Maternal Child Nursing Care Chapter 15 Fetal Assessment During Labor
3 The use of illicit drugs (such as cocaine or methamphetamines) might cause increased variability . Maternal ingestion of narcotics may be the cause of decreased variability. The use of barbiturates may also result in a significant decrease in variability as these are known to cross the placental barrier. Tranquilizer use is a possible cause of decreased variability in the fetal heart rate.
A nurse caring for a woman in labor understands that increased variability of the fetal heart rate might be caused by: 1 narcotics. 2 barbiturates. 3 methamphetamines. 4 tranquilizers.
1, 4 Tachycardia (an increase in the FHR) is the early sign of fetal hypoxemia. Prolonged decelerations in FHR lasting for more than 2 minutes indicates the fetus is hypoxemic. Early decelerations, moderate variability, and occasional variable decelerations in the FHR are common observations during labor. These are normal findings and require no intervention.
After monitoring the fetal heart activity, the nurse concludes that there is impaired fetal oxygenation. What had the nurse observed in the fetal monitor to come to this conclusion? Select all that apply. 1 Increase in the fetal heart rate (FHR) to over 160 beats/min 2 Early decelerations 3 Moderate variability 4 Late decelerations 5 Occasional variable decelerations
2, 3 When performing the ECG of the fetus, the nurse should insert the electrode into the cervix to reach the fetus. Therefore the nurse should check if the cervix is dilated up to 3 cm and if the membranes are ruptured. This allows the nurse to reach the fetus's position. Lactate levels do not affect the ECG testing and thus need not be checked before the test. Umbilical cord compression or decreased frequency of UCs is not the required conditions for performing an ECG on the fetus.
After observing the electronic fetal monitor, a primary health care provider asks the nurse to conduct an electrocardiogram (ECG) of the fetus. What should the nurse assess before obtaining an ECG of the fetus? Select all that apply. 1 Fetal lactate levels 2 Placental membranes 3 Cervical dilation 4 Umbilical cord compression 5 Frequency of uterine contractions
4 In the umbilical cord acid-base stimulation method, arterial values indicate the condition of the newborn. Arterial blood pH of 7.2 to 7.3, carbon dioxide pressure (Pco2) value of 45 to 55 mm Hg, and oxygen pressure (Po2) value of 15 to 25 mm Hg approximately indicates the normal fetal condition. Therefore pH of 7.3, Pco2 of 45 mm Hg, and Po2 of 25 mm Hg represent the normal fetal condition. Arterial blood pH of 7.1, Pco2 of 50 mm Hg, and Po2 of 20 mm Hg indicate that the fetus may have respiratory acidosis. Arterial blood pH of 7.4 is indicative of fetal alkalosis.
After observing the reports of the umbilical cord acid-base determination test, the nurse informs the patient that the newborn's condition is normal. Which value indicates the normal condition of the newborn? 1 Umbilical artery: pH, 7.1; Pco2, 50 mm Hg; Po2, 20 mm Hg 2 Umbilical artery: pH, 7.3; Pco2, 40 mm Hg; Po2, 10 mm Hg 3 Umbilical artery: pH, 7.4; Pco2, 52 mm Hg; Po2, 27 mm Hg 4 Umbilical artery: pH, 7.3; Pco2, 45 mm Hg; Po2, 25 mm Hg
4 If pH 2 >55 mm Hg (elevated), and base deficit value respiratory acidosis. In this case, the partial pressure carbon dioxide >55 mm Hg is indicative of respiratory acidosis. A pH >7.20 and base deficit value ≥12 mmol/L are all considered normal. Blood glucose level is not a part of this acid-base report.
After reviewing the umbilical cord acid-base report, the nurse confirms that the fetus has respiratory acidosis. Which reading is consistent with the nurse's conclusion? 1 A base deficit value ≥12 mmol/L 2 Blood glucose levels = 120 mg/dL 3 Arterial pH >7.20 4 Partial pressure carbon dioxide >55 mm Hg
3 Variability in the fetal heart rate can be classified as absent, mild, or moderate variability. This results in hypoxia and metabolic acidemia in the fetus. Central nervous system (CNS) depressants, such as secobarbital (Seconal), cause variability in the fetal heart rate. This medication affects the baseline heart rate in the fetus by less than 5 beats/min. Hydroxyzine (Vistaril), terbutaline (Brethine), and atropine (Sal-Tropine) may result in tachycardia in the fetus. These drugs can increase the baseline fetal heart rate as much as 25 beats/min.
