Deck 14: Intrapartum Fetal Surveillance

Question 1

Which statement correctly describes the nurse's responsibility related to electronic monitoring?

A) Report abnormal findings to the physician before initiating corrective actions.
B) Teach the woman and her support person about the monitoring equipment and discuss any of their questions.
C) Document the frequency, duration, and intensity of contractions measured by the external device.
D) Inform the support person that the nurse will be responsible for all comfort measures when the electronic equipment is in place.

Answer 1

Teach the woman and her support person about the monitoring equipment and discuss any of their questions.

Question 2

Why is continuous electronic fetal monitoring generally used when oxytocin is administered?

A) Fetal chemoreceptors are stimulated.
B) The mother may become hypotensive.
C) Maternal fluid volume deficit may occur.
D) Uteroplacental exchange may be compromised.

Answer 2

Uteroplacental exchange may be compromised.

Question 3

The fetal heart rate baseline increases 20 bpm after vibroacoustic stimulation. The best interpretation of this is that the fetus is showing:

A) a worsening hypoxia.
B) progressive acidosis.
C) a reassuring response.
D) parasympathetic stimulation.

Answer 3

a reassuring response.

Question 4

Which can be determined only by electronic fetal monitoring?

A) Variability
B) Tachycardia
C) Bradycardia
D) Fetal response to contractions

Question 5

In which situation would a baseline fetal heart rate of 160 to 170 bpm be considered a normal finding?

A) The fetus is at 30 weeks of gestation.
B) The mother has a history of fast labors.
C) The mother has been given an epidural block.
D) The mother has mild preeclampsia but is not in labor.

Question 6

When the deceleration pattern of the fetal heart rate mirrors the uterine contraction, which nursing action is indicated?

A) Reposition the client.
B) Apply a fetal scalp electrode.
C) Record this reassuring pattern.
D) Administer oxygen by nasal cannula.

Question 7

A client is receiving oxytocin (Pitocin) to induce labor. The uterine contractions have become persistently hypertonic and the infusion is stopped. The health care provider has prescribed a tocolytic to stop contractions. Which medication should the nurse be prepared to administer?

A) Naloxone (Narcan)
B) Terbutaline (Brethine)
C) Ephedrine
D) Diphenhydramine (Benadryl)

Question 8

Which maternal condition should be considered a contraindication for the application of internal monitoring devices?

A) Unruptured membranes
B) Cervix dilated to 4 cm
C) Fetus has known heart defect
D) External monitors currently being used

Question 9

Which nursing action is correct when initiating electronic fetal monitoring?

A) Lubricate the tocotransducer with an ultrasound gel.
B) Securely apply the tocotransducer with a strap or belt.
C) Inform the client that she should remain in the semi-Fowler position.
D) Determine the position of the fetus before attaching the electrode to the maternal abdomen.

Question 10

The nurse is instructing a nursing student on the application of fetal monitoring devices. Which method of assessing the fetal heart rate requires the use of a gel?

A) Doppler
B) Fetoscope
C) Scalp electrode
D) Tocodynamometer

Question 11

Observation of a fetal heart rate pattern indicates an increase in heart rate from the prior baseline rate of 152 bpm. Which physiologic mechanisms would account for this situation?

A) Inhibition of epinephrine
B) Inhibition of norepinephrine
C) Stimulation of the vagus nerve
D) Sympathetic stimulation

Question 12

The nurse is concerned that a client's uterine activity is too intense and that her obesity is preventing accurate assessment of the actual intrauterine pressure. Based on this information, which action should the nurse take?

A) Reposition the tocotransducer.
B) Reposition the Doppler transducer.
C) Obtain an order from the health care provider for a spiral electrode.
D) Obtain an order from the health care provider for an intrauterine pressure catheter.

Question 13

Proper placement of the tocotransducer for electronic fetal monitoring is:

A) inside the uterus.
B) on the fetal scalp.
C) over the uterine fundus.
D) over the mother's lower abdomen.

Question 14

In which situation would it be appropriate to obtain a fetal scalp blood sample to establish fetal well-being?

A) The fetus has developed tachycardia related to maternal fever.
B) The mother has vaginal bleeding, and the baseline fetal heart rate is decreasing.
C) The fetal heart tracing on a preterm fetus shows decreased baseline variability.
D) The fetal heart tracing shows a persistent pattern of late decelerations, with normal baseline variability.

Question 15

The nurse sees a pattern on the fetal monitor that looks similar to early decelerations, but the deceleration begins near the acme of the contraction and continues well beyond the end of the contraction. Which nursing action indicates the proper evaluation of this situation?

