Fetal Monitoring Strips Quiz

1. According to AWHONN, the normal baseline Fetal Heart Rate (FHR) is:

90-150 bpm

100-170 bpm

110-160 bpm

120-140 bpm

The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) defines the normal baseline Fetal Heart Rate (FHR) as 110-160 beats per minute (bpm). This range indicates a healthy fetal heart rate, suggesting that the baby is receiving adequate oxygen and is not under stress. Monitoring FHR within this range helps healthcare providers ensure that the baby is well during labor. If the heart rate falls outside this range, it may indicate a need for further evaluation and possible intervention to ensure the well-being of both mother and baby.

Explanation

The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) defines the normal baseline Fetal Heart Rate (FHR) as 110-160 beats per minute (bpm). This range indicates a healthy fetal heart rate, suggesting that the baby is receiving adequate oxygen and is not under stress. Monitoring FHR within this range helps healthcare providers ensure that the baby is well during labor. If the heart rate falls outside this range, it may indicate a need for further evaluation and possible intervention to ensure the well-being of both mother and baby.

2. Umbilical cord influences that can alter blood flow include true knots, hematomas, and the number of umbilical vessels.

True

False

Umbilical cord influences such as true knots, hematomas, and the number of umbilical vessels can significantly alter blood flow. True knots occur when the umbilical cord forms an actual knot, which can tighten and reduce blood flow to the fetus. Hematomas, or collections of blood outside the blood vessels, can compress the cord and restrict blood flow. Additionally, the number of umbilical vessels is crucial; typically, there are two arteries and one vein. Any variation from this norm can impact the efficiency of blood and nutrient transport between the mother and the fetus, potentially leading to complications during pregnancy and delivery.

Explanation

Umbilical cord influences such as true knots, hematomas, and the number of umbilical vessels can significantly alter blood flow. True knots occur when the umbilical cord forms an actual knot, which can tighten and reduce blood flow to the fetus. Hematomas, or collections of blood outside the blood vessels, can compress the cord and restrict blood flow. Additionally, the number of umbilical vessels is crucial; typically, there are two arteries and one vein. Any variation from this norm can impact the efficiency of blood and nutrient transport between the mother and the fetus, potentially leading to complications during pregnancy and delivery.

3. What is the primary goal of effective communication in the care of the intrapartum patient?

Getting out of work on time

Preventing lawsuits

Meeting patients' needs appropriately

Maintaining a professional environment

The primary goal of effective communication in the care of the intrapartum patient is to meet patients' needs appropriately. Clear and accurate communication among healthcare providers ensures that all aspects of the patient's condition and care plan are understood and acted upon correctly. This helps in providing timely and effective interventions, reducing the risk of complications, and enhancing patient safety. Additionally, good communication fosters a supportive and trusting relationship between the patient and healthcare team, contributing to a positive birthing experience. While preventing lawsuits and maintaining professionalism are important, the foremost priority is always the patient's well-being.

Explanation

The primary goal of effective communication in the care of the intrapartum patient is to meet patients' needs appropriately. Clear and accurate communication among healthcare providers ensures that all aspects of the patient's condition and care plan are understood and acted upon correctly. This helps in providing timely and effective interventions, reducing the risk of complications, and enhancing patient safety. Additionally, good communication fosters a supportive and trusting relationship between the patient and healthcare team, contributing to a positive birthing experience. While preventing lawsuits and maintaining professionalism are important, the foremost priority is always the patient's well-being.

4. Which fetal heart rate pattern is considered reassuring?

Minimal variability

Moderate variability

Marked variability

Absent variability

Moderate variability in the fetal heart rate pattern is considered reassuring and indicates a healthy, well-oxygenated fetus. Variability refers to the fluctuations in the fetal heart rate, reflecting the interplay between the sympathetic and parasympathetic nervous systems. Moderate variability suggests that the fetus is responding appropriately to its environment and is not experiencing significant stress. It contrasts with minimal or absent variability, which can be concerning and may indicate fetal distress, hypoxia, or other complications that require further evaluation and intervention.

