NCC Electronic Fetal Monitoring Certification
In a patient with oxytocin-induced tachysystole with indeterminate or abnormal fetal heart tones, which of the following should be the nurse's initial intervention? A. Assist the patient to lateral position B. Discontinue Pitocin C. Administer IV fluid bolus
B. Discontinue Pitocin
Central _______ are located in the medulla oblongata; peripheral _______ are found in the carotid sinuses and aortic arch. A. Baroreceptors B. Chemoreceptors
B. Chemoreceptors
T/F: Variable decelerations are a vagal response.
True
T/F: The fetal heart rate baseline can be determined during periods of marked variability.
False
T/F: The fetal spiral electrode can be placed when vaginal bleeding of unknown origin is present.
False
T/F: The heart rate from a well-applied fetal spiral electrode can only be fetal, not maternal.
False
T/F: Variability can be determined with the fetoscope.
False
_______ FHR patterns are those that are not associated with uterine contractions. A. Periodic B. Episodic C. Recurrent D. Irregular
B. Episodic
Accurate determination of baseline rate requires A. At least 2 contiguous minutes of FHR in a 10-min window B. Evaluation of the FHR over at least a 10-min window C. Averaging the FHR over 30 min
B. Evaluation of the FHR over at least a 10-min window
_____ denotes the readiness of cardiac cells to receive and respond to electrical stimuli. A. Automaticity B. Excitability C. Conductivity
B. Excitability
Oxygen, carbon dioxide, water, electrolytes, urea, uric acid, fatty acids, fat-soluble vitamins, narcotics barbiturates, anesthetics, and antibiotics are transferred across the placenta via _____ _____.
Simple (passive) diffusion
The primary goal in the treatment of variable decelerations is to A. Correct umbilical cord compression B. Improve maternal oxygenation C. Maximize blood flow to the uterus
A. Correct umbilical cord compression
T/F: Contractions cause an increase in uterine venous pressure and a decrease in uterine artery perfusion.
True
Which of the following most closely approximates normal umbilical artery pH at term? A. 7.0-7.1 B. 7.1-7.2 C. 7.2-7.3
C. 7.2-7.3
A woman has 10 fetal movements in one hour. This is considered what kind of movement? A. Decreased B. Excessive C. Normal
C. Normal
The _____ _____ allows relatively well-oxygenated blood to enter the fetal heart directly, bypassing the liver.
Ductus venosus
T/F: Intrauterine pressure catheters (IUPCs) do not increase risk for infection when placed on patients with intact membranes.
False Membranes must be ruptured for use; infection is a risk
T/F: Minimal variability is always an indicator of hypoxia and a Cesarean section is indicated.
False
T/F: Preterm contractions are usually painful.
False
T/F: The external toco gives measurable uterine pressure.
False
T/F: The intrauterine catheter is used to pick up the fetal heart rate.
False
T/F: The paper speed on the fetal monitor should always be set at 1cm/min.
False
T/F: The parasympathetic nervous system is a cardioaccelerator.
False
T/F: The spiral electrode is used to more accurately determine the frequency, duration, and intensity of uterine contractions.
False
T/F: Fetal tachycardia is a normal compensatory response to transient fetal hypoxemia.
True
T/F: If etiology of fetal tachycardia is secondary to extrauterine infection, FHR will return to normal as maternal fever resolves.
True
T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor.
True
Normal frequency of contractions is A. </= 5 in 10 min averaged over 20 min B. </= 6 in 10 min averaged over 30 min C. </= 5 in 10 min averaged over 30 min
C. </= 5 in 10 min averaged over 30 min
One compensatory mechanism that helps maintain oxygen availability to the fetus during maternal exercise is A. A decrease in maternal hematocrit B. Transient increase in uterine blood flow C. An increase in uterine oxygen uptake
C. An increase in uterine oxygen uptake
T/F: Uterine resting tone may appear higher (25 to 40 mmHg) during amnioinfusion.
True
T/F: Corticosteroid administration may cause an increase in FHR.
True
T/F: Fetal arrhythmias can be seen on both internal and external monitor tracings.
True
Stimulation of _____ results in abrupt decreases in FHR, CO, and BP.
Baroreceptors
The normal mean value range for arterial PCO2 is A. 22-24 B. 35-40 C. 49-56
C. 49-56
Mono-mono zygotic twins are prone to what type of deceleration during labor? A. Early B. Late C. Variable
C. Variable
The _____ _____ _____ maintains transmission of beat-to-beat variability.
Parasympathetic nervous system
T/F: Variable decelerations are a result of cord compression.
True
FHR decelerations that results from decreased uteroplacental blood flow are A. Early B. Late C. Variable
B. Late
Which method of assessing FHR allows the clinician to hear the opening and closing of heart valves, which helps detect dysrhythmias? A. A fetoscope B. An internal scalp electrode (FSE) C. An ultrasound transducer
A. A fetoscope
To correctly interpret a baseline FHR as tachycardic or bradycardic, the rate must persist for a minimum of _____ min.
10
The _____ _____ allows blood to bypass the lungs, flowing from the pulmonary artery to the aorta.
Ductus arteriosus
Fetal hypoxia and acidemia are demonstrated by pH < _____ and base excess < _____.
< 7.15; < -8
The presence of moderate FHR variability is most specifically an excellent predictor of A. Absence of fetal metabolic acidosis B. Fetal movement C. Fetal oxygenation
A. Absence of fetal metabolic acidosis
For a low-risk woman in the second stage of labor, the FHR should be auscultated every A. 5-15 min B. 30 min C. 60 min
A. 5-15 min
Normal oxygen saturation for the fetus in labor is ___% to ___%.
30% to 65%
What would be a suspected pH in a fetus whose FHTs included recurrent late decelerations during labor? A. 7.10 B. 7.26 C. 7.32 D. 7.41
A. 7.10
Which method of assessment allows the clinician to visually see cardiac wall movements? A. A fetal echocardiogram B. A fetal pulse oximetry reading C. A nonstress test (NST)
A. A fetal echocardiogram
As the FHR increases, the myocardium consumes _____ oxygen. A. More B. Less
A. More
Baseline FHR variability is determined in what amount of time, excluding accelerations and decelerations? A. 10 min B. 20 min C. 30 min
A. 10 min
During labor, the recommended fetal heart rate assessment interval for auscultation is every A. 15-30 minutes in the active phase of the first stage and every 5-15 minutes in second stage B. 15 minutes no matter what stage of labor C. 60 minutes in the active phase of the first stage and every 30 minutes in second stage
A. 15-30 minutes in the active phase of the first stage and every 5-15 minutes in second stage
The normal mean value range for arterial base deficit is A. 2.7-8.3 B. -3.0-2.5 C. 4.2-12.9
A. 2.7-8.3
The normal mean value range for arterial bicarbonate (HCO3) is A. 22-24 B. 35-40 C. 49-56
A. 22-24
A prolonged acceleration lasts greater than ___ minutes and less than ___ minutes. A. 2; 10 B. 2; 20 C. 10; 20 D. 10; 20
A. 2; 10
Which is a characteristic of a negative CST? A. Absence of late decelerations B. Recurrent late decelerations C. Reactive FHR tracing
A. Absence of late decelerations
As a contraction beings, partial umbilical cord compression causes occlusion of the low-pressure vein and decreased return of blood to the fetal heart, resulting in decreased CO, hypotension, and a compensatory FHR _____. A. Acceleration B. Early deceleration C. Late deceleration D. Variable deceleration
A. Acceleration
Resuscitation measures improves the baby's variability, but the FHR is still not reactive. You attempt fetal scalp stimulation (FSE) because you know that a well-oxygenated fetus will respond to FSE with a(n) A. Acceleration B. Deceleration C. Fetal movement D. Sleep pattern
A. Acceleration
Which of the following is the primary neurotransmitter of the parasympathetic branch of the autonomic nervous system? A. Acetylcholine B. Dopamine C. Norepinephrine
A. Acetylcholine
_______ denotes an increase in hydrogen ions in the fetal tissues. A. Acidosis B. Acidemia C. Hypercapnia
A. Acidosis
The process that requires energy to accomplish the passage of substances within the intervillous space is A. Active transport B. Diffusion C. Facilitated diffusion
A. Active transport
Which of the following is not a component of a BPP? A. Amniotic fluid index (AFI) B. Fetal breathing C. Nonstress test (NST)
A. Amniotic fluid index (AFI) (Should be volume, not index)
The BPP includes the assessment of FHR along with what other four components? A. Amniotic fluid, fetal breathing, fetal movement, fetal tone B. Amniotic fluid, fetal anomalies, fetal breathing, fetal movement C. Estimated fetal weight, fetal breathing, fetal movement, placental grading
A. Amniotic fluid, fetal breathing, fetal movement, fetal tone
_____ are patterns of abnormal FHR associated with variability in R-to-R intervals, but with normal P-waves preceding normal QRS complexes. A. Arrhythmias B. Complete heart blocks C. Dysrhythmias
A. Arrhythmias
In a patient with oxytocin-induced tachysystole with normal fetal heart tones, which of the following should be the nurse's initial intervention? A. Assist the patient to lateral position B. Discontinue Pitocin C. Administer IV fluid bolus
A. Assist the patient to lateral position
_____ denotes the spontaneous, rhythmic depolarization of cardiac cells. A. Automaticity B. Excitability C. Conductivity
A. Automaticity
A woman desires a natural childbirth. The nurse puts pressure on her to get an epidural. This is an example of going against which ethical principle? A. Autonomy B. Beneficence C. Justice
A. Autonomy
Supporting the parents decision to choose no extraordinary measures on their baby who is about to deliver at 24 3/7 weeks gestation despite the nurses personal opinion is an example of A. Autonomy B. Beneficence C. Non-maleficence
A. Autonomy
The area of maximum intensity of the FHR is usually the fetal A. Back B. Chest C. Umbilicus
A. Back
Which intrinsic homeostatic response is the fetus demonstrating when abrupt variable decelerations are present? A. Baroreceptor B. Catecholamine C. Sympathetic
A. Baroreceptor
_______ are protective stretch receptors located in the aortic arch and the carotid sinuses at the bifurcation of the external and internal carotid arteries. A. Baroreceptors B. Chemoreceptors C. Arteries
A. Baroreceptors
_______ respond to increases in fetal arterial blood pressure by detecting the amount of stretch and sending impulses via the vagus nerve to the midbrain, decreasing FHR, CO, and BP. A. Baroreceptors B. Chemoreceptors C. Veins
A. Baroreceptors
A transient decrease in cerebral blood flow (increased cerebral blood pressure) during a contraction may stimulate _____ and may cause a(n) _____ A. Baroreceptors; early deceleration B. Baroreceptors; late deceleration C. Chemoreceptors; early deceleration
A. Baroreceptors; early deceleration
_______ _______ occurs when the HCO3 concentration is lower than normal. A. Base deficit B. Base excess C. Metabolic acidosis
A. Base deficit
What fetal heart rate characteristics can be determined with auscultation? A. Baseline B. Early decelerations C. Variability
A. Baseline
Which of the following characteristics can be determined using FHR auscultation? A. Baseline B. Type of decelerations C. Variability
A. Baseline
A Category I FHR tracing requires which of the following? A. Baseline rate 110-160 bpm B. Accelerations C. No late, variable, or early decelerations
A. Baseline rate 110-160 bpm
Baroreceptors respond mainly to changes in A. Blood pressure B. Hormonal changes C. Oxygen and carbon dioxide levels
A. Blood pressure
Baroreceptors respond to changes in fetal A. Blood pressure B. Oxygen status C. Acid-base status
A. Blood pressure
The FHR pattern that is likely to be seen with maternal hypothermia is A. Bradycardia B. Marked variability C. Tachycardia
A. Bradycardia
In the context of hypoxemia, fetal blood flow is shifted to the A. Brain B. Liver C. Lungs
A. Brain
The legal term that describes a failure to meet the required standard of care is A. Breach of duty B. Negligence C. Proximate cause
A. Breach of duty
When educating the patient about the IUPC, the nurse should include the following: A. Can't get out of bed B. Does not accurately measure contraction strength C. Measures the FHR more accurately
