DOSAGE CALCULATION RN MATERNAL NEWBORN ONLINE PRACTICE ASSESSMENT 3.1, Exams of Nursing

Download DOSAGE CALCULATION RN MATERNAL NEWBORN ONLINE PRACTICE ASSESSMENT 3.1 and more Exams Nursing in PDF only on Docsity! 1 | P a g e NCC EFM FINAL CERTIFICATION EXAM 2024-2025 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+|NEWEST|GUARANTEED PASS |LATEST UPDATE _______ denotes an increase in hydrogen ions in the fetal blood. A. Acidosis B. Acidemia C. Hypercapnia B. Acidemia _______ _______ occurs when there is low bicarbonate (base excess) in the presence of normal pressure of carbon dioxide (PCO2) values. A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis A. Metabolic acidosis _______ _______ occurs when there is high PCO2 with normal bicarbonate levels. A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis B. Respiratory acidosis _______ _______ occurs when the HCO3 concentration is lower than normal. A. Base deficit 2 | P a g e B. Base excess C. Metabolic acidosis A. Base deficit _______ _______ occurs when the HCO3 concentration is higher than normal. A. Base deficit B. Base excess C. Metabolic acidosis B. Base excess _______ is defined as the energy-consuming process of metabolism. Anabolism _______ is defined as the energy-releasing process of metabolism. Catabolism Normal oxygen saturation for the fetus in labor is ___% to ___%. 30% to 65% pH 7.05 PO2 21 PCO2 72 HCO3 24 Base excess -12 A. Metabolic acidosis B. Respiratory acidosis C. Mixed acidosis B. Respiratory acidosis pH 7.0 PO2 18 PCO2 54 HCO3 20 Base deficit 14 A. Metabolic acidosis B. Respiratory acidosis C. Mixed acidosis A. Metabolic acidosis pH 7.02 PO2 17 PCO2 72 5 | P a g e Which assessment or intervention would be least appropriate in a patient whose FHR tracing revealed tachycardia and a prolonged deceleration? A. Change maternal position to right lateral B. Further assess fetal oxygenation with scalp stimulation C. Perform a vaginal exam to assess fetal descent B. Further assess fetal oxygenation with scalp stimulation Only used with normal baseline rate and never during decels; not an intervention Which of the following pieces of information would be of highest priority to relay to the neonatal team as they prepare for an emergency cesarean delivery? A. FHR arrhythmia, meconium, length of labor B. Gestational age, meconium, arrhythmia C. Gravidity & parity, gestational age, maternal temperature B. Gestational age, meconium, arrhythmia Which medications used with preterm labor can affect the FHR characteristics? A. Terbutaline and antibiotics B. Betamethasone and terbutaline C. Antibiotics and narcotics B. Betamethasone and terbutaline What characterizes a preterm fetal response to stress? A. More frequently occurring late decelerations B. More frequently occurring prolonged decelerations C. More rapid deterioration from Category I to Category II or III C. More rapid deterioration from Category I to Category II or III More likely to be subjected to hypoxia ***A woman being monitored externally has a suspected fetal arrhythmia. The most appropriate action is to A. Insert a spiral electrode and turn off the logic B. Turn the logic on if an external monitor is in place C. Use a Doppler to listen to the ventricular rate A. Insert a spiral electrode and turn off the logic *** The fetus responds to a significant drop of PO2 by A. Increasing O2 consumption B. Reducing lactic acid production C. Shifting blood to vital organs 6 | P a g e C. Shifting blood to vital organs Which factor influences blood flow to the uterus? A. Fetal arterial pressure B. Intervillous space flow C. Maternal arterial vasoconstriction C. Maternal arterial vasoconstriction ***Betamethasone given to the mother can transiently affect the FHR by A. Decreasing variability B. Increasing variability C. Lowering the baseline A. Decreasing variability In a fetal heart rate tracing with marked variability, which of the following is likely the cause? A. Recent ephedrine administration B. Recent epidural placement C. Fetal acidemia A. Recent ephedrine administration A fetal heart rate change that can be seen after administration of butorphanol (Stadol) is A. Bradycardia B. Marked variability C. Sinusoidal-appearing C. Sinusoidal-appearing The FHR pattern that is likely to be seen with maternal hypothermia is A. Bradycardia B. Marked variability C. Tachycardia A. Bradycardia *** Baseline FHR variability is determined in what amount of time, excluding accelerations and decelerations? A. 10 min B. 20 min C. 30 min A. 10 min Which of the