Davis Edge: Fetal Heart Rate Assessment

A nursing instructor explains to a group of students that an amnioinfusion is a procedure used most commonly in the first stage of labor to treat which type of decelerations? 1. Variable 2. Late 3. Early 4. Prolonged

1

Which assessments of uterine activity are obtained by the nurse when the patient has an intrauterine pressure catheter (IUPC) placed? Select all that apply. 1. Frequency 2. Intensity 3. Duration 4. Fetal Heart Rate 5. Resting Tone

1, 2, 3, 5

The midwife is explaining to the patient how to palpate contractions during labor. The midwife explains that in between contractions the uterus should feel soft. Which is the midwife assessing between contractions? 1. Intensity 2. Resting tone 3. Frequency 4. Duration

2

After assessing a patient, the nurse records the following findings: FHR 145BPM with moderate variability. The patient is contracting with a frequency of every 3 minutes and duration of 60-75 minutes, with intermittent decelerations to 125 bm beginning 10 seconds after the peak of a contraction and lasting 50-70 seconds with a baseline to nadir interval greater than 30 seconds. Which does the nurse record to describe the decelerations? 1. Late deceleration 2. Early deceleration 3. Variable deceleration 4. Prolonged deceleration

1

The nurse is caring for a patient who has experienced a prolonged labor and difficulty pushing. The FHR is 90 bpm and the nurse is aware that which nursing action is contraindicated at this time? 1. Closed glottis pushing 2. Confirming FHR versus maternal heart rate 3. Performing a vaginal exam and assessing for a prolapsed cord 4. Giving oxygen at 10L/min via nonrebreather face mask

1

The nurse is caring for a patient who was just admitted to the labor and delivery (L&D) unit. Her exam is 6/90/0. The initial fetal heart monitor (FHM) strip is Category I. Her pregnancy was complicated by gestational diabetes mellitus (GDM), well controlled with diet. The nurse will base assessment interventions related to the frequency of assessment of the FHR for this patient on The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), which is? 1. Every 15 minutes during the active phase and every 5 minutes for the second stage 2. Every 30 minutes during the active phase and every 15 minutes for the second stage 3. Every 60 minutes during the active phase and every 30 minutes for the second stage 4. Every hour, on the hour

1

The nurse performs Leopold's maneuvers on a patient prior to auscultating the FHR with a handheld doppler. The nurse palpates the fetal head at the fundus and the presenting part is not engaged. Where would the nurse position the doppler to evaluate the FHR? 1. Upper fundal area 2. Right lower abdomen 3. Left lower pelvis 4. Near umbilicus

1

While assessing a pregnant patient, the nurse notes the fetal heart rate (FHR) is 125 with moderate variability, no accelerations and no decelerations. Using the National Institute of Child Health and Human Development (NICHD) Criteria, which would the nurse record as the appropriate category related to the assessment findings? 1. Category I: Strongly predictive of a well- oxygenated, non-acidotic fetus. No action required. 2. Category II: Indeterminate. Requires continued surveillance and reevaluation. 3. Category III: Abnormal requiring prompt evaluation and intervention. 4. Category IV: Fetal Demise.

1

The patient asks the nurse what can be detected with external electronic fetal and uterine monitoring. which is the appropriate nursing response? Select all that apply. 1. Fetal Heart Rate (FHR) baseline and variability 2. Fetal Heart Rate (FHR) accelerations and decelerations 3. The frequency and durations of contractions 4. Fetal station and position 5. The pressure and intensity of contractions

1, 2, 3

The Labor and Delivery (L&D) unit educator discusses the prioritization of fetal monitoring goals, creating a plan of care, and setting goals for implementation with a group of nurses. Which goals are correct? Select all that apply. 1. Interpretation of ongoing assessment of fetal oxygenation. 2. Prevention of significant fetal academia. 3. Minimize unnecessary interventions. 4. Promote a satisfying family-centered birth experience. 5. Use of EFM for all laboring women in the U.S. is required.