A) This pattern reflects variable decelerations. No interventions are necessary at this time.
B) Document this reassuring fetal heart rate pattern but decrease the rate of the intravenous (IV) fluid.
C) Continue to monitor these early decelerations, which occur as the fetal head is compressed during a contraction.
D) This deceleration pattern is associated with uteroplacental insufficiency, so the nurse acts quickly to improve placental blood flow and fetal oxygen supply.

Question 16

When a nonreassuring pattern of the fetal heart rate is noted and the client is lying on her left side, which nursing action is indicated?

A) Lower the head of the bed.
B) Place a wedge under the left hip.
C) Change her position to the right side.
D) Place the mother in Trendelenburg position.

Question 17

When the mother's membranes rupture during active labor, the fetal heart rate should be observed for the occurrence of which periodic pattern?

A) Early decelerations
B) Variable decelerations
C) Nonperiodic accelerations
D) Increase in baseline variability

Question 18

Which is the most appropriate method of intrapartum fetal monitoring when a woman has a history of hypertension during pregnancy?

A) Continuous auscultation with a fetoscope
B) Continuous electronic fetal monitoring
C) Intermittent assessment with a Doppler transducer
D) Intermittent electronic fetal monitoring for 15 minutes each hour

Question 19

If the position of a fetus in a cephalic presentation is right occiput anterior, the nurse should assess the fetal heart rate in which quadrant of the maternal abdomen?

A) Right upper
B) Left upper
C) Right lower
D) Left lower

Question 20

Increasing the infusion rate of nonadditive intravenous fluids can increase fetal oxygenation primarily by:

A) expanding the maternal blood volume.
B) maintaining a normal maternal temperature.
C) preventing normal maternal hypoglycemia.
D) increasing the oxygen-carrying capacity of the maternal blood.

Question 21

The nurse observes the following data on an electronic fetal monitor attached to a client in the active phase of the first stage of labor: fetal heart rate baseline, 125 to 140 bpm, three accelerations over the course of 20 minutes, moderate variability. What is the priority action based on these findings?

A) Document the findings.
B) Contact the health care provider.
C) Increase the rate of the existing IV to 200 mL/hr as per the standing prescription.
D) Place oxygen via a rebreather mask at 10 L/min as per the standing prescription.

Question 22

The nurse is monitoring a client in labor and notes this fetal heart rate pattern on the electronic fetal monitoring strip (see figure). Which is the most appropriate nursing action?

A) Administer oxygen with a face mask at 8 to 10 L/min.
B) Reposition the fetal monitor ultrasound transducer.
C) Assist the client to the bathroom to empty her bladder .
D) Continue to monitor the client and fetal heart rate patterns.

Question 23

To clarify the fetal condition when baseline variability is absent, the nurse should first:

A) monitor fetal oxygen saturation using fetal pulse oximetry.
B) notify the physician so that a fetal scalp blood sample can be obtained.
C) apply pressure to the fetal scalp with a glove finger using a circular motion.
D) increase the rate of nonadditive IV fluid to expand the mother's blood volume.

Question 24

The physician has ordered an amnioinfusion for the laboring client. What data supports the use of this therapeutic procedure?

A) Presenting part not engaged
B) +4 meconium-stained amniotic fluid on artificial rupture of membranes (AROM)
C) Breech position of fetus
D) Twin gestation

Question 25

The nurse is reviewing an electronic fetal monitor tracing from a patient in active labor and notes the fetal heart rate gradually drops to 20 beats per minute (bpm) below the baseline and returns to the baseline well after the completion of the patient's contractions. How will the nurse document these findings?

A) Late decelerations
B) Early decelerations
C) Variable decelerations
D) Proximal decelerations

Question 26

When a pattern of variable decelerations occur, the nurse should:

A) administer O ₂ at 8 to 10 L/min.
B) place a wedge under the right hip.
C) increase the IV fluids to 150 mL/hr.
D) position client in a knee-chest position.

Question 27

Which medications could potentially cause hyperstimulation of the uterus during labor? (Select all that apply.)

A) Oxytocin (Pitocin)
B) Misoprostol (Cytotec)
C) Dinoprostone (Cervidil)
D) Methylergonovine maleate (Methergine)

Question 28

The nurse recognizes that fetal scalp stimulation may be prescribed to evaluate the response of the fetus to tactile stimulation. Which conditions contraindicate the use of fetal scalp stimulation? (Select all that apply.)

A) Post-term fetus
B) Maternal fever
C) Placenta previa
D) Induction of labor
E) Prolonged rupture of membranes

Question 29

Client is at 38 weeks' gestation, gravida 1, para 0, vaginal exam-4 cm, 100% effaced, +1 station vertex. What is the most likely intervention for this fetal heart rate pattern?

A) Continue oxytocin (Pitocin) infusion.
B) Contact the anesthesia department for epidural administration.
C) Change maternal position.
D) Administer Narcan to client and prepare for immediate vaginal delivery.

