NARM (Heart and Hands) I – Study Guide & Practice Questions
What is the cornerstone of safe, sustainable midwifery practice? - correct answer ✔✔careful
prenatal assessment
When is prenatal care crucial? - correct answer ✔✔During the last six weeks of pregnancy
What are the components of prenatal care? - correct answer ✔✔Nutrition\nExercise\nNon-
allopathic healing\n herbology\n homeopathy\nMind body integration\n yoga\n meditation\
nTests and screening\nRoutine Urinalysis\nVitals\nPalpation\n fetal heart monitoring\n fundal
height \n fetal growth
What information should be discussed during the initial phone call? - correct answer ✔✔Why
home birth?\nWhat are you looking for in a midwife?\nRule out risk\nCurrent health, partner,
and pregnancy history\npersonal philosophy of care and back up plan
What is the most important task of the initial interview? - correct answer ✔✔to determine
compatability
Social insincts - correct answer ✔✔Lead us to make socially recognized choices
Biological instincts - correct answer ✔✔survival and self realization: deeply rooted
When may HIPAA be broken? - correct answer ✔✔1. If it is believed that the care provider's life
is in danger or someone else's life, safety or property are in danger\n2. Evidence or suspicion of
child, disabled or elderly person abuse or neglect\n \n3. court order
What are you required to disclose in the initial visit? - correct answer ✔✔insurance and legal
status
,What two serious complications should be discussed early in care? - correct answer ✔✔PP
hemorrhage and possible need for resuscitation (procedure and indications)
What preexisting conditions are contraindicated for home birth? - correct answer ✔✔Diabetes\
nHypertension\nHyperthyroid disorder\nChronic lung disease\nSevere asthma\nClotting
disorder\nEpilepsy\nCongenital heart disease\nKidney disease\nExtreme obesity
What conditions that may arise during pregnancy are contraindicated for home birth? - correct
answer ✔✔Rh-/ with antibodies\nSevere anemia\nCancer\nAcute viral infections: Rubella,
CMV, Toxoplasmosis, Chicken pox, Herpes\nor any of the preexisting conditions listed
What lifestyle factors and conditions may be contraindicated for home birth? - correct answer
✔✔Unresolved STI\nChronic malnutrition\nDrug addiction\nModerate/Frequent alcohol use\
nSmoking
What abortion method is least traumatic to the uterine lining? - correct answer ✔✔Suction
What two abortion-related factors may effect placental implantation? - correct answer ✔✔D&C,
post abortion sepsis
What is the rate of uterine rupture for VBAC with low transverse scar and stimulant induction? -
correct answer ✔✔<1%
What labor stimulant is associated with uterine rupture? - correct answer
✔✔Misoprostol/Cytotec (6% rate)
What are the risks of Cesarean section? - correct answer ✔✔Sepsis\nperforation of organs\
nScarring of the uterine lining\n increased risk of future abnormal placental implantation\
nHemorrhage\nIncreased risk for adhesions\n3.6X greater chance of death
,What factors decrease risk of rupture and increase chances for successful VBAC? - correct
answer ✔✔Double layer suturing\nLow transverse incision (uterine layer)\nNo other uterine
surgeries\nAt least 18 months since cesarean\nUS of placenta is favorable \nClient lives less
than 20 min from hospital
What therapeutic options may be effective for healing emotional VBAC scars? - correct answer
✔✔Hypnotherapy\nEye movement desensitization and reprocessing (EMDR)\nSupport groups
and Organizations (ICAN)
List the main symptom of fibroids - correct answer ✔✔Painless bleeding with intercourse
What are fibroids? How can they effect pregnancy? - correct answer ✔✔Fibroids are benign
uterine masses. Fibroids experience considerable growth during pregnancy. If inside the uterus,
may cause IUGR by restricting space, or cause abnormal placental implanation
What is one treatment option for fibroids? - correct answer ✔✔Green tea
How can cervical scarring be softened near term? - correct answer ✔✔Evening primrose oil
massaged into the tissue
List the gynecoligical surgeries that may effect pregnancy - correct answer ✔✔Cervical cone
biopsy\nCervical cauterization or cryosurgery\nLEEP (correlation w/ incompetent cervix and
preterm labor)
Concerns to consider for client with a history of IUD use - correct answer ✔✔Anemia\nScarring
(Predisposes for ectopic pregnancy or irregular implantation or the placenta, and hemorrhage
PID and IUD use have two similar effects on pregnancy - correct answer ✔✔Anemia\nUterine
scarring
, History of hormonal contraception may cause deficiency of what nutrient? - correct answer
✔✔Folic acid
What is the window for rupture of ectopic pregnancy? - correct answer ✔✔10-13 weeks
What are the main symptoms of ectopic pregnancy? - correct answer ✔✔Bleeding, non-
rhythmic pain unaffected by position change
In the third trimester, bleeding and non-rhythmic pain amy indicate what serious complication?
