NARM Exam Correctly Solved
What two mechanisms are responsible for placental separation? - ✅✅ Uterine
contractions and the abrupt decrease in the size of the uterine cavity.
Once you are sure that the placenta has separated, what is the next step you should
take in managing the delivery of the placenta? - ✅✅ Assess whether the uterus is
contracted
What time period is defined as the fourth stage of labor? - ✅✅ The period
beginning with the birth of the placenta and ending one hour later.
A woman's BP, pulse and respirations should be monitored how often during the
normal fourth stage of labor? - ✅✅ At least every 15 minutes until stable at pre-
labor levels.
Which of the following pelvic muscles comprises the largest portion of the pelvic
floor: Deep transverse perineal, superficial transverse perineal, pubococcygeus, or
the levator ani? - ✅✅ Levator ani
What gauge suture should you use to repair a tear/incision of the vaginal mucosa? -
✅✅ 3-0
What gauge suture should you use to repair a clitoral tear? - ✅✅ 4-0
A sulcus tear is what degree laceration? - ✅✅ First degree
What is the most widely accepted definition of postpartum hemorrhage? - ✅✅
Loss of 500ml of blood or greater
Approximately what percentage of infants born with only one umbilical artery will
have multiple, severe malformations? - ✅✅ 30%
Define Premature Rupture of Membranes (PROM) - ✅✅ Rupture of membranes
prior to the onset of labor, regardless of gestational age
,What is the most prevalent sexually transmitted disease in the United States? -
✅✅ Chlamydia. 50% of women are asymptomatic. Increased incidence in women
using OC, because pills cause cervical ectopia and makes a woman more
vulnerable. Symptoms are mucopurulent discharge from the cervix, wet mount will
reveal a high WBC. Diagnosis is by cervical culture, treatment is with antibiotics.
High incidence of coexisting gonorrhea infection.
How long should you leave a diaphragm in after intercourse to maximize
effectiveness? - ✅✅ 6 hours
Approximately what percentage of women with untreated syphilis infection
experience fetal or neonatal loss? - ✅✅ 40%
What test is diagnostic for syphilis? - ✅✅ Positive darkfield microscopic
examination of exudate (fluid) from a chancre - the painless ulceration (sore)
formed during the primary stage of syphilis.
What is the treatment for syphilis in pregnancy? - ✅✅ Parenteral penicillin G is
the only drug effective and safe in pregnancy. Tetracycline and doxycyclin are
contraindicated in pregnancy, and erthromycin will not cure an infected fetus.
How is syphilis transmitted? - ✅✅ Direct contact with body fluids or blood
transfusion. Perinatal transfer may occur hematogenously through the placenta or
during delivery.
What are the possible results of syphilis infection in pregnancy? - ✅✅ SAB,
stillbirth, premature delivery, nonimmune hydrops, generalized congenital disease,
or neonatal death. An infant is presumed infected if the mother had untreated
syphilis at the time of delivery.
Women presenting with gonorrheal infection should also be treated for? - ✅✅
Chlamydia
A pattern of petechiae (bleeding under the skin can occur from broken blood
vessels that form tiny pinpoint red dots) on the vaginal walls and cervix, a
condition referred to as "strawberry cervix" is associated with? - ✅✅
Trichomoniasis
,Name two vulvovaginal/cervical infections that are NOT usually transmitted
sexually. - ✅✅ Candidiasis and Bacterial Vaginosis. Pregnancy almost doubles
the incidence of candida, most often in 3rd trimester.
Which one necessitates a C-Section if they are present when a woman goes into
labor: Active HSV (Herpes Simplex Virus) lesions or Condylomata Acuminata
(genital warts, venereal warts) caused by human papillomavirus (HPV)? - ✅✅
Active HSV
Which forms of birth control DECREASE the risk of PID (pelvic inflammatory
disease)? - ✅✅ Diaphragms and cervical caps used with vaginal spermicides, and
condoms.
Lower abdominal tenderness, bilateral adnexal tenderness, cervical motion
tenderness and vaginal/cervical mucopurulent discharge and increased leukocytes
on wet mount are symptoms of? - ✅✅ PID- Pelvic Inflammatory Disease
What makes a tampon more likely to be indicated in TSS (Toxic Shock
syndrome)? - ✅✅ The higher the absorbency of the tampon, the greater the risk.
What bacteria causes TSS (Toxic Shock Syndrome)? - ✅✅ A strain of
Staphylococcus Aureus
What are the symptoms of TSS? - ✅✅ Sudden and severe fever of 102 degree of
higher, vomiting, copious watery diarrhea, dizziness and fainting or near fainting
when standing. There may also be sore throat, headache, severe myalgia (muscle
pain), and bloodshot eyes. Uncared for, the disease can lead to cardiac dysfunction,
respiratory distress, and death within a week of onset.
