CH 14: lntrapartum Fetal Surveillance

Question 1

1. 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?
   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.

Answer 1

ANS: D
A pattern similar to early decelerations, but the deceleration begins near the acme of the
contraction and continues well beyond the end of the contraction, describes a late
deceleration. Oxygen should be given via a snug face mask. Position the patient on her left
side to increase placental blood flow. Variable decelerations are caused by cord compression.
A vaginal examination should be performed to identify this potential emergency. This is not a
normal pattern, rather it is a Category III tracing, predictive of abnormal fetal acid status at the
time of observation. The IV rate should be increased in order to add to the mother’s blood
volume. These are late decelerations, not early; therefore interventions are necessary.

Question 2

2. 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.
   Maternal HIV

Answer 2

ANS: A
To apply internal monitoring devices, the membranes must be ruptured. Cervical dilation of 4
cm would permit the insertion of fetal scalp electrodes and an intrauterine catheter. A
compromised fetus should be monitored with the most accurate monitoring devices. An
internal electrode should not be placed if the patient has hemophilia, maternal HIV, or genital
herpes

Question 3

3. 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

.

Answer 3

ANS: A
Doppler is the only listed method involving ultrasonic transmission of fetal heart rates; it
requires the use of a gel. The fetoscope does not require gel because ultrasonic transmission is
not used. The scalp electrode is attached to the fetal scalp; gel is not necessary. The
tocodynamometer does not require gel. This device monitors uterine contractions

Question 4

4. 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.

Answer 4

ANS: C
The tocotransducer monitors uterine activity and should be placed over the fundus, where the
most intensive uterine contractions occur. The tocotransducer is for external use. The
tocotransducer monitors uterine contractions. The most intensive uterine contractions occur at
the fundus; this is the best placement area

Question 5

5. Which clinical finding can be determined only by electronic fetal monitoring?
   a.
   Variability
   b.
   Tachycardia
   c.
   Bradycardia
   d.
   Fetal response to contractions

Answer 5

ANS: A
Beat-to-beat variability cannot be determined by auscultation because auscultation provides
only an average fetal heart rate (FHR) as it fluctuates. Tachycardia can be determined by any
of the FHR monitoring techniques. Bradycardia can be determined by any of the FHR
monitoring techniques. The fetal response to the contractions is usually noted by an increase
or decrease in fetal heart rate. These can be determined by any of the FHR monitoring
techniques

Question 6

6. Which method of intrapartum fetal monitoring is the most appropriate 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

Answer 6

ANS: B
Maternal hypertension may reduce placental blood flow through vasospasm of the spiral
arteries. Reduced placental perfusion is best assessed with continuous electronic fetal
monitoring to identify patterns associated with this condition. It is not practical to provide
continuous auscultation with a fetoscope. This fetus needs continuous monitoring because it is
at high risk for complications

Question 7

7. 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 7

ANS: D
The uterus may contract more firmly and the resting tone may be increased with oxytocin use.
This response reduces the entrance of freshly oxygenated maternal blood into the intervillous
spaces, depleting fetal oxygen reserves. Oxytocin affects the uterine muscles. Hypotension is
not a common side effect of oxytocin. All laboring women are at risk for fluid volume deficit;
oxytocin administration does not increase the risk.

Question 8

8. 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?
   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.

Answer 8

ANS: D
An intrauterine pressure catheter can measure actual intrauterine pressure. The tocotransducer
measures the uterine pressure externally; this would not be accurate with an obese patient,
even with repositioning. A Doppler auscultates the FHR. A scalp electrode (or spiral
electrode) measures the fetal heart rate (FHR).

Question 9

9. 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

Answer 9

ANS: C

the fetus is in a right occiput anterior position, the fetal spine will be on the mother’s right
side. The best location to hear the fetal heart rate is through the fetal shoulder, which would be
in the right lower quadrant. The right upper, left upper, and left lower areas are not the best
locations for assessing the fetal heart rate in this case

Question 10

10. 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.

Answer 10

ANS: A
The normal preterm fetus may have a baseline rate slightly higher than the term fetus because
of an immature parasympathetic nervous system that does not yet exert a slowing effect on the
fetal heart rate (FHR). Fast labors should not alter the FHR normally. Any change in the FHR
with an epidural is not considered an expected outcome. Preeclampsia should not cause a
normal elevation of the FHR.

Question 11

11. When the deceleration pattern of the fetal heart rate mirrors the uterine contraction, which
    nursing action is indicated?
    a.
    Reposition the patient.
    b.
    Apply a fetal scalp electrode.
    c.
    Record this normal pattern.
    d.
    Administer oxygen by nasal cannula.

