AWHONN Advanced FHM Course Exam
AnswersQUESTIONS AND VERIFIED
CORRECT SOLUTIONS || 100%
GUARANTEED PASS BRAND NEW
VERSION
CASE STUDY A) SILVIA. Silvia, a 28-year-old G1P0000 at 39 1/7 weeks by sonogram,
and her partner arrived on the labor unit at 0730 for scheduled induction for IUGR/FGR.
Silvia's family history is negative for medical problems with the exception of her
mother's long-term history of diabetes. Silvia has no history of medical problems and
she has never had any surgeries. She developed gestational diabetes with this
pregnancy, but her other prenatal labs were all normal. During one of the ultrasound
examinations performed to evaluate the IUGR/FGR, a single umbilical artery was noted.
On her most recent biophysical profile (BPP), the amniotic fluid index (AFI) was 11 cm
(AFI less than 5 cm is defined as oligohydramnios) and the estimated fetal weight
(EFW) was 2524 grams (7th percentile). WHAT FETAL HEART RATE
DECELERATION IS MORE LIKELY TO OCCUR IN THE PRESENCE OF SILVIA'S
SINGLE UMBILICAL ARTERY? -ANSWER✅✅✅✅Variable decelerations
The single umbilical artery impacts which component of the oxygen transfer system? -
ANSWER✅✅✅✅Oxygen delivery
Which of Silvia's findings indicates a potential for chronic fetal hypoxemia? -
ANSWER✅✅✅✅Intrauterine growth restriction (IUGR)
With the finding of a single umbilical artery, what would you expect to occur with fetal
perfusion? -ANSWER✅✅✅✅Decreased blood perfusion from the fetus to the placenta
Silvia's admission vital signs were BP 109/60, pulse 83 bpm, respirations 18/minute,
temperature 97F (36.6C). Vaginal examination findings were 2-3 cm dilated, 50%
effaced, -1 station, membranes intact, and cephalic presentation. External electronic
fetal monitor devices were placed (ultrasound and tocodynamometer). She denied
having contractions, vaginal leaking or bleeding. Following this admission tracing,
oxytocin was ordered and initiated at 2 mU/min. Within an hour, the rate was increased
to 5 mU/min. PRIMARY BENEFITS ASSOCIATED WITH THE USE OF
STANDARDIZED TERMINOLOGY FOR FHM INTERPRETATION IN THE CLINICAL
,SETTING INCLUDE: -ANSWER✅✅✅✅Enhanced communication among health care
providers and promotion of patient safety
Refer to tracing A-1. Which is the correct assessment of the admission tracing? -
ANSWER✅✅✅✅Moderate variability
Refer to tracing A-1. Based on this tracing, a necessary intervention would be to: -
ANSWER✅✅✅✅Readjust the toco
Refer to tracing A-2. Oxytocin was infusing at 5 mU/min when the provider arrived and
ordered the oxytocin increased to 8 mU/min. A CORRECT INTERPRETATION OF
THIS TRACING IS: -ANSWER✅✅✅✅An oxygenated, neurologically intact fetus
Refer to tracing A-2. A high-priority intervention at this time is to: -
ANSWER✅✅✅✅Readjust the toco
One hour later, the nurse observed two 3 cm sized, thick dark blood clots on the under
pad. Silvia denied pain and her abdomen was soft to palpation. Which component of
oxygen transport to the fetus could potentially be compromised by this bleeding? -
ANSWER✅✅✅✅Delivery
Refer to tracing A-3. Silvia's vital signs were BP 123/70, pulse 86 bpm, respirations
18/minute. The oxytocin was infusing at 11 mU/min and VE findings were 3-4 cm, 80%
effaced, -2 station, membranes intact and cephalic presentation, with a moderate
amount of blood on vaginal exam. WHICH OF THE FOLLOWING IS AN
APPROPRIATE PHYSIOLOGIC GOAL BASED ON TRACING A-3? -
ANSWER✅✅✅✅Maximize utero-placental circulation
Refer to tracing A-3. The correct assessment of this tracing includes: -
ANSWER✅✅✅✅Sinusoidal pattern
