Ch 14 OB Intrapartum Fetal Surv
The nurse is monitoring the fetal heart rate (FHR) of a patient. When would the nurse observe early decelerations? 1 During uterine contractions 2 When external sound is applied 3 When the abdomen is palpated 4 During regular fetal movement
1 Compression of the fetal head during uterine contraction can cause early decelerations. Fetal heart rate accelerations occur in response to applying external sounds. Palpation of the abdomen also causes FHR accelerations, but not decelerations. Spontaneous and regular fetal movement indicates fetal well-being and results in FHR accelerations.
What does the nurse providing care for a laboring woman understand about accelerations in fetal movement? 1 They are reassuring. 2 They are caused by umbilical cord compression. 3 They warrant close observation. 4 They are caused by uteroplacental insufficiency.
1 Episodic accelerations in the fetal heart rate (FHR) occur during fetal movement and are indications of fetal well-being. Umbilical cord compression results in variable decelerations in the FHR. Accelerations in the FHR are an indication of fetal well-being and do not warrant close observation. Uteroplacental insufficiency would result in late decelerations in the FHR.
While monitoring the fetal heart rate (FHR) of a patient, the nurse notes tachycardia. What is a probable cause for this condition? 1 Early signs of fetal distress 2 Maternal hypothermia 3 Maternal hypoglycemia 4 Atrioventricular dissociation
1 Tachycardia is a baseline FHR greater than 160 beats/minute that lasts for 10 minutes or longer. It may be considered an early sign of fetal distress or even fetal hypoxemia, especially when associated with late decelerations and minimal or absent variability. It can result from maternal or fetal infection. Bradycardia is a baseline FHR less than 110 beats/minute that lasts for 10 minutes or longer. Maternal hypothermia or maternal hypoglycemia may cause bradycardia. Bradycardia, not tachycardia, is often caused by some type of fetal cardiac problem. These may include structural defects involving the conduction system, as in atrioventricular dissociation.
The nurse is monitoring the fetal heart rate (FHR) of a patient who is in labor at full term. What measure does the nurse take to obtain the most accurate baseline fetal heart rate? 1 Record or monitor a 10-minute segment of tracing. 2 Include periods of marked variability in the segment. 3 Include episodic changes in the segment of tracing. 4 Obtain at least 5 minutes of interpretable data in the segment.
1 The baseline fetal heart rate is the average rate during a 10-minute segment, and that is why the nurse must obtain a 10-minute segment of tracing to determine the baseline FHR. In order to determine a baseline heart rate, the 10-minute segment must not include periods of marked variability or periodic or episodic changes. The nurse must ensure there are at least 2 minutes of interpretable baseline data in a 10-minute segment of tracing.
Fetal well-being during labor is assessed by monitoring what? 1 The response of the fetal heart rate (FHR) to uterine contractions (UCs) 2 Maternal pain control 3 Accelerations in the FHR 4 An FHR greater than 110 beats/minute
1 Fetal well-being during labor can be measured by the response of the FHR to UCs. In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110 to 160 beats/minute with no periodic changes, a moderate baseline variability, and accelerations with fetal movement. Maternal pain control is not the measure used to determine fetal well-being in labor. Although FHR accelerations are a reassuring pattern, they are only one component of the criteria by which fetal well-being is assessed. Although an FHR greater than 110 beats/minute may be reassuring, it is only one component of the criteria by which fetal well-being is assessed. More information is needed to determine fetal well-being.
The nurse is monitoring the fetal heart rate (FHR) of a patient in term labor. The FHR varies between 120 and 130 beats/minute over a 10-minute period. How does the nurse record the baseline? Record your answer using a whole number. ________ beats/minute
120 + 130 /2 = 125 After 10 minutes of tracing is observed, the approximate mean rate is rounded to the closest 5 beats/minute interval, which is 125 beats/minute.
Which of the following FHR tracing characteristics are considered reassuring or normal (category I)? 1 Bradycardia not accompanied by baseline variability 2 Early decelerations, either present or absent 3 Sinusoidal pattern 4 Tachycardia
2 Early decelerations, the absence of late decelerations, and the presence of accelerations indicate a normal category I tracing. Bradycardia not accompanied by variability is a category II tracing. A sinusoidal pattern is considered an ominous sign and is definitely an abnormal category III tracing. Fetal tachycardia is a category II tracing and not considered normal
The diagnostic test reports of a pregnant patient reveal a baseline fetal heart rate of 175 beats/minute. What does this finding indicate to the nurse? 1 The fetus has ischemia. 2 The fetus has tachycardia. 3 The fetus has bradycardia. 4 The fetus has hypotension.
