AWHONN Advanced FHM Course Exam & Answers 2024 / Correctly Answered

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? - CORRECT ANSWER Variable decelerations The single umbilical artery impacts which component of the oxygen transfer system? - CORRECT ANSWER Oxygen delivery Which of Silvia's findings indicates a potential for chronic fetal hypoxemia? - CORRECT ANSWER Intrauterine growth restriction (IUGR) With the finding of a single umbilical artery, what would you expect to occur with fetal perfusion? - CORRECT 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: - CORRECT 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? - CORRECT ANSWER Moderate variability Refer to tracing A-1. Based on this tracing, a necessary intervention would be to: - CORRECT 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: - CORRECT ANSWER An oxygenated, neurologically intact fetus Refer to tracing A-2. A high-priority intervention at this time is to: - CORRECT 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? - CORRECT 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? - CORRECT ANSWER Maximize utero-placental circulation Refer to tracing A-3. The correct assessment of this tracing includes: - CORRECT ANSWER Sinusoidal pattern