A. Can't get out of bed
FHTs with moderate variability, no accelerations, and early decelerations would be categorized as A. Category I B. Category II C. Category III
A. Category I
Which of the following is responsible for fetal muscle coordination? A. Cerebellum B. Cerebral cortex C. Medulla oblongata
A. Cerebellum
The purpose of autocorrelation in external monitoring is to A. Compare incoming waveforms for comparison B. Decrease signal to noise levels C. Distinguish fetal from maternal HR
A. Compare incoming waveforms for comparison
When using a fetal scalp electrode (FSE), you notice an abnormally low FHR on the monitor. You should first A. Compare maternal pulse simultaneously with FHR B. Remove FSE C. Call the doctor immediately D. Turn off the monitor
A. Compare maternal pulse simultaneously with FHR
A workup for maternal systemic lupus erythematosus would likely be ordered in the presence of A. Complete fetal heart block B. Premature ventricular contractions C. Fetal supraventricular tachycardia
A. Complete fetal heart block
The nurse wants to document her conversation with the attending physician during an emergent situation. The best approach to documentation would be to A. Continue providing care for the patient and write a late entry summarizing the conversation after the cesarean is completed B. Enter an objective transcription of the conversation in the electronic record while colleagues are preparing the patient for surgery C. Report the conversation to the charge nurse, who can make an entry in the medical record
A. Continue providing care for the patient and write a late entry summarizing the conversation after the cesarean is completed
Activation of fetal chemoreceptors results in which FHR change? A. Decrease B. Increase C. No change
A. Decrease
Stimulation of the parasympathetic nervous system causes the FHR to A. Decrease B. Increase C. Remain the same
A. Decrease
With the finding of a single umbilical artery, what would you expect to observe with Doppler flow studies? A. Decreased blood perfusion from the fetus to the placenta B. Decreased blood perfusion from the placenta to the fetus C. Homeostatic dilation of the umbilical artery
A. Decreased blood perfusion from the fetus to the placenta Two umbilical arteries flow from the fetus to the placenta
The parasympathetic branch of the autonomic nervous system A. Decreases FHR B. Increases contractility of the fetal heart C. Increases FHR
A. Decreases FHR
What affect does magnesium sulfate have on the fetal heart rate? A. Decreases variability B. Increases variability C. No change
A. Decreases variability
Betamethasone given to the mother can transiently affect the FHR by A. Decreasing variability B. Increasing variability C. Lowering the baseline
A. Decreasing variability
A preterm fetus with persistent supraventricular tachycardia that is not hydropic is best treated with maternal administration of A. Digoxin B. Phenobarbital C. Terbutaline
A. Digoxin
Which medication is used to treat fetal arrhythmias? A. Digoxin B. Labetolol C. Nifedipine
A. Digoxin Inotropic - promotes regular and effective cardiac contraction
The primary assumption when using EFM is that _____ produces physiological changes that can be detected by changes in the FHR. A. Disruption of oxygen B. Labor induction C. Parity
A. Disruption of oxygen
Which of the following is not commonly affected by corticosteroids? A. Doppler flow studies B. FHR baseline C. Frequency of FHR accelerations
A. Doppler flow studies
The primary difference between intermittent auscultation (IA) and EFM is A. EFM is primarily a visual assessment B. IA is associated with worse outcomes C. IA is less labor-intensive than EFM
A. EFM is primarily a visual assessment
FHR decelerations that are benign and do not require intervention are A. Early B. Late C. Variable
A. Early
Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially when seen at the onset of labor? A. Early deceleration B. Late deceleration C. Variable deceleration
A. Early deceleration
Primary benefits associated with the use of standardized terminology for fetal heart monitoring interpretation include A. Enhanced communication among health care providers and promotion of patient safety B. Increased nursing time at the bedside and enhanced patient satisfaction C. Increased likelihood of correctly diagnosing fetal acidosis during labor
A. Enhanced communication among health care providers and promotion of patient safety
Resting tone and intensity of uterine contractions cannot be assessed by A. External tocodynamometer B. Manual palpation C. Intrauterine pressure catheter
A. External tocodynamometer
Fetal heart rate bradycardia is defined as A. FHR <110bpm lasting 10 min or greater B. FHR <110bpm lasting 2 min or greater C. FHR <110bpm lasting 20 min or greater
A. FHR <110bpm lasting 10 min or greater
One possible cause of a sinusoidal FHR pattern from fetal hypoxemia is A. Fetal anemia B. Fetal thumb sucking C. Maternal administration of a narcotic
A. Fetal anemia
Assessment of the _____ is an indirect measurement of fetal oxygenation. A. Fetal heart rate B. Fetal scalp sampling C. Uterine activity D. Direct Coombs
A. Fetal heart rate
Which statement best describes the relationship between maternal and fetal hemoglobin levels? A. Fetal hemoglobin is higher than maternal hemoglobin B. Maternal hemoglobin is higher than fetal hemoglobin C. Maternal and fetal hemoglobin are the same
A. Fetal hemoglobin is higher than maternal hemoglobin
Maternal infection most often results in A. Fetal tachycardia B. Moderate variability C. Placenta previa
A. Fetal tachycardia
How long may a standard NST be extended in a term gestation if reactivity is not initially demonstrated? A. From the initial 20 min to 40 min B. From the initial 20 min to 60 min C. From the initial 30 min to 60 min
A. From the initial 20 min to 40 min Accounts for fetal sleep
T/F: Corticosteroid administration may cause an increase in FHR accelerations.
False
Fetal blood has a _______ affinity for oxygen compared with the mother's blood, which facilitates adaptation to the low PO2 at which the placenta oxygenates the fetus. A. Higher B. Lower
A. Higher
In comparison to maternal blood, the affinity of fetal blood for oxygen is A. Higher B. Lower C. The same
A. Higher
The fetus has a _______ cardiac output and heart rate than the adult, resulting in rapid circulation. A. Higher B. Lower
A. Higher
Fetal blood has a _______ hemoglobin concentration compared to adults. A. Higher B. Lower
A. Higher Greater oxygen-carrying capacity
_______ denotes an increase in carbon dioxide in the fetal blood. A. Hypercapnia B. Hypoxia C. Hypoxemia
A. Hypercapnia
What might increase fetal oxygen consumption? A. Hyperthermia B. Umbilical cord compression C. Uterine tachysystole
A. Hyperthermia Increases metabolism and oxygen consumption
What is the most sensitive method of assessing uterine activity? A. IUPC B. Manual palpation C. Maternal perception
A. IUPC
Which of the following is not commonly caused by magnesium sulfate? A. Increased FHR baseline B. Decreased FHR variability C. Decreased FHR accelerations
A. Increased FHR baseline
Maternal supine hypotension is caused mainly by compression of the A. Inferior vena cava B. Spiral arteries C. Uterine vessels
A. Inferior vena cava
A woman being monitored externally has a suspected fetal arrhythmia. The most appropriate action is to A. Insert a spiral electrode and turn off the logic B. Turn the logic on if an external monitor is in place C. Use a Doppler to listen to the ventricular rate
A. Insert a spiral electrode and turn off the logic
The fetus of a mother with preeclampsia is at high risk for developing A. Intrauterine growth restriction (IUGR) B. Macrosomia C. Polyhydramnios
A. Intrauterine growth restriction (IUGR)
A preterm fetus A. Is more susceptible to hypoxic insults during labor than the term fetus B. Requires internal monitoring if oxytocin is used for labor induction or augmentation C. Should be born via cesarean section unless there are maternal contraindications
A. Is more susceptible to hypoxic insults during labor than the term fetus
All of the following are disadvantages of the ultrasound transducer for monitoring the FHR except A. It is noninvasive B. It may half or double the actual FHR C. It restricts patient movement
A. It is noninvasive
When the hydrogen ion content in the blood rises, the pH A. Lowers B. Neutralizes C. Rises
A. Lowers
The maternal medical condition that predisposes the fetus to a heart block is A. Lupus erythematosus B. Marfan's disease C. Mitral valve prolapse
A. Lupus erythematosus
When using SBAR communication, the "R" involves A. Making a recommendation B. Reporting pertinent lab results C. Reviewing the patient's medical history
A. Making a recommendation
Which of the following is most responsible for producing FHR variability as the fetus grows? A. Maturation of the parasympathetic nervous system B. Maturation of the sympathetic nervous system C. Release of maternal prostaglandins
A. Maturation of the parasympathetic nervous system
_______ _______ occurs when there is low bicarbonate (base excess) in the presence of normal pressure of carbon dioxide (PCO2) values. A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis
A. Metabolic acidosis
pH 7.0 PO2 18 PCO2 54 HCO3 20 Base deficit 14 A. Metabolic acidosis B. Respiratory acidosis C. Mixed acidosis
A. Metabolic acidosis
pH 6.9, PO2 15, PCO2 55, HCO3 18, BE -22 The nurse reviews the arterial gas results and concludes that the fetus had _____ acidosis. With results such as these, you would expect a _____ resuscitation. A. Metabolic; lengthy B. Metabolic; short C. Respiratory; lengthy
A. Metabolic; lengthy
Fetal scalp stimulation is appropriate in the context of A. Minimal variability B. Prolonged deceleration C. Bradycardia
A. Minimal variability
The FHR characteristic most predictive of a well-oxygenated baby at the time observed is A. Moderate variability B. Stable baseline rate C. Absence of decelerations
A. Moderate variability
A contraction stress test (CST) is done. During the testing, there were three contractions in 10 minutes, no decels, the baseline was 145, and there was moderate variability. This is interpreted as A. Negative B. Positive C. Suspicious
A. Negative
_______ FHR patterns are those associated with uterine contractions. A. Periodic B. Episodic C. Recurrent D. Irregular
A. Periodic
Which of the following tachyarrhythmias can result in fetal hydrops? A. Persistent supraventricular tachycardia B. Premature atrial contractions C. Sinus tachycardia
A. Persistent supraventricular tachycardia
When the placenta covers the cervical os, this is called A. Placenta previa B. Succenturiate lobe (SL) C. Velamentous insertion
A. Placenta previa
A fetus of a diabetic mother may commonly develop A. Polyhydramnios B. Supraventricular tachycardia C. Third-degree heart block
A. Polyhydramnios
A contraction stress test (CST) is performed. Late decelerations were noted in three out of the five contractions in 10 minutes. This is interpreted as A. Positive B. Negative C. Suspicious
A. Positive
Which of the following is most likely to result in absent end diastolic flow during umbilical artery velocimetry? A. Preeclampsia B. Preterm labor C. Previous cesarean delivery
A. Preeclampsia
Which is the most common type of fetal dysrhythmia? A. Premature atrial contraction (PAC) B. Premature ventricular contraction (PVC) C. Third-degree heart block
A. Premature atrial contraction (PAC)
In a fetal heart rate tracing with marked variability, which of the following is likely the cause? A. Recent ephedrine administration B. Recent epidural placement C. Fetal acidemia
A. Recent ephedrine administration
_______ decelerations occur with greater than or equal to 50% of contractions. A. Recurrent B. Intermittent C. Repetitive
A. Recurrent
Which FHR tracing features must be assessed to distinguish arrhythmias from artifact? A. Shape and regularity of the spikes B. Spikes and variability C. Spikes and baseline
A. Shape and regularity of the spikes
T/F: It is an appropriate intervention to perform fetal scalp stimulation during a deceleration.