following tachyarrhythmias can result in fetal hydrops? A. Persistent supraventricular tachycardia B. Premature atrial contractions C. Sinus tachycardia A. Persistent supraventricular tachycardia 7 | P a g e *** A preterm fetus with persistent supraventricular tachycardia that is not hydropic is best treated with maternal administration of A. Digoxin B. Phenobarbital C. Terbutaline A. Digoxin The initial response in treating a primigravida being induced for preeclampsia who has a seizure is A. Administer terbutaline to slow down uterine activity B. Initiate magnesium sulfate C. Perform an immediate cesarean delivery B. Initiate magnesium sulfate Which FHR sounds are counted with a stethoscope and a fetoscope? A. Atrial B. Atrial and ventricular C. Ventricular C. Ventricular *** When using auscultation to determine FHR baseline, the FHR should be counted after the contractions for A. 5-10 sec B. 15-30 sec C. 30-60 sec C. 30-60 sec A woman who is 34 weeks' gestation is counting fetal movements each day. Today she counted eight fetal movements in a two-hour period. Based on her kick counts, this woman should A. Continue counting for one more hour B. Discontinue counting until tomorrow C. Notify her provider for further evaluation C. Notify her provider for further evaluation A BPP score of 6 is considered A. Abnormal B. Normal C. Equivocal C. Equivocal *** As fetal hypoxia (asphyxia) worsens, the last component of the BPP to disappear is fetal A. Breathing B. Movement C. Tone 10 | P a g e B. Supraventricular tachycardia C. Third-degree heart block A. Polyhydramnios The fetus of a mother with preeclampsia is at high risk for developing A. Intrauterine growth restriction (IUGR) B. Macrosomia C. Polyhydramnios A. Intrauterine growth restriction (IUGR) High resting tone may occur with an IUPC because of all of the following except A. Extraovular placement B. Maternal BMI C. Multiple gestations B. Maternal BMI Which of the following is the primary neurotransmitter of the sympathetic branch of the autonomic nervous system? A. Acetylcholine B. Dopamine C. Norepinephrine C. Norepinephrine Which of the following is the primary neurotransmitter of the parasympathetic branch of the autonomic nervous system? A. Acetylcholine B. Dopamine C. Norepinephrine A. Acetylcholine Which of the following is responsible for variations in the FHR and fetal behavioral states? A. Cerebellum B. Cerebral cortex C. Medulla oblongata B. Cerebral cortex When the umbilical vessels traverse the membranes to the placenta without any cord protection, this is called A. Placenta previa B. Succenturiate lobe (SL) C. Velamentous insertion C. Velamentous insertion 11 | P a g e Which of the following is the primary factor in uteroplacental blood flow? A.. Fetal heart rate B. Maternal cardiac output C. Maternal oxygen consumption B. Maternal cardiac output Which of the following occurs when the parasympathetic branch of the autonomic nervous system is stimulated? A. Norepinephrine release B. Slowed conduction to sinoatrial node C. Increase in fetal heart rate B. Slowed conduction to sinoatrial node Which of the following is responsible for fetal muscle coordination? A. Cerebellum B. Cerebral cortex C. Medulla oblongata A. Cerebellum During periods of fetal tachycardia, FHR variability is usually diminished due to A. The dominance of the parasympathetic nervous system B. The dominance of the sympathetic nervous system C. Stimulation of the fetal vagus nerve A. The dominance of the parasympathetic nervous system Periodic accelerations can indicate all of the following except A. Stimulation of fetal chemoreceptors B. Tracing is a maternal tracing C. Umbilical vein compression A. Stimulation of fetal chemoreceptors A transient decrease in cerebral blood flow (increased cerebral blood pressure) during a contraction may stimulate _____ and may cause a(n) _____ A. Baroreceptors; early deceleration B. Baroreceptors; late deceleration C. Chemoreceptors; early deceleration A. Baroreceptors; early deceleration The primary physiologic goal of interventions for late decelerations is to A. Decrease maternal oxygen consumption B. Maximize placental blood flow C. Maximize umbilical circulation B. Maximize placental blood flow 12 | P a g e Which of the following is most responsible for producing FHR variability as the fetus grows? A. Maturation of the parasympathetic nervous system B. Maturation of the sympathetic nervous system C. Release of maternal prostaglandins A. Maturation of the parasympathetic nervous system Which of the following