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AWHONN ADVANCED FETAL MONITORING EXAM| 2025 -
2026|REAL 270+EXAM Qs&As|GRADED A+|
What do you observe in the tracing that rules out metabolic acidemia at this time? ANS:->>>A: 15x15 accelerations What pattern is observed in the fetal heart tracing? ANS:->>>A. Late decelerations What extrinsic factor can you identify as a possible cause for the observed pattern? ANS:->>>C. Aging placenta What physiologic goals are priorities for Olivia's care? ANS:->>>B. Maximize oxygenation and maintain appropriate uterine activity What bedside interventions are appropriate for Olivia at this time? ANS:->>>C. Position change to a lateral position and initiate a 500-mL IVFB. What could Olivia's nurse do during second stage of labor to promote oxygenation? ANS:->>>B. Encourage Olivia to push with every other contraction Did the fetal monitor tracing prior to delivery accurately predict the cor ANS:->>>A> Yes, the presence of moderate variability rules out the metabolic acidemia.
What is the baseline FHR? ANS:->>>B. 160 bpm What type of variability is observed? ANS:->>>A. Moderate What interventions are appropriate at this time? ANS:->>>C. Reposition Shelby from left lateral to right lateral What type of pattern is observed in the tracing? ANS:->>>B. Variable decelerations What category is this tracing? ANS:->>>B. Category II What is the baseline rate? ANS:->>>C. Unable to determine Based on your observation of the tracing, what action(s) is (are) required? ANS:->>>B. Palpate Shelby's radial pulse to verify maternal vs. fetal heart rate Which statement most accurately reflects the EFM tracing? ANS:->>>A. Maternal and fetal heart rates should be verified Which pattern in the fetal heart rate would increase suspicion of a nuchal cord?
is caused by:ANS:->>>A. Occlusion of the umbilical vein When assessing a FHR tracing, the first step is to:ANS:->>>C. Establish the baseline rate Which deceleration in the FHR is considered benign and does not require an intervention to correct?ANS:->>>A. Early deceleration If the umbilical vein is the only vessel occluded during cord compressionANS:-
B. Oxygenated blood may be restricted from being delivered to the fetus During a fetal sleep cycle, FHR variability is usually .ANS:->>>C. Minimal Uterine tachysystole is defined as:ANS:->>>B. >5 contractions in 10 mind over 30 minutes Maternal-fetal oxygen and nutrient transfer takes place in the:ANS:->>>B. intervillous space During a contraction, the tocodynamometer detects:ANS:->>>A. Pressure created by tensing of uterine muscle If fetal arterial pressure begins to fall below normal levels:ANS:->>>A. BARORECEPTORS CAUSE VASOCONSTRICTION AND INCREASE THE FHR An increase in arterial blood pressure produces vessel distension and causes arterial baroreceptors to send neuronal messages to the cardioinhibitory center,
which in turn causes rapid slowing of the fetal heart rate via the parasympathetic vagus nerve. A decrease in arterial pressure results in an increased heart rate. Source: https://perigen.com/what-regulates-fetal-heart-rate/ Which of the following is an extrinsic influence on the FHR? ANS:->>>Fetal- placental circulation Fetal heart rate vaiability is definded as fluctuations in the baseline that are irregular in ANS:->>>AMPLITUDE and FREQUENCY The most highly oxygenated blood in fetal circulation is carried by: ANS:->>>Ductus venosus An increase in the fetal heart rate immediately preceding a variable deceleration is caused by: ANS:->>>Occlusion of the umbilical vein The etiology of variable decelerations is likely related to umbilical venous and arterial occlusion. Initially, with occlusion of the thin-walled umbilical vein, venous return to the fetal right atrium is reduced, producing a reflex tachycardia. This pattern often is observed as a shoulder on the FHR monitor strip immediately before the abrupt variable FHR deceleration Source: https://www.glowm.com/section- view/heading/Intrapartum%20Fetal%20Monitoring/item/202#
Following birth, a fetal cord blood sample is taken. The results are: pH: 6. pCO2: 86 mmHg pO2: 4 mmHg BE: - 18.6 mEq/L These results are best interpreted as:ANS:->>>mixed acidemia A characteristic of variable decelerations is:ANS:->>>The onset of the deceleration is abrupt Stimulation of the vagus nerve in a healthy fetus will cause:ANS:->>>a decrease in fetal heart rate Umbilical arterial cord blood gas results are as follows pH: 6. pCO2: 48 pO2: 4. BE: - 23.7ANS:->>>metabolic academia Cat 1ANS:->>>What category rules out fetal acidemia? Severe astha, cardiac issues, and ecclampic seizuresANS:->>>What maternal conditions greatly impact fetal oxygenation? intervillous spaceANS:->>>Where does the exchange of O2 and nutrients take
place? O2 enters the intervillous space via the maternal arteries, to the villi then the umbilical vein take the o2 blood to the fetus. The umbilical arteries take the deO2 blood from the baby through the villi and back to the motherANS:-
How is o2 blood transferred to the fetus? High to low concentration Mom to fetus for O Low to high concentration for CO2 so baby to momANS:->>>Diffusion DiffusionANS:->>>How is O2 transferred from mom to baby Carry O2 into intervillous space Are maximally dilated so they can not be increasedANS:->>>Explain spiral arteries in placenta Maternal conditions like pre-e and cardiac disease Maternal hypotension Placental changes- abruptions, infections, edema, or smaller size Excessive uterine activity VasoconstrictionANS:->>>What are factors that can decrease uteroplacental blood flow?
