AWHONN ADVANCED FETAL MONITORING EXAM Q&A |
2026-2027 - 100 Questions and Answers Already Graded A+
Premium Exam Tested And Verified
Subject Area Maternal-Fetal Medicine / Perinatal Nursing
Description This advanced exam assesses the ability to interpret intrapartum fetal heart rate
tracings using NICHD terminology, identify acid-base status, manage obstetric
emergencies, and apply evidence-based interventions in complex clinical
scenarios. It reflects the latest AWHONN guidelines and standards for fetal
monitoring.
Expected Grade A+
Total Questions 100
Duration 3 hours
Learning Outcomes 1. Apply NICHD three-tier fetal heart rate classification to identify fetal acidemia
risk
2. Differentiate between maternal, placental, and fetal causes of abnormal FHR
patterns
3. Select appropriate intrauterine resuscitation maneuvers based on FHR and
clinical context
4. Interpret fetal scalp pH and ST segment analysis (STAN) to guide delivery
decisions
Accreditation Meets AWHONN continuing education standards for advanced fetal monitoring
certification
Page 1
,1. A term fetus presents with a baseline FHR of 170 bpm, minimal variability, and
recurrent late decelerations. Which acid-base status is most consistent with this
pattern?
A. pH 7.30, base excess -2 mEq/L
B. pH 7.25, base excess -6 mEq/L
C. pH 7.20, base excess -10 mEq/L
D. pH 7.15, base excess -14 mEq/L
Answer: D. pH 7.15, base excess -14 mEq/L
Tachycardia with minimal variability and late decelerations indicates significant fetal
hypoxemia and metabolic acidosis. A pH of 7.15 with base excess -14 mEq/L represents
severe metabolic acidosis, consistent with progressive fetal decompensation. Higher pH
values (A, B) are too mild, and C is less severe than D.
2. During a category II tracing, variability decreases from moderate to minimal, and
variable decelerations develop shoulders. Which intervention should be performed
first?
A. Amnioinfusion
B. Maternal oxygen at 10 L/min via non-rebreather mask
C. Change maternal position to left lateral
D. Prepare for operative vaginal delivery
Answer: C. Change maternal position to left lateral
The initial step for any category II tracing is to improve uteroplacental perfusion. Left
lateral position relieves aortocaval compression. Amnioinfusion (A) is for recurrent
variable decelerations without shoulders, oxygen (B) is not first-line, and operative
delivery (D) is reserved for failed resuscitation.
Page 2
,3. Which of the following FHR patterns is most associated with umbilical cord
compression leading to fetal hypertension and baroreceptor-mediated decelerations?
A. Early decelerations
B. Variable decelerations
C. Late decelerations
D. Prolonged decelerations
Answer: B. Variable decelerations
Variable decelerations are caused by umbilical cord compression, which triggers a
hypertensive response and baroreceptor-mediated vagal slowing. Early decelerations
(A) are from head compression, late decelerations (C) from uteroplacental insufficiency,
and prolonged decelerations (D) can have various causes.
4. A patient at 39 weeks gestation has a category I tracing for 2 hours. Suddenly, the
FHR drops to 90 bpm and remains there for 3 minutes. What is the most likely
diagnosis?
A. Umbilical cord prolapse
B. Uterine tachysystole
C. Maternal Valsalva maneuver
D. Fetal sleep cycle
Answer: A. Umbilical cord prolapse
A sudden, profound, and sustained deceleration in the setting of previously normal
tracing is classic for umbilical cord prolapse. Uterine tachysystole (B) usually presents
with frequent contractions, not an isolated drop. Maternal Valsalva (C) causes transient
decelerations, and fetal sleep (D) does not cause bradycardia.
5. Which of the following is an indication for fetal scalp blood sampling to assess
pH?
A. Category I tracing with moderate variability
B. Category II tracing with minimal variability and no accelerations
C. Category III tracing with absent variability and recurrent late decelerations
D. Prolonged deceleration resolving spontaneously within 5 minutes
Answer: B. Category II tracing with minimal variability and no accelerations
Fetal scalp sampling is indicated when the FHR tracing is indeterminate (Category II)
and cannot reliably predict acidemia. Minimal variability without accelerations
suggests possible acidosis. Category III (C) usually warrants expedited delivery, not
scalp sampling. Category I (A) and resolved deceleration (D) are reassuring.