Explanation

Moderate variability in the fetal heart rate pattern is considered reassuring and indicates a healthy, well-oxygenated fetus. Variability refers to the fluctuations in the fetal heart rate, reflecting the interplay between the sympathetic and parasympathetic nervous systems. Moderate variability suggests that the fetus is responding appropriately to its environment and is not experiencing significant stress. It contrasts with minimal or absent variability, which can be concerning and may indicate fetal distress, hypoxia, or other complications that require further evaluation and intervention.

5. The best placement for the tocodynamometer to pick up uterine contractions is the:

Vagina

Perineum

Fundus

Lower abdomen

The tocodynamometer, a device used to measure uterine contractions, is best placed on the fundus, which is the top part of the uterus. The fundus is where the strongest contractions occur, making it the optimal location for detecting and recording the frequency, duration, and intensity of uterine contractions during labor. Proper placement ensures accurate monitoring, helping healthcare providers assess the progress of labor and make informed decisions about the care needed for both the mother and the baby. Placement in other areas, such as the lower abdomen, perineum, or vagina, would not provide as accurate readings.

Explanation

The tocodynamometer, a device used to measure uterine contractions, is best placed on the fundus, which is the top part of the uterus. The fundus is where the strongest contractions occur, making it the optimal location for detecting and recording the frequency, duration, and intensity of uterine contractions during labor. Proper placement ensures accurate monitoring, helping healthcare providers assess the progress of labor and make informed decisions about the care needed for both the mother and the baby. Placement in other areas, such as the lower abdomen, perineum, or vagina, would not provide as accurate readings.

6. Contractions cause an increase in uterine venous pressure and a decrease in uterine artery perfusion.

True

False

During contractions, uterine muscles tighten, leading to an increase in uterine venous pressure and a decrease in uterine artery perfusion. The increased pressure in the veins can reduce blood flow back to the heart, while the decreased perfusion in the arteries can limit the oxygen and nutrients delivered to the fetus. This physiological change is temporary and occurs with each contraction. Monitoring these changes is important to ensure that the fetus is not experiencing distress due to reduced oxygenation during contractions. Understanding these dynamics helps healthcare providers manage labor effectively and ensure the safety of both the mother and baby.

Explanation

During contractions, uterine muscles tighten, leading to an increase in uterine venous pressure and a decrease in uterine artery perfusion. The increased pressure in the veins can reduce blood flow back to the heart, while the decreased perfusion in the arteries can limit the oxygen and nutrients delivered to the fetus. This physiological change is temporary and occurs with each contraction. Monitoring these changes is important to ensure that the fetus is not experiencing distress due to reduced oxygenation during contractions. Understanding these dynamics helps healthcare providers manage labor effectively and ensure the safety of both the mother and baby.

7. When using a fetal scalp electrode (FSE) you notice an abnormally low FHR on the monitor. You should first:

Compare maternal pulse simultaneously with FHR

Remove FSE

Call the doctor immediately

Turn off the monitor

When an abnormally low Fetal Heart Rate (FHR) is detected using a fetal scalp electrode (FSE), the first action should be to compare the maternal pulse simultaneously with the FHR. This step helps determine whether the monitor is picking up the maternal heart rate instead of the fetal heart rate. This can happen if the FSE is not placed correctly or if there is interference. Confirming the source of the heartbeat ensures accurate monitoring and prevents unnecessary interventions. If the FHR is indeed low after this check, further steps such as removing the FSE or calling the doctor may be necessary.

Explanation

When an abnormally low Fetal Heart Rate (FHR) is detected using a fetal scalp electrode (FSE), the first action should be to compare the maternal pulse simultaneously with the FHR. This step helps determine whether the monitor is picking up the maternal heart rate instead of the fetal heart rate. This can happen if the FSE is not placed correctly or if there is interference. Confirming the source of the heartbeat ensures accurate monitoring and prevents unnecessary interventions. If the FHR is indeed low after this check, further steps such as removing the FSE or calling the doctor may be necessary.