Refer to tracing A-4. At the time of tracing 4, the resident performed an AROM and fluid
was clear. A vaginal exam indicated the cervix was unchanged. The resident placed a
fetal spiral electrode and had difficulty placing an IUPC. The nurse could palpate
contractions but could not determine the frequency and duration by palpation. The
oxytocin was discontinued, an intravenous fluid bolus was administered, and Silvia was
repositioned. WHAT FHR CHARACTERISTICS SHOULD THE NURSE REPORT TO
THE PROVIDER? -ANSWER✅✅✅✅Recurrent decelerations
Refer to tracing A-4. The correct physiologic interpretation of this tracing is: -
ANSWER✅✅✅✅Fetal hypoxemia may be present
Refer to tracing A-5. At 1332, the resident successfully placed the IUPC and an
amnioinfusion was initiated at 1430. The resident telephoned the provider to report the
,initiation of the amnioinfusion. WHICH INTRINSIC HOMEOSTATIC RESPONSE IS
THE FETUS DEMONSTRATING? -ANSWER✅✅✅✅Baroreceptor
Refer to tracing A-5. An amnioinfusion is intended to relieve which extrinsic factor that
compromises oxygen transport? -ANSWER✅✅✅✅Umbilical cord compression
At 1410, the nurse again telephoned the provider to report Silvia's status, including two
more dark red blood clots and absent variability with recurrent decelerations, and asked
the provider to come to the bedside for evaluation. The provider indicated she was "on
the way to the hospital" and ordered an emergency cesarean to be started by the senior
resident. Silvia was prepped for cesarean birth. The nurse is planning to document her
telephone report to the attending physician. Given the emergent situation, the best
approach to documentation would be: -ANSWER✅✅✅✅Continue providing care for
Silvia and write a late entry summarizing the conversation after the cesarean is
completed
What additional action should the nurse take to minimize risk, based on this case
scenario? -ANSWER✅✅✅✅Ensure that the neonatal team is notified of the
circumstances and is present for the birth
The provider delivered a male infant by cesarean birth at 1447 and noted bloody
amniotic fluid at delivery. Apgar scores were 3/3/3 at 1/5/10 minutes. The infant was
visibly pale. Inspection of the placenta revealed a velamentous insertion of the umbilical
cord and a ruptured fetal vessel. The umbilical cord gases were: pH 6.88/PCO2 114
mmHg/PO2 10 mmHg/bicarb 15/base excess -20 mEq/L. The initial hematocrit was
20% and the hemoglobin was 8. WHICH INTERPRETATION OF THSE UMBILICAL
CORD AND INITIAL NEONATAL BLOOD RESULTS IS CORRECT? -
ANSWER✅✅✅✅The neonate is anemic
The provider delivered a male infant by cesarean birth at 1447 and noted bloody
amniotic fluid at delivery. Apgar scores were 3/3/3 at 1/5/10 minutes. The infant was
visibly pale. Inspection of the placenta revealed a velamentous insertion of the umbilical
cord and a ruptured fetal vessel. The umbilical cord gases were: pH 6.88/PCO2 114
mmHg/PO2 10 mmHg/bicarb 15/base excess -20 mEq/L. The initial hematocrit was
20% and the hemoglobin was 8. THESE UMBILICAL CORD GASES INDICATE: -
ANSWER✅✅✅✅Mixed acidosis (respiratory & metabolic)
CASE STUDY B) NELL. Nell, a 24-year-old G3 P020 at 42&3 weeks arrived on L&D for
an evening IOL for post-dates. Nell has had an exploratory lap. to remove scar tissue on
her L ovary and intestines and has had infrequent menstrual cycles. She had has 2
SABs - at 12 and 5 weeks. Prenatal labs were WDL. Her thyroid is enlarged; however,
her TSH, T4, and T3 were done at 39 weeks and were WDL. Nell has a family history of
HTN. An US at 19 weeks revealed a low-lying placenta that resolved by 37 5/7 weeks.
