Fetal Monitoring Test Questions and Answers: A Comprehensive Guide for Nursing Students, Exams of Nursing

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AWHONN Intermediate Fetal Monitoring TEST Questions and

Answers (A+ Solution guide)

Which of the following is an extrinsic influence on the FHR? The most highly oxygenated blood in fetal circulation is carried by ductus venosus If fetal arterial pressure begins to fall below normal levels baroreceptors cause vasoconstriction and increase FHR Fetal heart rate variability is defined as fluctuations in the baseline that are irregular in _________ and __________. amplitude and frequency An increase in FHR immediately preceding a variable deceleration is caused by: occlusion of the umbilical vein When assessing a FHR tracing, the first step is to establish a baseline rate Which deceleration in the FHR is considered benign and does not require an intervention to correct? early deceleration If the umbilical vein is the only vessel occluded during cord compression oxygenated blood may be restricted from being delivered to the fetus

During fetal sleep cycle, FHR variability is usually minimal Uterine tachysystole is defined as < 5 contractions in 10 minutes averaged over 30 minutes Maternal-fetal oxygen and nutrient transfer takes place in the intervillous space During a contraction, the toco detects pressure created by the tensing of uterine muscles Normal FHR baseline is 110 - 160 Following birth, a fetal cord blood sample is taken. The results are: pH: 6. pCO2: 86 mmHg pO2: 4 mmHg BE: - 18.6 mEq/L These results are best interpreted as: mixed acidemia A characteristic of variable decelerations is: the onset of the deceleration is abrupt stimulation of the vagus nerve in a healthy fetus will cause a decrease in the FHR Assess the tracing. What is the baseline rate?

Assess the tracing. What is the correct interpretation? Baseline of 160bpm with recurrent late decelerations Assess the tracing: what is the primary physiologic goal? maximize oxygenation Assess the tracing. The patient is a 20-year-old G1 at 41 weeks undergoing induction of labor. She is 4 cm/80%/-1 and the oxytocin dose is currently 14 mU/min. Based on the tracing, the most appropriate interventions are: Decrease oxytocin from 14 to 7 mU/min and start a 500-mL IVFB. Case Study A: Robin Robin is a 32-year-old G1 at 34 4/7 weeks. She has a history of chronic hypertension that was well controlled on Labetolol. She had regular prenatal care with no pregnancy complications. She called her OB office today with complaints of abdominal pain and is advised to present to the hospital for assessment and care. On admission, vital signs are: T 98.1°F HR 77 bpm RR 20/min. BP 124/ The nurse documents the patient "complains of abdominal

and back pain since 11 AM today." Which of the following is a correct interpretation of the tracing? The tracing of uterine activity requires palpation for accurate assessment Vaginal exam findings were: 1 cm/thick/-3. Robin rates her pain as a 9 on a 1 - 10 pain scale. She is crying and moving around in the bed. The nurse supports maternal coping to appropriately assist Robin because Reducing maternal catecholamine production enhances blood flow to the uterus and decreases fetal stress Robin’s nurse noti fies the provider about the vital signs, EFM tracing and vaginal exam. The nurse also reports Robin’s pain level. The provider orders an IV fluid bolus, continuous EFM, and butorphanol tartrate for pain. This is Robin’s tracing 1 hour later. She reports that her pain is now a 5 on a 1 – 10 scale. She also states that the pain is constant. Describe the type of variability seen in the majority of the tracing Absent

Identify appropriate interventions to implement based on this tracing. Palpate the uterus, adjust toco, and assist patient to a lateral position. Robin's nurse notes that contractions are occurring every 4- 6 minutes and the uterus is not relaxing completely between contractions. The nurse notifies the provider of this and she states that she will be at the hospital in 30 minutes to evaluate the patient. Five minutes later, the patient states her pain is increasing again. The nurse also notes a trickle of dark blood from the vagina. What does the EFM tracing above and the observed patient assessment raise your suspicion of? Placental abruption What is the physiologic goal of top priority for Robin? Maximize oxygenation What bedside interventions are important at this time? Notify provider of vaginal bleeding, EFM tracing, and request presence at the bedside immediately if the nurse does not get the appropriate response from the provider, the next step is Activate the chain of communication (command)