2 Normal baseline fetal heart rate ranges from 110 to 160 beats/minute. If the fetal heart rate is more than 160 beats/minute, then tachycardia in the fetus is indicated. Ischemia is a condition in which there is a reduced blood supply to the fetal tissues. Baseline heart rate below 110 beats/minute indicates bradycardia in fetus. Hypotension indicates a blood pressure level below 120/80 mm Hg, which is a life-threatening condition for the fetus.
Which area does the nurse assess to hear loud, clear fetal heart sounds? 1 Fetal head 2 Fetal back 3 Fetal neck 4 Fetal abdomen
2 The nurse must locate the fetal back to listen and count the heart sounds. The heart sounds are loudest and clearest over the fetal back. It is difficult for the nurse to count the heart sounds over the fetal head, neck, or abdomen because the heart sounds are not loud and clear in these areas.
The nurse is monitoring the fetal heart rate (FHR) of a patient and notices late decelerations, including a gradual decrease in and return to baseline, associated with uterine contractions. To which condition does the nurse attribute this? 1 Fundal pressure 2 Uteroplacental insufficiency 3 Vaginal examination 4 Fetal scalp stimulation
2 Uteroplacental insufficiency leads to disruption of the oxygen transfer from the maternal blood to the fetus. This can lead to late decelerations of the fetal heart rate. Early FHR decelerations may be caused by fetal head compression caused by fundal pressure or vaginal examination. Fetal scalp stimulation typically causes FHR accelerations, not late FHR decelerations.
A nurse caring for a woman in labor understands that increased variability of the fetal heart rate might be caused by what? 1 Narcotics 2 Barbiturates 3 Methamphetamines 4 Tranquilizers
2 The use of illicit drugs such as cocaine or methamphetamines might cause increased variability. Maternal ingestion of narcotics may be the cause of decreased variability. The use of barbiturates may also result in a significant decrease in variability because these are known to cross the placental barrier. Tranquilizer use is a possible cause of decreased variability in the fetal heart rate.
While assessing the fetal heart rate (FHR) of a patient in labor, what does the nurse identify as normal variability of the FHR? 1 Absent variability 2 Minimal variability 3 Moderate variability 4 Marked variabilit
3 Moderate variability is highly predictive of a normal fetal acid-base balance. It indicates that FHR regulation is not significantly affected by fetal sleep cycles, tachycardia, prematurity, congenital anomalies, preexisting neurologic injury, or central nervous system depressant medications. Absent or minimal variability is classified as either abnormal or indeterminate. It can result from fetal hypoxemia and metabolic academia. The significance of marked variability is unclear.
The nurse is monitoring the fetal heart rate of a pregnant patient. Which fetal heart rate is indicative of adequate fetal oxygen supply? 1 Fetal heart rate is 90 beats/minute. 2 Fetal heart rate is 100 beats/minute. 3 Fetal heart rate is 130 beats/minute. 4 Fetal heart rate is 170 beats/minute.
3 The fetal heart rate needs to be at a certain level to ensure a sufficient oxygen supply to the infant from the maternal blood. An insufficient supply of oxygen leads to hypoxia in the fetus. If the fetal heart rate is from 110 beats/minute to 160 beats/minute, it indicates that the fetus has adequate circulation and is obtaining a sufficient amount of oxygen from the maternal blood. The fetus with a heart rate of 130 beats/minute is normal. Fetal heart rates of 90 beats/minute or 100 beats/minute are indications of fetal bradycardia. A heart rate of 170 beats/minute in a fetus indicates tachycardia. Both conditions indicate impaired cardiac activity in the fetus
The nurse notes variable fetal heart rate (FHR) decelerations while monitoring the fetal heart rate of a patient. What causes variable decelerations? 1 Uterine tachysystole 2 Maternal hypertension 3 Umbilical cord compression 4 Epidural or spinal anesthesia
3 Variable FHR decelerations are usually transient and correctable. They can occur at any time during the uterine contraction phase and are caused by umbilical cord compression. Uterine tachysystole is a condition that causes frequent uterine contractions, often more than five contractions in 10 minutes. This causes disruption of oxygen transfer from the environment to the fetus, leading to late decelerations. Maternal hypertension leads to late FHR decelerations due to reduced oxygen transfer to the fetus. Epidural or spinal anesthesia reduces blood flow through maternal vessels, causing late decelerations.