Today in triage, an US revealed an EFW of 3300g and an AFI of 3 cm. Nell has had
reactive NSTs. Admission vital signs were WDL. SVE findings: fingertip, 40%, and -2
station. Membranes intact and cephalic presentation. Nell denied feeling regular
, cramping. Category I tracing. A vaginal prostaglandin insert was placed. WHICH
COMPROMISE IN FETAL OXYGENATION COULD BE A RESULT OF A POST-DATE
PREGNANCY? -ANSWER✅✅✅✅Decreased placental perfusion
What are the possible implications of an oligohydramnios for labor? -
ANSWER✅✅✅✅Potential umbilical cord compression
If Nell's low-lying placenta had not resolved prior to labor and she experienced a large
amount of bright red vaginal bleeding, possibly indicating hemorrhage, what FHM
characteristic could occur? -ANSWER✅✅✅✅Sinusoidal FHR pattern
What clinical intervention is supported by Nell's gestational age and risk factors? -
ANSWER✅✅✅✅Continuous EFM monitoring throughout the night
The prostaglandin was removed at 0600 and Nell took a shower and ate a light
breakfast. An oxytocin infusion was then initiated at 2 mU/min. From 0730 to 0900 the
FHR baseline was 150 bpm, moderate variability, occasional periodic variable
decelerations and contractions every 2-5 minutes lasting 30-60 second, mild to
moderate by palpation. Nell was coping well and reported her pain as a 2 on a scale of
1-10 during contractions. SVE 2/80/-2. Vital signs: 108/67, HR 119, RR 16, and T 98.2F
(36.8C). Oxytocin was infusing at 10 mU/min. At 0925 Nell's provider performed AROM
with return of thick, particulate yellow-green meconium. A fetal spiral electrode was
placed. Refer to tracing B-1. Based on review of the tracing, the nurse's primary
intervention is: -ANSWER✅✅✅✅Auscultate the FHR with a doppler to confirm
arrhythmia
Refer to tracing B-1. In Nell's tracing, what do the FHR spikes likely represent? -
ANSWER✅✅✅✅FHR arrhythmia or artifact
Refer to tracing B-1. Which is a correct interpretation of Nell's tracing? -
ANSWER✅✅✅✅Normal baseline rate and possible arrhythmia
How could a fetal arrhythmia affect fetal oxygenation? -ANSWER✅✅✅✅By reducing
fetal perfusion
Fetal hydrops may present on ultrasound as fetal scalp edema and increased
abdominal fluid as a result of which fetal condition? -ANSWER✅✅✅✅Congestive
heart failure
The FSE was removed due to the increased challenges evaluating the tracing with the
arrhythmia. At 1030, oxytocin was infusing at 13 mU/min and SVE was 2-3/90//-2. Nell's
vital signs were 100/66, HR 122, RR 18, T 101.2F (38.4C). She has not voided and was
offered a bedpan. Nell voided 350 mL of amber colored urine. Refer to tracing B-2.
What would increase oxygen consumption in Nell's fetus? -
ANSWER✅✅✅✅Hyperthermia
AnswersQUESTIONS AND VERIFIED
CORRECT SOLUTIONS || 100%
GUARANTEED PASS BRAND NEW
VERSION
CASE STUDY A) SILVIA. Silvia, a 28-year-old G1P0000 at 39 1/7 weeks by sonogram,
and her partner arrived on the labor unit at 0730 for scheduled induction for IUGR/FGR.
Silvia's family history is negative for medical problems with the exception of her
mother's long-term history of diabetes. Silvia has no history of medical problems and
she has never had any surgeries. She developed gestational diabetes with this
pregnancy, but her other prenatal labs were all normal. During one of the ultrasound
examinations performed to evaluate the IUGR/FGR, a single umbilical artery was noted.
On her most recent biophysical profile (BPP), the amniotic fluid index (AFI) was 11 cm
(AFI less than 5 cm is defined as oligohydramnios) and the estimated fetal weight
(EFW) was 2524 grams (7th percentile). WHAT FETAL HEART RATE
DECELERATION IS MORE LIKELY TO OCCUR IN THE PRESENCE OF SILVIA'S
SINGLE UMBILICAL ARTERY? -ANSWER✅✅✅✅Variable decelerations
The single umbilical artery impacts which component of the oxygen transfer system? -
ANSWER✅✅✅✅Oxygen delivery
Which of Silvia's findings indicates a potential for chronic fetal hypoxemia? -
ANSWER✅✅✅✅Intrauterine growth restriction (IUGR)
With the finding of a single umbilical artery, what would you expect to occur with fetal
perfusion? -ANSWER✅✅✅✅Decreased blood perfusion from the fetus to the placenta