is not a type of supraventricular dysrhythmia? A. Premature atrial contraction (PAC) B. Premature ventricular contraction (PVC) C. Supraventricular tachycardia (SVT) B. Premature ventricular contraction (PVC) Which is the most common type of fetal dysrhythmia? A. Premature atrial contraction (PAC) B. Premature ventricular contraction (PVC) C. Third-degree heart block A. Premature atrial contraction (PAC) All of the following are traits of fetal supraventricular tachycardia (SVT), but which is most problematic? A. Decreases diastolic filling time B. Dramatically increases oxygen consumption C. Often leads to ventricular tachycardia (VT) C. Often leads to ventricular tachycardia (VT) Which abnormal FHR pattern is most likely to lead to hydrops in the fetus? A. Marked variability B. A premature ventricular contraction (PVC) C. Supraventricular tachycardia (SVT) C. Supraventricular tachycardia (SVT) Which of the following is an irregular FHR pattern associated with normal conduction and rate? A. Premature atrial contractions (PACs) B. Sinus arrhythmias C. Sinus tachycardias B. Sinus arrhythmias Which of the following is one example of a fetal tachyarrhythmia? A. Second-degree heart block, Type I B. Atrial fibrillation C. Premature atrial contraction (PAC) B. Atrial fibrillation (T/F) Sinus bradycardias, sinus tachycardias, and sinus arrhythmias are all associated with normal conduction (normal P-waves followed by narrow QRS complexes). 15 | P a g e B. Decreased FHR variability C. Decreased FHR accelerations A. Increased FHR baseline pH 6.9, PO2 15, PCO2 55, HCO3 18, BE -22 The nurse reviews the arterial gas results and concludes that the fetus had _____ acidosis. With results such as these, you would expect a _____ resuscitation. A. Metabolic; lengthy B. Metabolic; short C. Respiratory; lengthy A. Metabolic; lengthy Which of the following umbilical artery cord gases would most likely result in a fetus who had a Category I strip, then had a cord prolapse and was delivered within 3 minutes? A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5 B. pH 7.25, PO2 23, PCO2 46, HCO3 22, BE -8 C. pH 7.02, PO2 18, PCO2 56, HCO3 15, BE -18 A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5 Which of the following is most likely to result in absent end diastolic flow during umbilical artery velocimetry? A. Preeclampsia B. Preterm labor C. Previous cesarean delivery A. Preeclampsia A contraction stress test (CST) is performed. Late decelerations were noted in two out of the five contractions in 10 minutes. This is interpreted as A. Positive B. Negative C. Suspicious C. Suspicious A contraction stress test (CST) is performed. Two variable decelerations were seen on the FHR tracing and there were four contractions in 10 minutes. This is interpreted as A. Positive B. Negative C. Suspicious B. Negative A contraction stress test (CST) is performed. No decelerations were noted with the two contractions that occurred over 10 minutes. This is interpreted as A. Positive 16 | P a g e B. Negative C. Unsatisfactory C. Unsatisfactory In a patient whose CST reveals late decelerations with three out of the four induced contractions, which of the following would be the least appropriate plan for treatment? A. Obtain physician order for BPP B. Prepare for possible induction of labor C. Repeat CST in 24 hours C. Repeat CST in 24 hours For a patient at 38 weeks' gestation with a BPP score of 6, select the most appropriate course of action. A. Repeat in one week B. Consider induction of labor C. Prepare for cesarean delivery B. Consider induction of labor For a patient at 35 weeks' gestation with a BPP score of 4, select the most appropriate course of action. A. Repeat in 24 hours B. Obtain physician order for CST C. Prepare for probable induction of labor C. Prepare for probable induction of labor (T/F) Vibroacoustic stimulation may be less effective for preterm fetuses or when membranes have been ruptured. True _____ cord blood sampling is predictive of uteroplacental function. A. Arterial B. Venous C. Maternal B. Venous (T/F) Metabolic acidosis is more easily reversible and potentially less detrimental to the fetus when compared to respiratory acidosis. False (T/F) There is a strong correlation between arterial cord blood gas results and Apgar scores. False Which of the following fetal systems bear the greatest influence on fetal pH? A. Heart and lungs 17 | P a g e B. Lungs and kidneys C. Sympathetic and parasympathetic nervous systems B. Lungs and kidneys All of the following are components of liability except A. Breach of duty B. Chain of command C. Damages/loss B. Chain of command Elements of a malpractice claim include all of the following except A. Breach of duty B. Deposition C. Injury or loss B. Deposition *** pH 6.86 pCO2 28 pO2 2.1 HCO3 4.0 B.D. 42 the umbilical arterial cord blood gas values reflect A. metabolic acidemia B. mixed acidemia C. respiratory acidemia A. Metabolic acidemia Which of the following factors can have a negative effect on uterine blood flow? a. Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above e. All of the above Stimulating the vagus nerve typically produces: a. A decrease in the heart rate b. An increase in the heart rate c. An increase in stroke volume d. No change a. A decrease in the heart rate 20 | P a g e A. True knot B. Gestational diabetes C. Umbilical cord entanglement D. Oligohydramnios B. Gestational diabetes All of the following are likely causes of prolonged decelerations except: A. Uterine tachysystole B. Prolapsed cord C. Maternal hypotension D. Maternal fever D. Maternal fever All of the following could likely cause minimal variability in FHR except A. Magnesium sulfate administration B. Fetal sleep cycle C. Narcotic administration D. Ephedrine administration D. Ephedrine administration When an IUPC has been placed, Montevideo units must be ___ or greater for adequate cervical change to occur. A. 100 B. 200 C. 300 D. 400 B. 200 What would be a suspected pH in a fetus whose FHTs included recurrent late decelerations during labor? A. 7.10 B. 7.26 C. 7.32 D. 7.41 A. 7.10 The nurse notes a pattern of decelerations on the fetal monitor that begins shortly after the contraction and returns to baseline just before the contraction is over. The correct nursing response is to: a. Give the woman oxygen by facemask at 8-10 L/min b. Position the woman on her opposite side c. Increase the rate of the woman's intravenous fluid d. Continue to observe and record the normal pattern d. Continue to observe and record the normal pattern 21 | P a g e Determining the FHR baseline requires the nurse to approximate the mean FHR rounded to increments of 5 bpm during a ___-minute window (excluding accelerations and decelerations). A. 2 B. 5 C. 10 D. 20 C. 10 Which of the following interventions would best stimulate an acceleration in the FHR? A. Provide juice to patient B. Perform vaginal exam C. Turn patient on left side D. Vibroacoustic stimulation B. Perform vaginal exam Scalp stimulation The FHR is controlled by the A. Sympathetic nervous system B. Sinoatrial node C. Atrioventricular node D. Parasympathetic nervous system B. Sinoatrial node T/F: Fetal tachycardia is a normal compensatory response to transient fetal hypoxemia. True At how many weeks gestation should FHR variability be normal in manner? A. 24 weeks B. 28 weeks C. 32 weeks D. 36 weeks B. 28 weeks Reduced respiratory gas exchange from persistent decelerations may cause a rise in fetal PCO2, which leads first to _______ _______, then _______ _______. A. Respiratory alkalosis; metabolic acidosis B. Respiratory acidosis; metabolic acidosis C. Respiratory alkalosis; metabolic alkalosis D. Respiratory acidosis; metabolic acidosis B. Respiratory acidosis; metabolic acidosis Decreased intervillious exchange of oxygenated blood resulting in fetal hypoxia is typically present in _______. 22 | P a g e A. Variable decelerations B. Late decelerations C. Early decelerations D. Accelerations B. Late decelerations Place the following interventions for a sinusoidal FHR in the correct order: 1. Prepare for cesarean delivery 2. Place patient in lateral position 3. Determine if pattern is related to narcotic analgesic administration 4. Provide oxygen via face mask A. 4, 2, 3, 1 B. 3, 1, 2, 4 C. 4, 3, 2, 1 D. 3, 2, 4, 1 D. 3, 2, 4, 1 FHTs with accelerations, no decelerations, and minimal variability would be categorized as A. Category I B. Category II C. Category III B. Category II FHTs with minimal variability, absent accelerations, and a 3-minute prolonged deceleration would be categorized as A. Category I B. Category II C. Category III B. Category II Which of the following is not a likely cause of a sinusoidal FHR pattern? A. Chronic fetal bleeding B. Fetal hypoxia or anemia C. Triple screen positive for Trisomy 21 D. Fetal isoimmunization C. Triple screen positive for Trisomy 21 Which of the following factors is not likely to cause uteroplacental insufficiency? A. Late-term gestation B. Preeclampsia C. Gestational diabetes D. Polyhydramnios E. Maternal smoking or drug use 25 | P a g