FETAL HEART Monitoring Practice
FINAL
Exam Questions and Answers
Verified Solutions Latest Update
Question:
Ms. Johnson is a 29-year-old G3P2. She has been admitted for premature rupture of
membranes at 38 weeks' gestation, following an uncomplicated pregnancy. Her
medical history includes asthma with frequent use of rescue inhalers. Ms. Johnson is at
risk of interruption at which points in the maternal-fetal oxygen pathway? Select 2
answers. A Maternal inhalation b Maternal circulation c Placenta d Uterus e Umbilical
cord f Fetal circulation.
Answer:
A Maternal inhalation e Umbilical cord Due to her history of asthma and loss of
amniotic fluid, there is a risk of interruption in the maternal-fetal oxygen pathway due
to the potential issue with maternal inhalation (asthma) and the potential for umbilical
cord compression (decreased amniotic fluid). She has no identified issues with
makernal or fetal circulation or with her placenta or uterus.
Question:
A new nurse is learning about electronic fetal monitoring (EFM) while being oriented to
labor and delivery. Which of the following are true regarding EFM? Select 2 answers. a.
Since continuous fetal monitoring has been implemented, there has been a decrease in
fetal morbidity and mortality. b. Continuous fetal monitoring is the most popular type
of FHR monitoring in the United States. c. Wireless EFM allows freedom of movement
while still continuously monitoring the FHR. d. AlI EFM devices are used continuously
while a patient is in labor..
Answer:
b. Continuous fetal monitoring is the most popular type of FHR monitoring in the United
States. c. Wireless EFM allows freedom of movement while still continuously monitoring
the FHR. Continuous FM is the most common type of intrapartum FHR monitoring in use
today, even though there has been no evidence that it has lowered cerebral palsy
rates, perinatal death, neonatal death, low AGAR scores, or rates of neonatal
encephalopathy (Sartwelle, Johnston 2018). FM is performed using either a handheld
Doppler ultrasound device or external ultrasound transducer. Wireless EFM allows the
patient to move about without being tethered to the monitor base. EFM devices may be
,used intermittently or continuously in labor.
Question:
Each type of deceleration on the FHR tracing points to a distinct underlying cause.
Knowledge of the etiologies underlying each deceleration type is important when
choosing corrective interventions. Risk factors for late decelerations include which of
the following? Select all that apply. a. Maternal asthma b. Intrauterine growth
restriction c. 42 weeks' gestation d. Oligohydramnios.
Answer:
a. Maternal asthma b. Intrauterine growth restriction c. 42 weeks' gestation
Maternal/uteroplacental factors: tachysystole, postterm, placental abruption,
inadequate spiral artery dilation r/t PEC
Question:
Maternal factor-inhalation: asthma, sleep apnea
Question:
Maternal factor-circulation: hypotension, hypertension, hypovolemia, anemia,
microvascular disease (DM, lupus, rheumatoid arthritis), tachycardia Fetal factors:
IUGR, hypoxia, tachycardia, hyperthermia
Question:
Although Category II patterns do not predict abnormal fetal acid-base status, they
require which of the following? Select all that apply. a Immediate delivery b More
frequent evaluation c. Continued surveillance with documentation d. Initiation of
appropriate corrective measures when indicated.
Answer:
b c. d. Category II FHR patterns are considered indeterminate, meaning they do not
predict abnormal fetal acid-base status. They require more frequent evaluation,
initiation of corrective measures when indicated, and ongoing assessment for
progressive changes in the FHR characteristics. Failure to do so may result in the
deterioration of the pattern to Category IlI that is strongly predictive of abnormal fetal
acid-base status.
, Question:
Ms. Goldberg is in labor. Her fetal tracing is showing a prolonged deceleration that has
lasted 4 minutes in spite of repositioning the patient and discontinuing the oxytocin
infusion. Her current Sa02 is 90%. Which additional interventions could be considered
at this time? Select all that apply. A. Vaginal examination for prolapsed cord b.
