AWHONN Advanced Fetal Heart Monitoring
(FHM) Course Exam 2026.
CASE STUDY A) SILVIA. Silvia, a 28 -year-old G1P0000 at 39 1/7 weeks by sonogram, and her partner arrived
on the laborunit at 0730 forscheduled induction for
IUGR/FGR. Silvia's family history is
negative for medical
problems with the exception of her mother's-term
long 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
biophysicalprofile(BPP), theamniotic
fluid index(AFI) was11 cm (AFI lessthan5 cm is defined as oligohydramnios) and the estimated fetal weight
(EFW) was 2524 grams (7th percentile). WHAT FETAL HEARTRATE DECELERATION IS MORE LIKELY TO
OCCUR IN THE PRESENCE OF SILVIA'S SINGLE UMBILICAL
ARTERY? - ✔◻✔◻Variabledecelerations
The singleumbilicalarteryimpactswhichcomponentof theoxygentransfersystem?- ✔◻✔◻Oxygendelivery
Which of Silvia'sfindingsindicatesa potentialfor chronicfetalhypoxemia?- ✔◻✔◻Intrauterine growth
restriction (IUGR)
With thefinding of a singleumbilicalartery,whatwouldyou expectto occurwithfetalperfusion?- ✔◻
✔◻Decreasedbloodperfusionfrom thefetusto theplacenta
Silvia's admissionvital signs were BP 109/60,
pulse 83 bpm, respirations 18/minute, temperature
97F (36.6C).
Vaginal examinationfindingswere2-3 cm dilated,50% effaced,-1 station,membranesintact, 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: - ✔◻✔◻Enhanced
communicationamonghealthcareprovidersand promotionof patientsafety
Referto tracingA-1. Which is thecorrectassessmentof theadmissiontracing?- ✔◻✔◻Moderatevariability
Referto tracingA-1. Basedon this tracing,a necessaryinterventionwouldbe to:- ✔◻✔◻Readjustthetoco
Referto tracingA-2. Oxytocinwasinfusingat 5 mU/minwhentheproviderarrivedand orderedthe oxytocin
increased to 8 mU/min. A CORRECT INTERPRETATION OF THIS TRACING IS: - ✔◻✔◻An oxygenated,
neurologically intact fetus
, Referto tracingA-2. A high-priorityinterventionat this timeis to:- ✔◻✔◻Readjustthetoco
One hour later, the nurse observed two 3 cm sized, thick dark blood clots on the under pad. Silvia
pain
denied
and her abdomenwassoftto palpation.Which componentof oxygentransportto thefetus could potentially be
- ✔◻✔◻Delivery
compromised by this bleeding?
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/minand 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? - ✔◻✔◻Maximize
utero-placentalcirculation
Referto tracingA-3. The correctassessmentof this tracingincludes:- ✔◻✔◻Sinusoidalpattern
Refer to tracing A
-4. At the time of tracing 4, the resident performed an AROM and fluid was clear. A vaginal
exam indicated the cervix was unchanged. The resident placed a fetal spiral electrode and had difficulty placing
an IUPC. The nurse could palpate contractions but could not determine the frequency
duration
and by
palpation.The oxytocinwasdiscontinued,an intravenousfluid boluswasadministered, and Silvia was
repositioned. WHAT FHR CHARACTERISTICS SHOULD THE NURSE REPORT TO THE PROVIDER? -
✔◻✔◻Recurrent decelerations
Referto tracingA-4. The correctphysiologicinterpretationof this tracingis: - ✔◻✔◻Fetalhypoxemia may be
present
Refer to tracing A
-5. At 1332, the resident successfully placed the IUPC and an amnioinfusion was initiated at
1430. The resident telephoned the provider to report the initiation of the amnioinfusion. INTRINSIC
WHICH
HOMEOSTATIC RESPONSE IS THE FETUS DEMONSTRATING? - ✔◻✔◻Baroreceptor
Referto tracingA-5. An amnioinfusionis intendedto relievewhichextrinsicfactorthatcompromises oxygen
transport?- ✔◻✔◻Umbilical cord compression
At 1410,thenurseagaintelephonedtheproviderto reportSilvia'sstatus,includingtwomoredark red blood
clots and absent
variability with recurrent decelerations, and asked the provider to come to the bedside for
evaluation. The provider indicated she was "on the way to the hospital" and ordered an emergency cesarean to
be started by the senior resident. Silvia was prepped for cesarean birth. The nurse is planning to document her
telephone report to the attending physician. Given the emergent situation, the best approach to documentation
would be:- ✔◻✔◻Continue providing care for Silvia and write a late entry summarizing the conversation
after the cesarean is completed
Whatadditionalactionshouldthenursetaketo minimizerisk, basedon this casescenario?- ✔◻✔
◻Ensurethattheneonatalteamis notifiedof thecircumstancesand is presentfor thebirth
The provider deliveredmale
a infant bycesareanbirth at 1447 andnoted bloodyamniotic fluidat delivery.
Apgar scoreswere3/3/3at 1/5/10minutes.The infantwasvisiblypale.Inspectionof the
(FHM) Course Exam 2026.
