Intrapartal Period: Fetal Heart Rate Assessment (Ch 9)

The Labor and Delivery (L&D) unit educator discusses the prioritization of fetal monitoring goals, creating a plan of care, and setting goals for implementation with a group of nurses. Which goals are correct? Select all that apply.

Interpretation of ongoing assessment of fetal oxygenation. Prevention of significant fetal academia. Minimize unnecessary interventions. Promote a satisfying family-centered birth experience.

The nurse is teaching the patient about internal electronic fetal monitoring prior to the provider inserting the fetal scalp electrode. The patient begins crying and states, "I don't want a wire screwed in my baby's head!" Which is the most appropriate response by the nurse?

"Let me show you the tip that is placed superficially under the skin to monitor the baby's heart rate. We want you to understand the procedure."

The nurse is describing baseline fetal heart rate (FHR) to a practicum student. which would the nurse mention when teaching about the definition and assessment criteria related to baseline FHR? Select all

"Periodic changes in baseline of FHR occur in relation to uterine contractions." "Episodic changes in baseline of FHR occur independent of uterine contractions." "FHR is rounded to increments of 5 beats per minute during a 10-minute window. This must be at least 2 minutes of identifiable baseline segment."

The nursing instructor has just completed a lecture on fetal surveillance and the use of structured intermittent auscultation (SIA). The instructor knows that teaching was effective when the students recognize which contradiction to the use of SIA?

26-year-old G4P3 at 39 weeks who is 3 cm dilated with a Category I tracing, being induced for gestational diabetes mellitus (GDM)

The Labor and Delivery (L&D) educator has explained to a group of nurses how the utero-placental unit functions. Which components are necessary for the fetus to receive appropriate oxygenation? Select all that apply.

Adequate oxygenation of the mother Adequate uteroplacental circulation Adequate umbilical circulation Adequate blood flow to the placenta

The OB nurse is assessing a patient utilizing structured intermittent auscultation (SIA). Which intervention assists the nurse in identifying fetal heart tones (FHT)?

Auscultate FHT's between contractions for at least 30 to 60 seconds.

The nurse is caring for a patient whose fetus has been diagnosed with Intrauterine Growth Restriction (IUGR). The patient asks the nurse how this could have happened. Which does the nurse recognize as a possible cause?

Available oxygen chronically falls below 50% of normal levels and there is a redistribution of blood to vital organs.

While assessing a pregnant patient, the nurse notes the fetal heart rate (FHR) is 125 with moderate variability, no accelerations and no decelerations. Using the National Institute of Child Health and Human Development (NICHD) Criteria, which would the nurse record as the appropriate category related to the assessment findings?

Category I: Strongly predictive of a well- oxygenated, non-acidotic fetus. No action required.

The nurse notes a fetal heart rate (FHR) deceleration that begins after the peak of the contraction and ends once the contraction is over. Which is the priority nursing action for this patient?

Change the maternal position.

Which assessments of uterine activity are obtained by the nurse when the patient has an intrauterine pressure catheter (IUPC) placed? Select all that apply.

Frequency Intensity Duration Resting Tone

When palpating the patient's fundus during a contraction, the nurse notes that it feels like a 'chin.' The nurse documents this finding as which contraction intensity?

Moderate (AUTHOR'S NOTE: please don't tell your patient their fundus feels like a chin.)

The nurse has just completed a fetal monitoring course and is explaining the normal findings of structured intermittent auscultation (SIA) with a handheld Doppler. Which would the nurse identify as a normal finding of SIA? Select all that apply.

Normal baseline between 110 to 160 bpm Regular rhythm Presence of FHR increases from baseline Absence of FHR decreases from baseline

The nurse is auscultating the fetal heart rate on a patient who states her fetus is breech at 32 weeks gestation. Which is the appropriate nursing action to perform the auscultation?

Palpate the maternal abdomen to determine fetal position.

The instructor is teaching the modes of fetal heart rate and contraction assessment to a class of nursing students. What are the modes of uterine monitoring? Select all that apply.

Palpation Intrauterine pressure catheter Tocodynamometer

The nurse is caring for an obese patient and having difficulty maintaining the fetal heart rate (FHR) and contractions on an external fetal monitor (EFM). Which is the best action by the nurse in this situation?

Reposition patient, adjust tocodynamometer and ultrasound transducer.

The midwife is explaining to the patient how to palpate contractions during labor. The midwife explains that in between contractions the uterus should feel soft. Which is the midwife assessing between contractions?

Resting tone

Nurses in Labor and Delivery (L&D) participated in interprofessional unit-based drills and debriefings. Which strategy is critical to teamwork and communication according to the National Institute of Child Health and Human Development (NICHD)?

Standardize language for fetal heart rate definitions and patterns for all professional communications

The nurse is assessing a pregnant patient who is externally monitored and contracting every 3 to 4 minutes with each contraction lasting 40 to 60 seconds. The peak of the contraction reads 90 on the graph paper with a resting tone of 20. The patient rates her contractions as 10/10 and is crying. Which can the nurse document, based on these findings?

The frequency and duration of contractions.

The nurse caring for a G4P3 patient in active labor. Her fetus continues to have late decelerations with minimal variability despite interventions and notifies the provider on call. The provider gives an order to continue with the current plan of care. Which is the nurse's priority at this time?

Use the chain of command and communicate the FHR findings clearly to the charge nurse or next provider.

A nursing instructor explains to a group of students that an amnioinfusion is a procedure used most commonly in the first stage of labor to treat which type of decelerations?

Variable