1, 2, 3, 4

The Labor and Delivery (L&D) educator has explained to a group of nurses how the utero-placental unit functions. Which components are necessary for the fetus to receive appropriate oxygenation? Select all that apply. 1. Adequate oxygenation of the mother 2. Adequate uteroplacental circulation 3. Adequate umbilical circulation 4. Adequate fetal blood volume 5. Adequate blood flow to the placenta

1, 2, 3, 5

The nurse assesses a patient who has an indeterminate fetal heart rate and places the patient on electronic fetal heart rate (FHR) monitoring. Which assessments are priorities from the electronic FHR monitoring? Select all that apply. 1. Clarify the pattern interpretation 2. Assess the baseline variability 3. Confirm maternal heart rate with fetal heart rate 4. Further assess fetal status 5. Determine fetal movement

1, 2, 4

The Labor and Delivery unit educator is teaching a group of nurses how to respond when a nurse assesses a patient that is demonstrating minimal or absent variability. Which responses by the nurses are correct regarding appropriate interventions? Select all that apply. 1. Perform vibroacoustic stimulation 2. Change maternal position 3. Provide oxygen via nasal cannula 4. Give an IV fluid bolus 5. Discontinue oxytocin

1, 2, 4, 5

The nurse is reviewing information of the fetal heart rate (FHR) baseline with a practicum student in labor and delivery. Which findings are correct regarding interpretation of FHR baseline characteristics? Select all that apply. 1. Baseline FHR is the mean FHR rounded to increments of 5 bpm 2. Normal range is 110-160 bpm 3. Fetal tachycardia >200 bpm for at least 10 minutes 4. Fetal bradycardia <110 bpm for at least 10 minutes 5. Assess the baseline over a 10-minute period

1, 2, 4, 5

The nurse is receiving a report on a patient and notes that the patient's exam is 8/90/+2, with contractions every 2-3 minutes and lasting 70-90 seconds. The FHR is 145 bpm with minimal variability and repetitive late decelerations to 110's, lasting 60-100 seconds. which are the appropriate nursing interventions for this patient? Select all that apply. 1. Administer 02 at 10L/min via non-rebreather mask 2. Begin oxytocin at 2mu/min to hasten delivery 3. Position patient on either side. 4. Limit IV fluids to prepare for cesarean section and prevent fluid overload 5. Notify the provider

1, 3, 5

The provider orders an amnioinfusion for a patient who is a G2P1 at 40 weeks gestation. which education would the nurse provide to the patient? Select all that apply. 1. Explain placement of intrauterine pressure catheter into the uterus. 2. Explain that the procedure is performed to resolve all types of decelerations. 3. Explain that room temperature sterile IV fluids are infused to cushion the umbilical cord. 4. Inform patient that she will remain flat until infusion is completed. 5. Discuss that fluid will continue to leak vaginally and should be monitored to prevent over-distention.

1, 3, 5

The nurse is describing baseline fetal heart rate (FHR) to a practicum student. which would the nurse mention when teaching about the definition and assessment criteria related to baseline FHR? Select all that apply. 1. "Periodic changes in baseline of FHR occur in relation to uterine contractions." 2. "Recurrent changes in baseline of FHR occur in less than 50% of the contractions in 20 minutes." 3. "Intermittent changes in baseline of FHR occur in greater than 50% of the contractions in 20 minutes." 4. "Episodic changes in baseline of FHR occur independent of uterine contractions." 5. "FHR is rounded to increments of 5 beats per minute during a 10-minute window. This must be at least 2 minutes of identifiable baseline segment."

1, 4, 5

A nurse is admitting a diabetic patient with decreased fetal movement at 39 weeks gestation. As the nurse adjusts the tocodynamometer (toco) and ultrasound transducer on the patient, a fetal heart rate in the 80's is noted. Which is the most appropriate nursing action? 1. Readjust the ultrasound and toco 2. Confirm maternal heart rate to FHR 3. Call for an ultrasound 4. Call the provider

2

The Labor and Delivery educator is teaching a group of new nurses the overall goals of fetal monitoring. Which response by the new nurses indicates that the educator should provide further education? 1. "Support maternal coping and labor progress." 2. "Support coached pushing." 3. "Maximize oxygenation." 4. "Maximize umbilical blood flow."

