Fetal Heart Rate Monitoring and Interpretation, Exams of Nursing

Download Fetal Heart Rate Monitoring and Interpretation and more Exams Nursing in PDF only on Docsity! AWHONN ADVANCED FETAL MONITORING EXAM 2025 | ACCURATE REAL EDXAM QUESTIONS AND ANSWERS WITH A STUDY GUIDE | ACCURATE AND VERIFIED FOR GUARANTEED PASS | ALREADY GRADED A What do you observe in the tracing that rules out metabolic acidemia at this time? - CORRECT ANSWER A: 15x15 accelerations What pattern is observed in the fetal heart tracing? - CORRECT ANSWER A. Late decelerations What extrinsic factor can you identify as a possible cause for the observed pattern? - CORRECT ANSWER C. Aging placenta What physiologic goals are priorities for Olivia's care? - CORRECT ANSWER B. Maximize oxygenation and maintain appropriate uterine activity What bedside interventions are appropriate for Olivia at this time? - CORRECT 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? - CORRECT ANSWER B. Encourage Olivia to push with every other contraction Did the fetal monitor tracing prior to delivery accurately predict the cor - CORRECT ANSWER A> Yes, the presence of moderate variability rules out the metabolic acidemia. What is the baseline FHR? - CORRECT ANSWER B. 160 bpm What type of variability is observed? - CORRECT ANSWER A. Moderate What interventions are appropriate at this time? - CORRECT ANSWER C. Reposition Shelby from left lateral to right lateral What type of pattern is observed in the tracing? - CORRECT ANSWER B. Variable decelerations What category is this tracing? - CORRECT ANSWER B. Category II What is the baseline rate? - CORRECT ANSWER C. Unable to determine Based on your observation of the tracing, what action(s) is (are) required? - CORRECT ANSWER B. Palpate Shelby's radial pulse to verify maternal vs. fetal heart rate Which statement most accurately reflects the EFM tracing? - CORRECT ANSWER A. Maternal and fetal heart rates should be verified Which pattern in the fetal heart rate would increase suspicion of a nuchal cord? - CORRECT 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? - CORRECT ANSWER A. Respiratory academia Which of the following is an extrinsic influence on the FHR? - CORRECT ANSWER C. Fetal- placental circulation If the umbilical vein is the only vessel occluded during cord compression - CORRECT ANSWER Deoxygenated blood cannot be removed from fetal circulation During umbilical cord compression, the vein on the umbilical cord becomes compressed leading to CO2 (carbon dioxide) to accumulate in your baby's blood, which produces respiratory acidosis. Source: https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/umbilical- cord-prolapse/ During a fetal sleep cycle, FHR variability is usually - CORRECT ANSWER minimal uterine tachysystole is defined as - CORRECT ANSWER >5 contractions in 10 minutes averaged over 30 minutes Maternal-fetal oxygen and nutrient transfer takes place in the - CORRECT ANSWER Placental cotyledon During a contraction, the tocodynamometer detects: - CORRECT ANSWER Pressure created by tensing of uterine muscles Normal fetal heart rate baseline is - CORRECT ANSWER 110-160 Following birth, a fetal cord blood sample is taken. The results are: pH: 6.95 pCO2: 86 mmHg pO2: 4 mmHg BE: -18.6 mEq/L These results are best interpreted as: - CORRECT ANSWER mixed acidemia A characteristic of variable decelerations is: - CORRECT ANSWER The onset of the deceleration is abrupt Stimulation of the vagus nerve in a healthy fetus will cause: - CORRECT 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 - CORRECT ANSWER metabolic academia Cat 1 - CORRECT ANSWER What category rules out fetal acidemia? Severe astha, cardiac issues, and ecclampic seizures - CORRECT ANSWER What maternal conditions greatly impact fetal oxygenation? intervillous space - CORRECT ANSWER 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 - CORRECT ANSWER How is o2 blood transferred to the fetus? High to low concentration Mom to fetus for O2 Low to high concentration for CO2 so baby to mom - CORRECT ANSWER Diffusion Diffusion - CORRECT ANSWER How is O2 transferred from mom to baby Carry O2 into intervillous space Are maximally dilated so they can not be increased - CORRECT 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 - CORRECT ANSWER What are factors that can decrease uteroplacental blood flow? They are constricted which decreases blood flow - CORRECT ANSWER What happens to the spiral arteries during pre-e? The aorta and vena cava get compressed (20 weeks) - CORRECT 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 - CORRECT ANSWER Why does maternal hypotension happen after regional analgesia? 