AWHONN Advanced FHM Course Exam
r r r r
Answers r
CASErSTUDYrA)rSILVIA.rSilvia,rar28-year-
oldrG1P0000ratr39r1/7rweeksrbyrsonogram,randrherrpartnerrarrivedronrtherlaborrunitratr0730r
forrscheduledrinductionrforrIUGR/FGR.rSilvia'srfamilyrhistoryrisrnegativerforrmedicalrproble
msrwithrtherexceptionrofrherrmother'srlong-
termrhistoryrofrdiabetes.rSilviarhasrnorhistoryrofrmedicalrproblemsrandrsherhasrneverrhadran
yrsurgeries.rSherdevelopedrgestationalrdiabetesrwithrthisrpregnancy,rbutrherrotherrprenatalrl
absrwererallrnormal.rDuringronerofrtherultrasoundrexaminationsrperformedrtorevaluatertherI
UGR/FGR,rarsinglerumbilicalrarteryrwasrnoted.rOnrherrmostrrecentrbiophysicalrprofiler(BPP)
,rtheramnioticrfluidrindexr(AFI)rwasr11rcmr(AFIrlessrthanr5rcmrisrdefinedrasroligohydramnios)r
andrtherestimatedrfetalrweightr(EFW)rwasr2524rgramsr(7thrpercentile).rWHATrFETALrHEA
RTrRATErDECELERATIONrISrMORErLIKELYrTOrOCCURrINrTHErPRESENCErOFrSILVIA
'SrSINGLErUMBILICALrARTERY?r-rVariablerdecelerations
Thersinglerumbilicalrarteryrimpactsrwhichrcomponentrofrtheroxygenrtransferrsystem?r-
rOxygenrdelivery
WhichrofrSilvia'srfindingsrindicatesrarpotentialrforrchronicrfetalrhypoxemia?r-
rIntrauterine rgrowth rrestrictionr(IUGR)
Withrtherfindingrofrarsinglerumbilicalrartery,rwhatrwouldryourexpectrtoroccurrwithrfetalrperfusi
on?r-rDecreasedrbloodrperfusionrfromrtherfetusrtortherplacenta
Silvia'sradmissionrvitalrsignsrwererBPr109/60,rpulser83rbpm,rrespirationsr18/minute,rtemper
aturer97Fr(36.6C).rVaginalrexaminationrfindingsrwerer2-3rcmrdilated,r50%reffaced,r-
1rstation,rmembranesrintact,randrcephalicrpresentation.rExternalrelectronicrfetalrmonitorrde
vicesrwererplacedr(ultrasoundrandrtocodynamometer).rSherdeniedrhavingrcontractions,rva
ginalrleakingrorrbleeding.rFollowingrthisradmissionrtracing,roxytocinrwasrorderedrandrinitiate
dratr2rmU/min.rWithinranrhour,rtherraterwasrincreasedrtor5rmU/min.rPRIMARYrBENEFITSrA
SSOCIATEDrWITHrTHErUSErOFrSTANDARDIZEDrTERMINOLOGYrFORrFHMrINTERPR
ETATIONrINrTHErCLINICALrSETTINGrINCLUDE:r-
rEnhancedrcommunication ramongrhealthrcarerprovidersrand rpromotionrof rpatientrsafety
ReferrtortracingrA-1.rWhichrisrthercorrectrassessmentrofrtheradmissionrtracing?r-
rModerate rvariability
ReferrtortracingrA-1.rBasedronrthisrtracing,rarnecessaryrinterventionrwouldrberto:r-
rReadjustrthertoco
ReferrtortracingrA-
2.rOxytocinrwasrinfusingratr5rmU/minrwhenrtherproviderrarrivedrandrorderedrtheroxytocinrinc
, reasedrtor8rmU/min.rArCORRECTrINTERPRETATIONrOFrTHISrTRACINGrIS:r-
rAnroxygenated, rneurologicallyrintactrfetus
ReferrtortracingrA-2.rArhigh-priorityrinterventionratrthisrtimerisrto:r-rReadjustrthertoco
Onerhourrlater,rthernurserobservedrtwor3rcmrsized,rthickrdarkrbloodrclotsronrtherunderrpad.rS
ilviardeniedrpainrandrherrabdomenrwasrsoftrtorpalpation.rWhichrcomponentrofroxygenrtransp
ortrtortherfetusrcouldrpotentiallyrbercompromisedrbyrthisrbleeding?r-rDelivery
ReferrtortracingrA-
3.rSilvia'srvitalrsignsrwererBPr123/70,rpulser86rbpm,rrespirationsr18/minute.rTheroxytocinrw
asrinfusingratr11rmU/minrandrVErfindingsrwerer3-4rcm,r80%reffaced,r-
2rstation,rmembranesrintactrandrcephalicrpresentation,rwithrarmoderateramountrofrbloodronr
vaginalrexam.rWHICHrOFrTHErFOLLOWINGrISrANrAPPROPRIATErPHYSIOLOGICrGOA
LrBASEDrONrTRACINGrA-3?r-rMaximizerutero-placentalrcirculation
ReferrtortracingrA-3.rThercorrectrassessmentrofrthisrtracingrincludes:r-rSinusoidalrpattern