If you do a bimanual exam and note that a woman's uterus bends backwards at the
isthmus you would classify it as? - ✅✅ Retro-flexed
Which Natural Family Planning Methods are the most effective? - ✅✅ The
ovulation method (the Billings method) and the sympto-thermal method
When using the Billings method (cervical mucus method, ovulation method) how
many days after ovulation (peak day) are counted as fertile days? - ✅✅ Three
, Describe the sympto-thermal method of birth control. - ✅✅ The sympto-thermal
method of birth control utilizes all the signs and symptoms that ovulation is
impending or has occurred- mucus observation, basal body temp, mittelschmerz,
libido, cervical mucus ferning (spinnbarkeit) and cervical changes.
What are the three important guidelines for using the LAM (Lactation Amenorrhea
Method) of birth control in order to achieve its purported 98% effectiveness? -
✅✅ 1. Baby must be less than 6 months old
2. The woman has no vaginal bleeding after 56 days PP
3. Breastfeeding must be the exclusive source of nourishment for the baby
What is the active ingredient in spermicide? What sexually transmitted diseases
does it help protect women from? Why? - ✅✅ The active agent in most
spermicidal preparations is nonoxynol-9, which is lethal to the organisms that
cause chlamydia, gonorrhea, syphilis and genital herpes.
How long before intercourse is vaginal contraceptive film (VCF) inserted, and how
long does it remain effective? - ✅✅ 5 minutes, and 1 hour. A new film should be
inserted with each act of intercourse.
How long is a contraceptive sponge effective after insertion? - ✅✅ 6 hours. It
should also not be removed until at least 6 hours after intercourse. For a repeat act
of intercourse during this time, another smaller sponge is inserted in addition to the
first one.
How many hours before intercourse can the female condom be inserted? - ✅✅ 8
hours. It is removed after intercourse before standing up.
Diagnose this position:
The lie is longitudinal, the head is at or in the pelvis,
The back is on the left & toward the mother's flank,
The small parts of on the right and sometimes can felt clearly, the breech is in the
fundus, the cephalic prominence (forehead) is on the right, FHT loudest in L lower
quadrant - ✅✅ LOT- Left Occiput Transverse. This is the most common position
at the onset of labor.
When palpating, if the attitude of the fetal head is flexed, what will be the cephalic
prominence? - ✅✅ The forehead- sinciput, on the opposite side as the back.
What two mechanisms are responsible for placental separation? - ✅✅ Uterine
contractions and the abrupt decrease in the size of the uterine cavity.
Once you are sure that the placenta has separated, what is the next step you should
take in managing the delivery of the placenta? - ✅✅ Assess whether the uterus is
contracted
What time period is defined as the fourth stage of labor? - ✅✅ The period
beginning with the birth of the placenta and ending one hour later.
A woman's BP, pulse and respirations should be monitored how often during the
normal fourth stage of labor? - ✅✅ At least every 15 minutes until stable at pre-
labor levels.
Which of the following pelvic muscles comprises the largest portion of the pelvic
floor: Deep transverse perineal, superficial transverse perineal, pubococcygeus, or
the levator ani? - ✅✅ Levator ani
What gauge suture should you use to repair a tear/incision of the vaginal mucosa? -
✅✅ 3-0
What gauge suture should you use to repair a clitoral tear? - ✅✅ 4-0
A sulcus tear is what degree laceration? - ✅✅ First degree
What is the most widely accepted definition of postpartum hemorrhage? - ✅✅
Loss of 500ml of blood or greater
Approximately what percentage of infants born with only one umbilical artery will
have multiple, severe malformations? - ✅✅ 30%
Define Premature Rupture of Membranes (PROM) - ✅✅ Rupture of membranes
prior to the onset of labor, regardless of gestational age
,What is the most prevalent sexually transmitted disease in the United States? -
✅✅ Chlamydia. 50% of women are asymptomatic. Increased incidence in women
using OC, because pills cause cervical ectopia and makes a woman more
vulnerable. Symptoms are mucopurulent discharge from the cervix, wet mount will
reveal a high WBC. Diagnosis is by cervical culture, treatment is with antibiotics.
High incidence of coexisting gonorrhea infection.
How long should you leave a diaphragm in after intercourse to maximize
effectiveness? - ✅✅ 6 hours
Approximately what percentage of women with untreated syphilis infection
experience fetal or neonatal loss? - ✅✅ 40%
What test is diagnostic for syphilis? - ✅✅ Positive darkfield microscopic
examination of exudate (fluid) from a chancre - the painless ulceration (sore)
formed during the primary stage of syphilis.
What is the treatment for syphilis in pregnancy? - ✅✅ Parenteral penicillin G is
the only drug effective and safe in pregnancy. Tetracycline and doxycyclin are
contraindicated in pregnancy, and erthromycin will not cure an infected fetus.
