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NCC ELECTRONIC FETAL MONITORING CERTIFICATION EXAM QUESTIONS
AND ANSWERS (2023-2024) VERIFIED ANSWERS
Which of the following factors can have a negative effect on uterine blood flow?
a. Hypertension
b. Epidural
c. Hemorrhage
d. Diabetes
e. All of the above
Answer: e. All of the above
Rationale:
All of the listed factors can negatively affect uterine blood flow. Hypertension can lead to
vasoconstriction, reducing blood flow. Epidural anesthesia can cause hypotension, which
decreases uterine perfusion. Hemorrhage directly reduces blood volume and therefore uterine
blood flow. Diabetes can lead to vascular changes that affect blood flow to the uterus.
How does the fetus compensate for decreased maternal circulating volume?
a. Increases cardiac output by increasing stroke volume.
b. Increases cardiac output by increasing its heart rate.
c. Increases cardiac output by increasing fetal movement.
Answer: b. Increases cardiac output by increasing its heart rate.
Rationale:
When maternal circulating volume decreases, the fetal heart rate increases to maintain
adequate cardiac output. Increasing stroke volume or fetal movement would not directly
increase cardiac output.
Stimulating the vagus nerve typically produces:
a. A decrease in the heart rate
b. An increase in the heart rate

c. An increase in stroke volume
d. No change
Answer: a. A decrease in the heart rate
Rationale:
Stimulation of the vagus nerve typically leads to a decrease in heart rate through its
parasympathetic effect on the heart.
What initially causes a chemoreceptor response?
a. Epidurals
b. Supine maternal position
c. Increased CO2 levels
d. Decreased O2 levels
e. A & C
f. A & B
g. C & D
Answer: g. C & D
Rationale:
Chemoreceptors primarily respond to changes in blood oxygen (decreased O2 levels) and
carbon dioxide (increased CO2 levels) levels.
The vagus nerve begins maturation 26 to 28 weeks. Its dominance results in what effect to the
FHR baseline?
a. Increases baseline
b. Decreases baseline
Answer: b. Decreases baseline
Rationale:

The vagus nerve's increasing dominance leads to a decrease in the fetal heart rate baseline as
pregnancy progresses.
Oxygen exchange in the placenta takes place in the intervillous space.
Answer: True
Rationale:
Oxygen exchange between maternal and fetal blood occurs in the intervillous space of the
placenta, where maternal blood comes into close contact with the fetal chorionic villi.
The parasympathetic nervous system is a cardioaccelerator.
Answer: False
Rationale:
The parasympathetic nervous system is responsible for slowing the heart rate. It is not a
cardioaccelerator; instead, it has a cardioinhibitory effect.
Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure.
Answer: True
Rationale:
Baroreceptors are specialized stretch receptors located in the walls of blood vessels and the
heart that detect changes in blood pressure. They respond to changes by sending signals to
regulate blood pressure.
There are two electronic fetal monitoring methods of obtaining the fetal heart rate: the
ultrasound transducer and the fetal spiral electrode.
Answer: True
Rationale:
Both the ultrasound transducer and the fetal spiral electrode are methods used in electronic
fetal monitoring to obtain the fetal heart rate. The ultrasound transducer measures fetal heart
rate through ultrasound waves, while the fetal spiral electrode is attached to the fetal scalp to
directly measure the fetal heart rate.Variability can be determined with the fetoscope.
Answer: False

Rationale:
Variability in fetal heart rate can only be accurately determined using electronic fetal
monitoring methods such as the ultrasound transducer or fetal scalp electrode. A fetoscope is
used for intermittent auscultation of the fetal heart rate and cannot accurately assess
variability.
Because the ultrasound transducer and toco transducer are sealed units, they can be dipped in
warm water to make cleaning easier.
Answer: False
Rationale:
The ultrasound transducer and toco transducer are not waterproof and should not be
submerged in water for cleaning. They should be cleaned according to the manufacturer's
instructions to prevent damage.
The most common artifact with the ultrasound transducer system for fetal heart rate is
increased variability.
Answer: True
Rationale:
Increased variability is a common artifact associated with the ultrasound transducer system.
This can be caused by maternal or fetal movement, electrode displacement, or signal
interference.
All fetal monitors contain a logic system designed to reject artifact.
Answer: True
Rationale:
Fetal monitors are equipped with a logic system designed to identify and reject artifacts, such
as maternal movement or interference, to provide accurate fetal heart rate and contraction
monitoring.
The monitor should always be tested before starting a tracing, either external or internal mode
and labeled a test.
Answer: True

Rationale:
It is essential to test the fetal monitor before use to ensure proper functioning and accurate
readings. Testing should be done in both external and internal monitoring modes, and the test
should be clearly labeled.
The paper speed on the fetal monitor should always be set at 1cm/min.
Answer: False
Rationale:
The paper speed on the fetal monitor can vary depending on the clinical situation and the
preference of the healthcare provider. Common paper speeds include 1 cm/min, 3 cm/min,
and 6 cm/min.
Both internal and external monitoring methods are equally accurate means of obtaining the
fetal heart rate and contraction patterns.
Answer: False
Rationale:
Internal monitoring methods, such as fetal scalp electrode placement, generally provide more
accurate fetal heart rate and contraction pattern information compared to external monitoring
methods.
The external toco is usually placed over the uterine fundus to pick up contractions.
Answer: True
Rationale:
The external tocodynamometer (toco) is typically placed over the uterine fundus to detect and
measure uterine contractions during labor.
The external toco gives measurable uterine pressure.
Answer: False
Rationale:
The external toco measures changes in abdominal contour associated with uterine
contractions but does not directly measure uterine pressure.

The fetal spiral electrode can be placed when vaginal bleeding of unknown origin is present.
Answer: False
Rationale:
The fetal spiral electrode should not be placed when vaginal bleeding of unknown origin is
present due to the risk of introducing infection. It is contraindicated in such cases.
The ultrasound transducer is usually placed on the side of the uterus over the baby's back, as
the fetal heart is heard best there.
Answer: True
Rationale:
True. The ultrasound transducer is usually placed on the side of the uterus over the baby's
back as the fetal heart is heard best there due to the orientation of the heart in the chest.
The spiral electrode is used to more accurately determine the frequency, duration, and
intensity of uterine contractions.
Answer: False
Rationale:
False. The spiral electrode is used to monitor the fetal heart rate, not uterine contractions. It is
an internal fetal heart rate monitoring device.
The heart rate from a well-applied fetal spiral electrode can only be fetal, not maternal.
Answer: False
Rationale:
False. A well-applied fetal spiral electrode can pick up both fetal and maternal heart rates.
The intrauterine catheter is used to pick up the fetal heart rate.
Answer: False
Rationale:
False. The intrauterine catheter is used to monitor uterine contractions, not the fetal heart rate.
The internal spiral electrode may pick up the maternal heart rate if the baby has died.

Answer: True
Rationale:
True. If the baby has died, the internal spiral electrode may pick up the maternal heart rate
instead of the fetal heart rate.
Fetal arrhythmias can be seen on both internal and external monitor tracings.
Answer: True
Rationale:
True. Fetal arrhythmias can be detected using both internal (spiral electrode) and external
(ultrasound) monitoring.
Variability and periodic changes can be detected with both internal and external monitoring.
Answer: True
Rationale:
True. Variability and periodic changes in fetal heart rate can be detected using both internal
and external monitoring methods.
Variable decelerations are a result of cord compression.
Answer: True
Rationale:
True. Variable decelerations are caused by umbilical cord compression, resulting in a
transient decrease in fetal heart rate.
The presence of FHR accelerations in the intrapartum and antepartum periods is a sign of
adequate fetal oxygenation.
Answer: True
Rationale:
True. FHR accelerations are indicative of fetal well-being and adequate oxygenation.
Variable decelerations are a vagal response.
Answer: True

Rationale:
True. Variable decelerations are believed to be caused by a vagal response to transient
umbilical cord compression.
Late decelerations have a gradual decrease in FHR (onset to nadir 30 seconds) and are
delayed in timing with the nadir of the deceleration occurring after the peak of the
contraction.
Answer: True
Rationale:
True. Late decelerations have a gradual onset, a decrease in FHR that lasts more than 30
seconds, and the nadir of the deceleration occurs after the peak of the contraction.
The fetal heart rate baseline can be determined during periods of marked variability.
Answer: False
Rationale:
False. The fetal heart rate baseline should be determined during periods of minimal to absent
variability.
Anything that affects maternal blood flow (cardiac output) can affect the blood flow through
the placenta.
Answer: True
Rationale:
True. Maternal blood flow is essential for placental function. Anything that affects maternal
blood flow, such as maternal hypertension or hypotension, can affect blood flow through the
placenta, potentially affecting fetal oxygenation.
Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in
labor.
Answer: True
Rationale:

True. Variable decelerations are the most common type of deceleration observed during labor
and are usually associated with umbilical cord compression.
Minimal variability is always an indicator of hypoxia and a Cesarean section is indicated.
Answer: False
Rationale:
False. While minimal variability can be a concerning sign, it is not always indicative of
hypoxia. Other factors need to be considered, such as the presence of accelerations, the
baseline fetal heart rate, and the presence of decelerations, before determining the need for a
Cesarean section.
What is your first intervention in management of a patient experiencing variable
decelerations?
a. Immediate delivery
b. Change maternal position
c. No treatment indicated
d. Oxygen
e. Stop oxytocin infusion
Answer: b. Change maternal position
Rationale:
Variable decelerations are usually caused by cord compression. Changing the maternal
position can relieve the compression and improve fetal oxygenation, making it the initial
management strategy.
Etiology of a baseline FHR of 165bpm occurring for the last hour can be:
a. Maternal supine hypotension
b. Maternal fever
c. Maternal dehydration
d. Unknown

e. 1 and 2
f. 1, 2 and 3
g. 2, 3 and 4
Answer: g. 2, 3 and 4
Rationale:
A baseline fetal heart rate (FHR) of 165 bpm for the last hour could be due to maternal fever,
maternal dehydration, or maternal supine hypotension. Maternal fever can increase the
baseline fetal heart rate. Dehydration can cause fetal tachycardia, and supine hypotension can
lead to fetal tachycardia due to decreased maternal cardiac output and subsequent fetal
compensatory response.
What is the most probable cause of recurrent late decelerations?
a. Utero-placental insufficiency
b. Head compression
c. Cord compression
d. Maternal position change
Answer: a. Utero-placental insufficiency
Rationale:
Recurrent late decelerations are typically due to utero-placental insufficiency, which results in
decreased oxygen transfer to the fetus during contractions.
The most prevalent risk factor associated with fetal death before the onset of labor is:
a. Low socioeconomic status
b. Fetal malpresentation
c. Uteroplacental insufficiency
d. Uterine anomalies
Answer: c. Uteroplacental insufficiency
Rationale:

Uteroplacental insufficiency, which leads to chronic fetal hypoxia, is the most prevalent risk
factor associated with fetal death before the onset of labor.
Which of the following is NOT used for antepartum fetal surveillance?
a. Fetal movement counting
b. Antepartum fetal heart rate testing
c. Biophysical profile testing
d. Maternal HCG levels
Answer: d. Maternal HCG levels
Rationale:
Maternal HCG levels are not used for antepartum fetal surveillance. Fetal movement
counting, antepartum fetal heart rate testing, and biophysical profile testing are commonly
used methods for antepartum fetal surveillance.
Which of the following conditions is not an indication for antepartum fetal surveillance?
a. Gestational hypertension
b. Diabetes in pregnancy
c. Fetus in breech presentation
d. Decreased fetal movement
Answer: c. Fetus in breech presentation
Rationale:
Fetus in breech presentation is not an indication for antepartum fetal surveillance. However,
gestational hypertension, diabetes in pregnancy, and decreased fetal movement are all
indications for antepartum fetal surveillance.
Which of the following does not affect the degree of fetal activity?
a. Vibroacoustic stimulation
b. Smoking
c. Fetal position

d. Gestational age
Answer: a. Vibroacoustic stimulation
Rationale:
Vibroacoustic stimulation does not affect the degree of fetal activity. However, smoking, fetal
position, and gestational age can all affect fetal activity.
To be considered reactive, a nonstress test must have:
a. 4 fetal heart rate accelerations in a 20 minute window
b. 2 fetal heart rate accelerations in a 10 minute window
c. 4 fetal heart rate accelerations in a 40 minute window
d. 2 fetal heart rate accelerations in a 20 minute window
Answer: d. 2 fetal heart rate accelerations in a 20 minute window
Rationale:
A nonstress test is considered reactive if there are two or more fetal heart rate accelerations of
at least 15 beats per minute above the baseline, lasting at least 15 seconds, within a 20-minute
window.
If a nonstress test is nonreactive after 40 minutes, the next step should be:
a. Have the client go home and do fetal movement counts
b. Do a biophysical profile or contraction stress test
c. Repeat the nonstress test within a week
d. Admit the client for delivery
Answer: b. Do a biophysical profile or contraction stress test
Rationale:
If a nonstress test is nonreactive after 40 minutes, the next step should be to perform a
biophysical profile or a contraction stress test to further assess fetal well-being.
All of the following are components of a biophysical profile except:

a. Contraction stress test
b. Assessment of fetal breathing
c. Amniotic fluid volume measurement
d. Fetal movement assessment
Answer: a. Contraction stress test
Rationale:
A biophysical profile includes assessment of fetal breathing, amniotic fluid volume
measurement, and fetal movement assessment. It does not include a contraction stress test.
A modified biophysical profile includes a nonstress test and:
a. Contraction stress test
b. Ultrasound assessment of fetal movement
c. Ultrasound assessment of amniotic fluid volume
d. Fetal movement counts
Answer: c. Ultrasound assessment of amniotic fluid volume
Rationale:
A modified biophysical profile includes a nonstress test and ultrasound assessment of
amniotic fluid volume, in addition to fetal movement counts.
For a contraction stress test to be interpretable, you must have a minimum of:
a. 5 contractions in a 10-minute window
b. 3 contractions in a 10-minute window
c. 4 contractions in a 10-minute window
d. 2 contractions in a 10-minute window
Answer: b. 3 contractions in a 10-minute window
Rationale:

To perform an interpretable contraction stress test, there must be a minimum of three
contractions in a 10-minute window to adequately assess the fetal response to uterine
contractions.
A negative contraction stress test is one in which:
a. No contractions are seen
b. There are late decelerations with > 50% of the contractions seen
c. There are no fetal heart rate late decelerations with the contractions
d. There is one fetal heart rate deceleration seen
Answer: c. There are no fetal heart rate late decelerations with the contractions
Rationale:
A negative contraction stress test is one in which there are no fetal heart rate late
decelerations with the contractions, indicating that the fetus can tolerate the stress of
contractions well.
According to AWHONN, the normal baseline Fetal Heart Rate (FHR) is
a. 90-150 bpm
b. 100-170 bpm
c. 110-160 bpm
d. 120-140 bpm
Answer: c. 110-160 bpm
Rationale:
According to the Association of Women's Health, Obstetric and Neonatal Nurses
(AWHONN), the normal baseline fetal heart rate (FHR) is 110-160 bpm.
What are the two most important characteristics of the FHR?
a. Rate and decelerations
b. Variability and accelerations
c. Variability and decelerations

d. Rate and variability
Answer: b. Variability and accelerations
Rationale:
The two most important characteristics of the fetal heart rate (FHR) are variability and
accelerations. Variability indicates the autonomic nervous system's ability to modulate the
heart rate, while accelerations are indicative of fetal well-being.
You recognize that an FHR tracing has been showing a decrease in variability for the last 45
minutes. Your first intervention should be to
a. Encourage ambulation
b. Administer oxygen
c. Discontinue IV fluids
d. Increase Pitocin rate
Answer: b. Administer oxygen
Rationale:
A decrease in variability of the fetal heart rate (FHR) may indicate fetal hypoxia.
Administering oxygen can improve fetal oxygenation, which may improve variability.
Resuscitation measures improve the baby's variability, but the FHR is still not reactive. You
attempt fetal scalp stimulation (FSE) because you know that a well-oxygenated fetus will
respond to FSE with a(n)
a. Acceleration
b. Deceleration
c. Fetal movement
d. Sleep pattern
Answer: a. Acceleration
Rationale:

A well-oxygenated fetus will respond to fetal scalp stimulation (FSE) with an acceleration of
the fetal heart rate (FHR), indicating fetal well-being.
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
a. 10
b. 6
c. 8
Answer: b. 6
Rationale:
A biophysical profile (BPP) score of 6 or less is concerning for chronic fetal asphyxia and
indicates further evaluation and possible intervention.
When using a fetal scalp electrode (FSE), you notice an abnormally low FHR on the monitor.
You should first
a. Compare maternal pulse simultaneously with FHR
b. Remove FSE
c. Call the doctor immediately
d. Turn off the monitor
Answer: a. Compare maternal pulse simultaneously with FHR
Rationale:
Before taking any action, it's important to ensure that the fetal heart rate (FHR) being
displayed is accurate. Comparing maternal pulse simultaneously with FHR can help
determine if the low FHR is accurate or if there is an equipment issue.
Umbilical cord influences that can alter blood flow include true knots, hematomas, and
number of umbilical vessels.
Answer: True
Rationale:

True knots, hematomas, and abnormalities in the number of umbilical vessels are all factors
that can alter blood flow in the umbilical cord, potentially leading to fetal compromise.
Low amplitude contractions are not an early sign of preterm labor.
Answer: False
Rationale:
Low amplitude contractions can indeed be an early sign of preterm labor. These contractions
may not be painful but can still be indicative of uterine irritability and early labor.
Preterm contractions are usually painful.
Answer: False
Rationale:
Preterm contractions are often not painful, especially in the early stages. They may be
uncomfortable or perceived as pressure rather than pain.
Corticosteroid administration may cause an increase in FHR accelerations.
Answer: False
Rationale:
Corticosteroid administration does not typically cause an increase in fetal heart rate (FHR)
accelerations.
Corticosteroid administration may cause an increase in FHR.
Answer: True
Rationale:
Corticosteroid administration, such as betamethasone or dexamethasone, can lead to an
increase in fetal heart rate (FHR) as a physiological response to the medication.
Contractions cause an increase in uterine venous pressure and a decrease in uterine artery
perfusion.
Answer: True
Rationale:

Contractions lead to an increase in uterine venous pressure and a temporary decrease in
uterine artery perfusion during each contraction. This decrease in perfusion is what leads to
the transient decrease in oxygenated blood reaching the fetus during contractions.
As a result of the intrinsic fetal response to oxygen deprivation, increased catecholamine
levels cause the peripheral blood flow to decrease while the blood flow to vital organs
increases. These flow changes along with increased catecholamine secretions have what
effect on fetal blood pressure and fetal heart rate?
a. Increase BP and increase HR
b. Increase BP and decrease HR
c. Decrease BP and increase HR
d. Decrease BP and decrease HR
Answer: b. Increase BP and decrease HR
Rationale:
Increased catecholamine levels in response to oxygen deprivation cause peripheral
vasoconstriction, leading to increased fetal blood pressure (BP). At the same time, there is a
compensatory decrease in fetal heart rate (HR) to redistribute blood flow to vital organs.
All of the following might indicate a pseudosinusoidal pattern as opposed to a sinusoidal
pattern, except:
a. Recent administration of narcotics to mother
b. Accelerations in FHR
c. Moderate variability
d. Frequency of oscillations of two to five cycles/min
Answer: d. Frequency of oscillations of two to five cycles/min
Rationale:
A pseudosinusoidal pattern in fetal heart rate (FHR) is characterized by a smooth, sine-like
waveform with regular oscillations of 3-5 cycles per minute. Moderate variability,

accelerations, and recent administration of narcotics are all consistent with a
pseudosinusoidal pattern.
All of the following are appropriate interventions for fetal tachycardia except:
a. Increase maternal IV fluid rate
b. Assess maternal vital signs
c. Perform SVE
d. Administer oxygen
Answer: c. Perform SVE
Rationale:
A sterile vaginal examination (SVE) is not an appropriate intervention for fetal tachycardia. It
does not directly address the cause of fetal tachycardia and may increase the risk of infection.
During a term antepartum NST (non-stress test), you notice several variable decelerations that
decrease at least 15 bpm and last at least 15 sec long. Which of the following is the least
likely explanation?
a. True knot
b. Gestational diabetes
c. Umbilical cord entanglement
d. Oligohydramnios
Answer: b. Gestational diabetes
Rationale:
Variable decelerations in fetal heart rate (FHR) during an antepartum non-stress test (NST)
could be caused by factors such as a true knot, umbilical cord entanglement, or
oligohydramnios. Gestational diabetes is less likely to directly cause variable decelerations.
All of the following are likely causes of prolonged decelerations except:
a. Uterine tachysystole
b. Prolapsed cord

