AWHONN Intermediate Fetal Monitoring TEST EXAM 2024 AND PRACTICE QUESTIONS |ACCURATE ANS, Exams of Nursing

Download AWHONN Intermediate Fetal Monitoring TEST EXAM 2024 AND PRACTICE QUESTIONS |ACCURATE ANS and more Exams Nursing in PDF only on Docsity! AWHONN Intermediate Fetal Monitoring TEST EXAM 2024 AND PRACTICE QUESTIONS |ACCURATE ANSWERS| VERIFIED FOR GUARANTEED PASS |GRADED A |NEW VERSION with 100+ questions 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 Based on the tracing, the most appropriate interventions are: - ANSWER B. Decrease oxytocin from 14 to 7 mU/min and start a 500-mL IVFB. Which of the following is a correct interpretation of the tracing? - ANSWER C. The tracing of uterine activity requires palpation for accurate assessment The nurse supports maternal coping to appropriately assist Robin because - ANSWER A. Reducing maternal catecholamine production enhances blood flow to the uterus Describe the type of variability seen in the majority of the tracing. - ANSWER C. Absent Identify appropriate interventions to implement based on this tracing. - ANSWER B. Palpate uterus, adjust toco, assist patient to lateral position. What does the EFM tracing above and the observed patient assessment raise your suspicion of? - ANSWER B. Placental abruption What is the physiologic goal of top priority for Robin? - ANSWER A. Maximize oxygenation What bedside interventions are important at this time? - ANSWER C. Notify provider of vaginal bleeding, EFM tracing, and request presence at the bedside. If the nurse does not get the appropriate response from the provider, the next step is - ANSWER B. Activate the chain of communication (command) What is the correct interpretation of the tracing? - ANSWER A. Sinusoidal pattern The tracing in question 29 is which category? - ANSWER C. Category III 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 BE: -7.6 What is the correct interpretation of the cod blood gas? - ANSWER A. Respiratory acidemia 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 True or False: Moderate variability reliably predicts the absence of metabolic acidemia at the time it is observed - ANSWER True Paper speed for fetal monitoring in the US is... - ANSWER 3cm/min Where is the baseline FHR regulated? - ANSWER Intrinsic cardiac pacemakers, SA node (110-160bpm) and AV node (40-60bpm) Baseline FHR decreases with gestational age due to... - ANSWER Increasing parasympathetic tone At what gestational age are FHR accelerations expected to be 15x15? - ANSWER 32 weeks. Under 32 weeks, 10x10 is acceptable. Risk Management is... - ANSWER any activity, process, or policy to reduce liability Quality assurance is... - ANSWER activities and programs intended to improve quality of care A sentinel event is... - ANSWER any unanticipated event resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient's illness Nonmaleficence is... - ANSWER the principle of not doing harm Beneficence is... - ANSWER an act of charity, mercy, and kindness with a strong connotation of doing good to others, including moral obligation Personal autonomy is... - ANSWER the capacity to decide for oneself and pursue the course of action in one's life, often regardless of any particular moral content Fetal oxygenation consists of what two basic elements: - ANSWER Transfer of oxygen from the environment to the fetus (extrinsic factors/external environment) and Fetal response to interruption of oxygen transfer (intrinsic factors/internal environment) Conditions that increase oxygen consumption include: - ANSWER Exercise, stress, fever, tissue healing, pregnancy, and labor Oxygen consumption increases: ___ during pregnancy, another ___ in a twin gestation, and another _______ during labor - ANSWER 20%. 10%, 40%-60%. True or False: Oxygen delivery is increased in pregnancy and labor because oxygen consumption is also increased. - ANSWER True True or False: Oxygen transfer across the placental blood-blood barrier occurs faster than carbon dioxide. - ANSWER False. It occurs slower, therefor interruption in the blood flow affects oxygen transfer greater than carbon dioxide transfer Maternal chronic disease processes that decrease the size of the placenta will decrease the exchange of gases and other substances. This may result in... - ANSWER FGR and fetal metabolic acidemia What are the components of the umbilical cord? - ANSWER 1 vein, 2 arteries, and Wharton's jelly The umbilical vein carries... - ANSWER oxygen rich blood from the placenta to the fetus The umbilical arteries carry... - ANSWER deoxygenated blood from the fetus to the placenta Wharton's Jelly is responsible for... - ANSWER protecting the umbilical cord from compression Fetal response to hypoxemia (hint: think about cord gas content) - ANSWER Decreased O2 content in blood, umbilical artery PaO2 goes below 15-25mmHg Maternal hypoxemia (decreased O2 content in blood) may lead to... - ANSWER Fetal hypoxia (caused by decreased O2 in the tissues) Fetal hypoxia, caused by decreased O2 to the tissues due to maternal hypoxemia, may lead to.... - ANSWER Fetal metabolic acidosis Fetal metabolic acidosis is the result of what in the tissues? - ANSWER Increased lactic acid A decrease in pH and buffers... - ANSWER Metabolic