Download 2022 NCC EFM Certification: Fetal Heart Rate & Uterine Monitoring and more Exams Medicine in PDF only on Docsity!
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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 - CORRECT ANSWERS e. All of the above How does the fetus compensate for decreased maternal circulating volume? a. Increases cardiac output by increasing stroke volume. b. Increases cardiac output by increasing it's heart rate. c. Increases cardiac output by increasing fetal movement. - CORRECT ANSWERS b. Increases cardiac output by increasing it's heart rate. 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 - CORRECT ANSWERS a. A decrease in the heart rate What initially causes a chemoreceptor response? a. Epidurals b. Supine maternal position c. Increased CO2 levels d. Decreased O2 levels e. A & C f. A & B g. C & D - CORRECT ANSWERS g. C & D 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 - CORRECT ANSWERS b. Decreases baseline T/F: Oxygen exchange in the placenta takes place in the intervillous space. - CORRECT ANSWERS True T/F: The parasympathetic nervous system is a cardioaccelerator. - CORRECT ANSWERS False T/F: Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure. - CORRECT ANSWERS True
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T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart rate: the ultrasound transducer and the fetal spiral electrode. - CORRECT ANSWERS True T/F: Variability can be determined with the fetoscope. - CORRECT ANSWERS False T/F: Because the ultrasound transducer and toco transducer are sealed units, they can be dipped in warm water to make cleaning easier. - CORRECT ANSWERS False T/F: The most common artifact with the ultrasound transducer system for fetal heart rate is increased variability. - CORRECT ANSWERS True T/F: All fetal monitors contain a logic system designed to reject artifact. - CORRECT ANSWERS True T/F: The monitor should always be tested before starting a tracing, either external or internal mode and labeled a test. - CORRECT ANSWERS True T/F: The paper speed on the fetal monitor should always be set at 1cm/min. - CORRECT ANSWERS False T/F: Both internal and external monitoring methods are equally accurate means of obtaining the fetal heart rate and contraction patterns. - CORRECT ANSWERS False T/F: The external toco is usually placed over the uterine fundus to pick up contractions.
- CORRECT ANSWERS True T/F: The external toco gives measurable uterine pressure. - CORRECT ANSWERS False T/F: The fetal spiral electrode can be placed when vaginal bleeding of unknown origin is present. - CORRECT ANSWERS False T/F: The ultrasound transducer is usually placed on the side of the uterus over the baby's back, as the fetal heart is heard best there. - CORRECT ANSWERS True T/F: The spiral electrode is used to more accurately determine the frequency, duration, and intensity of uterine contractions. - CORRECT ANSWERS False
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c. No treatment indicated d. Oxygen e. Stop oxytocin infusion - CORRECT ANSWERS b. Change maternal position 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 - CORRECT ANSWERS c. 2, 3 and 4 What is the most probable cause of recurrent late decelerations? a. Utero-placental insufficiency b. Head compression c. Cord compression d. Maternal position change - CORRECT ANSWERS a. Utero- placental insufficiency 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 - CORRECT ANSWERS c. Uteroplacental insufficiency Which of the following is NOT used for antepartum fetal surveillance? a. Fetal movement counting b. Antepartum fetal heart rate testing c. Biophysical profile testing d. Maternal HCG levels - CORRECT ANSWERS d. Maternal HCG levels 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 - CORRECT ANSWERS c. Fetus in breech presentation Which of the following does not affect the degree of fetal activity? a. Vibroacoustic stimulation