c. Maternal hypotension
d. Maternal fever
Answer: d. Maternal fever
Rationale:
Prolonged decelerations in fetal heart rate (FHR) can be caused by factors such as uterine
tachysystole, prolapsed cord, or maternal hypotension. Maternal fever is less likely to directly
cause prolonged decelerations in FHR.
_________ decelerations occur with less than 50% of contractions.
a. Recurrent
b. Intermittent
c. Repetitive
Answer: b. Intermittent
Rationale:
Intermittent decelerations are defined as those that occur with less than 50% of contractions.
These decelerations are usually transient and not associated with significant fetal
compromise.
_________ decelerations occur with greater than or equal to 50% of contractions.
a. Recurrent
b. Intermittent
c. Repetitive
Answer: a. Recurrent
Rationale:
Recurrent decelerations are defined as those that occur with greater than or equal to 50% of
contractions. These decelerations are more concerning as they can indicate ongoing fetal
compromise and may require intervention.
All of the following could likely cause minimal variability in FHR except

a. Magnesium sulfate administration
b. Fetal sleep cycle
c. Narcotic administration
d. Ephedrine administration
Answer: d. Ephedrine administration
Rationale:
Ephedrine administration is not typically associated with minimal variability in fetal heart
rate (FHR). Magnesium sulfate administration, fetal sleep cycle, and narcotic administration
are all known to cause minimal variability in FHR.
When an IUPC has been placed, Montevideo units must be _________ or greater for
adequate cervical change to occur.
a. 100
b. 200
c. 300
d. 400
Answer: b. 200
Rationale:
Montevideo units measure the intensity of uterine contractions. A minimum of 200
Montevideo units is necessary for adequate cervical change to occur during labor.
The _________, increases the heart rate and strengthens myocardial contractions through the
release of epinephrine and nonepinephrine.
a. Sympathetic nervous system
b. Parasympathetic nervous system
Answer: a. Sympathetic nervous system
Rationale:

The sympathetic nervous system increases the heart rate and strengthens myocardial
contractions through the release of epinephrine and norepinephrine.
The _________, through stimulation of the vagus nerve, reduces FHR and maintains
variability.
a. Sympathetic nervous system
b. Parasympathetic nervous system
Answer: b. Parasympathetic nervous system
Rationale:
The parasympathetic nervous system, through stimulation of the vagus nerve, reduces fetal
heart rate (FHR) and maintains variability.
What would be a suspected pH in a fetus whose FHTs included recurrent late decelerations
during labor?
a. 7.10
b. 7.26
c. 7.32
d. 7.41
Answer: a. 7.10
Rationale:
Recurrent late decelerations during labor are associated with significant fetal compromise,
which could result in metabolic acidosis. A pH of 7.10 would be suspected in such a case.
What is the most common cause of sinusoidal patterns?
a. Prolapsed cord
b. Rh incompatibility
c. Recurrent late decelerations
d. Oligohydramnios
Answer: b. Rh incompatibility

Rationale:
Rh incompatibility is the most common cause of sinusoidal patterns in fetal heart rate (FHR)
monitoring.
Before weeks of gestation, an increase in FHR that peaks at least 10 bpm above the baseline
and lasts at least 10 seconds is considered an acceleration.
a. 28
b. 30
c. 32
d. 36
Answer: c. 32
Rationale:
Before 32 weeks of gestation, an increase in fetal heart rate (FHR) that peaks at least 10 beats
per minute (bpm) above the baseline and lasts at least 10 seconds is considered an
acceleration.
The expected response of the fetal heart rate to active fetal movement of a 31week gestational
age fetus is:
a. Suppression of normal short term variability for 15 seconds
b. Acceleration of at least 15 beats per minute for 15 seconds
c. Acceleration followed by a 15-second deceleration of the heart rate
d. Acceleration of at least 10 beats per minute for 10 seconds
Answer: d. Acceleration of at least 10 beats per minute for 10 seconds
Rationale:
The expected response of the fetal heart rate to active fetal movement of a 31-week
gestational age fetus is an acceleration of at least 10 beats per minute (bpm) for at least 10
seconds.
The nurse notes a pattern of variable decelerations to 75 bpm on the fetal monitor. The initial
nursing action is to:

a. Reposition the woman
b. Administer oxygen
c. Increase the intravenous fluid infusion
d. Stimulate the fetal scalp
Answer: a. Reposition the woman
Rationale:
The initial nursing action for variable decelerations is to reposition the woman to relieve cord
compression, which is often the cause of variable decelerations.
The tocotransducer should be placed:
a. In the suprapubic area
b. In the fundal area
c. Over the xiphoid process
d. Within the uterus
Answer: b. In the fundal area
Rationale:
The tocotransducer, which measures uterine contractions, should be placed over the fundus of
the uterus.
The nurse notes a pattern of decelerations on the fetal monitor that begins shortly after the
contraction and returns to baseline just before the contraction is over. The correct nursing
response is to:
a. Give the woman oxygen by facemask at 8-10 L/min
b. Position the woman on her opposite side
c. Increase the rate of the woman's intravenous fluid
d. Continue to observe and record the normal pattern
Answer: d. Continue to observe and record the normal pattern

Rationale:
Decelerations that begin shortly after the start of a contraction and return to baseline before
the end of the contraction are considered early decelerations, which are benign and do not
require intervention.
Determining the FHR baseline requires the nurse to approximate the mean FHR rounded to
increments of 5 bpm during a -minute window (excluding accelerations and decelerations).
a. 2
b. 5
c. 10
d. 20
Answer: c. 10
Rationale:
Determining the fetal heart rate (FHR) baseline involves approximating the mean FHR
rounded to increments of 10 bpm during a 10-minute window, excluding accelerations and
decelerations.
Uterine tachysystole is observed when there are
a. 5 or more contractions in 10 min
b. 6 or more contractions in 10 min
c. 10 or more contractions in 10 min
d. 7 or more contractions in 10 min
Answer: b. 6 or more contractions in 10 min
Rationale:
Uterine tachysystole is defined as six or more contractions in a 10-minute period.
Which of the following interventions would best stimulate an acceleration in the FHR?
a. Provide juice to patient
b. Perform vaginal exam

c. Turn patient on left side
d. Vibroacoustic stimulation
Answer: b. Perform vaginal exam
Rationale:
Performing a vaginal exam can stimulate an acceleration in the fetal heart rate (FHR) due to
the vagal stimulation associated with the procedure.
Assessment of the is an indirect measurement of fetal oxygenation.
a. Fetal heart rate
b. Fetal scalp sampling
c. Uterine activity
d. Direct Coombs
Answer: a. Fetal heart rate
Rationale:
Assessment of the fetal heart rate (FHR) is an indirect measurement of fetal oxygenation.
Changes in FHR patterns can indicate fetal distress and oxygenation status.
Intrauterine pressure catheters (IUPCs) do not increase risk for infection when placed on
patients with intact membranes. Membranes must be ruptured for use; infection is a risk
Answer: False
Rationale:

While IUPCs can increase the risk of infection when the amniotic sac is intact, they are
generally considered safe when the membranes are ruptured, providing direct access for
bacteria to enter the uterus.
What are abnormal fetal heart rate tracings predictive of?
a. Likelihood of spontaneous vaginal delivery
b. Newborn condition at time of delivery
c. Fetal acid-base abnormalities

d. Fetal intrauterine growth
Answer: c. Fetal acid-base abnormalities
Rationale:
Abnormal fetal heart rate (FHR) tracings are predictive of fetal acid-base abnormalities,
which can indicate fetal distress and the need for intervention.
Which of the following is not an intervention that should be implemented in a patient with
uterine tachysystole?
a. Administer terbutaline
b. Increase IV fluid rate
c. Decrease or discontinue IV oxytocin
d. Prepare patient for cesarean section
Answer: d. Prepare patient for cesarean section
Rationale:
Uterine tachysystole can often be managed without the need for cesarean section.
Interventions such as administering terbutaline, increasing IV fluid rate, and decreasing or
discontinuing IV oxytocin are appropriate first-line measures to manage uterine tachysystole.
Which of the following is most effective in determining the strength of a patient's
contractions?
a. Patient report
b. Tocodynanamometer tracing
c. RN palpation
d. Sterile vaginal exam during a contraction
Answer: c. RN palpation
Rationale:

RN palpation is the most effective method for determining the strength of a patient's
contractions. It allows for a subjective assessment of contraction intensity, which cannot be
accurately measured by patient report or external monitoring alone.
The FHR is controlled by the
a. Sympathetic nervous system
b. Sinoatrial node
c. Atrioventricular node
d. Parasympathetic nervous system
Answer: b. Sinoatrial node
Rationale:
The fetal heart rate (FHR) is controlled by the sinoatrial (SA) node, which is the primary
pacemaker of the fetal heart.
How do baseline heart rates differ in premature fetuses?
a. They are often lower
b. They are often higher
c. They are less likely to have decelerations
d. They experience longer accelerations
Answer: b. They are often higher
Rationale:
Baseline heart rates in premature fetuses are often higher compared to term fetuses. This is a
normal physiological adaptation in premature infants.
If etiology of fetal tachycardia is secondary to extrauterine infection, FHR will return to
normal as maternal fever resolves.
Answer: True
Rationale:

True. Fetal tachycardia secondary to extrauterine infection is often a response to maternal
fever. As the maternal fever resolves, the fetal heart rate (FHR) typically returns to normal.
Fetal tachycardia is a normal compensatory response to transient fetal hypoxemia.
Answer: True
Rationale:
True. Fetal tachycardia is a normal compensatory response to transient fetal hypoxemia. It is
the fetus's way of increasing oxygen delivery to vital organs during periods of hypoxemia.
Fetal heart rate bradycardia is defined as
a. FHR <110bpm lasting 10 min or greater
b. FHR <110bpm lasting 2 min or greater
c. FHR <110bpm lasting 20 min or greater
Answer: a. FHR <110bpm lasting 10 min or greater
Rationale:
Fetal heart rate (FHR) bradycardia is defined as an FHR less than 110 beats per minute (bpm)
lasting for 10 minutes or longer.
_________ variability warrants cesarean section delivery.
a. Minimal
b. Moderate
c. Marked
d. Absent
Answer: d. Absent
Rationale:
Absent variability in fetal heart rate (FHR) is associated with fetal compromise and is an
indication for cesarean section delivery. Minimal, moderate, or marked variability is
considered normal and does not typically warrant cesarean delivery.
At how many weeks gestation should FHR variability be normal in manner?

