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Fetal Heart Monitoring Exam – Relias 2025/2026 | 100+ Solved Questions with Rationales | Acid-Base Balance, FHR Patterns, Decels, IUPC, Variability

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This document is a complete and expert-level Relias Fetal Heart Monitoring (FHM) exam review for the 2025/2026 certification cycle, featuring 100+ correctly answered questions with clear rationales. Built around Relias module objectives and current ACOG and AWHONN fetal monitoring standards, it provides an in-depth understanding of fetal oxygenation, acid-base interpretation, and electronic fetal monitoring (EFM) strip analysis. Core concepts and skills covered include: Fetal circulation, oxygenation pathways, and causes of hypoxemia and acidosis FHR variability, accelerations, and baseline categorization (Cat I–III) Types and causes of decelerations: early, late, variable, and prolonged Interpretation of respiratory, metabolic, and mixed acidosis via cord blood gases Clinical interventions for tachysystole, bradycardia, and deceleration patterns Use of IUPC and fetal scalp electrode (FSE): indications, risks, and contraindications Relias-based management protocols: maternal repositioning, oxygenation, tocolysis, and amnioinfusion Neonatal outcomes associated with fetal hypoxia and acidemia This resource is essential for: Labor & Delivery nurses, perinatal educators, nurse midwives, and OB providers Nursing students in Maternal-Child Health, OB rotations, or Fetal Monitoring Certification programs Clinicians preparing for Relias competency testing, AWHONN intermediate/advanced EFM certification, or facility-based annual skills validation By blending pathophysiology, interpretation skills, and standardized response protocols, this study guide enhances both clinical reasoning and confidence in high-risk labor scenarios. Keywords: fetal heart monitoring, Relias FHM exam, fetal variability, late decels, variable decelerations, IUPC use, fetal scalp electrode, acid base fetal assessment, fetal bradycardia, tachysystole management, FHR categories, uterine rupture signs, fetal acidosis, AWHONN fetal monitoring, labor MVU calculation, neonatal encephalopathy, cord gas interpretation, FHR interpretation guide

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September 23, 2025
Number of pages
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Written in
2025/2026
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Relias - Fetal Heart Monitoring 2025/2026
Exam Questions and Correct Answers |
New Update



uterine blood supply - 🧠 ANSWER ✔✔- uterine arteries deliver oxygenated

blood to spiral arteries which bring oxygen rich blood to intervillous space

of placenta that has fetal capillaries




- fetal capillaries carry the O2 rich blood to umbilical VEIN that goes to

fetus




-in contrast, the umbilical ARTERIES return waste products to that

intervillous space that go into mother's venous system

Potential issues that negatively affect fetal oxygenation - 🧠 ANSWER

✔✔*Maternal Oxygenation:* asthma, hyper- or hypo- ventilation

,*Maternal Circulation:* decreased maternal cardiac output, hypotension,

decreased Hgb




*Placental O2 and CO2 Exchange:* postterm, abruption, HTN,

hypotension, uterine tachysystole




*Fetal circulation:* cord compression or occlusion


Fetal hypoxemia - 🧠 ANSWER ✔✔- can occur d/t reduced fetal O2

reserves, excessive uterine activity, or reduced uteroplacental blood flow




- worsening fetal hypoxemia can lead to abnormal FHR patterns, mostly

minimal or absent variability from acidemia


(1) hypoxemia vs. (2) hypoxia - 🧠 ANSWER ✔✔1 - reduce O2 in blood




2 - reduced O2 delivery at tissue level

, Fetal anaerobic metabolism - 🧠 ANSWER ✔✔- occurs when long term O2

delivery is insufficient to meet cellular needs of tissues




- results in production of lactic acid and other noncarbonic acids




- ACIDOSIS is the presence of excessive acids in tissues


acidosis - 🧠 ANSWER ✔✔pH below 7.35




pH is low




(acidosis is the process that leads to low blood pH, or acidemia)


alkalosis - 🧠 ANSWER ✔✔pH above 7.45




pH is high


buffers - 🧠 ANSWER ✔✔- help maintain acid base homeostasis




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