AWHONN ADVANCED FETAL HEART MONITORING EXAM COMPREHENSIVE EXAM QUESTIONS COMPLETE WITH 100% CORRECT ANSWERS

AWHONN ADVANCED FETAL HEART MONITORING EXAM COMPREHENSIVE EXAM QUESTIONS COMPLETE WITH 100% CORRECT ANSWERS Question 1 A laboring patient at 41 weeks gestation has an EFM tracing showing a baseline FHR of 165 bpm for greater than 10 minutes. What is the correct interpretation and initial nursing action? A) This is a normal finding for a post-term fetus, continue routine monitoring B) This indicates fetal tachycardia, notify the provider and assess for maternal fever or infection C) This represents a benign arrhythmia that requires no intervention D) This is caused by fetal sleep cycles and will resolve spontaneously Correct Answer: B) This indicates fetal tachycardia, notify the provider and assess for maternal fever or infection Rationale: Fetal tachycardia is defined as a baseline FHR greater than 160 bpm persisting for 10 minutes or longer. Common causes include maternal fever, chorioamnionitis, fetal anemia, maternal hyperthyroidism, or medications. Prompt notification of the provider and assessment for underlying causes is essential. ________________________________________ Question 2 A patient's EFM tracing reveals a sinusoidal pattern with a frequency of 3-5 cycles per minute and amplitude of 15 bpm. What is the priority nursing intervention? A) Document the pattern as benign and continue monitoring B) Prepare for immediate cesarean delivery and notify the neonatal team C) Administer oxygen at 10L/min via non-rebreather mask D) Change the patient's position to left lateral Correct Answer: B) Prepare for immediate cesarean delivery and notify the neonatal team Rationale: A true sinusoidal pattern is a Category III tracing associated with severe fetal anemia, often from fetomaternal hemorrhage or ruptured vasa previa. This is an obstetric emergency requiring immediate delivery and neonatal resuscitation preparation. ________________________________________ Question 3 A nurse is evaluating a fetal monitor strip and notes late decelerations that are recurrent and associated with minimal variability. What is the correct category classification for this tracing? A) Category I B) Category II C) Category III D) Category IV Correct Answer: C) Category III Rationale: Category III tracings include either absent baseline variability with recurrent late decelerations, recurrent variable decelerations, or bradycardia, OR a sinusoidal pattern. This indicates abnormal fetal acid-base status and requires immediate intervention. ________________________________________ Question 4 A patient with gestational diabetes at 38 weeks is being monitored. The EFM shows accelerations of 20 bpm lasting 20 seconds. What do these findings indicate? A) Fetal acidosis B) Fetal hypoxia C) Fetal well-being and reactivity D) Fetal sleep cycle Correct Answer: C) Fetal well-being and reactivity Rationale: Accelerations are transient increases in FHR above baseline and are the hallmark of fetal well-being. In a term fetus, an acceleration of at least 15 bpm lasting 15 seconds (or 10x10 for preterm) indicates an intact central nervous system and is a reassuring finding. ________________________________________ Question 5 A patient at 42 weeks gestation with oligohydramnios (AFI 4.5 cm) is in active labor. The nurse observes variable decelerations on the EFM. What is the most likely underlying cause? A) Uteroplacental insufficiency B) Head compression C) Umbilical cord compression D) Maternal hypotension Correct Answer: C) Umbilical cord compression Rationale: Variable decelerations are caused by umbilical cord compression. Oligohydramnios reduces the cushioning effect of amniotic fluid, increasing the risk of cord compression during contractions. These decelerations are characterized by abrupt onset and return, with variable shapes and depths. ________________________________________ Question 6 What medication is most commonly associated with causing a sinusoidal FHR pattern? A) Magnesium sulfate B) Oxytocin C) Meperidine (Demerol) D) Terbutaline Correct Answer: C) Meperidine (Demerol) Rationale: Meperidine has been associated with causing a sinusoidal-like FHR pattern. Other causes include fetal anemia, fetomaternal hemorrhage, twin-twin transfusion syndrome, and severe fetal hypoxia. Distinguishing a true sinusoidal pattern from a pseudosinusoidal pattern is critical.