Advanced Fetal Monitoring: Practice Questions and Answers, Exams of Nursing

Download Advanced Fetal Monitoring: Practice Questions and Answers and more Exams Nursing in PDF only on Docsity! AWHONN ADVANCED FETAL MONITORING ACTUAL EXAM QUESTIONS AND AMSWERS Which of the following is an extrinsic influence on the FHR? - ANSWER>>C. Fetal- placental circulation The most highly oxygenated blood in fetal circulation is carried by: - ANSWER>>C. Ductus venosus If fetal arterial pressure begins to fall below normal levels: - ANSWER>>A. Baroreceptors cause vasoconstriction and increase the FHR Fetal heart rate variability is defined as fluctuations in the baseline that are irregular in and . - ANSWER>>B. Amplitude and frequency An increase in the fetal heart rate immediately preceding a variable deceleration is caused by: - ANSWER>>A. Occlusion of the umbilical vein When assessing a FHR tracing, the first step is to: - ANSWER>>C. Establish the baseline rate Which deceleration in the FHR is considered benign and does not require an intervention to correct? - ANSWER>>A. Early deceleration If the umbilical vein is the only vessel occluded during cord compression - ANSWER>>B. Oxygenated blood may be restricted from being delivered to the fetus During a fetal sleep cycle, FHR variability is usually . - ANSWER>>C. Minimal Uterine tachysystole is defined as: - ANSWER>>B. >5 contractions in 10 mind over 30 minutes Maternal-fetal oxygen and nutrient transfer takes place in the: - ANSWER>>B. intervillous space During a contraction, the tocodynamometer detects: - ANSWER>>A. Pressure created by tensing of uterine muscle Normal fetal heart rate baseline is: - ANSWER>>C. 110-160 bpm Following birth, a fetal cord blood sample is taken. The results are: pH: 6.95 pCO2: 86 mmHg pO2: 4mmHg BE: -18.6 mEq/L These results are best interpreted as: - ANSWER>>C. Mixed acidemia A characteristic of variable decelerations is: - ANSWER>>B. The onset of the deceleration is abrupt Stimulation of the vagus nerve in a healthy fetus will cause: - ANSWER>>A. A decrease in the fetal heart rate What is the baseline rate? - ANSWER>>B. 145 bpm What is the correct interpretation? - ANSWER>>B. Baseline of 160 bpm with recurrent late decelerations What is the primary physiologic goal? - ANSWER>>B. Maximize oxygenation Robin has a cesarean birth, Umbilical arterial cord blood gas results are as follows: pH: 6.86 pCO2: 48 pO2: 4.2 BE: -23.7 These results meet the criteria for: - ANSWER>>B. Metabolic acidemia What is the baseline rate? - ANSWER>>B. 135 bpm What type of variability is observed? - ANSWER>>C. Moderate What do you observe in the tracing that rules out metabolic acidemia at this time? - ANSWER>>A: 15x15 accelerations What pattern is observed in the fetal heart tracing? - ANSWER>>A. Late decelerations What extrinsic factor can you identify as a possible cause for the observed pattern? - ANSWER>>C. Aging placenta What physiologic goals are priorities for Olivia's care? - ANSWER>>B. Maximize oxygenation and maintain appropriate uterine activity What bedside interventions are appropriate for Olivia at this time? - ANSWER>>C. Position change to a lateral position and initiate a 500-mL IVFB. What could Olivia's nurse do during second stage of labor to promote oxygenation? - ANSWER>>B. Encourage Olivia to push with every other contraction Did the fetal monitor tracing prior to delivery accurately predict the cor - ANSWER>>A> Yes, the presence of moderate variability rules out the metabolic acidemia. What is the baseline FHR? - ANSWER>>B. 160 bpm What type of variability is observed? - ANSWER>>A. Moderate What interventions are appropriate at this time? - ANSWER>>C. Reposition Shelby from left lateral to right lateral What type of pattern is observed in the tracing? - ANSWER>>B. Variable decelerations What category is this tracing? - ANSWER>>B. Category II What is the baseline rate? - ANSWER>>C. Unable to determine Based on your observation of the tracing, what action(s) is (are) required? - ANSWER>>B. Palpate Shelby's radial pulse to verify maternal vs. fetal heart rate Which statement most accurately reflects the EFM tracing? - ANSWER>>A. Maternal and fetal heart rates should be verified Which pattern in the fetal heart rate would increase suspicion of a nuchal cord? - ANSWER>>C. Variable decelerations Shelby delivers a male