MICROSOFT WORD - NCC ELECTRONIC FETAL MONITORING CERTIFICATION EXAM-WITH 100% VERIFIED ANSWERS-

MICROSOFT WORD - NCC ELECTRONIC FETAL MONITORING CERTIFICATION EXAM-WITH 100% VERIFIED ANSWERS- Which of the following factors can have a negative effect on uterine blood flow? a. Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above Correct Ans - e. All of the above How does the fetus compensate for decreased maternal circulating volume? a. Increases cardiac output by increasing stroke volume. b. Increases cardiac output by increasing it's heart rate. c. Increases cardiac output by increasing fetal movement. Correct Ans - b. Increases cardiac output by increasing it's heart rate. Stimulating the vagus nerve typically produces: a. A decrease in the heart rate b. An increase in the heart rate c. An increase in stroke volume d. No change Correct Ans - a. A decrease in the heart rate What initially causes a chemoreceptor response? a. Epidurals b. Supine maternal position c. Increased CO2 levels d. Decreased O2 levels e. A & C f. A & B g. C & D Correct Ans - g. C & D The vagus nerve begins maturation 26 to 28 weeks. Its dominance results in what effect to the FHR baseline? a. Increases baseline b. Decreases baseline Correct Ans - b. Decreases baseline T/F: Oxygen exchange in the placenta takes place in the intervillous space. Correct Ans - True T/F: The parasympathetic nervous system is a cardioaccelerator. Correct Ans - False T/F: The monitor should always be tested before starting a tracing, either external or internal mode and labeled a test. Correct Ans - True T/F: The spiral electrode is used to more accurately determine the frequency, duration, and intensity of uterine contractions. Correct Ans - False T/F: Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure. Correct Ans - True T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart rate: the ultrasound transducer and the fetal spiral electrode. Correct Ans - True T/F: Variability can be determined with the fetoscope. Correct Ans - False T/F: Because the ultrasound transducer and toco transducer are sealed units, they can be dipped in warm water to make cleaning easier. Correct Ans - False T/F: The most common artifact with the ultrasound transducer system for fetal heart rate is increased variability. Correct Ans - True T/F: All fetal monitors contain a logic system designed to reject artifact. Correct Ans - True T/F: The paper speed on the fetal monitor should always be set at 1cm/min. Correct Ans - False T/F: Both internal and external monitoring methods are equally accurate means of obtaining the fetal heart rate and contraction patterns. Correct Ans - False T/F: The external toco is usually placed over the uterine fundus to pick up contractions. Correct Ans - True T/F: The external toco gives measurable uterine pressure. Correct Ans - False T/F: The fetal spiral electrode can be placed when vaginal bleeding of unknown origin is present. Correct Ans - False T/F: The ultrasound transducer is usually placed on the side of the uterus over the baby's back, as the fetal heart is heard best there. Correct Ans - True T/F: The presence of FHR accelerations in the intrapartum and antepartum periods is a sign of adequate fetal oxygenation. Correct Ans - True T/F: Late decelerations have a gradual decrease in FHR (onset to nadir 30 seconds) and are delayed in timing with the nadir of the deceleration occurring after the peak of the contraction. Correct Ans - True T/F: The heart rate from a well-applied fetal spiral electrode can only be fetal, not maternal. Correct Ans - False T/F: The intrauterine catheter is used to pick up the fetal heart rate. Correct Ans - False T/F: The internal spiral electrode may pick up the maternal heart rate if the baby has died. Correct Ans - True T/F: Fetal arrhythmias can be seen on both internal and external monitor tracings. Correct Ans - True T/F: Variability and periodic changes can be detected with both internal and external monitoring. Correct Ans - True T/F: Variable decelerations are a result of cord compression. Correct Ans - True T/F: Variable decelerations are a vagal response. Correct Ans - True T/F: The fetal heart rate baseline can be determined during periods of marked variability. Correct Ans - False T/F: Anything that affects maternal blood flow (cardiac output) can affect the blood flow through the placenta. Correct Ans - True T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor. Correct Ans - True T/F: Minimal variability is always an indicator of hypoxia and a Cesarean section is indicated. Correct Ans - False What is your first intervention in management of a patient experiencing variable decelerations? a. Immediate delivery