Maternity Nursing Chap 11

Question 1

The goals of intrapartum fetal heart rate monitoring are to identify and differentiate the ____________ patterns from the __________ patterns that indicate fetal compromise. Fetal hypoxemia is a deficiency of oxygen in the arterial blood, whereas fetal hypoxia is an inadequate supply of oxygen at the cellular level.

Answer 1

• normal (reassuring)

- abnormal (nonreassuring)

Question 2

One method to assess fetal status is intermittent __________, using a fetoscope or ultrasound device to listen to the FHR.

Answer 2

-auscultation

Question 3

_______ is the method used to assess the FHR pattern continuously. Two modes can be used to accomplish this method of assessment. External monitoring uses a ultrasound transducer to assess the FHR pattern and a tocotransducer to monitor the frequency and duration of contractions. Internal monitoring uses a spiral electrode attached to the fetal presenting part to assess the FHR pattern and an intrauterine pressure catheter to monitor the frequency, duration, and intensity of contractions.

Answer 3

-EFM

Question 4

Compression of the umbilical cord can result in a ________ FHR pattern. Amnioinfusion can be used to instill normal saline or lactated Ringer’s solution into the uterine cavity via the intrauterine catheter to add fluid around the umbilical cord and thus prevent its compression during uterine contractions.

Answer 4

-variable deceleration

Question 5

________ therapy can be used when fetal compromise occurs related to increased uterine activity. Tocolysis improves blood flow through the placenta by inhibiting uterine contractions. Terbutaline can be administered to achieve a reduction in uterine activity.

Answer 5

-tocolytic

Question 6

Factors associated with a reduction in fetal oxygen supply:

Answer 6

• reduction in blood flow through the maternal vessels
• reduction in oxygen content of maternal blood
• alterations in fetal circulation
• reduction in blood flow in placenta

Question 7

Characteristics of nonreassuring FHR patterns:

Answer 7

-characteristics are fully identified in terms of changes in rate, variability, and pattern associated with uterine contractions

Question 8

Average FHR range of 110 to 160 beats/min at term as assessed during a 10 min period that excludes periodic and episodic changes and periods of marked variability?

Answer 8

-baseline FHR

Question 9

Persistent (longer than 10 mins) baseline FHR below 110 beats/min?

Answer 9

-bradycardia

Question 10

Visually apparent decrease in the FHR of 15 beats/min or more below baseline that lasts longer than 2 mins but less than 10 mins?

Answer 10

prolonged deceleration

Question 11

Changes from baseline patterns in FHR that occur with uterine contractions?

Answer 11

periodic changes

Question 12

Persistent (longer than 10 mins) baseline FHR above 106 beats/mins?

Answer 12

tachycardia

Question 13

Expected irregular fluctuations of the baseline FHR of two or more cycles per min?

Answer 13

variability

Question 14

FHR decrease shortly after onset of a contraction in response to uteroplacental insufficiency?

Answer 14

early decelerations

Question 15

FHR decrease after the peak of a contraction in response to uteroplacental insufficiency?

Answer 15

late decelerations

Question 16

FHR decrease at any time during a contraction in response to umbilical cord compression?

Answer 16

variable decelerations

Question 17

Visually apparent abrupt increase in the FHR of 15 beats/min or more above the baseline that lasts 15 seconds or longer, with return to baseline less than 2 mins after onset?

Answer 17

acceleration

Question 18

Changes from baseline patterns in FHR that are not associated with uterine contractions?

Answer 18

episodic (nonperiodic) changes

Question 19

Low risk patient (risk factors are absent during labor): auscultate FHR/assess tracing with __________ in the latent phase of the first stage of labor, every ______ in the active and transition phases of the first stage of labor, and every ______ in the second stage of labor.

Answer 19

• maternal vital signs
• 30 mins
• 15 mins

Question 20

High risk patient (risk factors are present during labor): auscultate FHR/assess tracing with ___________ in the latent phase of the first stage of labor, every _______ in the active and transition phases of the first stage of labor, and every _______ in the second stage of labor.

Answer 20

• maternal vital signs
• 15 mins
• 5 mins

Question 21

What are the advantages and disadvantages for intermittent auscultation to assess fetus during labor?