False
Periodic accelerations can indicate all of the following except A. Stimulation of fetal chemoreceptors B. Tracing is a maternal tracing C. Umbilical vein compression
A. Stimulation of fetal chemoreceptors
The ________ increases the heart rate and strengthens myocardial contractions through the release of epinephrine and nonepinephrine. A. Sympathetic nervous system B. Parasympathetic nervous system
A. Sympathetic nervous system
During periods of fetal tachycardia, FHR variability is usually diminished due to A. The dominance of the parasympathetic nervous system B. The dominance of the sympathetic nervous system C. Stimulation of the fetal vagus nerve
A. The dominance of the parasympathetic nervous system
Cord blood gases from one of the umbilical arteries best represent A. The status of fetal acid-base balance B. The status of maternal oxygenation C. The status of placental function
A. The status of fetal acid-base balance
Use of the terms "beat-to-beat" variability and "long-term" variability is not recommended by the NICHD because in clinical practice A. They are visually determined as a unit B. Both signify an intact cerebral cortex C. Clinical management is unchanged
A. They are visually determined as a unit
When a fetus is stressed, catecholamine release (epinephrine, norepinephrine) occurs from the medulla oblongata, shunting blood _______ the brain, heart, and adrenal glands. A. Toward B. Away from
A. Toward
Which of the following umbilical artery cord gases would most likely result in a fetus who had a Category I strip, then had a cord prolapse and was delivered within 3 minutes? A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5 B. pH 7.25, PO2 23, PCO2 46, HCO3 22, BE -8 C. pH 7.02, PO2 18, PCO2 56, HCO3 15, BE -18
A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5
Amino acids, water-soluble vitamins, calcium, phosphorus, iron, and iodine are transferred across the placenta via _____ _____.
Active transport
When auscultation is used for fetal assessment during labor for a low-risk woman, the FHR should be auscultated in the first stage of labor every A. 5 min B. 15-30 min C. 60 min
B. 15-30 min
When an IUPC has been placed, Montevideo units must be ___ or greater for adequate cervical change to occur. A. 100 B. 200 C. 300 D. 400
B. 200
At how many weeks gestation should FHR variability be normal in manner? A. 24 weeks B. 28 weeks C. 32 weeks D. 36 weeks
B. 28 weeks
Variable decelerations in FHR are defined as visually apparent, abrupt decreases in FHR. The time from onset to nadir is less than A. 15 sec B. 30 sec C. 2 min
B. 30 sec
What is the maximum amount of time allotted for a nonstress test? A. 20 minutes B. 40 minutes C. 60 minutes
B. 40 minutes
You are evaluating a patient in the Prenatal Testing Department who has just completed a biophysical profile (BPP). You suspect that there could be chronic fetal asphyxia because the score is below A. 10 B. 6 C. 8
B. 6
_______ is defined as the energy-consuming process of metabolism.
Anabolism
Which of the following represents the normal range for FHR baseline? A. 120-160 bpm B. 110-160 bpm
B. 110-160 bpm
According to ACOG, in a patient without complications, the FHR tracing during the second stage of labor should be reviewed approximately every A. 5 min B. 15 min C. 30 min
B. 15 min
The normal mean value range for arterial PO2 is A. 22-24 B. 15-24 C. 49-56
B. 15-24
Uterine tachysystole is observed when there are A. 5 or more contractions in 10 min B. 6 or more contractions in 10 min C. 10 or more contractions in 10 min D. 7 or more contractions in 10 min
B. 6 or more contractions in 10 min
The normal mean value range for arterial pH is A. 7.0-7.20 B. 7.20-7.29 C. 7.29-7.39
B. 7.20-7.29
What characteristics are necessary for a reactive NST in a G3P0 patient who is 25 6/7 weeks' gestation? A. Accelerations of 15bpm above the baseline lasting at least 15 seconds above the baseline B. Accelerations of 10bpm above the baseline lasting at least 10 seconds above the baseline C. Any acceleration greater than 10bpm above the baseline
B. Accelerations of 10bpm above the baseline lasting at least 10 seconds above the baseline
_______ denotes an increase in hydrogen ions in the fetal blood. A. Acidosis B. Acidemia C. Hypercapnia
B. Acidemia
You recognize that an FHR tracing has been showing a decrease in variability for the last 45 minutes. Your first intervention should be to A. Encourage ambulation B. Administer oxygen C. Discontinue IV fluids D. Increase Pitocin rate
B. Administer oxygen
An infant was delivered via cesarean. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. The initial neonatal hemocrit was 20% and the hemoglobin was 8. Which phrase best describes acidemia? A. A decrease of oxygen concentration in the blood B. An increase in hydrogen ions in the blood C. An increase of hydrogen ions in the tissues
B. An increase in hydrogen ions in the blood
The NICHD definitions are applicable to A. Antepartum only B. Antepartum and intrapartum C. Intrapartum only
B. Antepartum and intrapartum
Interpretation and classification of FHR patterns are based on predictability of fetal status A. At birth B. At the time the pattern is observed C. Over the previous hour
B. At the time the pattern is observed
Which of the following is one example of a fetal tachyarrhythmia? A. Second-degree heart block, Type I B. Atrial fibrillation C. Premature atrial contraction (PAC)
B. Atrial fibrillation
_______ _______ occurs when the HCO3 concentration is higher than normal. A. Base deficit B. Base excess C. Metabolic acidosis
B. Base excess
Which of the following would be classified as a Category III FHR tracing? A. Baseline 180 bpm, minimal variability, no accels, recurrent late decels B. Baseline rate 140 bpm, absent variability, recurrent late decels C. Baseline 105 bpm, minimal variability, recurrent variable decels
B. Baseline rate 140 bpm, absent variability, recurrent late decels
A complete description of an FHR tracing requires a qualitative and quantitative description of all of the following except A. Baseline rate B. Beat-to-beat variability C. Changes or trends in the FHR patterns over time
B. Beat-to-beat variability
Which medications used with preterm labor can affect the FHR characteristics? A. Terbutaline and antibiotics B. Betamethasone and terbutaline C. Antibiotics and narcotics
B. Betamethasone and terbutaline
With _____ premature ventricular contractions (PVCs), the baseline and variability are obscured. A. Idioventricular B. Bigeminal C. Trigeminal
B. Bigeminal
T/F: Low amplitude contractions are not an early sign of preterm labor.
False
Which of the following would likely be affected by betamethasone administration? A. Fetal echocardiogram B. Biophysical profile (BPP) score C. Contraction stress test (CST)
B. Biophysical profile (BPP) score Fetal breathing decreased with betamethasone administration
A nonstress test (NST) is nonreactive after 40 minutes. The nurse should A. Call the physician to plan for a possible induction B. Call the physician to arrange for a BPP or CST C. Perform vibroacoustic stimulation and monitor patient for 20 additional minutes
B. Call the physician to arrange for a BPP or CST
Absence of accelerations following fetal stimulation (i.e. scalp stimulation) is categorized as A. Category I B. Category II C. Category III
B. Category II
An EFM tracing with absent variability and intermittent late decelerations would be classified as A. Category I B. Category II C. Category III
B. Category II
FHTs with a baseline 135bpm, moderate variability, accelerations, and one late deceleration would be categorized as A. Category I B. Category II C. Category III
B. Category II
FHTs with a baseline of 170bpm, moderate variability, and no accelerations or decelerations would be categorized as A. Category I B. Category II C. Category III
B. Category II
FHTs with absent variability and no accelerations or decelerations would be categorized as A. Category I B. Category II C. Category III
B. Category II
FHTs with accelerations, no decelerations, and minimal variability would be categorized as A. Category I B. Category II C. Category III
B. Category II
FHTs with minimal variability and a baseline of 95bpm would be categorized as A. Category I B. Category II C. Category III
B. Category II
FHTs with minimal variability, absent accelerations, and a 3-minute prolonged deceleration would be categorized as A. Category I B. Category II C. Category III
B. Category II
FHTs with recurrent variable decelerations, no accelerations, and minimal variability would be categorized as A. Category I B. Category II C. Category III
B. Category II
An EFM tracing with absent variability and no decelerations would be classified as A. Category I B. Category II (indeterminate) C. Category III
B. Category II (indeterminate)
Sinusoidal pattern is categorized as A. Category I B. Category II C. Category III
B. Category III
Which of the following is responsible for variations in the FHR and fetal behavioral states? A. Cerebellum B. Cerebral cortex C. Medulla oblongata
B. Cerebral cortex
All of the following are components of liability except A. Breach of duty B. Chain of command C. Damages/loss
B. Chain of command
_______ primarily function(s) to regulate respiratory activity and control circulation by responding to changes in arterial PO2, PCO2, and acid-base balance. A. Baroreceptors B. Chemoreceptors C. Cardioregulatory center
B. Chemoreceptors
Fetal hydrops may present on ultrasound as fetal scalp edema and increased abdominal fluid as a results of A. An increase in gestational age B. Congestive heart failure C. Sustained oligohydramnios
B. Congestive heart failure
For a patient at 38 weeks' gestation with a BPP score of 6, select the most appropriate course of action. A. Repeat in one week B. Consider induction of labor C. Prepare for cesarean delivery
B. Consider induction of labor
With complete umbilical cord occlusion, the two umbilical arteries also become occluded, resulting in sudden fetal hypertension, stimulation of the baroreceptors, and a sudden _______ in FHR. A. Increase B. Decrease
B. Decrease
Stimulation of the fetal vagus nerve will A. Increase FHR B. Decrease FHR C. Initially increase, then decrease FHR
B. Decrease FHR
T/F: Meconium-stained amniotic fluid is an indication for amnioinfusion.
