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AWHONN ADVANCED FHM COURSE EXAM ANSWERS
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AWHONN ADVANCED FHM COURSE EXAM ANSWERS
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AWHONN ADVANCED FHM COURSE EXAM ANSWERSCASE STUDY A) NELL. Nell, a 24-year-old G3 P020 at 42&3 weeks arrived on L&D for
an evening IOL for post-dates. Nell has had an exploratory lap. to remove scar tissue on
her L ovary and intestines and has had infrequent menstrual cycles. She had has 2
SABs - at 12 and 5 weeks. Prenatal labs were WDL. Her thyroid is enlarged; however,
her TSH, T4, and T3 were done at 39 weeks and were WDL. Nell has a family history of
HTN. An US at 19 weeks revealed a low-lying placenta that resolved by 37 5/7 weeks.
Today in triage, an US revealed an EFW of 3300g and an AFI of 3 cm. Nell has had
reactive NSTs. Admission vital signs were WDL. SVE findings: fingertip, 40%, and -2
station. Membranes intact and cephalic presentation. Nell denied feeling regular
cramping. Category I tracing. A vaginal prostaglandin insert was placed. WHICH
COMPROMISE IN FETAL OXYGENATION COULD BE A RESULT OF A POST-DATE
PREGNANCY? - Answers -Decreased placental perfusion
What are the possible implications of an oligohydramnios for labor? - Answers -Potential
umbilical cord compression
If Nell's low-lying placenta had not resolved prior to labor and she experienced a large
amount of bright red vaginal bleeding, possibly indicating hemorrhage, what FHM
characteristic could occur? - Answers -Sinusoidal FHR pattern
What clinical intervention is supported by Nell's gestational age and risk factors? -
Answers -Continuous EFM monitoring throughout the night
The prostaglandin was removed at 0600 and Nell took a shower and ate a light
breakfast. An oxytocin infusion was then initiated at 2 mU/min. From 0730 to 0900 the
FHR baseline was 150 bpm, moderate variability, occasional periodic variable
decelerations and contractions every 2-5 minutes lasting 30-60 second, mild to
moderate by palpation. Nell was coping well and reported her pain as a 2 on a scale of
1-10 during contractions. SVE 2/80/-2. Vital signs: 108/67, HR 119, RR 16, and T 98.2F
(36.8C). Oxytocin was infusing at 10 mU/min. At 0925 Nell's provider performed AROM
with return of thick, particulate yellow-green meconium. A fetal spiral electrode was
placed. Refer to tracing B-1. Based on review of the tracing, the nurse's primary
intervention is: - Answers -Auscultate the FHR with a doppler to confirm arrhythmia
Refer to tracing B-1. In Nell's tracing, what do the FHR spikes likely represent? -
Answers -FHR arrhythmia or artifact
Refer to tracing B-1. Which is a correct interpretation of Nell's tracing? - Answers -
Normal baseline rate and possible arrhythmia
How could a fetal arrhythmia affect fetal oxygenation? - Answers -By reducing fetal
perfusion
, Fetal hydrops may present on ultrasound as fetal scalp edema and increased
abdominal fluid as a result of which fetal condition? - Answers -Congestive heart failure
The FSE was removed due to the increased challenges evaluating the tracing with the
arrhythmia. At 1030, oxytocin was infusing at 13 mU/min and SVE was 2-3/90//-2. Nell's
vital signs were 100/66, HR 122, RR 18, T 101.2F (38.4C). She has not voided and was
offered a bedpan. Nell voided 350 mL of amber colored urine. Refer to tracing B-2.
What would increase oxygen consumption in Nell's fetus? - Answers -Hyperthermia
Refer to tracing B-2. What is the correct interpretation of fetal oxygenation status from
this tracing? - Answers -The FHR characteristics are indicative of an indeterminate
status
Refer to tracing B-2. Which assessment or intervention would be effective for increasing
fetal oxygenation at this time? - Answers -Change maternal position to right lateral
The fetal heart rate tracing continues for 45 minutes and is unresolved with intrauterine
resuscitative measures. Nell's vaginal exam is unchanged. Nell is complaining of
nausea and increased abdominal pain. Refer to tracing B-2. Based on a systematic
assessment of the fetal heart rate tracing, the Category of this tracing is: - Answers -
Category II
Refer to tracing B-2. Based on the clinical scenario and the fetal heart rate tracing, the
highest priority clinical course of action is to: - Answers -Alert the provider
Refer to tracing B-2. Which of the following would be the most appropriate care as Nell
is prepared for a cesarean delivery? - Answers -Transport Nell to the operating room
and assess FHR before the abdominal prep
Refer to tracing B-2. What pieces of information would be of highest priority to report to
the neonatal team as they prepare for the delivery? - Answers -Gestational age,
meconium, and FHR tracing
A female was delivered by cesarean at 1211 and thick meconium was noted. Apgar
scores were 4/5/7 at 1/5/10. Arterial umbilical cord gas results are: pH 7.26/pCO2
56.5/pO2 23/BE -19. The newborn had a normal sinus rhythm, normal ECG, and
echocardiogram and was discharged to home with mother. What is the most plausible
explanation for the neonate's normal sinus rhythm at birth? - Answers -The source of
the ectopic fetal cardiac stimulation had resolved
CASE STUDY B) SILVIA. Silvia, a 28-year-old G1P0000 at 39 1/7 weeks by sonogram,
and her partner arrived on the labor unit at 0730 for scheduled induction for IUGR/FGR.
Silvia's family history is negative for medical problems with the exception of her
mother's long-term history of diabetes. Silvia has no history of medical problems and
she has never had any surgeries. She developed gestational diabetes with this
pregnancy, but her other prenatal labs were all normal. During one of the ultrasound
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