AWHONN Advanced FHM Course
Exam Answers 2025
CaseAstudyAa)Asilvia.ASilvia,AaA28-year-
oldAg1p0000AatA39A1/7AweeksAbyAsonogram,AandAherApartnerAarrivedAonAtheAlaborAunitAatA0
730AforAscheduledAinductionAforAiugr/fgr.ASilvia'sAfamilyAhistoryAisAnegativeAforAmedicalApro
blemsAwithAtheAexceptionAofAherAmother'sAlong-
termAhistoryAofAdiabetes.ASilviaAhasAnoAhistoryAofAmedicalAproblemsAandAsheAhasAneverAha
dAanyAsurgeries.ASheAdevelopedAgestationalAdiabetesAwithAthisApregnancy,AbutAherAotherA
prenatalAlabsAwereAallAnormal.ADuringAoneAofAtheAultrasoundAexaminationsAperformedAtoAe
valuateAtheAiugr/fgr,AaAsingleAumbilicalAarteryAwasAnoted.AOnAherAmostArecentAbiophysicalA
profileA(bpp),AtheAamnioticAfluidAindexA(afi)AwasA11AcmA(afiAlessAthanA5AcmAisAdefinedAasAoli
gohydramnios)AandAtheAestimatedAfetalAweightA(efw)AwasA2524AgramsA(7thApercentile).AW
hatAfetalAheartArateAdecelerationAisAmoreAlikelyAtoAoccurAinAtheApresenceAofAsilvia'sAsingleAu
mbilicalAartery?A-AcorrectAanswers-variableAdecelerations
TheAsingleAumbilicalAarteryAimpactsAwhichAcomponentAofAtheAoxygenAtransferAsystem?A-
AcorrectAanswers-oxygenAdelivery
WhichAofAsilvia'sAfindingsAindicatesAaApotentialAforAchronicAfetalAhypoxemia?A-
AcorrectAanswers-intrauterineAgrowthArestrictionA(iugr)
WithAtheAfindingAofAaAsingleAumbilicalAartery,AwhatAwouldAyouAexpectAtoAoccurAwithAfetalApe
rfusion?A-AcorrectAanswers-decreasedAbloodAperfusionAfromAtheAfetusAtoAtheAplacenta
Silvia'sAadmissionAvitalAsignsAwereAbpA109/60,ApulseA83Abpm,ArespirationsA18/minute,Atem
peratureA97fA(36.6c).AVaginalAexaminationAfindingsAwereA2-3AcmAdilated,A50%Aeffaced,A-
1Astation,AmembranesAintact,AandAcephalicApresentation.AExternalAelectronicAfetalAmonitor
AdevicesAwereAplacedA(ultrasoundAandAtocodynamometer).ASheAdeniedAhavingAcontractio
ns,AvaginalAleakingAorAbleeding.AFollowingAthisAadmissionAtracing,AoxytocinAwasAorderedAa
ndAinitiatedAatA2Amu/min.AWithinAanAhour,AtheArateAwasAincreasedAtoA5Amu/min.APrimaryAbe
nefitsAassociatedAwithAtheAuseAofAstandardizedAterminologyAforAfhmAinterpretationAinAtheAcl
inicalAsettingAinclude:A-AcorrectAanswers-
enhancedAcommunicationAamongAhealthAcareAprovidersAandApromotionAofApatientAsafety
ReferAtoAtracingAa-1.AWhichAisAtheAcorrectAassessmentAofAtheAadmissionAtracing?A-
AcorrectAanswers-moderateAvariability
ReferAtoAtracingAa-1.ABasedAonAthisAtracing,AaAnecessaryAinterventionAwouldAbeAto:A-
AcorrectAanswers-readjustAtheAtoco
ReferAtoAtracingAa-
2.AOxytocinAwasAinfusingAatA5Amu/minAwhenAtheAproviderAarrivedAandAorderedAtheAoxytoci
nAincreasedAtoA8Amu/min.AAAcorrectAinterpretationAofAthisAtracingAis:A-AcorrectAanswers-
anAoxygenated,AneurologicallyAintactAfetus
ReferAtoAtracingAa-2.AAAhigh-priorityAinterventionAatAthisAtimeAisAto:A-AcorrectAanswers-
readjustAtheAtoco
OneAhourAlater,AtheAnurseAobservedAtwoA3AcmAsized,AthickAdarkAbloodAclotsAonAtheAunderA
pad.ASilviaAdeniedApainAandAherAabdomenAwasAsoftAtoApalpation.AWhichAcomponentAofAox
, ygenAtransportAtoAtheAfetusAcouldApotentiallyAbeAcompromisedAbyAthisAbleeding?A-
AcorrectAanswers-delivery
