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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
These flow changes along with increased catecholamine secretions have what effect on fetal blood pressure and fetal heart rate? A. Increase BP and increase HR B. Increase BP and decrease HR C. Decrease BP and increase HR D. Decrease BP and decrease HR - B. Increase BP and decrease HR During a term antepartum NST (non-stress test), you notice several variable decelerations that decrease at least 15 bpm and last at least 15 sec long. Which of the following is the least likely explanation? 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
Reduced respiratory gas exchange from persistent decelerations may cause a rise in fetal PCO2, which leads first to _______ _______, then _______ _______. A. Respiratory alkalosis; metabolic acidosis B. Respiratory acidosis; metabolic acidosis C. Respiratory alkalosis; metabolic alkalosis D. Respiratory acidosis; metabolic acidosis - B. Respiratory acidosis; metabolic acidosis Decreased intervillious exchange of oxygenated blood resulting in fetal hypoxia is typically present in _______. A. Variable decelerations B. Late decelerations C. Early decelerations D. Accelerations - B. Late decelerations Place the following interventions for a sinusoidal FHR in the correct order:
- Prepare for cesarean delivery
- Place patient in lateral position
- Determine if pattern is related to narcotic analgesic administration
- Provide oxygen via face mask A. 4, 2, 3, 1 B. 3, 1, 2, 4 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
B. D5L/R
C. Normal saline - C. Normal saline An EFM tracing with absent variability and no decelerations would be classified as A. Category I B. Category II (indeterminate) C. Category III - B. Category II (indeterminate) An EFM tracing with absent variability and intermittent late decelerations would be classified as A. Category I B. Category II C. Category III - B. Category II Maternal oxygen administration is appropriate in the context of A. Recurrent variable decelerations/moderate variability B. Intermittent late decelerations/minimal variability C. Prolonged decelerations/moderate variability - B. Intermittent late decelerations/minimal variability In the context of hypoxemia, fetal blood flow is shifted to the A. Brain B. Liver C. Lungs - A. Brain Baroreceptor-mediated decelerations are A. Early
B. Late C. Variable - C. Variable An appropriate initial treatment for recurrent late decelerations with moderate variability during first stage labor is 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
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 36 week gestation patient is brought to triage by squad after an MVA on her back. She is not bleeding and denies pain. She is not short of breath, but c/o dizziness and nausea since they put her on the gurney. The most likely cause is A. Abruptio placenta B. Preterm labor C. Supine hypotension - C. Supine hypotension When the hydrogen ion content in the blood rises, the pH A. Lowers B. Neutralizes C. Rises - A. Lowers
***A woman receives terbutaline for an external version. You may expect what on the fetal heart tracing? A. Decrease in variability B. Increase in baseline C. No change - B. Increase in baseline What affect does magnesium sulfate have on the fetal heart rate? A. Decreases variability B. Increases variability C. No change - A. Decreases variability Sinusoidal pattern can be documented when A. Cycles are 4-6 beats per minute in frequency B. The pattern lasts 20 minutes or longer C. There is moderate or minimal variability - B. The pattern lasts 20 minutes or longer Vagal stimulation would be manifested as what type of fetal heart rate pattern? 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. 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. A. Increase
B. Decrease - B. Decrease Central _______ are located in the medulla oblongata; peripheral _______ are found in the carotid sinuses and aortic arch. A. Baroreceptors B. Chemoreceptors - B. Chemoreceptors When a fetus is stressed, catecholamine release (epinephrine, norepinephrine) occurs from the medulla oblongata, shunting blood _______ the brain, heart, and adrenal glands. A. Toward B. Away from - A. Toward T/F: A Doppler device used for intermittent auscultation of the fetal heart rate may be used to identify rhythm irregularities, such as supraventricular tachycardia. - False T/F: Use of a fetoscope for intermittent auscultation of the fetal heart rate may be used to detect accelerations and decelerations from the baseline, and can clarify double-counting of half-counting of baseline rate. - True T/F: In the context of moderate variability, late decelerations are considered neurogenic in origin and are typically amenable to intrauterine resuscitation techniques directed towards maximizing uterine blood flow. - True When coupling or tripling is apparent on the uterine activity tracing, this may be indicative of a dysfunctional labor process and saturation (down regulation) of uterine oxytocin receptor sites in response to excess exposure to oxytocin. Which of the following interventions would be most appropriate? A. Normal response; continue to increase oxytocin titration B. Turn patient on side
_______ 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 Base excess - 12 A. Metabolic acidosis B. Respiratory acidosis C. Mixed acidosis - B. Respiratory acidosis pH 7. PO2 18 PCO2 54 HCO3 20 Base deficit 14 A. Metabolic acidosis B. Respiratory acidosis C. Mixed acidosis - A. Metabolic acidosis