Fetal monitoring of a pregnant patient revealed that the fetal heart rate has minimal variability. Which prescribed drug is most likely responsible for the condition? 1 Hydroxyzine (Vistaril) 2 Terbutaline (Brethine) 3 Secobarbital (Seconal) 4 Atropine (Sal-Tropine)
1 Fetal well-being during labor is measured by the response of the FHR to UCs . In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110 to 160 beats/min with no periodic changes, a moderate baseline variability, and accelerations with fetal movement. Maternal pain control is not the measure used to determine fetal well-being in labor. Although FHR accelerations are a reassuring pattern, they are only one component of the criteria by which fetal well-being is assessed. Although an FHR greater than 110 beats/min may be reassuring, it is only one component of the criteria by which fetal well-being is assessed. More information is needed to determine fetal well-being. Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of this text over an extended period of time ensures your understanding of the mechanics of the examination and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding to your strength and inner conviction to achieve success.
Fetal well-being during labor is assessed by: 1 the response of the fetal heart rate (FHR) to uterine contractions (UCs). 2 maternal pain control. 3 accelerations in the FHR. 4 an FHR greater than 110 beats/min
1 An early deceleration pattern from head compression is described. No action other than documentation of the finding is required because this is an expected reaction to compression of the fetal head as it passes through the cervix. Repositioning the woman onto her side would be implemented when non-reassuring or ominous changes are noted. Calling the physician would be implemented when non-reassuring or ominous changes are noted. Administering oxygen would be implemented when non-reassuring or ominous changes are noted.
On review of a fetal monitor tracing, the nurse notes that for several contractions the fetal heart rate decelerates as a contraction begins and returns to baseline just before it ends. The nurse should: 1 describe the finding in the nurse's notes. 2 reposition the woman onto her side. 3 call the physician for instructions. 4 administer oxygen at 8 to 10 L/min with a tight face mask.
4 Montevideo units can only be calculated using the internal monitoring of UA. An intrauterine pressure catheter (IUPC) monitors UA internally. Therefore Montevideo units can only be calculated using the IUPC. Spiral electrode monitoring is used for assessing the fetal heart rate (FHR), not UA internally. The tocotransducer monitoring system is used to monitor the UA externally. An ultrasound transducer is also used to monitor the FHR externally.
The charge nurse instructed a group of student nurses about the monitoring of uterine activity (UA) during labor. Which statement by the student nurse is accurate regarding the calculation of Montevideo units? "They can be calculated: 1 Using a spiral electrode monitoring device." 2 Using a tocotransducer monitoring system." 3 Using an ultrasound transducer machine." 4 With an intrauterine pressure catheter (IUPC)."
2 The normal baseline fetal heart rate ranges from 110 to 160 beats/min. If the fetal heart rate is more than 160 beats/min, then tachycardia in the fetus is indicated. Ischemia is a condition in which there is a reduced blood supply to the fetal tissues. Baseline heart rate below 110 beats/min indicates bradycardia in fetus. Hypotension indicates a blood pressure level below 120/80 mm Hg, which is a life-threatening condition for the fetus.
The diagnostic test reports of a pregnant patient reveal a baseline fetal heart rate of 175 beats/min. What does this finding indicate to the nurse? 1 Presence of fetal ischemia 2 Fetal tachycardia 3 Fetal bradycardia 4 Hypotension in the fetus
3 Variable decelerations in the fetal heart rate (FHR) are observed when the umbilical cord is compressed. An amnioinfusion refers to the infusion of isotonic fluid into the uterine cavity when the amniotic fluid levels are decreased. This intervention is usually done for the prevention of umbilical cord compression. Late decelerations are observed when infections or elevated uterine contractions (UCs) are seen in a patient. This condition will be reversed by maintaining an I.V. solution, but aminoinfusion is not administered. Early deceleration in the FHR is a normal sign that does not require any intervention. Prolonged deceleration of the FHR occurs when there is a marked reduction of the fetal oxygen supply.
The nurse administers an amnioinfusion to a pregnant patient according to the primary health care provider's (PHP's) instructions. What is the reason behind the PHP's instructions? 1 Late decelerations 2 Early decelerations 3 Variable decelerations 4 Prolonged decelerations
3 If the nurse notes minimal FHR variability, the nurse should reassess the heart rate to determine a pattern. If in 30 minutes the nurse notices moderate variability, the fetus may be in a sleep state. The nurse would further confirm after half an hour and report it as moderate variability, where the heart rate baseline is confirmed as normal (110-160 beats/min). Heart rate variability is a characteristic of the baseline FHR and does not include accelerations or decelerations of the FHR. A fetal baseline heart rate of 180 beats/min is considered severe variability.