ReferAtoAtracingAa-
3.ASilvia'sAvitalAsignsAwereAbpA123/70,ApulseA86Abpm,ArespirationsA18/minute.ATheAoxytoci
nAwasAinfusingAatA11Amu/minAandAveAfindingsAwereA3-4Acm,A80%Aeffaced,A-
2Astation,AmembranesAintactAandAcephalicApresentation,AwithAaAmoderateAamountAofAbloo
dAonAvaginalAexam.AWhichAofAtheAfollowingAisAanAappropriateAphysiologicAgoalAbasedAonAtr
acingAa-3?A-AcorrectAanswers-maximizeAutero-placentalAcirculation
ReferAtoAtracingAa-3.ATheAcorrectAassessmentAofAthisAtracingAincludes:A-AcorrectAanswers-
sinusoidalApattern
ReferAtoAtracingAa-
4.AAtAtheAtimeAofAtracingA4,AtheAresidentAperformedAanAaromAandAfluidAwasAclear.AAAvaginal
AexamAindicatedAtheAcervixAwasAunchanged.ATheAresidentAplacedAaAfetalAspiralAelectrodeA
andAhadAdifficultyAplacingAanAiupc.ATheAnurseAcouldApalpateAcontractionsAbutAcouldAnotAde
termineAtheAfrequencyAandAdurationAbyApalpation.ATheAoxytocinAwasAdiscontinued,AanAintr
avenousAfluidAbolusAwasAadministered,AandAsilviaAwasArepositioned.AWhatAfhrAcharacterist
icsAshouldAtheAnurseAreportAtoAtheAprovider?A-AcorrectAanswers-recurrentAdecelerations
ReferAtoAtracingAa-4.ATheAcorrectAphysiologicAinterpretationAofAthisAtracingAis:A-
AcorrectAanswers-fetalAhypoxemiaAmayAbeApresent
ReferAtoAtracingAa-
5.AAtA1332,AtheAresidentAsuccessfullyAplacedAtheAiupcAandAanAamnioinfusionAwasAinitiatedA
atA1430.ATheAresidentAtelephonedAtheAproviderAtoAreportAtheAinitiationAofAtheAamnioinfusio
n.AWhichAintrinsicAhomeostaticAresponseAisAtheAfetusAdemonstrating?A-AcorrectAanswers-
baroreceptor
ReferAtoAtracingAa-
5.AAnAamnioinfusionAisAintendedAtoArelieveAwhichAextrinsicAfactorAthatAcompromisesAoxyge
nAtransport?A-AcorrectAanswers-umbilicalAcordAcompression
AtA1410,AtheAnurseAagainAtelephonedAtheAproviderAtoAreportAsilvia'sAstatus,AincludingAtwoA
moreAdarkAredAbloodAclotsAandAabsentAvariabilityAwithArecurrentAdecelerations,AandAaskedA
theAproviderAtoAcomeAtoAtheAbedsideAforAevaluation.ATheAproviderAindicatedAsheAwasA"onAt
heAwayAtoAtheAhospital"AandAorderedAanAemergencyAcesareanAtoAbeAstartedAbyAtheAseniorA
resident.ASilviaAwasApreppedAforAcesareanAbirth.ATheAnurseAisAplanningAtoAdocumentAherAt
elephoneAreportAtoAtheAattendingAphysician.AGivenAtheAemergentAsituation,AtheAbestAappro
achAtoAdocumentationAwouldAbe:A-AcorrectAanswers-
continueAprovidingAcareAforAsilviaAandAwriteAaAlateAentryAsummarizingAtheAconversationAaft
erAtheAcesareanAisAcompleted
WhatAadditionalAactionAshouldAtheAnurseAtakeAtoAminimizeArisk,AbasedAonAthisAcaseAscena
rio?A-AcorrectAanswers-
ensureAthatAtheAneonatalAteamAisAnotifiedAofAtheAcircumstancesAandAisApresentAforAtheAbirt
h
TheAproviderAdeliveredAaAmaleAinfantAbyAcesareanAbirthAatA1447AandAnotedAbloodyAamnioti
cAfluidAatAdelivery.AApgarAscoresAwereA3/3/3AatA1/5/10Aminutes.ATheAinfantAwasAvisiblyApal
e.AInspectionAofAtheAplacentaArevealedAaAvelamentousAinsertionAofAtheAumbilicalAcordAandA
aArupturedAfetalAvessel.ATheAumbilicalAcordAgasesAwere:AphA6.88/pco2A114Ammhg/po2A10A
mmhg/bicarbA15/baseAexcessA-
20Ameq/l.ATheAinitialAhematocritAwasA20%AandAtheAhemoglobinAwasA8.AWhichAinterpretatio
