Chapter 14: Intrapartum Fetal Surveillance OB Nclex questions

Chapter 14: Intrapartum Fetal Surveillance OB Nclex

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Chapter 17: Postpartum Adaptations ...

44 terms kmariot3Preview OB Pos 52 terms ash The nurse sees a pattern on the fetal monitor that looks similar to early decelerations, but the deceleration begins near the acme of the contraction and continues well beyond the end of the contraction. Which nursing action indicates the proper evaluation of this situation?

• This pattern reflects variable decelerations. No

interventions are necessary at this time.

• Document this reassuring fetal heart rate pattern but

decrease the rate of the intravenous (IV) fluid.

• Continue to monitor these early decelerations, which

occur as the fetal head is compressed during a contraction.

• This deceleration pattern is associated with

uteroplacental insufficiency, so the nurse acts quickly to improve placental blood flow and fetal oxygen supply.

ANS: D

A pattern similar to early decelerations, but the deceleration begins near the acme of the contraction and continues well beyond the end of the contraction, describes a late deceleration. Oxygen should be given via a snug face mask.Position the client on her left side to increase placental blood flow. Variable decelerations are caused by cord compression. A vaginal examination should be performed to identify this potential emergency. This is not a reassuring pattern, so the IV rate should be increased to increase the mother's blood volume. These are late decelerations, not early; therefore, interventions are necessary.Which maternal condition should be considered a contraindication for the application of internal monitoring devices?

• Unruptured membranes
• Cervix dilated to 4 cm
• Fetus has known heart defect
• External monitors currently being used

ANS: A

To apply internal monitoring devices, the membranes must be ruptured. Cervical dilation of 4 cm would permit the insertion of fetal scalp electrodes and an intrauterine catheter. A compromised fetus should be monitored with the most accurate monitoring devices. The external monitor can be discontinued after the internal ones are applied.

The nurse is instructing a nursing student on the application of fetal monitoring devices. Which method of assessing the fetal heart rate requires the use of a gel?

• Doppler
• Fetoscope
• Scalp electrode
• Tocodynamometer

ANS: A

Doppler is the only listed method involving ultrasonic transmission of fetal heart rates; it requires the use of a gel. The fetoscope does not require gel because ultrasonic transmission is not used. The scalp electrode is attached to the fetal scalp; gel is not necessary. The tocodynamometer does not require gel. This device monitors uterine contractions.Proper placement of the tocotransducer for electronic

fetal monitoring is:

• inside the uterus.
• on the fetal scalp.
• over the uterine fundus.
• over the mother's lower abdomen.

ANS: C

The tocotransducer monitors uterine activity and should be placed over the fundus, where the most intensive uterine contractions occur. The tocotransducer is for external use. The tocotransducer monitors uterine contractions. The most intensive uterine contractions occur at the fundus; this is the best placement area.Which can be determined only by electronic fetal monitoring?

• Variability
• Tachycardia
• Bradycardia
• Fetal response to contractions

ANS: A

Beat-to-beat variability cannot be determined by auscultation because auscultation provides only an average fetal heart rate (FHR) as it fluctuates.Tachycardia can be determined by any of the FHR monitoring techniques.Bradycardia can be determined by any of the FHR monitoring techniques. The fetal response to the contractions is usually noted by an increase or decrease in fetal heart rate. These can be determined by any of the FHR monitoring techniques.Which is the most appropriate method of intrapartum fetal monitoring when a woman has a history of hypertension during pregnancy?

• Continuous auscultation with a fetoscope

b.Continuous electronic fetal monitoring

• Intermittent assessment with a Doppler transducer
• Intermittent electronic fetal monitoring for 15 minutes

each hour

ANS: B

Maternal hypertension may reduce placental blood flow through vasospasm of the spiral arteries. Reduced placental perfusion is best assessed with continuous electronic fetal monitoring to identify patterns associated with this condition. It is not practical to provide continuous auscultation with a fetoscope. This fetus needs continuous monitoring because it is at high risk for complications.Why is continuous electronic fetal monitoring generally used when oxytocin is administered?

