,This study document brings together 97 carefully worded exam questions drawn from NARM
STUDY QUESTIONS (THE 700 SET QUESTION NARM STUDY GUIDE) VERIFIED ANSWERS
2026 UPDATE 100% CORRECT - MIDWIVES COLLEGE OF UTAH, with the strongest emphasis
placed on Synthesize antepartum risk factors and diagnostic findings to determine appropriate
midwifery management and referral thresholds, Interpret intrapartum fetal heart rate patterns and
labor progress data to select evidence-based interventions or transfers of care, Apply
pathophysiologic reasoning to postpartum hemorrhage, hypertensive disorders and and neonatal
transition emergencies. Every item follows the wording style and level of reasoning you meet in the
real paper, and each one is paired with a clear rationale so the correct choice is never a guess.
Work through the set at your own pace, mark the questions that slow you down, then come back to
them until the reasoning feels automatic. Learners who revise this way walk into the exam room
recognising the pattern behind the questions instead of meeting them for the first time. Keep going
- steady, honest practice is what turns a difficult paper into a comfortable pass.
Q1 SYNTHESIZE ANTEPARTUM RISK FACTORS AND DIAGNOSTIC FINDINGS TO DETERMINE
APPROPRIATE MIDWIFERY MANAGEMENT AND REFERRAL THRESHOLDS
A primigravida at 41 weeks presents with spontaneous rupture of membranes and
clear fluid; cervical exam is 2 cm/50%/-2. Which combination of findings would
most strongly indicate the need for immediate transfer of care rather than
continued out-of-hospital management?
A. Meconium-stained fluid with a Category I FHR tracing and 3 cm dilation after 4 hours
B. Persistent late decelerations with minimal variability despite maternal repositioning and IV
fluid bolus CORRECT
C. Contractions every 3-4 minutes with moderate variability and accelerations present
D. Arrest of dilation at 6 cm for 2 hours with adequate contractions and reassuring FHR
RATIONALE: Persistent late decelerations with minimal variability indicate uteroplacental
insufficiency and fetal hypoxemia, requiring immediate obstetric intervention. Options A, C, and D
represent either reassuring or manageable findings that do not mandate immediate transfer per
ACOG/NARM guidelines.
Page 2
,Q2 SYNTHESIZE ANTEPARTUM RISK FACTORS AND DIAGNOSTIC FINDINGS TO DETERMINE
APPROPRIATE MIDWIFERY MANAGEMENT AND REFERRAL THRESHOLDS
Which statement best reflects the current evidence regarding delayed cord
clamping in term and preterm neonates, and how should a midwife integrate this
into practice?
A. Delayed clamping for 30-60 seconds is recommended for term infants only; preterm infants
benefit from immediate clamping to reduce jaundice.
B. Delayed clamping for at least 30-60 seconds is recommended for both term and preterm
infants, improving iron stores and reducing intraventricular hemorrhage in preterm infants.
CORRECT
C. Delayed clamping increases the risk of polycythemia and should be avoided in all neonates
requiring resuscitation.
D. Delayed clamping has no significant benefit in high-resource settings and is not
recommended by ACOG.
RATIONALE: ACOG and WHO recommend delayed cord clamping for at least 30-60 seconds for
both term and preterm infants, with evidence of improved iron status and reduced IVH in preterm
infants. Immediate clamping is not supported, and delayed clamping is compatible with
resuscitation when needed.
Q3 SYNTHESIZE ANTEPARTUM RISK FACTORS AND DIAGNOSTIC FINDINGS TO DETERMINE
APPROPRIATE MIDWIFERY MANAGEMENT AND REFERRAL THRESHOLDS
A client at 28 weeks presents with a fundal height of 24 cm and a history of two
prior first-trimester losses. Which combination of findings would most increase
suspicion for a condition requiring referral for targeted ultrasound and possible
cerclage?
A. Fundal height lag with normal fetal movement and no cervical changes
B. Shortened cervix (<25 mm) on transvaginal ultrasound with funneling and prior
second-trimester loss CORRECT
C. Fundal height lag with normal amniotic fluid and no prior pregnancy losses
D. Normal cervical length with history of two first-trimester losses and no current symptoms
RATIONALE: A shortened cervix with funneling and a history of second-trimester loss is classic
for cervical insufficiency, warranting cerclage consideration. Fundal height lag alone or
first-trimester losses without cervical changes do not meet criteria for cerclage.
