AWHONN ADVANCED FETAL MONITORING LATEST EXAM WITH 100 QUESTIONS AND ANSWERS, Exams of Nursing

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AWHONN ADVANCED FETAL MONITORING

LATEST EXAM WITH 100 QUESTIONS AND

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They are constricted which decreases blood flow - ANSWER What happens to the spiral arteries during pre-e? The aorta and vena cava get compressed (20 weeks) - ANSWER 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 - ANSWER Why does maternal hypotension happen after regional analgesia? 60% - ANSWER What percentage is uteroplacental blood flow decreased by during cxts? Environment to lungs to heart to vasculature to uterus to placenta to umbilical cord - ANSWER Explain the pathway for maternal- fetal exchange for fetal oxygenation (basic)

Limbs, kidneys, and descending aorta - ANSWER Where is the least O2 blood in the fetus? Umbilical vein and ductous venous - ANSWER Where is the most O2 blood in the fetus? Ductus venosus - ANSWER 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 - ANSWER 3 important shunts in fetal circulation Foramen Ovale - ANSWER connects the two atria in the fetal heart Allows O2 blood to flow through the heart and directly to the brain Ductus Arteriosus - ANSWER a blood vessel in a fetus that bypasses pulmonary circulation by connecting the pulmonary artery directly to the ascending aorta 80 - 100 mL/kg - ANSWER What is a normal blood volume for a fetus at term? Increased heart rate - ANSWER What happens if you stimulate the sympathetic nervous system? Regulates the sympathetic - ANSWER What does the parasympathetic nervous system do?

Increased heart rate - ANSWER What happens when catecholamines (sympathetic) get released? The sympathetic develops first so there is no parasympathetic to regulate the heart rate - ANSWER Why do pre-termers have increased heart rates? Acetylcholine is released which decreases the intrinsic heart rate Vagus stimulation - ANSWER What happens when the parasympathetic nervous system is stimulated? Protect Regulates BP - ANSWER What do baroreceptors do? Decreased FHR, BP and CO - ANSWER 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 - ANSWER What happens when there is cord compression (in regards to baroreceptors)? Variables - ANSWER What decels relate to baroreceptors? Lates - ANSWER What decels relate to chemoreceptors? Increased PCO

Decreased PO2 and pH - ANSWER What action takes place when chemoreceptors are stimulated? Bradycardia and hypertension - ANSWER What effect do chemoreceptors have? Decreased or absent variability - ANSWER The stoke volume does not fluctuate - ANSWER What differs in fetal CO from adult CO? The CO decreases which leads to hypoxia and acidemia - ANSWER What happens when the fetal heart decreases (in regards to CO)? 51 - 56% - ANSWER 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 O2 blood - ANSWER 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 - ANSWER What is the fetal response to acute hypoxia

anaerobic metabolism - ANSWER 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). - ANSWER Explain the oxygenation depletion cascade 60 - 90 minutes - ANSWER How one does it take for significant acidemia to take place? Adrenergic activity - ANSWER What is marked variability mediated by? Opioids, magnesium, and tobacco (medications or drugs) Fetal sleep cycles Fetal acidemia- there will be no accels here - ANSWER What are things that can cause decreased variability? 10x10 - ANSWER 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 - ANSWER Describe the reasoning for early decels

Uteroplacental insufficiency results in decreased maternal/fetal O2 transfer - ANSWER Describe the physiology of a late decel It's neurogenic Exclude clinically significant acidemia Provide interventions to increase perfusion - ANSWER What do late decels with moderate variability mean and indicate? Means myocardial depression Expedited delivery - ANSWER 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 - ANSWER What are 3 causes of prolonged decels? Vasa previa - ANSWER 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 - ANSWER What nervous system has control over bradycardia? Fever

Dehydration Infection Medications- terbutaline, albuterol, atropine, cocaine, or caffeine Medical conditions- hyperthyroidism - ANSWER What are some maternal conditions that can lead to fetal tachycardia? Fetal bleeding- placental abruption Fetal anemia Fetal sepsis Fetal hypoxia Arrhythmias - ANSWER What are some fetal conditions that can cause tachycardia? Severe fetal anemia- ruptured vasa previa, TTTS, Rh isoimmunization Severe metabolic acidemia - ANSWER What are causes of sinusoidal pattens? Every 30 mins - ANSWER 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 - ANSWER 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 - ANSWER At what rate is exogenous oxytocin at for the mother during the first stage of labor?