Answer 21

• advantages: high-touch/low-tech approach, natural method that facilitates activity, comfortable and noninvasive
• disadvantages: inconvenient, time consuming, increased anxiety of patient if nurse has difficulty locating point of maximal intensity, less information is determines about the FHR pattern

Question 22

Characteristics of reassuring FHR patterns:

Answer 22

• include baseline
• 110 to 160 beats/min
• no periodic changes
• moderate baseline irritability
• accelerations with fetal movement

Question 23

Characteristics of normal uterine activity:

Answer 23

• frequency of contractions every 2 to 5 mins
• duration less than 90 seconds
• moderate to strong intensity or intensity less than 100 mm Hg
• rest period of at least 30 seconds, with average intrauterine pressure of 15 mm Hg

Question 24

True or False: An abnormal (nonreassuring) FHR pattern indicates that the fetus is compromised and is experiencing some degree of hypoxemia or both.

Answer 24

True

Question 25

True or False: Auscultation should be performed during a uterine contraction and for at least 10 seconds after the end of the contraction to detect periodic changes in pattern.

Answer 25

False:

Question 26

True or False: FHR variability can temporarily decrease when the fetus is in a sleep state.

Answer 26

True

Question 27

True or False: When external monitoring is used, the tocotransducer should be repositioned every 3 to 4 hours.

Answer 27

False:

Question 28

True or False: Maternal supine hypotensive syndrome reduces blood flow to the placenta, resulting in fetal hypoxia as reflected in fetal bradycardia, absent or minimal variability, and late decelerations.

Answer 28

True

Question 29

True or False: Acceleration of the FHR associated with fetal movement is a reassuring sign.

Answer 29

True

Question 30

True or False: Decelerations of the FHR can be either benign or nonreassuring in terms of fetal well being.

Answer 30

True

Question 31

True or False: Late deceleration patterns are characterized by a U or V shape with acceleration shoulders before and after the deceleration.

Answer 31

False:

Question 32

True or False: Early decelerations are nonoreassuring patterns that typically occur when blood flow through the placenta is diminished.

Answer 32

False:

Question 33

True or False: The average intrauterine pressure during a contraction ranges from 50 to 85 mm Hg.

Answer 33

True

Question 34

True or False: The tocotransducer should be placed on the abdomen over the fundus.

Answer 34

True

Question 35

True or False: The intrauterine pressure catheter is able to assess uterine contraction frequency, duration, and intensity.

Answer 35

True

Question 36

True or False: A Ritgen maneuver is used to determine the correct placement of the ultrasound transducer.

Answer 36

False:

Question 37

True or False: Late deceleration patterns are caused by uteroplacental insufficiency.

Answer 37

True

Question 38

A laboring woman’s uterine contractions are being monitored internally. When evaluating the monitor tracing, which of the following findings would be a source of concern and require further assessment?

a. frequency every 2 1/2 to 3 mins
b. duration of 80 to 85 seconds
c. intensity during a uterine contraction of 85 to 90 mm Hg
d. average resting tone of 20 to 25 mm Hg

Answer 38

d. average resting tone of 20 to 25 mm Hg

- all the rest are normal findings

Question 39

External electronic fetal monitoring will be used for a woman just admitted to the labor unit in active labor. A guideline that the nurse should follow when implementing this form of monitoring would be to:

a. use Leopold maneuvers to determine the correct placement of the tocotransducer
b. apply contact gel to the ultrasound transducer before application over the point of maximum intensity
c. reposition the ultrasound transducer every hour and massage the site
d. apply a spiral electrode if abnormal (nonreassuring) FHR signs are noted

Answer 39

b. apply contact gel to the ultrasound transducer before application over the point of maximum intensity

Question 40

The nurse caring for women in labor should be aware of signs characterizing normal (reassuring) FHR patterns. A reassuring signs would be:

a. moderate baseline variability
b. average baseline FHR of 90 to 110 beats/min
c. transient episodic deceleration with movement
d. late deceleration patterns approximately every 3 to 4 contractions.

Answer 40

a. moderate baseline variability

Question 41

A laboring woman’s temperature is elevated as a result of an upper respiratory infection. The FHR pattern that reflects maternal fever would be:

a. diminished variability
b. variable deceleration
c. tachycardia
d. early deceleration

Answer 41

c. tachycardia

Question 42

A nulliparous woman is in the active phase of labor, and her cervix has progressed to 6 cm dilation. The nurse caring for this woman evaluates the external monitor tracing and notes the following: decrease in FHR shortly after onset of several uterine contractions, returning to baseline rate by the end of the contraction; shape is uniform. On the basis of these findings, the nurse should:

a. change the woman’s position to her left side
b. document the finding on the woman’s chart
c. notify the physician
d. perform a vaginal examination to check for cord prolapse

Answer 42

b. document the finding on the woman’s chart