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Fetal bradycardia is most common during:Prolonged umbilical cord compression.Fetal bradycardia can be considered a later sign of fetal hypoxia and is known to occur before fetal death

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Bradycardia can result from placental transfer of drugs, prolonged compression of the umbilical cord, maternal hypothermia, and maternal hypotension.

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While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring

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after the peak of the contraction. The nurse's first priority is to: Change the woman's position.Late decelerations may be caused by maternal supine hypotension syndrome.

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The nurse caring for the laboring woman should understand that early decelerations are caused by:

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Altered fetal cerebral blood flow.Early decelerations are the fetus's response to fetal head compression

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The nurse providing care for the laboring woman comprehends that accelerations with fetal movement:Are reassuring.

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Episodic accelerations in the fetal heart rate (FHR) occur during fetal movement and are indications of fetal well-being

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The nurse providing care for the laboring woman realizes that variable fetal heart rate decelerations are caused by:Umbilical cord compression.

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Variable decelerations can occur any time during the uterine contracting phase and are caused by compression of the umbilical cord.

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The nurse providing care for the laboring woman should understand that late fetal heart rate decelerations are the result of:

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Uteroplacental insufficiency.Uteroplacental insufficiency would result in late decelerations in the FHR

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The nurse providing care for the laboring woman should understand that amnioinfusion is used to treat:Variable decelerations

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Amnioinfusion is used during labor either to dilute meconium-stained amniotic fluid or to supplement the amount of amniotic fluid to reduce the severity of variable decelerations caused by cord compression

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The nurse caring for the woman in labor should understand that maternal hypotension can result in:

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Uteroplacental insufficiency.Low maternal blood pressure reduces placental blood flow during uterine contractions and results in fetal hypoxemia.

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The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by:

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Change in position.

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While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate at the onset of several contractions

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and returns to baseline before each contraction ends. The nurse should Document the finding in the client's record The FHR indicates early decelerations, which are not an ominous sign and do not require any intervention

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Which fetal heart rate (FHR) finding would concern the nurse during labor? Late decelerations

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Late decelerations are caused by uteroplacental insufficiency and are associated with fetal hypoxemia. They are considered ominous if persistent and uncorrected.

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The most common cause of decreased variability in the fetal heart rate FHR that lasts 30 minutes or less is:Fetal sleep cycles

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A temporary decrease in variability can occur when the fetus is in a sleep state. These sleep states do not usually last longer than 30 minutes

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Fetal well-being during labor is assessed by

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The response of the fetal heart rate to uterine contractions

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You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase

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IV fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the fetal heart rate remains in the 80s. What additional nursing measures should you take?Notify the physcian

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What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken.

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Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask.

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Perinatal nurses are legally responsible for:

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Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes

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As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations or loss of variability is nonreassuring and is associated with:

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Hypoxemia.Nonreassuring heart rate patterns are associated with fetal hypoxemia

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A new client and her partner arrive on the labor, delivery, recovery, and postpartum unit for the birth of their first child. You apply the electronic fetal monitor (EFM) to the woman. Her partner asks you to explain what is printing

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on the graph, referring to the EFM strip. He wants to know what the baby's heart rate should be. Your best response is:

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The top line graphs the baby's heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor."

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normal uterine activity pattern in labor is characterized by:Contractions every 2 to 5 minutes.Contractions normally occur every 2 to 5 minutes and last less than 90 seconds with about 30 seconds in between

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According to standard professional thinking, nurses should auscultate the fetal heart rate (FHR):

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Before and after ambulation and rupture of membranes.

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When using intermittent auscultation (IA) for fetal heart rate, nurses should be aware that:

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Ultrasound can be used to find the fetal heartbeat and reassure the mother if initial difficulty was a factor.

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When using intermittent auscultation (IA) to assess uterine activity, the nurse should be cognizant that

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The examiner's hand should be placed over the fundus before, during, and after contractions

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What is an advantage of external electronic fetal monitoring?

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The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor.

