Deck 18: Fetal Assessment During Labor

Question 1

What is a distinct advantage of external EFM?

A) The ultrasound transducer can accurately measure short-term variability and beat-to-beat changes in the FHR.
B) The tocotransducer can measure and record the frequency, regularity, intensity, and approximate duration of uterine contractions.
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.

Answer 1

The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor.

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?

A) "Don't worry about that machine; that's my job."
B) "The baby's 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 physician will explain all of that later."

Answer 2

"The baby's heart rate will fluctuate in response to what is happening during labor."

Question 3

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

A) Maternal fever
B) Umbilical cord prolapse
C) Regional anesthesia
D) Magnesium sulfate administration

Answer 3

Maternal fever

Question 4

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

A) The nurse can be expected to cover only two or three clients 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 immediately found, then a shift must be made to EFM.
D) Ultrasound can be used to find the FHR and to reassure the mother if the initial difficulty is a factor.

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?

A) Early FHR decelerations
B) Fetal arrhythmias
C) Uteroplacental insufficiency
D) Spontaneous rupture of membranes

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?

A) Periodic fetal sleep state
B) Extreme prematurity
C) Fetal hypoxemia
D) Preexisting neurologic injury

Question 7

What is the most likely cause for variable FHR decelerations?

A) Altered fetal cerebral blood flow
B) Umbilical cord compression
C) Uteroplacental insufficiency
D) Fetal hypoxemia

Question 8

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

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

Question 9

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

A) Early deceleration-umbilical cord compression
B) Late deceleration-uteroplacental insufficiency
C) Variable deceleration-head compression
D) Prolonged deceleration-unknown cause

Question 10

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

A) Accelerations with fetal movement
B) Early decelerations
C) Average FHR of 126 beats per minute
D) Late decelerations

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?

A) Hypotension
B) Cord compression
C) Maternal drug use
D) Hypoxemia

Question 12

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

A) Call the provider, reposition the mother, and perform a vaginal examination.
B) Turn the client onto her side, provide oxygen (O₂) via face mask, and increase intravenous (IV) fluids.
C) Administer O₂ to the mother, increase IV fluids, and notify the health care provider.
D) Perform a vaginal examination, reposition the mother, and provide O₂ via face mask.

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?

A) Change the woman's position.
B) Notify the health care provider.
C) Assist with amnioinfusion
D) Insert a scalp electrode.

Question 14

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

A) Client who still has intact membranes
B) Woman whose fetus is well engaged in the pelvis
C) Pregnant woman who has a comorbidity of obesity
D) Client whose cervix is dilated to 4 to 5 cm

Question 15

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

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

Question 16

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

A) Contractions every 2 to 5 minutes
B) Contractions lasting approximately 2 minutes
C) Contractions approximately 1 minute apart
D) Contraction intensity of approximately 500 mm Hg with relaxation at 50 mm Hg

Question 17

What are the legal responsibilities of the perinatal nurses?

A) Correctly interpreting FHR patterns, initiating appropriate nursing interventions, and documenting the outcomes
B) Greeting the client on arrival, assessing her status, and starting an IV line
C) Applying the external fetal monitor and notifying the health care provider
D) Ensuring that the woman is comfortable

Question 18

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

A) FHR accelerations are indications of fetal well-being when they are periodic.
B) FHR accelerations are greater and longer in preterm gestations.
C) FHR accelerations are usually observed with breech presentations when they are episodic.
D) An acceleration in the FHR presents a visually apparent and abrupt peak.

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?

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

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?

A) Bradycardia
B) Normal baseline heart rate
C) Tachycardia
D) Hypoxia

Question 21

The baseline FHR is the average rate during a 10-minute segment.Changes in FHR are categorized as periodic or episodic.These patterns include both accelerations and decelerations.The labor nurse is evaluating the client's most recent 10-minute segment on the monitor strip and notes a late deceleration.Which is likely to have caused this change?

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

Fetal well-being in labor can be measured by the response of the FHR to uterine contractions. Match the characteristic of normal uterine activity during labor with the correct description.

Commonly 45 seconds or more in the second stage of labor

A)Frequency
B)Duration
C)Strength
D)Resting tone
E)Relaxation time

Question 23

Which nursing intervention would result in an increase in maternal cardiac output?

A) Change in position
B) Oxytocin administration
C) Regional anesthesia
D) IV analgesic

Question 24

Which FHR decelerations would require the nurse to change the maternal position?