- correct answer ✔✔Placental abruption
What conditions should be ruled out if a client is experiencing chronic brown bleeding? - correct
answer ✔✔Molar pregnancy, missed abortion/incomplete miscarriage
What is varicella? - correct answer ✔✔Chicken pox
What may be indicated by repeated episodes of painless bleeding? - correct answer
✔✔placenta previa
Generalized edema may indicate ...? - correct answer ✔✔Diet concerns\nPossible preeclampsia
(after 26 weeks)\nif before 24 weeks, refer for consultation
What should be done to treat generalized edema? - correct answer ✔✔Eliminate processsed
foods\ninclude high quality protein\ninclude fresh veggies\nsalt food to taste
What are some preeclampsia warning signs? - correct answer ✔✔headaches, visual
disturbances, epigastric pain
What is the cornerstone of safe, sustainable midwifery practice? - correct answer ✔✔careful
prenatal assessment
When is prenatal care crucial? - correct answer ✔✔During the last six weeks of pregnancy
What are the components of prenatal care? - correct answer ✔✔Nutrition\nExercise\nNon-
allopathic healing\n herbology\n homeopathy\nMind body integration\n yoga\n meditation\
nTests and screening\nRoutine Urinalysis\nVitals\nPalpation\n fetal heart monitoring\n fundal
height \n fetal growth
What information should be discussed during the initial phone call? - correct answer ✔✔Why
home birth?\nWhat are you looking for in a midwife?\nRule out risk\nCurrent health, partner,
and pregnancy history\npersonal philosophy of care and back up plan
What is the most important task of the initial interview? - correct answer ✔✔to determine
compatability
Social insincts - correct answer ✔✔Lead us to make socially recognized choices
Biological instincts - correct answer ✔✔survival and self realization: deeply rooted
When may HIPAA be broken? - correct answer ✔✔1. If it is believed that the care provider's life
is in danger or someone else's life, safety or property are in danger\n2. Evidence or suspicion of
child, disabled or elderly person abuse or neglect\n \n3. court order
What are you required to disclose in the initial visit? - correct answer ✔✔insurance and legal
status
,What two serious complications should be discussed early in care? - correct answer ✔✔PP
hemorrhage and possible need for resuscitation (procedure and indications)
What preexisting conditions are contraindicated for home birth? - correct answer ✔✔Diabetes\
nHypertension\nHyperthyroid disorder\nChronic lung disease\nSevere asthma\nClotting
disorder\nEpilepsy\nCongenital heart disease\nKidney disease\nExtreme obesity
What conditions that may arise during pregnancy are contraindicated for home birth? - correct
answer ✔✔Rh-/ with antibodies\nSevere anemia\nCancer\nAcute viral infections: Rubella,
CMV, Toxoplasmosis, Chicken pox, Herpes\nor any of the preexisting conditions listed
What lifestyle factors and conditions may be contraindicated for home birth? - correct answer
✔✔Unresolved STI\nChronic malnutrition\nDrug addiction\nModerate/Frequent alcohol use\
nSmoking
What abortion method is least traumatic to the uterine lining? - correct answer ✔✔Suction
What two abortion-related factors may effect placental implantation? - correct answer ✔✔D&C,
post abortion sepsis
What is the rate of uterine rupture for VBAC with low transverse scar and stimulant induction? -
correct answer ✔✔<1%
What labor stimulant is associated with uterine rupture? - correct answer
✔✔Misoprostol/Cytotec (6% rate)
What are the risks of Cesarean section? - correct answer ✔✔Sepsis\nperforation of organs\
nScarring of the uterine lining\n increased risk of future abnormal placental implantation\
nHemorrhage\nIncreased risk for adhesions\n3.6X greater chance of death
,What factors decrease risk of rupture and increase chances for successful VBAC? - correct
answer ✔✔Double layer suturing\nLow transverse incision (uterine layer)\nNo other uterine
surgeries\nAt least 18 months since cesarean\nUS of placenta is favorable \nClient lives less
than 20 min from hospital
What therapeutic options may be effective for healing emotional VBAC scars? - correct answer
✔✔Hypnotherapy\nEye movement desensitization and reprocessing (EMDR)\nSupport groups
and Organizations (ICAN)
List the main symptom of fibroids - correct answer ✔✔Painless bleeding with intercourse
What are fibroids? How can they effect pregnancy? - correct answer ✔✔Fibroids are benign
uterine masses. Fibroids experience considerable growth during pregnancy. If inside the uterus,
may cause IUGR by restricting space, or cause abnormal placental implanation
What is one treatment option for fibroids? - correct answer ✔✔Green tea
How can cervical scarring be softened near term? - correct answer ✔✔Evening primrose oil
massaged into the tissue
List the gynecoligical surgeries that may effect pregnancy - correct answer ✔✔Cervical cone
biopsy\nCervical cauterization or cryosurgery\nLEEP (correlation w/ incompetent cervix and
preterm labor)
Concerns to consider for client with a history of IUD use - correct answer ✔✔Anemia\nScarring
(Predisposes for ectopic pregnancy or irregular implantation or the placenta, and hemorrhage
PID and IUD use have two similar effects on pregnancy - correct answer ✔✔Anemia\nUterine
scarring
, History of hormonal contraception may cause deficiency of what nutrient? - correct answer
✔✔Folic acid
What is the window for rupture of ectopic pregnancy? - correct answer ✔✔10-13 weeks
What are the main symptoms of ectopic pregnancy? - correct answer ✔✔Bleeding, non-
rhythmic pain unaffected by position change
In the third trimester, bleeding and non-rhythmic pain amy indicate what serious complication?
- correct answer ✔✔Placental abruption
What conditions should be ruled out if a client is experiencing chronic brown bleeding? - correct
answer ✔✔Molar pregnancy, missed abortion/incomplete miscarriage
What is varicella? - correct answer ✔✔Chicken pox
What may be indicated by repeated episodes of painless bleeding? - correct answer
✔✔placenta previa
Generalized edema may indicate ...? - correct answer ✔✔Diet concerns\nPossible preeclampsia
(after 26 weeks)\nif before 24 weeks, refer for consultation
What should be done to treat generalized edema? - correct answer ✔✔Eliminate processsed
foods\ninclude high quality protein\ninclude fresh veggies\nsalt food to taste
What are some preeclampsia warning signs? - correct answer ✔✔headaches, visual
disturbances, epigastric pain
