North American Registry of Midwives (NARM) Practice Exam

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What should be the immediate action after checking the fetal heart rate when membranes rupture?

Perform a cesarean section
Administer analgesia
Perform a vaginal exam to feel for a prolapsed cord
Initiate fetal monitoring

The correct answer is: Perform a vaginal exam to feel for a prolapsed cord

When membranes rupture, assessing for a prolapsed umbilical cord is a critical action. This situation is particularly urgent because a prolapsed cord can lead to cord compression, which may compromise the fetal heart rate and oxygenation, potentially resulting in fetal distress. By performing a vaginal examination as soon as the membranes rupture, the midwife can determine whether the cord is positioned in the vagina, indicating a need for immediate intervention to relieve pressure on the cord and manage the situation appropriately. Initiating fetal monitoring is certainly important, as it provides ongoing information about the fetal heart rate and well-being, but it does not address the immediate concern of assessing potential cord prolapse. Immediate actions should focus on the health and safety of the fetus, especially after a significant event like membrane rupture. Therefore, while monitoring is essential, ensuring there is no prolapsed cord through an immediate vaginal examination takes precedence in this scenario.