2026 Fetal Monitoring Nursing Practice
Questions Answer Explanations Fetal Heart Rate
Patterns Accelerations Decelerations Variability
Labor Assessment Clinical Decisions
SECTION 1: FETAL MONITORING BASICS AND EQUIPMENT
(Questions 1–20)
1. A nurse is preparing to apply external fetal monitoring. Which component
measures the fetal heart rate?
A. Tocodynamometer
B. Ultrasound transducer
C. Intrauterine pressure catheter
D. Fetal scalp electrode
Answer: B
Rationale: The ultrasound transducer uses Doppler technology to detect and
measure the fetal heart rate externally. The tocodynamometer measures uterine
activity. The IUPC and fetal scalp electrode are internal monitoring devices.
2. Which external monitoring device assesses uterine contraction frequency
and duration?
A. Ultrasound transducer
B. Tocodynamometer
C. Intrauterine pressure catheter
D. Fetal scalp electrode
Answer: B
,Rationale: The tocodynamometer (TOCO) is placed on the maternal abdomen
over the uterine fundus and detects changes in abdominal wall tension, providing
information about contraction frequency and duration. It does not measure
intensity accurately.
3. A nurse is caring for a client with ruptured membranes and cervical
dilation of 4 cm. Which monitoring method provides the most accurate
measurement of uterine contraction intensity?
A. External tocodynamometer
B. Intrauterine pressure catheter
C. Maternal palpation
D. Ultrasound transducer
Answer: B
Rationale: The intrauterine pressure catheter (IUPC) directly measures uterine
resting tone and contraction intensity in mmHg. External TOCO and palpation
cannot quantify intensity accurately.
4. Which condition is a contraindication to placing a fetal scalp electrode?
A. Ruptured membranes
B. Cervical dilation of 3 cm
C. Maternal HIV infection
D. Vertex presentation
Answer: C
Rationale: Fetal scalp electrode placement is contraindicated in maternal
infections such as HIV and hepatitis because it creates a break in fetal skin and
increases transmission risk. Ruptured membranes and cervical dilation are required
for placement.
,5. A nurse is explaining internal fetal monitoring to a client. Which statement
by the client indicates understanding?
A. "The internal monitor can be placed before my water breaks."
B. "The internal monitor gives more accurate readings than the external monitor."
C. "The internal monitor cannot measure contraction strength."
D. "The internal monitor increases the risk of maternal fever."
Answer: B
Rationale: Internal monitoring, including the fetal scalp electrode and IUPC,
provides more accurate and continuous data than external monitoring. It requires
ruptured membranes and cervical dilation. The IUPC does measure contraction
strength.
6. A nurse notes that the external fetal monitor tracing is interrupted by
maternal movement. Which action is most appropriate?
A. Reposition the ultrasound transducer
B. Increase the paper speed
C. Discontinue monitoring
D. Document the finding as fetal distress
Answer: A
Rationale: Maternal movement can displace the ultrasound transducer and cause
signal loss. Repositioning the transducer usually restores the tracing. Discontinuing
monitoring or documenting fetal distress is not appropriate.
7. Which factor can limit the accuracy of external fetal monitoring?
A. Maternal obesity
B. Vertex presentation
C. Gestational age of 39 weeks
D. Ruptured membranes
, Answer: A
Rationale: Maternal obesity can interfere with ultrasound signal transmission and
TOCO sensitivity, reducing tracing accuracy. Vertex presentation, term gestation,
and ruptured membranes do not inherently limit external monitoring.
8. A nurse is determining the fetal heart rate baseline. Over which time period
should the baseline be assessed?
A. 1 minute
B. 2 minutes
C. 5 minutes
D. 10 minutes
Answer: D
Rationale: The fetal heart rate baseline is the average rate over a 10-minute
segment, excluding accelerations, decelerations, and periods of marked variability.
It must be rounded to the nearest 5 bpm.
9. What is the minimum duration required to define a fetal heart rate
baseline?
A. 30 seconds
B. 1 minute
C. 2 minutes
D. 5 minutes
Answer: C
Rationale: A baseline must be present for at least 2 minutes within a 10-minute
window to be defined. If not, the baseline is considered indeterminate.