infant with Apgar scores of 2 and 3. Umbilical arterial cord blood gases show: pH: 6.92 pCO2: 79 pO2: 11 BE: -7.6 What is the correct interpretation of the cod blood gas? - ANSWER>>A. Respiratory acidemia A characteristic of variable decelerations is: - ANSWER>>The onset of the deceleration is abrupt Stimulation of the vagus nerve in a healthy fetus will cause: - ANSWER>>a decrease in fetal heart rate Umbilical arterial cord blood gas results are as follows pH: 6.86 pCO2: 48 pO2: 4.2 BE: -23.7 - ANSWER>>metabolic acidemia 110-160 -<<ANSWER ;normal fetal heart rate range infection, low o2, young -<<ANSWER ;what could it mean if FHR is high post date pregnancy -<<ANSWER ;what could it mean if FHR is low sonogram -<<ANSWER ;what is the number one way to know a babies age amnioinfusion -<<ANSWER ;what do you do if theres low amniotic fluid, variable decels kidneys, low urine output, low amniotic fluid -<<ANSWER ;if baby is stressed, the baby will divert the blood flow to the brain, heart, and adrenals. this organ won't get good blood flow which will lead to what? 2 -<<ANSWER ;what category tracing is absent variability without decels 3 -<<ANSWER ;what category tracing is absent variability with decels extrinsic -<<ANSWER ;influences on fetal heart patterns that are outside the fetus extrinsic -<<ANSWER ;what type of influences are associated with maternal-fetal exchange: -placenta -maternal utero placental circulation -fetal placental circulation -placental transfer -uterine blood flow -umbilical cord -amniotic fluid intervillous space -<<ANSWER ;ALL transfer takes place here transient hypoxemia -<<ANSWER ;all babies have this with uterine contraction but it's worse with a problematic placenta cord compression -<<ANSWER ;when is the only time you give an amnioinfusion intrinsic -<<ANSWER ;influences on fetal heart rate that are inside the babies heart ductus venosus, liver -<<ANSWER ;where is the most oxygenated blood foramen ovale -<<ANSWER ;where does the blood go to avoid the lungs moderate variability -<<ANSWER ;if the baby has this, then they DO NOT have metabolic acidosis infection, movement , loud noise, repositioning -<<ANSWER ;what would cause a sympathetic response (things speed up, accelerations) variable decel, early decal, post dates, head compression -<<ANSWER ;what would cause parasympathetic response vagus nerve -<<ANSWER ;what nerve decreases bp hypoxemia -<<ANSWER ;during this, the blood flow gets shunted to the brain heart and adrenals. can't tolerate labor fetal reserve -<<ANSWER ;the degree of hypoxemia a fetus can tolerate before true tissue hypoxia and acidosis occur normal baseline, moderate variability, no late or variable decels - <<ANSWER ;3 things that indicate fetal well being late or variable decels -<<ANSWER ;signs of utero-placental insufficiency change position -<<ANSWER ;what is the first thing you should do with recurrent late decels 7.10 or higher -<<ANSWER ;what should pH be 60 or lower -<<ANSWER ;what should CO2 be 12 or lower -<<ANSWER ;what should base excess or base deficit be respiratory -<<ANSWER ;if CO2 is greater than 60, what type of acidosis metabolic -<<ANSWER ;if base excess greater than 12, what type of acidosis baseline fetal heart rate, 5, 10 -<<ANSWER ;the approximate mean FHR rounded to increments of bpm during a minute window, excluding: well oxygenated -<<ANSWER ;what does variability show a sign that the baby is 3 -<<ANSWER ;what category is absent variability with recurrent decels 2 -<<ANSWER ;what category is absent variability without recurrent decels recurrent decels -<<ANSWER ;minimal variability is unlikely to be associated with hypoxia during labor unless with what? fetal hypoxemia -<<ANSWER ;marked variability may be related to what? periodic -<<ANSWER ;FHR pattern associated with uterine contractions, p is for pain episodic -<<ANSWER ;FHR pattern not associated with uterine contractions recurrent, 20 -<<ANSWER ;decelerations that occur with at least 50% of uterine contractions within a minute period intermittent, 20 -<<ANSWER ;decelerations that occur with less than 50% of uterine contractions within a minute period accelerations -<<ANSWER ;visually apparent abrupt increases in FHR above the baseline 30 -<<ANSWER ;accelerations go from onset to peak in less than seconds 15, 15 -<<ANSWER ;in fetus 32 weeks or more, the