Shunt that allows most O2 blood to fetal heart ductus venosus, foramen ovale, ductus arteriosusANS:->>> 3 important shunts in fetal circulation Foramen OvaleANS:->>>connects the two atria in the fetal heart Allows O2 blood to flow through the heart and directly to the brain Ductus ArteriosusANS:->>>a blood vessel in a fetus that bypasses pulmonary circulation by connecting the pulmonary artery directly to the ascending aorta 80 - 100 mL/kgANS:->>>What is a normal blood volume for a fetus at term? Increased heart rateANS:->>>What happens if you stimulate the sympathetic nervous system? Regulates the sympatheticANS:->>>What does the parasympathetic nervous system do? Increased heart rateANS:->>>What happens when catecholamines (sympathetic) get released? The sympathetic develops first so there is no parasympathetic to regulate the heart rateANS:->>>Why do pre-termers have increased heart rates?
Acetylcholine is released which decreases the intrinsic heart rate Vagus stimulationANS:->>>What happens when the parasympathetic nervous system is stimulated? Protect Regulates BPANS:->>>What do baroreceptors do? Decreased FHR, BP and COANS:->>>What effect do baroreceptors have on the fetus? The cord gets compressed and then fetal BP increased which triggers baroreceptors that decreased the FHR which produces a variableANS:-
What happens when there is cord compression (in regards to baroreceptors)? VariablesANS:->>>What decels relate to baroreceptors? LatesANS:->>>What decels relate to chemoreceptors? Increased PCO Decreased PO2 and pHANS:->>>What action takes place when chemoreceptors are stimulated? Bradycardia and hypertensionANS:->>>What effect do chemoreceptors have? Decreased or absent variability - CORRECT ANSWER
acidosis (causes cellular death).ANS:->>>Explain the oxygenation depletion cascade 60 - 90 minutesANS:->>>How one does it take for significant acidemia to take place? Adrenergic activityANS:->>>What is marked variability mediated by? Opioids, magnesium, and tobacco (medications or drugs) Fetal sleep cycles Fetal acidemia- there will be no accels hereANS:->>>What are things that can cause decreased variability? 10x10ANS:->>>What accelerations do gestations less than 32 weeks need? Fetal head compression leads to altered cerebral blood flow which produces a vagabond reflex and cardiac slowingANS:->>>Describe the reasoning for early decels Uteroplacental insufficiency results in decreased maternal/fetal O transferANS:->>>Describe the physiology of a late decel It's neurogenic Exclude clinically significant acidemia Provide interventions to increase perfusionANS:->>>What do late decels with moderate variability mean and indicate?