The nurse assesses the fetal heart rate (FHR) of a pregnant patient and finds minimal FHR variability. The nurse reassesses the patient 30 minutes later and finds moderate variability. What should the nurse infer? 1 No acceleration 2 Late deceleration 3 Baseline heart rate is 150 beats/min 4 Baseline heart rate is 180 beats/min
4 The fetal blood is collected by making a small incision on the fetal scalp, which is visible in the newborn. This might be disturbing to the patient, but the nurse should help the patient understand the purpose of the test. Postpartum hemorrhage or increased risk for cesarean birth is not associated with this procedure. The test has to be conducted only once, and it does not have to be reconducted.
The nurse has a prescription to obtain a blood sample from a patient to determine fetal lactate levels. What information should the nurse provide to the patient before the procedure? 1 "There is an increased risk for postpartum hemorrhage." 2 "There may be a need to reconduct the diagnostic test." 3 "There is an increased risk for requiring a cesarean birth." 4 "There will be a small incision on the scalp of the newborn."
3 During labor, the nurse asks the patient to breathe through the mouth to keep the mouth open to increase both maternal and fetal oxygenation. Nasal congestion is not a complication associated with labor. Opening of the mouth does not increase the pushing capability. Early decelerations are observed by pushing which does not require any intervention.
The nurse instructs a pregnant patient to breathe through the mouth and keep it open while pushing during labor. What is the rationale for this nursing intervention? 1 To avoid nasal congestion in the patient 2 To decrease the efforts required for pushing 3 To facilitate increased oxygen to the fetus 4 To avoid deceleration in the fetal heart rate
3 n a pregnant patient the normal range of uterine contractions (UCs) during labor are noted to be 2 to 5 in every 10 minutes. Each one contraction lasts from 45 to 80 seconds. Therefore, when the nurse reports the contraction period as 2 minutes, 15 seconds (135 seconds) in 10 minutes of time, the nurse should have observed 135 ÷ 45 = 3 contractions.
The nurse is assessing a pregnant patient during labor and reports the normal duration of the contraction period as 2 minutes, 15 seconds in a span of 10 minutes. What would be the number of contractions observed in this span of 10 minutes? Record your answer using a whole number._______
3, 4, 5 A tocotransducer is an external device that is used for assessment of uterine activity (UA). This instrument would report duration and frequency of the uterine contractions (UCs). The spiral electrode can monitor accelerations of the fetal heart rate. These systems do not report the intensity of UCs. Strength of UCs can be assessed using an intrauterine pressure catheter (IUPC). Neither a tocotransducer nor a spiral electrode is used to determine the lactate level; it is obtained by the fetal scalp sampling method.
The nurse is assessing a pregnant patient through a tocotransducer placed externally and a spiral electrode placed internally. What information would the nurse obtain by this arrangement? Select all that apply. 1 Lactate levels in the fetal blood 2 Strength of uterine contractions 3 Duration of uterine contractions 4 Frequency of uterine contractions 5 Accelerations of fetal heart rate
4 Terbutaline (Brethine) is administered during pregnancy, especially during elective cesarean birth. Terbutaline (Brethine) is known to improve the Apgar score of the fetus to more than 5 and the pH value of the cord to 7.2. Terbutaline (Brethine) has no effect on placental integrity or function. Terbutaline (Brethine) does not cause fetal heart rate (FHR) acceleration. The fetal scalp stimulators are used to improve the accelerations.
The nurse is assessing a pregnant patient who has been given terbutaline (Brethine). What is the desired outcome from the administration of the drug? 1 Increased fetal accelerations 2 Reduced placental abruption 3 An Apgar score less than 2 4 A cord blood ph result of 7.2
2, 3, 5 The nurse helps the pregnant patient during labor. This includes teaching the patient relaxation techniques. The nurse teaches the patient to keep the mouth open during exhalation to allow air to easily leave the lungs. Placing the patient in a semi-Fowler or lateral position is helpful during labor. Therefore the nurse should instruct the patient to maintain a lateral or semi-Fowler position with a lateral tilt. Asking the patient to cough frequently would increase intraabdominal pressure of the patient and would make the patient uncomfortable. Having the patient lie down in a supine position during labor may cause orthostatic hypotension. Therefore the nurse should instruct the patient to lie down in a position other than supine.
