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lOMoARcPSD|279 160 40 Interpretation of Fetal and Uterine Monitoring
Lesson Assessment
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Question 1 of 15
Which qualities are considered normal when assessing
fetal heart rate (FHR)?
- o FHR variability of <5 beats/min FHR variability of ≤5 beats/min is classified as minimal variability and is considered abnormal or indeterminate and may be a sign of fetal compromise. Correct o Baseline FHRof 140 beats/min A baseline FHR of 110 to 160 beats/min is considered normal. Correct o
FHR variability of 20 beats/min FHR variability of 6 to 25 beats/min is classified as moderate variability and is considered normal (reassuring).
- o Baseline FHR of 100 beats/min A baseline FHR below 110 beats/min is classified as bradycardia and is considered abnormal (nonreassuring).
- o Baseline FHR of 170 beats/min A baseline FHR above 160 beats/min is classified as tachycardia and is considered abnormal (nonreassuring).
Question 2 of 15
Which deceleration is considered a normal finding?
o Variable Variable decelerations may result from reduced blood flow through the umbilical cord; recurrent variable decelerations may indicate hypoxemia and are nonreassuring. oProlonged Prolonged decelerations indicate a prolonged interruption in fetal oxygen supply and are an ominous finding; immediate intervention is needed. Correct
“Variability demonstrates that there is adequate oxygenation of the fetus.” Adequate oxygenation of the fetus, demonstrated by variability, is necessary, and therefore variability is significant. Correct o “Variability suggests that the fetus is able to adapt to the labor process.” Variability is significant because its presence indicates that the autonomic nervous system is intact, allowing the fetus to adapt to the normal stress of labor. o “Variability indicates that the fetus has no congenital abnormalities.” Although variability is a reassuring finding, it cannot predict the presence of congenital abnormalities.
Question 4 of 15
The nurse knows that patient education has been
effective when the patient makes which statement
about the difference between a tocodynamometer and
an intrauterine pressure catheter (IUPC)?
- o“Only the tocodynamometer shows my uterine activity.” Both the tocodynamometer and the IUPC can provide information on uterine activity, such as contraction strength.
- o“The tocodynamometer is much more accurate than the
lOMoARcPSD|279 160 40 IUPC.” Because it is placed internally versus outside of the abdomen, the IUPC would give a more accurate reading. Correct o “The tocodynamometer is positioned outside my body, while the IUPC is positioned inside my body.” Whereas the tocodynamometer is an external monitoring device, the IUPC is an internal monitoring device. o“The tocodynamometer will be connected to my bedside monitor, but the IUPC will not.” Both a tocodynamometer and an IUPC can output information via a bedside monitor.
Question 5 of 15
Which uterine activity indicators does the intrauterine
pressure catheter (IUPC) measure in mm HG?
- o Frequency Frequency is not a pressure calculation. It is determined by the electronic fetal monitor.
- o Duration Duration is not a pressure calculation. It is determined by the electronic fetal monitor. Correct
lOMoARcPSD|279 160 40 Moderate uterine activity would be a description of the frequency of the contractions. The nurse is measuring the uterine pressure. oHypotonic Hypotonic describes uterine activity that is decreased, not increased above the expected 400 MVUs. Correct o Hypertonic Above 400 MVUs, the uterine contraction strength is considered hypertonic, which is abnormal.
Question 7 of 15
Which fetal heart rate finding may result from maternal
fever?
oNo expected changes Maternal fever does affect the fetal heart rate. oProlonged decelerations Prolonged decelerations reflect a disturbance in the oxygen transfer from the environment to the fetus but do not typically result from maternal fever. oFetal heart rate of 90 beats/min for 15 minutes Bradycardia is not caused by maternal fever. Causes of fetal bradycardia include head compression, hypoxia, and acidosis.
Correct o Fetal heart rate of 180 beats/min for 12 minutes A maternal fever can directly increase the fetal temperature or infect the fetus in cases of infection. The fetus responds with an increased heart rate, which can lead to fetal tachycardia.
Question 8 of 1 5
Which nonreassuring fetal heart rate (FHR) pattern
includes a reduction in FHR of ≥15 beats/min for more
than 2 minutes?
oAccelerations Accelerations refers to an increase in fetal heart peaking at least 15 beats/min above the baseline (typically 110 to 160 beats/min), not a decrease in heart rate in relation to a contraction. oTachycardia Tachycardia describes an FHR greater than 160 beats/min as a baseline for at least 10 minutes, not a decrease in heart rate in relation to a contraction. oEarly decelerations Early decelerations mirror the contraction and return to baseline once the contraction is over. FHR nadir is usually no lower than 30 to 40 beats/min from baseline. Correct
Question 10 of 15
The nurse notes fetal tachycardia and suspects that the
patient may be dehydrated. Which nursing action is
appropriate to address this nonreassuring finding?