Answer 11

ANS: C
The periodic pattern described is early deceleration that is not associated with fetal
compromise and requires no intervention. This is a Category I tracing which is a normal
pattern. Repositioning the patient, applying a fetal scalp electrode, or administering oxygen
would be interventions performed for Category II or III patterns.

Question 12

12. 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

Answer 12

ANS: B

When the membranes rupture, amniotic fluid may carry the umbilical cord to a position where
it will be compressed between the maternal pelvis and the fetal presenting part, resulting in a
variable deceleration pattern. Early declarations are considered reassuring; they are not a
concern after rupture of membranes. Accelerations are considered reassuring; they are not a
concern after rupture of membranes. Increase in baseline variability is not an expected
occurrence after the rupture of membranes

Question 12

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.
an expected response.
d.
parasympathetic stimulation.

Answer 12

ANS: C
The fetus with adequate reserve for the stress of labor will usually respond to vibroacoustic
stimulation with a temporary increase in the fetal heart rate (FHR) baseline. An increase in the
FHR with stimulation does not indicate hypoxia. An increase in the FHR after stimulation is
an anticipated response and does not indicate acidosis. An increase in the FHR after
stimulation is a normal pattern, and does not indicate problems with the parasympathetic
nervous system. A Category I pattern is normal and strongly predictive of adequate fetal
acid-base status.

Question 13

14. 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?
    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.

Answer 13

ANS: C
A Category II pattern indicates an indeterminate fetal heart rate. Repositioning on the opposite
side may relieve compression on the umbilical cord and improve blood flow to the placenta.
Lowering the head of the bed would not be the first position change choice. The woman is
already on her left side, so a wedge on that side would not be an appropriate choice.
Repositioning to the opposite side is the first intervention. If unsuccessful with improving the
FHR pattern, further changes in position can be attempted; the Trendelenburg position might
be the choice.

Question 14

15. 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 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.

Answer 14

ANS: B
The tocotransducer should fit snugly on the abdomen to monitor uterine activity accurately.
The tocotransducer does not need gel to operate appropriately. The patient should be
encouraged to move around during labor. The tocotransducer should be placed at the fundal
area of the uterus

Question 15

16. 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 15

ANS: B
Teaching is an essential part of the nurse’s role. Corrective actions should be initiated first to
correct abnormal findings as quickly as possible. Electronic monitoring will record the
contractions and FHR response. The support person should still be encouraged to assist with
the comfort measure

Question 16

17. 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

Answer 16

ANS: D
Sympathetic nerve innervation would result in an increase in fetal heart rate. The release of
epinephrine as a result of sympathetic innervation would lead to an increase in fetal heart rate.
The release of norepinephrine as a result of sympathetic innervation would lead to an increase
in fetal heart rate. Stimulation of the vagus nerve would indicate parasympathetic innervation
and result in a decreased heart rate.

Question 17

18. 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

Answer 17

ANS: C
IUPC is a clinical tool that provides an accurate assessment of uterine contraction strength.
EFM provides evidence of contraction pattern and fetal heart rate but only estimates uterine
contraction strength. Internal fetal monitoring provides direct evidence of fetal heart rate and
contraction pattern. It only estimates uterine contraction strength. Maternal comments related
to pain may not be related to uterine contraction strength and thus are influenced by the
patient’s own pain perception.

Question 18

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

Answer 18

ANS: B
Variable deceleration patterns are seen in response to head compression or cord compression.
A breech presentation would not be likely to cause this fetal heart rate pattern. Similarly,
administration of medication and/or an epidural would not cause this fetal heart rate pattern.

Question 19

20. 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?
    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.

Answer 19

ANS: C
Late decelerations indicate fetal compromise (uteroplacental insufficiency) and are considered
to be a significant event requiring immediate assessment and intervention. Of all the options
listed, changing maternal position may increase placental perfusion. In the presence of late
decelerations, Pitocin infusion should be stopped. Contacting anesthesia for epidural
administration will not solve the existing problem of late decelerations. There are no data to
support the administration of Narcan and because patient is still in early labor, birth is not
imminent.

Question 20

21. The physician has ordered an amnioinfusion for the laboring patient. Which 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

Answer 20

ANS: B
Amnioinfusion is a procedure utilized during labor when cord compression or the detection of
gross meconium staining is found in the amniotic fluid. An isotonic (Lactated Ringers or
normal saline) solution is used as an irrigation method through the IUPC (intrauterine pressure
catheter)

Question 21

22. Which of the following is the priority intervention for a supine patient 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/minute.

