MIDTERM: Fetal Monitoring

Question 1

What does moderate fetal heart rate variability indicate?

a) Fetal hypoxia
b) Normal fetal acid-base balance
c) Uteroplacental insufficiency
d) Fetal bradycardia

Answer 1

b) Normal fetal acid-base balance

Rationale: Moderate fetal heart rate variability (6–25 bpm) reflects adequate fetal oxygenation and a normal autonomic nervous system response, indicating a healthy acid-base balance.

Question 2

Which fetal monitoring finding is most reassuring?

a) Minimal variability with late decelerations
b) Accelerations of 15 bpm lasting at least 15 seconds
c) Marked variability with early decelerations
d) Variable decelerations without recovery

Answer 2

b) Accelerations of 15 bpm lasting at least 15 seconds

Rationale: Accelerations signify fetal well-being, reflecting an intact central nervous system and adequate oxygenation.

Question 3

Which deceleration type is associated with uteroplacental insufficiency?

a) Late decelerations
b) Early decelerations
c) Variable decelerations
d) Prolonged decelerations

Answer 3

a) Late decelerations

Rationale: Late decelerations occur after the contraction peak and are caused by uteroplacental insufficiency, indicating fetal hypoxia.

Question 4

What is the primary purpose of intrauterine pressure catheters (IUPC)?

a) To monitor fetal heart rate variability
b) To detect uteroplacental insufficiency
c) To identify fetal hypoxia
d) To evaluate uterine contraction intensity and resting tone

Answer 4

d) To evaluate uterine contraction intensity and resting tone

Rationale: IUPCs directly measure uterine contraction pressure and resting tone, providing more accurate data than external monitoring (TOCO).

Question 5

Which fetal heart rate pattern requires immediate intervention?

a) Accelerations lasting longer than 15 seconds
b) Minimal variability with recurrent late decelerations
c) Moderate variability with early decelerations
d) Marked variability for less than 5 minutes

Answer 5

b) Minimal variability with recurrent late decelerations

Rationale: Minimal variability combined with recurrent late decelerations suggests fetal hypoxia and requires immediate intervention to improve oxygenation.

Question 6

What is the appropriate intervention for variable decelerations caused by cord compression?

a) Administer oxygen at 10 L/min via face mask

b) Perform a vaginal examination to evaluate for prolapsed cord

c) Increase the Pitocin infusion rate

d) Reposition the patient to relieve cord compression

Answer 6

d) Reposition the patient to relieve cord compression

Rationale: Repositioning can alleviate pressure on the umbilical cord, resolving variable decelerations.

Question 7

Which of the following is an indication to stop Pitocin during labor?

a) Uterine contractions every 5 minutes

b) Baseline fetal heart rate of 130 bpm

c) Recurrent late decelerations or uterine tachysystole

d) Presence of early decelerations

Answer 7

c) Recurrent late decelerations or uterine tachysystole

Rationale: Pitocin should be stopped if there are signs of fetal distress, such as recurrent late decelerations, or uterine tachysystole to reduce the risk of hypoxia.

Question 8

What is the frequency of uterine contractions measured in?

a) Seconds from start to end of a contraction
b) Minutes from the start of one contraction to the start of the next
c) Amplitude of uterine pressure in mmHg
d) Time from the peak of one contraction to the peak of the next

Answer 8

b) Minutes from the start of one contraction to the start of the next

Rationale: Uterine contraction frequency is measured in minutes from the beginning of one contraction to the beginning of the next.

Question 9

*Which fetal heart rate variability level is associated with fetal distress?

a) Moderate variability
b) Minimal variability lasting >20 minutes
c) Marked variability lasting >30 minutes
d) Absent variability

Answer 9

d) Absent variability

Rationale: Absent variability is a non-reassuring sign and indicates potential fetal hypoxia or acidemia.

