Deck 17: Intrapartum Fetal Surveillance

Question 1

The nurse assesses the fetal monitor and sees the following strip.What action by the nurse is most appropriate?

A) Administer oxygen by nasal cannula.
B) Reposition the woman.
C) Apply a fetal scalp electrode.
D) Record this reassuring pattern.

Answer 1

Record this reassuring pattern.

Question 2

A student nurse is placing a tocotransducer on a woman for electronic fetal monitoring.What action by the student indicates to the registered nurse that the student understands the procedure?

A) Places the tocotransducer over the uterine fundus
B) Prepares sterile field for fetal scalp electrode placement
C) Positions the tocotransducer on the woman's upper arm
D) Attaches the tocotransducer to the woman's lower abdomen

Answer 2

Places the tocotransducer over the uterine fundus

Question 3

Which statement correctly describes the nurse's responsibility related to electronic monitoring?

A) Teach the woman and her support person about the monitoring equipment, and discuss any questions they have.
B) Report abnormal findings to the physician before initiating corrective actions.
C) Inform the support person that the nurse will be responsible for all comfort measures when the electronic equipment is in place.
D) Document the frequency, duration, and intensity of contractions measured by the external device.

Answer 3

Teach the woman and her support person about the monitoring equipment, and discuss any questions they have.

Question 4

The nursing student is planning to assess a fetal heart rate.The registered nurse reminds the student to get gel.Which method of assessing the fetal heart rate is the student planning on conducting?

A) Fetoscope
B) Tocodynamometer
C) Doppler
D) Scalp electrode

Question 5

Which nursing action is correct when initiating electronic fetal monitoring?

A) Lubricate the tocotransducer with an ultrasound gel.
B) Inform the patient that she should remain in the semi-Fowler's position.
C) Securely apply the tocotransducer with a strap or belt.
D) Determine the position of the fetus before attaching the electrode.

Question 6

The precepting nurse explains to the newly hired nurse that when using IA for FHR which situation is unit protocol?

A) The nurses can be expected to cover only two or three patients when IA is the primary method of fetal assessment.
B) The best course is to use the descriptive terms associated with 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 fetal heartbeat and reassure the mother if initial difficulty was a factor.

Question 7

A student nurse is preparing to administer misoprostol (Cytotec).What action by the student seen by the registered nurse demonstrates adequate knowledge about this medication?

A) Assesses maternal blood pressure 30 minutes after administration
B) Assesses fetal heart tones prior to administering the medication
C) Documents the drug administration in the woman's chart
D) Takes and records an apical pulse for 1 minute prior to administration

Question 8

The nurse sees this pattern on the fetal monitor.

What action by the nurse is most appropriate?

A) Apply oxygen via face mask, and position the woman on her left side.
B) Document the findings in the chart along with maternal vital signs.
C) Prepare to start an infusion of oxytocin per unit protocol.
D) Decrease the rate of the woman's IV maintenance fluids.

Question 9

Which maternal condition is considered a contraindication for the application of internal monitoring devices?

A) Unruptured membranes
B) Cervix is dilated to 4 cm
C) External monitors are currently being used
D) Fetus has a known heart defect

Question 10

A nurse manager plans staffing for the Labor and Delivery unit.How does the available staff influence the selection of either continuous electronic or intermittent auscultation as the fetal monitoring method?

A) There must be a 1:1 nurse-to-patient ratio regardless of the method used.
B) Staffing patterns do not influence fetal monitoring choices.
C) Use of intermittent auscultation requires a lower nurse-to-patient ratio.
D) More nurses are needed when electronic fetal monitoring is used.

Question 11

The nurse explains to the student that increasing the infusion rate of non-additive intravenous fluids can increase fetal oxygenation primarily by

A) maintaining normal maternal temperature.
B) preventing normal maternal hypoglycemia.
C) increasing the oxygen-carrying capacity of the maternal blood.
D) expanding maternal blood volume.

