ch 18

Question 1

1.What is the most likely cause for early decelerations in the fetal heart rate (FHR) pattern?

Answer 1

a. Altered fetal cerebral blood flow

Question 2

2.Which clinical finding or intervention might be considered the rationale for fetal tachycardia to
occur?

Answer 2

a. Maternal fever

Question 3

3.While evaluating an external monitor tracing of a woman in active labor, the nurse notes that
the FHR for five sequential contractions begins to decelerate late in the contraction, with the
nadir of the decelerations occurring after the peak of the contraction. What is the
nurse’sfirstpriority?

Answer 3

a. Change the woman’s position.

Question 4

4.What is the most likely cause for variable FHR decelerations?

Answer 4

b. Umbilical cord compression

Question 5

5.The nurse providing care for a high-risk laboring woman is alert for late FHR decelerations.
Which clinical finding might be the cause for these late decelerations?

Answer 5

c.. Uteroplacental insufficiency

Question 6

6.Which alteration in the FHR pattern would indicate the potential need for an amnioinfusion?

Answer 6

a. Variable decelerations

Question 7

7.Which FHR finding is the most concerning to the nurse who is providing care to a laboring
client?

Answer 7

d. Late decelerations

Question 8

8.What three measures should the nurse implement to provide intrauterine resuscitation?

Answer 8

Turn the client onto her side, provide oxygen (O2) via face mask, and increase intravenous
(IV) fluids.

Question 9

9.The nurse who provides care to clients in labor must have a thorough understanding of the
physiologic processes of maternal hypotension. Which outcome might occur if the interventions
for maternal hypotension are inadequate?

Answer 9

c. Uteroplacental insufficiency

Question 10

10.What are the legal responsibilities of the perinatal nurses?

Answer 10

Correctly interpreting FHR patterns, initiating appropriate nursing interventions, and
documenting the outcomes

Question 11

11.The perinatal nurse realizes that an FHR that is tachycardic, bradycardic, has late
decelerations, or loss of variability is nonreassuring and is associated with which condition?

Answer 11

d. Hypoxemia

Question 12

12.A new client and her partner arrive on the labor, delivery, recovery, and postpartum (LDRP)
unit for the birth of their first child. The nurse applies the electronic fetal monitor (EFM) to the
woman. Her partner asks you to explain what is printing on the graph, referring to the EFM strip.
He wants to know what the baby’s heart rate should be. What is the nurse’sbestresponse?

Answer 12

b. “The baby’s heart rate will fluctuate in response to what is happening during labor.”

Question 13

13.Which statementbestdescribes a normal uterine activity pattern in labor?

Answer 13

a. Contractions every 2 to 5 minutes

Question 14

14.The nurse is using intermittent auscultation (IA) to locate the fetal heartbeat. Which statement
regarding this method of surveillance isaccurate?

Answer 14

Ultrasound can be used to find the FHR and to reassure the mother if the initial difficulty is
a factor.

Question 15

15.What is a distinct advantage of external EFM?

Answer 15

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

Question 16

16.Which client wouldnotbe a suitable candidate for internal EFM?

Answer 16

a. Client who still has intact membranes

Question 17

17. During labor a fetus displays an average FHR of 135 beats per minute over a 10-minute
    period. Which statementbestdescribes the status of this fetus?

Answer 17

b. Normal baseline heart rate

Question 18

18.A nurse caring for a woman in labor should understand that absent or minimal variability is
classified as either abnormal or indeterminate. Which condition related to decreased variability is
considered benign?

Answer 18

a. Periodic fetal sleep state

Question 19

19.Which definition of an acceleration in the fetal heart rate (FHR) isaccurate?

Answer 19

d. An acceleration in the FHR presents a visually apparent and abrupt peak.

Question 20

20.Which characteristiccorrectlymatches the type of deceleration with its likely cause?

Answer 20

b. Late deceleration—uteroplacental insufficiency

Question 21

21.Which information related to a prolonged deceleration is important for the labor nurse to
understand?

Answer 21

c. A disruption to the fetal oxygen supply causes prolonged decelerations.

Question 22

22.In which situation would the nurse be called on to stimulate the fetal scalp?

Answer 22

d. To elicit an acceleration in the FHR

Question 23

23.Part of the nurse’s role is assisting with pushing and positioning. Which guidance should the
nurse provide to her client in active labor?

Answer 23

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

Question 24

24.In which clinical situation would the nursemostlikely anticipate a fetal bradycardia?

Answer 24

c. Prolonged umbilical cord compression

Question 25

25. Which nursing intervention would result in an increase in maternal cardiac output?

Answer 25

a. Change in position

Question 26

26. The nurse is evaluating the EFM tracing of the client who is in active labor. Suddenly, the FHR drops from its baseline of 125 down to 80 beats per minute. The mother is repositioned, and the nurse provides oxygen, increased IV fluids, and performs a vaginal examination. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should the nurse take next?

Answer 26

d. Immediately notify the care provider.

Question 27

``` 27. The nurse observes a sudden increase in variability on the ERM tracing. Which class of medications may cause this finding? ```

Answer 27

c. Methamphetamines

Question 28

28. What is the correct placement of the tocotransducer for effective EFM?

Answer 28

a. Over the uterine fundus

Question 29

29. What physiologic change occurs as the result of increasing the infusion rate of nonadditive IV fluids?

Answer 29

d. Expanding maternal blood volume

Question 30

30. The client has delivered by urgent caesarean birth for fetal compromise. Umbilical cord gases were obtained for acid-base determination. The pH is 6.9, partial pressure of carbon dioxide (PCO2) is elevated, and the base deficit is 11 mmol/L. What type of acidemia is displayed by the infant?

Answer 30

a. Respiratory

Question 31

1. In assessing the immediate condition of the newborn after birth, a sample of cord blood may be a useful adjunct to the Apgar score. Cord blood is then tested for pH, carbon dioxide, oxygen, and base deficit or excess. Which clinical situation warrants this additional testing? (Select all that apply.)

Answer 31

a. Low 5-minute Apgar score b. Intrauterine growth restriction (IUGR) c. Maternal thyroid disease d. Intrapartum fever

Question 32

2. According to the National Institute of Child Health and Human Development (NICHD) Three- Tier System of FHR Classification, category III tracings include all FHR tracings not categorized as category I or II. Which characteristics of the FHR belong in category III? (Select all that apply.)

Answer 32

b. Tachycardia d. Variable decelerations with other characteristics such as shoulders or overshoots e. Absent baseline variability with recurrent variable decelerations f. Bradycardia

Question 33

3. Which FHR decelerations would require the nurse to change the maternal position? (Select all that apply.)

Answer 33

b. Late decelerations c. Variable decelerations e. Prolonged decelerations

Question 34

4. A tiered system of categorizing FHR has been recommended by professional organizations. Nurses, midwives, and physicians who care for women in labor must have a working knowledge of fetal monitoring standards and understand the significance of each category. What is the correct nomenclature for these categories? (Select all that apply.)

Answer 34

b. Category I c. Category II e. Category III

Question 35

5. The baseline 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 evaluating the client’s most recent 10-minute segment on the monitor strip and notes a late deceleration. Which is likely to have caused this change? (Select all that apply.)

Answer 35

c. Placental abruption | e. Maternal supine hypotension