Question 10

What is the purpose of uterine resuscitation interventions during labor?

a) To increase uterine contractions
b) To reduce maternal blood pressure
c) To improve placental perfusion and fetal oxygenation
d) To accelerate fetal descent

Answer 10

c) To improve placental perfusion and fetal oxygenation

Rationale: Uterine resuscitation interventions, such as repositioning and oxygen administration, aim to enhance placental perfusion and fetal oxygenation.

Question 11

What is a key feature of early decelerations on fetal monitoring?

a) They occur after the peak of a contraction.
b) They mirror the contraction in timing and shape.
c) They are caused by umbilical cord compression.
d) They require immediate emergency intervention.

Answer 11

b) They mirror the contraction in timing and shape.

Rationale: Early decelerations mirror the contraction and are caused by fetal head compression, which is typically benign.

Question 12

Which intervention is recommended for uterine tachysystole? (Select all that apply)

a) Stop Pitocin infusion
b) Administer a tocolytic, such as terbutaline
c) Increase IV fluid rate
d) Apply fundal pressure
e) Perform an amnioinfusion

Answer 12

a) Stop Pitocin infusion
b) Administer a tocolytic, such as terbutaline
c) Increase IV fluid rate

Rationale: Uterine tachysystole is managed by stopping Pitocin, administering a tocolytic to reduce contraction frequency, and increasing IV fluids to improve uteroplacental perfusion. Fundal pressure and amnioinfusion are not indicated in this situation.

Question 13

A patient is in active labor with continuous external fetal monitoring. The nurse observes no variability in the fetal heart rate tracing over a 20-minute period. What is the priority nursing action?

a) Administer oxygen via mask at 10 L/min.

b) Notify the provider immediately.

c) Reassess the variability in 30 minutes.

d) Prepare the patient for delivery.

Answer 13

b) Notify the provider immediately.

Rationale: Absent variability is a sign of possible fetal hypoxia or distress and requires immediate evaluation by the provider.

Question 14

A 38-week pregnant patient is undergoing a non-stress test (NST). Two accelerations of 18 bpm lasting 20 seconds each are noted within 15 minutes. How should the nurse interpret this NST?

a) Non-reactive

b) Reactive

c) Inconclusive

d) Abnormal

Answer 14

b) Reactive

Rationale: A reactive NST requires two accelerations of at least 15 bpm lasting 15 seconds in a 20-40 minute period.

Question 15

The fetal monitor shows abrupt drops in FHR unrelated to uterine contractions. What is the likely cause of the decelerations?

a) Head compression

b) Placental insufficiency

c) Umbilical cord compression

d) Maternal hypotension

Answer 15

c) Umbilical cord compression

Rationale: Variable decelerations are caused by cord compression, which disrupts blood flow to the fetus.

Question 16

A nurse notices that the FHR decelerates after the peak of contractions in a patient on oxytocin. What is the most appropriate intervention?

a) Increase IV fluids.

b) Stop oxytocin infusion.

c) Notify the provider immediately.

d) Administer a tocolytic.

Answer 16

b) Stop oxytocin infusion.

Rationale: Late decelerations indicate placental insufficiency, often exacerbated by excessive uterine activity. Stopping oxytocin reduces contraction frequency.

Question 17

A patient on Pitocin has 6 contractions in 10 minutes, with each contraction lasting over 120 seconds. What should the nurse do first?

a) Administer oxygen at 10 L/min.

b) Turn the patient to a lateral position.

c) Notify the provider immediately.

d) Stop the Pitocin infusion.

Answer 17

d) Stop the Pitocin infusion.

Rationale: Tachysystole can compromise fetal oxygenation. Stopping Pitocin is the first step to decrease contraction frequency.

Question 18

The FHR tracing shows a consistent range of 170 bpm. What is this finding called, and what should the nurse do?

a) Fetal bradycardia; administer oxygen.

b) Fetal tachycardia; investigate maternal temperature.

c) Normal baseline; continue monitoring.

d) Tachysystole; reduce Pitocin.

Answer 18

b) Fetal tachycardia; investigate maternal temperature.