Question 12

The fetal heart rate baseline increases 15 beats per minute after vibroacoustic stimulation.What action by the nurse is most appropriate?

A) Reassure the family the finding is normal.
B) Prepare to assist with obtaining cord blood gases.
C) Position the woman on her left side.
D) Administer oxygen at 4 L via nasal cannula.

Question 13

The nurse notes a nonreassuring pattern of the fetal heart rate.The mother is already lying on her left side.What nursing action is indicated?

A) Lower the head of the bed.
B) Place the mother in a Trendelenburg position.
C) Change her position to the right side.
D) Place a wedge under the left hip.

Question 14

In which situation is a baseline fetal heart rate of 160 to 170 beats per minute considered a normal finding?

A) The fetus is at 28 weeks of gestation.
B) The mother has been given an epidural block.
C) The mother has a history of fast labors.
D) The mother has mild preeclampsia but is not in labor.

Question 15

The new nurse learns that 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 16

When the mother's membranes rupture during active labor,the fetal heart rate should be observed for the occurrence of which periodic pattern?

A) Increase in baseline variability
B) Nonperiodic accelerations
C) Early decelerations
D) Variable decelerations

Question 17

The nurse notes a pattern of late decelerations on the fetal monitor.The most appropriate action is to

A) continue observation of this reassuring pattern.
B) notify the physician or nurse-midwife.
C) give the woman oxygen by face mask.
D) place the woman in a Trendelenburg position.

Question 18

A woman has a history of hypertension during pregnancy.What method of intrapartum fetal monitoring does the nurse initiate?

A) Continuous auscultation with a fetoscope
B) Continuous electronic fetal monitoring
C) Intermittent assessment with a Doppler transducer
D) Intermittent electronic fetal monitoring for 15 minutes each hour

Question 19

The nurse-midwife is concerned that a woman's uterine activity is too intense and that her obesity is preventing accurate assessment of the actual intrauterine pressure.On the basis of this information,the nurse should obtain a(n)

A) tocotransducer.
B) scalp electrode.
C) intrauterine pressure catheter.
D) Doppler transducer.

Question 20

Why is continuous electronic fetal monitoring usually used when oxytocin is administered?

A) The mother may become hypotensive.
B) Uteroplacental exchange may be compromised.
C) Maternal fluid volume deficit may occur.
D) Fetal chemoreceptors are stimulated.

Question 21

The labor nurse is evaluating the patient's most recent 10-minute segment on the monitor strip and notes a late deceleration.This is likely to be caused by which physiologic alterations? (Select all that apply.)

A) Spontaneous fetal movement
B) Compression of the fetal head
C) Placental abruption
D) Cord around the baby's neck
E) Maternal supine hypotension

Question 22

A new nurse to Labor and Delivery learns about the three categories of fetal heart rate patterns.Which characteristics of the fetal heart belong in Category III? (Select all that apply.)

A) Baseline rate of 110 to 160 bpm
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 23

Which of the following factors place the intrapartum woman at risk for complications during labor and delivery? (Select all that apply.)

A) Prolonged rupture of membranes
B) Chorioamnionitis
C) Fever
D) History of stillbirth
E) Drug use

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 FHR.

Question 25

In the low-risk patient assessments for variability and periodic changes if using the fetal monitor should be done how often?

A) Every 15 to 30 minutes
B) Every 5 to 15 minutes
C) Every 30 to 60 minutes
D) Only before and after ambulation

Question 26

A Labor and Delivery nurse knows that four of the five fetal factors that interact to regulate the heart rate are which of the following? (Select all that apply.)

A) Uterine activity
B) Autonomic nervous system
C) Baroreceptors
D) Chemoreceptors
E) Adrenal glands

Question 27

A new nurse notes a fetal heart rate pattern of late deceleration with minimal variability in a laboring woman with vaginal bleeding.Which action by the new nurse warrants intervention by the charge nurse?

A) Assesses maternal blood pressure
B) Assesses for a prolapsed cord
C) Prepares to administer terbutaline
D) Discontinues oxytocin