Deck 18: Fetal Assessment During Labor

Question 1

While evaluating an external monitor tracing of a woman in active labor,the nurse notes that the fetal heart rate (FHR)for five sequential contractions begins to decelerate late in the contraction,with the nadir of the decelerations occurring after the peak of the contraction.The nurse's first priority is to:

A)Change the woman's position
B)Notify the health care provider
C)Assist with amnioinfusion
D)Insert a scalp electrode

Answer 1

Change the woman's position

Question 2

A nurse caring for a laboring woman is cognizant that early decelerations are caused by:

A)Altered fetal cerebral blood flow
B)Umbilical cord compression
C)Uteroplacental insufficiency
D)Spontaneous rupture of membranes

Answer 2

Altered fetal cerebral blood flow

Question 3

During labor a fetus with an average fetal heart rate (FHR)of 135 beats/min over a 10-minute period is considered to have:

A)Bradycardia
B)A normal baseline heart rate
C)Tachycardia
D)Hypoxia

Answer 3

A normal baseline heart rate

Question 4

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

A)"Don't worry about that machine;that's my job."
B)"The top line graphs the baby's heart rate.Generally the heart rate is between 110 and 160.The heart rate will fluctuate in response to what is happening during labor."
C)"The top line graphs the baby's heart rate,and the bottom line lets me know how strong the contractions are."
D)"Your doctor will explain all of that later."

Question 5

The nurse providing care for the laboring woman understands that variable fetal heart rate (FHR)decelerations are caused by:

A)Altered fetal cerebral blood flow
B)Umbilical cord compression
C)Uteroplacental insufficiency
D)Fetal hypoxemia

Question 6

Fetal tachycardia is most common during:

A)Maternal fever
B)Umbilical cord prolapse
C)Regional anesthesia
D)Magnesium sulfate administration

Question 7

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

A)Contractions every 2 to 5 minutes
B)Contractions lasting about 2 minutes
C)Contractions about 1 minute apart
D)A contraction intensity of about 500 mm Hg with relaxation at 50 mm Hg

Question 8

Which deceleration of the fetal heart rate (FHR)does not require the nurse to change the maternal position?

A)Early decelerations
B)Late decelerations
C)Variable decelerations
D)It is always a good idea to change the woman's position.

Question 9

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

A)Call the provider,reposition the mother,and perform a vaginal exam.
B)Provide oxygen via face mask,reposition the mother,and increase IV fluid.
C)Administer oxygen to the mother,increase IV fluid,and notify the health care provider.
D)Perform a vaginal examination,reposition the mother,and provide oxygen via face mask.

Question 10

Which fetal heart rate (FHR)finding concerns the nurse during labor?

A)Accelerations with fetal movement
B)Early decelerations
C)An average FHR of 126 beats/min
D)Late decelerations

Question 11

As a perinatal nurse,you realize that a fetal heart rate (FHR)that is tachycardic,bradycardic,has late decelerations,or loss of variability is nonreassuring and is associated with:

A)Hypotension
B)Cord compression
C)Maternal drug use
D)Hypoxemia

Question 12

A nurse caring for a woman in labor understands that maternal hypotension can result in:

A)Early decelerations
B)Fetal arrhythmias
C)Uteroplacental insufficiency
D)Spontaneous rupture of membranes

Question 13

When using intermittent auscultation (IA)for a fetal heart rate (FHR),nurses should be aware that:

A)They can be expected to cover only two or three clients when IA is the primary method of fetal assessment
B)The best course is to use the descriptive terms associated with electronic fetal monitoring (EFM)when documenting results
C)If the heartbeat cannot be found immediately,a shift must be made to electronic monitoring
D)Ultrasound can be used to find the FHR and reassure the mother if initial difficulty was a factor

Question 14

A nurse caring for a woman in labor should understand that absent or minimal variability is classified as either abnormal or indeterminate.Which condition related to decreased variability is considered benign?

A)A periodic fetal sleep state
B)Extreme prematurity
C)Fetal hypoxemia
D)Preexisting neurologic injury

Question 15

When assessing the relative advantages of internal electronic fetal monitoring (EFM),nurses should be cognizant of which of the following clients is not an appropriate choice for this type of fetal surveillance:

A)A client who still has intact membranes
B)A woman whose fetus is well engaged in the pelvis
C)A pregnant woman who has a comorbidity of obesity
D)A client whose cervix is dilated to 4 to 5 cm

Question 16

Perinatal nurses are legally responsible for:

A)Correctly interpreting fetal heart rate (FHR)patterns,initiating appropriate nursing interventions,and documenting the outcomes
B)Greeting the client on arrival,assessing her,and starting an IV line
C)Applying the external fetal monitor and notifying the health care provider
D)Making sure the woman is comfortable

Question 17

What is an advantage of external electronic fetal monitoring?