CASE STUDY A) SILVIA. Silvia, a 28 -year-old G1P0000 at 39 1/7 weeks by sonogram, and her partner arrived
on the laborunit at 0730 forscheduled induction for
IUGR/FGR. Silvia's family history is
negative for medical
problems with the exception of her mother's-term
long 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
biophysicalprofile(BPP), theamniotic
fluid index(AFI) was11 cm (AFI lessthan5 cm is defined as oligohydramnios) and the estimated fetal weight
(EFW) was 2524 grams (7th percentile). WHAT FETAL HEARTRATE DECELERATION IS MORE LIKELY TO
OCCUR IN THE PRESENCE OF SILVIA'S SINGLE UMBILICAL
ARTERY? - ✔◻✔◻Variabledecelerations
The singleumbilicalarteryimpactswhichcomponentof theoxygentransfersystem?- ✔◻✔◻Oxygendelivery
Which of Silvia'sfindingsindicatesa potentialfor chronicfetalhypoxemia?- ✔◻✔◻Intrauterine growth
restriction (IUGR)
With thefinding of a singleumbilicalartery,whatwouldyou expectto occurwithfetalperfusion?- ✔◻
✔◻Decreasedbloodperfusionfrom thefetusto theplacenta
Silvia's admissionvital signs were BP 109/60,
pulse 83 bpm, respirations 18/minute, temperature
97F (36.6C).
Vaginal examinationfindingswere2-3 cm dilated,50% effaced,-1 station,membranesintact, 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: - ✔◻✔◻Enhanced
communicationamonghealthcareprovidersand promotionof patientsafety
Referto tracingA-1. Which is thecorrectassessmentof theadmissiontracing?- ✔◻✔◻Moderatevariability
Referto tracingA-1. Basedon this tracing,a necessaryinterventionwouldbe to:- ✔◻✔◻Readjustthetoco
Referto tracingA-2. Oxytocinwasinfusingat 5 mU/minwhentheproviderarrivedand orderedthe oxytocin
increased to 8 mU/min. A CORRECT INTERPRETATION OF THIS TRACING IS: - ✔◻✔◻An oxygenated,
neurologically intact fetus
, Referto tracingA-2. A high-priorityinterventionat this timeis to:- ✔◻✔◻Readjustthetoco
One hour later, the nurse observed two 3 cm sized, thick dark blood clots on the under pad. Silvia
pain
denied
and her abdomenwassoftto palpation.Which componentof oxygentransportto thefetus could potentially be
- ✔◻✔◻Delivery
compromised by this bleeding?
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/minand 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? - ✔◻✔◻Maximize
utero-placentalcirculation
Referto tracingA-3. The correctassessmentof this tracingincludes:- ✔◻✔◻Sinusoidalpattern
Refer to tracing A
-4. At the time of tracing 4, the resident performed an AROM and fluid was clear. A vaginal
exam indicated the cervix was unchanged. The resident placed a fetal spiral electrode and had difficulty placing
an IUPC. The nurse could palpate contractions but could not determine the frequency
duration
and by
palpation.The oxytocinwasdiscontinued,an intravenousfluid boluswasadministered, and Silvia was
repositioned. WHAT FHR CHARACTERISTICS SHOULD THE NURSE REPORT TO THE PROVIDER? -
✔◻✔◻Recurrent decelerations
Referto tracingA-4. The correctphysiologicinterpretationof this tracingis: - ✔◻✔◻Fetalhypoxemia may be
present
Refer to tracing A
-5. At 1332, the resident successfully placed the IUPC and an amnioinfusion was initiated at
1430. The resident telephoned the provider to report the initiation of the amnioinfusion. INTRINSIC
WHICH
HOMEOSTATIC RESPONSE IS THE FETUS DEMONSTRATING? - ✔◻✔◻Baroreceptor
Referto tracingA-5. An amnioinfusionis intendedto relievewhichextrinsicfactorthatcompromises oxygen
transport?- ✔◻✔◻Umbilical cord compression
At 1410,thenurseagaintelephonedtheproviderto reportSilvia'sstatus,includingtwomoredark red blood
clots and absent
variability with recurrent decelerations, and asked the provider to come to the bedside for
evaluation. The provider indicated she was "on the way to the hospital" and ordered an emergency cesarean to
be started by the senior resident. Silvia was prepped for cesarean birth. The nurse is planning to document her
telephone report to the attending physician. Given the emergent situation, the best approach to documentation
would be:- ✔◻✔◻Continue providing care for Silvia and write a late entry summarizing the conversation
after the cesarean is completed
Whatadditionalactionshouldthenursetaketo minimizerisk, basedon this casescenario?- ✔◻✔
◻Ensurethattheneonatalteamis notifiedof thecircumstancesand is presentfor thebirth
The provider deliveredmale
a infant bycesareanbirth at 1447 andnoted bloodyamniotic fluidat delivery.
Apgar scoreswere3/3/3at 1/5/10minutes.The infantwasvisiblypale.Inspectionof the