Application of oxygen via tight face mask for 15-30 minutes c. Palpate uterus d. Digital
scalp stimulation to provoke FHR acceleration.
Answer:
a, b Although an evoked FHR acceleration can provide reassurance regarding the
absence of current fetal acidemia, this is true only when scalp stimulation is performed
while the FHR is at baseline. Scalp stimulation during a deceleration can cause a vagal
response, further decreasing the FHR. Appropriate interventions for a prolonged
deceleration include repositioning the patient, performing a vaginal exam to rule out a
cord prolapse, discontinuation of uterine stimulants, and application of supplemental
maternal oxygen for 15-30 minutes. Repositioning the patient may increase uterine
perfusion by alleviating the pressure of the aorta and vena cava. It may also reposition
the fetus alleviating cord compression by the fetus. For a sudden prolonged
deceleration, it is important to perform a vaginal exam to ensure that a cord did not
prolapse, requiring an immediate intervention to relieve compression and cesarean
delivery. Discontinuation of uterine stimulants, such as oxytocin, may lessen uterine
contractions allowing for increased oxygenation to the fetus. Short-term application of
oxygen to the mother may improve fetal oxygenation, but long-term use may be
detrimental to the fetus and should be discouraged. More data is needed on the
long-term use of oxygen on the mother and fetus (Lyndon, Wiser 2021).
Question:
Fetal heart rate bradycardia associated with umbilical cord prolapse, when pH would
result in which of the following? Select an answer. a. Normal acid-base balance b.
Metabolic acidosis c. Respiratory acidosis d. Mixed acidosis.
Answer:
d. Mixed acidosis Mixed acidosis is concurrent metabolic and respiratory acidosis that
may develop when respiratory acidosis persists for a prolonged period of time,
resulting in a large amount of buffers being used in the physiological compensatory
effort to reduce the acidic environment. Mixed acidosis is most often seen in prolonged
bradycardia at the time of birth.
FINAL
Exam Questions and Answers
Verified Solutions Latest Update
Question:
Ms. Johnson is a 29-year-old G3P2. She has been admitted for premature rupture of
membranes at 38 weeks' gestation, following an uncomplicated pregnancy. Her
medical history includes asthma with frequent use of rescue inhalers. Ms. Johnson is at
risk of interruption at which points in the maternal-fetal oxygen pathway? Select 2
answers. A Maternal inhalation b Maternal circulation c Placenta d Uterus e Umbilical
cord f Fetal circulation.
Answer:
A Maternal inhalation e Umbilical cord Due to her history of asthma and loss of
amniotic fluid, there is a risk of interruption in the maternal-fetal oxygen pathway due
to the potential issue with maternal inhalation (asthma) and the potential for umbilical
cord compression (decreased amniotic fluid). She has no identified issues with
makernal or fetal circulation or with her placenta or uterus.
Question:
A new nurse is learning about electronic fetal monitoring (EFM) while being oriented to
labor and delivery. Which of the following are true regarding EFM? Select 2 answers. a.
Since continuous fetal monitoring has been implemented, there has been a decrease in
fetal morbidity and mortality. b. Continuous fetal monitoring is the most popular type
of FHR monitoring in the United States. c. Wireless EFM allows freedom of movement
while still continuously monitoring the FHR. d. AlI EFM devices are used continuously
while a patient is in labor..
Answer:
b. Continuous fetal monitoring is the most popular type of FHR monitoring in the United
States. c. Wireless EFM allows freedom of movement while still continuously monitoring
the FHR. Continuous FM is the most common type of intrapartum FHR monitoring in use
today, even though there has been no evidence that it has lowered cerebral palsy
rates, perinatal death, neonatal death, low AGAR scores, or rates of neonatal
encephalopathy (Sartwelle, Johnston 2018). FM is performed using either a handheld
Doppler ultrasound device or external ultrasound transducer. Wireless EFM allows the
patient to move about without being tethered to the monitor base. EFM devices may be
,used intermittently or continuously in labor.