False
Which of the following is not commonly caused by administration of indomethacin? A. Decreased fetal urine (decreased amniotic fluid index [AFI]) B. Decreased FHR baseline C. Increased variable decelerations
B. Decreased FHR baseline
Which of the following is not commonly caused by terbutaline administration? A. Increased FHR baseline B. Decreased FHR late decelerations C. Increased maternal HR
B. Decreased FHR late decelerations
Fetal hypoxia is best described as a condition of A. Decreased oxygen in the blood B. Decreased oxygen in the tissue C. Increased hydrogen ions in the blood
B. Decreased oxygen in the tissue
Elements of a malpractice claim include all of the following except A. Breach of duty B. Deposition C. Injury or loss
B. Deposition
If the EFM pattern you see does not fit any of the definitions for the NICHD, you should A. Choose the term closest to the pattern you see B. Describe the tracing in detail C. Do not chart the tracing, as there is no correlating terminology to match it
B. Describe the tracing in detail
In the healthy fetus, the umbilical cord enters the fetal abdomen and bypasses the liver through the A. Ductus arteriosus B. Ductus venosus C. Foramen ovale
B. Ductus venosus
Vagal stimulation would be manifested as what type of fetal heart rate pattern? A. Acceleration B. Early deceleration C. Tachycardia
B. Early deceleration
When recurrent late decelerations are occurring, the correct physiologic interpretation of this event is A. Fetal myocardial acidosis is occurring B. Fetal hypoxemia may be present C. The fetus has oxygen reserves
B. Fetal hypoxemia may be present
Umbilical artery gas results reflect the status of the A. Mother B. Fetus C. Placenta
B. Fetus
Palpating the uterus is best performed by using the A. Back of the hand B. Fingertips C. Palm
B. Fingertips
The normal FHR baseline A. Decreases during labor B. Fluctuates during labor C. Increases during labor
B. Fluctuates during labor
Intrinsic factors are those that are A. External to the fetus B. Internal to the fetus C. Related to the mother
B. Internal to the fetus
Which assessment or intervention would be least appropriate in a patient whose FHR tracing revealed tachycardia and a prolonged deceleration? A. Change maternal position to right lateral B. Further assess fetal oxygenation with scalp stimulation C. Perform a vaginal exam to assess fetal descent
B. Further assess fetal oxygenation with scalp stimulation Only used with normal baseline rate and never during decels; not an intervention
Which of the following pieces of information would be of highest priority to relay to the neonatal team as they prepare for an emergency cesarean delivery? A. FHR arrhythmia, meconium, length of labor B. Gestational age, meconium, arrhythmia C. Gravidity & parity, gestational age, maternal temperature
B. Gestational age, meconium, arrhythmia
During a term antepartum NST (non-stress test), you notice several variable decelerations that decrease at least 15 bpm and last at least 15 sec long. Which of the following is the least likely explanation? A. True knot B. Gestational diabetes C. Umbilical cord entanglement D. Oligohydramnios
B. Gestational diabetes
The greater affinity that fetal hemoglobin has for oxygen allows for A. Easier release of oxygen to the tissues B. Greater binding of oxygen C. Stimulation of erythropoietin release
B. Greater binding of oxygen
_______ denotes a decrease in oxygenation of the fetal tissues. A. Hypercapnia B. Hypoxia C. Hypoxemia
B. Hypoxia
A woman who is admitted for an induction of labor with oxytocin is questioning the need for continuous electronic fetal monitoring. The appropriate response to this woman is A. Hospital policy requires that all patients have continuous electronic fetal monitoring. B. I would like to answer your questions about continuous monitoring and give you some information about why continuous monitoring is recommended. C. Nurses have more training with continuous electronic fetal monitoring than intermittent auscultation so it is safer for you and your baby to use this method.
B. I would like to answer your questions about continuous monitoring and give you some information about why continuous monitoring is recommended.
When educating the patient about the ultrasound transducer, the nurse should include the following: A. Contraction strength can alter the ability to monitor the FHR B. If baby moves, the tracing may "drop" or become erratic C. The ultrasound detects electrical activity of the fetal heart
B. If baby moves, the tracing may "drop" or become erratic
A wandering FHR baseline may be indicative of A. Fetal seizure activity B. Impending fetal death C. Maternal medication administration
B. Impending fetal death
Stimulation of the sympathetic nervous system causes the fetal heart rate to A. Decrease B. Increase C. Remain the same
B. Increase
A key point regarding the occurrence of tachysystole is that A. It requires FHR decelerations to be significant B. It can occur in spontaneous or stimulated labor C. It should be documented as hyperstimulation if oxytocin is being used
B. It can occur in spontaneous or stimulated labor
As a result of the intrinsic fetal response to oxygen deprivation, increased catecholamine levels cause the peripheral blood flow to decrease while the blood flow to vital organs increases. These flow changes along with increased catecholamine secretions have what effect on fetal blood pressure and fetal heart rate? A. Increase BP and increase HR B. Increase BP and decrease HR C. Decrease BP and increase HR D. Decrease BP and decrease HR
B. Increase BP and decrease HR
A woman receives terbutaline for an external version. You may expect what on the fetal heart tracing? A. Decrease in variability B. Increase in baseline C. No change
B. Increase in baseline
Which of the following characteristics are most common in the preterm fetus? A. Increased baseline rate and prolonged accelerations B. Increased baseline rate and variable decelerations C. Prolonged accelerations and variable decelerations
B. Increased baseline rate and variable decelerations As well as decreased variability
One of the side effects of terbutaline as a tocolytic is A. Fetal bradycardia B. Increased oxygen consumption C. Marked variability
B. Increased oxygen consumption
Which of the following FHR changes would not typically be seen in a mother with chorioamnionitis? A. Increased baseline B. Increased variability C. Decreased accelerations
B. Increased variability
A woman with gestational diabetes is 38 weeks gestation. Her Biophysical Profile score is 4. This indicates need for A. Follow up in one week B. Induction of labor C. Emergent cesarean section
B. Induction of labor
The initial response in treating a primigravida being induced for preeclampsia who has a seizure is A. Administer terbutaline to slow down uterine activity B. Initiate magnesium sulfate C. Perform an immediate cesarean delivery
B. Initiate magnesium sulfate
Clinical decision-making at the bedside should include: A. Communication with the primary care provider only during a crisis B. Integration of physiologic concepts with maternal-fetal assessment findings C. Reliance primarily on technology over bedside assessments
B. Integration of physiologic concepts with maternal-fetal assessment findings
_______ decelerations occur with less than 50% of contractions. A. Recurrent B. Intermittent C. Repetitive
B. Intermittent
One example of evidence-based practice related to fetal monitoring is A. Diagnosis of uterine rupture with an IUPC B. Intermittent auscultation for the low-risk patient C. Using electronic fetal monitoring to prevent cerebral palsy
B. Intermittent auscultation for the low-risk patient
Maternal oxygen administration is appropriate in the context of A. Recurrent variable decelerations/moderate variability B. Intermittent late decelerations/minimal variability C. Prolonged decelerations/moderate variability
B. Intermittent late decelerations/minimal variability
All of the following can be used to describe episodic FHR changes except A. Accelerations B. Late decelerations C. Variable decelerations
B. Late decelerations
Decreased intervillious exchange of oxygenated blood resulting in fetal hypoxia is typically present in _______. A. Variable decelerations B. Late decelerations C. Early decelerations D. Accelerations
B. Late decelerations
What typical characteristics of preterm uterine activity may be present in a patient experiencing preterm labor? A. An irritable uterus with wandering hypertonus B. Low-amplitude high-frequency contractions C. Tetanic contractions
B. Low amplitude high-frequency contractions
Which of the following fetal systems bear the greatest influence on fetal pH? A. Heart and lungs B. Lungs and kidneys C. Sympathetic and parasympathetic nervous systems
B. Lungs and kidneys
High resting tone may occur with an IUPC because of all of the following except A. Extraovular placement B. Maternal BMI C. Multiple gestations
B. Maternal BMI
Which of the following is the primary factor in uteroplacental blood flow? A.. Fetal heart rate B. Maternal cardiac output C. Maternal oxygen consumption
B. Maternal cardiac output
A likely cause of fetal tachycardia with moderate variability is A. Fetal hypoxemia B. Maternal fever C. Vagal stimulation
B. Maternal fever
What is the most common cause of third-degree heart block in the fetus? A. Maternal HIV infection B. Maternal lupus C. Tocolysis
B. Maternal lupus
An appropriate initial treatment for recurrent late decelerations with moderate variability during first stage labor is A. Amnioinfusion B. Maternal repositioning C. Oxygen at 10L per nonrebreather face mask
B. Maternal repositioning
The primary physiologic goal of interventions for late decelerations is to A. Decrease maternal oxygen consumption B. Maximize placental blood flow C. Maximize umbilical circulation
B. Maximize placental blood flow
What is the most common cause of sinusoidal patterns? A. Prolapsed cord B. Rh incompatibility C. Recurrent late decelerations D. Oligohydramnios
B. Rh incompatibility
What is the most appropriate physiologic goal for a patient whose tracing reveals a sinusoidal baseline? A. Maximize umbilical circulation B. Maximize uteroplacental circulation C. Reduce uterine activity
B. Maximize uteroplacental circulation Compromised oxygenation - maximize uteroplacental circulation to promote perfusion and oxygenation
The internal scalp electrode works by A. Detecting heart motion B. Measuring the R-to-R interval of the fetal ECG C. Sensing the opening and closing of the fetal heart valves
B. Measuring the R-to-R interval of the fetal ECG
The ultrasound transducer on the electronic fetal monitor measures the A. Electrical signal of the fetal heart B. Mechanical movements of the fetal heart reflected off of sound waves C. R-to-R intervals of the fetal heart
B. Mechanical movements of the fetal heart reflected off of sound waves
Reduction in FHR variability can result from A. Fetal scalp stimulation B. Medication administration C. Vaginal examination
B. Medication administration
A modified biophysical profile (mBPP) is considered normal if A. NST is reactive and mother reports at least 10 fetal movements in 2 hours B. NST is reactive and the amniotic fluid index (AFI) is greater than 5 cm C. There are no decelerations following contractions
B. NST is reactive and the amniotic fluid index (AFI) is greater than 5 cm
A contraction stress test (CST) is performed. Two variable decelerations were seen on the FHR tracing and there were four contractions in 10 minutes. This is interpreted as A. Positive B. Negative C. Suspicious
B. Negative
In _____ sleep, the fetus may be observed to have infrequent or absent body movements, normal FHR baseline, minimal variability, and a nonreactive NST, but may respond to external stimuli. Such typically occurs by 28 to 32 weeks' gestation. A. REM (active sleep state) B. Non-REM (quiet sleep state)
B. Non-REM (quiet sleep state)
Which of the following is considered using the chain of command? A. Asking the patient to talk with the provider directly B. Notifying the charge nurse C. Writing a variance report
B. Notifying the charge nurse
The objective of intrapartum FHR monitoring is to assess for fetal A. Acidemia B. Oxygenation C. Well-being