acidemia True or False: Metabolic acidemia may lead to fetal hypertension - ANSWER False, it may lead to fetal hypotension Normal fetal PaO2 is... - ANSWER 30mmHg Normal hemoglobin saturation is... - ANSWER 50-70% True or False: fetal blood has a higher concentration of hemoglobin and higher affinity than maternal blood - ANSWER True Fetal circulation preferentially shifts higher concentrations of oxygen to organs that consume the most, like the... - ANSWER Heart, brain, and adrenals The fetus has a higher _________ and ______________ relative to its body size compared to the adult - ANSWER heart rate and cardiac output Aerobic metabolism is maintained until... - ANSWER The available oxygen in the intervillous space decreases to 50% of normal levels True or False: With transient hypoxemia, the normoxic fetus can compensate by redistributing blood flow to the vital organs and the FHR will slow to consume less oxygen - ANSWER True Baroreceptors ("stretch receptors").... - ANSWER Sense pressure changes in the BP When fetal BP increases, baroreceptor stimulation results in parasympathetic stimulation which.... - ANSWER Slow the FHR True or False: Baroreceptor stimulation causes vagal stimulation, a reflex bradycardia and vasodilation that is nearly instantaneous - ANSWER True What is placental reserve? - ANSWER Oxygen that is in the placenta during a contraction when no other blood flow is entering the placenta Compensatory mechanisms in the hypoxic fetus: - ANSWER Redistribution of blood flow to maintain O2 to vital organs (redistribution decreases oxygen consumption) The Cental Nervous System is made of the Autonomic and Voluntary systems. Which is divided into Sympathetic and Parasympathetic systems? - ANSWER Autonomic Sympathetic nervous system: - ANSWER Located in the heart muscle. Stimulation of the heart muscle by the sympathetic nervous system results in the release of ______________, which _________ the FHR to ________ cardiac output. - ANSWER Norepinephrine. Increases. Increase. Which medication will block the release of norepinephrine and therefore cause a drop in the FHR? - ANSWER Propranolol Parasympathetic nervous system consists of... - ANSWER Vagus fibers in the SA and AV nodes. Stimluation of the vagus fibers in the SA and AV nodes will cause... - ANSWER A drop in the FHR Which medication will block the vagus fibers and cause an increase in the FHR? - ANSWER Atropine. Baroreceptors respond to... - ANSWER Pressure (Fetal BP with a variable) Fetal chemoreceptors are stimulated by: A. An increase in CO2 B. A decrease in CO2 C. An increase in O2 - ANSWER A. An increase in CO2 When chemoreceptors are stimulated, the FHR will: A. Decrease or decelerate B. Increase of accelerate C. Increase or decrease - ANSWER C. Increase or decrease When fetal baroreceptors are stimulated by rising pressure, the FHR will: A. Decrease or decelerate B. Increase or accelerate C. Remain stable - ANSWER A. Decrease or decelerate Uterine blood flow through the placenta can be decreased by: A. Maternal hyper-oxygenation B. Maternal hypotension C. Contractions that last 35 seconds - ANSWER B. Maternal hypotension Uteroplacental blood flow may also be diminished by procedures and interventions performed by healthcare team members such as: A. IV analgesia B. Maternal lateral position C. Following regional anesthesia - ANSWER C. Following regional anesthesia Umbilical Vein carries: A. Oxygenated blood to the fetus B. Deoxygenated blood away from the fetus C. Carbon Dioxide away from the fetus - ANSWER A. Oxygenated blood to the fetus Umbilical arteries carry: A. Oxygenated blood to the fetus B. Deoxygenated blood away from the fetus C. Oxygenated blood away from the fetus - ANSWER B. Deoxygenated blood away from the fetus When lactic acid builds up in the fetal circulation: A. Hydrogen ions are released B. Hydrogen ions decrease in the blood C. The buffer system gets activated - ANSWER C. The buffer system gets activated When the buffer or base gets used up due to the need to neutralize the lactic acid, the results of a fetal blood sample will show: A. An increase in the pH B. An increase in the base deficit (depletion of base) C. No change - ANSWER B. An increase in the base deficit (depletion of base) Base deficit/excess is the parameter that is used to distinguish between: A. Metabolic acidosis and a low pH B. Metabolic acidosis and a respiratory acidosis C. Metabolic acidosis and respiratory alkalosis - ANSWER B. Metabolic acidosis and a respiratory acidosis When a positive response (acceleration of the FHR) is achieved in response to fetal scalp stimulation: A. It is an indication of the presence of fetal metabolic acidemia B. There is an absence of fetal metabolic acidemia C. The fetus needs to have a fetal blood gas drawn and evaluated - ANSWER B. There is an absence of fetal metabolic acidemia Acidemia is when there is an increase in: A. Hydrogen ions in the blood B. Hydrogen ions in the tissue C. Hydrogen ions in the buffer system - ANSWER A. Hydrogen ions in the blood Acidosis occurs when there is an increase in: A. Hydrogen ions in the blood B. Hydrogen ions in the tissue C. Hydrogen ions in the buffer system - ANSWER B. Hydrogen ions in the tissue Hypoxemia