AWHONN Advanced Fetal Heart Monitoring Exam | Ultimate
Study Guide with Comprehensive Questions & Answer Reviews
– Latest Update 2026/2027 | Already Graded A+
1. A fetal heart rate tracing demonstrates a baseline of 145 beats/min,
moderate variability, accelerations, and no decelerations. How should
this tracing be interpreted?
A. Category I
B. Category II
C. Category III
D. Sinusoidal pattern
Answer: A. Category I
Explanation: Category I is a reassuring fetal heart rate pattern. It includes a
baseline of 110–160 beats/min, moderate variability, and no late or variable
decelerations. Accelerations may be present or absent. Category I patterns
generally indicate adequate fetal oxygenation and do not require intervention
solely because of the tracing.
2. A fetal heart rate baseline is 170 beats/min for 15 minutes. Which
finding does this represent?
A. Fetal bradycardia
B. Fetal tachycardia
C. Moderate variability
D. Sinusoidal activity
Answer: B. Fetal tachycardia
Explanation: Fetal tachycardia is a baseline fetal heart rate greater than 160
beats/min for at least 10 minutes. Potential causes include maternal fever,
infection, medications, dehydration, fetal hypoxia, and maternal or fetal
conditions. The clinician should assess the maternal and fetal condition rather
than treating the heart rate alone.
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,3. Which fetal heart rate characteristic provides the strongest evidence
of an intact fetal autonomic nervous system and adequate oxygenation?
A. Absent variability
B. Moderate variability
C. Persistent tachycardia
D. Recurrent late decelerations
Answer: B. Moderate variability
Explanation: Moderate variability reflects normal interaction between the
sympathetic and parasympathetic nervous systems. It is one of the most
important reassuring features of fetal status. Persistent minimal or absent
variability can occur with fetal sleep, medications, prematurity, acidemia, or
other conditions and must be interpreted in context.
4. During a contraction, the fetal heart rate gradually decreases
beginning after the contraction starts, reaches its lowest point after the
contraction peak, and returns to baseline after the contraction ends.
What type of deceleration is present?
A. Early
B. Variable
C. Late
D. Prolonged
Answer: C. Late
Explanation: Late decelerations are gradual decreases in fetal heart rate that
begin after the contraction has started, with the nadir occurring after the
contraction peak. Recurrent late decelerations can indicate uteroplacental
insufficiency and require evaluation and appropriate intrauterine
resuscitative measures.
5. Which mechanism is most commonly associated with variable
decelerations?
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,A. Head compression
B. Umbilical cord compression
C. Maternal fever
D. Uteroplacental insufficiency
Answer: B. Umbilical cord compression
Explanation: Variable decelerations are caused primarily by intermittent
umbilical cord compression. Compression can produce rapid changes in fetal
heart rate. Their significance depends on frequency, duration, depth,
associated variability, and the overall clinical picture.
6. A fetal heart rate suddenly decreases from 140 to 90 beats/min and
returns rapidly to baseline. The decrease has an abrupt onset and
variable timing in relation to contractions. Which finding is most likely?
A. Early deceleration
B. Late deceleration
C. Variable deceleration
D. Sinusoidal pattern
Answer: C. Variable deceleration
Explanation: Variable decelerations have an abrupt onset and are typically
associated with cord compression. Their timing in relation to contractions can
vary. Recurrent or severe variable decelerations require assessment and
intervention based on the overall fetal status.
7. Which finding is characteristic of a Category III fetal heart rate
pattern?
A. Moderate variability with accelerations
B. Absent variability with recurrent late decelerations
C. Minimal variability with occasional variables
D. Baseline of 150 beats/min with no decelerations
Answer: B. Absent variability with recurrent late decelerations
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, Explanation: Category III includes absent variability accompanied by
recurrent late decelerations, recurrent variable decelerations, or bradycardia.
A true sinusoidal pattern is also Category III. Category III indicates an
abnormal tracing requiring prompt evaluation and appropriate intervention.
8. A patient receiving oxytocin develops recurrent late decelerations
with minimal variability. What is the priority nursing action?
A. Increase the oxytocin infusion
B. Continue observation without intervention
C. Assess the patient and initiate intrauterine resuscitative measures
D. Encourage pushing
Answer: C. Assess the patient and initiate intrauterine resuscitative
measures
Explanation: Recurrent late decelerations with minimal variability are
concerning for impaired fetal oxygenation. The nurse should assess the
maternal and fetal condition and address reversible causes, which may
include excessive uterine activity. Oxytocin should generally be reduced or
discontinued when tachysystole or concerning fetal status is associated with
its use.
9. Which definition best describes uterine tachysystole?
A. More than five contractions in 10 minutes averaged over a 30-minute
window
B. Contractions lasting more than 30 seconds
C. Any contraction occurring before the expected due date
D. Fewer than two contractions in 10 minutes
Answer: A. More than five contractions in 10 minutes averaged over a
30-minute window
Explanation: Uterine tachysystole is defined as more than five contractions in
10 minutes, averaged over a 30-minute window. It may occur spontaneously
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Study Guide with Comprehensive Questions & Answer Reviews
– Latest Update 2026/2027 | Already Graded A+
1. A fetal heart rate tracing demonstrates a baseline of 145 beats/min,
moderate variability, accelerations, and no decelerations. How should
this tracing be interpreted?