A) Early decelerations
B) Late decelerations
C) Variable decelerations
D) Moderate decelerations
E) Prolonged decelerations

Question 25

Fetal well-being in labor can be measured by the response of the FHR to uterine contractions. Match the characteristic of normal uterine activity during labor with the correct description.

Peaking at 40 to 70 mm Hg in the first stage of labor

A)Frequency
B)Duration
C)Strength
D)Resting tone
E)Relaxation time

Question 26

Part of the nurse's role is assisting with pushing and positioning.Which guidance should the nurse provide to her client in active labor?

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 27

The nurse is evaluating the EFM tracing of the client who is in active labor.Suddenly,the FHR drops from its baseline of 125 down to 80 beats per minute.The mother is repositioned,and the nurse provides oxygen,increased IV fluids,and performs a vaginal examination.The cervix has not changed.Five minutes have passed,and the FHR remains in the 80s.What additional nursing measures should the nurse take next?

A) Call for help.
B) Insert a Foley catheter.
C) Start administering Pitocin.
D) Immediately notify the care provider.

Question 28

A tiered system of categorizing FHR has been recommended by professional organizations.Nurses,midwives,and physicians who care for women in labor must have a working knowledge of fetal monitoring standards and understand the significance of each category.What is the correct nomenclature for these categories?

A) Reassuring
B) Category I
C) Category II
D) Nonreassuring
E) Category III

Question 29

Fetal well-being in labor can be measured by the response of the FHR to uterine contractions. Match the characteristic of normal uterine activity during labor with the correct description.

Generally ranging from two to five contractions per 10 minutes of labor

A)Frequency
B)Duration
C)Strength
D)Resting tone
E)Relaxation time

Question 30

What physiologic change occurs as the result of increasing the infusion rate of nonadditive IV fluids?

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 31

What is the correct placement of the tocotransducer for effective EFM?

A) Over the uterine fundus
B) On the fetal scalp
C) Inside the uterus
D) Over the mother's lower abdomen

Question 32

The nurse observes a sudden increase in variability on the ERM tracing.Which class of medications may cause this finding?

A) Narcotics
B) Barbiturates
C) Methamphetamines
D) Tranquilizers

Question 33

Fetal well-being in labor can be measured by the response of the FHR to uterine contractions. Match the characteristic of normal uterine activity during labor with the correct description.

Average of 10 mm Hg

A)Frequency
B)Duration
C)Strength
D)Resting tone
E)Relaxation time

Question 34

In which situation would the nurse 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 35

Which information related to a prolonged deceleration is important for the labor nurse to understand?

A) Prolonged decelerations present a continuing pattern of benign decelerations that do not require intervention.
B) Prolonged decelerations constitute a baseline change when they last longer than 5 minutes.
C) A disruption to the fetal oxygen supply causes prolonged decelerations.
D) Prolonged decelerations require the customary fetal monitoring by the nurse.

Question 36

The client has delivered by urgent caesarean birth for fetal compromise.Umbilical cord gases were obtained for acid-base determination.The pH is 6.9,partial pressure of carbon dioxide (PCO₂)is elevated,and the base deficit is 11 mmol/L.What type of acidemia is displayed by the infant?

A) Respiratory
B) Metabolic
C) Mixed
D) Turbulent

Question 37

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.Which clinical situation warrants this additional testing?

A) Low 5-minute Apgar score
B) Intrauterine growth restriction (IUGR)
C) Maternal thyroid disease
D) Intrapartum fever
E) Vacuum extraction

Question 38

According to the National Institute of Child Health and Human Development (NICHD)Three-Tier System of FHR Classification,category III tracings include all FHR tracings not categorized as category I or II.Which characteristics of the FHR belong in category III?

A) Baseline rate of 110 to 160 beats per minute
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 39

Fetal well-being in labor can be measured by the response of the FHR to uterine contractions. Match the characteristic of normal uterine activity during labor with the correct description.

Remaining fairly stable throughout the first and second stages

A)Frequency
B)Duration
C)Strength
D)Resting tone
E)Relaxation time

Question 40

In which clinical situation would the nurse most likely anticipate a fetal bradycardia?

A) Intraamniotic infection
B) Fetal anemia
C) Prolonged umbilical cord compression
D) Tocolytic treatment using terbutaline