b. Change maternal position c. No treatment indicated d. Oxygen e. Stop oxytocin infusion Correct Ans - b. Change maternal position Etiology of a baseline FHR of 165bpm occurring for the last hour can be: 1. Maternal supine hypotension 2. Maternal fever 3. Maternal dehydration 4. Unknown a. 1 and 2 b. 1, 2 and 3 c. 2, 3 and 4 Correct Ans - c. 2, 3 and 4 What is the most probable cause of recurrent late decelerations? a. Utero-placental insufficiency b. Head compression c. Cord compression d. Maternal position change Correct Ans - a. Utero-placental insufficiency The most prevalent risk factor associated with fetal death before the onset of labor is: a. Low socioeconomic status b. Fetal malpresentation c. Uteroplacental insufficiency d. Uterine anomalies Correct Ans - c. Uteroplacental insufficiency Which of the following is NOT used for antepartum fetal surveillance? a. Fetal movement counting b. Antepartum fetal heart rate testing c. Biophysical profile testing d. Maternal HCG levels Correct Ans - d. Maternal HCG levels Which of the following conditions is not an indication for antepartum fetal surveillance? a. Gestational hypertension b. Diabetes in pregnancy c. Fetus in breech presentation d. Decreased fetal movement Correct Ans - c. Fetus in breech presentation Which of the following does not affect the degree of fetal activity? a. Vibroacoustic stimulation b. Smoking c. Fetal position d. Gestational age Correct Ans - a. Vibroacoustic stimulation To be considered reactive, a nonstress test must have: a. 4 fetal heart rate accelerations in a 20 minute window b. 2 fetal heart rate accelerations in a 10 minute window c. 4 fetal heart rate accelerations in a 40 minute window d. 2 fetal heart rate accelerations in a 20 minute window Correct Ans - d. 2 fetal heart rate accelerations in a 20 minute window If a nonstress test is nonreactive after 40 minutes, the next step should be: a. Have the client go home and do fetal movement counts b. Do a biophysical profile or contraction stress test c. Repeat the nonstress test within a week d. Admit the client for delivery Correct Ans - b. Do a biophysical profile or contraction stress test All of the following are components of a biophysical profile except: a. Contraction stress test b. Assessment of fetal breathing c. Amniotic fluid volume measurement d. Fetal movement assessment Correct Ans - a. Contraction stress test A modified biophysical profile includes a nonstress test and: a. Contraction stress test b. Ultrasound assessment of fetal movement c. Ultrasound assessment of amniotic fluid volume d. Fetal movement counts Correct Ans - c. Ultrasound assessment of amniotic fluid volume For a contraction stress test to be interpretable, you must have a minimum of: a. 5 contractions in a 10-minute window b. 3 contractions in a 10-minute window c. 4 contractions in a 10-minute window d. 2 contractions in a 10-minute window Correct Ans - b. 3 contractionsin a 10 minute window A negative contraction stress test is one in which: a. No contractions are seen b. There are late decelerations with > 50% of the contractions seen c. There are no fetal heart rate late decelerations with the contractions d. There is one fetal heart rate deceleration seen Correct Ans - c. There are no fetal heart rate late decelerations with the contractions According to AWHONN, the normal baseline Fetal Heart Rate (FHR) is A. 90-150 bpm B. 100-170 bpm C. 110-160 bpm D. 120-140 bpm Correct Ans - C. 110-160 bpm T/F: Umbilical cord influences that can alter blood flow include true knots, hematomas, and number of umbilical vessels. Correct Ans - True What are the two most important characteristics of the FHR? A. Rate and decelerations B. Variability and accelerations C. Variability and decelerations D. Rate and variability Correct Ans - B. Variability and accelerations You recognize that an FHR tracing has been showing a decrease in variability for the last 45 minutes. Your first intervention should be to A. Encourage ambulation B. Administer oxygen C. Discontinue IV fluids D. Increase Pitocin rate Correct Ans - B. Administer oxygen Resuscitation measures improves the baby's variability, but the FHR is still not reactive. You attempt fetal scalp stimulation (FSE) because you know that a well-oxygenated fetus will respond to FSE with a(n) A. Acceleration B. Deceleration C. Fetal movement D. Sleep pattern Correct Ans - A. Acceleration You are evaluating a patient in the Prenatal Testing Department who has just completed a biophysical profile (BPP). You suspect that there could be chronic fetal asphyxia because the score is below A. 10 B. 6 C. 8 Correct Ans - B. 6 When using a fetal scalp electrode (FSE), you notice an abnormally low