Question 1

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

Accepted Answer

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

Question 2

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

Accepted Answer

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

Question 3

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?

Accepted Answer

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

Question 4

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

Accepted Answer

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

Question 5

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

Accepted Answer

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 6

The patient presenting 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?

Accepted Answer

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

Question 7

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

Accepted Answer

A)   administer O2 at 8 to 10 L/minute.
B)   place a wedge under the right hip.
C)   increase the IV fluids to 150 mL/hour.
D)   position patient in a knee-chest position.

Question 8

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

Accepted Answer

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 9

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

Accepted Answer

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 10

The nurse is concerned that a patient'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?

Accepted Answer

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 11

Which nursing action is correct when initiating electronic fetal monitoring?

Accepted Answer

A)   Lubricate the tocotransducer with an ultrasound gel.
B)   Securely apply the tocotransducer with a strap or belt.
C)   Inform the patient 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 12

Which clinical finding can be determined only by electronic fetal monitoring?

Accepted Answer

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

Question 13

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

Accepted Answer

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 14

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

Accepted Answer

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.

Question 15

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

Accepted Answer

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 16

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

Accepted Answer

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

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?

Accepted Answer

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

Question 18

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?

Accepted Answer

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

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?

Accepted Answer

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

Question 20

The nurse evaluates a pattern on the fetal monitor that appears similar to early decelerations. 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?

Accepted Answer

A)   This pattern reflects variable decelerations. No interventions are necessary at this time.
B)   Document this Category I fetal heart rate pattern and 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. The nurse must act quickly to improve placental blood flow and fetal oxygen supply.

Exam 14: Intrapartum Fetal Surveillance