How is syphilis transmitted? - ✅✅ Direct contact with body fluids or blood
transfusion. Perinatal transfer may occur hematogenously through the placenta or
during delivery.
What are the possible results of syphilis infection in pregnancy? - ✅✅ SAB,
stillbirth, premature delivery, nonimmune hydrops, generalized congenital disease,
or neonatal death. An infant is presumed infected if the mother had untreated
syphilis at the time of delivery.
Women presenting with gonorrheal infection should also be treated for? - ✅✅
Chlamydia
A pattern of petechiae (bleeding under the skin can occur from broken blood
vessels that form tiny pinpoint red dots) on the vaginal walls and cervix, a
condition referred to as "strawberry cervix" is associated with? - ✅✅
Trichomoniasis
,Name two vulvovaginal/cervical infections that are NOT usually transmitted
sexually. - ✅✅ Candidiasis and Bacterial Vaginosis. Pregnancy almost doubles
the incidence of candida, most often in 3rd trimester.
Which one necessitates a C-Section if they are present when a woman goes into
labor: Active HSV (Herpes Simplex Virus) lesions or Condylomata Acuminata
(genital warts, venereal warts) caused by human papillomavirus (HPV)? - ✅✅
Active HSV
Which forms of birth control DECREASE the risk of PID (pelvic inflammatory
disease)? - ✅✅ Diaphragms and cervical caps used with vaginal spermicides, and
condoms.
Lower abdominal tenderness, bilateral adnexal tenderness, cervical motion
tenderness and vaginal/cervical mucopurulent discharge and increased leukocytes
on wet mount are symptoms of? - ✅✅ PID- Pelvic Inflammatory Disease
What makes a tampon more likely to be indicated in TSS (Toxic Shock
syndrome)? - ✅✅ The higher the absorbency of the tampon, the greater the risk.
What bacteria causes TSS (Toxic Shock Syndrome)? - ✅✅ A strain of
Staphylococcus Aureus
What are the symptoms of TSS? - ✅✅ Sudden and severe fever of 102 degree of
higher, vomiting, copious watery diarrhea, dizziness and fainting or near fainting
when standing. There may also be sore throat, headache, severe myalgia (muscle
pain), and bloodshot eyes. Uncared for, the disease can lead to cardiac dysfunction,
respiratory distress, and death within a week of onset.
If you do a bimanual exam and note that a woman's uterus bends backwards at the
isthmus you would classify it as? - ✅✅ Retro-flexed
Which Natural Family Planning Methods are the most effective? - ✅✅ The
ovulation method (the Billings method) and the sympto-thermal method
When using the Billings method (cervical mucus method, ovulation method) how
many days after ovulation (peak day) are counted as fertile days? - ✅✅ Three
, Describe the sympto-thermal method of birth control. - ✅✅ The sympto-thermal
method of birth control utilizes all the signs and symptoms that ovulation is
impending or has occurred- mucus observation, basal body temp, mittelschmerz,
libido, cervical mucus ferning (spinnbarkeit) and cervical changes.
What are the three important guidelines for using the LAM (Lactation Amenorrhea
Method) of birth control in order to achieve its purported 98% effectiveness? -
✅✅ 1. Baby must be less than 6 months old
2. The woman has no vaginal bleeding after 56 days PP
3. Breastfeeding must be the exclusive source of nourishment for the baby
What is the active ingredient in spermicide? What sexually transmitted diseases
does it help protect women from? Why? - ✅✅ The active agent in most
spermicidal preparations is nonoxynol-9, which is lethal to the organisms that
cause chlamydia, gonorrhea, syphilis and genital herpes.
How long before intercourse is vaginal contraceptive film (VCF) inserted, and how
long does it remain effective? - ✅✅ 5 minutes, and 1 hour. A new film should be
inserted with each act of intercourse.
How long is a contraceptive sponge effective after insertion? - ✅✅ 6 hours. It
should also not be removed until at least 6 hours after intercourse. For a repeat act
of intercourse during this time, another smaller sponge is inserted in addition to the
first one.
How many hours before intercourse can the female condom be inserted? - ✅✅ 8
hours. It is removed after intercourse before standing up.
Diagnose this position:
The lie is longitudinal, the head is at or in the pelvis,
The back is on the left & toward the mother's flank,
The small parts of on the right and sometimes can felt clearly, the breech is in the
fundus, the cephalic prominence (forehead) is on the right, FHT loudest in L lower
quadrant - ✅✅ LOT- Left Occiput Transverse. This is the most common position
at the onset of labor.
When palpating, if the attitude of the fetal head is flexed, what will be the cephalic
prominence? - ✅✅ The forehead- sinciput, on the opposite side as the back.
