AWHONN ADVANCED FETAL MONITORING EXAM WITH GUARANTEED ACCURATE ANSWERS |VERIFIED, Exams of Nursing

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AWHONN ADVANCED FETAL MONITORING EXAM AWHONN ADVANCED FETAL MONITORING EXAM WITH GUARANTEED ACCURATE ANSWERS |VERIFIED Cat 1 - Accurate ✔✔✔ What category rules out fetal acidemia? Severe astha, cardiac issues, and ecclampic seizures - Accurate ✔✔✔ What maternal conditions greatly impact fetal oxygenation? intervillous space - Accurate ✔✔✔ Where does the exchange of O2 and nutrients take place? O2 enters the intervillous space via the maternal arteries, to the villi then the umbilical vein take the o2 blood to the fetus. The umbilical arteries take the deO2 blood from the baby through the villi and back to the mother - Accurate ✔✔✔ How is o2 blood transferred to the fetus? High to low concentration

Mom to fetus for O Low to high concentration for CO2 so baby to mom - Accurate ✔✔✔ Diffusion Diffusion - Accurate ✔✔✔ How is O2 transferred from mom to baby Carry O2 into intervillous space Are maximally dilated so they can not be increased - Accurate ✔✔✔ Explain spiral arteries in placenta Maternal conditions like pre-e and cardiac disease Maternal hypotension Placental changes- abruptions, infections, edema, or smaller size Excessive uterine activity Vasoconstriction - Accurate ✔✔✔ What are factors that can decrease uteroplacental blood flow? They are constricted which decreases blood flow - Accurate ✔✔✔ What happens to the spiral arteries during pre-e? The aorta and vena cava get compressed (20 weeks) - Accurate ✔✔✔ Why does the supine position cause decreased uteroplactenal blood flow? Blocks the sympathetic pathway

Pooling of blood in the lower extremities decreases blood flow back to moms heart which decreases blood flow to the fetus - Accurate ✔✔✔ Why does maternal hypotension happen after regional analgesia? 60% - Accurate ✔✔✔ What percentage is uteroplacental blood flow decreased by during cxts? Environment to lungs to heart to vasculature to uterus to placenta to umbilical cord - Accurate ✔✔✔ Explain the pathway for maternal- fetal exchange for fetal oxygenation (basic) Limbs, kidneys, and descending aorta - Accurate ✔✔✔ Where is the least O2 blood in the fetus? Umbilical vein and ductous venous - Accurate ✔✔✔ Where is the most O2 blood in the fetus? Ductus venosus - Accurate ✔✔✔ Connects the umbilical vein to the inferior vena cava, bypassing the liver Shunt that allows most O2 blood to fetal heart ductus venosus, foramen ovale, ductus arteriosus - Accurate ✔✔✔ 3 important shunts in fetal circulation Foramen Ovale - Accurate ✔✔✔ connects the two atria in the fetal heart Allows O2 blood to flow through the heart and directly to the brain

Ductus Arteriosus - Accurate ✔✔✔ a blood vessel in a fetus that bypasses pulmonary circulation by connecting the pulmonary artery directly to the ascending aorta 80-100 mL/kg - Accurate ✔✔✔ What is a normal blood volume for a fetus at term? Increased heart rate - Accurate ✔✔✔ What happens if you stimulate the sympathetic nervous system? Regulates the sympathetic - Accurate ✔✔✔ What does the parasympathetic nervous system do? Increased heart rate - Accurate ✔✔✔ What happens when catecholamines (sympathetic) get released? The sympathetic develops first so there is no parasympathetic to regulate the heart rate - Accurate ✔✔✔ Why do pre-termers have increased heart rates? Acetylcholine is released which decreases the intrinsic heart rate Vagus stimulation - Accurate ✔✔✔ What happens when the parasympathetic nervous system is stimulated? Protect

Regulates BP - Accurate ✔✔✔ What do baroreceptors do? Decreased FHR, BP and CO - Accurate ✔✔✔ What effect do baroreceptors have on the fetus? The cord gets compressed and then fetal BP increased which triggers baroreceptors that decreased the FHR which produces a variable - Accurate ✔✔✔ What happens when there is cord compression (in regards to baroreceptors)? Variables - Accurate ✔✔✔ What decels relate to baroreceptors? Lates - Accurate ✔✔✔ What decels relate to chemoreceptors? Increased PCO Decreased PO2 and pH - Accurate ✔✔✔ What action takes place when chemoreceptors are stimulated? Bradycardia and hypertension - Accurate ✔✔✔ What effect do chemoreceptors have? Decreased or absent variability - Accurate ✔✔✔ The stoke volume does not fluctuate - Accurate ✔✔✔ What differs in fetal CO from adult CO?