60% - CORRECT 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 - CORRECT ANSWER Explain the pathway for maternal- fetal exchange for fetal oxygenation (basic) Limbs, kidneys, and descending aorta - CORRECT ANSWER Where is the least O2 blood in the fetus? Umbilical vein and ductous venous - CORRECT ANSWER Where is the most O2 blood in the fetus? Increased Hct Fetal Hbg has a higher affinity for O2 Fetal HR and CO is increased which results in rapid circulation of O2 blood - CORRECT 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 - CORRECT ANSWER What is the fetal response to acute hypoxia anaerobic metabolism - CORRECT 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). - CORRECT ANSWER Explain the oxygenation depletion cascade 60-90 minutes - CORRECT ANSWER How one does it take for significant acidemia to take place? Adrenergic activity - CORRECT 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 - CORRECT ANSWER What are things that can cause decreased variability? 10x10 - CORRECT 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 - CORRECT ANSWER Describe the reasoning for early decels Uteroplacental insufficiency results in decreased maternal/fetal O2 transfer - CORRECT ANSWER Describe the physiology of a late decel It's neurogenic Exclude clinically significant acidemia Provide interventions to increase perfusion - CORRECT ANSWER What do late decels with moderate variability mean and indicate? Means myocardial depression Expedited delivery - CORRECT 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 - CORRECT ANSWER What are 3 causes of prolonged decels? Vasa previa - CORRECT 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 - CORRECT ANSWER What nervous system has control over bradycardia? Fever Dehydration Infection Medications- terbutaline, albuterol, atropine, cocaine, or caffeine Medical conditions- hyperthyroidism - CORRECT ANSWER What are some maternal conditions that can lead to fetal tachycardia? Fetal bleeding- placental abruption Fetal anemia Fetal sepsis Fetal hypoxia Arrhythmias - CORRECT ANSWER What are some fetal conditions that can cause tachycardia? Severe fetal anemia- ruptured vasa previa, TTTS, Rh isoimmunization Severe metabolic acidemia - CORRECT ANSWER What are causes of sinusoidal pattens? Every 30 mins - CORRECT 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 - CORRECT 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 - CORRECT ANSWER At what rate is exogenous oxytocin at for the mother during the first stage of labor? 3 mu - CORRECT ANSWER At what rate is exogenous oxytocin at for the fetus during the first stage of labor? 10 to 15 minutes - CORRECT ANSWER What is the biologic half-life of oxytocin? 30 to 60 minutes - CORRECT ANSWER How long does it take to reach a steady state of plasma concentration for Pitocin? Prior history, hypertension, cigarette smoking, cocaine use, or blunt abdominal trauma - CORRECT ANSWER What are some risk factors of abruptio placenta? It is a sympathetic response so catecholamines like norepinephrine and epinephrine are released to recuperate - CORRECT ANSWER Why is there if you tachycardic response after a prolonged decel? Can decrease variability and accelerations - CORRECT ANSWER What do narcotics to you in regards to fetal heart rates? Pseudo sinusoidal patterns - CORRECT ANSWER What can stadol and Nubian cause in fetal heart rates? Decrease variability and increased uterine activity - CORRECT ANSWER What can cocaine cause in regards to uterine activity and fetal heart rates? Decrease variability for 48 hours - CORRECT ANSWER What can betamethasone cause in regards to fetal heart rate? Increased fetal heart rate baseline and increase maternal heart rate - CORRECT 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 - CORRECT ANSWER How do you fetal dopplers work? Convert FECG to fetal heart rate by measuring consecutive R to R wave intervals - CORRECT ANSWER How do fetal scalp electrodes work? Increased caffeine intake - CORRECT ANSWER What can cause an irregular rhythm in a fetus? Requires a risk benefit analysis Digoxin or other drugs like amiodarone - CORRECT ANSWER What can be done to treat Fetal SVT? Maternal lupus - CORRECT ANSWER What can cause a complete or third-degree heart block in a fetus? 