Question 1

The nursing preceptor is teaching the nursing student about fetal bradycardia. Which is true of the maternal reasons for fetal bradycardia? Select all that apply.

Accepted Answer

B,C,D,E

Question 2

A nurse-preceptor is explaining to a new nurse about the tocodynamometer. The new nurse is looking at the EFM paper and sees that, of the two tracked heart rates, the one on the bottom is in the 80s; she is concerned that the fetal heart rate is bradycardic. Which of the following should the nurse do first?

Accepted Answer

Before taking any action, it is important to confirm the accuracy of the fetal heart rate reading. Checking the maternal radial pulse will help to ensure that the bottom tracing is not a recording of the maternal pulse instead of the fetal heart rate. Oxygen administration or calling the provider may not be necessary if the fetal heart rate is actually within the normal range. Adjusting the monitor on the maternal abdomen may not necessarily improve the accuracy of the reading.

Question 3

The nurse is monitoring a patient when the EFM strip conveys fetal bradycardia. Which action would be the most urgent for the nurse to take?

Accepted Answer

D

Question 4

The obstetric nurse is managing her patients while covering for another nurse who is on a break. Which patient is the lowest priority?

Accepted Answer

A patient with Category I FHR (Fetal Heart Rate) tracings is considered to have a normal fetal heart rate pattern, indicating that the fetus is not in distress. This makes the patient the lowest priority compared to the others who may have more immediate or potential complications.

Question 5

The nurse is caring for a 30-year-old woman who is G4P2012 at 38 weeks and 5 days gestation. The nurse is watching her EFM strip and notices that for the past 10 minutes the fetus has shown minimal variability. Which actions should the nurse perform? Select all that apply.

Accepted Answer

Minimal variability in the fetal heart rate (FHR) can be concerning and warrants investigation. Checking for ruptured membranes (A) can help identify potential cord compression, a serious condition requiring immediate attention. Changing the patient's position (B), especially to the left side, can improve fetal blood flow and potentially improve FHR variability. Recognizing that minimal variability might be due to fetal sleep cycles (C) is also important, as this can be a normal finding; however, continued monitoring is essential to ensure the pattern changes.

Question 6

The nurse preceptor is teaching a nursing student about the physiology of the fetal heart rate (FHR) pattern. Which statement by the student indicates successful teaching about this concept?

Accepted Answer

The sympathetic nervous system is indeed responsible for heart rate variability, as it adjusts the heart rate in response to various physiological conditions to maintain homeostasis. The other options incorrectly describe the mechanisms influencing fetal heart rate and its variability.

Question 7

The nurse is caring for a baby who is experiencing fetal tachycardia. Which action should the nurse take next?

Accepted Answer

The answer of The nurse is caring for a baby...

Question 8

The nurse is explaining telemetry to the patient, who has just begun active labor. The patient would like to have a labor in which she is mobile, able to change positions, and use hydrotherapy. Which response by the nurse is most appropriate?

Accepted Answer

Option D is the most appropriate response as it acknowledges the patient's desire for mobility and the use of hydrotherapy during labor while also providing information about the use of telemetry. It also offers a solution that can accommodate the patient's preferences by suggesting that telemetry can be started and continued throughout labor if there are no signal issues. Option A is incorrect as it suggests that telemetry is only used for bed-bound patients. Option B is incorrect as it provides incorrect information about the use of hydrotherapy while on telemetry. Option C is incorrect as it does not address the patient's concerns or offer any solutions.

Question 9

The nurse-educator is preparing a presentation on fetal heart monitoring. Which of the following should be included? Select all that apply.

Accepted Answer

The answer of The nurse-educator is preparing a presentation on...

Question 10

Which actions indicate the is assessing uterine activity? Select all that apply.

Accepted Answer

Assessing uterine activity involves evaluating the frequency, duration, and intensity of contractions, which can be done through palpation of the maternal abdomen in between contractions (A), analyzing the electronic fetal monitoring (EFM) strip for contraction patterns such as contractions being 2 or 3 minutes apart (B), and checking the intensity of contractions in Montevideo units (MVUs) as indicated by 200 MVU every 10 minutes (C). Evaluating the duration of each contraction, such as lasting 1 minute (E), is also part of assessing uterine activity. Option D is related to assessing fetal well-being, specifically looking at fetal heart rate patterns, not uterine activity.

Question 11

The EFM tracing shows the following: FHR baseline 166 bpm, moderate variability, and recurrent late decelerations to 100 bpm. Using the five-tier FHR interpretation system, how should the nurse interpret this tracing?