Rationale: Fetal tachycardia (>160 bpm) can indicate maternal fever or infection.

Question 19

The FHR tracing shows fluctuations of greater than 25 bpm from baseline. What should the nurse assess first?

a) Maternal oxygenation and hydration.

b) Uterine contraction strength.

c) Maternal blood pressure.

d) The external monitor placement.

Answer 19

a) Maternal oxygenation and hydration.

Rationale: Marked variability may indicate fetal hypoxia, which can be influenced by maternal oxygen and fluid levels.

Question 20

A patient’s FHR tracing shows a deceleration below baseline lasting over 3 minutes. What is the priority nursing action?

a) Reposition the patient to the left lateral position.

b) Increase the Pitocin infusion rate.

c) Perform an amnioinfusion.

d) Prepare for emergency delivery.

Answer 20

d) Prepare for emergency delivery.

Rationale: Prolonged decelerations indicate severe fetal compromise and often necessitate immediate delivery.

Question 21

An IUPC is placed for a patient with ruptured membranes. The nurse observes persistent decelerations. What action should the nurse take next?

a) Notify the provider.

b) Perform an amnioinfusion.

c) Increase Pitocin infusion.

d) Assess maternal temperature.

Answer 21

b) Perform an amnioinfusion.

Rationale: Amnioinfusion can relieve umbilical cord compression causing decelerations.

Question 22

A patient’s FHR tracing shows late decelerations. What is the likely cause?

a) Cord compression

b) Head compression

c) Oxygen compromise

d) Placental insufficiency

Answer 22

d) Placental insufficiency

Rationale: Late decelerations are associated with placental insufficiency and require immediate intervention.

Question 23

A patient on Pitocin has moderate variability and accelerations on the monitor. What should the nurse do?

a) Stop the Pitocin infusion.

b) Continue the Pitocin infusion as prescribed.

c) Decrease the Pitocin infusion rate.

d) Administer oxygen at 10 L/min.

Answer 23

b) Continue the Pitocin infusion as prescribed.

Rationale: Moderate variability and accelerations indicate normal fetal oxygenation and labor progression.

Question 24

A patient with late decelerations is repositioned to the left lateral position without improvement. What is the next intervention?

a) Administer oxygen at 10 L/min.

b) Stop Pitocin.

c) Increase IV fluids.

d) Notify the provider.

Answer 24

c) Increase IV fluids

Rationale: Increasing IV fluids can improve placental perfusion and fetal oxygenation.

Question 25

A neonate is delivered after a Category 3 FHR tracing. The provider orders cord blood gases.
What is the purpose of this test?

a) To confirm neonatal infection.

b) To assess acid/base status at delivery.

c) To evaluate fetal lung maturity.

d) To determine maternal-fetal blood mixing.

Answer 25

b) To assess acid/base status at delivery.

Rationale: Cord blood gas analysis determines fetal oxygenation and acid/base balance, which helps assess for hypoxic events.

Question 26

A nurse notices minimal variability on the fetal monitor. Which factors may contribute to minimal variability? (Select all that apply.)

• a) Fetal sleep cycle
• b) Maternal hypotension
• c) Maternal fever
• d) Umbilical cord compression
• e) Narcotic administration

Answer 26

a) Fetal sleep cycle, b) Maternal hypotension, e) Narcotic administration

Rationale: Minimal variability can result from temporary factors like fetal sleep cycles, maternal hypotension, or medications. Maternal fever and cord compression usually cause other abnormalities.

Question 27

A patient’s monitor shows late decelerations. What are potential causes of late decelerations? (Select all that apply.)

• a) Maternal hypotension
• b) Placental insufficiency
• c) Fetal head compression
• d) Tachysystole
• e) Cord prolapse

Answer 27

a) Maternal hypotension, b) Placental insufficiency, d) Tachysystole

Rationale: Late decelerations occur due to decreased oxygenation from placental insufficiency, maternal hypotension, or uterine hyperactivity. Head compression causes early decelerations, and cord prolapse causes variable decelerations.