a. 24 weeks
b. 28 weeks
c. 32 weeks
d. 36 weeks
Answer: b. 28 weeks
Rationale:
Fetal heart rate (FHR) variability should be normal in manner by 28 weeks gestation. Normal
FHR variability is an important indicator of fetal well-being.
A deceleration from 145bpm down to 100bpm lasting 12 minutes may be defined as a
a. Prolonged deceleration
b.Variable deceleration
c. Late deceleration
d. Baseline change
Answer: d. Baseline change
Rationale:
A deceleration from 145bpm down to 100bpm lasting 12 minutes represents a significant
change from the baseline fetal heart rate (FHR) and is considered a baseline change.
Reduced respiratory gas exchange from persistent decelerations may cause a rise in fetal
PCO2, which leads first to , then .
a. Respiratory alkalosis; metabolic acidosis
b. Respiratory acidosis; metabolic acidosis
c. Respiratory alkalosis; metabolic alkalosis
d. Respiratory acidosis; metabolic acidosis
Answer: b. Respiratory acidosis; metabolic acidosis
Rationale:

Reduced respiratory gas exchange from persistent decelerations may cause a rise in fetal
PCO2, leading to respiratory acidosis. This can subsequently lead to metabolic acidosis due to
the compensatory mechanisms.
Decreased intervillous exchange of oxygenated blood resulting in fetal hypoxia is typically
present in .
a. Variable decelerations
b. Late decelerations
c. Early decelerations
d. Accelerations
Answer: b. Late decelerations
Rationale:
Decreased intervillous exchange of oxygenated blood resulting in fetal hypoxia is typically
present in late decelerations. Late decelerations are indicative of uteroplacental insufficiency.
Place the following interventions for a sinusoidal FHR in the correct order:
a. Prepare for cesarean delivery
b. Place patient in lateral position
c. Determine if pattern is related to narcotic analgesic administration
d. Provide oxygen via face mask
a. 4, 2, 3, 1
b. 3, 1, 2, 4
c. 4, 3, 2, 1
d. 3, 2, 4, 1
Answer: d. 3, 2, 4, 1
Rationale:
The correct order of interventions for a sinusoidal fetal heart rate (FHR) pattern is to first
determine if the pattern is related to narcotic analgesic administration, then place the patient

in a lateral position, provide oxygen via face mask, and finally prepare for cesarean delivery
if necessary.
The _________ is the source of all fetal oxygenation.
a. Placenta
b. Umbilical cord
c. Mother
d. Amniotic fluid
Answer: c. Mother
Rationale:
The mother is the source of all fetal oxygenation. Oxygen and nutrients are transferred from
the mother to the fetus across the placenta.
FHTs with recurrent variable decelerations, no accelerations, and minimal variability would
be categorized as
a. Category I
b. Category II
c. Category III
Answer: b. Category II
Rationale:
Fetal heart tracings (FHTs) with recurrent variable decelerations, no accelerations, and
minimal variability are categorized as Category II. This category indicates that further
evaluation and continuous monitoring are needed.
FHTs with absent variability and bradycardia would be categorized as
a. Category I
b. Category II
c. Category III
Answer: c. Category III

Rationale:
Fetal heart tracings (FHTs) with absent variability and bradycardia are categorized as
Category III. This category indicates abnormal FHR patterns and is associated with
significant fetal compromise.
FHTs with moderate variability, no accelerations, and early decelerations would be
categorized as
a. Category I
b. Category II
c. Category III
Answer: a. Category I
Rationale:
Fetal heart tracings (FHTs) with moderate variability, no accelerations, and early
decelerations are categorized as Category I. This category indicates normal FHR patterns and
is associated with a low risk of fetal acidemia.
FHTs with accelerations, no decelerations, and minimal variability would be categorized as
a. Category I
b. Category II
c. Category III
Answer: b. Category II
Rationale:
Fetal heart tracings (FHTs) with accelerations, no decelerations, and minimal variability are
categorized as Category II. This category indicates indeterminate FHR patterns and requires
further evaluation.
Sinusoidal pattern is categorized as
a. Category I
b. Category II

c. Category III
Answer: b. Category III
Rationale:
Sinusoidal pattern is categorized as Category III. This category indicates abnormal FHR
patterns and is associated with significant fetal compromise.
FHTs with absent variability and no accelerations or decelerations would be categorized as
a. Category I
b. Category II
c. Category III
Answer: b. Category II
Rationale:
Fetal heart tracings (FHTs) with absent variability and no accelerations or decelerations are
categorized as Category II. This category indicates abnormal FHR patterns and requires
further evaluation.
Absence of accelerations following fetal stimulation (i.e. scalp stimulation) is categorized as
a. Category I
b. Category II
c. Category III
Answer: b. Category II
Rationale:
Absence of accelerations following fetal stimulation (i.e., scalp stimulation) is categorized as
Category II. This category indicates abnormal FHR patterns and requires further evaluation.
FHTs with minimal variability, absent accelerations, and a 3-minute prolonged deceleration
would be categorized as
a. Category I
b. Category II

c. Category III
Answer: b. Category II
Rationale:
Fetal heart tracings (FHTs) with minimal variability, absent accelerations, and a 3-minute
prolonged deceleration are categorized as Category II. This category indicates abnormal FHR
patterns and requires further evaluation.
FHTs with minimal variability and a baseline of 95bpm would be categorized as
a. Category I
b. Category II
c. Category III
Answer: b. Category II
Rationale:
Fetal heart tracings (FHTs) with minimal variability and a baseline of 95bpm are categorized
as Category II. Although the baseline is within the normal range (110-160 bpm), minimal
variability indicates indeterminate fetal status, necessitating further evaluation.
FHTs with a baseline of 170bpm, moderate variability, and no accelerations or decelerations
would be categorized as
a. Category I
b. Category II
c. Category III
Answer: b. Category II
Rationale:
Fetal heart tracings (FHTs) with a baseline of 170bpm, moderate variability, and no
accelerations or decelerations are categorized as Category II. Although the baseline is within
the normal range (110-160 bpm) and there is moderate variability, the absence of
accelerations or decelerations requires further evaluation.

FHTs with a baseline 135bpm, moderate variability, accelerations, and one late deceleration
would be categorized as
a. Category I
b. Category II
c. Category III
Answer: b. Category II
Rationale:
Fetal heart tracings (FHTs) with a baseline of 135bpm, moderate variability, accelerations,
and one late deceleration are categorized as Category II. Although there are reassuring
features such as moderate variability and accelerations, the presence of a late deceleration
indicates the need for continued monitoring and further evaluation.
A prolonged acceleration lasts greater than _________ minutes and less than _________
minutes.
a. 2; 10
b. 2; 20
c. 10; 20
d. 10; 20
Answer: a. 2; 10
Rationale:
A prolonged acceleration is defined as an increase in fetal heart rate lasting more than 2
minutes but less than 10 minutes.
_________ FHR patterns are those associated with uterine contractions.
a. Periodic
b. Episodic
c. Recurrent
d. Irregular

Answer: a. Periodic
Rationale:
Periodic fetal heart rate (FHR) patterns are those associated with uterine contractions.
_________ FHR patterns are those that are not associated with uterine contractions.
a. Periodic
b. Episodic
c. Recurrent
d. Irregular
Answer: b. Episodic
Rationale:
Episodic fetal heart rate (FHR) patterns are those that are not associated with uterine
contractions.
Which of the following is not a likely cause of a sinusoidal FHR pattern?
a. Chronic fetal bleeding
b. Fetal hypoxia or anemia
c. Triple screen positive for Trisomy 21
d. Fetal isoimmunization
Answer: c. Triple screen positive for Trisomy 21
Rationale:
A sinusoidal fetal heart rate (FHR) pattern is associated with severe fetal anemia, not with a
positive triple screen for Trisomy 21.
Which of the following factors is not likely to cause uteroplacental insufficiency?
a. Late-term gestation
b. Preeclampsia
c. Gestational diabetes

d. Polyhydramnios
e. Maternal smoking or drug use
Answer: d. Polyhydramnios
Rationale:
Polyhydramnios is not likely to cause uteroplacental insufficiency. However, it may be
associated with other complications such as macrosomia or cord prolapse.
Which of the following are considered determinants of fetal well-being?(Select all that
apply).
a. Absence of decelerations in FHR
b. Palpation of fetal movement
c. Presence of accelerations in FHR
d. Moderate variability in FHR
e. Presence of early decelerations in second stage
f. Moderate variability in FHR
Answer: c. Presence of accelerations in FHR
Rationale:
Determinants of fetal well-being include the presence of accelerations in fetal heart rate
(FHR), moderate variability in FHR, and absence of decelerations in FHR.
When auscultation is used for fetal assessment during labor for a low-risk woman, the FHR
should be auscultated in the first stage of labor every
a. 5 min
b. 15-30 min
c. 60 min
Answer: b. 15-30 min
Rationale:

When auscultation is used for fetal assessment during labor for a low-risk woman, the fetal
heart rate (FHR) should be auscultated in the first stage of labor every 15-30 minutes.
For a low-risk woman in the second stage of labor, the FHR should be auscultated every
a. 5-15 min
b. 30 min
c. 60 min
Answer: a. 5-15 min
Rationale:
For a low-risk woman in the second stage of labor, the fetal heart rate (FHR) should be
auscultated every 5-15 minutes.
The normal FHR baseline
a. Decreases during labor
b. Fluctuates during labor
c. Increases during labor
Answer: b. Fluctuates during labor
Rationale:
The normal fetal heart rate (FHR) baseline fluctuates during labor. It can vary in response to
fetal activity, sleep cycles, and other factors.
Bradycardia in the second stage of labor following a previously normal tracing may be
caused by fetal
a. Hypoxemia
b. Rotation
c. Vagal stimulation
Answer: c. Vagal stimulation
Rationale:

During the second stage of labor, fetal bradycardia can occur due to increased vagal
stimulation, often as a result of fetal head compression during descent through the birth canal.
A likely cause of fetal tachycardia with moderate variability is
a. Fetal hypoxemia
b. Maternal fever
c. Vagal stimulation
Answer: b. Maternal fever
Rationale:
Maternal fever can cause fetal tachycardia with moderate variability. It is a physiological
response of the fetus to maternal pyrexia.
Reduction in FHR variability can result from
a. Fetal scalp stimulation
b. Medication administration
c. Vaginal examination
Answer: b. Medication administration
Rationale:
Medications such as opioids or magnesium sulfate can lead to a reduction in fetal heart rate
variability.
The primary goal in treatment for late decelerations is to
a. Correct cord compression
b. Improve maternal oxygenation
c. Maximize uteroplacental blood flow
Answer: c. Maximize uteroplacental blood flow
Rationale:

Late decelerations are indicative of uteroplacental insufficiency, and the primary goal is to
maximize uteroplacental blood flow to improve fetal oxygenation.
The most frequently observed type of FHR deceleration is
a. Early
b. Late
c. Variable
Answer: c. Variable
Rationale:
Variable decelerations are the most frequently observed type of fetal heart rate decelerations.
Amnioinfusion may be useful in alleviating recurrent decelerations that are
a. Early
b. Late
c. Variable
Answer: c. Variable
Rationale:
Amnioinfusion is most useful in alleviating recurrent variable decelerations, which are often
caused by umbilical cord compression.
Findings indicative of progressive fetal hypoxemia are
a. Late decelerations, moderate variability, stable baseline rate
b. Prolonged decelerations recovering to baseline and moderate variability
c. Loss of variability and recurrent late or variable decelerations
Answer: c. Loss of variability and recurrent late or variable decelerations
Rationale:
Loss of variability and recurrent late or variable decelerations are indicative of progressive
fetal hypoxemia.

Clinically significant fetal metabolic academia is indicated by an arterial cord gas pH of less
than or equal to 7.10 and a base deficit of
a. 3
b. 6
c. 12
Answer: c. 12
Rationale:
Clinically significant fetal metabolic acidemia is indicated by an arterial cord gas pH of less
than or equal to 7.10 and a base deficit of 12 or greater.
Fetal bradycardia can result during
a. The sleep state
b. Umbilical vein compression
c. Vagal stimulation
Answer: c. Vagal stimulation
Rationale:
Fetal bradycardia can result from increased vagal stimulation.
While caring for a 235-lb laboring woman who is HIV-seropositive, the external FHR tracing
is difficult to obtain. An appropriate nursing action would be to
a. Apply a fetal scalp electrode
b. Auscultate for presence of FHR variability
c. Notify the attending midwife or physician
Answer: c. Notify the attending midwife or physician
Rationale:
If the external fetal heart rate tracing is difficult to obtain, it is appropriate to notify the
attending midwife or physician for further assessment and management.

FHR decelerations that are benign and do not require intervention are
a. Early
b. Late
c. Variable
Answer: a. Early
Rationale:
Early decelerations are considered benign and do not require intervention as they are
typically caused by head compression during contractions.
FHR decelerations that result from decreased uteroplacental blood flow are
a. Early
b. Late
c. Variable
Answer: b. Late
Rationale:
Late decelerations result from decreased uteroplacental blood flow.
FHR decelerations that result from umbilical cord compression are
a. Early
b. Late
c. Variable
Answer: c. Variable
Rationale:
Variable decelerations often result from umbilical cord compression.
An FHR pattern associated with severe fetal anemia is
a. Lambda
b. Saltatory

c. Sinusoidal
Answer: c. Sinusoidal
Rationale:
Sinusoidal pattern is associated with severe fetal anemia.
A workup for maternal systemic lupus erythematosus would likely be ordered in the presence
of
a. Complete fetal heart block
b. Premature ventricular contractions
c. Fetal supraventricular tachycardia
Answer: a. Complete fetal heart block
Rationale:
Complete fetal heart block is associated with maternal systemic lupus erythematosus and
would warrant a workup for this condition.
Which IV fluid is most appropriate for maternal administration for intrauterine resuscitation?
a. Lactated Ringer's solution
b. D5L/R
c. Normal saline
Answer: c. Normal saline
Rationale:
Normal saline is the most appropriate IV fluid for maternal administration during intrauterine
resuscitation because it does not contain any additional substances that could affect fetal
status.
The position that best promotes maternal-fetal exchange is
a. Left lateral
b. Right lateral

c. Either right or left lateral
Answer: c. Either right or left lateral
Rationale:
Either right or left lateral positioning promotes maternal-fetal exchange by reducing
compression of the maternal vena cava and improving blood flow to the placenta.
The most appropriate equipment for administration of maternal oxygen for intrauterine
resuscitation at 10 L/min is a
a. Nasal cannula
b. Simple face mask
c. Nonrebreather face mask
Answer: c. Nonrebreather face mask
Rationale:
A nonrebreather face mask is the most appropriate equipment for administration of maternal
oxygen at 10 L/min during intrauterine resuscitation because it can deliver high
concentrations of oxygen.
Accurate determination of baseline rate requires
a. At least 2 contiguous minutes of FHR in a 10-min window
b. Evaluation of the FHR over at least a 10-min window
c. Averaging the FHR over 30 min
Answer: b. Evaluation of the FHR over at least a 10min window
Rationale:
Accurate determination of baseline fetal heart rate requires evaluation of the FHR over at
least a 10-minute window.
An EFM tracing with absent variability and no decelerations would be classified as
a. Category I
b. Category II (indeterminate)

c. Category III
Answer: b. Category II (indeterminate)
Rationale:
An EFM tracing with absent variability and no decelerations is classified as Category II
(indeterminate).
An EFM tracing with absent variability and intermittent late decelerations would be classified
as
a. Category I
b. Category II
c. Category III
Answer: b. Category II
Rationale:
An EFM tracing with absent variability and intermittent late decelerations is classified as
Category II.
Interpretation and classification of FHR patterns are based on predictability of fetal status
a. At birth
b. At the time the pattern is observed
c. Over the previous hour
Answer: b. At the time the pattern is observed
Rationale:
Interpretation and classification of FHR patterns are based on the predictability of fetal status
at the time the pattern is observed.
Amnioinfusion is an appropriate measure for
a. Thick, meconium-stained fluid
b. Oligohydramnios

c. Recurrent variable decelerations unresolved by position changes
Answer: c. Recurrent variable decelerations unresolved by position changes
Rationale:
Amnioinfusion is appropriate for recurrent variable decelerations that are unresolved by
position changes, as it can help alleviate umbilical cord compression.
Baroreceptors respond to changes in fetal
a. Blood pressure
b. Oxygen status
c. Acid-base status
Answer: a. Blood pressure
Rationale:
Baroreceptors in the fetus respond to changes in fetal blood pressure.
Fetal scalp stimulation is appropriate in the context of
a. Minimal variability
b. Prolonged deceleration
c. Bradycardia
Answer: a. Minimal variability
Rationale:
Fetal scalp stimulation is appropriate in the context of minimal variability to assess fetal
response and reactivity.
Maternal oxygen administration is appropriate in the context of
a. Recurrent variable decelerations/moderate variability
b. Intermittent late decelerations/minimal variability
c. Prolonged decelerations/moderate variability
Answer: b. Intermittent late decelerations/minimal variability

Rationale:
Maternal oxygen administration is appropriate in the context of intermittent late decelerations
with minimal variability to improve fetal oxygenation.
A preterm fetus
a. Is more susceptible to hypoxic insults during labor than the term fetus
b. Requires internal monitoring if oxytocin is used for labor induction or augmentation
c. Should be born via cesarean section unless there are maternal contraindications
Answer: b. Is more susceptible to hypoxic insults during labor than the term fetus
Rationale:
Preterm fetuses are more susceptible to hypoxic insults during labor than term fetuses due to
their immature physiological systems.
Oxygen is transferred from the mother to the fetus via the placenta through
a. Active transport
b. Passive diffusion
c. Facilitated diffusion
Answer: b. Passive diffusion
Rationale:
Oxygen is transferred from the mother to the fetus via the placenta through passive diffusion.
Resting tone and intensity of uterine contractions cannot be assessed by
a. External tocodynamometer
b. Manual palpation
c. Intrauterine pressure catheter
Answer: a. External tocodynamometer
Rationale:

Resting tone and intensity of uterine contractions cannot be accurately assessed by an
external tocodynamometer.
The FHR characteristic most predictive of a well-oxygenated baby at the time observed is
a. Moderate variability
b. Stable baseline rate
c. Absence of decelerations
Answer: a. Moderate variability
Rationale:
Moderate variability is the FHR characteristic most predictive of a well-oxygenated baby at
the time observed.
In the context of hypoxemia, fetal blood flow is shifted to the
a. Brain
b. Liver
c. Lungs
Answer: a. Brain
Rationale:
In the context of hypoxemia, fetal blood flow is preferentially shunted to the brain to protect
vital organ function.
Baroreceptor-mediated decelerations are
a. Early
b. Late
c. Variable
Answer: c. Variable
Rationale:

Baroreceptor-mediated decelerations can occur at any time during labor and are therefore
classified as variable decelerations. They are typically associated with umbilical cord
compression.
The primary goal in the treatment of variable decelerations is to
a. Correct umbilical cord compression
b. Improve maternal oxygenation
c. Maximize blood flow to the uterus
Answer: a. Correct umbilical cord compression
Rationale:
The primary cause of variable decelerations is umbilical cord compression. Therefore, the
main goal of treatment is to relieve this compression to ensure adequate blood flow to the
fetus.
Umbilical artery gas results reflect the status of the
a. Mother
b. Fetus
c. Placenta
Answer: b. Fetus
Rationale:
Umbilical artery gas results provide information about the fetus's status, including its
oxygenation and acid-base balance.
An appropriate initial treatment for recurrent late decelerations with moderate variability
during first stage labor is
a. Amnioinfusion
b. Maternal repositioning
c. Oxygen at 10L per nonrebreather face mask
Answer: b. Maternal repositioning