B. Oxygenation
If the pH is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? A. HCO3 B. PCO2 C. PO2
B. PCO2
The ________, through stimulation of the vagus nerve, reduces FHR and maintains variability. A. Sympathetic nervous system B. Parasympathetic nervous system
B. Parasympathetic nervous system
Oxygen is transferred from the mother to the fetus via the placenta through A. Active transport B. Passive diffusion C. Facilitated diffusion
B. Passive diffusion
Which of the following interventions would best stimulate an acceleration in the FHR? A. Provide juice to patient B. Perform vaginal exam C. Turn patient on left side D. Vibroacoustic stimulation
B. Perform vaginal exam Scalp stimulation
Which of the following fetal dysrhythmias may be related to maternal hyperthyroidism? A. Sinus tachycardia B. Premature atrial contractions (PACs) C. Third-degree heart block
B. Premature atrial contractions (PACs)
Which of the following is not a type of supraventricular dysrhythmia? A. Premature atrial contraction (PAC) B. Premature ventricular contraction (PVC) C. Supraventricular tachycardia (SVT)
B. Premature ventricular contraction (PVC)
A fetal heart rate pattern that can occur when there is a prolapsed cord is A. Marked variability B. Prolonged decelerations C. Tachycardia
B. Prolonged decelerations
The fetal spiral electrode measures the A. Peaks of the Doppler waveforms B. R to R intervals of the fetal heart C. ST segments of the fetal ECG
B. R to R intervals of the fetal heart
Decelerations that occur with at least 50% of contractions in a 20-minute window are defined as A. Repetitive B. Recurrent C. Nonreassuring
B. Recurrent
One fetal heart rate pattern that is associated with an abnormal acid-base status is A. Minimal variability with no accelerations or decelerations B. Recurrent variable decelerations with absent variability C. Tachycardia with absent variability
B. Recurrent variable decelerations with absent variability
A patient has a nonreactive NST and negative CST. Select the appropriate followup. A. Prepare patient for delivery B. Repeat in 24 hours C. Repeat in one week
B. Repeat in 24 hours
For a patient with a suspicious or unsatisfactory CST, select the appropriate followup. A. Prepare patient for delivery B. Repeat in 24 hours C. Repeat in one week
B. Repeat in 24 hours
A fetus at 36 weeks receives a biophysical profile (BBP) score of 6. The amniotic fluid was scored as normal. The expected management is A. Immediate delivery B. Repeat the test in 24 hours C. Schedule the next test in one week
B. Repeat the test in 24 hours
_______ _______ occurs when there is high PCO2 with normal bicarbonate levels. A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis
B. Respiratory acidosis
pH 7.05 PO2 21 PCO2 72 HCO3 24 Base excess -12 A. Metabolic acidosis B. Respiratory acidosis C. Mixed acidosis
B. Respiratory acidosis
Reduced respiratory gas exchange from persistent decelerations may cause a rise in fetal PCO2, which leads first to _______ _______, then _______ _______. A. Respiratory alkalosis; metabolic acidosis B. Respiratory acidosis; metabolic acidosis C. Respiratory alkalosis; metabolic alkalosis D. Respiratory acidosis; metabolic acidosis
B. Respiratory acidosis; metabolic acidosis
The process by which oxygen and carbon dioxide pass from a region of higher concentration to one of a lower concentration is called A. Active transport B. Simple diffusion C. Facilitated diffusion
B. Simple diffusion
The FHR is controlled by the A. Sympathetic nervous system B. Sinoatrial node C. Atrioventricular node D. Parasympathetic nervous system
B. Sinoatrial node
Which of the following is an irregular FHR pattern associated with normal conduction and rate? A. Premature atrial contractions (PACs) B. Sinus arrhythmias C. Sinus tachycardias
B. Sinus arrhythmias
Which of the following occurs when the parasympathetic branch of the autonomic nervous system is stimulated? A. Norepinephrine release B. Slowed conduction to sinoatrial node C. Increase in fetal heart rate
B. Slowed conduction to sinoatrial node
An additional placental lobe is defined as A. Placenta previa B. Succenturiate lobe (SL) C. Velamentous insertion
B. Succenturiate lobe (SL)
Which of the following dysrhythmias may progress to atrial fibrillation or atrial flutter? A. Premature atrial contractions (PACs) B. Supraventricular tachycardia (SVT) C. Sinus tachycardia
B. Supraventricular tachycardia (SVT)
Which of the following is the most common type of fetal tachyarrhythmia? A. Atrial flutter B. Supraventricular tachycardia (SVT) C. Premature ventricular contraction (PVC)
B. Supraventricular tachycardia (SVT)
Tachycardia is associated with increased A. Parasympathetic tone B. Sympathetic tone C. Vagal response
B. Sympathetic tone
_______ represents increased sympathetic or decreased parasympathetic autonomic tone. A. Bradycardia B. Tachycardia
B. Tachycardia
Sinusoidal pattern can be documented when A. Cycles are 4-6 beats per minute in frequency B. The pattern lasts 20 minutes or longer C. There is moderate or minimal variability
B. The pattern lasts 20 minutes or longer
How do baseline heart rates differ in premature fetuses? A. They are often lower B. They are often higher C. They are less likely to have decelerations D. They experience longer accelerations
B. They are often higher
Which of the following is not true when assessing preterm fetuses? A. FHR baseline may be in upper range of normal (150-160 bpm) B. They may have fewer accels, and if <35 weeks, may be 10x10 C. Variability may be in lower range for moderate (6-10 bpm)
B. They may have fewer accels, and if <35 weeks, may be 10x10
Late decelerations of the FHR are associated most specifically with A. Transient fetal tissue metabolic acidosis during a contraction B. Transient fetal hypoxemia during a contraction C. Transient fetal asphyxia during a contraction
B. Transient fetal hypoxemia during a contraction
Which of the following is the most appropriate method of monitoring a patient who is a gestational diabetic? A. Daily NSTs B. Twice-weekly BPPs C. Weekly contraction stress tests
B. Twice-weekly BPPs
Which of the following is false regarding electronic fetal monitoring of twins? A. Both twins must be monitored, as opposed to monitoring one twin at a time B. Twins rarely have accelerations and decelerations simultaneously, and tracings should appear distinctly different C. Twins must be identified and monitored as A or B throughout the entire antenatal and intrapartum periods
B. Twins rarely have accelerations and decelerations simultaneously, and tracings should appear distinctly different
A risk of amnioinfusion is A. Prolonged labor B. Uterine overdistension C. Water intoxication
B. Uterine overdistension
In assessing fetal well-being, the most important characteristic of the FHR is A. Rate B. Variability C. Presence of accelerations D. Absence of decelerations
B. Variability
What are the two most important characteristics of the FHR? A. Rate and decelerations B. Variability and accelerations C. Variability and decelerations D. Rate and variability
B. Variability and accelerations
Which of the following is a common EFM finding when monitoring a preterm fetus? A. Decreased baseline B. Variable decelerations C. Increased FHR variability
B. Variable decelerations
_____ cord blood sampling is predictive of uteroplacental function. A. Arterial B. Venous C. Maternal
B. Venous
According to NICHD terminology, variability can be accurately accessed A. Visually, by determining the number of R to R intervals in a one minute period B. Visually, by determining the amplitude of the FHR change in bpm from the baseline C. Only when a fetal spiral electrode is in place
B. Visually, by determining the amplitude of the FHR change in bpm from the baseline
Determining the FHR baseline requires the nurse to approximate the mean FHR rounded to increments of 5 bpm during a ___-minute window (excluding accelerations and decelerations). A. 2 B. 5 C. 10 D. 20
C. 10
According to AWHONN, the normal baseline Fetal Heart Rate (FHR) is A. 90-150 bpm B. 100-170 bpm C. 110-160 bpm D. 120-140 bpm
C. 110-160 bpm
Clinically significant fetal metabolic academia is indicated by an arterial cord gas pH of less than or equal to 7.10 and a base deficit of A. 3 B. 6 C. 12
C. 12
At 32 weeks and beyond, FHR accelerations are defined as increases in FHR that must be at least A. 10 bpm above the baseline and the accel must last at least 10 sec B. 15 bpm above the baseline and the accel must last at least 10 sec C. 15 bpm above the baseline and the accel must last at least 15 sec
C. 15 bpm above the baseline and the accel must last at least 15 sec
A 35 week gestation fetus is having an NST. The fetal heart rate baseline is 130 bpm. The nurse is using vibroacoustic stimulation to reduce the length of time needed to obtain the NST. Fetal well-being requires A. 1 acceleration to 145 bpm B. 2 accelerations to 140 bpm C. 2 accelerations to at least 145 bpm
C. 2 accelerations to at least 145 bpm
The most common tachyarrhythmia in fetuses, supraventricular tachycardia, typically occurs at a rate of _____ to _____ bpm with minimal or absent variability. A. 160-200 B. 200-240 C. 240-260
C. 240-260
In the United States, the paper speed on the monitor is set at A. 1 cm/min B. 2 cm/min C. 3 cm/min
C. 3 cm/min
According to ACOG, in a patient without complications, the FHR tracing during the first stage of labor should be reviewed approximately every A. 5 min B. 15 min C. 30 min
C. 30 min
When using auscultation to determine FHR baseline, the FHR should be counted after the contractions for A. 5-10 sec B. 15-30 sec C. 30-60 sec
C. 30-60 sec
Before ___ weeks of gestation, an increase in FHR that peaks at least 10 bpm above the baseline and lasts at least 10 seconds is considered an acceleration. A. 28 B. 30 C. 32 D. 36
C. 32
Place the following steps for performing Leopold's maneuver in the appropriate order. 1. Assess location of fetal back 2. Determine the descent of the presenting part 3. Identify the presenting part 4. Assess part of the fetus in the upper uterus A. 1, 3, 2, 4 B. 2, 4, 1, 2 C. 4, 1, 3, 2 D. 4, 3, 2, 1
C. 4, 1, 3, 2
Because stroke volume in the fetus does not fluctuate significantly, fetal cardiac output is _______ fetal heart rate. A. Greater than B. Less than C. Approximately equal to
C. Approximately equal to
How might a fetal arrhythmia affect fetal oxygenation? A. By increasing fetal oxygen affinity B. By increasing sympathetic response C. By reducing fetal perfusion
C. By reducing fetal perfusion
Assessment of FHR variability A. Requires a fetal scalp electrode B. Includes quantification of beat-to-beat changes C. Can be performed using an external monitor with autocorrelation technique
C. Can be performed using an external monitor with autocorrelation technique
FHTs with absent variability and bradycardia would be categorized as A. Category I B. Category II C. Category III
C. Category III
_____ denotes the ability of cardiac cells to conduct electrical impulses from one cell to another. A. Automaticity B. Excitability C. Conductivity
C. Conductivity
The tocodynamometer is completely unreliable for A. Contraction duration B. Contraction frequency C. Contraction intensity
C. Contraction intensity
When coupling or tripling is apparent on the uterine activity tracing, this may be indicative of a dysfunctional labor process and saturation (down regulation) of uterine oxytocin receptor sites in response to excess exposure to oxytocin. Which of the following interventions would be most appropriate? A. Normal response; continue to increase oxytocin titration B. Turn patient on side C. Decrease or discontinue oxytocin infusion
C. Decrease or discontinue oxytocin infusion
Which compromise in fetal oxygenation could be a result of a post-date pregnancy? A. Increased saturation capacity B. Increased fetal oxygen affinity C. Decreased placental perfusion
C. Decreased placental perfusion
A patient presents with a small amount of thick dark blood clots who denies pain and whose abdomen is soft to the touch. Which component of oxygen transport to the fetus could potentially be compromised by this bleeding? A. Affinity B. Saturation C. Delivery