8. While caring for a gestational diabetic patient, you encounter a conflict with the attending physician because he refuses to order blood sugars on the patient. After speaking directly with the physician, the next person in the chain of command you should communicate with is:

Hospital administrator

Medical director

Another staff nurse

Nurse Manager

In the event of a conflict with an attending physician, especially regarding patient care, it is important to follow the chain of command. After addressing the issue directly with the physician and not reaching a resolution, the next step is to communicate with the Nurse Manager. The Nurse Manager has the authority to mediate conflicts, advocate for patient safety, and ensure proper clinical practices are followed. They can escalate the issue further if needed and facilitate discussions with higher management or medical directors to resolve the situation and ensure the patient receives appropriate care.

Explanation

In the event of a conflict with an attending physician, especially regarding patient care, it is important to follow the chain of command. After addressing the issue directly with the physician and not reaching a resolution, the next step is to communicate with the Nurse Manager. The Nurse Manager has the authority to mediate conflicts, advocate for patient safety, and ensure proper clinical practices are followed. They can escalate the issue further if needed and facilitate discussions with higher management or medical directors to resolve the situation and ensure the patient receives appropriate care.

9. Which of the following is a common cause of fetal tachycardia?

Fetal sleep cycle

Maternal fever

Umbilical cord compression

Maternal exercise

Fetal tachycardia, defined as a fetal heart rate above 160 beats per minute, can be caused by several factors. One common cause is maternal fever, which can result from infections or other inflammatory conditions. The elevated maternal temperature can increase the fetal heart rate as the fetus responds to the stress. Other possible causes of fetal tachycardia include fetal hypoxia, maternal hyperthyroidism, and certain medications. It is essential to identify and address the underlying cause to ensure the well-being of both the mother and the fetus.

Explanation

Fetal tachycardia, defined as a fetal heart rate above 160 beats per minute, can be caused by several factors. One common cause is maternal fever, which can result from infections or other inflammatory conditions. The elevated maternal temperature can increase the fetal heart rate as the fetus responds to the stress. Other possible causes of fetal tachycardia include fetal hypoxia, maternal hyperthyroidism, and certain medications. It is essential to identify and address the underlying cause to ensure the well-being of both the mother and the fetus.

10. Preterm contractions are usually painful.

True

False

Preterm contractions are not always painful. They can often be mild and feel similar to menstrual cramps or a tightening sensation in the abdomen. Because these contractions may not cause significant discomfort, they can sometimes go unnoticed or be mistaken for Braxton Hicks contractions, which are normal and non-labor-related. It's important to pay attention to the frequency and duration of these contractions and other signs of preterm labor, such as increased vaginal discharge or pelvic pressure. Early detection and medical intervention are crucial to managing preterm labor and preventing premature birth.

Explanation

Preterm contractions are not always painful. They can often be mild and feel similar to menstrual cramps or a tightening sensation in the abdomen. Because these contractions may not cause significant discomfort, they can sometimes go unnoticed or be mistaken for Braxton Hicks contractions, which are normal and non-labor-related. It's important to pay attention to the frequency and duration of these contractions and other signs of preterm labor, such as increased vaginal discharge or pelvic pressure. Early detection and medical intervention are crucial to managing preterm labor and preventing premature birth.

11. What does a sinusoidal pattern on a fetal monitoring strip indicate?

Fetal sleep cycle

Maternal dehydration

Severe fetal anemia

Normal fetal activity

A sinusoidal pattern on a fetal monitoring strip is characterized by a smooth, wave-like, undulating baseline with no variability. This pattern is often associated with severe fetal anemia, where the fetus has an abnormally low number of red blood cells. It can also indicate other serious conditions such as fetal hypoxia, acidosis, or infection. The presence of a sinusoidal pattern is a critical finding that requires immediate medical attention to assess and address the underlying cause and ensure the health and safety of the fetus.

Explanation

A sinusoidal pattern on a fetal monitoring strip is characterized by a smooth, wave-like, undulating baseline with no variability. This pattern is often associated with severe fetal anemia, where the fetus has an abnormally low number of red blood cells. It can also indicate other serious conditions such as fetal hypoxia, acidosis, or infection. The presence of a sinusoidal pattern is a critical finding that requires immediate medical attention to assess and address the underlying cause and ensure the health and safety of the fetus.