The nurse is assisting a pregnant patient in labor. What instructions should the nurse give to the patient to promote comfort? Select all that apply. 1 "You should cough frequently." 2 "Breathe with your mouth open." 3 "Lie down in the lateral position." 4 "Lie in the supine position in bed." 5 "Lie in the semi-Fowler position."
4 An elevated level of oxytocin increases UCs during labor. A reduced hemoglobin level leads to a decreased oxygen supply to the fetus but is not a complication associated with an elevated oxytocin level. Oxytocin has no effect on the blood glucose levels. A family history of diabetes may increase the risk for gestational diabetes in the patient. Conditions such as hypertension in the patient may lower the blood supply to the placenta but are not associated with oxytocin levels.
The nurse is teaching a group of nursing students regarding fetal oxygenation. The nurse questions a student, "What happens when oxytocin levels are elevated in the patient?" What would be the most appropriate answer given by the nursing student related to the patient's condition? 1 "Hemoglobin levels will decrease." 2 "Blood glucose levels will increase." 3 "Placenta lowers the blood supply." 4 "Uterine contractions (UCs) will increase."
4 Oligohydramnios is a condition that may cause umbilical cord compression and results in variable decelerations in the FHR. Usually lactated Ringer's or normal saline solution can be administered into the umbilical cord to increase the amniotic fluid volume and normalize fetal heart activity. Terbutaline (Brethine) is a uterine relaxant. It is mostly used to reduce uterine tachysystole. The nurse can administer phenylephrine (Endal) if other measures are unsuccessful in improving maternal hypotension. Oxytocin (Pitocin) is a uterine stimulant to induce labor. It is not used to reduce the umbilical cord compression.
The nurse observes variable decelerations in fetal heart rate (FHR) while assessing a pregnant patient with oligohydramnios. What medication should be immediately given to the patient? 1 Oxytocin (Pitocin) 2 Terbutaline (Brethine) 3 Phenylephrine (Endal) 4 Lactated Ringer's solution
3 It is necessary to monitor the FHR in the pregnant patient who is given general anesthesia. General anesthesia usually causes minimal variability or no change in the FHR. Tachycardia is caused by fetal hypoxemia, whereas bradycardia is caused from a structural defect in the fetal heart. Moderate variability in the FHR indicates normal fetal activity.
The primary health care provider has administered general anesthesia to a patient who is scheduled for an elective cesarean section. What changes should the nurse observe in the fetal heart rate (FHR) after the administration of general anesthesia? 1 Decrease 2 Increase 3 Minimal variability 4 Moderate variability
1 Terbutaline (Brethine) is usually prescribed to postpone labor, because the drug reduces the frequency of uterine contractions. Terbutaline (Brethine) can also increase the fetal heart rate (FHR). Terbutaline (Brethine) does not decrease the heart rate, nor does it cause any accelerations or decelerations in the FHR. Heart block or viral infections can decrease the FHR and may result in bradycardia. There may be accelerations in the FHR during a vaginal examination. A parasympathetic response may cause decelerations in heart rate. Terbutaline is a sympathomimetic drug and thus does not cause decelerations in FHR.
The primary health care provider has administered terbutaline (Brethine) to a pregnant patient to postpone preterm labor. What changes would the nurse observe in the fetal heart monitor after this drug was administered? 1 Increase in fetal heart rate 2 Decrease in fetal heart rate 3 Accelerations in heart rate 4 Decelerations in heart rate
4 Before the ultrasonic recording, the nurse should first locate the site on the abdomen where the maximal intensity of the fetal heart rate can be assessed. This should be done to find where the ultrasound transducer head can be placed. The apical heart rate of the patient need not be assessed before this procedure, because this procedure does not interfere with the cardiac activity of the pregnant patient. After finding the site of application, the nurse can apply conductive gel on the transducer and on the abdomen of the patient.
What should be the first step taken by the nurse when assessing fetal heart activity using an ultrasound transducer? 1 Auscultate the apical heart rate of the pregnant patient. 2 Apply some conductive gel on the maternal abdomen. 3 Apply some conductive gel on the ultrasound transducer. 4 Locate the maximal intensity area of the fetal heart rate.
