CHAPTER 14: INTRAPARTUM FETAL
SURVEILLANCE OB NCLEX EXAM
QUESTIONS WITH ANSWERS AND
RATIONALE
The nurse sees a pattern on the fetal monitor that looks similar to early
decelerations, but the deceleration begins near the acme of the contraction and
continues well beyond the end of the contraction. Which nursing action
indicates the proper evaluation of this situation?
a. This pattern reflects variable decelerations. No interventions are necessary at
this time.
b. Document this reassuring fetal heart rate pattern but decrease the rate of the
intravenous (IV) fluid.
c. Continue to monitor these early decelerations, which occur as the fetal head is
compressed during a contraction.
d. This deceleration pattern is associated with uteroplacental insufficiency, so
the nurse acts quickly to improve placental blood flow and fetal oxygen supply.
ANS: D
A pattern similar to early decelerations, but the deceleration begins near the
acme of the contraction and continues well beyond the end of the contraction,
describes a late deceleration. Oxygen should be given via a snug face mask.
Position the client on her left side to increase placental blood flow. Variable
decelerations are caused by cord compression. A vaginal examination should be
performed to identify this potential emergency. This is not a reassuring pattern,
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,so the IV rate should be increased to increase the mother's blood volume. These
are late decelerations, not early; therefore, interventions are necessary.
Which maternal condition should be considered a contraindication for the
application of internal monitoring devices?
a. Unruptured membranes
b. Cervix dilated to 4 cm
c. Fetus has known heart defect
d. External monitors currently being used
ANS: A
To apply internal monitoring devices, the membranes must be ruptured.
Cervical dilation of 4 cm would permit the insertion of fetal scalp electrodes
and an intrauterine catheter. A compromised fetus should be monitored with the
most accurate monitoring devices. The external monitor can be discontinued
after the internal ones are applied.
The nurse is instructing a nursing student on the application of fetal monitoring
devices. Which method of assessing the fetal heart rate requires the use of a gel?
a. Doppler
b. Fetoscope
c. Scalp electrode
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, d. Tocodynamometer
ANS: A
Doppler is the only listed method involving ultrasonic transmission of fetal
heart rates; it requires the use of a gel. The fetoscope does not require gel
because ultrasonic transmission is not used. The scalp electrode is attached to
the fetal scalp; gel is not necessary. The tocodynamometer does not require gel.
This device monitors uterine contractions.
Proper placement of the tocotransducer for electronic fetal monitoring is:
a. inside the uterus.
b. on the fetal scalp.
c. over the uterine fundus.
d. over the mother's lower abdomen.
ANS: C
The tocotransducer monitors uterine activity and should be placed over the
fundus, where the most intensive uterine contractions occur. The tocotransducer
is for external use. The tocotransducer monitors uterine contractions. The most
intensive uterine contractions occur at the fundus; this is the best placement
area.
Which can be determined only by electronic fetal monitoring?
a. Variability
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SURVEILLANCE OB NCLEX EXAM
QUESTIONS WITH ANSWERS AND
RATIONALE
The nurse sees a pattern on the fetal monitor that looks similar to early
decelerations, but the deceleration begins near the acme of the contraction and
continues well beyond the end of the contraction. Which nursing action
indicates the proper evaluation of this situation?
a. This pattern reflects variable decelerations. No interventions are necessary at
this time.
b. Document this reassuring fetal heart rate pattern but decrease the rate of the
intravenous (IV) fluid.
c. Continue to monitor these early decelerations, which occur as the fetal head is
compressed during a contraction.
d. This deceleration pattern is associated with uteroplacental insufficiency, so
the nurse acts quickly to improve placental blood flow and fetal oxygen supply.
ANS: D
A pattern similar to early decelerations, but the deceleration begins near the
acme of the contraction and continues well beyond the end of the contraction,
describes a late deceleration. Oxygen should be given via a snug face mask.
Position the client on her left side to increase placental blood flow. Variable
decelerations are caused by cord compression. A vaginal examination should be
performed to identify this potential emergency. This is not a reassuring pattern,
Page 1 of 28
,so the IV rate should be increased to increase the mother's blood volume. These
are late decelerations, not early; therefore, interventions are necessary.
Which maternal condition should be considered a contraindication for the
application of internal monitoring devices?
a. Unruptured membranes
b. Cervix dilated to 4 cm
c. Fetus has known heart defect
d. External monitors currently being used
ANS: A
To apply internal monitoring devices, the membranes must be ruptured.
Cervical dilation of 4 cm would permit the insertion of fetal scalp electrodes
and an intrauterine catheter. A compromised fetus should be monitored with the
most accurate monitoring devices. The external monitor can be discontinued
after the internal ones are applied.
The nurse is instructing a nursing student on the application of fetal monitoring
devices. Which method of assessing the fetal heart rate requires the use of a gel?
a. Doppler
b. Fetoscope
c. Scalp electrode
Page 2 of 28
, d. Tocodynamometer
ANS: A
Doppler is the only listed method involving ultrasonic transmission of fetal
heart rates; it requires the use of a gel. The fetoscope does not require gel
because ultrasonic transmission is not used. The scalp electrode is attached to
the fetal scalp; gel is not necessary. The tocodynamometer does not require gel.
This device monitors uterine contractions.
Proper placement of the tocotransducer for electronic fetal monitoring is:
a. inside the uterus.
b. on the fetal scalp.
c. over the uterine fundus.
d. over the mother's lower abdomen.
ANS: C
The tocotransducer monitors uterine activity and should be placed over the
fundus, where the most intensive uterine contractions occur. The tocotransducer
is for external use. The tocotransducer monitors uterine contractions. The most
intensive uterine contractions occur at the fundus; this is the best placement
area.
Which can be determined only by electronic fetal monitoring?
a. Variability
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