Fetal Monitoring: AWHONN Advanced FHM Exam Questions and Answers, Exams of Nursing

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AWHONN ADVANCED FHM EXAM AWHONN ADVANCED FHM EXAM WITH GUARANTEED ACCURATE ANSWERS |VERIFIED How do I maximize uterine blood flow? - Accurate ✔✔✔ Position change,hydration, decrease uterine ctx(meds), reduce fear and anxiety How do i maximize umbilical circulation? - Accurate ✔✔✔ Position change and amnioinfusion How do i maximize oxygenation? - Accurate ✔✔✔ Position change, o2, maternal hydration, breathing techniques, correct or treat underlying disease BPP - Accurate ✔✔✔ Biophysical profile My job as a LD RN is to assess fetal oxygenation of laboring woman with the following: - Accurate ✔✔✔ 1. Maximize uterine blood flow

2. Maximize umbilical circulation
3. Maximize oxygenation How can oxygen delivery be interrupted? - Accurate ✔✔✔ Maternal anemia, maternal decreases in cardiac output, patient bleeding Maternal anemia, decreases in mat cardiac output, and patient bleeding will diminish ______ ________. - Accurate ✔✔✔ Oxygen delivery Increased oxygen consumption occurs with ___________. - Accurate ✔✔✔ Hyperthermia How do i decrease maternal oxygen consumption? - Accurate ✔✔✔ Breathing techniques, pain management, repositioning Fetal oxygenation is dependent on the _____ _____ to the uterus and the placenta via the ___________ ______. It is also dependent on the? - Accurate ✔✔✔ Blood flow via umbilical vein, integrity of the placenta Post date pregnancies results in? - Accurate ✔✔✔ Decreased fetal oxygenation bc of the sao2 dropping by 30% at 43weeks The umbilical vein transport blood to the _____ and the umbilical arteries transport blood away from the _____ and to the ________. - Accurate ✔✔✔ Vein to the fetus and arteries away from fetus to placenta

Four fetal responses to decreased oxygen delivery? - Accurate ✔✔✔ Decreased fetal movement, decreased reactivity and decreased variability, ph goes down producing acidemia A base deficit of ____________ is of concern, any base excess of less than _____ indicates the need for? - Accurate ✔✔✔ A base deficit of greater than -6 is of concern, a base excess of less than -6 indicates need for fluids Asphyxia - Accurate ✔✔✔ Asphyxia is a Combo of hypoxia, acidemia, and metabolic acidosis Normal cord gas PH - Accurate ✔✔✔ 7.20-7. Normal cord gas PCO2 - Accurate ✔✔✔ 49.2-56. Normal cord gas HCO3 - Accurate ✔✔✔ 22.0-24. Normal cord gas Po2 - Accurate ✔✔✔ 15.1-23. Normal cord gas BD - Accurate ✔✔✔ 2.7-8.

Normal fetal oxygenation occurs with what criteria - Accurate ✔✔✔ Fhr 110-160, mod variability, acceleration in presence of ut ctx, no decels with ut ctx, What is the most consitent predictor of newborn acidemia? - Accurate ✔✔✔ Absent or min variability with recurrent late or variable decels or bradycardia What does a cat I and moderate variabilty indicate? - Accurate ✔✔✔ A well oxygenated, meorologically intact fetus which has reserves Category I - Accurate ✔✔✔ BL of 110-160, moderate var, no lates or variable decels, early decels or accelerations may pr may not be present. Bradycardia <110 is Category __ - Accurate ✔✔✔ Cat 2 Tachycardia >160 w/o variability is Category __ - Accurate ✔✔✔ Cat 2 Minimal or marked var is Category __ - Accurate ✔✔✔ Cat 2 Absent variability w/o recur decels is Category __ - Accurate ✔✔✔ Cat 2 Recurrent var decels w min or mod var - Accurate ✔✔✔ Cat 2

What constitutes recurrent - Accurate ✔✔✔ 50% or more w/ctx in 20 min Absence of accels after stimulation - Accurate ✔✔✔ Cat 2 The two causes of variable decels are: - Accurate ✔✔✔ Fetal hypoxemia and cord compression Prolonged decel - Accurate ✔✔✔ Down by 15bpm for > 2 min If decel is down by 15bpm but >10 min it is a - Accurate ✔✔✔ Baseline change What should I never do during decel - Accurate ✔✔✔ scalp stim Absent variability plus the following is which category? 1.recurrent lates or variables

