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Which of the following factors can have a negative effect on uterine blood flow? a. Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above - ✔✔e. All of the above Stimulating the vagus nerve typically produces: a. A decrease in the heart rate b. An increase in the heart rate c. An increase in stroke volume d. No change - ✔✔a. A decrease in the heart rate The vagus nerve begins maturation 26 to 28 weeks. Its dominance results in what effect to the FHR baseline? a. Increases baseline b. Decreases baseline - ✔✔b. Decreases baseline T/F: The most common artifact with the ultrasound transducer system for fetal heart rate is increased variability. - ✔✔True T/F: All fetal monitors contain a logic system designed to reject artifact. - ✔✔True T/F: Fetal arrhythmias can be seen on both internal and external monitor tracings. - ✔✔True
T/F: Variability and periodic changes can be detected with both internal and external monitoring. - ✔✔True T/F: Variable decelerations are a vagal response. - ✔✔True T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor. - ✔✔True Etiology of a baseline FHR of 165bpm occurring for the last hour can be:
- Maternal supine hypotension
- Maternal fever
- Maternal dehydration
- Unknown a. 1 and 2 b. 1, 2 and 3 c. 2, 3 and 4 - ✔✔c. 2, 3 and 4 The most prevalent risk factor associated with fetal death before the onset of labor is: a. Low socioeconomic status b. Fetal malpresentation c. Uteroplacental insufficiency d. Uterine anomalies - ✔✔c. Uteroplacental insufficiency Which of the following conditions is not an indication for antepartum fetal surveillance? a. Gestational hypertension b. Diabetes in pregnancy c. Fetus in breech presentation d. Decreased fetal movement - ✔✔c. Fetus in breech presentation
A. True knot B. Gestational diabetes C. Umbilical cord entanglement D. Oligohydramnios - ✔✔B. Gestational diabetes All of the following are likely causes of prolonged decelerations except: A. Uterine tachysystole B. Prolapsed cord C. Maternal hypotension D. Maternal fever - ✔✔D. Maternal fever All of the following could likely cause minimal variability in FHR except A. Magnesium sulfate administration B. Fetal sleep cycle C. Narcotic administration D. Ephedrine administration - ✔✔D. Ephedrine administration When an IUPC has been placed, Montevideo units must be ___ or greater for adequate cervical change to occur. A. 100 B. 200 C. 300 D. 400 - ✔✔B. 200 What would be a suspected pH in a fetus whose FHTs included recurrent late decelerations during labor? A. 7. B. 7. C. 7. D. 7.41 - ✔✔A. 7.
The nurse notes a pattern of decelerations on the fetal monitor that begins shortly after the contraction and returns to baseline just before the contraction is over. The correct nursing response is to: a. Give the woman oxygen by facemask at 8-10 L/min b. Position the woman on her opposite side c. Increase the rate of the woman's intravenous fluid d. Continue to observe and record the normal pattern - ✔✔d. Continue to observe and record the normal pattern Determining the FHR baseline requires the nurse to approximate the mean FHR rounded to increments of 5 bpm during a ___-minute window (excluding accelerations and decelerations). A. 2 B. 5 C. 10 D. 20 - ✔✔C. 10 Which of the following interventions would best stimulate an acceleration in the FHR? A. Provide juice to patient B. Perform vaginal exam C. Turn patient on left side D. Vibroacoustic stimulation - ✔✔B. Perform vaginal exam Scalp stimulation The FHR is controlled by the A. Sympathetic nervous system B. Sinoatrial node C. Atrioventricular node D. Parasympathetic nervous system - ✔✔B. Sinoatrial node
C. 4, 3, 2, 1
D. 3, 2, 4, 1 - ✔✔D. 3, 2, 4, 1
FHTs with accelerations, no decelerations, and minimal variability would be categorized as A. Category I B. Category II C. Category III - ✔✔B. Category II FHTs with minimal variability, absent accelerations, and a 3-minute prolonged deceleration would be categorized as A. Category I B. Category II C. Category III - ✔✔B. Category II Which of the following is not a likely cause of a sinusoidal FHR pattern? A. Chronic fetal bleeding B. Fetal hypoxia or anemia C. Triple screen positive for Trisomy 21 D. Fetal isoimmunization - ✔✔C. Triple screen positive for Trisomy 21 Which of the following factors is not likely to cause uteroplacental insufficiency? A. Late-term gestation B. Preeclampsia C. Gestational diabetes D. Polyhydramnios E. Maternal smoking or drug use - ✔✔D. Polyhydramnios The normal FHR baseline A. Decreases during labor
B. Fluctuates during labor C. Increases during labor - ✔✔B. Fluctuates during labor Bradycardia in the second stage of labor following a previously normal tracing may be caused by fetal A. Hypoxemia B. Rotation C. Vagal stimulation - ✔✔C. Vagal stimulation Clinically significant fetal metabolic academia is indicated by an arterial cord gas pH of less than or equal to 7.10 and a base deficit of A. 3 B. 6 C. 12 - ✔✔C. 12 Fetal bradycardia can result during A. The sleep state B. Umbilical vein compression C. Vagal stimulation - ✔✔C. Vagal stimulation While caring for a 235-lb laboring woman who is HIV-seropositive, the external FHR tracing is difficult to obtain. An appropriate nursing action would be to A. Apply a fetal scalp electrode B. Auscultate for presence of FHR variability C. Notify the attending midwife or physician - ✔✔C. Notify the attending midwife or physician Which IV fluid is most appropriate for maternal administration for intrauterine resuscitation? A. Lactated Ringer's solution B. D5L/R C. Normal saline - ✔✔C. Normal saline