2

The nurse calls to notify the provider that the patient has a Category II tracing. Which would the nurse include in her charting that was interpreted from the tracing? 1. Absent variability, FHR 120, recurrent variable decelerations 2. Minimal variability, FHR 165, recurrent variable decelerations 3. Early decelerations, FHR 145, moderate variability 4. No accelerations, FHR 110, moderate variability

2

The nurse caring for a G4P3 patient in active labor. Her fetus continues to have late decelerations with minimal variability despite interventions and notifies the provider on call. The provider gives an order to continue with the current plan of care. Which is the nurse's priority at this time? 1. Advise the patient that another provider will be notified because of the concerns for the fetus. 2. Use the chain of command and communicate the FHR findings clearly to the charge nurse or next provider. 3. Document the conversation with the provider using objective language and continue a close observation of the fetus. 4. Discuss concerns with another nurse in the department.

2

The nurse is assessing a patient who is 37 weeks pregnant and in active labor. The fetal heartrate is 130 BPM with moderate variability, no accelerations, no decelerations. The provider does a sterile vaginal exam on the patient which is 6/90/0 and ruptures the patient's amniotic sac (AROM). The nurse notes copious fluid coming from the vagina after the AROM and sudden repetitive and deep variables to the 80's and 90's. The nurse will base the needed nursing interventions on which of the following? 1. This is normal after rupture of membranes and will resolve spontaneously as the fetus adjusts 2. Deep variables may indicate a cord prolapse and the patient should be evaluated immediately. 3. Variable decelerations indicate utero-placental insufficiency. 4. Deep variables are also called prolonged decelerations.

2

The nurse is auscultating the fetal heart rate on a patient who states her fetus is breech at 32 weeks gestation. Which is the appropriate nursing action to perform the auscultation? 1. Place the doppler in the upper abdomen to locate the area of maximum intensity of fetal heart tones. 2. Palpate the maternal abdomen to determine fetal position. 3. Explain the procedure to the woman and her family. 4. Confirm fetal position by ultrasound.

2

The nurse is caring for a patient whose fetus has been diagnosed with Intrauterine Growth Restriction (IUGR). The patient asks the nurse how this could have happened. Which does the nurse recognize as a possible cause? 1. The fetus has a lower oxygen tension then an adult. 2. Available oxygen chronically falls below 50% of normal levels and there is a redistribution of blood to vital organs. 3. The amount of lactic acid exceeds fetal buffering capacity. 4. Oxygenated blood from the mother is delivered to the intervillous space in the placenta.

2

The nurse is caring for a patient with a birth plan who requested in the active phase of labor to be monitored without continuous electronic fetal monitoring (EFM). How often would the nurse intermittently assess the fetal heart rate? 1. Every 1 hour by auscultation 2. Every 5-30 minutes by auscultation 3. 10-30 minutes every 1-2.5 hours with EFM 4. Every 15 minutes with EFM

2

The nurse is caring for a patient with preeclampsia who has oligohydramnios. When developing the plan of care, which interventions would promote maternal-fetal exchange of oxygen during labor? 1. Insert an intrauterine pressure catheter for amnioinfusion 2. Maternal positioning 3. Monitor blood pressure 4. Provide oxygen at 10L per nonrebreather facemask

2

The nurse is reviewing the tracing of a patient who is pregnant with twins at 36 weeks gestation. which assessment data obtained by the nurse will require further evaluation? 1. Baby A: FHR 110, moderate variability 2. Baby B: FHR 130, minimal variability, two accelerations of 10 bpm for 10 seconds 3. Contractions every 2 to 3 minutes palpated strong 4. Resting tone palpated soft

2

The nurse notifies the provider that the patient has a Category III tracing and discontinued the oxytocin. The provider orders the nurse to restart the oxytocin infusion. Which is the most appropriate action by the nurse to minimize risks to the patient? 1. Refuse to restart the oxytocin. 2. Communicate concerns to the provider about restarting oxytocin and use the chain of command if necessary. 3. Restart the oxytocin as ordered. 4. Document the communication and concerns that were discussed, then restart the oxytocin as ordered.