Page 3
, 6. A patient receives oxytocin for augmentation. The FHR shows recurrent late
decelerations with moderate variability. What is the appropriate action?
A. Increase oxytocin rate to achieve adequate contractions
B. Discontinue oxytocin and administer terbutaline
C. Decrease or stop oxytocin and assess for uterine tachysystole
D. Continue oxytocin and apply fetal scalp electrode
Answer: C. Decrease or stop oxytocin and assess for uterine tachysystole
Late decelerations indicate uteroplacental insufficiency; oxytocin should be reduced or
stopped to improve placental perfusion. Tachysystole is a common cause. Increasing
oxytocin (A) worsens the pattern. Terbutaline (B) is for hyperstimulation, but stopping
oxytocin is first. Fetal scalp electrode (D) does not address the cause.
7. Which fetal heart rate characteristic is most predictive of fetal acidemia when
present in conjunction with recurrent decelerations?
A. Baseline tachycardia of 170 bpm
B. Absent variability
C. Accelerations with fetal movement
D. Baseline bradycardia of 100 bpm
Answer: B. Absent variability
Absent variability combined with recurrent decelerations is strongly associated with
fetal acidemia (Category III). Tachycardia (A) is less specific. Accelerations (C) are
reassuring. Bradycardia (D) may be benign if variability is present.
8. A nurse notes that the FHR baseline decreases gradually from 140 to 120 bpm
over 30 minutes, with normal variability and no decelerations. What is the most
likely cause?
A. Fetal hypoxemia
B. Maternal hypothermia
C. Fetal sleep state
D. Beta-blocker administration to the mother
Answer: D. Beta-blocker administration to the mother
A gradual decline in baseline without decelerations or variability changes is consistent
with beta-blocker effect, which crosses the placenta and lowers fetal heart rate. Fetal
hypoxemia (A) usually causes tachycardia or decelerations. Maternal hypothermia (B)
is rare, and fetal sleep (C) would not cause sustained baseline shift.
Page 4
2026-2027 - 100 Questions and Answers Already Graded A+
Premium Exam Tested And Verified
Subject Area Maternal-Fetal Medicine / Perinatal Nursing
Description This advanced exam assesses the ability to interpret intrapartum fetal heart rate
tracings using NICHD terminology, identify acid-base status, manage obstetric
emergencies, and apply evidence-based interventions in complex clinical
scenarios. It reflects the latest AWHONN guidelines and standards for fetal
monitoring.
Expected Grade A+
Total Questions 100
Duration 3 hours
Learning Outcomes 1. Apply NICHD three-tier fetal heart rate classification to identify fetal acidemia
risk
2. Differentiate between maternal, placental, and fetal causes of abnormal FHR
patterns
3. Select appropriate intrauterine resuscitation maneuvers based on FHR and
clinical context
4. Interpret fetal scalp pH and ST segment analysis (STAN) to guide delivery
decisions
Accreditation Meets AWHONN continuing education standards for advanced fetal monitoring
certification
Page 1
,1. A term fetus presents with a baseline FHR of 170 bpm, minimal variability, and
recurrent late decelerations. Which acid-base status is most consistent with this
pattern?
A. pH 7.30, base excess -2 mEq/L
B. pH 7.25, base excess -6 mEq/L
C. pH 7.20, base excess -10 mEq/L
D. pH 7.15, base excess -14 mEq/L
Answer: D. pH 7.15, base excess -14 mEq/L
Tachycardia with minimal variability and late decelerations indicates significant fetal
hypoxemia and metabolic acidosis. A pH of 7.15 with base excess -14 mEq/L represents
severe metabolic acidosis, consistent with progressive fetal decompensation. Higher pH
values (A, B) are too mild, and C is less severe than D.
2. During a category II tracing, variability decreases from moderate to minimal, and
variable decelerations develop shoulders. Which intervention should be performed
first?
