AWHONN ADVANCED FETAL MONITORING EXAM | COMPLETE
QUESTIONS WITH EXPERT SOLUTIONS | 2026 LATEST UPDATED |
GET A+
Michelle is a 31-year-old G1P0 at 38 6/7 weeks who arrives to triage holding her abdomen while
moaning in pain. She is accompanied by her sister. The nurse greets Michelle in triage and accompanies
her to the evaluation room. Michelle reports a history of normal blood pressure during the pregnancy,
opioid use disorder, and attendance at all her prenatal visits. Her abdominal pain started approximately
twelve hours ago and has increased in intensity. Michelle reports that she had loose stools while having
the abdominal pain and has kept down water and electrolyte drinks all day but continues to feel the urge
to have a bowel movement. She states that her vaccinations are up-to-date and that there is no history
of recent illness in her home.
With Michelle's presenting history, what are the nurse's priority interventions in Michelle's care: -
(answer)Initiate electronic fetal monitoring and reassess Michelle's blood pressure in 15 minutes
Michelle's blood pressure continues to be elevated in the 165/105 to 180/110 ranges. Lab work is drawn
and results are pending. Anticipated initial medical care for Michelle includes: -
(answer)Antihypertensive therapy
The perinatal team discussed Michelle's clinical picture with Michelle and her sister, including her
abnormal lab results. Her epigastric pain remains severe. The anticipated best plan of care includes
admitting Michelle, continuing with antihypertensive therapy, and: - (answer)Starting magnesium sulfate
After a discussion with Michelle and her health care team. The decision is made to admit Michelle for
induction. Magnesium Sulfate is initiated, and oxytocin is started at 2 mU/min. Over the next two hours,
Michelle received 3 doses of IV Labetalol and 1 dose of IV Hydralazine to reduce her blood pressure out
of the severe range. She received an epidural approximately 45 minutes ago and the oxytocin is currently
infusing at 10 mu/min.
What is the priority nursing intervention at this time? - (answer)Assess Michelle, evaluate her vital signs,
and attempt intrauterine resuscitation
What category is the tracing? - (answer)Category III
, Upon entry into the room, Michelle is found to be in the high fowler's position. Vital signs are as follows:
BP 157/89, HR 134, RR 32, SPO2 86%, urine output 200mL for the last 2 hours.
What is the most likely physiologic cause of impaired Oxygen delivery in Michelle's case? -
(answer)Pulmonary edema
A healthcare organization that reflects a culture of safety establishes an environment that is -
(answer)Blame-free and uses non-threatening processes in the presence of medical errors
Consistent systematic assessment of the fetal heart rate tracing is essential to observe pattern evolution
and identify tracings at are at an increased risk for adverse fetal-acid base status, which includes -
(answer)Normal baseline rate, absent variability, and recurrent variable decelerations
Silvia, a 28-year-old G1P0000 at 39 1/7 weeks by sonogram, and her partner arrived at the labor unit at
0730 for scheduled induction for intrauterine grown restriction (IUGR). Silvia's family history is negative
for medical problems except her mother's long-term history of diabetes. Silvia developed gestational
diabetes with this pregnancy, but her other prenatal labs were all normal. During one of the ultrasound
examinations performed to evaluate the IUGR, a single umbilical artery was noted. On her most recent
biophysical profile (BPP), the amniotic fluid index (AFI) was 11 cm (AFI less than 5 cm is defined as
oligohydramnios) and the estimated fetal weight (EFW) was 2524 grams (7th percentile).