Which fetal heart rate indicates that there is normal growth and development? 1 80 beats/minute 2 100 beats/minute 3 150 beats/minute 4 180 beats/minute
3 The normal fetal heart rate is found to be 110 to 160 beats/minute. Usually, the fetal heart rate is higher than normal healthy adults in order to meet the high oxygen demand of the fetus. If the fetal heart rate is 150 beats/minute, it indicates that the fetus is healthy and is receiving sufficient oxygen, as required for fetal growth. If the fetal heart rate is less than 110 beats/minute, it indicates an insufficient supply of oxygen to the fetus. If the fetal heart rate is more than 160 beats/minute, it indicates that the fetus is at risk of hypertension.
The nurse is teaching a group of nursing students about fetal oxygenation. The nurse questions a student, "What happens when oxytocin levels are elevated in the patient?" What would be the most appropriate answer given by the nursing student related to the patient's condition? 1 "Hemoglobin levels will decrease." 2 "Blood glucose levels will increase." 3 "Placenta lowers the blood supply." 4 "Uterine contractions (UCs) will increase."
4 An elevated level of oxytocin increases UCs during labor. Reduced hemoglobin levels lead to a decreased oxygen supply to the fetus, but are not a complication associated with an elevated oxytocin level. Oxytocin has no effect on blood glucose levels. A family history of diabetes may increase the risk of gestational diabetes in the patient. Conditions such as hypertension in the patient may lower the blood supply to the placenta, but are not associated with oxytocin levels.
You are evaluating the fetal monitor tracing of your patient, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase intravenous (IV) fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should you take? 1 Call for help. 2 Insert a Foley catheter. 3 Start oxytocin (Pitocin). 4 Notify the primary health care provider immediately.
4 To relieve an FHR deceleration the nurse can reposition the mother, increase IV fluid, and provide oxygen. In addition, if oxytocin is infusing, it should be discontinued. If the FHR does not resolve, the primary health care provider should be notified immediately. Although it is always a good idea to have extra help during any unanticipated obstetric event, this is not the most important nursing measure at this time. If the FHR were to continue in an abnormal or nonreassuring pattern, a cesarean section may be warranted. This would require the insertion of a Foley catheter; however, the physician must make that determination. Oxytocin may put additional stress on the fetus.
The nurse is caring for a patient with electronic fetal monitoring using a spiral electrode. How is the use of a spiral electrode different from the use of an ultrasound transducer? 1 It is used only during the antepartum period. 2 It is used when the cervix has not yet dilated. 3 It is applied firmly to the maternal abdomen. 4 It is used after the membranes have ruptured.
4 A spiral electrode can be used only after the membranes have ruptured. The electrode is attached securely to the presenting fetal body part to obtain a good signal. It can be used only during the intrapartum period and only if the cervix is sufficiently dilated and the membranes are ruptured. A tocotransducer is applied firmly to the maternal abdomen to monitor the frequency and duration of contractions. A spiral electrode penetrates into the presenting part by 1.5 mm.
The nurse is using auscultation to determine the fetal heart rate (FHR) during the first stage of labor. What measures can the nurse use to reassure the mother if it takes considerable time to locate and count the heartbeats? 1 Ask the health care provider to locate the heartbeat. 2 Let the mother know the sounds are muffled. 3 Use internal monitoring to locate the heartbeat. 4 Allow the mother to listen to the heartbeat.
4 The patient may become anxious if the nurse takes considerable time to locate and count the fetal heartbeats. The nurse can reassure the mother by allowing the mother to listen to the heartbeat after it is located. The nurse may seek assistance if necessary to identify the fetal heartbeat; however, the nurse is usually capable of locating the heartbeat with patience, and escalating the intervention to a health care provider can sometimes increase anxiety in the patient. The nurse must let the mother know that it takes time to identify the spot with the loudest and clearest heartbeats that can be counted. The nurse need not tell the mother that the sounds are muffled. The nurse must use an ultrasound to locate the heartbeat during the first stage of labor. Internal monitoring is possible only when the cervix is dilated sufficiently and the membranes are ruptured.
Which instruments are used to assess fetal heart rate (FHR) and rhythm? Select all that apply. 1 Fetoscope 2 Doppler ultrasound 3 Pinard stethoscope 4 Bell of adult stethoscope 5 Electrocardiogram (ECG)
Assessing FHR and rhythm is done with a fetoscope, Doppler ultrasound, and/or a Pinard stethoscope. The bell of an adult stethoscope is used to auscultate low-frequency sounds. An ECG uses electrical impulses to evaluate a cardiac rhythm after the infant is born.