Answer 21

ANS: C
Decelerations that begin at the peak of the contractions and recover after the contractions end
are caused by uteroplacental insufficiency. When the patient is in the supine position, the
weight of the uterus partially occludes the vena cava and descending aorta, resulting in
hypotension and decreased placental perfusion. Increasing the IV infusion, elevating the lower
extremities, and administering O2 will not be effective as long as the patient is in a supine
position

Question 22

23. 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/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.

Answer 22

ANS: A
Decelerations that mirror the contraction are early decelerations caused by fetal head
compression. Early decelerations are not associated with fetal compromise and require no
intervention. Administering O2, increasing the IV flow rate, and assessing for hypotension are
not necessary within early decelerations.

Question 23

24. 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.

Answer 23

ANS: C
Fetal scalp stimulation helps identify whether the fetus responds to gentle massage. An
acceleration in response to the massage suggests that the fetus is in normal oxygen and
acid-base balance. Monitoring fetal oxygen saturation using fetal pulse oximetry is no longer
available in the United States. Obtaining a fetal scalp blood sample is invasive and the results
are not immediately available. Increasing the rate of nonadditive IV fluid would not clarify the
fetal condition.

Question 24

Which patient is a candidate for internal monitoring with an intrauterine pressure catheter?
a.
Obese patient 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

Answer 24

ANS: A
A thick layer of abdominal fat absorbs energy from uterine contractions, reducing their
apparent intensity on the monitor strip. Contraction patterns of 2 to 3 minutes lasting 60
seconds and every 2 minutes lasting 60 to 70 seconds indicate accurate measurement of
uterine activity. Irregular and mild contractions are common in the latent phase.

Question 25

26. Which of the following is the priority intervention for the patient 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/minute.
    b.
    Decrease the IV rate to 100 mL/hour.
    c.
    Reposition the ultrasound transducer.
    d.
    Perform a vaginal exam to assess for cord prolapse.

Answer 25

ANS: A
A deceleration that returns to baseline after the end of the contraction is a late deceleration
caused by placental perfusion problems. Administering oxygen will increase the patient’s
blood oxygen saturation, making more oxygen available to the fetus. Decreasing the IV rate,
repositioning the ultrasound transducer, and performing a vaginal exam to assess for cord
prolapse are not effective interventions to improve fetal oxygenation

Question 26

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

Answer 26

ANS: D

Variable decelerations are caused by conditions that reduce flow through the umbilical cord.
The patient should be repositioned when the FHR pattern is associated with cord compression.
The knee–chest position uses gravity to shift the fetus out of the pelvis to relieve cord
compression. Administering oxygen will not be effective until cord compression is relieved.
Increasing the IV fluids and placing a wedge under the right hip are not effective interventions
for cord compression.

Question 27

28. 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

Answer 27

ANS: A
Late decelerations are similar to early decelerations in the degree of FHR slowing and lowest
rate (30 to 40 bpm) but are shifted to the right in relation to the contraction. They often begin
after the peak of the contraction. The FHR returns to baseline after the contraction ends. The
early decelerations mirror the contraction, beginning near its onset and returning to the
baseline by the end of the contraction, with the low point (nadir) of the deceleration occurring
near the contraction’s peak. The rate at the lowest point of the deceleration is usually no lower
than 30 to 40 bpm from the baseline. Conditions that reduce flow through the umbilical cord
may result in variable decelerations. These decelerations do not have the uniform appearance
of early and late decelerations. Their shape, duration, and degree of fall below baseline rate
vary. They fall and rise abruptly (within 30 seconds) with the onset and relief of cord
compression, unlike the gradual fall and rise of early and late decelerations. Proximal
deceleration is not a recognized term

Question 28

29. 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 birth.

Answer 28

ANS: A

There are multiple reasons for late decelerations. Address the probable cause first, such as
uterine hyperstimulation with Pitocin, to alleviate the outcome of late decelerations.
Repositioning can increase oxygenation to the fetus but does not address the cause of the
problem. Variable decelerations are more often seen with a prolapsed cord. In the presence of
moderate variability, the fetus continues to have adequate oxygen reserves. If a Category II
(indeterminate) or III (abnormal) tracing is interpreted, a prompt approach to assessing
oxygenation should be completed.

Question 29

30. 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

Answer 29

ANS: C
Evaluate the fetal monitoring strip systematically for the elements noted. The following are
recommended assessment and documentation intervals for IA and EFM (although facility
policies may be different): low-risk women, every 30 minutes during the active phase and
every 15 minutes during the second stage

Question 30

The nurse is monitoring a patient 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/minute

b. Reposition the fetal monitor ultrasound transducer.

c. Assist the patient to the bathroom to empty her bladder.

d. Continue to monitor the patient and FHR patterns.