Silvia's admission vital signs were BP 109/60, pulse 83 bpm, respirations 18/minute,
temperature 97F (36.6C). Vaginal examination findings were 2-3 cm dilated, 50%
effaced, -1 station, membranes intact, and cephalic presentation. External electronic
fetal monitor devices were placed (ultrasound and tocodynamometer). She denied
having contractions, vaginal leaking or bleeding. Following this admission tracing,
oxytocin was ordered and initiated at 2 mU/min. Within an hour, the rate was increased
to 5 mU/min. PRIMARY BENEFITS ASSOCIATED WITH THE USE OF
STANDARDIZED TERMINOLOGY FOR FHM INTERPRETATION IN THE CLINICAL
,SETTING INCLUDE: -ANSWER✅✅✅✅Enhanced communication among health care
providers and promotion of patient safety
Refer to tracing A-1. Which is the correct assessment of the admission tracing? -
ANSWER✅✅✅✅Moderate variability
Refer to tracing A-1. Based on this tracing, a necessary intervention would be to: -
ANSWER✅✅✅✅Readjust the toco
Refer to tracing A-2. Oxytocin was infusing at 5 mU/min when the provider arrived and
ordered the oxytocin increased to 8 mU/min. A CORRECT INTERPRETATION OF
THIS TRACING IS: -ANSWER✅✅✅✅An oxygenated, neurologically intact fetus
Refer to tracing A-2. A high-priority intervention at this time is to: -
ANSWER✅✅✅✅Readjust the toco
One hour later, the nurse observed two 3 cm sized, thick dark blood clots on the under
pad. Silvia denied pain and her abdomen was soft to palpation. Which component of
oxygen transport to the fetus could potentially be compromised by this bleeding? -
ANSWER✅✅✅✅Delivery
Refer to tracing A-3. Silvia's vital signs were BP 123/70, pulse 86 bpm, respirations
18/minute. The oxytocin was infusing at 11 mU/min and VE findings were 3-4 cm, 80%
effaced, -2 station, membranes intact and cephalic presentation, with a moderate
amount of blood on vaginal exam. WHICH OF THE FOLLOWING IS AN
APPROPRIATE PHYSIOLOGIC GOAL BASED ON TRACING A-3? -
ANSWER✅✅✅✅Maximize utero-placental circulation
Refer to tracing A-3. The correct assessment of this tracing includes: -
ANSWER✅✅✅✅Sinusoidal pattern
Refer to tracing A-4. At the time of tracing 4, the resident performed an AROM and fluid
was clear. A vaginal exam indicated the cervix was unchanged. The resident placed a
fetal spiral electrode and had difficulty placing an IUPC. The nurse could palpate
contractions but could not determine the frequency and duration by palpation. The
oxytocin was discontinued, an intravenous fluid bolus was administered, and Silvia was
repositioned. WHAT FHR CHARACTERISTICS SHOULD THE NURSE REPORT TO
THE PROVIDER? -ANSWER✅✅✅✅Recurrent decelerations
Refer to tracing A-4. The correct physiologic interpretation of this tracing is: -
ANSWER✅✅✅✅Fetal hypoxemia may be present
Refer to tracing A-5. At 1332, the resident successfully placed the IUPC and an
amnioinfusion was initiated at 1430. The resident telephoned the provider to report the
,initiation of the amnioinfusion. WHICH INTRINSIC HOMEOSTATIC RESPONSE IS
THE FETUS DEMONSTRATING? -ANSWER✅✅✅✅Baroreceptor
Refer to tracing A-5. An amnioinfusion is intended to relieve which extrinsic factor that
compromises oxygen transport? -ANSWER✅✅✅✅Umbilical cord compression
At 1410, the nurse again telephoned the provider to report Silvia's status, including two
more dark red blood clots and absent variability with recurrent decelerations, and asked
the provider to come to the bedside for evaluation. The provider indicated she was "on
the way to the hospital" and ordered an emergency cesarean to be started by the senior
resident. Silvia was prepped for cesarean birth. The nurse is planning to document her
telephone report to the attending physician. Given the emergent situation, the best
approach to documentation would be: -ANSWER✅✅✅✅Continue providing care for
Silvia and write a late entry summarizing the conversation after the cesarean is
completed
What additional action should the nurse take to minimize risk, based on this case
scenario? -ANSWER✅✅✅✅Ensure that the neonatal team is notified of the
circumstances and is present for the birth
The provider delivered a male infant by cesarean birth at 1447 and noted bloody
amniotic fluid at delivery. Apgar scores were 3/3/3 at 1/5/10 minutes. The infant was