12. Low amplitude contractions are not an early sign of preterm labor.

True

False

Low amplitude contractions, which are mild and infrequent, are not typically considered an early sign of preterm labor. Preterm labor usually presents with more frequent and intense contractions that increase in strength and duration over time. Other signs of preterm labor include changes in vaginal discharge, pelvic pressure, and lower back pain. Identifying these more significant symptoms early is crucial for timely intervention and management to prevent premature birth and associated complications. Therefore, low amplitude contractions alone are not a reliable indicator of preterm labor.

Explanation

Low amplitude contractions, which are mild and infrequent, are not typically considered an early sign of preterm labor. Preterm labor usually presents with more frequent and intense contractions that increase in strength and duration over time. Other signs of preterm labor include changes in vaginal discharge, pelvic pressure, and lower back pain. Identifying these more significant symptoms early is crucial for timely intervention and management to prevent premature birth and associated complications. Therefore, low amplitude contractions alone are not a reliable indicator of preterm labor.

13. You are evaluating a patient in the Prenatal Testing Department who has just completed a biophysical profile (BPP). You suspect that there could be chronic fetal asphyxia because the score is below:

5

6

7

8

A biophysical profile (BPP) is a test used to assess the well-being of the fetus. It includes measures such as fetal heart rate, movement, muscle tone, breathing movements, and amniotic fluid volume. The score ranges from 0 to 10, with each of the five components contributing up to 2 points. A score below 6 is concerning and may indicate chronic fetal asphyxia, meaning the baby is not receiving enough oxygen over a prolonged period. This situation requires further evaluation and possible intervention to ensure the health and safety of both the mother and the baby.

Explanation

A biophysical profile (BPP) is a test used to assess the well-being of the fetus. It includes measures such as fetal heart rate, movement, muscle tone, breathing movements, and amniotic fluid volume. The score ranges from 0 to 10, with each of the five components contributing up to 2 points. A score below 6 is concerning and may indicate chronic fetal asphyxia, meaning the baby is not receiving enough oxygen over a prolonged period. This situation requires further evaluation and possible intervention to ensure the health and safety of both the mother and the baby.

14. What are the two most important characteristics of the FHR?

Rate and decelerations

Variability and accelerations

Variability and decelerations

Rate and variability

The FHR refers to the fetal heart rate, which is an important indicator of the baby's well-being during pregnancy. Variability refers to the fluctuations in the fetal heart rate, which is considered a sign of a healthy and responsive nervous system. Accelerations, on the other hand, are temporary increases in the fetal heart rate, often in response to fetal movement or stimulation, and are also indicative of a healthy baby. Therefore, variability and accelerations are the two most important characteristics of the FHR as they provide valuable information about the baby's condition and well-being.

Explanation

The FHR refers to the fetal heart rate, which is an important indicator of the baby's well-being during pregnancy. Variability refers to the fluctuations in the fetal heart rate, which is considered a sign of a healthy and responsive nervous system. Accelerations, on the other hand, are temporary increases in the fetal heart rate, often in response to fetal movement or stimulation, and are also indicative of a healthy baby. Therefore, variability and accelerations are the two most important characteristics of the FHR as they provide valuable information about the baby's condition and well-being.

15. Corticosteroid administration may cause an increase in FHR accelerations.

True

False

Corticosteroid administration can cause an increase in Fetal Heart Rate (FHR) accelerations. Corticosteroids are often given to pregnant women at risk of preterm birth to help accelerate fetal lung maturity. One of the side effects of this treatment is an increase in FHR variability and accelerations, which are generally considered positive signs of fetal well-being. Accelerations indicate that the fetus is responding well to the uterine environment and that its autonomic nervous system is functioning properly. Therefore, seeing more frequent accelerations after corticosteroid administration is typically a normal and expected response.

Explanation

Corticosteroid administration can cause an increase in Fetal Heart Rate (FHR) accelerations. Corticosteroids are often given to pregnant women at risk of preterm birth to help accelerate fetal lung maturity. One of the side effects of this treatment is an increase in FHR variability and accelerations, which are generally considered positive signs of fetal well-being. Accelerations indicate that the fetus is responding well to the uterine environment and that its autonomic nervous system is functioning properly. Therefore, seeing more frequent accelerations after corticosteroid administration is typically a normal and expected response.