4 Fetal scalp and vibroacoustic stimulation are two stimulating methods that are used to determine the fetal scalp blood pH. They are performed only when the fetal baseline heart rate is within the normal range. These techniques are not suggested if there is fetal bradycardia. These stimulation methods are related to neither the patient's weight nor uterine contractions.
When does the nurse use the fetal scalp stimulation technique to assess the fetal scalp pH? 1 If the patient's contractions have increased 2 If there is maternal weight loss in the last trimester 3 If fetal bradycardia is present 4 When the fetal heart rate (FHR) is within the baseline
1 The fetal heart strip shows an early deceleration indicating expected head compression during contractions. Documenting this finding is appropriate. Positioning the woman on the left aside, applying oxygen via a face mask, and notifying the health care provider are correct actions for a late deceleration.
When the nurse observes this fetal heart pattern, the most important nursing action is to: 1 document the finding. 2 position mother on left side. 3 apply 10 L of oxygen via face mask. 4 notify the health care provider
1 The assessment includes palpation; duration, frequency, intensity, and resting tone. The duration of contractions is measured in seconds; the frequency is measured in minutes. The intensity of contractions usually is described as mild, moderate, or strong. The resting tone usually is characterized as soft or relaxed.
When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that: 1 the examiner's hand should be placed over the fundus before, during, and after contractions. 2 the frequency and duration of contractions are measured in seconds for consistency. 3 contraction intensity is given a judgment number of 1 to 7 by the nurse and patient together. 4 the resting tone between contractions is described as either placid or turbulent.
3 An ultrasound transducer is used to assess the FHR by an external mode of electronic fetal monitoring. It does not require membrane rupture and cervical dilation. A tocotransducer can be used to assess the uterine activity (UA) in a pregnant patient whose cervix is not sufficiently dilated, but it does not assess the FHR. Spiral electrode is used as an internal mode of electronic fetal monitoring to assess the FHR. It can be used only when the membranes are ruptured and the cervix is dilated during the intrapartum period. IUPC is used to assess uterine activity in internal mode. It can be used only when the membranes are ruptured and the cervix is dilated during the intrapartum period.
Which device can be used as a noninvasive way to assess the fetal heart rate (FHR) in a patient whose membranes are not ruptured? 1 Tocotransducer 2 Spiral electrode 3 Ultrasound transducer 4 Intrauterine pressure catheter (IUPC)
4 While assessing the fetal heart rate (FHR) with a fetoscope, the nurse palpates the abdomen of the fetus to evaluate uterine contractions (UCs). This is done to detect any changes in the FHR during and after UCs. FHR decelerations are not identified by palpating the abdomen. It is assessed using the electronic fetal monitoring system. Pain perception is a subjective assessment. Moreover, the pressure from the fetoscope is very minimal and does not cause pain.
While assessing a pregnant patient using a fetoscope, the nurse also palpates the abdomen of the patient. What is the purpose of palpating the abdomen of the patient? 1 Detection of fetal heart rate deceleration 2 Evaluation of the severity of the pain caused by active labor 3 Assessment of pain from pressure applied by the fetoscope 4 Assessment of changes in fetal heart rate during and after contraction
3 W-shaped waves in the FHR monitor are indicative of variable decelerations in the FHR. Variable decelerations are seen when the umbilical cord is compressed at the time of labor. Placental abruption and dilated cervical layers do not cause variable decelerations but may cause late decelerations. Similarly, increased rate of uterine contractions may also cause late decelerations in FHR.
While assessing a pregnant patient who is in labor, the nurse observes W-shaped waves on the fetal heart rate (FHR) monitor. What would the nurse infer from this observation? 1 Placental abruption 2 Dilated cervical layers 3 Umbilical cord compression 4 Elevated uterine contractions
2 Variable decelerations in the FHR are usually caused by umbilical cord compression. The knee-to-chest position is useful for relieving cord compression, and thus the nurse should ask the patient to move into this position. Prolonged decelerations in the FHR are not affected by the mother's position. If the nurse finds late decelerations in the FHR, the nurse should ask the mother to lie in the lateral position. Early decelerations in the FHR are a normal finding, and no nursing intervention is required.
While monitoring the fetal heart rate (FHR), the nurse instructs the patient to change positions and lie in the knee-to-chest position. What is the reason for the nurse to give this instruction to the patient? 1 Late decelerations in the FHR 2 Variable decelerations in the FHR 3 Early decelerations in the FHR 4 Prolonged decelerations in the FHR
