Question 1

What is a distinct advantage of external EFM?

Accepted Answer

The tocotransducer is valuable for measuring uterine activity during the first stage of labor and is especially true when the membranes are intact.Short-term variability and beat-to-beat changes cannot be measured with this technology.The tocotransducer cannot measure and record the intensity of uterine contractions.The transducer must be repositioned when the woman or the fetus changes position.

Question 2

A new client and her partner arrive on the labor,delivery,recovery,and postpartum (LDRP)unit for the birth of their first child.The nurse applies the electronic fetal monitor (EFM)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.What is the nurse's best response?

Accepted Answer

Explaining what indicates a normal FHR teaches the partner about fetal monitoring and provides support and information to alleviate his fears.Telling the partner not to worry discredits his feelings and does not provide the teaching he is requesting.Telling the partner that the graph indicates how strong the contractions are provides inaccurate information and does not address the partner's concerns about the FHR.The EFM graphs the frequency and duration of the contractions,not their intensity.Nurses should take every opportunity to provide teaching to the client and her family,especially when information is requested.

Question 3

Which clinical finding or intervention might be considered the rationale for fetal tachycardia to occur?

Accepted Answer

Fetal tachycardia can be considered an early sign of fetal hypoxemia and may also result from maternal or fetal infection.Umbilical cord prolapse,regional anesthesia,and the administration of magnesium sulfate will each more likely result in fetal bradycardia,not tachycardia.

Question 4

The nurse is using intermittent auscultation (IA)to locate the fetal heartbeat.Which statement regarding this method of surveillance is accurate?

Accepted Answer

Locating fetal heartbeats often takes time.Mothers can be verbally reassured and reassured by viewing the ultrasound pictures if that device is used to help locate the heartbeat.When used as the primary method of fetal assessment,IA requires a nurse-to-client ratio of one to one.Documentation should use only terms that can be numerically defined; the usual visual descriptions of EFM are inappropriate.

Question 5

The nurse who provides care to clients in labor must have a thorough understanding of the physiologic processes of maternal hypotension.Which outcome might occur if the interventions for maternal hypotension are inadequate?

Accepted Answer

Low maternal blood pressure reduces placental blood flow during uterine contractions,resulting in fetal hypoxemia.Maternal hypotension does not result in early FHR decelerations nor is it associated with fetal arrhythmias.Spontaneous rupture of membranes is not a result of maternal hypotension.

Question 6

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?

Accepted Answer

When the fetus is temporarily in a sleep state,minimal variability is present.Periodic fetal sleep states usually last no longer than 30 minutes.A woman in labor with extreme prematurity may display a FHR pattern of minimal or absent variability.Abnormal variability may also be related to fetal hypoxemia and metabolic acidemia.Congenital anomalies or a preexisting neurologic injury may also result in absent or minimal variability.Other possible causes might be central nervous system (CNS)depressant medications,narcotics,or general anesthesia.

Question 7

What is the most likely cause for variable FHR decelerations?

Accepted Answer

Variable FHR decelerations can occur at any time during the uterine contracting phase and are caused by compression of the umbilical cord.Altered fetal cerebral blood flow results in early decelerations in the FHR.Uteroplacental insufficiency results in late decelerations in the FHR.Fetal hypoxemia initially results in tachycardia and then bradycardia if hypoxia continues.

Question 8

Which alteration in the FHR pattern would indicate the potential need for an amnioinfusion?

Accepted Answer

Amnioinfusion is used during labor to either dilute meconium-stained amniotic fluid or supplement the amount of amniotic fluid to reduce the severity of variable FHR decelerations caused by cord compression.Late decelerations are unresponsive to amnioinfusion.Amnioinfusion is not appropriate for the treatment of fetal bradycardia and has no bearing on fetal tachycardia.

Question 9

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

Accepted Answer

Late deceleration is caused by uteroplacental insufficiency.Early deceleration is caused by head compression.Variable deceleration is caused by umbilical cord compression.Prolonged deceleration has a variety of either benign or critical causes.

Question 10

Which FHR finding is the most concerning to the nurse who is providing care to a laboring client?

Accepted Answer

Late decelerations are caused by uteroplacental insufficiency and are associated with fetal hypoxemia.Late FHR decelerations are considered ominous if they are persistent and left uncorrected.Accelerations with fetal movement are an indication of fetal well-being.Early decelerations in the FHR are associated with head compression as the fetus descends into the maternal pelvic outlet; they are not generally a concern during normal labor.An FHR finding of 126 beats per minute is normal and not a concern.

Question 11

The perinatal nurse realizes that an FHR that is tachycardic,bradycardic,has late decelerations,or loss of variability is nonreassuring and is associated with which condition?

Accepted Answer

Nonreassuring FHR patterns are associated with fetal hypoxemia.Fetal bradycardia may be associated with maternal hypotension.Variable FHR decelerations are associated with cord compression.Maternal drug use is associated with fetal tachycardia.

Question 12

What three measures should the nurse implement to provide intrauterine resuscitation?