Exam Answers 2025
CaseAstudyAa)Asilvia.ASilvia,AaA28-year-
oldAg1p0000AatA39A1/7AweeksAbyAsonogram,AandAherApartnerAarrivedAonAtheAlaborAunitAatA0
730AforAscheduledAinductionAforAiugr/fgr.ASilvia'sAfamilyAhistoryAisAnegativeAforAmedicalApro
blemsAwithAtheAexceptionAofAherAmother'sAlong-
termAhistoryAofAdiabetes.ASilviaAhasAnoAhistoryAofAmedicalAproblemsAandAsheAhasAneverAha
dAanyAsurgeries.ASheAdevelopedAgestationalAdiabetesAwithAthisApregnancy,AbutAherAotherA
prenatalAlabsAwereAallAnormal.ADuringAoneAofAtheAultrasoundAexaminationsAperformedAtoAe
valuateAtheAiugr/fgr,AaAsingleAumbilicalAarteryAwasAnoted.AOnAherAmostArecentAbiophysicalA
profileA(bpp),AtheAamnioticAfluidAindexA(afi)AwasA11AcmA(afiAlessAthanA5AcmAisAdefinedAasAoli
gohydramnios)AandAtheAestimatedAfetalAweightA(efw)AwasA2524AgramsA(7thApercentile).AW
hatAfetalAheartArateAdecelerationAisAmoreAlikelyAtoAoccurAinAtheApresenceAofAsilvia'sAsingleAu
mbilicalAartery?A-AcorrectAanswers-variableAdecelerations
TheAsingleAumbilicalAarteryAimpactsAwhichAcomponentAofAtheAoxygenAtransferAsystem?A-
AcorrectAanswers-oxygenAdelivery
WhichAofAsilvia'sAfindingsAindicatesAaApotentialAforAchronicAfetalAhypoxemia?A-
AcorrectAanswers-intrauterineAgrowthArestrictionA(iugr)
WithAtheAfindingAofAaAsingleAumbilicalAartery,AwhatAwouldAyouAexpectAtoAoccurAwithAfetalApe
rfusion?A-AcorrectAanswers-decreasedAbloodAperfusionAfromAtheAfetusAtoAtheAplacenta
Silvia'sAadmissionAvitalAsignsAwereAbpA109/60,ApulseA83Abpm,ArespirationsA18/minute,Atem
peratureA97fA(36.6c).AVaginalAexaminationAfindingsAwereA2-3AcmAdilated,A50%Aeffaced,A-
1Astation,AmembranesAintact,AandAcephalicApresentation.AExternalAelectronicAfetalAmonitor
AdevicesAwereAplacedA(ultrasoundAandAtocodynamometer).ASheAdeniedAhavingAcontractio
ns,AvaginalAleakingAorAbleeding.AFollowingAthisAadmissionAtracing,AoxytocinAwasAorderedAa
ndAinitiatedAatA2Amu/min.AWithinAanAhour,AtheArateAwasAincreasedAtoA5Amu/min.APrimaryAbe
nefitsAassociatedAwithAtheAuseAofAstandardizedAterminologyAforAfhmAinterpretationAinAtheAcl
inicalAsettingAinclude:A-AcorrectAanswers-
enhancedAcommunicationAamongAhealthAcareAprovidersAandApromotionAofApatientAsafety
ReferAtoAtracingAa-1.AWhichAisAtheAcorrectAassessmentAofAtheAadmissionAtracing?A-
AcorrectAanswers-moderateAvariability
ReferAtoAtracingAa-1.ABasedAonAthisAtracing,AaAnecessaryAinterventionAwouldAbeAto:A-
AcorrectAanswers-readjustAtheAtoco
ReferAtoAtracingAa-
2.AOxytocinAwasAinfusingAatA5Amu/minAwhenAtheAproviderAarrivedAandAorderedAtheAoxytoci
nAincreasedAtoA8Amu/min.AAAcorrectAinterpretationAofAthisAtracingAis:A-AcorrectAanswers-
anAoxygenated,AneurologicallyAintactAfetus
ReferAtoAtracingAa-2.AAAhigh-priorityAinterventionAatAthisAtimeAisAto:A-AcorrectAanswers-
readjustAtheAtoco
OneAhourAlater,AtheAnurseAobservedAtwoA3AcmAsized,AthickAdarkAbloodAclotsAonAtheAunderA
pad.ASilviaAdeniedApainAandAherAabdomenAwasAsoftAtoApalpation.AWhichAcomponentAofAox
, ygenAtransportAtoAtheAfetusAcouldApotentiallyAbeAcompromisedAbyAthisAbleeding?A-
AcorrectAanswers-delivery
ReferAtoAtracingAa-