accelerations peak bpm and last for seconds from onset o return to baseline 10, 10 -<<ANSWER ;if fetus less than 32 weeks, the accelerations peak bpm and last for seconds from onset to return to baseline prolonged acceleration -<<ANSWER ;accelerations greater than 2 minutes but less than 10 minutes in duration gradual greater than 30 seconds from onset to nadir, nadir simultaneous with peak of contraction -<<ANSWER ;early decel definition gradual greater than 30 seconds from onset to nadir , nadir after peak of contraction - <<ANSWER ;late decel definition abrupt onset less than 30 seconds from onset to beginning of nadir, lasting more than 15 seconds but less than 2 minutes, depth more than 15 bpm - <<ANSWER ;variable decel definition decrease greater than 15 bpm lasting more than 2 minutes but less than 10 minutes - <<ANSWER ;prolonged decel definition metabolic acidosis -<<ANSWER ;late decels lead to decreased uteroplacental oxygenated and transfer to the fetus with acidemia. which acid base imbalance no can exaggerate response -<<ANSWER ;should you perform scalp stimulation during a decel baseline 110-160, moderate variability, no late or variable decels - <<ANSWER ;what does category 1 tracing need 2 -<<ANSWER ;category tracing, indeterminate, not predictive of abnormal fetal aid-base status, require evaluation , surveillance 2 -<<ANSWER ;what category tracing? -bradycardia without absent variability -tachycardia -minimal baseline variability -absence of induced acceleration after fetal stimulation -prolonged decels -recurrent late decels with moderate variability absent baseline variability and recurrent late decels, recurrent variable decels, bradycardia, OR sinusoidal -<<ANSWER ;category 3 tracings include either 3 -<<ANSWER ;what tracing requires prompt evaluation and expeditious resolution position change, discontinue tocolytics, IV fluids, oxygen -<<ANSWER ;what can you do for category 3 tracing frequency -<<ANSWER ;how far apart the contractions are from beginning of one to beginning of the other in minutes duration -<<ANSWER ;how long the contraction lasts in seconds intensity -<<ANSWER ;contractions -mild, moderate, or strong- palpation or internal monitor resting tone -<<ANSWER ;soft or hard, palpation or internal monitor 5, 10, 30 -<<ANSWER ;normal uterine activity- less than or equal to contractions in minutes averaged over a minute window 5, 10, 30 -<<ANSWER ;tachysystole - greater than contractions in minutes averaged over a ruptured membranes and 2 cm dilation -<<ANSWER ;fetal spiral electrode requires what moms heart rate -<<ANSWER ;when the heart rate goes up when contractions goes up, what is on the strip artifact -<<ANSWER ;results from mechanical limitations of the monitor, electronic interference or weak signal. appears as gaps or dots with external monitoring and irregular lines of varying lengths with a fetal scalp electrode hepatitis -<<ANSWER ;out of herpes, hiv, placenta previa, hepatitis, what can you use the fetal spiral electrode with fingertips -<<ANSWER ;when palpating to assess uterine activity, what do you put on the maternal abdomen over the area where changes in uterine firmness is best felt (usually funds) toco -<<ANSWER ;detects changes in shape of abdomen resulting from uterine tension pressure -<<ANSWER ;what does the toco detect from the uterine muscle intrauterine pressure catheter -<<ANSWER ;quantitative measurement for strength of contractions and resting tone; still have to palpate variable decels -<<ANSWER ;what do you do an amnioinfusion for?; can be gravity or on the pump. make sure what goes in comes out montevideo units -<<ANSWER ;subtract resting tone from peak uterine activity for each contraction and add them all up in a 10 minute period increased iv fluids -<<ANSWER ;what is associated with shorter labor duration and lower frequency of both prolonged labor and oxytocin use category 3 -<<ANSWER ;never have pitocin running with this tracing 10 liters per minute nonrebreather -<<ANSWER ;administer how much supplemental oxygen and with what mask 10-12 minutes -<<ANSWER ;half life of oxytocin; need 3-4 half lives to reach steady concentration 0.5-2 -<<ANSWER ;starting dose of oxytocin 1-2 -<<ANSWER ;increase ocxytoci mU/minute every 30-60 minutes no -<<ANSWER ;should you continue oxytocin after active labor is established