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b. Smoking c. Fetal position d. Gestational age - CORRECT ANSWERS a. Vibroacoustic stimulation To be considered reactive, a nonstress test must have: a. 4 fetal heart rate accelerations in a 20 minute window b. 2 fetal heart rate accelerations in a 10 minute window c. 4 fetal heart rate accelerations in a 40 minute window d. 2 fetal heart rate accelerations in a 20 minute window - CORRECT ANSWERS d. 2 fetal heart rate accelerations in a 20 minute window If a nonstress test is nonreactive after 40 minutes, the next step should be: a. Have the client go home and do fetal movement counts b. Do a biophysical profile or contraction stress test c. Repeat the nonstress test within a week d. Admit the client for delivery - CORRECT ANSWERS b. Do a biophysical profile or contraction stress test All of the following are components of a biophysical profile except: a. Contraction stress test b. Assessment of fetal breathing c. Amniotic fluid volume measurement d. Fetal movement assessment - CORRECT ANSWERS a. Contraction stress test A modified biophysical profile includes a nonstress test and: a. Contraction stress test b. Ultrasound assessment of fetal movement c. Ultrasound assessment of amniotic fluid volume d. Fetal movement counts - CORRECT ANSWERS c. Ultrasound assessment of amniotic fluid volume For a contraction stress test to be interpretable, you must have a minimum of: a. 5 contractions in a 10-minute window b. 3 contractions in a 10-minute window c. 4 contractions in a 10-minute window d. 2 contractions in a 10-minute window - CORRECT ANSWERS b. 3 contractions in a 10 minute window A negative contraction stress test is one in which: a. No contractions are seen b. There are late decelerations with > 50% of the contractions seen c. There are no fetal heart rate late decelerations with the contractions
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D. Turn off the monitor - CORRECT ANSWERS A. Compare maternal pulse simultaneously with FHR T/F: Umbilical cord influences that can alter blood flow include true knots, hematomas, and number of umbilical vessels. - CORRECT ANSWERS True T/F: Low amplitude contractions are not an early sign of preterm labor. - CORRECT ANSWERS False T/F: Preterm contractions are usually painful. - CORRECT ANSWERS False T/F: Corticosteroid administration may cause an increase in FHR accelerations. - CORRECT ANSWERS False T/F: Corticosteroid administration may cause an increase in FHR. - CORRECT ANSWERS True T/F: Contractions cause an increase in uterine venous pressure and a decrease in uterine artery perfusion. - CORRECT ANSWERS True As a result of the intrinsic fetal response to oxygen deprivation, increased catecholamine levels cause the peripheral blood flow to decrease while the blood flow to vital organs increases. 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 - CORRECT ANSWERS B. Increase BP and decrease HR All of the following might indicate a pseudosinusoidal pattern as opposed to a sinusoidal pattern, except: A. Recent administration of narcotics to mother B. Accelerations in FHR C. Moderate variability D. Frequency of oscillations of two to five cycles/min - CORRECT ANSWERS D. Frequency of oscillations of two to five cycles/min All of the following are appropriate interventions for fetal tachycardia except: A. Increase maternal IV fluid rate B. Assess maternal vital signs C. Perform SVE D. Administer oxygen - CORRECT ANSWERS C. Perform SVE
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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 - CORRECT ANSWERS 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 - CORRECT ANSWERS D. Maternal fever _______ decelerations occur with less than 50% of contractions. A. Recurrent B. Intermittent C. Repetitive - CORRECT ANSWERS B. Intermittent _______ decelerations occur with greater than or equal to 50% of contractions. A. Recurrent B. Intermittent C. Repetitive - CORRECT ANSWERS A. Recurrent 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS B. 200 The ________ increases the heart rate and strengthens myocardial contractions through the release of epinephrine and nonepinephrine. A. Sympathetic nervous system B. Parasympathetic nervous system - CORRECT ANSWERS A. Sympathetic nervous system
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a. In the suprapubic area b. In the fundal area c. Over the xiphoid process d. Within the uterus - CORRECT ANSWERS b. In the fundal area 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS C. 10 Uterine tachysystole is observed when there are A. 5 or more contractions in 10 min B. 6 or more contractions in 10 min C. 10 or more contractions in 10 min D. 7 or more contractions in 10 min - CORRECT ANSWERS B. 6 or more contractions in 10 min 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 - CORRECT ANSWERS B. Perform vaginal exam Scalp stimulation Assessment of the _____ is an indirect measurement of fetal oxygenation. A. Fetal heart rate B. Fetal scalp sampling C. Uterine activity D. Direct Coombs - CORRECT ANSWERS A. Fetal heart rate