ReferrtortracingrA-
4.rAtrthertimerofrtracingr4,rtherresidentrperformedranrAROMrandrfluidrwasrclear.rArvaginalrex
amrindicatedrthercervixrwasrunchanged.rTherresidentrplacedrarfetalrspiralrelectroderandrhadr
difficultyrplacingranrIUPC.rThernursercouldrpalpatercontractionsrbutrcouldrnotrdeterminerther
frequencyrandrdurationrbyrpalpation.rTheroxytocinrwasrdiscontinued,ranrintravenousrfluidrb
olusrwasradministered,randrSilviarwasrrepositioned.rWHATrFHRrCHARACTERISTICSrSH
OULDrTHErNURSErREPORTrTOrTHErPROVIDER?r-rRecurrentrdecelerations
ReferrtortracingrA-4.rThercorrectrphysiologicrinterpretationrofrthisrtracingris:r-
rFetalrhypoxemiarmayrberpresent
ReferrtortracingrA-
5.rAtr1332,rtherresidentrsuccessfullyrplacedrtherIUPCrandranramnioinfusionrwasrinitiatedratr1
430.rTherresidentrtelephonedrtherproviderrtorreportrtherinitiationrofrtheramnioinfusion.rWHIC
HrINTRINSICrHOMEOSTATICrRESPONSErISrTHErFETUSrDEMONSTRATING?r-
rBaroreceptor
ReferrtortracingrA-
5.rAnramnioinfusionrisrintendedrtorrelieverwhichrextrinsicrfactorrthatrcompromisesroxygenrtr
ansport?r-rUmbilicalrcordrcompression
Atr1410,rthernurseragainrtelephonedrtherproviderrtorreportrSilvia'srstatus,rincludingrtwormore
rdarkrredrbloodrclotsrandrabsent rvariabilityrwithrrecurrent rdecelerations,randrasked rtherprovi
derrtorcomertortherbedsiderforrevaluation.rTherproviderrindicatedrsherwasr"onrtherwayrtorther
hospital"randrorderedranremergencyrcesareanrtorberstartedrbyrtherseniorrresident.rSilviarwa
srpreppedrforrcesareanrbirth.rThernurserisrplanningrtordocumentrherrtelephonerreportrtorther
attendingrphysician.rGivenrtheremergentrsituation,rtherbestrapproachrtordocumentationrwou
ldrbe:r-
r r r r
Answers r
CASErSTUDYrA)rSILVIA.rSilvia,rar28-year-
oldrG1P0000ratr39r1/7rweeksrbyrsonogram,randrherrpartnerrarrivedronrtherlaborrunitratr0730r
forrscheduledrinductionrforrIUGR/FGR.rSilvia'srfamilyrhistoryrisrnegativerforrmedicalrproble
msrwithrtherexceptionrofrherrmother'srlong-
termrhistoryrofrdiabetes.rSilviarhasrnorhistoryrofrmedicalrproblemsrandrsherhasrneverrhadran
yrsurgeries.rSherdevelopedrgestationalrdiabetesrwithrthisrpregnancy,rbutrherrotherrprenatalrl
absrwererallrnormal.rDuringronerofrtherultrasoundrexaminationsrperformedrtorevaluatertherI
UGR/FGR,rarsinglerumbilicalrarteryrwasrnoted.rOnrherrmostrrecentrbiophysicalrprofiler(BPP)
,rtheramnioticrfluidrindexr(AFI)rwasr11rcmr(AFIrlessrthanr5rcmrisrdefinedrasroligohydramnios)r
andrtherestimatedrfetalrweightr(EFW)rwasr2524rgramsr(7thrpercentile).rWHATrFETALrHEA
RTrRATErDECELERATIONrISrMORErLIKELYrTOrOCCURrINrTHErPRESENCErOFrSILVIA
'SrSINGLErUMBILICALrARTERY?r-rVariablerdecelerations
Thersinglerumbilicalrarteryrimpactsrwhichrcomponentrofrtheroxygenrtransferrsystem?r-
rOxygenrdelivery
WhichrofrSilvia'srfindingsrindicatesrarpotentialrforrchronicrfetalrhypoxemia?r-
rIntrauterine rgrowth rrestrictionr(IUGR)
Withrtherfindingrofrarsinglerumbilicalrartery,rwhatrwouldryourexpectrtoroccurrwithrfetalrperfusi
on?r-rDecreasedrbloodrperfusionrfromrtherfetusrtortherplacenta
Silvia'sradmissionrvitalrsignsrwererBPr109/60,rpulser83rbpm,rrespirationsr18/minute,rtemper
aturer97Fr(36.6C).rVaginalrexaminationrfindingsrwerer2-3rcmrdilated,r50%reffaced,r-
1rstation,rmembranesrintact,randrcephalicrpresentation.rExternalrelectronicrfetalrmonitorrde
vicesrwererplacedr(ultrasoundrandrtocodynamometer).rSherdeniedrhavingrcontractions,rva