- oConsult with the dietician. The nurse does not have to consult with the dietician to provide an appropriate intervention for fetal tachycardia.
- oAdminister parenteral feeding. Parenteral feeding is necessary for a woman whose digestive tract cannot absorb nutrients, not to address fetal tachycardia for a woman who is dehydrated. Correct o Increase the rate of intravenous (IV) saline administration. Tachycardia can be the result of maternal hypovolemia caused by dehydration. Increasing the rate of nonadditive intravenous fluids can improve placental perfusion by increasing maternal blood volume.
- oProvide the patient an oral (PO) electrolyte replacement. PO electrolyte replacement may be appropriate to address dehydration but would not result in immediate management of fetal tachycardia.
lOMoARcPSD|279 160 40
Question 11 of 15
Which nursing actions are appropriate when the fetal
monitor shows a pattern of late decelerations?
Correct o Discontinue oxytocin. Discontinuing oxytocin will decrease the effect of uterine stimulants on the contractions. o Provide water to the patient. Although dehydration may be a cause of nonreassuring fetal heart rate patterns, more immediate action is necessary for a pattern of late decelerations. The administration of water is not preferred while the patient is in labor. Correct o Administer oxygen by face mask. Oxygen increases the oxygenation to the patient, which increases perfusion of oxygen to the placenta. Correct o Reposition the patient onto her side. Repositioning the patient on her side, rather than allowing a supine position, is preferred. A supine position increases pressure on the vena cava, which reduces the blood supply, causing decreased perfusion of the placenta.
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Question 13 of 15
A patient arrives at a birthing center in active labor.
Her membranes are still intact, and the health care
provider prepares to perform an artificial rupture of
membranes (AROM). What will the nurse relay to the
patient as the most likely outcome of the procedure?
- oLess pressure on the cervix Rupturing amniotic membranes releases the cushion provided by the amniotic sac and causes an increase in the pressure of the fetal head on the cervix.
- oDecreased number of contractions The rupture of the amniotic membranes typically causes an increase in pressure on the cervix and an increase in uterine contractions. Correct o Increased pressure on the cervix The rupture of the amniotic membranes releases the cushion provided by the amniotic sac and causes an increase in the pressure of the fetal head on the cervix. This increased pressure will often result in an increase in contractions and a decrease in the time for dilation and effacement of the cervix.
- oThe need for more cervical exams Once the amniotic membranes have been ruptured (either spontaneously or artificially), the health care provider should prepare to check the cervix less frequently to decrease the risk for infection.
Question 14 of 15
A nurse is caring for a patient in labor who is receiving
oxytocin via intravenous infusion to stimulate uterine
contractions. Which assessment finding would indicate
to the nurse that the infusion needs to be discontinued?
oThree contractions occurring within a 10-minute period The goal of labor augmentation is to achieve three good- quality contractions in a 10-minute period. Correct o A fetal heart rate of 90 beats/min A normal fetal heart rate is 110 to 160 beats/min. Bradycardia and/or late or variable decelerations indicate fetal distress and the need to discontinue the oxytocin infusion. oA resting uterine tone of 15 mm Hg via the intrauterine pressure catheter A normal resting uterine tone during labor is less than 25 mm Hg via an intrauterine pressure catheter. Any resting tone greater than 25 mm Hg is considered abnormal, and the oxytocin may need to be discontinued. oEarly decelerations An early deceleration mirrors the uterine contraction, and the nadir of the early deceleration occurs with the peak of a contraction. Early decelerations are the result of head compression, which is considered a positive sign of labor
sion of anti bioti cs The administration of antibiotics during labor is only necessary if the patient is positive for group beta strep (GBS), is diagnosed with chorioamnionitis, or has a preexisting condition that requires antibiotics with medical procedures. Antibiotics are not necessary with the administration of IV oxytocin. Correct o Making sure that a vial of terbutaline is immediately available Terbutaline, administered either intravenously or subcutaneously, is a tocolytic that can be used to decrease or stop uterine contractions when uterine tachysystole occurs. Correct o Preparing an IV infusion pump IV oxytocin should only be administered via an IV pump. IV oxytocin during labor should never be administered without the use of a pump for titration. o Placing a code cart at the patient’s bedside The maternity unit should have a code cart available on the unit; however, it is not necessary to have a code cart at the bedside of a patient receiving IV oxytocin for labor induction or augmentation.