3.ASilvia'sAvitalAsignsAwereAbpA123/70,ApulseA86Abpm,ArespirationsA18/minute.ATheAoxytoci
nAwasAinfusingAatA11Amu/minAandAveAfindingsAwereA3-4Acm,A80%Aeffaced,A-
2Astation,AmembranesAintactAandAcephalicApresentation,AwithAaAmoderateAamountAofAbloo
dAonAvaginalAexam.AWhichAofAtheAfollowingAisAanAappropriateAphysiologicAgoalAbasedAonAtr
acingAa-3?A-AcorrectAanswers-maximizeAutero-placentalAcirculation
ReferAtoAtracingAa-3.ATheAcorrectAassessmentAofAthisAtracingAincludes:A-AcorrectAanswers-
sinusoidalApattern
ReferAtoAtracingAa-
4.AAtAtheAtimeAofAtracingA4,AtheAresidentAperformedAanAaromAandAfluidAwasAclear.AAAvaginal
AexamAindicatedAtheAcervixAwasAunchanged.ATheAresidentAplacedAaAfetalAspiralAelectrodeA
andAhadAdifficultyAplacingAanAiupc.ATheAnurseAcouldApalpateAcontractionsAbutAcouldAnotAde
termineAtheAfrequencyAandAdurationAbyApalpation.ATheAoxytocinAwasAdiscontinued,AanAintr
avenousAfluidAbolusAwasAadministered,AandAsilviaAwasArepositioned.AWhatAfhrAcharacterist
icsAshouldAtheAnurseAreportAtoAtheAprovider?A-AcorrectAanswers-recurrentAdecelerations
ReferAtoAtracingAa-4.ATheAcorrectAphysiologicAinterpretationAofAthisAtracingAis:A-
AcorrectAanswers-fetalAhypoxemiaAmayAbeApresent
ReferAtoAtracingAa-
5.AAtA1332,AtheAresidentAsuccessfullyAplacedAtheAiupcAandAanAamnioinfusionAwasAinitiatedA
atA1430.ATheAresidentAtelephonedAtheAproviderAtoAreportAtheAinitiationAofAtheAamnioinfusio
n.AWhichAintrinsicAhomeostaticAresponseAisAtheAfetusAdemonstrating?A-AcorrectAanswers-
baroreceptor
ReferAtoAtracingAa-
5.AAnAamnioinfusionAisAintendedAtoArelieveAwhichAextrinsicAfactorAthatAcompromisesAoxyge
nAtransport?A-AcorrectAanswers-umbilicalAcordAcompression
AtA1410,AtheAnurseAagainAtelephonedAtheAproviderAtoAreportAsilvia'sAstatus,AincludingAtwoA
moreAdarkAredAbloodAclotsAandAabsentAvariabilityAwithArecurrentAdecelerations,AandAaskedA
theAproviderAtoAcomeAtoAtheAbedsideAforAevaluation.ATheAproviderAindicatedAsheAwasA"onAt
heAwayAtoAtheAhospital"AandAorderedAanAemergencyAcesareanAtoAbeAstartedAbyAtheAseniorA
resident.ASilviaAwasApreppedAforAcesareanAbirth.ATheAnurseAisAplanningAtoAdocumentAherAt
elephoneAreportAtoAtheAattendingAphysician.AGivenAtheAemergentAsituation,AtheAbestAappro
achAtoAdocumentationAwouldAbe:A-AcorrectAanswers-
continueAprovidingAcareAforAsilviaAandAwriteAaAlateAentryAsummarizingAtheAconversationAaft
erAtheAcesareanAisAcompleted
WhatAadditionalAactionAshouldAtheAnurseAtakeAtoAminimizeArisk,AbasedAonAthisAcaseAscena
rio?A-AcorrectAanswers-
ensureAthatAtheAneonatalAteamAisAnotifiedAofAtheAcircumstancesAandAisApresentAforAtheAbirt
h
TheAproviderAdeliveredAaAmaleAinfantAbyAcesareanAbirthAatA1447AandAnotedAbloodyAamnioti
cAfluidAatAdelivery.AApgarAscoresAwereA3/3/3AatA1/5/10Aminutes.ATheAinfantAwasAvisiblyApal
e.AInspectionAofAtheAplacentaArevealedAaAvelamentousAinsertionAofAtheAumbilicalAcordAandA
aArupturedAfetalAvessel.ATheAumbilicalAcordAgasesAwere:AphA6.88/pco2A114Ammhg/po2A10A
mmhg/bicarbA15/baseAexcessA-
20Ameq/l.ATheAinitialAhematocritAwasA20%AandAtheAhemoglobinAwasA8.AWhichAinterpretatio