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T/F: Intrauterine pressure catheters (IUPCs) do not increase risk for infection when placed on patients with intact membranes. - CORRECT ANSWERS False Membranes must be ruptured for use; infection is a risk What are abnormal fetal heart rate tracings predictive of? A. Likelihood of spontaneous vaginal delivery B. Newborn condition at time of delivery C. Fetal acid-base abnormalities D. Fetal intrauterine growth - CORRECT ANSWERS C. Fetal acid- base abnormalities Which of the following is not an intervention that should be implemented in a patient with uterine tachysystole? A. Administer terbutaline B. Increase IV fluid rate C. Decrease or discontinue IV oxytocin D. Prepare patient for cesarean section - CORRECT ANSWERS D. Prepare patient for cesarean section Which of the following is most effective in determining the strength of a patient's contractions? A. Patient report B. Tocodynanamometer tracing C. RN palpation D. Sterile vaginal exam during a contraction - CORRECT ANSWERS C. RN palpation The FHR is controlled by the A. Sympathetic nervous system B. Sinoatrial node C. Atrioventricular node D. Parasympathetic nervous system - CORRECT ANSWERS B. Sinoatrial node How do baseline heart rates differ in premature fetuses? A. They are often lower B. They are often higher C. They are less likely to have decelerations D. They experience longer accelerations - CORRECT ANSWERS B. They are often higher
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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 - CORRECT ANSWERS D. 3, 2, 4, 1 The _____ is the source of all fetal oxygenation. A. Placenta B. Umbilical cord C. Mother D. Amniotic fluid - CORRECT ANSWERS C. Mother FHTs with recurrent variable decelerations, no accelerations, and minimal variability would be categorized as A. Category I B. Category II C. Category III - CORRECT ANSWERS B. Category II FHTs with absent variability and bradycardia would be categorized as A. Category I B. Category II C. Category III - CORRECT ANSWERS C. Category III FHTs with moderate variability, no accelerations, and early decelerations would be categorized as A. Category I B. Category II C. Category III - CORRECT ANSWERS A. Category I FHTs with accelerations, no decelerations, and minimal variability would be categorized as A. Category I B. Category II C. Category III - CORRECT ANSWERS B. Category II Sinusoidal pattern is categorized as A. Category I B. Category II C. Category III - CORRECT ANSWERS B. Category III
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FHTs with absent variability and no accelerations or decelerations would be categorized as A. Category I B. Category II C. Category III - CORRECT ANSWERS B. Category II Absence of accelerations following fetal stimulation (i.e. scalp stimulation) is categorized as A. Category I B. Category II C. Category III - CORRECT ANSWERS 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 - CORRECT ANSWERS B. Category II FHTs with minimal variability and a baseline of 95bpm would be categorized as A. Category I B. Category II C. Category III - CORRECT ANSWERS B. Category II FHTs with a baseline of 170bpm, moderate variability, and no accelerations or decelerations would be categorized as A. Category I B. Category II C. Category III - CORRECT ANSWERS B. Category II FHTs with a baseline 135bpm, moderate variability, accelerations, and one late deceleration would be categorized as A. Category I B. Category II C. Category III - CORRECT ANSWERS B. Category II A prolonged acceleration lasts greater than ___ minutes and less than ___ minutes. A. 2; 10 B. 2; 20 C. 10; 20 D. 10; 20 - CORRECT ANSWERS A. 2; 10 _______ FHR patterns are those associated with uterine contractions. A. Periodic
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B. 30 min C. 60 min - CORRECT ANSWERS A. 5-15 min The normal FHR baseline A. Decreases during labor B. Fluctuates during labor C. Increases during labor - CORRECT ANSWERS 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 - CORRECT ANSWERS C. Vagal stimulation A likely cause of fetal tachycardia with moderate variability is A. Fetal hypoxemia B. Maternal fever C. Vagal stimulation - CORRECT ANSWERS B. Maternal fever Reduction in FHR variability can result from A. Fetal scalp stimulation B. Medication administration C. Vaginal examination - CORRECT ANSWERS B. Medication administration The primary goal in treatment for late decelerations is to A. Correct cord compression B. Improve maternal oxygenation C. Maximize uteroplacental blood flow - CORRECT ANSWERS C. Maximize uteroplacental blood flow The most frequently observed type of FHR deceleration is A. Early B. Late C. Variable - CORRECT ANSWERS C. Variable Amnioinfusion may be useful in alleviating recurrent decelerations that are A. Early B. Late C. Variable - CORRECT ANSWERS C. Variable Findings indicative of progressive fetal hypoxemia are A. Late decelerations, moderate variability, stable baseline rate