The CO decreases which leads to hypoxia and acidemia - Accurate ✔✔✔ What happens when the fetal heart decreases (in regards to CO)? 51-56% - Accurate ✔✔✔ What is the fetal Hct? Increased Hct Fetal Hbg has a higher affinity for O Fetal HR and CO is increased which results in rapid circulation of O blood - Accurate ✔✔✔ What are 3 fetal physiologic adaptations from the mother? Increased blood flow to vital organs (heart, brain, adrenals) Decreased blood flow to spleen, kidneys, and limbs FHR slows and myocardium decreases O2 consumption - Accurate ✔✔✔ What is the fetal response to acute hypoxia anaerobic metabolism - Accurate ✔✔✔ The metabolism that takes place in the absence of oxygen; the principle product is lactic acid. Aerobic metabolism with O2 then there's hypoxemia (decrease in O2) which leads to tissue hypoxia. The body is forced to resort to anaerobic metabolism which leads to a buildup of lactic acid in the blood. This then causes metabolic acidosis (causes cellular death). - Accurate ✔✔✔ Explain the oxygenation depletion cascade

60-90 minutes - Accurate ✔✔✔ How one does it take for significant acidemia to take place? Adrenergic activity - Accurate ✔✔✔ What is marked variability mediated by? Opioids, magnesium, and tobacco (medications or drugs) Fetal sleep cycles Fetal acidemia- there will be no accels here - Accurate ✔✔✔ What are things that can cause decreased variability? 10x10 - Accurate ✔✔✔ What accelerations do gestations less than 32 weeks need? Fetal head compression leads to altered cerebral blood flow which produces a vagabond reflex and cardiac slowing - Accurate ✔✔✔ Describe the reasoning for early decels Uteroplacental insufficiency results in decreased maternal/fetal O transfer - Accurate ✔✔✔ Describe the physiology of a late decel It's neurogenic Exclude clinically significant acidemia Provide interventions to increase perfusion - Accurate ✔✔✔ What do late decels with moderate variability mean and indicate?

Means myocardial depression Expedited delivery - Accurate ✔✔✔ What do late decels with decreases variability mean and indicate? Interruption of uteroplacental perfusion or exchange- tachysystole, maternal hypotension, maternal hypoxia (seizure or cardiac arrest), placental abruption, or uterine rupture Interruption of umbilical blood flow- cord compression, cord prolapse, or ruptured vasa previa - Accurate ✔✔✔ What are 3 causes of prolonged decels? Vasa previa - Accurate ✔✔✔ Presence of fetal (not placental) blood vessels that cross the internal cervical os (marginal or velamentous cord insertions or with succenturiate lobes). Umbilical cord crosses the internal cervial os parasympathetic nervous system - Accurate ✔✔✔ What nervous system has control over bradycardia? Fever Dehydration Infection Medications- terbutaline, albuterol, atropine, cocaine, or caffeine Medical conditions- hyperthyroidism - Accurate ✔✔✔ What are some maternal conditions that can lead to fetal tachycardia?

Fetal bleeding- placental abruption Fetal anemia Fetal sepsis Fetal hypoxia Arrhythmias - Accurate ✔✔✔ What are some fetal conditions that can cause tachycardia? Severe fetal anemia- ruptured vasa previa, TTTS, Rh isoimmunization Severe metabolic acidemia - Accurate ✔✔✔ What are causes of sinusoidal pattens? Every 30 mins - Accurate ✔✔✔ How often do you chart heart tones for a low risk pt from latent phase up to the 2nd stage (until pushing)? Ever 15 mins - Accurate ✔✔✔ How often do you chart heart tones from the latent phase up until the second stage of labor with a high risk patient? 2 to 4 mu - Accurate ✔✔✔ At what rate is exogenous oxytocin at for the mother during the first stage of labor? 3 mu - Accurate ✔✔✔ At what rate is exogenous oxytocin at for the fetus during the first stage of labor?

10 to 15 minutes - Accurate ✔✔✔ What is the biologic half-life of oxytocin? 30 to 60 minutes - Accurate ✔✔✔ How long does it take to reach a steady state of plasma concentration for Pitocin? During the first stage of labor with recurrent they are both the cells that have not resolved with position changes - Accurate ✔✔✔ When should an amnioinfusion be used? Late decelerations, active pushing, meconium, VBAC or TOLAC - Accurate ✔✔✔ When should and amnioinfusion not be used? Maintain fetal physiologic reserve and maximize fetal oxygenation - Accurate ✔✔✔ What is the main goal during the second stage of labor? Pushing is approximately 6 to 8 seconds and repeated four times - Accurate ✔✔✔ What is open glottis pushing? Fergusons reflex - Accurate ✔✔✔ Spontaneous urge to push during labor that occurs when the presenting part (of the fetus) reaches the pelvic floor; may occur without full cervical effacement Any type of bleeding - Accurate ✔✔✔ What is a contraindication for terbutaline?