50 to 70 bpm - CORRECT ANSWER What ventricular rate in a fetus is associated with a complete or third-degree heart block? A pacemaker implantation - CORRECT 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 - CORRECT ANSWER How can hypoxemia lead to a decreased AFI in a fetus? CST - CORRECT 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 - CORRECT ANSWER What is a normal fetal movement count? Accelerations peak greater than 15 bpm above the baseline and last for greater than 15 seconds - CORRECT 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 - CORRECT 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 - CORRECT ANSWER How many contractions are needed for a contraction stress test? No late or significant variable decelerations - CORRECT 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 - CORRECT ANSWER What is a positive contraction stress test? Intermittent late or significant variable decelerations - CORRECT ANSWER What is a suspicious contraction stress test? An NST, fetal breathing movement, fetal movement, fetal tone, and amniotic fluid volume - CORRECT ANSWER What does a biophysical profile or BPP consist of? 8 to 10 - CORRECT ANSWER What is the normal value for a BPP? Four or less - CORRECT ANSWER What is a concerning BPP score? Loss of fetal tone - CORRECT ANSWER What is the most concerning in regards to a BPP? 5-25 - CORRECT ANSWER What is a normal AFI? Assess his vascular resistance to blood flow within the placenta Monitors for IUGR - CORRECT ANSWER What does a umbilical artery Doppler velocimetry do? 110-160 - CORRECT ANSWER normal fetal heart rate range infection, low o2, young - CORRECT ANSWER what could it mean if FHR is high late or variable decels - CORRECT ANSWER signs of utero-placental insufficiency change position - CORRECT ANSWER what is the first thing you should do with recurrent late decels 7.10 or higher - CORRECT ANSWER what should pH be 60 or lower - CORRECT ANSWER what should CO2 be 12 or lower - CORRECT ANSWER what should base excess or base deficit be respiratory - CORRECT ANSWER if CO2 is greater than 60, what type of acidosis metabolic - CORRECT ANSWER if base excess greater than 12, what type of acidosis baseline fetal heart rate, 5, 10 - CORRECT ANSWER the approximate mean FHR rounded to increments of bpm during a minute window, excluding: -accelerations and deceleratons -periods of marked variability 2, 10 - CORRECT ANSWER for baseline fetal heart rate there must be at least minutes of identifiable baseline segments in a minute window or the baseline for that period is indeterminate 110, 10 - CORRECT ANSWER bradycardia is a baseline of < bpm for > minutes 160, 10 - CORRECT ANSWER tachycardia is a baseline of > bpm for > minutes contractions, high pitocin - CORRECT ANSWER what can cause bradycardia infection, drugs, hypothyroid, fetal anemia - CORRECT ANSWER what can cause tachycardia sinusoidal, 20, anemia - CORRECT ANSWER smooth wavelike pattern for at least minutes, associated with fetal bleeding - CORRECT ANSWER what can cause sinusoidal FHR baseline variability - CORRECT ANSWER fluctuations in the baseline FHR that are irregular in amplitude and frequency absent variability - CORRECT ANSWER undetectable amplitude range minimal variability - CORRECT ANSWER > detectable amplitude range but less than or equal to 5 bpm moderate variability - CORRECT ANSWER 6-25 bpm amplitude range marked variability - CORRECT ANSWER greater than or equal to 25 bpm amplitude range well oxygenated - CORRECT ANSWER what does variability show a sign that the baby is 3 - CORRECT ANSWER what category is absent variability with recurrent decels 2 - CORRECT ANSWER what category is absent variability without recurrent decels recurrent decels - CORRECT ANSWER minimal variability is unlikely to be associated with hypoxia during labor unless with what? fetal