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B. Prolonged decelerations recovering to baseline and moderate variability C. Loss of variability and recurrent late or variable decelerations - CORRECT ANSWERS C. Loss of variability and recurrent late or variable decelerations 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 - CORRECT ANSWERS C. 12 Fetal bradycardia can result during A. The sleep state B. Umbilical vein compression C. Vagal stimulation - CORRECT ANSWERS 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 - CORRECT ANSWERS C. Notify the attending midwife or physician FHR decelerations that are benign and do not require intervention are A. Early B. Late C. Variable - CORRECT ANSWERS A. Early FHR decelerations that results from decreased uteroplacental blood flow are A. Early B. Late C. Variable - CORRECT ANSWERS B. Late FHR decelerations that results from umbilical cord compression are A. Early B. Late C. Variable - CORRECT ANSWERS C. Variable An FHR pattern associated with severe fetal anemia is A. Lambda B. Saltatory C. Sinusoidal - CORRECT ANSWERS C. Sinusoidal
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Interpretation and classification of FHR patterns are based on predictability of fetal status A. At birth B. At the time the pattern is observed C. Over the previous hour - CORRECT ANSWERS B. At the time the pattern is observed Amnioinfusion is an appropriate measure for A. Thick, meconium-stained fluid B. Oligohydramnios C. Recurrent variable decelerations unresolved by position changes - CORRECT ANSWERS C. Recurrent variable decelerations unresolved by position changes Baroreceptors respond to changes in fetal A. Blood pressure B. Oxygen status C. Acid-base status - CORRECT ANSWERS A. Blood pressure Fetal scalp stimulation is appropriate in the context of A. Minimal variability B. Prolonged deceleration C. Bradycardia - CORRECT ANSWERS A. Minimal variability 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 - CORRECT ANSWERS B. Intermittent late decelerations/minimal variability A preterm fetus A. Is more susceptible to hypoxic insults during labor than the term fetus B. Requires internal monitoring if oxytocin is used for labor induction or augmentation C. Should be born via cesarean section unless there are maternal contraindications - CORRECT ANSWERS A. Is more susceptible to hypoxic insults during labor than the term fetus Oxygen is transferred from the mother to the fetus via the placenta through A. Active transport B. Passive diffusion C. Facilitated diffusion - CORRECT ANSWERS B. Passive diffusion Resting tone and intensity of uterine contractions cannot be assessed by A. External tocodynamometer
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B. Manual palpation C. Intrauterine pressure catheter - CORRECT ANSWERS A. External tocodynamometer The FHR characteristic most predictive of a well-oxygenated baby at the time observed is A. Moderate variability B. Stable baseline rate C. Absence of decelerations - CORRECT ANSWERS A. Moderate variability In the context of hypoxemia, fetal blood flow is shifted to the A. Brain B. Liver C. Lungs - CORRECT ANSWERS A. Brain Baroreceptor-mediated decelerations are A. Early B. Late C. Variable - CORRECT ANSWERS C. Variable The primary goal in the treatment of variable decelerations is to A. Correct umbilical cord compression B. Improve maternal oxygenation C. Maximize blood flow to the uterus - CORRECT ANSWERS A. Correct umbilical cord compression Umbilical artery gas results reflect the status of the A. Mother B. Fetus C. Placenta - CORRECT ANSWERS B. Fetus 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 - CORRECT ANSWERS B. Maternal repositioning Most fetal dysrhythmias are not life-threatening, except for _______, which may lead to fetal congestive heart failure. - CORRECT ANSWERS Supraventricular tachycardia