Greater than or equal to 7.10 - Accurate ✔✔✔ What is normal pH in the umbilical artery? 49 to 56 Less than 60 - Accurate ✔✔✔ What is the normal PCO2 for an umbilical artery? 22 to 24 greater than 22 - Accurate ✔✔✔ What is the normal HCO3 in an umbilical artery? -2.7-(-3.6) Greater than -12 - Accurate ✔✔✔ What is the normal BE for an umbilical artery? When there is a buildup of carbon dioxide in the fetus Can happen during cord compression - Accurate ✔✔✔ What is respiratory acidemia? Decreased first Apgar then a normal APGAR - Accurate ✔✔✔ What do normal Apgars look like for a baby with respiratory acidemia? The type of metabolism that takes place when there is no available oxygen so glucose is used where it is converted into lactic acid

The base attempts to neutralize the lactic acid so there is usually a buildup of hydrogen ions Can lead to metabolic acidemia - Accurate ✔✔✔ What is anaerobic metabolism? When the base gets depleted so there is a buildup of hydrogen ions in lactic acid within the fetus This decreases the pH within the fetus which can lead to possible cell death Continued decreased Apgars - Accurate ✔✔✔ What is metabolic acidemia? Metabolic acidemia - Accurate ✔✔✔ Decreased pH, normal PCO2, decreased HCO3, decreased BE Respiratory acidemia - Accurate ✔✔✔ Decreased pH, increased PCO2, normal HCO3, normal BE When there is some oxygen but not enough so the base still gets depleted but not quite as much - Accurate ✔✔✔ What is mixed acidemia? Mixed acidemia - Accurate ✔✔✔ Decreased pH, increased PCO2, decreased HCO3, decreased BE When the vessels are not protected by whartons jelly - Accurate ✔✔✔ What is velamentous insertion of the umbilical cord?

Prior history, hypertension, cigarette smoking, cocaine use, or blunt abdominal trauma - Accurate ✔✔✔ What are some risk factors of abruptio placenta? It is a sympathetic response so catecholamines like norepinephrine and epinephrine are released to recuperate - Accurate ✔✔✔ Why is there if you tachycardic response after a prolonged decel? Can decrease variability and accelerations - Accurate ✔✔✔ What do narcotics to you in regards to fetal heart rates? Pseudo sinusoidal patterns - Accurate ✔✔✔ What can stadol and Nubian cause in fetal heart rates? Decrease variability and increased uterine activity - Accurate ✔✔✔ What can cocaine cause in regards to uterine activity and fetal heart rates? Decrease variability for 48 hours - Accurate ✔✔✔ What can betamethasone cause in regards to fetal heart rate? Increased fetal heart rate baseline and increase maternal heart rate - Accurate ✔✔✔ What terbutaline cause? By sending and receiving US waves through the mothers abdomen

When the waves are reflected from moving objects like the fetal heart the frequency changes slightly This change is then analyzed by the electronics inside the transducer and converted into audible beeps - Accurate ✔✔✔ How do you fetal dopplers work? Convert FECG to fetal heart rate by measuring consecutive R to R wave intervals - Accurate ✔✔✔ How do fetal scalp electrodes work? Increased caffeine intake - Accurate ✔✔✔ What can cause an irregular rhythm in a fetus? Requires a risk benefit analysis Digoxin or other drugs like amiodarone - Accurate ✔✔✔ What can be done to treat Fetal SVT? Maternal lupus - Accurate ✔✔✔ What can cause a complete or third- degree heart block in a fetus? 50 to 70 bpm - Accurate ✔✔✔ What ventricular rate in a fetus is associated with a complete or third-degree heart block? A pacemaker implantation - Accurate ✔✔✔ How can a complete heart block be treated in a neonate?

Hypoxemia can lead to shunting which leads to decreased renal perfusion which then causes a decrease in AFI - Accurate ✔✔✔ How can hypoxemia lead to a decreased AFI in a fetus? CST - Accurate ✔✔✔ What is the most accurate test for evaluating risk of fetal death within seven days of a reassuring test? 10 distinct movements in two hours - Accurate ✔✔✔ What is a normal fetal movement count? Accelerations peak greater than 15 bpm above the baseline and last for greater than 15 seconds - Accurate ✔✔✔ What is a reactive NST for greater than 32 weeks? Accelerations with a peak of greater than 10 bpm above the baseline and duration of longer than 10 seconds - Accurate ✔✔✔ What is a reactive NST for less than 32 weeks? At least three contractions and a 10 minute span each lasting greater than 40 seconds - Accurate ✔✔✔ How many contractions are needed for a contraction stress test? No late or significant variable decelerations - Accurate ✔✔✔ What is a negative contraction stress test?

Recurrent late decelerations even if the frequency of contractions is less than three in a 10 minute span - Accurate ✔✔✔ What is a positive contraction stress test? Intermittent late or significant variable decelerations - Accurate ✔✔✔ What is a suspicious contraction stress test? An NST, fetal breathing movement, fetal movement, fetal tone, and amniotic fluid volume - Accurate ✔✔✔ What does a biophysical profile or BPP consist of? 8 to 10 - Accurate ✔✔✔ What is the normal value for a BPP? Four or less - Accurate ✔✔✔ What is a concerning BPP score? Loss of fetal tone - Accurate ✔✔✔ What is the most concerning in regards to a BPP? 5-25 - Accurate ✔✔✔ What is a normal AFI? Assess his vascular resistance to blood flow within the placenta Monitors for IUGR - Accurate ✔✔✔ What does a umbilical artery Doppler velocimetry do?