NURS 4500 - W3 EXAM QUESTIONS WITH
VERIFIED ANSWERS
What is an important factor in fetal wellbeing? - ANSWER Utero-placental function
What is placental function dependent on - ANSWER Maternal BP supplying circulation
Interference with circulation to placenta = placenta cannot effectively engage in
diffusion of oxygen/carbon dioxide
Placental age (placental function decreases as the placenta ages - bringing concerns
with post-term births)
Decreased circulation to the uterus/placenta may lead to - ANSWER Fetal: IUGR, fetal
hypoxia, metabolic acidosis, stillbirth (fetal death)
Neonatal: Small for gestational age/low birth weight, metabolic acidosis, seizures,
cerebral palsy, neonatal mortality
Overview of Fetal Circulation - ANSWER Umbilical Vein carries oxygenated blood to the
fetal heart
The Ductus Venous allows oxygenated blood to bypass fetal liver (blood goes straight to
heart)
Oxygenated blood enters through the IVC into the RA and the Foramen Ovale shunts the
oxygenated blood to the LA (and LV) which is then sent to the rest of the body
Deoxygenated blood from the SVC goes to the RA and RV, to the pulmonary trunk, it is
then shunted through the Ductus Arteriosus (to bypass fetal lung) and sent back to the
placenta via the Umbilical Artery
Factors impacting fetal oxygenation/FHR patterns - ANSWER Intrinsic Factors (like
anatomy/physiology)
Environmental (affecting availability of oxygen)
Factors affecting the ability to transport oxygen to the fetus
Environmental Factors affecting FHR (by impacting availability of oxygen/ability to
transport oxygen - ANSWER Maternal Factors - Respiratory disease, smoking,
significant anemia, hypotension, regional anaesthesia, COPD
Utereoplacental Factors - Excessive uterine activity, placenta; abruption, uterine
rupture
,Fetal Factors - Malpresention, poly/oligohyramnios, cord compression
Baroreceptors - ANSWER Respond to changes in (blood) pressure
Increased BP = Decreased FHR (and vice versa)
Chemoreceptors - ANSWER Respond to changes in oxygen and CO2 in the bloodstream
Shows more severe/prolonged changes
Sympathetic Nervous System (SNS) - ANSWER Stimulation produces increase in
strength of cardiac contraction and increase in the FHR
Parasympathetic Nervous System (PSNS) - ANSWER Stimulation of the vagus nerve
slows the SA node rate of firing thus producing a decrease in FHR
Vagal tone increases as gestational age increases and produces a downward effect on
the bsl FHR (as pre. progress the FHR decreases)
The relationship with bsl rate and variability are influenced by - ANSWER The slow down
responses of the PSNS + speed up influence of the SNS (this variability shows that the
CNS is working)
Purpose of Fetal Surveillance in Labour - ANSWER To detect potential fetal
decompression and to intervene early enough to prevent perinatal/neonatal morbidity or
mortality
Always assessed in conjunction with uterine activity (contractions)
Methods of Fetal Surveillance in Labour - ANSWER Intermittent Auscultation (IA) -
Monitoring uterine contractions/activity (clock/palpation) and IA (portable doppler) of
FHR - done periodically
Electronic Fetal Monitoring (EFM) - Can be internal/external of uterine contractions and
FHR
External Noninvasive fetal monitoring - ANSWER Involves:
Tocodynamometer tocotransfucer (TOCO) - placed over the uterine fundus for
contractions
Doppler/Ultrasound Transducer - Placed on the fetus' back to measure FHR
Intrauterine Pressure Transducer - ANSWER Gives a number
A catheter (inside the uterus) and spinal electrode (placed on fetus' head) is placed
Membranes ruptured and cervix is dilated
FHR Assessment with IA - ANSWER Looking for:
, Rate
Rhythm (Regular/Irregular)
Changes in FHR (accelerations/decelerations - in relationship to contractions)
FHR Assessment with EFM - ANSWER Baseline - rate
Variability (SNS/PSNS)
Changes in FHR (accelerations/decelerations - in relation to contractions/type of
decelerations)
Assessment of Uterine Contractions for IA/EFM - ANSWER Frequency
Duration
Intensity
Resting Tone
Fetal Surveillance Recommendations - ANSWER IA recommended for healthy pregnant
person ≥ 37 weeks gestation without perinatal risk factors
EFM is good for those with perinatal risk factors
What conditions are Associated with adverse Fetal Outcomes (Antenatal/Antepartum) -
ANSWER Maternal: HTNsive disorder, diabetes, antepartum hemorrhage, maternal
medical conditions, maternal MVA/Trauma
Birther perception
Fetal: IUGR, Prematurity, Oligo/polyhydraminos, Single umbilical artery, multiple
pregnancy, significant fetal abnormality
Nursing Care with IA/EFM - ANSWER One-to-one nursing care
Assess uterine activity and FHR characteristics
Interpret/classify FHR patterns
Interventions PRN
Communication/Documentation
Myometrium - ANSWER Middle layer of uterus wall that is composed of smooth muscles