Question 30

Decelerations that mirror the contractions are present with each contraction on the monitor strip of a multipara who received epidural anesthesia 20 minutes ago. The nurse should:

A) maintain the normal assessment routine.
B) administer O₂ at 8 to 10 L/min by face mask.
C) increase the IV flow rate from 125 to 150 mL/hr.
D) assess the maternal blood pressure for a systolic pressure below 100 mm Hg.

Question 31

The nurse is monitoring a client in labor and notes this fetal heart rate pattern on the electronic fetal monitoring strip (see figure). Which is the most appropriate nursing action?

A) Decrease the rate of the IV fluids.
B) Document the fetal heart rate pattern.
C) Explain to the client that the pattern is reassuring.
D) Perform a vaginal exam to detect a prolapsed cord.

Question 32

When evaluating the client's progress, the nurse knows that four of the five fetal factors that interact to regulate the heart rate are (select all that apply):

A) baroreceptors.
B) adrenal glands.
C) chemoreceptors.
D) uterine activity.
E) autonomic nervous system.

Question 33

The nurse admits a laboring patient at term. On review of the prenatal record, the patient's pregnancy has been unremarkable and she is considered low risk. In planning the patient's care, at what interval will the nurse intermittently auscultate (IA) the fetal heart rate during the first stage of labor?

A) Every 10 minutes
B) Every 15 minutes
C) Every 30 minutes
D) Every 60 minutes

Question 34

A patient at 41 weeks' gestation is undergoing an induction of labor with an IV administration of oxytocin (Pitocin). The fetal heart rate starts to demonstrate a recurrent pattern of late decelerations with moderate variability. What is the nurse's priority action?

A) Stop the infusion of Pitocin.
B) Reposition the patient from her right to her left side.
C) Perform a vaginal exam to assess for a prolapsed cord.
D) Prepare the patient for an emergency cesarean section.

Question 35

Which client is a candidate for internal monitoring with an intrauterine pressure catheter?

A) Obese client whose contractions are 3 to 6 minutes apart, lasting 20 to 50 seconds
B) Gravida 1, para 0, whose contractions are 2 to 3 minutes apart, lasting 60 seconds
C) Multigravida whose contractions are 2 minutes apart, lasting 60 to 70 seconds
D) Gravida 2, para 1, in latent phase whose contractions are irregular and mild

Question 36

What is the most likely cause for this fetal heart rate pattern?

A) Administration of an epidural for pain relief during labor
B) Cord compression
C) Breech position of fetus
D) Administration of meperidine (Demerol) for pain relief during labor

Question 37

Which of the following therapeutic applications provides the most accurate information related to uterine contraction strength?

A) External fetal monitoring (EFM)
B) Internal fetal monitoring
C) Intrauterine pressure catheter (IUPC)
D) Maternal comments based on perception

Question 38

Which of the following is the priority intervention for the client in a left side-lying position whose monitor strip shows a deceleration that extends beyond the end of the contraction?

A) Administer O₂ at 8 to 10 L/min.
B) Decrease the IV rate to 100 mL/hr.
C) Reposition the ultrasound transducer.
D) Perform a vaginal exam to assess for cord prolapse.

Question 39

Which client has the priority need for fetal monitoring?

A) Primigravida at 38 weeks with spontaneous ROM
B) Multigravida at 40 weeks with history of 10-hour labors
C) Multigravida admitted for repeat elective cesarean section
D) Primigravida at 39 weeks with meconium-stained amniotic fluid

Question 40

Which of the following is the priority intervention for a supine client whose monitor strip shows decelerations that begin after the peak of the contraction and return to the baseline after the contraction ends?

A) Increase IV infusion.
B) Elevate lower extremities.
C) Reposition to left side-lying position.
D) Administer oxygen per face mask at 4 to 6 L/min.

Question 41

A nurse documents that the fetal heart rate variability is marked. This indicates that the range is greater than how many beats per minute? Record your answer as a whole number.
_____ bpm

Question 42

Match each term with the correct definition.

Late decelerations

A)Caused by umbilical cord compression
B)Caused by fetal head compression
C)Caused by uteroplacental insufficiency

Question 43

Match each term with the correct definition.

Early decelerations

A)Caused by umbilical cord compression
B)Caused by fetal head compression
C)Caused by uteroplacental insufficiency

Question 44

The nurse is preparing supplies for an amnioinfusion on a client with intact membranes. Which supplies should the nurse gather? (Select all that apply.)

A) Extra underpads
B) Solution of 3% normal saline
C) Amniotic hook to perform an amniotomy
D) Solid intrauterine pressure catheter with a pressure transducer on its tip

Question 45

Match each term with the correct definition.

Variable decelerations

A)Caused by umbilical cord compression
B)Caused by fetal head compression
C)Caused by uteroplacental insufficiency