Means myocardial depression Expedited deliveryANS:->>>What do late decels with decreases variability mean and indicate? Interruption of uteroplacental perfusion or exchange- tachysystole, maternal hypotension, maternal hypoxia (seizure or cardiac arrest), placental abruption, or uterine rupture Interruption of umbilical blood flow- cord compression, cord prolapse, or ruptured vasa previaANS:->>>What are 3 causes of prolonged decels? Vasa previaANS:->>>Presence of fetal (not placental) blood vessels that cross the internal cervical os (marginal or velamentous cord insertions or with succenturiate lobes). Umbilical cord crosses the internal cervial os parasympathetic nervous systemANS:->>>What nervous system has control over bradycardia? Fever Dehydratio n Infection Medications- terbutaline, albuterol, atropine, cocaine, or caffeine Medical conditions- hyperthyroidismANS:->>>What are some maternal conditions that can lead to fetal tachycardia?
10 to 15 minutesANS:->>>What is the biologic half-life of oxytocin? 30 to 60 minutesANS:->>>How long does it take to reach a steady state of plasma concentration for Pitocin? During the first stage of labor with recurrent they are both the cells that have not resolved with position changesANS:->>>When should an amnioinfusion be used? Late decelerations, active pushing, meconium, VBAC or TOLACANS:-
When should and amnioinfusion not be used? Maintain fetal physiologic reserve and maximize fetal oxygenationANS:- What is the main goal during the second stage of labor? Pushing is approximately 6 to 8 seconds and repeated four timesANS:- What is open glottis pushing? Fergusons reflexANS:->>>Spontaneous urge to push during labor that occurs when the presenting part (of the fetus) reaches the pelvic floor; may occur without full cervical effacement Any type of bleedingANS:->>>What is a contraindication for terbutaline? 7.20-7. Greater than or equal to 7.10ANS:->>>What is normal pH in the umbilical artery?
49 to 56 Less than 60 ANS:->>>What is the normal PCO2 for an umbilical artery? 22 to 24 greater than 22 ANS:->>>What is the normal HCO3 in an umbilical artery?
- 2.7-(-3.6) Greater than - 12 ANS:->>>What is the normal BE for an umbilical artery? When there is a buildup of carbon dioxide in the fetus Can happen during cord compressionANS:->>>What is respiratory acidemia? Decreased first Apgar then a normal APGARANS:->>>What do normal Apgars look like for a baby with respiratory acidemia? The type of metabolism that takes place when there is no available oxygen so glucose is used where it is converted into lactic acid The base attempts to neutralize the lactic acid so there is usually a buildup of hydrogen ions Can lead to metabolic acidemiaANS:->>>What is anaerobic metabolism? When the base gets depleted so there is a buildup of hydrogen ions in lactic acid within the fetus This decreases the pH within the fetus which can lead to possible cell death
Pseudo sinusoidal patternsANS:->>>What can stadol and Nubian cause in fetal heart rates? Decrease variability and increased uterine activityANS:->>>What can cocaine cause in regards to uterine activity and fetal heart rates? Decrease variability for 48 hoursANS:->>>What can betamethasone cause in regards to fetal heart rate? Increased fetal heart rate baseline and increase maternal heart rateANS:-
What terbutaline cause? By sending and receiving US waves through the mothers abdomen When the waves are reflected from moving objects like the fetal heart the frequency changes slightly This change is then analyzed by the electronics inside the transducer and converted into audible beepsANS:->>>How do you fetal dopplers work? Convert FECG to fetal heart rate by measuring consecutive R to R wave intervalsANS:->>>How do fetal scalp electrodes work? Increased caffeine intakeANS:->>>What can cause an irregular rhythm in a fetus? Requires a risk benefit analysis Digoxin or other drugs like amiodaroneANS:->>>What can be done to treat
Fetal SVT? Maternal lupusANS:->>>What can cause a complete or third-degree heart block in a fetus? 50 to 70 bpmANS:->>>What ventricular rate in a fetus is associated with a complete or third-degree heart block? A pacemaker implantationANS:->>>How can a complete heart block be treated in a neonate? Hypoxemia can lead to shunting which leads to decreased renal perfusion which then causes a decrease in AFIANS:->>>How can hypoxemia lead to a decreased AFI in a fetus? CSTANS:->>>What is the most accurate test for evaluating risk of fetal death within seven days of a reassuring test? 10 distinct movements in two hoursANS:->>>What is a normal fetal movement count? Accelerations peak greater than 15 bpm above the baseline and last for greater than 15 secondsANS:->>>What is a reactive NST for greater than 32 weeks? Accelerations with a peak of greater than 10 bpm above the baseline and duration of longer than 10 secondsANS:->>>What is a reactive NST for less than 32
