1 AWHONN Fetal Heart monitoring basics
Exam Questions With Verified Answers.
Which contraction characteristics can be assessed with a tocodynamometer?
a) Frequency
b) Duration
c) Intensity - answera) Frequency
b) Duration
All Fetuses of mothers in labor experience an interruption of the oxyg...
Which contraction characteristics can be assessed with a tocodynamometer?
a) Frequency
b) Duration
c) Intensity - answer✔a) Frequency
b) Duration
All Fetuses of mothers in labor experience an interruption of the oxygenation pathway at which
point? - answer✔Uterus
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 - answer✔a) Throughout labor and
delivery unless the use of a more accurate method is clearly indicated
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 - answer✔b) 110-160 bpm
Trace the flow of oxygen from mother to fetus and back. - answer✔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.
What factors impact maternal oxygen delivery? - answer✔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)
By what % does maternal cardiac output increase above the non-pregnant state and what position
helps this uteroplacental blood flow? - answer✔30-50%
lateral recumbent or semi-Fowler's
Define tachysystole contractions and the cause of. - answer✔>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.
List interventions for tachysystole contractions. - answer✔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.
Describe passive diffusion as related to the maternal placental fetal system. - answer✔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.
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 - answer✔Place her in lateral position, & increase IV
fluids. If no improvement may need to give epi to increase vascular tone.
Define maternal hypertension (gestational). - answer✔systolic BP >= 140mm hg, a diastolic
BP>= 90 mm hg or MAP of >=105
What is the normal expected value for a term fetal HGB? - answer✔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.
detail the umbilical cord - answer✔1 vein, 2 arteries encased in wharton's jelly.
O2 (high content) travels via the vein
CO2 travels via 2 arteries back to placenta
Define cord compression. - answer✔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.
Explain persistent or recurrent cord compression concerns and what to look at. - answer✔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.
Explain transient interruptions in fetal oxygen supple during labor. - answer✔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.
Define Uteroplacental insufficiency (UPI) - answer✔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)
Auscultation of Fetal Heart Sounds tell you what information?
Where is the best place to listen? - answer✔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.
Leopold's Maneuvers - answer✔Palpation to determine presentation and position of the fetus and
aid in location of fetal heart sounds.
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