C. Delivery
_______ is defined as the energy-releasing process of metabolism.
Catabolism
_____ are abnormal FHR rhythms associated with disordered impulse formation, conduction, or both. A. Arrhythmias B. Supraventricular tachycardias C. Dysrhythmias
C. Dysrhythmias
The position that best promotes maternal-fetal exchange is A. Left lateral B. Right lateral C. Either right or left lateral
C. Either right or left lateral
A BPP score of 6 is considered A. Abnormal B. Normal C. Equivocal
C. Equivocal
What are abnormal fetal heart rate tracings predictive of? A. Likelihood of spontaneous vaginal delivery B. Newborn condition at time of delivery C. Fetal acid-base abnormalities D. Fetal intrauterine growth
C. Fetal acid-base abnormalities
In the healthy fetus, blood flows from the right atrium to the left atrium through the A. Ductus arteriosus B. Ductus venosus C. Foramen ovale
C. Foramen ovale
_______ denotes a decrease in oxygen content of the fetal blood. A. Hypercapnia B. Hypoxia C. Hypoxemia
C. Hypoxemia
Which of the following best describes a condition in which there is decreased oxygen in the tissues? A. Acidosis B. Hypoxemia C. Hypoxia
C. Hypoxia
Which of the following is not commonly caused by nifedipine administration? A. Maternal hypotension B. Decreased uterine blood flow C. Increased FHR accelerations
C. Increased FHR accelerations
NICHD guidelines apply only to A. Intrapartum patients B. Internal monitoring of fetal heart rate C. Interpreting tracings of good quality
C. Interpreting tracings of good quality
Which of the following might indicate a potential for chronic fetal hypoxemia? A. Decreased amniotic fluid volume B. Increased amniotic fluid volume C. Intrauterine growth restriction
C. Intrauterine growth restriction
A Category II tracing A. Predicts abnormal fetal acid-base status B. Excludes abnormal fetal acid-base status C. Is not predictive of abnormal fetal acid-base status
C. Is not predictive of abnormal fetal acid-base status
Plans of the health care team with a patient with a sinusoidal FHR pattern may include A. Administration of an NST B. Administration of tocolytics C. Kleinhauer-Betke lab test
C. Kleinhauer-Betke lab test
Findings indicative of progressive fetal hypoxemia are A. Late decelerations, moderate variability, stable baseline rate B. Prolonged decelerations recovering to baseline and moderate variability C. Loss of variability and recurrent late or variable decelerations
C. Loss of variability and recurrent late or variable decelerations
Which factor influences blood flow to the uterus? A. Fetal arterial pressure B. Intervillous space flow C. Maternal arterial vasoconstriction
C. Maternal arterial vasoconstriction
Extrinsic factors affecting the FHR include A. Fetal baroreceptors B. Fetal chemoreceptors C. Maternal oxygen transport
C. Maternal oxygen transport
The primary goal in treatment for late decelerations is to A. Correct cord compression B. Improve maternal oxygenation C. Maximize uteroplacental blood flow
C. Maximize uteroplacental blood flow
An infant was delivered via cesarean. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. The initial neonatal hemocrit was 20% and the hemoglobin was 8. These umbilical cord blood gases indicate A. Asphyxia related to umbilical and placental abnormalities B. Hypoxia related to neurological damage C. Mixed acidosis
C. Mixed acidosis
pH 7.02 PO2 17 PCO2 72 HCO3 19 Base deficit 16 A. Metabolic acidosis B. Respiratory acidosis C. Mixed acidosis
C. Mixed acidosis
What characterizes a preterm fetal response to stress? A. More frequently occurring late decelerations B. More frequently occurring prolonged decelerations C. More rapid deterioration from Category I to Category II or III
C. More rapid deterioration from Category I to Category II or III More likely to be subjected to hypoxia
Using the NICHD terminology, tachysystole is defined as A. More than 5 contractions in 10 minutes averaged over a 20-minute period B. More than 5 contractions in 15 minutes averaged over a 30-minute period C. More than 5 contractions in 10 minutes averaged over a 30-minute period
C. More than 5 contractions in 10 minutes averaged over a 30-minute period
The _____ is the source of all fetal oxygenation. A. Placenta B. Umbilical cord C. Mother D. Amniotic fluid
C. Mother
The "overshoot" FHR pattern is highly predictive of A. Fetal hypoxia B. Preexisting fetal neurological injury C. None of the above
C. None of the above
The most appropriate equipment for administration of maternal oxygen for intrauterine resuscitation at 10 L/min is a A. Nasal cannula B. Simple face mask C. Nonrebreather face mask
C. Nonrebreather face mask
Which of the following is the primary neurotransmitter of the sympathetic branch of the autonomic nervous system? A. Acetylcholine B. Dopamine C. Norepinephrine
C. Norepinephrine
A modified BPP reveals the following: reactive NST with moderate variability; AFI of 7. This test would be interpreted as A. Abnormal B. Equivocal C. Normal
C. Normal
Which IV fluid is most appropriate for maternal administration for intrauterine resuscitation? A. Lactated Ringer's solution B. D5L/R C. Normal saline
C. Normal saline
A woman who is 34 weeks' gestation is counting fetal movements each day. Today she counted eight fetal movements in a two-hour period. Based on her kick counts, this woman should A. Continue counting for one more hour B. Discontinue counting until tomorrow C. Notify her provider for further evaluation
C. Notify her provider for further evaluation
While caring for a 235-lb laboring woman who is HIV-seropositive, the external FHR tracing is difficult to obtain. An appropriate nursing action would be to A. Apply a fetal scalp electrode B. Auscultate for presence of FHR variability C. Notify the attending midwife or physician
C. Notify the attending midwife or physician
All of the following are traits of fetal supraventricular tachycardia (SVT), but which is most problematic? A. Decreases diastolic filling time B. Dramatically increases oxygen consumption C. Often leads to ventricular tachycardia (VT)
C. Often leads to ventricular tachycardia (VT)
Chemoreceptors respond mainly to changes in A. Blood pressure B. Hormonal levels C. Oxygen and carbon dioxide levels
C. Oxygen and carbon dioxide levels
The umbilical vein carries A. Carbon dioxide from the fetus back to the placenta B. Deoxygenated blood from the fetus to the placenta C. Oxygenated blood from the placenta to the fetus
C. Oxygenated blood from the placenta to the fetus
Chemoreceptors respond to changes in A. Blood pressure B. Pulse C. Oxygenation
C. Oxygenation
When a patient reports that she is feeling contractions but the nurse does not note any on the toco tracing, what is the first intervention that should be performed? A. Ask the provider to place an IUPC B. Reposition the toco C. Palpate the uterus
C. Palpate the uterus
When the internal mode of monitoring (FSE, IUPC) is used, the information obtained on the uterine activity panel on the fetal monitor should be validated by the clinician by A. Asking the patient to report when she is feeling a contraction B. Ultrasound imaging C. Palpation
C. Palpation
All of the following are appropriate interventions for fetal tachycardia except: A. Increase maternal IV fluid rate B. Assess maternal vital signs C. Perform SVE D. Administer oxygen
C. Perform SVE
Uncontrolled maternal hypertension is often a causative factor in A. Postmaturity B. Preterm contractions C. Placental abruption
C. Placental abruption
Common problems seen during monitoring of postterm fetuses include all of the following except A. Baseline may be 100-110bpm B. Increased variables C. Polyhydramnios
C. Polyhydramnios
Which of the following is not typically associated with a postterm pregnancy? A. Meconium-stained amniotic fluid B. Presence of late decelerations in the fetal heart rate C. Polyhydramnios
C. Polyhydramnios
Regarding the reliability of EFM, there is A. Good interobserver reliability B. Good intraobserver reliability C. Poor interobserver and intraobserver reliability
C. Poor interobserver and intraobserver reliability
A woman at 38 weeks gestation is in labor. The labor has been uneventful, and the fetal heart tracings have been normal. Spontaneous rupture of membranes occurs; fetal heart rate drops to 90 beats per minute for four minutes and then resumes a normal pattern. The most likely etiology for this fetal heart rate change is A. Abnormal fetal presentation B. Impaired placental circulation C. Possible cord compression
C. Possible cord compression
What are the possible implications of an AFI of 3 cm for labor? A. An amnioinfusion will be needed B. Increased risk of uterine hyperstimulation C. Potential umbilical cord compression
C. Potential umbilical cord compression
For a patient at 35 weeks' gestation with a BPP score of 4, select the most appropriate course of action. A. Repeat in 24 hours B. Obtain physician order for CST C. Prepare for probable induction of labor
C. Prepare for probable induction of labor
Which of the following are considered determinants of fetal well-being? (Select all that apply). A. Absence of decelerations in FHR B. Palpation of fetal movement C. Presence of accelerations in FHR D. Moderate variability in FHR E. Presence of early decelerations in second stage
C. Presence of accelerations in FHR D. Moderate variability in FHR
When looking at the fetal heart rate, the most important characteristic to determine the absence of metabolic acidemia is A. Absence of late decelerations B. Baseline rate within normal range C. Presence of moderate variability
C. Presence of moderate variability
Which of the following is most effective in determining the strength of a patient's contractions? A. Patient report B. Tocodynanamometer tracing C. RN palpation D. Sterile vaginal exam during a contraction
C. RN palpation
When auscultating the fetal heart rate, the provider/nurse should simultaneously assess the maternal A. Blood pressure B. Pain level C. Radial pulse
C. Radial pulse
According to NICHD definitions of FHR variability, which of the following is accurate? A. Range 1-5 bpm = absent variability B. Range 6-25 bpm = average variability C. Range visually detectable but </=5 bpm = minimal variability
C. Range visually detectable but </=5 bpm = minimal variability
A fetal heart rate pattern that the NICHD has identified as predictive of current or impending fetal asphyxia so severe that the fetus is at risk of neurologic damage or death is A. Baseline tachycardia with absent variability B. Minimal baseline variability with recurrent late decelerations C. Recurrent late or variable decelerations with absent variability
C. Recurrent late or variable decelerations with absent variability
Amnioinfusion is an appropriate measure for A. Thick, meconium-stained fluid B. Oligohydramnios C. Recurrent variable decelerations unresolved by position changes
C. Recurrent variable decelerations unresolved by position changes