ginalrleakingrorrbleeding.rFollowingrthisradmissionrtracing,roxytocinrwasrorderedrandrinitiate
dratr2rmU/min.rWithinranrhour,rtherraterwasrincreasedrtor5rmU/min.rPRIMARYrBENEFITSrA
SSOCIATEDrWITHrTHErUSErOFrSTANDARDIZEDrTERMINOLOGYrFORrFHMrINTERPR
ETATIONrINrTHErCLINICALrSETTINGrINCLUDE:r-
rEnhancedrcommunication ramongrhealthrcarerprovidersrand rpromotionrof rpatientrsafety
ReferrtortracingrA-1.rWhichrisrthercorrectrassessmentrofrtheradmissionrtracing?r-
rModerate rvariability
ReferrtortracingrA-1.rBasedronrthisrtracing,rarnecessaryrinterventionrwouldrberto:r-
rReadjustrthertoco
ReferrtortracingrA-
2.rOxytocinrwasrinfusingratr5rmU/minrwhenrtherproviderrarrivedrandrorderedrtheroxytocinrinc
, reasedrtor8rmU/min.rArCORRECTrINTERPRETATIONrOFrTHISrTRACINGrIS:r-
rAnroxygenated, rneurologicallyrintactrfetus
ReferrtortracingrA-2.rArhigh-priorityrinterventionratrthisrtimerisrto:r-rReadjustrthertoco
Onerhourrlater,rthernurserobservedrtwor3rcmrsized,rthickrdarkrbloodrclotsronrtherunderrpad.rS
ilviardeniedrpainrandrherrabdomenrwasrsoftrtorpalpation.rWhichrcomponentrofroxygenrtransp
ortrtortherfetusrcouldrpotentiallyrbercompromisedrbyrthisrbleeding?r-rDelivery
ReferrtortracingrA-
3.rSilvia'srvitalrsignsrwererBPr123/70,rpulser86rbpm,rrespirationsr18/minute.rTheroxytocinrw
asrinfusingratr11rmU/minrandrVErfindingsrwerer3-4rcm,r80%reffaced,r-
2rstation,rmembranesrintactrandrcephalicrpresentation,rwithrarmoderateramountrofrbloodronr
vaginalrexam.rWHICHrOFrTHErFOLLOWINGrISrANrAPPROPRIATErPHYSIOLOGICrGOA
LrBASEDrONrTRACINGrA-3?r-rMaximizerutero-placentalrcirculation
ReferrtortracingrA-3.rThercorrectrassessmentrofrthisrtracingrincludes:r-rSinusoidalrpattern
ReferrtortracingrA-
4.rAtrthertimerofrtracingr4,rtherresidentrperformedranrAROMrandrfluidrwasrclear.rArvaginalrex
amrindicatedrthercervixrwasrunchanged.rTherresidentrplacedrarfetalrspiralrelectroderandrhadr
difficultyrplacingranrIUPC.rThernursercouldrpalpatercontractionsrbutrcouldrnotrdeterminerther
frequencyrandrdurationrbyrpalpation.rTheroxytocinrwasrdiscontinued,ranrintravenousrfluidrb
olusrwasradministered,randrSilviarwasrrepositioned.rWHATrFHRrCHARACTERISTICSrSH
OULDrTHErNURSErREPORTrTOrTHErPROVIDER?r-rRecurrentrdecelerations
ReferrtortracingrA-4.rThercorrectrphysiologicrinterpretationrofrthisrtracingris:r-
rFetalrhypoxemiarmayrberpresent
ReferrtortracingrA-
5.rAtr1332,rtherresidentrsuccessfullyrplacedrtherIUPCrandranramnioinfusionrwasrinitiatedratr1
430.rTherresidentrtelephonedrtherproviderrtorreportrtherinitiationrofrtheramnioinfusion.rWHIC
HrINTRINSICrHOMEOSTATICrRESPONSErISrTHErFETUSrDEMONSTRATING?r-
rBaroreceptor
ReferrtortracingrA-
5.rAnramnioinfusionrisrintendedrtorrelieverwhichrextrinsicrfactorrthatrcompromisesroxygenrtr
ansport?r-rUmbilicalrcordrcompression
Atr1410,rthernurseragainrtelephonedrtherproviderrtorreportrSilvia'srstatus,rincludingrtwormore
rdarkrredrbloodrclotsrandrabsent rvariabilityrwithrrecurrent rdecelerations,randrasked rtherprovi
derrtorcomertortherbedsiderforrevaluation.rTherproviderrindicatedrsherwasr"onrtherwayrtorther
hospital"randrorderedranremergencyrcesareanrtorberstartedrbyrtherseniorrresident.rSilviarwa
srpreppedrforrcesareanrbirth.rThernurserisrplanningrtordocumentrherrtelephonerreportrtorther
attendingrphysician.rGivenrtheremergentrsituation,rtherbestrapproachrtordocumentationrwou
ldrbe:r-
