.5 g/dL. Later in pregnancy: hematocrit >39%, hemoglobin >13 g/dL.
b) Early pregnancy: hematocrit >39%, hemoglobin >13 g/dL. Later in pregnancy: hematocrit over 31%, hemoglobin over 10.5 g/dL.
c) Early pregnancy: hematocrit >13 g/dL, hemoglobin >39%. Later in pregnancy: hematocrit over 10.5 g/dL, hemoglobin over 31%.
d) Early pregnancy: hematocrit over 10.5 g/dL, hemoglobin over 31%. Later in pregnancy: hematocrit >13 g/dL, hemoglobin >39%.
B
39 . Your new client, Gboyega, is vegan and is of Nigerian descent. She wears clothing that covers most of her skin year-round. Given this information, which Vitamin might you want to check with a view to potentially recommending supplementation?
a) Vitamin D
b) Vitamin C
c) Vitamin E
d) Vitamin A
A
40 . Which of the following would prompt you to obtain or refer for a urine culture?
a) Freya has high ketones in her urine dipstick test, and states that her water intake has been low today.
b) Freya has been acting strangely and you suspect drug use.
c) Freya is 34 weeks pregnant and has trace leukocytes on a normal urine dipstick test.
d) Freya complains of mild stinging on urination. When you check, she has marked CVAT.
D
41 . For which blood-borne pathogen found to be positive in the birthing person would you be most likely to recommend a vaccine in the neonate?
a) Rubella
b) HIV
c) Hepatitis B
d) Hepatitis C
C
42 . Normally produced by the corpus luteum for the first few weeks of pregnancy before the placenta takes over, which hormone might you want to test in a client with a history of early miscarriages?
a) Progestin
b) Progesterone
c) Estradiol
d) Estrogen
B
43 . Which of the following correctly describes macrocytic (megaloblastic) anemia, microcytic anemia and normocytic anemia?
a) In all, the total hemoglobin is low. In macrocytic anemia, MCV is high. In microcytic anemia, it is low, and in normocytic anemia, it is within normal limits. Macrocytic anemia is normally caused by low folate or B12. Microcytic anemia is normally caused by an iron deficiency. Normocytic anemia normally reflects acute blood loss.
b) In all, the total hemoglobin is high. In macrocytic anemia, MCV is low. In microcytic anemia, it is high, and in normocytic anemia, it is within normal limits. Macrocytic anemia is normally caused by low folate or B12. Microcytic anemia is normally caused by an iron deficiency. Normocytic anemia normally reflects acute blood loss.
c) In all, the total hemoglobin is high. In macrocytic anemia, MCV is low. In microcytic anemia, it is high, and in normocytic anemia, it is within normal limits. Macrocytic anemia is normally caused by an iron deficiency. Microcytic anemia is normally caused by acute blood loss. Normocytic anemia normally reflects low folate or B12.
d) In all, the total hemoglobin is low. In macrocytic anemia, MCV is high. In microcytic anemia, it is low, and in normocytic anemia, it is within normal limits. Macrocytic anemia is normally caused by an iron deficiency. Microcytic anemia is normally caused by acute blood loss. Normocytic anemia normally reflects low folate or B12.
A
44 . Today is Elle’s first appointment with you, and you’re reviewing the medications and supplements she takes. You discover she’s taking 400 mcg of folate, which is the ACOG recommended dose, she’s not taking DHA, and she has a total daily intake of Vitamin A over all supplements of 35,000 IU, which is three times the ACOG-recommended dose. What counseling do you give Elle?
a) Her folate intake is good, and it’s great that she’s taking folate rather than folic acid. You recommend that Elle add a DHA supplement and suggest a couple of good brands, as DHA has many benefits, including in the development of the baby’s eyes, brain and nervous system, it may help reduce the risk of preterm labor, and it supports the birthing parent’s mood in the postpartum period. Vitamin A is a teratogen in high doses, and Elle should reduce her intake immediately.
b) Her folate intake is good, but if would be better if she was taking the natural form, folic acid. You recommend that Elle add a DHA supplement and suggest a couple of good brands, as DHA has many benefits, including in the development of the baby’s eyes, brain and nervous system, it may help reduce the risk of preterm labor, and it supports the birthing parent’s mood in the postpartum period. Vitamin A is a teratogen in high doses, and Elle should reduce her intake immediately.
c) Her folate intake is good. You recommend that Elle add a DHA supplement and suggest a couple of good brands, as DHA has many benefits, including supporting placental perfusion, bone growth and fetal circulation. Vitamin A is a teratogen in high doses, and Elle should reduce her intake immediately.
d) Her folate intake is good. You recommend that Elle add a DHA supplement and suggest a couple of good brands. Vitamin A is essential during pregnancy, as it helps reduce the risk of childhood infections in the fetus. Elle should continue taking Vitamin A as she is, and may want to add Vitamin D.
A
45 . What are some of the indications for ultrasound in the three trimesters?
a) First trimester: To identify sex of the embryo, to confirm EDD, suspected ectopic pregnancy, suspected incarceration of the uterus. Second trimester: to monitor the location of the placenta, to investigate a possible missed abortion, to confirm multiple gestation, full anatomy scan. Third trimester: Assess the health of the placenta, investigate suspected IUGR, assess cervical length with risk for premature labor, 3D ‘fun’ ultrasound.
b) First trimester: Suspected placenta previa, pregnancy suspected outside the uterine cavity, possible fetal demise, to investigate suspected IUGR. Second trimester: To confirm a suspected multiple gestation, full anatomy scan, suspected incarceration of the uterus, to confirm position and lie of fetus. Third trimester: Suspected placental abruption, suspected uterine rupture, to confirm EDD, to investigate suspected fetal demise.
c) First trimester: Suspected ectopic pregnancy, to rule out multiples, to confirm viability of the embryo, to confirm EDD when LMP history is known. Second trimester: Monitor location of the placenta, monitor amniotic fluid levels, identify the lie of the fetus, investigate possible fetal demise. Third trimester: Look for a cord loop around the neck, investigate pelvic dimensions to assess for CPD, estimate fetal weight, assess amniotic fluid volume.
d) First trimester: Suspected ectopic pregnancy, suspected hydatidiform mole, to confirm dates, to confirm a multiple gestation. Second trimester: Investigate possible fetal demise, assess cervical length with risk for premature labor, to identify source of bleeding. Third trimester: Suspected placenta previa, to assess amniotic fluid levels, to assess the health of the placenta, to confirm fetal lie.
D