VERIFIED ANSWERS
What is an important factor in fetal wellbeing? - ANSWER Utero-placental function
What is placental function dependent on - ANSWER Maternal BP supplying circulation
Interference with circulation to placenta = placenta cannot effectively engage in
diffusion of oxygen/carbon dioxide
Placental age (placental function decreases as the placenta ages - bringing concerns
with post-term births)
Decreased circulation to the uterus/placenta may lead to - ANSWER Fetal: IUGR, fetal
hypoxia, metabolic acidosis, stillbirth (fetal death)
Neonatal: Small for gestational age/low birth weight, metabolic acidosis, seizures,
cerebral palsy, neonatal mortality
Overview of Fetal Circulation - ANSWER Umbilical Vein carries oxygenated blood to the
fetal heart
The Ductus Venous allows oxygenated blood to bypass fetal liver (blood goes straight to
heart)
Oxygenated blood enters through the IVC into the RA and the Foramen Ovale shunts the
oxygenated blood to the LA (and LV) which is then sent to the rest of the body
Deoxygenated blood from the SVC goes to the RA and RV, to the pulmonary trunk, it is
then shunted through the Ductus Arteriosus (to bypass fetal lung) and sent back to the
placenta via the Umbilical Artery
Factors impacting fetal oxygenation/FHR patterns - ANSWER Intrinsic Factors (like
anatomy/physiology)
Environmental (affecting availability of oxygen)
Factors affecting the ability to transport oxygen to the fetus
Environmental Factors affecting FHR (by impacting availability of oxygen/ability to
transport oxygen - ANSWER Maternal Factors - Respiratory disease, smoking,
significant anemia, hypotension, regional anaesthesia, COPD
Utereoplacental Factors - Excessive uterine activity, placenta; abruption, uterine
rupture
,Fetal Factors - Malpresention, poly/oligohyramnios, cord compression
Baroreceptors - ANSWER Respond to changes in (blood) pressure
Increased BP = Decreased FHR (and vice versa)
Chemoreceptors - ANSWER Respond to changes in oxygen and CO2 in the bloodstream
Shows more severe/prolonged changes
Sympathetic Nervous System (SNS) - ANSWER Stimulation produces increase in
strength of cardiac contraction and increase in the FHR
Parasympathetic Nervous System (PSNS) - ANSWER Stimulation of the vagus nerve
slows the SA node rate of firing thus producing a decrease in FHR
Vagal tone increases as gestational age increases and produces a downward effect on
the bsl FHR (as pre. progress the FHR decreases)
The relationship with bsl rate and variability are influenced by - ANSWER The slow down
responses of the PSNS + speed up influence of the SNS (this variability shows that the
CNS is working)
Purpose of Fetal Surveillance in Labour - ANSWER To detect potential fetal
decompression and to intervene early enough to prevent perinatal/neonatal morbidity or
mortality
Always assessed in conjunction with uterine activity (contractions)
Methods of Fetal Surveillance in Labour - ANSWER Intermittent Auscultation (IA) -
Monitoring uterine contractions/activity (clock/palpation) and IA (portable doppler) of
FHR - done periodically
Electronic Fetal Monitoring (EFM) - Can be internal/external of uterine contractions and
FHR
External Noninvasive fetal monitoring - ANSWER Involves:
Tocodynamometer tocotransfucer (TOCO) - placed over the uterine fundus for
contractions
Doppler/Ultrasound Transducer - Placed on the fetus' back to measure FHR
Intrauterine Pressure Transducer - ANSWER Gives a number
A catheter (inside the uterus) and spinal electrode (placed on fetus' head) is placed
Membranes ruptured and cervix is dilated
FHR Assessment with IA - ANSWER Looking for:
, Rate
Rhythm (Regular/Irregular)
Changes in FHR (accelerations/decelerations - in relationship to contractions)
FHR Assessment with EFM - ANSWER Baseline - rate
Variability (SNS/PSNS)
Changes in FHR (accelerations/decelerations - in relation to contractions/type of
decelerations)
Assessment of Uterine Contractions for IA/EFM - ANSWER Frequency
Duration
Intensity
Resting Tone
Fetal Surveillance Recommendations - ANSWER IA recommended for healthy pregnant
person ≥ 37 weeks gestation without perinatal risk factors
EFM is good for those with perinatal risk factors
What conditions are Associated with adverse Fetal Outcomes (Antenatal/Antepartum) -
ANSWER Maternal: HTNsive disorder, diabetes, antepartum hemorrhage, maternal
medical conditions, maternal MVA/Trauma
Birther perception
Fetal: IUGR, Prematurity, Oligo/polyhydraminos, Single umbilical artery, multiple
pregnancy, significant fetal abnormality
Nursing Care with IA/EFM - ANSWER One-to-one nursing care
Assess uterine activity and FHR characteristics
Interpret/classify FHR patterns
Interventions PRN
Communication/Documentation
Myometrium - ANSWER Middle layer of uterus wall that is composed of smooth muscles