A)The ultrasound transducer can accurately measure short-term variability and beat-to-beat changes in the fetal heart rate (FHR).
B)The tocotransducer can measure and record the frequency,regularity,intensity,and approximate duration of uterine contractions (UCs).
C)The tocotransducer is especially valuable for measuring uterine activity (UA)during the first stage of labor.
D)Once correctly applied by the nurse,the transducer need not be repositioned even when the woman changes positions.

Question 18

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

A)Are indications of fetal well-being when they are periodic
B)Are greater and longer in preterm gestations
C)Are usually seen with breech presentations when they are episodic
D)Are a visually apparent abrupt peak

Question 19

The nurse providing care for a high risk laboring woman is alert for late fetal heart rate (FHR)decelerations.These late decelerations may be caused by:

A)Altered cerebral blood flow
B)Umbilical cord compression
C)Uteroplacental insufficiency
D)Meconium fluid

Question 20

A nurse providing care for a laboring woman understands that amnioinfusion is used to treat:

A)Variable decelerations
B)Late decelerations
C)Fetal bradycardia
D)Fetal tachycardia

Question 21

When electronic fetal monitoring (EFM)made its debut for clinical use in the early 1970s,the expectation was that its use would result in fewer cases of cerebral palsy and be more sensitive than auscultation in predicting fetal compromise.Was this prediction correct?

Question 22

In assessing the immediate condition of the newborn after birth,a sample of cord blood may be a useful adjunct to the Apgar score.Cord blood is then tested for pH,carbon dioxide,oxygen,and base deficit or excess.Clinical situations that warrant this additional testing include (choose all that apply):

A)Low 5-minute Apgar score
B)Intrauterine growth restriction (IUGR)
C)Maternal thyroid disease
D)Intrapartum fever
E)Multiple gestation
F)Abnormal fetal heart rate tracing

Question 23

External fetal monitoring cannot detect the ____________________ of uterine contractions.

Question 24

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

A)As part of fetal scalp blood sampling
B)In response to tocolysis
C)In preparation for fetal oxygen saturation monitoring
D)To elicit an acceleration in the fetal heart rate (FHR)

Question 25

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

A)Are a continuing pattern of benign decelerations that do not require intervention
B)Constitute a baseline change when they last longer than 5 minutes
C)Are caused by a disruption to the fetal O2 supply
D)Require the usual fetal monitoring by the nurse

Question 26

Which characteristic correctly matches the type of deceleration with its likely cause?

A)Early deceleration-umbilical cord compression
B)Late deceleration-uteroplacental insufficiency
C)Variable deceleration-head compression
D)Prolonged deceleration-cause unknown

Question 27

Five essential components of any fetal heart rate (FHR)tracing must be evaluated regularly.These include (choose all that apply):

A)Baseline rate
B)Baseline variability
C)Accelerations
D)Decelerations
E)Changes or trends over time
F)Frequency of contractions

Question 28

A therapy often used in labor to promote relaxation of the uterus is referred to as ____________________.

Question 29

According to the National Institute of Child Health and Human Development (NICHD)Three-Tier System of Fetal Heart Rate Classification,category III tracings include all fetal heart rate (FHR)tracings not categorized as category I or II.Which characteristics of the fetal heart rate belong in category III?

A)Baseline rate of 110 to 160 beats/min
B)Tachycardia
C)Absent baseline variability not accompanied by recurrent decelerations
D)Variable decelerations with other characteristics such as shoulders or overshoots
E)Absent baseline variability with recurrent variable decelerations
F)Bradycardia

Question 30

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

A)Encourage the woman's cooperation in avoiding the supine position
B)Advise the woman to avoid the semi-Fowler position
C)Encourage the woman to hold her breath and tighten her abdominal muscles to produce a vaginal response
D)Instruct the woman to open her mouth and close her glottis,letting air escape after the push

Question 31

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

A)A fetal acoustic stimulator
B)Fetal blood sampling
C)Fetal pulse oximetry
D)Umbilical cord acid-base determination