Accepted Answer

Basic interventions for the management of any abnormal FHR pattern include administering O₂ via a nonrebreather face mask at a rate of 8 to 10 L/min,assisting the woman onto a side-lying (lateral)position,and increasing blood volume by increasing the rate of the primary IV infusion.The purpose of these interventions is to improve uterine blood flow and intervillous space blood flow and to increase maternal oxygenation and cardiac output.The term intrauterine resuscitation is sometimes used to refer to these interventions.If these interventions do not quickly resolve the abnormal FHR issue,then the primary provider should be immediately notified.

Question 13

While evaluating an external monitor tracing of a woman in active labor,the nurse notes that the 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.What is the nurse's first priority?

Accepted Answer

Late FHR decelerations may be caused by maternal supine hypotension syndrome.These decelerations are usually corrected when the woman turns onto her side to displace the weight of the gravid uterus from the vena cava.If the fetus does not respond to primary nursing interventions for late decelerations,then the nurse should continue with subsequent intrauterine resuscitation measures and notify the health care provider.An amnioinfusion may be used to relieve pressure on an umbilical cord that has not prolapsed.The FHR pattern associated with this situation most likely will reveal variable decelerations.Although a fetal scalp electrode will provide accurate data for evaluating the well-being of the fetus,it is not a nursing intervention that will alleviate late decelerations nor is it the nurse's first priority.

Question 14

Which client would not be a suitable candidate for internal EFM?

Accepted Answer

For internal EFM,the membranes must have ruptured and the cervix must be dilated at least 2 to 3 cm.The presenting part must be low enough to allow placement of the spiral electrode necessary for internal EFM.The accuracy of EFM is not affected by maternal size.However,evaluating fetal well-being using external EFM may be more difficult on an obese client.The client whose cervix is dilated to 4 to 5 cm is indeed a candidate for internal monitoring.

Question 15

What is the most likely cause for early decelerations in the fetal heart rate (FHR)pattern?

Accepted Answer

Early decelerations are the fetus' response to fetal head compression; these are considered benign,and interventions are not necessary.Variable decelerations are associated with umbilical cord compression.Late decelerations are associated with uteroplacental insufficiency.Spontaneous rupture of membranes has no bearing on the FHR unless the umbilical cord prolapses,which would result in variable or prolonged bradycardia.

Question 16

Which statement best describes a normal uterine activity pattern in labor?

Accepted Answer

Overall contraction frequency generally ranges from two to five contractions per 10 minutes of labor,with lower frequencies during the first stage and higher frequencies observed during the second stage.Contraction duration remains fairly stable throughout the first and second stages,ranging from 45 to 80 seconds,generally not exceeding 90 seconds.Contractions 1 minute apart are occurring too often and would be considered an abnormal labor pattern.The intensity of uterine contractions generally ranges from 25 to 50 mm Hg in the first stage of labor and may rise to more than 80 mm Hg in the second stage.

Question 17

What are the legal responsibilities of the perinatal nurses?

Accepted Answer

Nurses who care for women during childbirth are legally responsible for correctly interpreting FHR patterns,initiating appropriate nursing interventions based on those patterns,and documenting the outcomes of those interventions.Greeting the client on arrival,assessing her,and starting an IV line are activities that should be performed when any client arrives to the maternity unit.The nurse is not the only one legally responsible for performing these functions.Applying the external fetal monitor and notifying the health care provider is a nursing function that is part of the standard of care for all obstetric clients and falls within the registered nurse's scope of practice.Everyone caring for the pregnant woman should ensure that both she and her support partner are comfortable.

Question 18

Which definition of an acceleration in the fetal heart rate (FHR)is accurate?

Accepted Answer

Acceleration of the FHR is defined as a visually apparent abrupt (only to peak 30 seconds)increase in the FHR above the baseline rate.Periodic accelerations occur with uterine contractions and are usually observed with breech presentations.Episodic accelerations occur during fetal movement and are indications of fetal well-being.Preterm accelerations peak at 10 beats per minute above the baseline and last for at least 10 seconds.

Question 19

The nurse providing care for a high-risk laboring woman is alert for late FHR decelerations.Which clinical finding might be the cause for these late decelerations?

Accepted Answer

Uteroplacental insufficiency results in late FHR decelerations.Altered fetal cerebral blood flow results in early FHR decelerations.Umbilical cord compression results in variable FHR decelerations.Meconium-stained fluid may or may not produce changes in the FHR,depending on the gestational age of the fetus and whether other causative factors associated with fetal distress are present.

Question 20

During labor a fetus displays an average FHR of 135 beats per minute over a 10-minute period.Which statement best describes the status of this fetus?

Accepted Answer

The baseline FHR is measured over 10 minutes; a normal range is 110 to 160 beats per minute.Bradycardia is a FHR less than 110 beats per minute for 10 minutes or longer.Tachycardia is a FHR higher than 160 beats per minutes for 10 minutes or longer.Hypoxia is an inadequate supply of oxygen; no indication of hypoxia exists with a baseline FHR in the normal range.

Quiz 18: Fetal Assessment During Labor