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When assessing the relative advantages and disadvantages of internal and external electronic fetal monitoring, nurses comprehend that both:

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Can be used during the antepartum and intrapartum periods.

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During labor a fetus with an average heart rate of 135 beats/min over a 10-minute period would be considered to have:

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A normal baseline heart rate.

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The nurse caring for the woman in labor should understand that increased variability of the fetal heart rate may be caused by:Methamphetamines

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Narcotics, barbiturates, and tranquilizers may be causes of decreased variability; methamphetamines may cause increased variability.

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Which deceleration of the fetal heart rate would not require the nurse to change the maternal position? Early decelerations

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Early decelerations and accelerations generally do not need any nursing intervention.

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What correctly matches the type of deceleration with its likely cause?

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Late deceleration—uteroplacental inefficiency

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The nurse caring for a woman in labor understands that prolonged decelerations:

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Usually are isolated events that end spontaneously.

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A nurse may be called on to stimulate the fetal scalp:

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To elicit an acceleration in the fetal heart rate (FHR).The scalp can be stimulated using digital pressure during a vaginal examination

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In assisting with the two factors that have an effect on fetal status pushing and positioning , nurses should:

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Encourage the woman's cooperation in avoiding the supine position.

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The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The nurse notes that the intrauterine pressure at the peak of the contraction ranges from 65 to

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70 mm Hg and the resting tone range is 6 to 10 mm Hg. The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. On the basis of this information, the nurse should:

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Document the findings because they reflect the expected contraction pattern for the active phase of labor.

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The nurse is responsible for monitoring the uterine contractions to ascertain whether they are powerful and frequent enough to accomplish the work of expelling the fetus and the placenta.

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Which maternal condition is considered a contraindication for the application of internal monitoring devices?

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Unruptured membranes In order to apply internal monitoring devices, the membranes must be ruptured.

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The nurse knows that proper placement of the tocotransducer for electronic fetal monitoring is located: Over the uterine fundus

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The tocotransducer monitors uterine activity and should be placed over the fundus, where the most intensive uterine contractions occur.

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Why is continuous electronic fetal monitoring usually used when oxytocin is administered?

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Uteroplacental exchange may be compromised.The uterus may contract more firmly, and the resting tone may be increased with oxytocin use

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Increasing the infusion rate of nonadditive intravenous fluids can increase fetal oxygenation primarily by:

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Expanding maternal blood volume.Filling the mother's vascular system makes more blood available to perfuse the placenta and may correct hypotension

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A tiered system of categorizing FHR has been recommended by regulatory agencies. Nurses, midwives, and physicians who care for women in labor must have a working knowledge of fetal monitoring standards and

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understand the significance of each category. These categories include Category I. Category II. Nonreassuring.

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The three tiered system of FHR tracings include Category I, II, and III. Category I is a normal tracing requiring no action. Category II FHR tracings are indeterminate.

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This category includes tracings that do not meet Category I or III criteria. Category III tracings are abnormal and require immediate intervention.

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The baseline fetal heart rate (FHR) is the average rate during a 10-minute segment. Changes in FHR are categorized as periodic or episodic. These patterns include both accelerations and decelerations. The labor nurse is

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evaluating the patient's most recent 10-minute segment on the monitor strip and notes a late deceleration. is likely to be caused by which physiologic alteration. Compression of the fetal head Maternal supine hypotension

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Late decelerations are almost always caused by uteroplacental insufficiency.

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Insufficiency is caused by uterine tachysystole, maternal hypotension, epidural or spinal anesthesia, IUGR, intraamniotic infection, or placental abruption.

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Commonly 45 seconds or more in the second stage of labor

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Relaxation time

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Generally ranging from two to five contractions per 10 minutes of labor

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Frequency

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Average of 10 mm Hg

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Resting tone

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Peaking at 40 to 70 mm Hg in the first stage of labor

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Strength

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Remaining fairly stable throughout the first and second stages

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Duration

Chapter 15: Fetal Assessment during Labor – Flashcards

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