A. Amnioinfusion B. Maternal repositioning C. Oxygen at 10L per nonrebreather face mask - ✔✔B. Maternal repositioning Most fetal dysrhythmias are not life-threatening, except for _______, which may lead to fetal congestive heart failure. - ✔✔Supraventricular tachycardia Medications, prematurity, fetal sleep, fetal dysrhythmia, anesthetic agents, or cardiac anomalies may result in _______ variability. - ✔✔Decreased Stimulation of the _____ _____ _____ releases acetylcholine, resulting in decreased FHR. - ✔✔Parasympathetic nervous system The _____ _____ _____ maintains transmission of beat-to-beat variability. - ✔✔Parasympathetic nervous system Stimulation of the _____ _____ _____ releases catecholamines, resulting in increased FHR. - ✔✔Sympathetic nervous system Stimulation of _____ results in abrupt decreases in FHR, CO, and BP. - ✔✔Baroreceptors Baroreceptors influence _____ decelerations with moderate variability. - ✔✔Variable In comparing early and late decelerations, a distinguishing factor between the two is A. Onset time to the nadir of the deceleration B. The number of decelerations that occur C. Timing in relation to contractions - ✔✔C. Timing in relation to contractions The underlying cause of early decelerations is decreased A. Baroceptor response
B. Increased peripheral resistance C. Vagal reflex - ✔✔C. Vagal reflex Glucose is transferred across the placenta via _____ _____. - ✔✔Facilitated diffusion Oxygen, carbon dioxide, water, electrolytes, urea, uric acid, fatty acids, fat-soluble vitamins, narcotics barbiturates, anesthetics, and antibiotics are transferred across the placenta via _____ _____. - ✔✔Simple (passive) diffusion Amino acids, water-soluble vitamins, calcium, phosphorus, iron, and iodine are transferred across the placenta via _____ _____. - ✔✔Active transport Well-oxygenated fetal blood enters the _____ ventricle, which supplies the heart and brain. Less- oxygenated blood enters the ______ ventricle, which supplies the rest of the body. - ✔✔Left; right Fetal blood has a _______ affinity for oxygen compared with the mother's blood, which facilitates adaptation to the low PO2 at which the placenta oxygenates the fetus. A. Higher B. Lower - ✔✔A. Higher The fetus has a _______ cardiac output and heart rate than the adult, resulting in rapid circulation. A. Higher B. Lower - ✔✔A. Higher Which statement best describes the relationship between maternal and fetal hemoglobin levels? A. Fetal hemoglobin is higher than maternal hemoglobin B. Maternal hemoglobin is higher than fetal hemoglobin C. Maternal and fetal hemoglobin are the same - ✔✔A. Fetal hemoglobin is higher than maternal hemoglobin
A. Acceleration B. Early deceleration C. Tachycardia - ✔✔B. Early deceleration Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially when seen at the onset of labor? A. Early deceleration B. Late deceleration C. Variable deceleration - ✔✔A. Early deceleration A risk of amnioinfusion is A. Prolonged labor B. Uterine overdistension C. Water intoxication - ✔✔B. Uterine overdistension A fetal heart rate pattern that can occur when there is a prolapsed cord is A. Marked variability B. Prolonged decelerations C. Tachycardia - ✔✔B. Prolonged decelerations The patient is in early labor with pitocin at 8 mu/min, and FHR is Category I. In the next 15 minutes, there are 18 uterine contractions. Recommended management is to A. Address contraction frequency by reducing pitocin dose B. Continue to increase pitocin as long as FHR is Category I C. Turn the patient on her side and initiate an IV fluid bolus - ✔✔C. Turn the patient on her side and initiate an IV fluid bolus A woman at 38 weeks gestation is in labor. The labor has been uneventful, and the fetal heart tracings have been normal. Spontaneous rupture of membranes occurs; fetal heart rate drops to 90 beats per minute for four minutes and then resumes a normal pattern. The most likely etiology for this fetal heart rate change is
A. Abnormal fetal presentation B. Impaired placental circulation C. Possible cord compression - ✔✔C. Possible cord compression A woman has 10 fetal movements in one hour. This is considered what kind of movement? A. Decreased B. Excessive C. Normal - ✔✔C. Normal If the pH is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? A. HCO B. PCO C. PO2 - ✔✔B. PCO The following cord blood gasses are consistent with: pH 7.10, pCO2 70, pO2 25, base excess - 10 A. Metabolic acidosis B. Mixed acidosis C. Respiratory acidosis - ✔✔C. Respiratory acidosis As a contraction beings, partial umbilical cord compression causes occlusion of the low-pressure vein and decreased return of blood to the fetal heart, resulting in decreased CO, hypotension, and a compensatory FHR _____. A. Acceleration B. Early deceleration C. Late deceleration D. Variable deceleration - ✔✔A. Acceleration With complete umbilical cord occlusion, the two umbilical arteries also become occluded, resulting in sudden fetal hypertension, stimulation of the baroreceptors, and a sudden _______ in FHR.
