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1 AWHONN Fetal Heart monitoring basics Test Questions and Answers
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1 AWHONN Fetal Heart monitoringbasics
a) Frequency
b) Duration - Answer -Which contraction characteristics can be assessed with a tocodynamometer?
a) Frequency
b) Duration
c) Intensity
Uterus - Answer -All Fetuses of mothers in labor experience an interruption of the oxygenation pathway
at which point?
a) Throughout labor and delivery unless the use of a more accurate method is clearly indicated - Answer
-The FHR can be monitored using doppler ultrasound?
a) Throughout labor and delivery unless the use of a more accurate method is clearly indicated
b) Internally
c) Only early in labor
d) The FHR cannot be monitored by doppler ultrasound
b) 110-160 bpm - Answer -What is the normal range for FHR base line in a term infant?
a) 80-120 bpm
b) 110-160 bpm
,c) 140-180bpm
d) it depends on the sex of the fetus
Mother's inhalation to lungs to mat. circulatory system to hemoglobin in RBC's to bloodstream in uterus.
Uterus to spiral arteries to placenta to intervillous space to travel via simple diffusion into the villi. The
capillaries to the umb. vein to the fetus.
The umb. artery sends waste (CO2) to the intervillous space to the mothers venous system. - Answer -
Trace the flow of oxygen from mother to fetus and back.
1. Mother (blood plasma, cardiac output, hemoglobin concentration & O2 saturation)
2. Placenta/intervillous space (uterine contractions & calcification's)
3. Fetus (vagal response aka decel or cord compression) - Answer -What factors impact maternal oxygen
delivery?
30-50%
lateral recumbent or semi-Fowler's - Answer -By what % does maternal cardiac output increase above
the non-pregnant state and what position helps this uteroplacental blood flow?
>5 contractions in 10 min (more frequently than Q 2 min) averaged over 30 min window.
Caused by oxytocin, aminoinfusion or in rare cases spontaneously. - Answer -Define tachysystole
contractions and the cause of.
Maintaining mat. volume, mat. positioning, intravenous hydration. Decreasing mat. pain/anxiety.
1. Reposition pt to side.
2. Admin IV fluid bolus.
3. Admin 0.25mg terbutaline SQ.
4. Admin O2 10L via non rebreather face mask. - Answer -List interventions for tachysystole
contractions.
higher conc. to lower concentration.
1.Oxygen from maternal (higher) to fetal compartment (lower) to fetal hgb then transported to fetal
tissue.
,2. CO2 returns to intervillous space by passive diffusion and is removed by the mat. venous system. -
Answer -Describe passive diffusion as related to the maternal placental fetal system.
Place her in lateral position, & increase IV fluids. If no improvement may need to give epi to increase
vascular tone. - Answer -Maternal hypotension is a potential side effect of regional anesthesia and
analgesia. What nursing interventions could you use to raise the client's blood pressure? Choose all that
apply.
A) Place the woman in a supine position.
B) Place the woman in a lateral position.
C) Increase intravenous (IV) fluids.
D) Continuous Fetal Monitor
E) Administer ephedrine per MD order
systolic BP >= 140mm hg, a diastolic BP>= 90 mm hg or MAP of >=105 - Answer -Define maternal
hypertension (gestational).
17g/dl, fetal hgb has a higher oxygen affinity than an adult to develop in an oxygen poor environment.
The fetal circulatory pattern ensures blood with higher O2 and nutrition content is delivered to the vital
organs (brain and heart) to tolerate the stress of labor. - Answer -What is the normal expected value for
a term fetal HGB?
1 vein, 2 arteries encased in wharton's jelly.
O2 (high content) travels via the vein
CO2 travels via 2 arteries back to placenta - Answer -detail the umbilical cord
A decrease of blood flow and O2 delivery to fetus & increases CO2 level in fetus.
Transient cord compression can be common in labor. Variable FHR decel's is frequently associated with
cord compression. - Answer -Define cord compression.
May lead to hypoxemia and fetal acidemia. The depth of variable deceleration's is not enough to
determine degree. Evaluate oxygenation through baseline heart rate characteristics through rate,
variability and presence or absence of accelerations. - Answer -Explain persistent or recurrent cord
compression concerns and what to look at.
, A normal part of labor. As contractions build increased uterine pressure prevents blood from
entering/leaving the intervillous space. During the peak the fetus relies completely on its oxygen reserve
(an aerobic challenge that is not an issue for a health fetus. - Answer -Explain transient interruptions in
fetal oxygen supple during labor.
Chronic deficiency of placenta function, usually from an interruption of oxygenation pathway due to
abruption, mat. hypo or hypertension or other issues. Infant is not tolerant of contractions. Can result in
fetal grow restrictions (FGR) - Answer -Define Uteroplacental insufficiency (UPI)
Assess baseline FHR
Determine rhythms (regular vs irregular)
ID accelerations and deceleration's but not the type of deceleration (early/late/variable)
The fetal heartbeat is best heard over the fetal back. - Answer -Auscultation of Fetal Heart Sounds tell
you what information?
Where is the best place to listen?
Palpation to determine presentation and position of the fetus and aid in location of fetal heart sounds.
Head=hard, round, movable object
Buttocks=soft and irregular shape
Back=smooth, hard surface felt on one side of the abdomen
Irregular knobs and lumps on opposite side of abdomen may be hands, feet, elbows, and knees - Answer
-Leopold's Maneuvers
Uses sonar to track the fetal myocardium & converts movement into sound. If placed incorrectly may
pick up maternal heart.
Perform Leopold's maneuvers to find fetal back, locate heartbeat, count FHR, check mothers pulse and
compare. - Answer -Handheld Fetal Doppler
ID risk factors such as HTN (=vasoconstriction), Maternal smoking, abruption, post-term pregnancy,
maternal diabetes and consider FHR characteristics - Answer -How can you determine if the placenta is
functioning optimally?
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