Page 3
, Q4 SYNTHESIZE ANTEPARTUM RISK FACTORS AND DIAGNOSTIC FINDINGS TO DETERMINE
APPROPRIATE MIDWIFERY MANAGEMENT AND REFERRAL THRESHOLDS
Which of the following best explains the physiologic rationale for using a
hands-and-knees position during labor when a persistent occiput posterior
position is suspected?
A. It increases pelvic outlet diameter by 1-2 cm through sacral nutation.
B. It reduces pressure on the vena cava and improves placental perfusion.
C. It uses gravity to encourage fetal rotation by altering the angle of the pelvic inlet and reducing
lumbar lordosis. CORRECT
D. It decreases uterine contractility to allow fetal descent.
RATIONALE: The hands-and-knees position can facilitate fetal rotation by changing the pelvic
inlet angle and reducing lumbar lordosis, which may dislodge a persistently posterior fetal head.
Options A and B describe other mechanisms not specific to rotation, and D is incorrect as it
would not promote descent.
Q5 SYNTHESIZE ANTEPARTUM RISK FACTORS AND DIAGNOSTIC FINDINGS TO DETERMINE
APPROPRIATE MIDWIFERY MANAGEMENT AND REFERRAL THRESHOLDS
A postpartum client at 24 hours post-vaginal delivery has a hematocrit drop from
34% to 26%, heart rate 118, BP 98/60, and reports dizziness. Which finding is most
consistent with a delayed postpartum hemorrhage secondary to uterine atony?
A. Boggy uterus with excessive lochia and clots CORRECT
B. Firm uterus with bright red bleeding and no clots
C. Firm uterus with dark lochia and no active bleeding
D. Boggy uterus with minimal lochia and no clots
RATIONALE: Delayed postpartum hemorrhage from uterine atony typically presents with a boggy
uterus and excessive lochia with clots. A firm uterus suggests other causes (e.g., laceration), and
minimal lochia does not match atony.
Page 4
STUDY QUESTIONS (THE 700 SET QUESTION NARM STUDY GUIDE) VERIFIED ANSWERS
2026 UPDATE 100% CORRECT - MIDWIVES COLLEGE OF UTAH, with the strongest emphasis
placed on Synthesize antepartum risk factors and diagnostic findings to determine appropriate
midwifery management and referral thresholds, Interpret intrapartum fetal heart rate patterns and
labor progress data to select evidence-based interventions or transfers of care, Apply
pathophysiologic reasoning to postpartum hemorrhage, hypertensive disorders and and neonatal
transition emergencies. Every item follows the wording style and level of reasoning you meet in the
real paper, and each one is paired with a clear rationale so the correct choice is never a guess.
Work through the set at your own pace, mark the questions that slow you down, then come back to
them until the reasoning feels automatic. Learners who revise this way walk into the exam room
recognising the pattern behind the questions instead of meeting them for the first time. Keep going
- steady, honest practice is what turns a difficult paper into a comfortable pass.
Q1 SYNTHESIZE ANTEPARTUM RISK FACTORS AND DIAGNOSTIC FINDINGS TO DETERMINE
APPROPRIATE MIDWIFERY MANAGEMENT AND REFERRAL THRESHOLDS
A primigravida at 41 weeks presents with spontaneous rupture of membranes and
clear fluid; cervical exam is 2 cm/50%/-2. Which combination of findings would
most strongly indicate the need for immediate transfer of care rather than
continued out-of-hospital management?
A. Meconium-stained fluid with a Category I FHR tracing and 3 cm dilation after 4 hours
B. Persistent late decelerations with minimal variability despite maternal repositioning and IV
fluid bolus CORRECT
C. Contractions every 3-4 minutes with moderate variability and accelerations present
D. Arrest of dilation at 6 cm for 2 hours with adequate contractions and reassuring FHR
RATIONALE: Persistent late decelerations with minimal variability indicate uteroplacental
insufficiency and fetal hypoxemia, requiring immediate obstetric intervention. Options A, C, and D
represent either reassuring or manageable findings that do not mandate immediate transfer per
ACOG/NARM guidelines.