• Fetal chemoreceptors are stimulated.
• The mother may become hypotensive.
• Maternal fluid volume deficit may occur.
• Uteroplacental exchange may be compromised.

ANS: D

The uterus may contract more firmly and the resting tone may be increased with oxytocin use. This response reduces the entrance of freshly oxygenated maternal blood into the intervillous spaces, depleting fetal oxygen reserves. Oxytocin affects the uterine muscles. Hypotension is not a common side effect of oxytocin.All laboring women are at risk for fluid volume deficit; oxytocin administration does not increase the risk.The nurse is concerned that a client's uterine activity is too intense and that her obesity is preventing accurate assessment of the actual intrauterine pressure. Based on this information, which action should the nurse take?

• Reposition the tocotransducer.
• Reposition the Doppler transducer.
• Obtain an order from the health care provider for a

spiral electrode.

• Obtain an order from the health care provider for an

intrauterine pressure catheter.

ANS: D

An intrauterine pressure catheter can measure actual intrauterine pressure. The tocotransducer measures the uterine pressure externally; this would not be accurate with an obese client, even with repositioning. A Doppler auscultates the FHR. A scalp electrode (or spiral electrode) measures the fetal heart rate (FHR).

If the position of a fetus in a cephalic presentation is right occiput anterior, the nurse should assess the fetal heart rate in which quadrant of the maternal abdomen?

• Right upper
• Left upper
• Right lower
• Left lower

ANS: C

If the fetus is in a right occiput anterior position, the fetal spine will be on the mother's right side. The best location to hear the fetal heart rate is through the fetal shoulder, which would be in the right lower quadrant. The right upper, left upper, and left lower areas are not the best locations for assessing the fetal heart rate in this case.In which situation would a baseline fetal heart rate of 160 to 170 bpm be considered a normal finding?

• The fetus is at 30 weeks of gestation.
• The mother has a history of fast labors.
• The mother has been given an epidural block.
• The mother has mild preeclampsia but is not in labor.

ANS: A

The normal preterm fetus may have a baseline rate slightly higher than the term fetus because of an immature parasympathetic nervous system that does not yet exert a slowing effect on the fetal heart rate (FHR). Fast labors should not alter the FHR normally. Any change in the FHR with an epidural is not considered an expected outcome. Preeclampsia should not cause a normal elevation of the FHR.When the deceleration pattern of the fetal heart rate mirrors the uterine contraction, which nursing action is indicated?

• Reposition the client.
• Apply a fetal scalp electrode.
• Record this reassuring pattern.
• Administer oxygen by nasal cannula.

ANS: C

The periodic pattern described is early deceleration that is not associated with fetal compromise and requires no intervention. It is a reassuring pattern.Repositioning the client, applying a fetal scalp electrode, or administering oxygen would be interventions done for nonreassuring patterns.When the mother's membranes rupture during active labor, the fetal heart rate should be observed for the occurrence of which periodic pattern?

• Early decelerations
• Variable decelerations
• Nonperiodic accelerations
• Increase in baseline variability

ANS: B

When the membranes rupture, amniotic fluid may carry the umbilical cord to a position where it will be compressed between the maternal pelvis and the fetal presenting part, resulting in a variable deceleration pattern. Early declarations are considered reassuring; they are not a concern after rupture of membranes.Accelerations are considered reassuring; they are not a concern after rupture of membranes. Increase in baseline variability is not an expected occurrence after the rupture of membranes.Which statement correctly describes the nurse's responsibility related to electronic monitoring?

• Report abnormal findings to the physician before

initiating corrective actions.

• Teach the woman and her support person about the

monitoring equipment and discuss any of their questions.

• Document the frequency, duration, and intensity of

contractions measured by the external device.

• Inform the support person that the nurse will be

responsible for all comfort measures when the electronic equipment is in place.