The most common tachyarrhythmia in fetuses, supraventricular tachycardia, typically occurs at a rate of _____ to _____ bpm with minimal or absent variability. A. 160- 200 B. 200- 240 C. 240- 260 - ✔✔C. 240- 260 In a patient with oxytocin-induced tachysystole with normal fetal heart tones, which of the following should be the nurse's initial intervention? A. Assist the patient to lateral position B. Discontinue Pitocin C. Administer IV fluid bolus - ✔✔A. Assist the patient to lateral position In a patient with oxytocin-induced tachysystole with indeterminate or abnormal fetal heart tones, which of the following should be the nurse's initial intervention? A. Assist the patient to lateral position B. Discontinue Pitocin C. Administer IV fluid bolus - ✔✔B. Discontinue Pitocin Fetal hypoxia and acidemia are demonstrated by pH < _____ and base excess < _____. - ✔✔< 7.15; < - 8 T/F: Uterine resting tone may appear higher (25 to 40 mmHg) during amnioinfusion. - ✔✔True _______ denotes an increase in hydrogen ions in the fetal blood. A. Acidosis B. Acidemia C. Hypercapnia - ✔✔B. Acidemia _______ _______ occurs when there is low bicarbonate (base excess) in the presence of normal pressure of carbon dioxide (PCO2) values. A. Metabolic acidosis
B. Respiratory acidosis C. Metabolic alkalosis - ✔✔A. Metabolic acidosis _______ _______ occurs when there is high PCO2 with normal bicarbonate levels. A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis - ✔✔B. Respiratory acidosis _______ _______ occurs when the HCO3 concentration is lower than normal. A. Base deficit B. Base excess C. Metabolic acidosis - ✔✔A. Base deficit _______ _______ occurs when the HCO3 concentration is higher than normal. A. Base deficit B. Base excess C. Metabolic acidosis - ✔✔B. Base excess _______ is defined as the energy-consuming process of metabolism. - ✔✔Anabolism _______ is defined as the energy-releasing process of metabolism. - ✔✔Catabolism Normal oxygen saturation for the fetus in labor is ___% to ___%. - ✔✔30% to 65% pH 7. PO2 21 PCO2 72 HCO3 24
B. Decreased blood perfusion from the placenta to the fetus C. Homeostatic dilation of the umbilical artery - ✔✔A. Decreased blood perfusion from the fetus to the placenta Two umbilical arteries flow from the fetus to the placenta A patient presents with a small amount of thick dark blood clots who denies pain and whose abdomen is soft to the touch. Which component of oxygen transport to the fetus could potentially be compromised by this bleeding? A. Affinity B. Saturation C. Delivery - ✔✔C. Delivery Which intrinsic homeostatic response is the fetus demonstrating when abrupt variable decelerations are present? A. Baroreceptor B. Catecholamine C. Sympathetic - ✔✔A. Baroreceptor An infant was delivered via cesarean. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. The initial neonatal hemocrit was 20% and the hemoglobin was 8. Which interpretation of these umbilical cord and initial neonatal blood results is correct? A. Base buffers have been used to maintain oxygenation B. The mother was probably hypoglycemic C. The neonate is anemic - ✔✔C. The neonate is anemic An infant was delivered via cesarean. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. The initial neonatal hemocrit was 20% and the hemoglobin was 8.
These umbilical cord blood gases indicate A. Asphyxia related to umbilical and placental abnormalities B. Hypoxia related to neurological damage C. Mixed acidosis - ✔✔C. Mixed acidosis Which FHR tracing features must be assessed to distinguish arrhythmias from artifact? A. Shape and regularity of the spikes B. Spikes and variability C. Spikes and baseline - ✔✔A. Shape and regularity of the spikes How might a fetal arrhythmia affect fetal oxygenation? A. By increasing fetal oxygen affinity B. By increasing sympathetic response C. By reducing fetal perfusion - ✔✔C. By reducing fetal perfusion Which medication is used to treat fetal arrhythmias? A. Digoxin B. Labetolol C. Nifedipine - ✔✔A. Digoxin Inotropic - promotes regular and effective cardiac contraction Fetal hydrops may present on ultrasound as fetal scalp edema and increased abdominal fluid as a results of A. An increase in gestational age B. Congestive heart failure C. Sustained oligohydramnios - ✔✔B. Congestive heart failure