3 mu - ANSWER At what rate is exogenous oxytocin at for the fetus during the first stage of labor? 10 to 15 minutes - ANSWER What is the biologic half-life of oxytocin? 30 to 60 minutes - ANSWER How long does it take to reach a steady state of plasma concentration for Pitocin? Cat 1 - ANSWER What category rules out fetal acidemia? Severe astha, cardiac issues, and ecclampic seizures - ANSWER What maternal conditions greatly impact fetal oxygenation? intervillous space - ANSWER Where does the exchange of O 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 - ANSWER 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 - ANSWER Diffusion

Diffusion - ANSWER How is O2 transferred from mom to baby Carry O2 into intervillous space Are maximally dilated so they can not be increased - ANSWER 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 - ANSWER What are factors that can decrease uteroplacental blood flow? During the first stage of labor with recurrent they are both the cells that have not resolved with position changes - ANSWER When should an amnioinfusion be used? Late decelerations, active pushing, meconium, VBAC or TOLAC - ANSWER When should and amnioinfusion not be used? Maintain fetal physiologic reserve and maximize fetal oxygenation - ANSWER What is the main goal during the second stage of labor?

Pushing is approximately 6 to 8 seconds and repeated four times - ANSWER What is open glottis pushing? Fergusons reflex - ANSWER 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 - ANSWER What is a contraindication for terbutaline? 7.20-7. Greater than or equal to 7.10 - ANSWER What is normal pH in the umbilical artery? 49 to 56 Less than 60 - ANSWER What is the normal PCO2 for an umbilical artery? 22 to 24 greater than 22 - ANSWER What is the normal HCO3 in an umbilical artery?

• 2.7-(-3.6) Greater than - 12 - ANSWER 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 - ANSWER What is respiratory acidemia?

Decreased first Apgar then a normal APGAR - ANSWER 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 - ANSWER 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 - ANSWER What is metabolic acidemia? Metabolic acidemia - ANSWER Decreased pH, normal PCO2, decreased HCO3, decreased BE Respiratory acidemia - ANSWER 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 - ANSWER What is mixed acidemia?

Mixed acidemia - ANSWER Decreased pH, increased PCO2, decreased HCO3, decreased BE When the vessels are not protected by whartons jelly - ANSWER What is velamentous insertion of the umbilical cord? Prior history, hypertension, cigarette smoking, cocaine use, or blunt abdominal trauma - ANSWER What are some risk factors of abruptio placenta? It is a sympathetic response so catecholamines like norepinephrine and epinephrine are released to recuperate - ANSWER Why is there if you tachycardic response after a prolonged decel? Can decrease variability and accelerations - ANSWER What do narcotics to you in regards to fetal heart rates? Pseudo sinusoidal patterns - ANSWER What can stadol and Nubian cause in fetal heart rates? Decrease variability and increased uterine activity - ANSWER What can cocaine cause in regards to uterine activity and fetal heart rates? Decrease variability for 48 hours - ANSWER What can betamethasone cause in regards to fetal heart rate?

Increased fetal heart rate baseline and increase maternal heart rate - ANSWER 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 - ANSWER How do you fetal dopplers work? Convert FECG to fetal heart rate by measuring consecutive R to R wave intervals - ANSWER How do fetal scalp electrodes work? Increased caffeine intake - ANSWER What can cause an irregular rhythm in a fetus? Requires a risk benefit analysis Digoxin or other drugs like amiodarone - ANSWER What can be done to treat Fetal SVT? Maternal lupus - ANSWER What can cause a complete or third-degree heart block in a fetus? 50 to 70 bpm - ANSWER What ventricular rate in a fetus is associated with a complete or third-degree heart block? A pacemaker implantation - ANSWER 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 - ANSWER How can hypoxemia lead to a decreased AFI in a fetus? CST - ANSWER 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 - ANSWER What is a normal fetal movement count? Accelerations peak greater than 15 bpm above the baseline and last for greater than 15 seconds - ANSWER 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 - ANSWER 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 - ANSWER How many contractions are needed for a contraction stress test? No late or significant variable decelerations - ANSWER 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 - ANSWER What is a positive contraction stress test?

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