ANS: B

Teaching is an essential part of the nurse's role. Corrective actions should be initiated first to correct abnormal findings as quickly as possible. Electronic monitoring will record the contractions and FHR response. The support person should still be encouraged to assist with the comfort measures.Which of the following therapeutic applications provides the most accurate information related to uterine contraction strength?

• External fetal monitoring (EFM)
• Internal fetal monitoring
• Intrauterine pressure catheter (IUPC)
• Maternal comments based on perception

ANS: C

IUPC is a clinical tool that provides an accurate assessment of uterine contraction strength. EFM provides evidence of contraction pattern and fetal heart rate but only estimates uterine contraction strength. Internal fetal monitoring provides direct evidence of fetal heart rate and contraction pattern. It only estimates uterine contraction strength. Maternal comments related to pain may not be related to uterine contraction strength and thus are influenced by the client's own pain perception.

What is the most likely cause for this fetal heart rate pattern?

• Administration of an epidural for pain relief during

labor

• Cord compression
• Breech position of fetus
• Administration of meperidine (Demerol) for pain relief

during labor

ANS: B

Variable deceleration patterns are seen in response to head compression or cord compression. A breech presentation would not be likely to cause this fetal heart rate pattern. Similarly, administration of medication and/or an epidural would not cause this fetal heart rate pattern.The patient presenting at 38 weeks' gestation, gravida 1, para 0, vaginal exam 4 cm, 100?faced, +1 station vertex.What is the most likely intervention for this fetal heart rate pattern?

• Continue oxytocin (Pitocin) infusion.
• Contact the anesthesia department for epidural

administration.

• Change maternal position.
• Administer Narcan to patient and prepare for

immediate vaginal delivery.

ANS: C

Late decelerations indicate fetal compromise (uteroplacental insufficiency) and are considered to be a significant event requiring immediate assessment and intervention. Of all the options listed, changing maternal position may increase placental perfusion. In the presence of late decelerations, Pitocin infusion should be stopped. Contacting anesthesia for epidural administration will not solve the existing problem of late decelerations. There are no data to support the administration of Narcan and because patient is still in early labor, birth is not imminent.The physician has ordered an amnioinfusion for the laboring client. What data supports the use of this therapeutic procedure?

• Presenting part not engaged
• +4 meconium-stained amniotic fluid on artificial rupture

of membranes (AROM)

• Breech position of fetus
• Twin gestation

ANS: B

Amnioinfusion is a procedure used during labor when cord compression or the detection of gross meconium staining is found in the amniotic fluid. A saline solution is used as an irrigation method through the IUPC (intrauterine pressure catheter).Which of the following is the priority intervention for a supine client whose monitor strip shows decelerations that begin after the peak of the contraction and return to the baseline after the contraction ends?

• Increase IV infusion.
• Elevate lower extremities.
• Reposition to left side-lying position.
• Administer oxygen per face mask at 4 to 6 L/min.

ANS: C

Decelerations that begin at the peak of the contractions and recover after the contractions end are caused by uteroplacental insufficiency. When the client is in the supine position, the weight of the uterus partially occludes the vena cava and descending aorta, resulting in hypotension and decreased placental perfusion.Increasing the IV infusion, elevating the lower extremities, and administering O2 will not be effective as long as the client is in a supine position.Decelerations that mirror the contractions are present with each contraction on the monitor strip of a multipara who received epidural anesthesia 20 minutes ago. The

nurse should:

• maintain the normal assessment routine.
• administer O2 at 8 to 10 L/min by face mask.
• increase the IV flow rate from 125 to 150 mL/hr.
• assess the maternal blood pressure for a systolic

pressure below 100 mm Hg.

ANS: A

Decelerations that mirror the contraction are early decelerations caused by fetal head compression. Early decelerations are not associated with fetal compromise and require no intervention. Administering O2, increasing the IV flow rate, and assessing for hypotension are not necessary in early decelerations.