Question:
Each type of deceleration on the FHR tracing points to a distinct underlying cause.
Knowledge of the etiologies underlying each deceleration type is important when
choosing corrective interventions. Risk factors for late decelerations include which of
the following? Select all that apply. a. Maternal asthma b. Intrauterine growth
restriction c. 42 weeks' gestation d. Oligohydramnios.
Answer:
a. Maternal asthma b. Intrauterine growth restriction c. 42 weeks' gestation
Maternal/uteroplacental factors: tachysystole, postterm, placental abruption,
inadequate spiral artery dilation r/t PEC
Question:
Maternal factor-inhalation: asthma, sleep apnea
Question:
Maternal factor-circulation: hypotension, hypertension, hypovolemia, anemia,
microvascular disease (DM, lupus, rheumatoid arthritis), tachycardia Fetal factors:
IUGR, hypoxia, tachycardia, hyperthermia
Question:
Although Category II patterns do not predict abnormal fetal acid-base status, they
require which of the following? Select all that apply. a Immediate delivery b More
frequent evaluation c. Continued surveillance with documentation d. Initiation of
appropriate corrective measures when indicated.
Answer:
b c. d. Category II FHR patterns are considered indeterminate, meaning they do not
predict abnormal fetal acid-base status. They require more frequent evaluation,
initiation of corrective measures when indicated, and ongoing assessment for
progressive changes in the FHR characteristics. Failure to do so may result in the
deterioration of the pattern to Category IlI that is strongly predictive of abnormal fetal
acid-base status.
, Question:
Ms. Goldberg is in labor. Her fetal tracing is showing a prolonged deceleration that has
lasted 4 minutes in spite of repositioning the patient and discontinuing the oxytocin
infusion. Her current Sa02 is 90%. Which additional interventions could be considered
at this time? Select all that apply. A. Vaginal examination for prolapsed cord b.
Application of oxygen via tight face mask for 15-30 minutes c. Palpate uterus d. Digital
scalp stimulation to provoke FHR acceleration.
Answer:
a, b Although an evoked FHR acceleration can provide reassurance regarding the
absence of current fetal acidemia, this is true only when scalp stimulation is performed
while the FHR is at baseline. Scalp stimulation during a deceleration can cause a vagal
response, further decreasing the FHR. Appropriate interventions for a prolonged
deceleration include repositioning the patient, performing a vaginal exam to rule out a
cord prolapse, discontinuation of uterine stimulants, and application of supplemental
maternal oxygen for 15-30 minutes. Repositioning the patient may increase uterine
perfusion by alleviating the pressure of the aorta and vena cava. It may also reposition
the fetus alleviating cord compression by the fetus. For a sudden prolonged
deceleration, it is important to perform a vaginal exam to ensure that a cord did not
prolapse, requiring an immediate intervention to relieve compression and cesarean
delivery. Discontinuation of uterine stimulants, such as oxytocin, may lessen uterine
contractions allowing for increased oxygenation to the fetus. Short-term application of
oxygen to the mother may improve fetal oxygenation, but long-term use may be
detrimental to the fetus and should be discouraged. More data is needed on the
long-term use of oxygen on the mother and fetus (Lyndon, Wiser 2021).
Question:
Fetal heart rate bradycardia associated with umbilical cord prolapse, when pH would
result in which of the following? Select an answer. a. Normal acid-base balance b.
Metabolic acidosis c. Respiratory acidosis d. Mixed acidosis.
Answer:
d. Mixed acidosis Mixed acidosis is concurrent metabolic and respiratory acidosis that
may develop when respiratory acidosis persists for a prolonged period of time,
resulting in a large amount of buffers being used in the physiological compensatory
effort to reduce the acidic environment. Mixed acidosis is most often seen in prolonged
bradycardia at the time of birth.