Since the widespread use of EFM, the rate of cerebral palsy has A. Decreased B. Increased C. Remained the same
C. Remained the same
In a patient whose CST reveals late decelerations with three out of the four induced contractions, which of the following would be the least appropriate plan for treatment? A. Obtain physician order for BPP B. Prepare for possible induction of labor C. Repeat CST in 24 hours
C. Repeat CST in 24 hours
A patient has a reactive NST and negative CST. Select the appropriate followup. A. Prepare patient for delivery B. Repeat in 24 hours C. Repeat in one week
C. Repeat in one week
The following cord blood gasses are consistent with: pH 7.10, pCO2 70, pO2 25, base excess -10 A. Metabolic acidosis B. Mixed acidosis C. Respiratory acidosis
C. Respiratory acidosis
Which statement describes normal uterine activity? A. Frequency of 1-1/2 to 2 minutes B. Intensity of 90 mmHg early in labor C. Resting tone less than 20-25 mmHg
C. Resting tone less than 20-25 mmHg
EFM is an excellent _____ test for determining the presence or absence of neurological injury. A. Definitive B. Diagnostic C. Screening
C. Screening
The fetus responds to a significant drop of PO2 by A. Increasing O2 consumption B. Reducing lactic acid production C. Shifting blood to vital organs
C. Shifting blood to vital organs
An FHR pattern associated with severe fetal anemia is A. Lambda B. Saltatory C. Sinusoidal
C. Sinusoidal
A fetal heart rate change that can be seen after administration of butorphanol (Stadol) is A. Bradycardia B. Marked variability C. Sinusoidal-appearing
C. Sinusoidal-appearing
A 36 week gestation patient is brought to triage by squad after an MVA on her back. She is not bleeding and denies pain. She is not short of breath, but c/o dizziness and nausea since they put her on the gurney. The most likely cause is A. Abruptio placenta B. Preterm labor C. Supine hypotension
C. Supine hypotension
Which abnormal FHR pattern is most likely to lead to hydrops in the fetus? A. Marked variability B. A premature ventricular contraction (PVC) C. Supraventricular tachycardia (SVT)
C. Supraventricular tachycardia (SVT)
A contraction stress test (CST) is performed. Late decelerations were noted in two out of the five contractions in 10 minutes. This is interpreted as A. Positive B. Negative C. Suspicious
C. Suspicious
A patient receiving oxytocin has 17 contractions in 30 minutes. According to the NICHD guidelines, this is called A. Hyperstimulation B. Hypertonus C. Tachysystole
C. Tachysystole
Greater than 5 contractions in 10 minutes averaged over 30 minutes indicates A. Excessive uterine activity B. Hyperstimulation C. Tachysystole
C. Tachysystole
Your patient is a 41-year-old diabetic primigravida. You have just performed a vaginal exam: 6/90/-1. The fetus has been having late decels with absent to minimal variability and no accels for one hour, despite interventions to improve the tracing. The provider arrives on the unit and states that she will remain on the floor, and writes orders to start oxytocin. You inform the physician that you are not comfortable starting oxytocin based on maternal history, SVE, and FHR tracing. The provider insists that you should start oxytocin. What is your response? A. Tell the physician that if she will remain on the unit, you will start the oxytocin. B. Tell the physician that she can start the oxytocin herself. C. Tell the physician that you decline to start the oxytocin, and notify the physician that you are activating your chain of command.
C. Tell the physician that you decline to start the oxytocin, and notify the physician that you are activating your chain of command.
Which is a correct description of daily fetal movement counting? A. Counting should not be started by low-risk mothers until 38 weeks of gestation B. Fetal movement counting is not reliable because the methods of counting vary C. The mother counts the number of movements over a specified length of time
C. The mother counts the number of movements over a specified length of time
An infant was delivered via cesarean. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. The initial neonatal hemocrit was 20% and the hemoglobin was 8. Which interpretation of these umbilical cord and initial neonatal blood results is correct? A. Base buffers have been used to maintain oxygenation B. The mother was probably hypoglycemic C. The neonate is anemic
C. The neonate is anemic
One characteristic of a high reliability perinatal unit is A. Alarms can only be called by unit leaders B. Reliance on memorization of protocols C. The organization creates a safety-oriented culture
C. The organization creates a safety-oriented culture
Which is the most appropriate application of vibroacoustic stimulation (fetal acoustic stimulation) in a standard NST? A. The device is placed at the top of the maternal fundus B. The mother uses a marker button to document the fetal movement response C. The stimulation is applied after a baseline is established
C. The stimulation is applied after a baseline is established
In comparing early and late decelerations, a distinguishing factor between the two is A. Onset time to the nadir of the deceleration B. The number of decelerations that occur C. Timing in relation to contractions
C. Timing in relation to contractions
As fetal hypoxia (asphyxia) worsens, the last component of the BPP to disappear is fetal A. Breathing B. Movement C. Tone
C. Tone
With _____ premature ventricular contractions (PVCs), the upward spikes will be slightly longer than the downward spikes. A. Idioventricular B. Bigeminal C. Trigeminal
C. Trigeminal
Which of the following is not a likely cause of a sinusoidal FHR pattern? A. Chronic fetal bleeding B. Fetal hypoxia or anemia C. Triple screen positive for Trisomy 21 D. Fetal isoimmunization
C. Triple screen positive for Trisomy 21
The patient is in early labor with pitocin at 8 mu/min, and FHR is Category I. In the next 15 minutes, there are 18 uterine contractions. Recommended management is to A. Address contraction frequency by reducing pitocin dose B. Continue to increase pitocin as long as FHR is Category I C. Turn the patient on her side and initiate an IV fluid bolus
C. Turn the patient on her side and initiate an IV fluid bolus
An amnioinfusion is intended to relieve which extrinsic factor that compromises oxygen transport? A. Excessive uterine compression B. Structural abnormalities of the placenta C. Umbilical cord compression
C. Umbilical cord compression
According to ACOG, intermittent auscultation is appropriate for A. All pregnancies B. Neither complicated nor uncomplicated pregnancies C. Uncomplicated pregnancies
C. Uncomplicated pregnancies
Which of the following is most strongly correlated with placental abruption? A. Uncontrolled gestational diabetes B. Multiple gestation C. Uncontrolled hypertension
C. Uncontrolled hypertension
A contraction stress test (CST) is performed. No decelerations were noted with the two contractions that occurred over 10 minutes. This is interpreted as A. Positive B. Negative C. Unsatisfactory
C. Unsatisfactory
The underlying cause of early decelerations is decreased A. Baroceptor response B. Increased peripheral resistance C. Vagal reflex
C. Vagal reflex
Bradycardia in the second stage of labor following a previously normal tracing may be caused by fetal A. Hypoxemia B. Rotation C. Vagal stimulation
C. Vagal stimulation
Fetal bradycardia can result during A. The sleep state B. Umbilical vein compression C. Vagal stimulation
C. Vagal stimulation
Amnioinfusion may be useful in alleviating recurrent decelerations that are A. Early B. Late C. Variable
C. Variable
Baroreceptor-mediated decelerations are A. Early B. Late C. Variable
C. Variable
FHR decelerations that results from umbilical cord compression are A. Early B. Late C. Variable
C. Variable
The most frequently observed type of FHR deceleration is A. Early B. Late C. Variable
C. Variable
A 42 week gestation woman has been diagnosed with oligohydramnios. Based on this, a FHR change that can be expected is A. Late deceleration B. Minimal variability C. Variable deceleration
C. Variable deceleration
Following an ultrasound which revealed decreased amniotic fluid, a woman at term is admitted in early labor. It should be recognized that oligohydramnios often results in fetal heart rate decelerations that are A. Late in onset or occur after the peak of the contraction B. Synchronous with that of the contraction C. Varied in depth and duration
C. Varied in depth and duration
When the umbilical vessels traverse the membranes to the placenta without any cord protection, this is called A. Placenta previa B. Succenturiate lobe (SL) C. Velamentous insertion
C. Velamentous insertion
Which FHR sounds are counted with a stethoscope and a fetoscope? A. Atrial B. Atrial and ventricular C. Ventricular
C. Ventricular
One advantage of using a fetoscope is that it can A. Allow more rapid detection of a baseline change B. More accurately assess the FHR variability C. Verify the presence of an irregular rhythm
C. Verify the presence of an irregular rhythm
Place the following interventions for a sinusoidal FHR in the correct order: 1. Prepare for cesarean delivery 2. Place patient in lateral position 3. Determine if pattern is related to narcotic analgesic administration 4. Provide oxygen via face mask A. 4, 2, 3, 1 B. 3, 1, 2, 4 C. 4, 3, 2, 1 D. 3, 2, 4, 1
D. 3, 2, 4, 1
_______ variability warrants cesarean section delivery. A. Minimal B. Moderate C. Marked D. Absent
D. Absent
A deceleration from 145bpm down to 100bpm lasting 12 minutes may be defined as a A. Prolonged deceleration B. Variable deceleration C. Late deceleration D. Baseline change
D. Baseline change
All of the following could likely cause minimal variability in FHR except A. Magnesium sulfate administration B. Fetal sleep cycle C. Narcotic administration D. Ephedrine administration
D. Ephedrine administration
All of the following might indicate a pseudosinusoidal pattern as opposed to a sinusoidal pattern, except: A. Recent administration of narcotics to mother B. Accelerations in FHR C. Moderate variability D. Frequency of oscillations of two to five cycles/min
D. Frequency of oscillations of two to five cycles/min
All of the following are likely causes of prolonged decelerations except: A. Uterine tachysystole B. Prolapsed cord C. Maternal hypotension D. Maternal fever
D. Maternal fever
Which of the following factors is not likely to cause uteroplacental insufficiency? A. Late-term gestation B. Preeclampsia C. Gestational diabetes D. Polyhydramnios E. Maternal smoking or drug use
D. Polyhydramnios
Which of the following is not an intervention that should be implemented in a patient with uterine tachysystole? A. Administer terbutaline B. Increase IV fluid rate C. Decrease or discontinue IV oxytocin D. Prepare patient for cesarean section
D. Prepare patient for cesarean section
Medications, prematurity, fetal sleep, fetal dysrhythmia, anesthetic agents, or cardiac anomalies may result in _______ variability.
