Page 1 of 33
FETAL ASSESSMENT DURING LABOR FLASHCARD WITH
QUESTIONS AND CORRECT ANSWERS
Which clinical finding or intervention might be considered the rationale for
fetal tachycardia to occur?
a.Maternal fever
b.Umbilical cord prolapse
c.Regional anesthesia
d.Magnesium sulfate administration - answer-ANS: A
Fetal tachycardia can be considered an early sign of fetal hypoxemia and
may also result from maternal or fetal infection. Umbilical cord prolapse,
regional anesthesia, and the administration of magnesium sulfate will each
more likely result in fetal bradycardia, not tachycardia
What is the most likely cause for early decelerations in the fetal heart rate
(FHR) pattern?
a.Altered fetal cerebral blood flow
, Page 2 of 33
b.Umbilical cord compression
c.Uteroplacental insufficiency
d.Spontaneous rupture of membranes - answer-ANS: A
Early decelerations are the fetus' response to fetal head compression;
these are considered benign, and interventions are not necessary. Variable
decelerations are associated with umbilical cord compression. Late
decelerations are associated with uteroplacental insufficiency.
Spontaneous rupture of membranes has no bearing on the FHR unless the
umbilical cord prolapses, which would result in variable or prolonged
bradycardia.
While evaluating an external monitor tracing of a woman in active labor, the
nurse notes that the FHR for five sequential contractions begins to
decelerate late in the contraction, with the nadir of the decelerations
occurring after the peak of the contraction. What is the nurse's first priority?
a.Change the woman's position.
b.Notify the health care provider.
c.Assist with amnioinfusion
, Page 3 of 33
d.Insert a scalp electrode. - answer-ANS: A
Late FHR decelerations may be caused by maternal supine hypotension
syndrome. These decelerations are usually corrected when the woman
turns onto her side to displace the weight of the gravid uterus from the
vena cava. If the fetus does not respond to primary nursing interventions
for late decelerations, then the nurse should continue with subsequent
intrauterine resuscitation measures and notify the health care provider. An
amnioinfusion may be used to relieve pressure on an umbilical cord that
has not prolapsed. The FHR pattern associated with this situation most
likely will reveal variable decelerations. Although a fetal scalp electrode will
provide accurate data for evaluating the well-being of the fetus, it is not a
nursing intervention that will alleviate late decelerations nor is it the nurse's
first priority.
What is the most likely cause for variable FHR decelerations?
a.Altered fetal cerebral blood flow
b.Umbilical cord compression
c.Uteroplacental insufficiency
d.Fetal hypoxemia - answer-ANS: B
, Page 4 of 33
Variable FHR decelerations can occur at any time during the uterine
contracting phase and are caused by compression of the umbilical cord.
Altered fetal cerebral blood flow results in early decelerations in the FHR.
Uteroplacental insufficiency results in late decelerations in the FHR. Fetal
hypoxemia initially results in tachycardia and then bradycardia if hypoxia
continues.
The nurse providing care for a high-risk laboring woman is alert for late
FHR decelerations. Which clinical finding might be the cause for these late
decelerations?
a.Altered cerebral blood flow
b.Umbilical cord compression
c.Uteroplacental insufficiency
d.Meconium fluid - answer-ANS: C
Uteroplacental insufficiency results in late FHR decelerations. Altered fetal
cerebral blood flow results in early FHR decelerations. Umbilical cord
compression results in variable FHR decelerations. Meconium-stained fluid
may or may not produce changes in the FHR, depending on the gestational
age of the fetus and whether other causative factors associated with fetal
distress are present.
FETAL ASSESSMENT DURING LABOR FLASHCARD WITH
QUESTIONS AND CORRECT ANSWERS
Which clinical finding or intervention might be considered the rationale for
fetal tachycardia to occur?
a.Maternal fever
b.Umbilical cord prolapse
c.Regional anesthesia
d.Magnesium sulfate administration - answer-ANS: A
Fetal tachycardia can be considered an early sign of fetal hypoxemia and
may also result from maternal or fetal infection. Umbilical cord prolapse,
regional anesthesia, and the administration of magnesium sulfate will each
more likely result in fetal bradycardia, not tachycardia
What is the most likely cause for early decelerations in the fetal heart rate
(FHR) pattern?
a.Altered fetal cerebral blood flow
, Page 2 of 33
b.Umbilical cord compression
c.Uteroplacental insufficiency
d.Spontaneous rupture of membranes - answer-ANS: A
Early decelerations are the fetus' response to fetal head compression;
these are considered benign, and interventions are not necessary. Variable
decelerations are associated with umbilical cord compression. Late
decelerations are associated with uteroplacental insufficiency.
Spontaneous rupture of membranes has no bearing on the FHR unless the
umbilical cord prolapses, which would result in variable or prolonged
bradycardia.
While evaluating an external monitor tracing of a woman in active labor, the
nurse notes that the FHR for five sequential contractions begins to
decelerate late in the contraction, with the nadir of the decelerations
occurring after the peak of the contraction. What is the nurse's first priority?
a.Change the woman's position.
b.Notify the health care provider.
c.Assist with amnioinfusion
, Page 3 of 33
d.Insert a scalp electrode. - answer-ANS: A
Late FHR decelerations may be caused by maternal supine hypotension
syndrome. These decelerations are usually corrected when the woman
turns onto her side to displace the weight of the gravid uterus from the
vena cava. If the fetus does not respond to primary nursing interventions
for late decelerations, then the nurse should continue with subsequent
intrauterine resuscitation measures and notify the health care provider. An
amnioinfusion may be used to relieve pressure on an umbilical cord that
has not prolapsed. The FHR pattern associated with this situation most
likely will reveal variable decelerations. Although a fetal scalp electrode will
provide accurate data for evaluating the well-being of the fetus, it is not a
nursing intervention that will alleviate late decelerations nor is it the nurse's
first priority.
What is the most likely cause for variable FHR decelerations?
a.Altered fetal cerebral blood flow
b.Umbilical cord compression
c.Uteroplacental insufficiency
d.Fetal hypoxemia - answer-ANS: B
, Page 4 of 33
Variable FHR decelerations can occur at any time during the uterine
contracting phase and are caused by compression of the umbilical cord.
Altered fetal cerebral blood flow results in early decelerations in the FHR.
Uteroplacental insufficiency results in late decelerations in the FHR. Fetal
hypoxemia initially results in tachycardia and then bradycardia if hypoxia
continues.
The nurse providing care for a high-risk laboring woman is alert for late
FHR decelerations. Which clinical finding might be the cause for these late
decelerations?
a.Altered cerebral blood flow
b.Umbilical cord compression
c.Uteroplacental insufficiency
d.Meconium fluid - answer-ANS: C
Uteroplacental insufficiency results in late FHR decelerations. Altered fetal
cerebral blood flow results in early FHR decelerations. Umbilical cord
compression results in variable FHR decelerations. Meconium-stained fluid
may or may not produce changes in the FHR, depending on the gestational
age of the fetus and whether other causative factors associated with fetal
distress are present.