Rationale:
Maternal repositioning, such as changing the mother's position or providing lateral tilt, can
alleviate pressure on the vena cava and improve fetal oxygenation.
Most fetal dysrhythmias are not life-threatening, except for _________, which may lead to
fetal congestive heart failure.
Answer: Supraventricular tachycardia
Rationale:
Supraventricular tachycardia is a fetal dysrhythmia that can lead to congestive heart failure
and is therefore considered life-threatening.
Medications, prematurity, fetal sleep, fetal dysrhythmia, anesthetic agents, or cardiac
anomalies may result in variability
Answer: Decreased
Rationale:
These factors can lead to decreased variability in fetal heart rate.
In the presence of late or variable decelerations, two parameters that indicate adequate fetal
oxygenation are and .
Answer: Moderate variability; normal baseline rate
Rationale:
Late or variable decelerations can indicate fetal distress. Adequate fetal oxygenation is
indicated by moderate variability and a normal baseline heart rate.
To correctly interpret a baseline FHR as tachycardic or bradycardic, the rate must persist for a
minimum of min.
Answer: 10
Rationale:
To accurately classify the baseline fetal heart rate as tachycardic or bradycardic, the abnormal
rate must persist for at least 10 minutes.
In assessing fetal well-being, the most important characteristic of the FHR is

a. Rate
b. Variability
c. Presence of accelerations
d. Absence of decelerations
Answer: b. Variability
Rationale:
Fetal heart rate variability is the most important characteristic when assessing fetal wellbeing. It reflects the fetal autonomic nervous system's integrity and the fetus's ability to
respond to hypoxic stress.
Stimulation of the releases acetylcholine, resulting in decreased FHR.
Answer: Parasympathetic nervous system
Rationale:
The parasympathetic nervous system, when stimulated, releases acetylcholine, which leads to
a decrease in fetal heart rate.
The maintains transmission of beat-to-beat variability.
Answer: Parasympathetic nervous system
Rationale:
The parasympathetic nervous system is responsible for maintaining beat-to-beat variability in
fetal heart rate.
Stimulation of the releases catecholamines, resulting in increased FHR.
Answer: Sympathetic nervous system
Rationale:
The sympathetic nervous system, when stimulated, releases catecholamines, which lead to an
increase in fetal heart rate.
Stimulation of results in abrupt decreases in FHR, CO, and BP.
Answer: Baroreceptors

Rationale:
Stimulation of baroreceptors results in abrupt decreases in fetal heart rate, cardiac output, and
blood pressure as part of the baroreceptor reflex, which helps regulate blood pressure.
Baroreceptors influence _________ decelerations with moderate variability.
Answer: Variable
Rationale:
Baroreceptors influence variable decelerations with moderate variability by responding to
changes in blood pressure associated with contractions or other factors affecting fetal
circulation.
Following an ultrasound which revealed decreased amniotic fluid, a woman at term is
admitted in early labor. It should be recognized that oligohydramnios often results in fetal
heart rate decelerations that are
a. Late in onset or occur after the peak of the contraction
b. Synchronous with that of the contraction
c. Varied in depth and duration
Answer: c. Varied in depth and duration
Rationale:
Oligohydramnios can lead to variable decelerations in fetal heart rate. These decelerations are
often varied in depth and duration due to the reduced cushioning effect of amniotic fluid.
In comparing early and late decelerations, a distinguishing factor between the two is
a. Onset time to the nadir of the deceleration
b. The number of decelerations that occur
c. Timing in relation to contractions
Answer: c. Timing in relation to contractions
Rationale:

A distinguishing factor between early and late decelerations is their timing in relation to
contractions. Early decelerations coincide with the onset, peak, and recovery of contractions,
while late decelerations begin after the contraction has started and reach their nadir after the
contraction's peak.
The underlying cause of early decelerations is decreased
a. Baroceptor response
b. Increased peripheral resistance
c. Vagal reflex
Answer: c. Vagal reflex
Rationale:
Early decelerations are caused by fetal head compression during contractions, which
stimulates the vagal reflex and leads to a temporary decrease in fetal heart rate.
Glucose is transferred across the placenta via _________
Answer: Facilitated diffusion
Rationale:
Glucose is transferred across the placenta via facilitated diffusion, facilitated by glucose
transporter proteins.
Oxygen, carbon dioxide, water, electrolytes, urea, uric acid, fatty acids, fat-soluble vitamins,
narcotics, barbiturates, anesthetics, and antibiotics are transferred across the placenta via
_________
Answer: Simple (passive) diffusion
Rationale:
These substances are small enough to pass through the placental membrane via simple
diffusion, moving from areas of higher concentration (maternal circulation) to areas of lower
concentration (fetal circulation).
Amino acids, water-soluble vitamins, calcium, phosphorus, iron, and iodine are transferred
across the placenta via ________

Answer: Active transport
Rationale:
These substances require specific carrier proteins to facilitate their transfer across the
placenta against concentration gradients, a process known as active transport.
Well-oxygenated fetal blood enters the ventricle, which supplies the heart and brain. Lessoxygenated blood enters ________ the ventricle, which supplies the rest of the body.
Answer: Left; right
Rationale:
Well-oxygenated blood enters the left ventricle, which pumps blood to the heart and brain.
Less-oxygenated blood enters the right ventricle, which pumps blood to the rest of the body.
The ________allows relatively well-oxygenated blood to enter the fetal heart directly,
bypassing the liver.
Answer: Ductus venosus
Rationale:
The ductus venosus shunts oxygenated blood from the umbilical vein directly into the inferior
vena cava, bypassing the liver.
The ________allows blood to bypass the lungs, flowing from the pulmonary artery to the
aorta.
Answer: Ductus arteriosus
Rationale:
The ductus arteriosus shunts blood from the pulmonary artery to the aorta, allowing blood to
bypass the non-functioning fetal lungs.
The _________ is the shunt that bypasses the fetal lungs, moving blood from the right atrium
to the left atrium.
Answer: Foramen ovale
Rationale:

The foramen ovale is a fetal cardiac structure that allows blood to bypass the pulmonary
circulation by shunting oxygenated blood from the right atrium directly to the left atrium.
Fetal blood has a _________ hemoglobin concentration compared to adults
a. Higher
b. Lower
Answer: a. Higher
Rationale:
Fetal blood has a higher hemoglobin concentration compared to adults, resulting in a greater
oxygen-carrying capacity.
Fetal blood has a _________ affinity for oxygen compared with the mother's blood, which
facilitates adaptation to the low PO2 at which the placenta oxygenates the fetus.
a. Higher
b. Lower
Answer: a. Higher
Rationale:
Fetal blood has a higher affinity for oxygen compared to the mother's blood, facilitating
oxygen transfer across the placenta despite the lower partial pressure of oxygen (PO 2) in the
placenta.
The fetus has a cardiac output and heart rate than the adult, resulting in rapid circulation.
a. Higher
b. Lower
Answer: a. Higher
Rationale:
The fetus has a higher cardiac output and heart rate than adults, resulting in more rapid
circulation necessary for the demands of fetal growth and development.
As the FHR increases, the myocardium consumes oxygen.

a. More
b. Less
Answer: a. More
Rationale:
As the fetal heart rate (FHR) increases, the myocardium consumes more oxygen to meet the
increased metabolic demands associated with the higher heart rate.
The fetal spiral electrode measures the
a. Peaks of the Doppler waveforms
b. R to R intervals of the fetal heart
c. ST segments of the fetal ECG
Answer: b. R to R intervals of the fetal heart
Rationale:
The fetal spiral electrode measures the R to R intervals of the fetal heart, providing
information about the fetal heart rate and rhythm.
A woman who is admitted for an induction of labor with oxytocin is questioning the need for
continuous electronic fetal monitoring. The appropriate response to this woman is
a. Hospital policy requires that all patients have continuous electronic fetal monitoring.
b. I would like to answer your questions about continuous monitoring and give you some
information about why continuous monitoring is recommended.
c. Nurses have more training with continuous electronic fetal monitoring than intermittent
auscultation so it is safer for you and your baby to use this method.
Answer: b. I would like to answer your questions about continuous monitoring and give you
some information about why continuous monitoring is recommended.
Rationale:
Providing the woman with information about continuous electronic fetal monitoring and its
benefits allows her to make an informed decision about her labor and delivery.

The greater affinity that fetal hemoglobin has for oxygen allows for
a. Easier release of oxygen to the tissues
b. Greater binding of oxygen
c. Stimulation of erythropoietin release
Answer: b. Greater binding of oxygen
Rationale:
Fetal hemoglobin's greater affinity for oxygen allows for greater binding of oxygen in the
fetal bloodstream, facilitating oxygen transport across the placenta to meet fetal metabolic
needs.
The process by which oxygen and carbon dioxide pass from a region of higher concentration
to one of a lower concentration is called
a. Active transport
b. Simple diffusion
c. Facilitated diffusion
Answer: b. Simple diffusion
Rationale:
Simple diffusion is the passive movement of molecules from an area of higher concentration
to an area of lower concentration, which is how oxygen and carbon dioxide exchange occurs
across the placenta and in the lungs.
In the healthy fetus, blood flows from the right atrium to the left atrium through the
a. Ductus arteriosus
b. Ductus venosus
c. Foramen ovale
Answer: c. Foramen ovale
Rationale:

In the healthy fetus, blood flows from the right atrium to the left atrium through the foramen
ovale, bypassing the pulmonary circulation.
In the healthy fetus, the umbilical cord enters the fetal abdomen and bypasses the liver
through the
a. Ductus arteriosus
b. Ductus venosus
c. Foramen ovale
Answer: b. Ductus venosus
Rationale:
The umbilical cord enters the fetal abdomen and bypasses the liver through the ductus
venosus, allowing oxygenated blood from the placenta to flow directly to the fetal heart.
Which statement best describes the relationship between maternal and fetal hemoglobin
levels?
a. Fetal hemoglobin is higher than maternal hemoglobin
b. Maternal hemoglobin is higher than fetal hemoglobin
c. Maternal and fetal hemoglobin are the same
Answer: a. Fetal hemoglobin is higher than maternal hemoglobin
Rationale:
Fetal hemoglobin has a higher concentration than maternal hemoglobin, allowing for greater
oxygen-carrying capacity for the fetus.
Baroreceptors respond mainly to changes in
a. Blood pressure
b. Hormonal changes
c. Oxygen and carbon dioxide levels
Answer: a. Blood pressure
Rationale:

Baroreceptors are specialized sensors that detect changes in blood pressure and help regulate
it by sending signals to the brain.
Stimulation of the sympathetic nervous system causes the fetal heart rate to
a. Decrease
b. Increase
c. Remain the same
Answer: b. Increase
Rationale:
Stimulation of the sympathetic nervous system causes an increase in the fetal heart rate as
part of the fight or flight response.
Which statement describes normal uterine activity?
a. Frequency of 1-1/2 to 2 minutes
b. Intensity of 90 mmHg early in labor
c. Resting tone less than 20-25 mmHg
Answer: c. Resting tone less than 20-25 mmHg
Rationale:
Normal uterine activity is characterized by a resting tone less than 20-25 mmHg, indicating a
relaxed state between contractions.
Greater than 5 contractions in 10 minutes averaged over 30 minutes indicates
a. Excessive uterine activity
b. Hyperstimulation
c. Tachysystole
Answer: c. Tachysystole
Rationale:

Tachysystole is defined as more than 5 contractions in 10 minutes, averaged over 30 minutes,
and can lead to fetal distress due to decreased uterine blood flow.
A 36-week gestation patient is brought to triage by squad after an MVA on her back. She is
not bleeding and denies pain. She is not short of breath, but c/o dizziness and nausea since
they put her on the gurney. The most likely cause is
a. Abruptio placenta
b. Preterm labor
c. Supine hypotension
Answer: c. Supine hypotension
Rationale:
Dizziness and nausea in a pregnant woman, especially when lying on her back, are classic
symptoms of supine hypotension syndrome, caused by compression of the vena cava by the
uterus when the woman is in a supine position.
One compensatory mechanism that helps maintain oxygen availability to the fetus during
maternal exercise is
a. A decrease in maternal hematocrit
b. Transient increase in uterine blood flow
c. An increase in uterine oxygen uptake
Answer: c. An increase in uterine oxygen uptake
Rationale:
During maternal exercise, there is an increase in uterine oxygen uptake, which helps maintain
oxygen availability to the fetus.
When the hydrogen ion content in the blood rises, the pH
a. Lowers
b. Neutralizes
c. Rises

Answer: a. Lowers
Rationale:
An increase in hydrogen ion content in the blood leads to a decrease in pH, making it more
acidic.
A woman receives terbutaline for an external version. You may expect what on the fetal heart
tracing?
a. Decrease in variability
b. Increase in baseline
c. No change
Answer: b. Increase in baseline
Rationale:
Terbutaline, a beta-agonist, can cause tachycardia in the fetus, resulting in an increase in the
fetal heart rate baseline.
What affect does magnesium sulfate have on the fetal heart rate?
a. Decreases variability
b. Increases variability
c. No change
Answer: a. Decreases variability
Rationale:
Magnesium sulfate, commonly used to prevent preterm labor, can depress the fetal central
nervous system, resulting in decreased variability in the fetal heart rate.
NICHD guidelines apply only to
a. Intrapartum patients
b. Internal monitoring of fetal heart rate
c. Interpreting tracings of good quality

Answer: c. Interpreting tracings of good quality
Rationale:
NICHD guidelines apply to the interpretation of fetal heart rate tracings of good quality
during labor and delivery.
According to NICHD terminology, variability can be accurately accessed
a. Visually, by determining the number of R to R intervals in a one-minute period
b. Visually, by determining the amplitude of the FHR change in bpm from the baseline
c. Only when a fetal spiral electrode is in place
Answer: b. Visually, by determining the amplitude of the FHR change in bpm from the
baseline
Rationale:
NICHD recommends assessing variability visually by determining the amplitude of the fetal
heart rate (FHR) change in beats per minute (bpm) from the baseline.
When looking at the fetal heart rate, the most important characteristic to determine the
absence of metabolic acidemia is
a. Absence of late decelerations
b. Baseline rate within normal range
c. Presence of moderate variability
Answer: c. Presence of moderate variability
Rationale:
Moderate variability in the fetal heart rate is the most important characteristic to determine
the absence of metabolic acidemia, as it indicates a healthy autonomic nervous system and
adequate oxygenation to the fetus.
Sinusoidal pattern can be documented when
a. Cycles are 4-6 beats per minute in frequency
b. The pattern lasts 20 minutes or longer

c. There is moderate or minimal variability
Answer: b. The pattern lasts 20 minutes or longer
Rationale:
Sinusoidal pattern can be documented when the pattern lasts 20 minutes or longer and is
characterized by a smooth, sine-like waveform with a consistent frequency of 3-5 cycles per
minute and an amplitude of 5-15 bpm.
Vagal stimulation would be manifested as what type of fetal heart rate pattern?
a. Acceleration
b. Early deceleration
c. Tachycardia
Answer: b. Early deceleration
Rationale:
Vagal stimulation would be manifested as early decelerations in the fetal heart rate pattern,
which are typically benign and associated with fetal head compression during contractions.
Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially
when seen at the onset of labor?
a. Early deceleration
b. Late deceleration
c. Variable deceleration
Answer: a. Early deceleration
Rationale:
Early decelerations are characteristic of cephalopelvic disproportion, especially when seen at
the onset of labor, and are caused by compression of the fetal head against the maternal
pelvis.
A risk of amnioinfusion is
a. Prolonged labor

b. Uterine overdistension
c. Water intoxication
Answer: b. Uterine overdistension
Rationale:
A risk of amnioinfusion is uterine overdistension, which can lead to uterine hyperstimulation,
fetal bradycardia, and increased risk of umbilical cord prolapse.
A fetal heart rate pattern that the NICHD has identified as predictive of current or impending
fetal asphyxia so severe that the fetus is at risk of neurologic damage or death is
a. Baseline tachycardia with absent variability
b. Minimal baseline variability with recurrent late decelerations
c. Recurrent late or variable decelerations with absent variability
Answer: c. Recurrent late or variable decelerations with absent variability
Rationale:
According to NICHD, recurrent late or variable decelerations with absent variability are
predictive of current or impending fetal asphyxia, indicating severe fetal compromise.
A fetal heart rate pattern that can occur when there is a prolapsed cord is
a. Marked variability
b. Prolonged decelerations
c. Tachycardia
Answer: b. Prolonged decelerations
Rationale:
Prolonged decelerations can occur when there is a prolapsed cord, as the cord compression
leads to decreased oxygenation and prolonged decelerations in the fetal heart rate.
The patient is in early labor with pitocin at 8 mu/min, and FHR is Category I. In the next 15
minutes, there are 18 uterine contractions. Recommended management is to
a. Address contraction frequency by reducing pitocin dose

b. Continue to increase pitocin as long as FHR is Category I
c. Turn the patient on her side and initiate an IV fluid bolus
Answer: c. Turn the patient on her side and initiate an IV fluid bolus
Rationale:
Increased uterine activity can compromise fetal oxygenation. Turning the patient on her side
and initiating an IV fluid bolus can help improve uterine blood flow and oxygenation to the
fetus.
A woman at 38 weeks gestation is in labor. The labor has been uneventful, and the fetal heart
tracings have been normal. Spontaneous rupture of membranes occurs; fetal heart rate drops
to 90 beats per minute for four minutes and then resumes a normal pattern. The most likely
etiology for this fetal heart rate change is
a. Abnormal fetal presentation
b. Impaired placental circulation
c. Possible cord compression
Answer: c. Possible cord compression
Rationale:
A sudden drop in fetal heart rate following rupture of membranes suggests possible cord
compression, as the umbilical cord may become compressed between the presenting part and
the maternal pelvis, compromising fetal oxygenation.
A 42-week gestation woman has been diagnosed with oligohydramnios. Based on this, an
FHR change that can be expected is
a. Late deceleration
b. Minimal variability
c. Variable deceleration
Answer: c. Variable deceleration
Rationale:

Oligohydramnios increases the risk of umbilical cord compression, leading to variable
decelerations in the fetal heart rate.
Mono-mono zygotic twins are prone to what type of deceleration during labor?
a. Early
b. Late
c. Variable
Answer: c. Variable
Rationale:
Mono-mono zygotic twins are prone to cord entanglement, leading to variable decelerations
in the fetal heart rate.
During labor, the recommended fetal heart rate assessment interval for auscultation is every
a. 15-30 minutes in the active phase of the first stage and every 5-15 minutes in the second
stage
b. 15 minutes no matter what stage of labor
c. 60 minutes in the active phase of the first stage and every 30 minutes in the second stage
Answer: a. 15-30 minutes in the active phase of the first stage and every 5-15 minutes in the
second stage
Rationale:
During labor, fetal heart rate should be assessed every 15-30 minutes in the active phase of
the first stage and every 5-15 minutes in the second stage to monitor fetal well-being and
detect any abnormalities promptly.
What fetal heart rate characteristics can be determined with auscultation?
a. Baseline
b. Early decelerations
c. Variability
Answer: a. Baseline

Rationale:
Auscultation allows for the determination of the fetal heart rate baseline, which is essential
for assessing fetal well-being during labor.
When auscultating the fetal heart rate, the provider/nurse should simultaneously assess the
maternal
a. Blood pressure
b. Pain level
c. Radial pulse
Answer: c. Radial pulse
Rationale:
While auscultating the fetal heart rate, the provider/nurse should simultaneously assess the
maternal radial pulse to ensure that maternal and fetal heart rates are distinct and to detect any
maternal arrhythmias.
A woman has 10 fetal movements in one hour. This is considered what kind of movement?
a. Decreased
b. Excessive
c. Normal
Answer: c. Normal
Rationale:
Ten fetal movements in one hour are considered normal fetal activity, indicating fetal wellbeing.
If the pH is low, what other blood gas parameter is used to determine if the acidosis is
respiratory or metabolic?
a. HCO3
b. PCO2
c. PO2