A. Amnioinfusion
B. Maternal oxygen at 10 L/min via non-rebreather mask
C. Change maternal position to left lateral
D. Prepare for operative vaginal delivery
Answer: C. Change maternal position to left lateral
The initial step for any category II tracing is to improve uteroplacental perfusion. Left
lateral position relieves aortocaval compression. Amnioinfusion (A) is for recurrent
variable decelerations without shoulders, oxygen (B) is not first-line, and operative
delivery (D) is reserved for failed resuscitation.
Page 2
,3. Which of the following FHR patterns is most associated with umbilical cord
compression leading to fetal hypertension and baroreceptor-mediated decelerations?
A. Early decelerations
B. Variable decelerations
C. Late decelerations
D. Prolonged decelerations
Answer: B. Variable decelerations
Variable decelerations are caused by umbilical cord compression, which triggers a
hypertensive response and baroreceptor-mediated vagal slowing. Early decelerations
(A) are from head compression, late decelerations (C) from uteroplacental insufficiency,
and prolonged decelerations (D) can have various causes.
4. A patient at 39 weeks gestation has a category I tracing for 2 hours. Suddenly, the
FHR drops to 90 bpm and remains there for 3 minutes. What is the most likely
diagnosis?
A. Umbilical cord prolapse
B. Uterine tachysystole
C. Maternal Valsalva maneuver
D. Fetal sleep cycle
Answer: A. Umbilical cord prolapse
A sudden, profound, and sustained deceleration in the setting of previously normal
tracing is classic for umbilical cord prolapse. Uterine tachysystole (B) usually presents
with frequent contractions, not an isolated drop. Maternal Valsalva (C) causes transient
decelerations, and fetal sleep (D) does not cause bradycardia.
5. Which of the following is an indication for fetal scalp blood sampling to assess
pH?
A. Category I tracing with moderate variability
B. Category II tracing with minimal variability and no accelerations
C. Category III tracing with absent variability and recurrent late decelerations
D. Prolonged deceleration resolving spontaneously within 5 minutes
Answer: B. Category II tracing with minimal variability and no accelerations
Fetal scalp sampling is indicated when the FHR tracing is indeterminate (Category II)
and cannot reliably predict acidemia. Minimal variability without accelerations
suggests possible acidosis. Category III (C) usually warrants expedited delivery, not
scalp sampling. Category I (A) and resolved deceleration (D) are reassuring.
Page 3
, 6. A patient receives oxytocin for augmentation. The FHR shows recurrent late
decelerations with moderate variability. What is the appropriate action?
A. Increase oxytocin rate to achieve adequate contractions
B. Discontinue oxytocin and administer terbutaline
C. Decrease or stop oxytocin and assess for uterine tachysystole
D. Continue oxytocin and apply fetal scalp electrode
Answer: C. Decrease or stop oxytocin and assess for uterine tachysystole
Late decelerations indicate uteroplacental insufficiency; oxytocin should be reduced or
stopped to improve placental perfusion. Tachysystole is a common cause. Increasing
oxytocin (A) worsens the pattern. Terbutaline (B) is for hyperstimulation, but stopping
oxytocin is first. Fetal scalp electrode (D) does not address the cause.
7. Which fetal heart rate characteristic is most predictive of fetal acidemia when
present in conjunction with recurrent decelerations?
A. Baseline tachycardia of 170 bpm
B. Absent variability
C. Accelerations with fetal movement
D. Baseline bradycardia of 100 bpm
Answer: B. Absent variability
Absent variability combined with recurrent decelerations is strongly associated with
fetal acidemia (Category III). Tachycardia (A) is less specific. Accelerations (C) are
reassuring. Bradycardia (D) may be benign if variability is present.
8. A nurse notes that the FHR baseline decreases gradually from 140 to 120 bpm
over 30 minutes, with normal variability and no decelerations. What is the most
likely cause?
A. Fetal hypoxemia
B. Maternal hypothermia
C. Fetal sleep state
D. Beta-blocker administration to the mother
Answer: D. Beta-blocker administration to the mother
A gradual decline in baseline without decelerations or variability changes is consistent
with beta-blocker effect, which crosses the placenta and lowers fetal heart rate. Fetal
hypoxemia (A) usually causes tachycardia or decelerations. Maternal hypothermia (B)
is rare, and fetal sleep (C) would not cause sustained baseline shift.
Page 4
