Deck 9: Fetal Heart Rate Assessment

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.

A)A maternal fever in labor is usually due to dehydration and therefore should be treated with a fluid bolus.
B)Administering terbutaline to the mother for uterine tachysystole; this is self-limiting to when the drug is affecting the mother.
C)A urine toxicology screen may reveal recent cocaine use; the nurse should also monitor for placental abruption.
D)Check the chart for a history of maternal mental illness, particularly maternal anxiety; speak with the patient regarding her anxiety and take steps to ease her anxieties.
E)Check the maternal blood pressure, as hypertension is linked to fetal tachycardia; identify the on-call provider and correct with lisinopril as necessary.

Answer 1

Administering terbutaline to the mother for uterine tachysystole; this is self-limiting to when the drug is affecting the mother.
A urine toxicology screen may reveal recent cocaine use; the nurse should also monitor for placental abruption.
Check the chart for a history of maternal mental illness, particularly maternal anxiety; speak with the patient regarding her anxiety and take steps to ease her anxieties.
Check the maternal blood pressure, as hypertension is linked to fetal tachycardia; identify the on-call provider and correct with lisinopril as necessary.

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?

A)Give the mother oxygen to increase the fetal heart rate.
B)Immediately call the provider into the room.
C)Check to make sure that the maternal radial pulse is being recorded correctly.
D)Adjust the monitor on the maternal abdomen.

Answer 2

Check to make sure that the maternal radial pulse is being recorded correctly.

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?

A)Check the patient's input and output.
B)Take a blood pressure to determine if the mother has hypotension.
C)Change the mother's position from supine to left lateral.
D)Check the mother for vaginal bleeding and severe abdominal pain.

Answer 3

Check the mother for vaginal bleeding and severe abdominal pain.

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?

A)A patient with a previous cesarean section
B)A patient with an epidural in place
C)A patient with decreased fetal activity
D)A patient with Category I FHR tracings

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.

A)Check to see if the patients' membranes have been ruptured, as there could be potential cord compression.
B)Look to see what the patient's position is and is she supine; change her to left side lying.
C)Continue to watch the strip, but know that this could be due to fetal sleep.
D)Recognize that the fetus is 38 weeks and therefore this could be due to fetal maturity.
E)Check the FHR and connect the minimal variability to fetal bradyasystole.

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?

A)"Vagus nerve stimulation increases FHR and helps maintain variability."
B)"The sympathetic nervous system is responsible for heart rate variability."
C)"Action of the FHR occurs through the absence of norepinephrine."
D)"Baroreceptors are responsible for increasing FHR and fetal blood pressure."

Question 7

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

A)Perform fetal scalp stimulation for 5 seconds.
B)Check maternal allergies in the patient chart.
C)Apply heat packs to the maternal chest and head.
D)Stimulate the fetus with a vibroacoustic device.

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?

A)"Telemetry is used mostly for women who are laboring in bed and changing positions every half hour or so."
B)"Unfortunately, you will not be able to use the shower while using telemetry."
C)"The nurses will need to come in and check your telemetry reading every half hour."
D)"We can start using telemetry now, and if there are no problems with the signal, we can continue it throughout your labor until delivery."

Question 9

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

A)Intermittent auscultation should be performed every hour in the latent phase.
B)For Category I situations, intermittent electronic fetal monitoring (EFM) should be performed for 10 to 30 minutes every 1 to 2.5 hours.
C)A patient with a previous cesarean section should have EFM for 10 to 30 minutes every 1 to 2.5 hours.
D)A patient with membranes ruptured over 24 hours should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage.
E)A patient with fever should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage.

Question 10

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

A)Feeling the maternal abdomen in between contractions
B)Checking the EFM strip to determine if contractions are either 2 or 3 minutes apart
C)Evaluating that the EFM strip shows 200 MVU every 10 minutes.
D)Checking the EFM strip to see if the fetus has an elevation of 15 bpm over baseline for 15 seconds twice in a 20-minute period
E)Evaluating that the EFM strip shows that each contraction lasts 1 minute

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?

A)Green: very low risk of evolution, no action
B)Red: unacceptably high risk of acidemia, deliver
C)Yellow: moderate risk of evolution, increase surveillance
D)Orange: acceptable low risk of acidemia, prepare for possible urgent delivery

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?

A)Perform conservative measures.
B)Prepare for urgent delivery.
C)Assist provider in immediate delivery.
D)Increase surveillance of patient.

Question 13

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

A)Help the patient move around to help obtain the signal.
B)Place the transducer in a different position.
C)Check the mother's cervical progress to see if she is in the second stage of labor.
D)Remove some of the ultrasound gel from the transducer.

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?

A)Prepare Chrissy for the placement of an internal monitor.
B)Take the required two blood pressure readings every 15 minutes prior to insertion of the internal fetal monitor due to her pregnancy-induced hypertension.
C)Discuss with the health care provider the fact that Chrissy's blood type is O negative and she should therefore receive Rhogam before insertion of an internal monitor.
D)Discuss with the health care provider that Chrissy is GBS positive and therefore should not receive an internal monitor.

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?

A)IUPC to make sure that her contractions are adequate to keep labor progressing
B)FSE to make sure that her fetus is tolerating the hydrotherapy
C)Telemetry to allow for the patient to accomplish her birth plan
D)External EFM to make sure that there is continuous monitoring

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.

A)"There is a reduced rate of seizures if a patient has EFM during labor."
B)"There is a decrease in the incidence of cerebral palsy if a patient has EFM during labor."
C)"There is a link between decreased infant mortality and EFM during delivery."
D)"There is a link between the rate of cesarean sections and continuous EFM."
E)"There is an increase in operative vaginal births and the use of continuous EFM."

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?

A)The baseline changes from 140 bpm to 150 bpm.
B)The change from moderate variability to minimal variability.
C)The consistent presence of accelerations.
D)The presence of 2 and then 3 decelerations.

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?

A)The patients' contractions are adequate, so the main focus should be on resuscitating the fetus with maternal oxygen and maternal position change.
B)The patients' contractions are inadequate; the provider could consider an amnioinfusion through the IUPC, and once the fetus has improved, contractions need to be augmented to be more effective.
C)The patients' contractions are adequate, so the main focus should be on determining her progress through cervical change.
D)The patients' contractions are inadequate; the provider could consider augmenting with Pitocin to be more effective.

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?

A)A Category I tracing
B)A Category II tracing
C)A Category III tracing
D)A Category IV tracing