2. Bradycardia
3. Sinusoidal - Accurate ✔✔✔ cat 3 Intervention for sinusoidal pattern - Accurate ✔✔✔ maximize utero- placental circulation

How can i tell if a baby is well oxygenated? - Accurate ✔✔✔ mod variabilty and accels Variables are caused by _______ homeostatic response by the baroreceptors, the umb vein _______ causing the umb ____ to vasoconstrict with response to ____________ in art and veins. - Accurate ✔✔✔ intrinsic....vasoconstrict....artery.....baroreceptors _________ factors cause umbilical cord compromise which compromises ___ _______, causing _______ - Accurate ✔✔✔ extrinsic factors cause umb cord complications, which compromises o2 transport, leading to hypoxemia What is my top priority with cord compression? - Accurate ✔✔✔ maximize umbilical circulation (pos change and amnioinfusion) What should i do when a ctx is difficult to trace? - Accurate ✔✔✔ palpate and adjust toco Intervention for hypersystole? - Accurate ✔✔✔ terb When is terb contraindicated? - Accurate ✔✔✔ r/o placental seperation, uteroplacental bleeding, mat hr of 118- Assess FHR before when in the OR? - Accurate ✔✔✔ abd prep, bc it will then be sterile

Key pieces to report to the neonatal team - Accurate ✔✔✔ 1. Gest age

2. Presence of mec
3. Arrythmia Post date pregnancies r/o - Accurate ✔✔✔ decreased gas exchange Old placenta = decrease o2 saturation What provides perfusion assessment from the fetus to the placenta - Accurate ✔✔✔ doppler flow studies What increases the potential for umb cord compression - Accurate ✔✔✔ low AFI What does betamethasone and mag cause in FHR - Accurate ✔✔✔ alterations in fetal movements supressing variablilty (decreased) and decreased biophysical activities Reactive term NST - Accurate ✔✔✔ >2 FHR accels (15X15)in a 20 min window (may extend to 40m) Non reactive term NST - Accurate ✔✔✔ no FHR accels in max of 40 min

Reactive pre term NST - Accurate ✔✔✔ 2 fhr accels (10 X10) in 20 min, may be increased to 60- Non reactive pre term NST - Accurate ✔✔✔ no FHR accels in 60- Before doing a vibroacustic stim (VAS) eastablish what first - Accurate ✔✔✔ baseline, and only use VAS if normal, never use if abnormal or prolonged decel How do i do a VAS vibroacustic stim - Accurate ✔✔✔ establish baseline, apply for 3 sec Goal of VAS vibroacustic stim - Accurate ✔✔✔ 2 or more FHR accels in 20 min following the VAS BPP - Accurate ✔✔✔ do with NST over 30 min 4 components of BPP plus NST - Accurate ✔✔✔ fetal movement, fetal tone, fetal breathing, Amniotic fluid vol(AFI) Decreased amniotic fluid is a - Accurate ✔✔✔ variable that can be reflective of more chronic fetal problems Amniotic fluid vol is a direct reflection of - Accurate ✔✔✔ fetal urine production during times of stress

Blood flow to the kidneys decreases in the presence of _______&________ thus decreasing the fluid volume - Accurate ✔✔✔ hypoxemia and acidemia Decreased AFI increases ______ __________ - Accurate ✔✔✔ cord compression _______ to relieve cord compressin - Accurate ✔✔✔ amnio infusion How do i distinguish between artifact and arrythmias? - Accurate ✔✔✔ assess the shape and regularity of the spikes. Ectopic beats have ________ ____ after the contractions - Accurate ✔✔✔ compensatory pauses. If unsure of whether tachycardia vs artifact - Accurate ✔✔✔ ausculate the FHR by listening with the fetoscope or doppler. Fetal arrythmias affect fetal _____ by reducing fetal ______ - Accurate ✔✔✔ fetal arrythmias affect fetal oxygenation by reducing fetal perfusion.