Deck 11: Fetal Assessment During Labor

Question 1

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

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

Answer 1

Uteroplacental insufficiency.

Question 2

The nurse providing care for the laboring woman should understand 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.

Answer 2

Umbilical cord compression.

Question 3

A new patient and her partner arrive on the labor, delivery, recovery, and postpartum unit for the birth of their first child. You apply 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. 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."

Answer 3

"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."

Question 4

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

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) May visibly resemble the shape of the uterine contraction.

Question 5

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

A) Call the provider, reposition the mother, and perform a vaginal examination.
B) Administer oxygen by face mask, assist the woman to a side-lying position, and increase maternal blood volume by increasing the rate of the primary IV.
C) Administer oxygen to the mother, increase IV fluid, and notify the care provider.
D) Perform a vaginal examination, reposition the mother, and provide oxygen via face mask.

Question 6

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.
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 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 7

During labor a fetus with an average heart rate of 135 beats/min over a 10-minute period would be considered to have:

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

Question 8

In assisting with the two factors that have an effect on fetal status (i.e., 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 9

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 10

When assessing the relative advantages and disadvantages of internal and external electronic fetal monitoring, nurses should be aware that both:

A) Can be used when membranes are intact.
B) Measure the frequency, duration, and intensity of uterine contractions.
C) May need to rely on the woman to indicate when uterine activity (UA) is occurring.
D) Can be used during the antepartum and intrapartum periods.

Question 11

Which deceleration of the fetal heart rate would 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 12

According to standard professional thinking, nurses should auscultate the fetal heart rate (FHR):

A) Every 15 minutes in the active phase of the first stage of labor in the absence of risk factors.
B) Every 20 minutes in the second stage, regardless of whether risk factors are present.
C) Before, during, and after a contraction.
D) More often in a woman's first pregnancy.

Question 13

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

A) They 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 electronic fetal monitoring (EFM) when documenting results.
C) If the heartbeat cannot be found immediately, a shift must be made to EFM.
D) Ultrasound can be used to find the fetal heartbeat and reassure the mother if initial difficulty was a factor.

Question 14

While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate at the onset of several contractions and returns to baseline before each contraction ends. The nurse should:

A) Change the woman's position.
B) Discontinue the oxytocin infusion.
C) Insert an internal monitor.
D) Document the finding in the patient's record.

Question 15

The nurse caring for the woman in labor should understand that maternal hypotension can result in:

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

Question 16

The nurse caring for the laboring woman should understand that early decelerations are caused by:

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

Question 17

As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or 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 18

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 care provider.
C) Assist with amnioinfusion.
D) Insert a scalp electrode.

Question 19

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 patient on arrival, assessing her, and starting an intravenous line.
C) Applying the external fetal monitor and notifying the care provider.
D) Making sure that the woman is comfortable.

Question 20

The nurse providing care for the laboring woman should understand that amnioinfusion is used to treat:

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

Question 21

A number of methods for assisting in the assessment of fetal well-being have been developed for use in conjunction with electronic fetal monitoring. These various technologies assist in supporting interventions for a nonreassuring fetal heart rate 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.

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) IUGR.
C) Maternal thyroid disease.
D) Intrapartum fever.
E) Multiple gestation.
F) Abnormal fetal heart rate tracing.
G) None of the above