FHR on the monitor. You should first A. Compare maternal pulse simultaneously with FHR B. Remove FSE C. Call the doctor immediately D. Turn of f the monitor Correct Ans - A. Compare maternal pulse simultaneously with FHR T/F: Low amplitude contractions are not an early sign of preterm labor. Correct Ans - False T/F: Preterm contractions are usually painful. Correct Ans - False T/F: Corticosteroid administration may cause an increase in FHR accelerations. Correct Ans - False T/F: Corticosteroid administration may cause an increase in FHR. Correct Ans - True T/F: Contractions cause an increase in uterine venous pressure and a decrease in uterine artery perfusion. Correct Ans - True As a result of the intrinsic fetal response to oxygen deprivation, increased catecholamine levels cause the peripheral blood flow to decrease while the blood flow to vital organs increases. These flow changes along with increased catecholamine secretions have what effect on fetal blood pressure and fetal heart rate? A. Increase BP and increase HR B. Increase BP and decrease HR C. Decrease BP and increase HR D. Decrease BP and decrease HR Correct Ans - B. Increase BP and decrease HR All of the following might indicate a pseudosinusoidal pattern as opposed to a sinusoidal pattern, except: A. Recent administration of narcotics to mother B. Accelerations in FHR C. Moderate variability D. Frequency of oscillations of two to five cycles/min Correct Ans - D. Frequency of oscillations of two to five cycles/min All of the following are appropriate interventions for fetal tachycardia except: A. Increase maternal IV fluid rate B. Assess maternal vital signs C. Perform SVE D. Administer oxygen Correct Ans - C. Perform SVE During a term antepartum NST (non-stress test), you notice several variable decelerations that decrease at least 15 bpm and last at least 15 sec long. Which of the following is the least likely explanation? A. True knot B. Gestational diabetes C. Umbilical cord entanglement D. Oligohydramnios Correct Ans - B. Gestational diabetes All of the following are likely causes of prolonged decelerations except: A. Uterine tachysystole B. Prolapsed cord C. Maternal hypotension D. Maternal fever Correct Ans - D. Maternal fever decelerations occur with less than 50% of contractions. A. Recurrent B. Intermittent C. Repetitive Correct Ans - B. Intermittent decelerations occur with greater than or equal to 50% of contractions. A. Recurrent B. Intermittent C. Repetitive Correct Ans - A. Recurrent All of the following could likely cause minimal variability in FHR except A. Magnesium sulfate administration B. Fetal sleep cycle C. Narcotic administration D. Ephedrine administration Correct Ans - D. Ephedrine administration When an IUPC has been placed, Montevideo units must be or greater for adequate cervical change to occur. A. 100 B. 200 C. 300 D. 400 Correct Ans - B. 200 The increases the heart rate and strengthens myocardial contractions through the release of epinephrine and nonepinephrine. A. Sympathetic nervous system B. Parasympathetic nervous system Correct Ans - A. Sympathetic nervous system The , through stimulation of the vagus nerve, reduces FHR and maintains variability. A. Sympathetic nervous system B. Parasympathetic nervous system Correct Ans - B. Parasympathetic nervous system What would be a suspected pH in a fetus whose FHTs included recurrent late decelerations during labor? A. 7.10 B. 7.26 C. 7.32 D. 7.41 Correct Ans - A. 7.10 What is the most common cause of sinusoidal patterns? A. Prolapsed cord B. Rh incompatibility C. Recurrent late decelerations D. Oligohydramnios Correct Ans - B. Rh incompatibility Before weeks of gestation, an increase in FHR that peaks at least 10 bpm above the baseline and lasts at least 10 seconds is considered an acceleration. A. 28 B. 30 C. 32 D. 36 Correct Ans - C. 32 The expected response of the fetal heart rate to active fetal movement of a 31-week gestational age fetus is: a. Suppression of normal short term variability for 15 seconds b. Acceleration of at least 15 beats per minute for 15 seconds c. Acceleration followed by a 15-second deceleration of the heart rate d. Acceleration of at least 10 beats per minute for 10 seconds Correct Ans - d. Acceleration of at least 10 beats per minute for 10 seconds The nurse notes a pattern of variable decelerations to 75 bpm on the fetal monitor. The initial nursing action is to: a. Reposition the woman b. Administer oxygen c. Increase the intravenous fluid infusion d. Stimulate the fetal scalp Correct Ans - a. Reposition the woman The tocotransducer should be placed: a. In the suprapubic area b. In the fundal area c. Over the xiphoid process d. Within the uterus Correct Ans - b. In the fundal area The nurse notes a pattern of decelerations on the fetal monitor that begins shortly after the contraction and returns to baseline just before the contraction is over. The correct nursing response is to: a. Give the woman oxygen by facemask at 8-10 L/min b. Position the woman on her opposite side c. Increase the rate of the woman's intravenous fluid d. Continue to observe and record the normal pattern Correct Ans - d. Continue to observe and record the normal pattern Determining the FHR baseline requires the nurse to approximate the mean FHR rounded to increments of 5 bpm during a -minute window (excluding accelerations and decelerations). A. 2 B. 5 T/F: Intrauterine pressure catheters (IUPCs) do not increase risk for infection when placed on patients with intact membranes. Correct Ans - False C. 10 D. 20 Correct Ans - C. 10 Uterine tachysystole is observed when there are A. 5 or more contractions in 10 min B. 6 or more contractions in 10 min C. 10 or more contractions in 10 min D. 7 or more contractions in 10 min Correct Ans - B. 6 or more contractions in 10 min Which of the following interventions would best stimulate an acceleration in the FHR? A. Provide juice to patient B. Perform vaginal exam C. Turn patient on left side D. Vibroacoustic stimulation Correct Ans - B. Perform vaginal exam Scalp stimulation Assessment of the is an indirect measurement of fetal oxygenation. A. Fetal heart rate B. Fetal scalp sampling C. Uterine activity D. Direct Coombs Correct Ans - A. Fetal heart rate Membranes must be ruptured for use; infection is a risk What are abnormal fetal heart rate tracings predictive of? A. Likelihood of spontaneous vaginal delivery B. Newborn condition at time of delivery C. Fetal acid-base abnormalities D. Fetal intrauterine growth Correct Ans - C. Fetal acid-base abnormalities Which of the following is not an intervention that should be implemented in a patient with uterine tachysystole? A. Administer terbutaline B. Increase IV fluid rate C. Decrease or discontinue IV oxytocin D. Prepare patient for cesarean section Correct Ans - D. Prepare patient for cesarean section T/F: If etiology of fetal tachycardia is secondary to extrauterine infection, FHR will return to normal as maternal fever resolves. Correct Ans - True Which of the following is most effective in determining the strength of a patient's contractions? A. Patient report B. Tocodynanamometer tracing C. RN palpation D. Sterile vaginal exam during a contraction Correct Ans - C. RN palpation The FHR is controlled by the A. Sympathetic nervous system B. Sinoatrial node C. Atrioventricular node D. Parasympathetic nervous system Correct Ans - B. Sinoatrial node How do baseline heart rates differ in premature fetuses? A. They are often lower B. They are often higher C. They are less likely to have decelerations D. They experience longer accelerations Correct Ans - B. They are often higher T/F: Fetal tachycardia is a normal compensatory response to transient fetal hypoxemia. Correct Ans - True Fetal heart rate bradycardia is defined as A. FHR <110bpm lasting 10 min or greater B. FHR <110bpm lasting 2 min or greater C. FHR <110bpm lasting 20 min or greater Correct Ans - A. FHR <110bpm lasting 10 min or greater variability warrants cesarean section delivery. A. Minimal B. Moderate C. Marked D. Absent Correct Ans - D. Absent At how many weeks gestation should FHR variability be normal in manner? A. 24 weeks B. 28 weeks C. 32 weeks D. 36 weeks Correct Ans - B. 28 weeks Decreased intervillious exchange of oxygenated blood resulting in fetal A deceleration from 145bpm down to 100bpm lasting 12 minutes may be defined as a A. Prolonged deceleration B. Variable deceleration C. Late deceleration D. Baseline change Correct Ans - D. Baseline change Reduced respiratory gas exchange from persistent decelerations may cause A. Respiratory alkalosis; metabolic acidosis B. Respiratory acidosis; metabolic acidosis C. Respiratory alkalosis; metabolic alkalosis D. Respiratory acidosis; metabolic acidosis Correct Ans - B. Respiratory acidosis; metabolic acidosis hypoxia is typically present in . A. Variable decelerations B. Late decelerations C. Early decelerations D. Accelerations Correct Ans - B. Late decelerations Place the following interventions for a sinusoidal FHR in the correct order: 1. Prepare for cesarean delivery 2. Place patient in lateral position 3. Determine if pattern is related to narcotic analgesic administration 4. Provide oxygen via face mask A. 4, 2, 3, 1 B. 3, 1, 2, 4 C. 4, 3, 2, 1 D. 3, 2, 4, 1 Correct Ans - D. 3, 2, 4, 1 The is the source of all fetal oxygenation. A. Placenta B. Umbilical cord C. Mother D. Amniotic fluid Correct Ans - C. Mother