visibly pale. Inspection of the placenta revealed a velamentous insertion of the umbilical
cord and a ruptured fetal vessel. The umbilical cord gases were: pH 6.88/PCO2 114
mmHg/PO2 10 mmHg/bicarb 15/base excess -20 mEq/L. The initial hematocrit was
20% and the hemoglobin was 8. WHICH INTERPRETATION OF THSE UMBILICAL
CORD AND INITIAL NEONATAL BLOOD RESULTS IS CORRECT? -
ANSWER✅✅✅✅The neonate is anemic
The provider delivered a male infant by cesarean birth at 1447 and noted bloody
amniotic fluid at delivery. Apgar scores were 3/3/3 at 1/5/10 minutes. The infant was
visibly pale. Inspection of the placenta revealed a velamentous insertion of the umbilical
cord and a ruptured fetal vessel. The umbilical cord gases were: pH 6.88/PCO2 114
mmHg/PO2 10 mmHg/bicarb 15/base excess -20 mEq/L. The initial hematocrit was
20% and the hemoglobin was 8. THESE UMBILICAL CORD GASES INDICATE: -
ANSWER✅✅✅✅Mixed acidosis (respiratory & metabolic)
CASE STUDY B) NELL. Nell, a 24-year-old G3 P020 at 42&3 weeks arrived on L&D for
an evening IOL for post-dates. Nell has had an exploratory lap. to remove scar tissue on
her L ovary and intestines and has had infrequent menstrual cycles. She had has 2
SABs - at 12 and 5 weeks. Prenatal labs were WDL. Her thyroid is enlarged; however,
her TSH, T4, and T3 were done at 39 weeks and were WDL. Nell has a family history of
HTN. An US at 19 weeks revealed a low-lying placenta that resolved by 37 5/7 weeks.
Today in triage, an US revealed an EFW of 3300g and an AFI of 3 cm. Nell has had
reactive NSTs. Admission vital signs were WDL. SVE findings: fingertip, 40%, and -2
station. Membranes intact and cephalic presentation. Nell denied feeling regular
, cramping. Category I tracing. A vaginal prostaglandin insert was placed. WHICH
COMPROMISE IN FETAL OXYGENATION COULD BE A RESULT OF A POST-DATE
PREGNANCY? -ANSWER✅✅✅✅Decreased placental perfusion
What are the possible implications of an oligohydramnios for labor? -
ANSWER✅✅✅✅Potential umbilical cord compression
If Nell's low-lying placenta had not resolved prior to labor and she experienced a large
amount of bright red vaginal bleeding, possibly indicating hemorrhage, what FHM
characteristic could occur? -ANSWER✅✅✅✅Sinusoidal FHR pattern
What clinical intervention is supported by Nell's gestational age and risk factors? -
ANSWER✅✅✅✅Continuous EFM monitoring throughout the night
The prostaglandin was removed at 0600 and Nell took a shower and ate a light
breakfast. An oxytocin infusion was then initiated at 2 mU/min. From 0730 to 0900 the
FHR baseline was 150 bpm, moderate variability, occasional periodic variable
decelerations and contractions every 2-5 minutes lasting 30-60 second, mild to
moderate by palpation. Nell was coping well and reported her pain as a 2 on a scale of
1-10 during contractions. SVE 2/80/-2. Vital signs: 108/67, HR 119, RR 16, and T 98.2F
(36.8C). Oxytocin was infusing at 10 mU/min. At 0925 Nell's provider performed AROM
with return of thick, particulate yellow-green meconium. A fetal spiral electrode was
placed. Refer to tracing B-1. Based on review of the tracing, the nurse's primary
intervention is: -ANSWER✅✅✅✅Auscultate the FHR with a doppler to confirm
arrhythmia
Refer to tracing B-1. In Nell's tracing, what do the FHR spikes likely represent? -
ANSWER✅✅✅✅FHR arrhythmia or artifact
Refer to tracing B-1. Which is a correct interpretation of Nell's tracing? -
ANSWER✅✅✅✅Normal baseline rate and possible arrhythmia
How could a fetal arrhythmia affect fetal oxygenation? -ANSWER✅✅✅✅By reducing
fetal perfusion
Fetal hydrops may present on ultrasound as fetal scalp edema and increased
abdominal fluid as a result of which fetal condition? -ANSWER✅✅✅✅Congestive
heart failure
The FSE was removed due to the increased challenges evaluating the tracing with the
arrhythmia. At 1030, oxytocin was infusing at 13 mU/min and SVE was 2-3/90//-2. Nell's
vital signs were 100/66, HR 122, RR 18, T 101.2F (38.4C). She has not voided and was
offered a bedpan. Nell voided 350 mL of amber colored urine. Refer to tracing B-2.
What would increase oxygen consumption in Nell's fetus? -
ANSWER✅✅✅✅Hyperthermia