Accepted Answer

The answer of The EFM tracing shows the following: FHR...

Question 12

The nurse is using the Parer and Ikeda five-tier system. A co-worker is concerned about a patient whose fetus has an acceptably low risk of acidemia and evidence of impending fetal asphyxia. What is the next best step for the nurse?

Accepted Answer

According to the Parer and Ikeda five-tier system, if the fetus has evidence of impending fetal asphyxia and an acceptably low risk of acidemia, the next step would be to prepare for urgent delivery. This means that the delivery should be initiated as soon as possible to prevent any possible harm to the fetus. Therefore, the nurse should prepare to assist in the delivery and alert the provider to the urgency of the situation.

Question 13

While providing care for a patient, the nurse notices an erratic FHR recording. What action should the nurse take next?

Accepted Answer

An erratic FHR recording may be caused by a poor fetal heart rate signal, which can be improved by repositioning the transducer. Option A is incorrect because moving the patient around may not improve the signal, and it is not the best initial action. Option C is incorrect because checking cervical progress is important but is not the best initial action for an erratic FHR recording. Option D is incorrect because removing ultrasound gel is unlikely to improve the signal.

Question 14

An internal fetal monitor has been ordered for Chrissy, a 24-year-old G2P0010 at 38 weeks and 1 day gestation. Her medical history is significant for a history of pregnancy-induced hypertension. Her laboratory values are as follows: H/H 11/30, O negative, RPR negative, GBS positive. Based on Chrissy's history and presentation, what action should the nurse take next?

Accepted Answer

The answer of An internal fetal monitor has been ordered...

Question 15

While reviewing the birth plan of an uncomplicated and healthy patient in active labor, the nurse notices that she would like to have a natural labor and potentially experience hydrotherapy. Which option should the nurse suggest for the patient?

Accepted Answer

Telemetry would be the best option for this patient because it allows for continuous monitoring of the fetal heart rate and contractions while also allowing the patient to move around freely and potentially use hydrotherapy. The other options, IUPC, FSE, and external EFM, are unnecessary and can actually limit the patient's movement and ability to have a natural labor experience.

Question 16

The nurse is caring for a pregnant patient who expresses concern about the effects of electronic fetal monitoring (EFM) on her labor and delivery. Which responses by the nurse would be appropriate in this situation? Select all that apply.

Accepted Answer

A) Electronic Fetal Monitoring (EFM) has been associated with a reduced rate of neonatal seizures, although it does not significantly change long-term outcomes.D) Continuous EFM has been linked to an increased rate of cesarean sections, as it may lead to interventions based on perceived fetal distress.E) The use of continuous EFM is also associated with an increase in operative vaginal births, such as forceps or vacuum-assisted deliveries, due to interventions for perceived fetal distress.

Question 17

The nurse-educator is instructing on the physiology of fetal heart rate (FHR) patterns. He is showing the students an EFM strip, and there is a tracing that is classified as baseline 140 bpm, moderate variability, accelerations, and 2 decelerations. A half hour later the baseline is 150 bpm, there is minimal variability, accelerations, and 3 decelerations. Which of these findings would the nurse attribute to the parasympathetic nervous system?

Accepted Answer

Decelerations in fetal heart rate are typically mediated by the parasympathetic nervous system, which slows the heart rate.

Question 18

The nurse is looking at an EFM strip and sees that the patient is having contractions that are measuring 150 MVU every 10 minutes for the past 2 hours and the fetus is in fetal distress. What would this indicate for next steps?

Accepted Answer

The contractions are measuring 150 MVU which is a normal range, but the distress of the fetus indicates that they are not effective enough. The provider could consider an amnioinfusion through the IUPC to provide fluid to the fetus and improve fetal oxygenation. The contractions also need to be augmented to be more effective after the fetus has improved. Maternal oxygen and position changes can also help to improve fetal oxygenation. Progress through cervical change is important but not the main focus at this time. Augmenting with Pitocin may not be the best choice initially as the fetus is already in distress, and increasing contractions without improving fetal oxygenation could worsen the situation.

Question 19

The nurse is monitoring the fetal heart rate (FHR) tracing and sees that her patient has a tracing with a baseline of 120, moderate variability, with absence of decelerations and accelerations. According to the National Institute of Child Health and Human Development tier system, what category tracing does the patient's fall into?

Accepted Answer

The patient's tracing has a baseline between 110-160, moderate variability, and absence of decelerations and accelerations, meeting the criteria for a Category I tracing according to the National Institute of Child Health and Human Development tier system.

Quiz 9: Fetal Heart Rate Assessment