Chapter 15: Fetal Assessment during Labor

question

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
answer

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

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
answer

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.
question

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

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

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

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

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

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

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

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

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

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
question

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

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

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

Change in position.
question

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
answer

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
question

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

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

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

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
question

Fetal well-being during labor is assessed by
answer

The response of the fetal heart rate to uterine contractions
question

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
answer

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
question

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.
answer

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

Perinatal nurses are legally responsible for:
answer

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

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:
answer

Hypoxemia.Nonreassuring heart rate patterns are associated with fetal hypoxemia
question

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
answer

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

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.”
answer

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
question

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

Before and after ambulation and rupture of membranes.
question

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

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

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

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

What is an advantage of external electronic fetal monitoring?
answer

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

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

Can be used during the antepartum and intrapartum periods.
question

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

A normal baseline heart rate.
question

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

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

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

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

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

Late deceleration—uteroplacental inefficiency
question

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

Usually are isolated events that end spontaneously.
question

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

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

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

Encourage the woman’s cooperation in avoiding the supine position.
question

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
answer

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:
question

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

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.
question

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

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

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

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

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

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

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

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

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
answer

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

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.
answer

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

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
answer

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
question

Late decelerations are almost always caused by uteroplacental insufficiency.
answer

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

Commonly 45 seconds or more in the second stage of labor
answer

Relaxation time
question

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

Frequency
question

Average of 10 mm Hg
answer

Resting tone
question

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

Strength
question

Remaining fairly stable throughout the first and second stages
answer

Duration

Get instant access to
all materials

Become a Member