results from a decrease in: A. Oxygen in the blood B. Oxygen in the tissue C. Oxygen content in the tissue and blood - ANSWER A. Oxygen in the blood The interruption of oxygen transfer to the fetus may result in the fetal need for: A. More lactic acid B. More carbon dioxide C. Buffers - ANSWER C. Buffers The buildup of lactic acid causes: A. A release of hydrogen ions B. A decrease of hydrogen ions in the blood (acidemia) C. An increase in the hydrogen ion concentration in the tissues (acidosis) - ANSWER C. An increase in the hydrogen ion concentration in the tissues (acidosis) To neutralize the increase in lactic acid, the fetal response is to begin using: A. Sodium Bicarbonate (NaHCO3) B. Sodium Pentathol Prolonged deceleration is... - ANSWER Decrease is FHR below baseline by >/= 15bpm lasting >/= 2minutes but < 10minutes from onset to return to baseline Recurrent is... - ANSWER Occurs with >/= 50% of contractions in a 20-minute period Intermittent is... - ANSWER Occurs with < 50% of contractions in a 20-minute period Sinusoidal is... - ANSWER Visually apparent undulating sine wave-like pattern in FHR baseline and cycle frequency of 3-5 per minute which persists for >/= 20-minutes True or False: Baseline variability is caused by sympathetic and parasympathetic signals that regulate the FHR in response to moment-to- moment changes (fetal position, pCO2, blood pressure, etc.). - ANSWER True True or False: In fetal baseline variability, the slight corrections (up and down) with each heartbeat helps optimize fetal cardiac output and maximize the distribution of oxygenated blood to the fetal tissues. - ANSWER True In FHR patterns, periodic changes are associated with... - ANSWER Uterine contractions In FHR patterns, episodic changes are not associated with... - ANSWER Uterine contractions What is the mechanism of early deceleration? - ANSWER Pressure on the fetal head --> Increased intracranial pressure --> Alteration in cerebral blood flow --> central vagal stimulation --> FHR deceleration What is the mechanism of late deceleration? - ANSWER Decreased uteroplacental oxygen transfer to fetus --> Chemoreceptor stimulus --> Catecholamine production --> Fetal HTN --> Baroreceptor stimulus - -> Parasympathetic response --> Deceleration In the presence of fetal metabolic acidemia, late decelerations may result from direct hypoxic myocardial depression. During this period of fetal metabolic acidemia, what will be absent from the FHR tracing? - ANSWER Moderate variability and Accelerations What is the mechanism of variable deceleration? - ANSWER Partial occlusion of umbilical vein --> Chemoreceptor stimulus --> Catecholamine production --> Complete occlusion of umbilical vasculature -- > Baroreceptor stimulus --> Deceleration --> Partial occlusion of umbilical vein --> Return to baseline FHR Sinusoidal FHR is usually associated with _____________, but could also be linked to ________________, ____________, or _____________________________________. - ANSWER fetal anemia, chorioamnionitis, fetal sepsis, administration of narcotic analgesics. Causes of prolonged deceleration include... - ANSWER Interruption of uteroplacental perfusion or oxygen exchange, interruption of umbilical blood flow, and vagal stimulation Interruption of uteroplacental perfusion may be caused by uterine ____________, maternal ___________, maternal _______, placental _________, uterine _______. - ANSWER tachysystole, hypotension, hypoxia, abruption, rupture Interruption of umbilical blood flow may be caused by cord ___________, cord ________, ruptured ___________. - ANSWER compression, prolapse, vasa previa Vagal stimulation may be caused by profound ________________ or rapid _____________ - ANSWER head compression, fetal descent Category I FHR tracing includes A. Baseline FHR 110-160 bpm B. Moderate variability C. Accelerations (absent or present) D. Early Decelerations (absent or present) E. Late or Variable Decelerations (absent or present) F. A, B, and E G. All except E - ANSWER G. All except E. Category II FHR tracing includes A. Baseline FHR 110-150 B. Minimal variability C. Accelerations (absent or present) D. Early Decelerations (absent or present) E. Late or Variable Decelerations (absent or present) F. A, B, and E G. All tracings not categorized as I or III - ANSWER G. All tracings not categorized as I or III Category III FHR tracing includes absent variability and A. Recurrent late decelerations B. Recurrent variable decelerations C. Baseline FHR 110-150 D. Baseline FHR <110 E. Sinusoidal pattern F. A, B, C, and E G. All of the above - ANSWER F. A, B, C, and E What are the components of uterine contraction assessment? - ANSWER Frequency (start of 1 contraction to beginning of next), Duration (length of contraction in seconds), Intensity (strength of contraction noted by either palpation or IUPC), and Resting tone (uterine tone between contractions noted by either palpation or IUPC) In normal uterine activity, there should be </= _ contractions in __ minutes, averaged over a __-minute window. In tachysystole, there will be > _ contractions in __ minutes, averaged over a __-minute window. - ANSWER 5, 10, 30. 5, 10, 30. Intermittent Auscultation frequency: Latent Phase (<6cm) =