Questions Answer Explanations Fetal Heart Rate
Patterns Accelerations Decelerations Variability
Labor Assessment Clinical Decisions
SECTION 1: FETAL MONITORING BASICS AND EQUIPMENT
(Questions 1–20)
1. A nurse is preparing to apply external fetal monitoring. Which component
measures the fetal heart rate?
A. Tocodynamometer
B. Ultrasound transducer
C. Intrauterine pressure catheter
D. Fetal scalp electrode
Answer: B
Rationale: The ultrasound transducer uses Doppler technology to detect and
measure the fetal heart rate externally. The tocodynamometer measures uterine
activity. The IUPC and fetal scalp electrode are internal monitoring devices.
2. Which external monitoring device assesses uterine contraction frequency
and duration?
A. Ultrasound transducer
B. Tocodynamometer
C. Intrauterine pressure catheter
D. Fetal scalp electrode
Answer: B
,Rationale: The tocodynamometer (TOCO) is placed on the maternal abdomen
over the uterine fundus and detects changes in abdominal wall tension, providing
information about contraction frequency and duration. It does not measure
intensity accurately.
3. A nurse is caring for a client with ruptured membranes and cervical
dilation of 4 cm. Which monitoring method provides the most accurate
measurement of uterine contraction intensity?
A. External tocodynamometer
B. Intrauterine pressure catheter
C. Maternal palpation
D. Ultrasound transducer
Answer: B
Rationale: The intrauterine pressure catheter (IUPC) directly measures uterine
resting tone and contraction intensity in mmHg. External TOCO and palpation
cannot quantify intensity accurately.
4. Which condition is a contraindication to placing a fetal scalp electrode?
A. Ruptured membranes
B. Cervical dilation of 3 cm
C. Maternal HIV infection
D. Vertex presentation
Answer: C
Rationale: Fetal scalp electrode placement is contraindicated in maternal
infections such as HIV and hepatitis because it creates a break in fetal skin and
increases transmission risk. Ruptured membranes and cervical dilation are required
for placement.
,5. A nurse is explaining internal fetal monitoring to a client. Which statement
by the client indicates understanding?
A. "The internal monitor can be placed before my water breaks."
B. "The internal monitor gives more accurate readings than the external monitor."
C. "The internal monitor cannot measure contraction strength."
D. "The internal monitor increases the risk of maternal fever."
Answer: B
Rationale: Internal monitoring, including the fetal scalp electrode and IUPC,
provides more accurate and continuous data than external monitoring. It requires
ruptured membranes and cervical dilation. The IUPC does measure contraction
strength.
6. A nurse notes that the external fetal monitor tracing is interrupted by
maternal movement. Which action is most appropriate?
A. Reposition the ultrasound transducer
B. Increase the paper speed
C. Discontinue monitoring
D. Document the finding as fetal distress
Answer: A
Rationale: Maternal movement can displace the ultrasound transducer and cause
signal loss. Repositioning the transducer usually restores the tracing. Discontinuing
monitoring or documenting fetal distress is not appropriate.
7. Which factor can limit the accuracy of external fetal monitoring?
A. Maternal obesity
B. Vertex presentation
C. Gestational age of 39 weeks
D. Ruptured membranes
, Answer: A
Rationale: Maternal obesity can interfere with ultrasound signal transmission and
TOCO sensitivity, reducing tracing accuracy. Vertex presentation, term gestation,
and ruptured membranes do not inherently limit external monitoring.
8. A nurse is determining the fetal heart rate baseline. Over which time period
should the baseline be assessed?
A. 1 minute
B. 2 minutes
C. 5 minutes
D. 10 minutes
Answer: D
Rationale: The fetal heart rate baseline is the average rate over a 10-minute
segment, excluding accelerations, decelerations, and periods of marked variability.
It must be rounded to the nearest 5 bpm.
9. What is the minimum duration required to define a fetal heart rate
baseline?
A. 30 seconds
B. 1 minute
C. 2 minutes
D. 5 minutes
Answer: C
Rationale: A baseline must be present for at least 2 minutes within a 10-minute
window to be defined. If not, the baseline is considered indeterminate.