Page 2
,Q2 SYNTHESIZE ANTEPARTUM RISK FACTORS AND DIAGNOSTIC FINDINGS TO DETERMINE
APPROPRIATE MIDWIFERY MANAGEMENT AND REFERRAL THRESHOLDS
Which statement best reflects the current evidence regarding delayed cord
clamping in term and preterm neonates, and how should a midwife integrate this
into practice?
A. Delayed clamping for 30-60 seconds is recommended for term infants only; preterm infants
benefit from immediate clamping to reduce jaundice.
B. Delayed clamping for at least 30-60 seconds is recommended for both term and preterm
infants, improving iron stores and reducing intraventricular hemorrhage in preterm infants.
CORRECT
C. Delayed clamping increases the risk of polycythemia and should be avoided in all neonates
requiring resuscitation.
D. Delayed clamping has no significant benefit in high-resource settings and is not
recommended by ACOG.
RATIONALE: ACOG and WHO recommend delayed cord clamping for at least 30-60 seconds for
both term and preterm infants, with evidence of improved iron status and reduced IVH in preterm
infants. Immediate clamping is not supported, and delayed clamping is compatible with
resuscitation when needed.
Q3 SYNTHESIZE ANTEPARTUM RISK FACTORS AND DIAGNOSTIC FINDINGS TO DETERMINE
APPROPRIATE MIDWIFERY MANAGEMENT AND REFERRAL THRESHOLDS
A client at 28 weeks presents with a fundal height of 24 cm and a history of two
prior first-trimester losses. Which combination of findings would most increase
suspicion for a condition requiring referral for targeted ultrasound and possible
cerclage?
A. Fundal height lag with normal fetal movement and no cervical changes
B. Shortened cervix (<25 mm) on transvaginal ultrasound with funneling and prior
second-trimester loss CORRECT
C. Fundal height lag with normal amniotic fluid and no prior pregnancy losses
D. Normal cervical length with history of two first-trimester losses and no current symptoms
RATIONALE: A shortened cervix with funneling and a history of second-trimester loss is classic
for cervical insufficiency, warranting cerclage consideration. Fundal height lag alone or
first-trimester losses without cervical changes do not meet criteria for cerclage.
Page 3
, Q4 SYNTHESIZE ANTEPARTUM RISK FACTORS AND DIAGNOSTIC FINDINGS TO DETERMINE
APPROPRIATE MIDWIFERY MANAGEMENT AND REFERRAL THRESHOLDS
Which of the following best explains the physiologic rationale for using a
hands-and-knees position during labor when a persistent occiput posterior
position is suspected?
A. It increases pelvic outlet diameter by 1-2 cm through sacral nutation.
B. It reduces pressure on the vena cava and improves placental perfusion.
C. It uses gravity to encourage fetal rotation by altering the angle of the pelvic inlet and reducing
lumbar lordosis. CORRECT
D. It decreases uterine contractility to allow fetal descent.
RATIONALE: The hands-and-knees position can facilitate fetal rotation by changing the pelvic
inlet angle and reducing lumbar lordosis, which may dislodge a persistently posterior fetal head.
Options A and B describe other mechanisms not specific to rotation, and D is incorrect as it
would not promote descent.
Q5 SYNTHESIZE ANTEPARTUM RISK FACTORS AND DIAGNOSTIC FINDINGS TO DETERMINE
APPROPRIATE MIDWIFERY MANAGEMENT AND REFERRAL THRESHOLDS
A postpartum client at 24 hours post-vaginal delivery has a hematocrit drop from
34% to 26%, heart rate 118, BP 98/60, and reports dizziness. Which finding is most
consistent with a delayed postpartum hemorrhage secondary to uterine atony?
A. Boggy uterus with excessive lochia and clots CORRECT
B. Firm uterus with bright red bleeding and no clots
C. Firm uterus with dark lochia and no active bleeding
D. Boggy uterus with minimal lochia and no clots
RATIONALE: Delayed postpartum hemorrhage from uterine atony typically presents with a boggy
uterus and excessive lochia with clots. A firm uterus suggests other causes (e.g., laceration), and
minimal lochia does not match atony.
Page 4