e The _____ _____ _____ maintains transmission of beat-to-beat variability. Parasympathetic nervous system Stimulation of the _____ _____ _____ releases catecholamines, resulting in increased FHR. Sympathetic nervous system Stimulation of _____ results in abrupt decreases in FHR, CO, and BP. Baroreceptors Baroreceptors influence _____ decelerations with moderate variability. Variable In comparing early and late decelerations, a distinguishing factor between the two is A. Onset time to the nadir of the deceleration B. The number of decelerations that occur C. Timing in relation to contractions C. Timing in relation to contractions The underlying cause of early decelerations is decreased A. Baroceptor response B. Increased peripheral resistance C. Vagal reflex C. Vagal reflex Glucose is transferred across the placenta via _____ _____. Facilitated diffusion Oxygen, carbon dioxide, water, electrolytes, urea, uric acid, fatty acids, fat-soluble vitamins, narcotics barbiturates, anesthetics, and antibiotics are transferred across the placenta via _____ _____. Simple (passive) diffusion Amino acids, water-soluble vitamins, calcium, phosphorus, iron, and iodine are transferred across the placenta via _____ _____. Active transport Well-oxygenated fetal blood enters the _____ ventricle, which supplies the heart and brain. Less- oxygenated blood enters the ______ ventricle, which supplies the rest of the body. Left; right Fetal blood has a _______ affinity for oxygen compared with the mother's blood, which facilitates adaptation to the low PO2 at which the placenta oxygenates the fetus. A. Higher B. Lower 26 | P a g e A. Higher The fetus has a _______ cardiac output and heart rate than the adult, resulting in rapid circulation. A. Higher B. Lower A. Higher Which statement best describes the relationship between maternal and fetal hemoglobin levels? A. Fetal hemoglobin is higher than maternal hemoglobin B. Maternal hemoglobin is higher than fetal hemoglobin C. Maternal and fetal hemoglobin are the same A. Fetal hemoglobin is higher than maternal hemoglobin A 36 week gestation patient is brought to triage by squad after an MVA on her back. She is not bleeding and denies pain. She is not short of breath, but c/o dizziness and nausea since they put her on the gurney. The most likely cause is A. Abruptio placenta B. Preterm labor C. Supine hypotension C. Supine hypotension When the hydrogen ion content in the blood rises, the pH A. Lowers B. Neutralizes C. Rises A. Lowers ***A woman receives terbutaline for an external version. You may expect what on the fetal heart tracing? A. Decrease in variability B. Increase in baseline C. No change B. Increase in baseline What affect does magnesium sulfate have on the fetal heart rate? A. Decreases variability B. Increases variability C. No change A. Decreases variability Sinusoidal pattern can be documented when A. Cycles are 4-6 beats per minute in frequency B. The pattern lasts 20 minutes or longer C. There is moderate or minimal variability 27 | P a g e B. The pattern lasts 20 minutes or longer Vagal stimulation would be manifested as what type of fetal heart rate pattern? A. Acceleration B. Early deceleration C. Tachycardia B. Early deceleration Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially when seen at the onset of labor? A. Early deceleration B. Late deceleration C. Variable deceleration A. Early deceleration A risk of amnioinfusion is A. Prolonged labor B. Uterine overdistension C. Water intoxication B. Uterine overdistension A fetal heart rate pattern that can occur when there is a prolapsed cord is A. Marked variability B. Prolonged decelerations C. Tachycardia B. Prolonged decelerations The patient is in early labor with pitocin at 8 mu/min, and FHR is Category I. In the next 15 minutes, there are 18 uterine contractions. Recommended management is to A. Address contraction frequency by reducing pitocin dose B. Continue to increase pitocin as long as FHR is Category I C. Turn the patient on her side and initiate an IV fluid bolus C. Turn the patient on her side and initiate an IV fluid bolus A woman at 38 weeks gestation is in labor. The labor has been uneventful, and the fetal heart tracings have been normal. Spontaneous rupture of membranes occurs; fetal heart rate drops to 90 beats per minute for four minutes and then resumes a normal pattern. The most likely etiology for this fetal heart rate change is A. Abnormal fetal presentation B. Impaired placental circulation C. Possible cord compression C. Possible cord compression