2

When palpating the patient's fundus during a contraction, the nurse notes that it feels like a 'chin.' The nurse documents this finding as which contraction intensity? 1. Mild 2. Moderate 3. Strong 4. Firm

2

he nurse is caring for a patient with a birth plan who requested in the active phase of labor to be monitored without continuous electronic fetal monitoring (EFM). How often would the nurse intermittently assess the fetal heart rate? 1. Every 1 hour by auscultation 2. Every 5-30 minutes by auscultation 3. 10-30 minutes every 1-2.5 hours with EFM 4. Every 15 minutes with EFM

2

A G1P0 patient is 40 weeks gestation and receiving an oxytocin infusion for labor induction. Which nursing actions are appropriate when late decelerations are identified on the fetal heart rate tracing? Select all that apply. 1. Decrease the maintenance IV fluid rate 2. Discontinue oxytocin 3. Administer oxygen via non-rebreather face mask 4. Notify the provider 5. Place the woman in high Fowler\"s position

2, 3, 4

The nurse has just completed a fetal monitoring course and is explaining the normal findings of structured intermittent auscultation (SIA) with a handheld Doppler. Which would the nurse identify as a normal finding of SIA? Select all that apply. 1. Moderate variability 2. Normal baseline between 110 to 160 bpm 3. Regular rhythm 4. Presence of FHR increases from baseline 5. Absence of FHR decreases from baseline

2, 3, 4, 5

The instructor is teaching the modes of fetal heart rate and contraction assessment to a class of nursing students. What are the modes of uterine monitoring? Select all that apply. 1. Auscultation 2. Palpation 3. Fetal spiral electrode 4. Intrauterine pressure catheter 5. Tocodynamometer

2, 4, 5

A patient has been laboring for over 18 hours when the provider ruptures her membranes. The fetus experiences a prolonged deceleration immediately following the procedure. Which is the priority nursing action for this patient? 1. Notify the provider. 2. Administer an IV fluid bolus. 3. Change the maternal position. 4. Perform a vaginal exam.

3

The nurse educator has just completed a lecture on intrauterine resuscitation. Which of the following definitions given by the new nurse graduates indicates the need for further teaching? 1. Emergency cesarean section 2. Placing internal monitors for a more accurate assessment of FHR and UCs 3. Interventions that maximize maternal-fetal oxygenation 4. CPR on the fetus while in utero

3

The nurse is caring for an obese patient and having difficulty maintaining the fetal heart rate (FHR) and contractions on an external fetal monitor (EFM). Which is the best action by the nurse in this situation? 1. Notify the provider and document. 2. Insert intrauterine pressure catheter (IUPC) and fetal spiral/scalp electrode (FSE). 3. Reposition patient, adjust tocodynamometer and ultrasound transducer. 4. Discontinue EFM and notify provider.

3

The nurse is teaching the patient about internal electronic fetal monitoring prior to the provider inserting the fetal scalp electrode. The patient begins crying and states, "I don't want a wire screwed in my baby's head!" Which is the most appropriate response by the nurse? 1. "I will let the doctor explain the procedure to you, so that you understand how safe it is for your baby." 2. "Internal monitoring is safe and will not cause the baby any harm." 3. "Let me show you the tip that is placed superficially under the skin to monitor the baby's heart rate. We want you to understand the procedure." 4. "I understand your concern. You can refuse the procedure if you are uncomfortable with it."

3

The provider wants to insert an intra-uterine pressure catheter (IUPC) into a pregnant patient. Which patient does the nurse recognize as the patient most likely to warrant placement of an IUPC? 1. A patient with a category I tracing 2. A patient progressing 2 cm an hour, but doesn't feel her contractions because of her epidural 3. A patient whose membranes are ruptured, has an exam of 5/90/-2 and a worsening category II tracing 4. A patient with a BMI of 40 in latent labor

3

Which patient with a fetus displaying minimal variability would the nurse assess first? 1. A patient who received nalbuphine 10 mg slow IV push 10 minutes ago 2. A patient who is 25 weeks gestation with intermittent contractions 3. A patient who is 39 weeks gestation with 8 contractions in 10 minutes 4. A patient who is 37 weeks gestation contracting every 6 to 7 minutes with no accelerations