A. Category I
B. Category II
C. Category III
D. Sinusoidal pattern
Answer: A. Category I
Explanation: Category I is a reassuring fetal heart rate pattern. It includes a
baseline of 110–160 beats/min, moderate variability, and no late or variable
decelerations. Accelerations may be present or absent. Category I patterns
generally indicate adequate fetal oxygenation and do not require intervention
solely because of the tracing.
2. A fetal heart rate baseline is 170 beats/min for 15 minutes. Which
finding does this represent?
A. Fetal bradycardia
B. Fetal tachycardia
C. Moderate variability
D. Sinusoidal activity
Answer: B. Fetal tachycardia
Explanation: Fetal tachycardia is a baseline fetal heart rate greater than 160
beats/min for at least 10 minutes. Potential causes include maternal fever,
infection, medications, dehydration, fetal hypoxia, and maternal or fetal
conditions. The clinician should assess the maternal and fetal condition rather
than treating the heart rate alone.
1|Page
,3. Which fetal heart rate characteristic provides the strongest evidence
of an intact fetal autonomic nervous system and adequate oxygenation?
A. Absent variability
B. Moderate variability
C. Persistent tachycardia
D. Recurrent late decelerations
Answer: B. Moderate variability
Explanation: Moderate variability reflects normal interaction between the
sympathetic and parasympathetic nervous systems. It is one of the most
important reassuring features of fetal status. Persistent minimal or absent
variability can occur with fetal sleep, medications, prematurity, acidemia, or
other conditions and must be interpreted in context.
4. During a contraction, the fetal heart rate gradually decreases
beginning after the contraction starts, reaches its lowest point after the
contraction peak, and returns to baseline after the contraction ends.
What type of deceleration is present?
A. Early
B. Variable
C. Late
D. Prolonged
Answer: C. Late
Explanation: Late decelerations are gradual decreases in fetal heart rate that
begin after the contraction has started, with the nadir occurring after the
contraction peak. Recurrent late decelerations can indicate uteroplacental
insufficiency and require evaluation and appropriate intrauterine
resuscitative measures.
5. Which mechanism is most commonly associated with variable
decelerations?
2|Page
,A. Head compression
B. Umbilical cord compression
C. Maternal fever
D. Uteroplacental insufficiency
Answer: B. Umbilical cord compression
Explanation: Variable decelerations are caused primarily by intermittent
umbilical cord compression. Compression can produce rapid changes in fetal
heart rate. Their significance depends on frequency, duration, depth,
associated variability, and the overall clinical picture.
6. A fetal heart rate suddenly decreases from 140 to 90 beats/min and
returns rapidly to baseline. The decrease has an abrupt onset and
variable timing in relation to contractions. Which finding is most likely?
A. Early deceleration
B. Late deceleration
C. Variable deceleration
D. Sinusoidal pattern
Answer: C. Variable deceleration
Explanation: Variable decelerations have an abrupt onset and are typically
associated with cord compression. Their timing in relation to contractions can
vary. Recurrent or severe variable decelerations require assessment and
intervention based on the overall fetal status.
7. Which finding is characteristic of a Category III fetal heart rate
pattern?
A. Moderate variability with accelerations
B. Absent variability with recurrent late decelerations
C. Minimal variability with occasional variables
D. Baseline of 150 beats/min with no decelerations
Answer: B. Absent variability with recurrent late decelerations
3|Page
, Explanation: Category III includes absent variability accompanied by
recurrent late decelerations, recurrent variable decelerations, or bradycardia.
A true sinusoidal pattern is also Category III. Category III indicates an
abnormal tracing requiring prompt evaluation and appropriate intervention.
8. A patient receiving oxytocin develops recurrent late decelerations
with minimal variability. What is the priority nursing action?
A. Increase the oxytocin infusion
B. Continue observation without intervention
C. Assess the patient and initiate intrauterine resuscitative measures
D. Encourage pushing
Answer: C. Assess the patient and initiate intrauterine resuscitative
measures
Explanation: Recurrent late decelerations with minimal variability are
concerning for impaired fetal oxygenation. The nurse should assess the
maternal and fetal condition and address reversible causes, which may
include excessive uterine activity. Oxytocin should generally be reduced or
discontinued when tachysystole or concerning fetal status is associated with
its use.
9. Which definition best describes uterine tachysystole?
A. More than five contractions in 10 minutes averaged over a 30-minute
window
B. Contractions lasting more than 30 seconds
C. Any contraction occurring before the expected due date
D. Fewer than two contractions in 10 minutes
Answer: A. More than five contractions in 10 minutes averaged over a
30-minute window
Explanation: Uterine tachysystole is defined as more than five contractions in
10 minutes, averaged over a 30-minute window. It may occur spontaneously
4|Page