Evaluate Robin’s tracing 5 minutes later: What is the correct interpretation of the tracing? Sinusoidal pattern The tracing in question 29 is which category? Category III Robin has a cesarean birth. Umbilical arterial cord blood gas results are as follows pH: 6. pCO2: 48 pO2: 4. BE: - 23. These results meet the criteria for: Metabolic acidemia CASE STUDY B: OLIVIA Olivia is a 34-year-old G2 P1001 @41 6/7 weeks. She received regular prenatal care starting at eight weeks of pregnancy. She has no underlying medical conditions and no complications occurred during this pregnancy. She presents to the labor and delivery unit with complaints of regular uterine contractions (every 4-5 minutes by her report) for the last 4 hours. On admission, her VS are: BP 128/82; HR 86 bpm; RR 20/min.; T 97.6°F. SVE: 5 cm/80%/-1; vertex; intact

membranes. What is the baseline rate? 135bpm What type of variability is observed? Moderate What do you observe in the tracing that rules out metabolic acidemia at the time of assessment? 15x15 accelerations Two hours later Olivia reports spontaneous rupture of membranes. Clear fluid is noted. Her cervix is now 8- 9 cm/100%/0 station. What pattern is observed in the fetal heart tracing? late decelerations What extrinsic factor can you identify as a possible cause for the observed pattern? aging placenta What physiologic goals are priorities for Olivia's care? Maximize oxygenation and maintain appropriate uterine activity What bedside interventions are appropriate for Olivia at this time? Position change to a lateral position and initiate a 500-mL IVFB

Following nursing interventions at the bedside, the following tracing is observed. Recheck of Olivia’s cervix reveals that she is completely dilated, a +2 station and feeling pressure. The physician is notified to come to the bedside for delivery. What could Olivia’s nurse do during second stage of labor to promote improved oxygenation of the fetus? Encourage Olivia to push with every other contraction Olivia delivered a baby boy vaginally soon after the end of this tracing. Apgar scores are 7/9. Cord gas results are normal. Did the fetal monitor tracing prior to delivery accurately predict the cord gas results? Yes, the presence of moderate variability rules out metabolic acidemia CASE STUDY C: SHELBY Shelby is a 17-year-old G1 at 41 2/7 weeks. She is admitted to the labor and delivery unit for a scheduled induction of labor. She had an uncomplicated pregnancy and received regular prenatal care. Vital signs at the time of admission are normal. Assess the following tracing. At this time, Shelby is 5 cm/80%/-1 and has oxytocin infusing at 14 mU/min. AROM

was performed at the time of the cervical exam with clear fluid noted. What is the baseline FHR? 160 bpm What type of variability is observed? Moderate What interventions are appropriate at this time? Reposition Shelby from left lateral to right lateral Assess Shelby’s tracing that occurs three hours later. She recently had a cervical exam which shows 8 – 9 cm/ 100%/ station. What type of pattern is observed in the tracing? Variable decelerations What category is this tracing? Category II Approximately 1 hour later, Shelby reports feeling increased perineal pressure. The nurse checks Shelby’s cervix and notes that it is completely dilated with the presenting vertex at +2 station. The nurse updates the provider and then returns to Shelby’s r oom to assist her with the second stage of labor. Assess the tracing which occurs after approximately 15 minutes of pushing:

What is the baseline rate? Unable to determine Based on your observation of the tracing, what action(s) is (are) required? Palpate Shelby's radial pulse to verify maternal vs. fetal heart rate Which statement most accurately reflects the EFM tracing? Maternal and fetal heart rates should be verified. A tight nuchal cord x 2 is noted after delivery of the baby's head. Which pattern in the fetal heart rate would increase suspicion of a nuchal cord? Variable decelerations Shelby delivers a male infant with Apgar scores of 2 and 3. Umbilical arterial cord blood gas results are: pH: 6. pCO2: 79 pO2: 11 BE: - 7. What is the correct interpretation of the cord blood gas? Respiratory acidemia