3

A patient had spontaneous rupture of membranes and is in active labor with oxytocin augmentation. The FHR is presently 180 with no accelerations. Which is the priority nursing action for this patient? 1. Notify the provider 2. Administer an IV fluid bolus 3. Discontinue oxytocin 4. Assess maternal vital signs

4

Nurses in Labor and Delivery (L&D) participated in interprofessional unit-based drills and debriefings. Which strategy is critical to teamwork and communication according to the National Institute of Child Health and Human Development (NICHD)? 1. Accurate interpretation of fetal monitoring tracings 2. Mutual respect encouraged among disciplines 3. Policies and procedures for each discipline to follow 4. Standardize language for fetal heart rate definitions and patterns for all professional communications

4

The OB nurse is assessing a patient utilizing structured intermittent auscultation (SIA). Which intervention assists the nurse in identifying fetal heart tones (FHT)? 1. Perform a 20-minute Non-Stress Test (NST). 2. Auscultate fetal heart tones (FHT) for at least 20 minutes. 3. Auscultate FHT's during and after contractions for 30 seconds. 4. Auscultate FHT's between contractions for at least 30 to 60 seconds.

4

The instructor explained how the fetus maintains acid-base balance during labor and discussed the process that occurs when available oxygen in the intervillous space falls below 50% of normal levels. Which response by the nurse indicates that the instructor would provide further teaching? 1. "The fetus will convert from aerobic to anaerobic metabolism." 2. "The fetal myocardium will change in oxygen consumption, which leads to changes in the FHR." 3. "Redistribution of blood to vital organs occurs." 4. "Lactic acid production increases and fetal growth accelerates."

4

The nurse evaluates the tracing on a patient and notices 6 contractions in 10 minutes. Which assessment regarding the contraction pattern is priority? 1. What is the intensity? 2. What is the duration? 3. What is the resting tone? 4. What are possible causes?

4

The nurse is assessing a pregnant patient who is externally monitored and contracting every 3 to 4 minutes with each contraction lasting 40 to 60 seconds. The peak of the contraction reads 90 on the graph paper with a resting tone of 20. The patient rates her contractions as 10/10 and is crying. Which can the nurse document, based on these findings? 1. The contractions are very strong, and the patient will probably deliver soon. 2. The contractions are not adequate to make cervical changes. 3. The resting tone is too high. 4. The frequency and duration of contractions.

4

The nurse is caring for a patient in active labor. Assessment findings include: fetal heart rate (FHR) 125BPM, moderate variability, intermittent variable decelerations to the 100's and occasional accelerations, and the patient reports labor pain as 10/10. The nurse administers 50mcg of Fentanyl IV. Twenty minutes after administering the Fentanyl, the nurse notes FHR has been steady at 125 BPM, minimal variability, no decelerations and no accelerations. Which does the nurse assess related to these findings? 1. Fetal hypoxia due to respiratory depression caused by administration Fentanyl 2. Fetal Prematurity 3. Utero-placental insufficiency 4. Sedation caused by administration of Fentanyl

4

The nursing instructor has just completed a lecture on fetal surveillance and the use of structured intermittent auscultation (SIA). The instructor knows that teaching was effective when the students recognize which contradiction to the use of SIA? 1. 32-year-old G1, P0 patient at 40 weeks who is 6 cm dilated with a Category I tracing 2. Presence of nurses and providers experienced in SIA 3. Institutional policy addressing technique and frequency of SIA 4. 26-year-old G4P3 at 39 weeks who is 3 cm dilated with a Category I tracing, being induced for gestational diabetes mellitus (GDM)

4

The patient is 38 weeks gestation and the nurse notes a decrease in the fetal heart rate (FHR) from 145 to 115 for a period of 15 minutes. How will the nurse document this finding? 1. Prolonged deceleration 2. Change in variability 3. Fetal distress 4. Change in baseline FHR

4

Which plan would be most appropriate for monitoring a patient who presents to the labor and delivery unit in the active phase of labor with ruptured membranes? 1. At least hourly by auscultation 2. Every 30 minutes by electronic fetal heart monitoring 3. Every 15-30 minutes by auscultation 4. Every 15 minutes by electronic fetal heart monitoring

4