Maternal Health

"The top line graphs the baby's heart rate. Generally, the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor"

A new client and her partner arrive on the LDRP unit for the birth of their first child. You apply EFM to the woman. Her partner asks you to explain what is printing on the graph, referring to the EFM strip. He wants to know what the baby's heart rate should be. Your best response is:

Contractions every 2-5 minutes

A normal uterine activity (UA) pattern in labor is characterized by:

Fetal pulse oximetry

A number of methods to assist in the assessment of fetal well-being have been developed for use in conjunction with EFM. These various technologies assist in supporting interventions for a non reassuring fetal heart rate pattern when necessary. The labor and delivery nurse should be aware that one of these modalities, fetal oxygen saturation monitoring includes use of:

To elicit an acceleration in the FHR

A nurse might be called on to stimulate the fetal scalp:

Before and after ambulation and rupture of membranes: The FHR should be auscultated before and after administration of medications and induction of anesthesia.

According to standard professional thinking, nurses should auscultate the FHR:

May visibly resemble the shape of the uterine contraction.

Nurses should be aware that accelerations in the fetal heart rate:

Hypoxemia: Non-reassuring heart rate patterns are associated with fetal hypoxemia

As a perinatal nurse, you realize that an FHR that is tachycardic, bradycardic, has late deceleration, or loss of variability is non-reassuring and is associated with:

A normal baseline heart rate

During labor a fetus with an average heart rate of 135 bpm over a 10-minute period would be considered to have:

Prolonged umbilical cord compression

Fetal bradycardia is most common during:

Maternal Fever

Fetal tachycardia is most common during:

The response of the FHR to uterine contractions: Fetal well-being during labor can be 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 bpm with no periodic change and a moderate baseline variability, and accelerations with fetal movement.

Fetal well-being during labor is assessed by:

Encourage the woman's cooperation in avoiding the supine position: Woman should maintain a side-lying position.

In assisting with the two factors that have an effect on fetal status, namely pushing and positioning, nurses should:

Correctly interpreting FHR patterns, initiating appropriate nursing interventions, and documenting the outcomes. Nurses who care for women during childbirth are legally responsible for correctly interpreting FHR patterns, initiating appropriate nursing interventions based on those patterns, and documenting the outcomes of those interventions.

Perinatal nurses are legally responsible for:

Fetal sleep cycles: A temporary decrease in variability can occur when the fetus is in a sleep state. These sleep states do not usually last longer than 30 minutes.

The most common cause of decreased variability in the FHR that lasts 30 minutes or less is:

change in position

The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by:

Usually are isolated events that end spontaneously: Prolonged deceleration usually are isolated events that end spontaneously. However,in certain combinations wit late and/or variable deceleration, they are a danger sign that requires the nurse to notify the physician or midwife immediately.

The nurse caring for a woman in labor understands that prolonged deceleration:

Altered fetal cerebral blood flow

The nurse caring for the laboring woman should understand that early deceleration are caused by:

A periodic fetal sleep state

The nurse caring for the woman in labor should understand that decreased variability of the fetal heart rate would be considered benign if caused by:

Methamphetamines: Narcotics, barbiturates, and tranqs might be causes of decreased variability.

The nurse caring for the woman in labor should understand that increased variability of the fetal heart rate might be caused by:

uteroplacental insufficiency

The nurse caring for the woman in labor should understand that maternal hypotension can result in:

Are reassuring

The nurse providing care for the laboring woman should understand that accelerations with fetal movement:

Variable decelerations

The nurse providing care for the laboring woman should understand that amniofusion is used to treat:

Uteroplacental insufficiency

The nurse providing care for the laboring woman should understand that late FHR deceleration are caused by:

Umbilical cord compression

The nurse providing care for the laboring woman should understand that variable FHR deceleration are caused by:

Late deceleration- uteroplacental inefficiency

What correctly matches the type of deceleration with its likely cause?

The tocotransducer is especially valuable for measuring UA during the first state of labor.

What is an advantage of external electronic fetal monitoring?

Re position the mother, increase IV fluid, and provide O2 via face mask,

What three measures should the nurse implement to provide intrauterine resuscitation? Select best response that indicates the priority of actions that should be taken, starting with the most important.

Can be used during the antepartum and intrapartum periods

When assessing the relative advantages and disadvantages of internal and external electronic fetal monitoring, nurses should be aware that both:

Ultrasound can be used to find the fetal heartbeat and reassure the mother if initial difficulty was a factor. Locating fetal heartbeats often takes time. Mothers can be reassured verbally and by the ultrasound pictures if that device is used to help locate the heartbeat.

When using IA for FHR, nurses should be aware that:

The examiner's hand should be placed over the fundus before, during, and after contractions.

When using IA to assess uterine activity, nurses should be aware that:

Late deceleration: Late deceleration are caused by uteroplacental insufficiency and are associated with fetal hypoxemia

Which FHR finding would concern the nurse during labor?

Early decelerations: Early decelerations (and accelerations) generally do not need any nursing interventions

Which deceleration of the FHR would NOT require the nurse to change the maternal position?

Document the finding the client's record

While evaluating an external monitor tracing of a woman in acive labor whose labor is being induced, the nurse notes that the FHR begins to deelerate at the onset of several contractions and returns to baseline before each contraction ends. The nurse should:

Change the woman's position

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate for five sequential contractions begins to decelerate late in the contraction, with the nadir of the deceleration occurring after the peak of the contraction.

Notify the care provider immediately: To relieve an FHR deceleration, the nurse can re position the mother, increase IV fluid, and provide O2. Also, if oxytocin is infusing, it should be discontinued. If the FHR does not resolve, the primary care provider should be notified immediately.

You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly, you see the FHR drop from its baseline of 125 down to 80. You re position the mother, provide oxygen, increase intravenous fluid, and perform a vaginal exam. The cervix has not changed. Five minutes have passed, and the fetal heart rate remains in the 80s. What additional nursing measures should you take?