hypoxemia - CORRECT ANSWER marked variability may be related to what? periodic - CORRECT ANSWER FHR pattern associated with uterine contractions, p is for pain episodic - CORRECT ANSWER FHR pattern not associated with uterine contractions recurrent, 20 - CORRECT ANSWER decelerations that occur with at least 50% of uterine contractions within a minute period intermittent, 20 - CORRECT ANSWER decelerations that occur with less than 50% of uterine contractions within a minute period accelerations - CORRECT ANSWER visually apparent abrupt increases in FHR above the baseline 30 - CORRECT ANSWER accelerations go from onset to peak in less than seconds 15, 15 - CORRECT ANSWER in fetus 32 weeks or more, the accelerations peak bpm and last for seconds from onset o return to baseline 10, 10 - CORRECT ANSWER if fetus less than 32 weeks, the accelerations peak bpm and last for seconds from onset to return to baseline prolonged acceleration - CORRECT 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 - CORRECT ANSWER early decel definition gradual greater than 30 seconds from onset to nadir , nadir after peak of contraction - CORRECT ANSWER late decel definition fetoscope - CORRECT ANSWER detects heart sounds doppler - CORRECT ANSWER detects reflected sound from heart motion fetoscope - CORRECT ANSWER detects fhr baseline detects fhr rhythm verifies presence of irregular rhythm detects increases and decreases from FHR baseline clarifies double counting or half counting by EFM doppler - CORRECT ANSWER detects fhr baseline detects fhr rhythm detects increases and decreases fetal spiral electrode - CORRECT ANSWER direct monitoring of fetal ECG indicated when continuous detection of FHR clinically necessary and not achievable by US transducer ruptured membranes and 2 cm dilation - CORRECT ANSWER fetal spiral electrode requires what moms heart rate - CORRECT ANSWER when the heart rate goes up when contractions goes up, what is on the strip artifact - CORRECT 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 - CORRECT ANSWER out of herpes, hiv, placenta previa, hepatitis, what can you use the fetal spiral electrode with fingertips - CORRECT 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 - CORRECT ANSWER detects changes in shape of abdomen resulting from uterine tension pressure - CORRECT ANSWER what does the toco detect from the uterine muscle intrauterine pressure catheter - CORRECT ANSWER quantitative measurement for strength of contractions and resting tone; still have to palpate variable decels - CORRECT ANSWER what do you do an amnioinfusion for?; can be gravity or on the pump. make sure what goes in comes out montevideo units - CORRECT ANSWER subtract resting tone from peak uterine activity for each contraction and add them all up in a 10 minute period increased iv fluids - CORRECT ANSWER what is associated with shorter labor duration and lower frequency of both prolonged labor and oxytocin use category 3 - CORRECT ANSWER never have pitocin running with this tracing 10 liters per minute nonrebreather - CORRECT ANSWER administer how much supplemental oxygen and with what mask 10-12 minutes - CORRECT ANSWER half life of oxytocin; need 3-4 half lives to reach steady concentration 0.5-2 - CORRECT ANSWER starting dose of oxytocin 1-2 - CORRECT ANSWER increase ocxytoci mU/minute every 30-60 minutes no - CORRECT ANSWER should you continue oxytocin after active labor is established Normal fetal heart rate baseline is: - CORRECT 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: - CORRECT ANSWER C. Mixed acidemia A characteristic of variable decelerations is: - CORRECT ANSWER B. The onset of the deceleration is abrupt Stimulation of the vagus nerve in a healthy fetus will cause: - CORRECT ANSWER A. A decrease in the fetal heart rate What is the baseline rate? - CORRECT ANSWER B. 145 bpm What is the correct interpretation? - CORRECT ANSWER B. Baseline of 160 bpm with recurrent late decelerations What is the primary physiologic goal? - CORRECT ANSWER B. Maximize oxygenation Based on the tracing, the most appropriate interventions are: - CORRECT 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? - CORRECT ANSWER C. The tracing of uterine activity requires palpation for accurate assessment