NCC EFM practice
Central _______ are located in the medulla oblongata; peripheral _______ are found in the carotid sinuses and aortic arch. A. Baroreceptors B. Chemoreceptors
B. Chemoreceptors
Stimulation of the fetal vagus nerve will A. Increase FHR B. Decrease FHR C. Initially increase, then decrease FHR
B. Decrease FHR
The objective of intrapartum FHR monitoring is to assess for fetal A. Acidemia B. Oxygenation C. Well-being
B. Oxygenation
T/F: Corticosteroid administration may cause an increase in FHR accelerations.
False
T/F: Low amplitude contractions are not an early sign of preterm labor.
False
The _____ _____ _____ maintains transmission of beat-to-beat variability.
Parasympathetic nervous system
T/F: Variable decelerations are a vagal response.
True
Baroreceptors influence _____ decelerations with moderate variability.
Variable
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
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
_______ _______ occurs when the HCO3 concentration is lower than normal. A. Base deficit B. Base excess C. Metabolic acidosis
A. Base deficit
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
Which of the following is responsible for fetal muscle coordination? A. Cerebellum B. Cerebral cortex C. Medulla oblongata
A. Cerebellum
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
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
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
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
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
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
*** pH 6.86 pCO2 28 pO2 2.1 HCO3 4.0 B.D. 42 the umbilical arterial cord blood gas values reflect A. metabolic acidemia B. mixed acidemia C. respiratory acidemia
A. Metabolic acidemia
_______ _______ 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
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
A fetus of a diabetic mother may commonly develop A. Polyhydramnios B. Supraventricular tachycardia C. Third-degree heart block
A. Polyhydramnios
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
Fetal hypoxia and acidemia are demonstrated by pH < _____ and base excess < _____.
< 7.15; < -8
*** 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
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
Stimulation of _____ results in abrupt decreases in FHR, CO, and BP.
Baroreceptors
A BPP score of 6 is considered A. Abnormal B. Normal C. Equivocal
C. Equivocal
Normal oxygen saturation for the fetus in labor is ___% to ___%.
30% to 65%
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
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
_____ 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
Which intrinsic homeostatic response is the fetus demonstrating when abrupt variable decelerations are present? A. Baroreceptor B. Catecholamine C. Sympathetic
A. Baroreceptor
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
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
The fetus has a _______ cardiac output and heart rate than the adult, resulting in rapid circulation. A. Higher B. Lower
A. Higher
What might increase fetal oxygen consumption? A. Hyperthermia B. Umbilical cord compression C. Uterine tachysystole
A. Hyperthermia Increases metabolism and oxygen consumption
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
***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)
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
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
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
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
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
With _____ premature ventricular contractions (PVCs), the baseline and variability are obscured. A. Idioventricular B. Bigeminal C. Trigeminal
B. Bigeminal
Amino acids, water-soluble vitamins, calcium, phosphorus, iron, and iodine are transferred across the placenta via _____ _____.
Active transport
_______ is defined as the energy-consuming process of metabolism.
Anabolism
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
_______ denotes an increase in hydrogen ions in the fetal blood. A. Acidosis B. Acidemia C. Hypercapnia
B. Acidemia
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 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
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 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, absent accelerations, and a 3-minute prolonged deceleration 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)
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
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
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
Elements of a malpractice claim include all of the following except A. Breach of duty B. Deposition C. Injury or loss
B. Deposition
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
Vagal stimulation would be manifested as what type of fetal heart rate pattern? A. Acceleration B. Early deceleration C. Tachycardia
B. Early deceleration
The normal FHR baseline A. Decreases during labor B. Fluctuates during labor C. Increases during labor
B. Fluctuates during labor
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
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
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
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
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
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
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
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
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
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
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
_______ _______ 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 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
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)
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
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
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
A risk of amnioinfusion is A. Prolonged labor B. Uterine overdistension C. Water intoxication
B. Uterine overdistension
_____ cord blood sampling is predictive of uteroplacental function. A. Arterial B. Venous C. Maternal
B. Venous
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
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
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
*** 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
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
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
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
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
_____ are abnormal FHR rhythms associated with disordered impulse formation, conduction, or both. A. Arrhythmias B. Supraventricular tachycardias C. Dysrhythmias
C. Dysrhythmias
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
Which factor influences blood flow to the uterus? A. Fetal arterial pressure B. Intervillous space flow C. Maternal arterial vasoconstriction
C. Maternal arterial vasoconstriction
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
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
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 woman has 10 fetal movements in one hour. This is considered what kind of movement? A. Decreased B. Excessive 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
Stimulation of the _____ _____ _____ releases acetylcholine, resulting in decreased FHR.
Parasympathetic nervous system
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)
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
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
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
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
*** 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
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
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
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
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
Baroreceptor-mediated decelerations are A. Early B. Late C. Variable
C. Variable
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
_______ is defined as the energy-releasing process of metabolism.
Catabolism
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
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 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
(T/F) An internal scalp electrode can solely diagnose a fetal dysrhythmia.
False
Medications, prematurity, fetal sleep, fetal dysrhythmia, anesthetic agents, or cardiac anomalies may result in _______ variability.
Decreased
(T/F) There is a strong correlation between arterial cord blood gas results and Apgar scores.
False
Glucose is transferred across the placenta via _____ _____.
Facilitated diffusion
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
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) An internal scalp electrode will detect the actual fetal ECG.
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: All fetal monitors contain a logic system designed to reject artifact.
True
T/F: Contractions cause an increase in uterine venous pressure and a decrease in uterine artery perfusion.
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
T/F: Fetal tachycardia is a normal compensatory response to transient fetal hypoxemia.
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: The most common artifact with the ultrasound transducer system for fetal heart rate is increased variability.
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
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
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
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
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
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 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
When the hydrogen ion content in the blood rises, the pH A. Lowers B. Neutralizes C. Rises
A. Lowers
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
(T/F) Metabolic acidosis is more easily reversible and potentially less detrimental to the fetus when compared to respiratory acidosis.
False
T/F: Uterine resting tone may appear higher (25 to 40 mmHg) during amnioinfusion.
True
T/F: Variability and periodic changes can be detected with both internal and external monitoring.
True
T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor.
True