Answer 30

ANS A:

Late decelerations are similar to early decelerations in that the FHR slows (30 to 40 bpm);
however, the decelerations are shifted to the right in relation to the contraction. They often
begin after the peak of the contraction. They reflect possible impaired placental exchange
(uteroplacental insufficiency). Administration of 100% oxygen through a snug face mask
makes more oxygen available for transfer to the fetus. A commonly suggested rate is 8 to 10
L/minute. The pattern is abnormal, so repositioning the fetal ultrasound transducer, assisting
the patient to the bathroom, or continuing to monitor the pattern will not correct the problem.

Question 31

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

a. Decrease the rate of the IV fluids.

b. Document the fetal FHR pattern.

c. Explain to the patient that the pattern is normal

d. Perform a vaginal exam to detect a prolapsed cord

Answer 31

ANS: D
Variable decelerations do not have the uniform appearance of early and late decelerations.
Their shape, duration, and degree of fall below baseline rate vary. They fall and rise abruptly
(within 30 seconds) with the onset and relief of cord compression, unlike the gradual fall and
rise of early and late decelerations. A vaginal examination may identify a prolapsed cord,
which may cause variable decelerations, bradycardia, or both as it is compressed. A vaginal
examination also evaluates the woman’s labor status, which helps the birth attendant decide if
labor should continue. This is a Category III tracing (abnormal); therefore the IV rate should
be increased and an intervention needs to occur.

Question 32

33. Which clinical finding would be considered normal for a preterm fetus during the labor
    period?
    a.
    Baseline tachycardia
    b.
    Baseline bradycardia
    c.
    Fetal anemia
    d.
    Acidosis

Answer 32

ANS: A
Because the nervous system is immature, it is expected that the preterm fetus will have a
baseline tachycardia because of stimulation of the sympathetic nervous system. Baseline
bradycardia, fetal anemia, and acidosis would indicate abnormal findings and fetal
compromise

Question 33

1. 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)

Answer 33

ANS: A, B, C, D
Oxytocin, misoprostol, and dinoprostone fall under the general category of uterine stimulants.
Cytotec and Cervidil are prostaglandins. Methergine is an ergot alkaloid.

Question 34

2. When evaluating the patient’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.

Answer 34

ANS: A, B, C, E
The sympathetic and parasympathetic branches of the autonomic nervous system are balanced
forces that regulate FHR. Sympathetic stimulation increases the heart rate, whereas
parasympathetic responses, through stimulation of the vagus nerve, reduce the FHR, and
maintain variability. The baroreceptors stimulate the vagus nerve to slow the FHR and
decrease the blood pressure. These are located in the carotid arch and major arteries. The
chemoreceptors are cells that respond to changes in oxygen, carbon dioxide, and pH. They are
found in the medulla oblongata and aortic and carotid bodies. The adrenal medulla secretes
epinephrine and norepinephrine in response to stress, causing accelerations in FHR.
Hypertonic uterine activity can reduce the time available for the exchange of oxygen and
waste products; however, this is a maternal factor. The fifth fetal factor is the central nervous
system. The fetal cerebral cortex causes the heart rate to increase during fetal movement and
decrease when the fetus sleeps.

Question 35

3. 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

Answer 35

ANS: B, C, E
Fetal scalp stimulation is not done when there is maternal fever (possibility of introducing
microorganisms into the uterus), placenta previa (placenta overlies the cervix, and hemorrhage
is likely), or prolonged rupture of membranes (risk of infection). Fetal scalp stimulation may
be used to evaluate a post-term fetus’ response to stimulation. It is also used to evaluate a
fetus when labor is being induced

Question 36

4. The nurse is preparing supplies for an amnioinfusion on a patient 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

Answer 36

ANS: A, C
Amnioinfusion is performed with lactated Ringer’s solution or normal saline, not 3%. Normal
saline is infused into the uterus through an intrauterine pressure catheter (IUPC). The
underpads must be changed regularly because fluid leaks out constantly. The membranes need
to be ruptured before an amnioinfusion can be initiated so an amniotic hook will be needed.
The IUPC must have a double lumen to run the infusion through.

Question 37

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

Answer 37

ANS:
25

There are four categories of fetal heart rate variability:
Absent: Amplitude range is visually undetectable
Minimal: Detectable to less than or equal to 5 beats/minute
Moderate (normal): 6 to 25 beats/minute
Marked: Range >25 beats/minute