The single umbilical artery impacts which component of the oxygen transfer system? - (answer)Oxygen
delivery
Which of Silvia's findings indicates a potential for chronic fetal hypoxemia? - (answer)Intrauterine growth
restriction
With the finding of a single umbilical artery, what would you expect to occur with fetal perfusion? -
(answer)Homeostatic dilation of the umbilical artery
Silvia's admission vital signs were BP 109/60, pulse 83 bpm, respirations 18/minute, temperature 97ºF
(36.6ºC). Vaginal examination findings were 2-3 cm dilated, 50% effaced, -1 station, membranes intact,
and cephalic presentation. External electronic fetal monitor devices were placed (ultrasound and
tocodynamometer). She denied having contractions, vaginal leaking, or bleeding. Following this
QUESTIONS WITH EXPERT SOLUTIONS | 2026 LATEST UPDATED |
GET A+
Michelle is a 31-year-old G1P0 at 38 6/7 weeks who arrives to triage holding her abdomen while
moaning in pain. She is accompanied by her sister. The nurse greets Michelle in triage and accompanies
her to the evaluation room. Michelle reports a history of normal blood pressure during the pregnancy,
opioid use disorder, and attendance at all her prenatal visits. Her abdominal pain started approximately
twelve hours ago and has increased in intensity. Michelle reports that she had loose stools while having
the abdominal pain and has kept down water and electrolyte drinks all day but continues to feel the urge
to have a bowel movement. She states that her vaccinations are up-to-date and that there is no history
of recent illness in her home.
With Michelle's presenting history, what are the nurse's priority interventions in Michelle's care: -
(answer)Initiate electronic fetal monitoring and reassess Michelle's blood pressure in 15 minutes
Michelle's blood pressure continues to be elevated in the 165/105 to 180/110 ranges. Lab work is drawn
and results are pending. Anticipated initial medical care for Michelle includes: -
(answer)Antihypertensive therapy
The perinatal team discussed Michelle's clinical picture with Michelle and her sister, including her
abnormal lab results. Her epigastric pain remains severe. The anticipated best plan of care includes
admitting Michelle, continuing with antihypertensive therapy, and: - (answer)Starting magnesium sulfate
After a discussion with Michelle and her health care team. The decision is made to admit Michelle for
induction. Magnesium Sulfate is initiated, and oxytocin is started at 2 mU/min. Over the next two hours,
Michelle received 3 doses of IV Labetalol and 1 dose of IV Hydralazine to reduce her blood pressure out
of the severe range. She received an epidural approximately 45 minutes ago and the oxytocin is currently
infusing at 10 mu/min.
What is the priority nursing intervention at this time? - (answer)Assess Michelle, evaluate her vital signs,
and attempt intrauterine resuscitation
What category is the tracing? - (answer)Category III
, Upon entry into the room, Michelle is found to be in the high fowler's position. Vital signs are as follows:
BP 157/89, HR 134, RR 32, SPO2 86%, urine output 200mL for the last 2 hours.
What is the most likely physiologic cause of impaired Oxygen delivery in Michelle's case? -
(answer)Pulmonary edema
A healthcare organization that reflects a culture of safety establishes an environment that is -
(answer)Blame-free and uses non-threatening processes in the presence of medical errors
Consistent systematic assessment of the fetal heart rate tracing is essential to observe pattern evolution
and identify tracings at are at an increased risk for adverse fetal-acid base status, which includes -
(answer)Normal baseline rate, absent variability, and recurrent variable decelerations
Silvia, a 28-year-old G1P0000 at 39 1/7 weeks by sonogram, and her partner arrived at the labor unit at
0730 for scheduled induction for intrauterine grown restriction (IUGR). Silvia's family history is negative
for medical problems except her mother's long-term history of diabetes. Silvia developed gestational
diabetes with this pregnancy, but her other prenatal labs were all normal. During one of the ultrasound
examinations performed to evaluate the IUGR, a single umbilical artery was noted. On her most recent
biophysical profile (BPP), the amniotic fluid index (AFI) was 11 cm (AFI less than 5 cm is defined as
oligohydramnios) and the estimated fetal weight (EFW) was 2524 grams (7th percentile).
The single umbilical artery impacts which component of the oxygen transfer system? - (answer)Oxygen
delivery
Which of Silvia's findings indicates a potential for chronic fetal hypoxemia? - (answer)Intrauterine growth
restriction
With the finding of a single umbilical artery, what would you expect to occur with fetal perfusion? -
(answer)Homeostatic dilation of the umbilical artery
Silvia's admission vital signs were BP 109/60, pulse 83 bpm, respirations 18/minute, temperature 97ºF
(36.6ºC). Vaginal examination findings were 2-3 cm dilated, 50% effaced, -1 station, membranes intact,
and cephalic presentation. External electronic fetal monitor devices were placed (ultrasound and
tocodynamometer). She denied having contractions, vaginal leaking, or bleeding. Following this