Decreased
Glucose is transferred across the placenta via _____ _____.
Facilitated diffusion
(T/F) An internal scalp electrode can solely diagnose a fetal dysrhythmia.
False
(T/F) Metabolic acidosis is more easily reversible and potentially less detrimental to the fetus when compared to respiratory acidosis.
False
(T/F) The baseline can be established in a fetal heart rate tracing in which there is marked variability.
False
(T/F) There is a strong correlation between arterial cord blood gas results and Apgar scores.
False
T/F: A Doppler device used for intermittent auscultation of the fetal heart rate may be used to identify rhythm irregularities, such as supraventricular tachycardia.
False
T/F: Amnioinfusion is an appropriate intervention to attempt to resolve patterns of moderate to severe late decelerations.
False
T/F: Amnioinfusion is an appropriate intervention to attempt to resolve patterns with absent variability.
False
T/F: Auscultation may be used to detect baseline variability and discriminate FHR deceleration patterns.
False
T/F: Because the ultrasound transducer and toco transducer are sealed units, they can be dipped in warm water to make cleaning easier.
False
T/F: Both internal and external monitoring methods are equally accurate means of obtaining the fetal heart rate and contraction patterns.
False
T/F: Amnioinfusion may be an appropriate intervention for patients with oligohydramnios in the prevention of the development of variable decelerations.
False Not for prevention
The _____ _____ is the shunt that bypasses the fetal lungs, moving blood from the right atrium to the left atrium.
Foramen ovale
Well-oxygenated fetal blood enters the _____ ventricle, which supplies the heart and brain. Less-oxygenated blood enters the ______ ventricle, which supplies the rest of the body.
Left; right
In the presence of late or variable decelerations, two parameters that indicate adequate fetal oxygenation are _____ and _____.
Moderate variability; normal baseline rate
Stimulation of the _____ _____ _____ releases acetylcholine, resulting in decreased FHR.
Parasympathetic nervous system
Most fetal dysrhythmias are not life-threatening, except for _______, which may lead to fetal congestive heart failure.
Supraventricular tachycardia
Stimulation of the _____ _____ _____ releases catecholamines, resulting in increased FHR.
Sympathetic nervous system
T/F: Anything that affects maternal blood flow (cardiac output) can affect the blood flow through the placenta.
True
T/F: Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure.
True
(T/F) An internal scalp electrode will detect the actual fetal ECG.
True
(T/F) Contractions during a contraction stress test (CST) may be spontaneous or induced with oxytocin or nipple stimulation.
True
(T/F) Sinus bradycardias, sinus tachycardias, and sinus arrhythmias are all associated with normal conduction (normal P-waves followed by narrow QRS complexes).
True
(T/F) Vibroacoustic stimulation may be less effective for preterm fetuses or when membranes have been ruptured.
True
T/F: Adequacy of uterine resting tone measured by an IUPC should be validated by palpation.
True
T/F: All fetal monitors contain a logic system designed to reject artifact.
True
T/F: In the context of moderate variability, late decelerations are considered neurogenic in origin and are typically amenable to intrauterine resuscitation techniques directed towards maximizing uterine blood flow.
True
T/F: Late decelerations have a gradual decrease in FHR (onset to nadir 30 seconds) and are delayed in timing with the nadir of the deceleration occurring after the peak of the contraction.
True
T/F: Oxygen exchange in the placenta takes place in the intervillous space.
True
T/F: The external toco is usually placed over the uterine fundus to pick up contractions.
True
T/F: The internal spiral electrode may pick up the maternal heart rate if the baby has died.
True
T/F: The monitor should always be tested before starting a tracing, either external or internal mode and labeled a test.
True
T/F: The most common artifact with the ultrasound transducer system for fetal heart rate is increased variability.
True
T/F: The presence of FHR accelerations in the intrapartum and antepartum periods is a sign of adequate fetal oxygenation.
True
T/F: The ultrasound transducer is usually placed on the side of the uterus over the baby's back, as the fetal heart is heard best there.
True
T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart rate: the ultrasound transducer and the fetal spiral electrode.
True
T/F: Umbilical cord influences that can alter blood flow include true knots, hematomas, and number of umbilical vessels.
True
T/F: Use of a fetoscope for intermittent auscultation of the fetal heart rate may be used to detect accelerations and decelerations from the baseline, and can clarify double-counting of half-counting of baseline rate.
True
T/F: Use of a fetoscope for intermittent auscultation of the fetal heart rate may be used to detect baseline, rhythm, changes from baseline, and presence of an irregular rhythm.
True
T/F: Variability and periodic changes can be detected with both internal and external monitoring.
True
Baroreceptors influence _____ decelerations with moderate variability.
Variable
If a nonstress test is nonreactive after 40 minutes, the next step should be: a. Have the client go home and do fetal movement counts b. Do a biophysical profile or contraction stress test c. Repeat the nonstress test within a week d. Admit the client for delivery
b. Do a biophysical profile or contraction stress test
The tocotransducer should be placed: a. In the suprapubic area b. In the fundal area c. Over the xiphoid process d. Within the uterus
b. In the fundal area
Which setting is most appropriate for fetal vibroacoustic stimulation? A. 38 weeks, active labor, FHR baseline 140 bpm, minimal variability for 60 min, no accels, no decels B. 40 weeks, active labor, FHR baseline 150 bpm, moderate variability, prolonged decel to 60 bpm lasting 8 min C. 34 weeks, frequent contractions without cervical change, FHR baseline 180 bpm, moderate variability, late decels
Which setting is most appropriate for fetal vibroacoustic stimulation? A. 38 weeks, active labor, FHR baseline 140 bpm, minimal variability for 60 min, no accels, no decels
How does the fetus compensate for decreased maternal circulating volume? a. Increases cardiac output by increasing stroke volume. b. Increases cardiac output by increasing it's heart rate. c. Increases cardiac output by increasing fetal movement.
b. Increases cardiac output by increasing it's heart rate.
Stimulating the vagus nerve typically produces: a. A decrease in the heart rate b. An increase in the heart rate c. An increase in stroke volume d. No change
a. A decrease in the heart rate
All of the following are components of a biophysical profile except: a. Contraction stress test b. Assessment of fetal breathing c. Amniotic fluid volume measurement d. Fetal movement assessment
a. Contraction stress test
The nurse notes a pattern of variable decelerations to 75 bpm on the fetal monitor. The initial nursing action is to: a. Reposition the woman b. Administer oxygen c. Increase the intravenous fluid infusion d. Stimulate the fetal scalp
a. Reposition the woman
What is the most probable cause of recurrent late decelerations? a. Utero-placental insufficiency b. Head compression c. Cord compression d. Maternal position change
a. Utero-placental insufficiency
Which of the following does not affect the degree of fetal activity? a. Vibroacoustic stimulation b. Smoking c. Fetal position d. Gestational age
a. Vibroacoustic stimulation
For a contraction stress test to be interpretable, you must have a minimum of: a. 5 contractions in a 10-minute window b. 3 contractions in a 10-minute window c. 4 contractions in a 10-minute window d. 2 contractions in a 10-minute window
b. 3 contractions in a 10 minute window
What is your first intervention in management of a patient experiencing variable decelerations? a. Immediate delivery b. Change maternal position c. No treatment indicated d. Oxygen e. Stop oxytocin infusion
b. Change maternal position
The vagus nerve begins maturation 26 to 28 weeks. Its dominance results in what effect to the FHR baseline? a. Increases baseline b. Decreases baseline
b. Decreases baseline
Etiology of a baseline FHR of 165bpm occurring for the last hour can be: 1. Maternal supine hypotension 2. Maternal fever 3. Maternal dehydration 4. Unknown a. 1 and 2 b. 1, 2 and 3 c. 2, 3 and 4
c. 2, 3 and 4
Which of the following conditions is not an indication for antepartum fetal surveillance? a. Gestational hypertension b. Diabetes in pregnancy c. Fetus in breech presentation d. Decreased fetal movement
c. Fetus in breech presentation
A negative contraction stress test is one in which: a. No contractions are seen b. There are late decelerations with > 50% of the contractions seen c. There are no fetal heart rate late decelerations with the contractions d. There is one fetal heart rate deceleration seen
c. There are no fetal heart rate late decelerations with the contractions
A modified biophysical profile includes a nonstress test and: a. Contraction stress test b. Ultrasound assessment of fetal movement c. Ultrasound assessment of amniotic fluid volume d. Fetal movement counts
c. Ultrasound assessment of amniotic fluid volume
The most prevalent risk factor associated with fetal death before the onset of labor is: a. Low socioeconomic status b. Fetal malpresentation c. Uteroplacental insufficiency d. Uterine anomalies
c. Uteroplacental insufficiency
To be considered reactive, a nonstress test must have: a. 4 fetal heart rate accelerations in a 20 minute window b. 2 fetal heart rate accelerations in a 10 minute window c. 4 fetal heart rate accelerations in a 40 minute window d. 2 fetal heart rate accelerations in a 20 minute window
d. 2 fetal heart rate accelerations in a 20 minute window
The expected response of the fetal heart rate to active fetal movement of a 31-week gestational age fetus is: a. Suppression of normal short term variability for 15 seconds b. Acceleration of at least 15 beats per minute for 15 seconds c. Acceleration followed by a 15-second deceleration of the heart rate d. Acceleration of at least 10 beats per minute for 10 seconds
d. Acceleration of at least 10 beats per minute for 10 seconds
The nurse notes a pattern of decelerations on the fetal monitor that begins shortly after the contraction and returns to baseline just before the contraction is over. The correct nursing response is to: a. Give the woman oxygen by facemask at 8-10 L/min b. Position the woman on her opposite side c. Increase the rate of the woman's intravenous fluid d. Continue to observe and record the normal pattern
d. Continue to observe and record the normal pattern
Which of the following is NOT used for antepartum fetal surveillance? a. Fetal movement counting b. Antepartum fetal heart rate testing c. Biophysical profile testing d. Maternal HCG levels
d. Maternal HCG levels
Which of the following factors can have a negative effect on uterine blood flow? a. Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above
e. All of the above
What initially causes a chemoreceptor response? a. Epidurals b. Supine maternal position c. Increased CO2 levels d. Decreased O2 levels e. A & C f. A & B g. C & D
g. C & D