Answer: b. PCO2
Rationale:
If the pH is low, the PCO2 is used to determine if the acidosis is respiratory (elevated PCO2)
or metabolic (normal or decreased PCO2).
The following cord blood gases are consistent with: pH 7.10, pCO2 70, pO2 25, base excess 10
a. Metabolic acidosis
b. Mixed acidosis
c. Respiratory acidosis
Answer: c. Respiratory acidosis
Rationale:
The given values indicate respiratory acidosis, as evidenced by a low pH (45 mmHg) with a low pO2 (<60 mmHg).
A fetus at 36 weeks receives a biophysical profile (BPP) score of 6. The amniotic fluid was
scored as normal. The expected management is
a. Immediate delivery
b. Repeat the test in 24 hours
c. Schedule the next test in one week
Answer: b. Repeat the test in 24 hours
Rationale:
A BPP score of 6 at 36 weeks gestation with normal amniotic fluid warrants repeat testing in
24 hours to reassess fetal well-being before making any decisions about delivery.
A woman with gestational diabetes is 38 weeks gestation. Her Biophysical Profile score is 4.
This indicates the need for
a. Follow-up in one week
b. Induction of labor

c. Emergent cesarean section
Answer: b. Induction of labor
Rationale:
A BPP score of 4 at 38 weeks gestation indicates the need for induction of labor to prevent
potential adverse outcomes associated with fetal compromise.
A 35-week gestation fetus is having an NST. The fetal heart rate baseline is 130 bpm. The
nurse is using vibroacoustic stimulation to reduce the length of time needed to obtain the
NST. Fetal well-being requires
a. 1 acceleration to 145 bpm
b. 2 accelerations to 140 bpm
c. 2 accelerations to at least 145 bpm
Answer: c. 2 accelerations to at least 145 bpm
Rationale:
Fetal well-being requires two accelerations in the fetal heart rate to at least 145 bpm within a
20-minute period in response to vibroacoustic stimulation during a non-stress test (NST).
A woman desires a natural childbirth. The nurse puts pressure on her to get an epidural. This
is an example of going against which ethical principle?
a. Autonomy
b. Beneficence
c. Justice
Answer: a. Autonomy
Rationale:
Pressuring a woman to get an epidural against her wishes goes against the ethical principle of
autonomy, which respects the patient's right to make her own decisions regarding her
healthcare.
One characteristic of a high reliability perinatal unit is

a. Alarms can only be called by unit leaders
b. Reliance on memorization of protocols
c. The organization creates a safety-oriented culture
Answer: c. The organization creates a safety-oriented culture
Rationale:
High reliability perinatal units prioritize patient safety by creating a safety-oriented culture
that focuses on error prevention, open communication, and continuous improvement.
One example of evidence-based practice related to fetal monitoring is
a. Diagnosis of uterine rupture with an IUPC
b. Intermittent auscultation for the low-risk patient
c. Using electronic fetal monitoring to prevent cerebral palsy
Answer: b. Intermittent auscultation for the low-risk patient
Rationale:
Intermittent auscultation for the low-risk patient is an evidence-based practice supported by
research as an effective method of fetal monitoring during labor, providing the same level of
safety as continuous electronic fetal monitoring for low-risk pregnancies.
Supporting the parents' decision to choose no extraordinary measures for their baby who is
about to deliver at 24 3/7 weeks gestation despite the nurse's personal opinion is an example
of
a. Autonomy
b. Beneficence
c. Non-maleficence
Answer: a. Autonomy
Rationale:

Respecting the parents' decision to choose no extraordinary measures for their baby despite
the nurse's personal opinion is an example of respecting the principle of autonomy, allowing
the parents to make decisions regarding their child's care.
_________ primarily function(s) to regulate respiratory activity and control circulation by
responding to changes in arterial PO2, PCO2, and acid-base balance.
a. Baroreceptors
b. Chemoreceptors
c. Cardioregulatory center
Answer: b. Chemoreceptors
Rationale:
Chemoreceptors primarily function to regulate respiratory activity and control circulation by
responding to changes in arterial oxygen (PO2), carbon dioxide (PCO2), and acid-base
balance.
_________ are protective stretch receptors located in the aortic arch and the carotid sinuses at
the bifurcation of the external and internal carotid arteries.
a. Baroreceptors
b. Chemoreceptors
c. Arteries
Answer: a. Baroreceptors
Rationale:
Baroreceptors are protective stretch receptors located in the aortic arch and the carotid
sinuses, which respond to changes in arterial blood pressure.
_________ respond to increases in fetal arterial blood pressure by detecting the amount of
stretch and sending impulses via the vagus nerve to the midbrain, decreasing FHR, CO, and
BP.
a. Baroreceptors
b. Chemoreceptors

c. Veins
Answer: a. Baroreceptors
Rationale:
Baroreceptors respond to increases in fetal arterial blood pressure by detecting the amount of
stretch and sending impulses via the vagus nerve to the midbrain, resulting in decreased fetal
heart rate (FHR), cardiac output (CO), and blood pressure (BP).
As a contraction begins, partial umbilical cord compression causes occlusion of the lowpressure vein and decreased return of blood to the fetal heart, resulting in decreased CO,
hypotension, and a compensatory FHR .
a. Acceleration
b. Early deceleration
c. Late deceleration
d. Variable deceleration
Answer: a. Acceleration
Rationale:
As a contraction begins, partial umbilical cord compression causes occlusion of the lowpressure vein, resulting in decreased blood return to the fetal heart, which stimulates the
baroreceptors and leads to a compensatory fetal heart rate acceleration.
With complete umbilical cord occlusion, the two umbilical arteries also become occluded,
resulting in sudden fetal hypertension, stimulation of the baroreceptors, and a sudden
decrease in FHR.
a. Increase
b. Decrease
Answer: b. Decrease
Rationale:
Complete umbilical cord occlusion leads to sudden fetal hypertension, stimulating the
baroreceptors and resulting in a sudden decrease in fetal heart rate (FHR).

Central chemoreceptors are located in the medulla oblongata; peripheral chemoreceptors are
found in the carotid sinuses and aortic arch.
a. Baroreceptors
b. Chemoreceptors
Answer: b. Chemoreceptors
Rationale:
Central chemoreceptors are located in the medulla oblongata, while peripheral
chemoreceptors are found in the carotid sinuses and aortic arch.
When a fetus is stressed, catecholamine release (epinephrine, norepinephrine) occurs from
the medulla oblongata, shunting blood away from the brain, heart, and adrenal glands.
a. Toward
b. Away from
Answer: b. Toward
Rationale:
When a fetus is stressed, catecholamine release (epinephrine, norepinephrine) occurs from
the medulla oblongata, shunting blood away from the brain, heart, and adrenal glands to
prioritize blood flow to vital organs.
Because stroke volume in the fetus does not fluctuate significantly, fetal cardiac output is
fetal heart rate.
a. Greater than
b. Less than
c. Approximately equal to
Answer: c. Approximately equal to
Rationale:
Fetal cardiac output is approximately equal to fetal heart rate because stroke volume in the
fetus does not fluctuate significantly.

In _________ sleep, the fetus may be observed to have infrequent or absent body movements,
normal FHR baseline, minimal variability, and a nonreactive NST, but may respond to
external stimuli. Such typically occurs by 28 to 32 weeks' gestation.
a. REM (active sleep state)
b. Non-REM (quiet sleep state)
Answer: b. Non-REM (quiet sleep state)
Rationale:
In Non-REM (quiet sleep state), the fetus may have infrequent or absent body movements,
normal fetal heart rate (FHR) baseline, minimal variability, and a nonreactive non-stress test
(NST), but may respond to external stimuli. This typically occurs by 28 to 32 weeks'
gestation.
Place the following steps for performing Leopold's maneuver in the appropriate order.
a. Assess location of fetal back
b. Determine the descent of the presenting part
c. Identify the presenting part
d. Assess part of the fetus in the upper uterus
a. 1, 3, 2, 4
b. 2, 4, 1, 2
c. 4, 1, 3, 2
d. 4, 3, 2, 1
Answer: c. 4, 1, 3, 2
Rationale:
The correct order for performing Leopold's maneuver is to first assess the part of the fetus in
the upper uterus (4), then identify the presenting part (1), determine the descent of the
presenting part (3), and finally assess the location of the fetal back (2).
When the internal mode of monitoring (FSE, IUPC) is used, the information obtained on the
uterine activity panel on the fetal monitor should be validated by the clinician by

a. Asking the patient to report when she is feeling a contraction
b. Ultrasound imaging
c. Palpation
Answer: c. Palpation
Rationale:
When the internal mode of monitoring (FSE, IUPC) is used, the information obtained on the
uterine activity panel on the fetal monitor should be validated by the clinician through
palpation to ensure accuracy and reliability.
Use of a fetoscope for intermittent auscultation of the fetal heart rate may be used to detect
baseline, rhythm, changes from baseline, and presence of an irregular rhythm.
Answer: True
Rationale:
A fetoscope can detect baseline FHR, rhythm, changes from baseline, and irregular rhythms
such as arrhythmias.
A Doppler device used for intermittent auscultation of the fetal heart rate may be used to
identify rhythm irregularities, such as supraventricular tachycardia.
Answer: False
Rationale:
While a Doppler device can detect the fetal heart rate, it may not be as effective in identifying
rhythm irregularities compared to a fetoscope.
Use of a fetoscope for intermittent auscultation of the fetal heart rate may be used to detect
accelerations and decelerations from the baseline, and can clarify double-counting of halfcounting of baseline rate.
Answer: True
Rationale:
A fetoscope allows for the detection of accelerations and decelerations from the baseline, as
well as clarifies any double-counting or half-counting of the baseline rate.

Auscultation may be used to detect baseline variability and discriminate FHR deceleration
patterns.
Answer: False
Rationale:
Auscultation is not typically used to detect baseline variability or discriminate FHR
deceleration patterns. These are usually assessed through electronic fetal monitoring.
_________ represents increased sympathetic or decreased parasympathetic autonomic tone.
a. Bradycardia
b. Tachycardia
Answer: b. Tachycardia
Rationale:
Tachycardia typically represents increased sympathetic or decreased parasympathetic
autonomic tone.
In the context of moderate variability, late decelerations are considered neurogenic in origin
and are typically amenable to intrauterine resuscitation techniques directed towards
maximizing uterine blood flow.
Answer: True
Rationale:
Late decelerations are often due to decreased uteroplacental perfusion and are neurogenic in
origin. Intrauterine resuscitation techniques aim to maximize uterine blood flow to improve
fetal oxygenation.
When coupling or tripling is apparent on the uterine activity tracing, this may be indicative of
a dysfunctional labor process and saturation (down regulation) of uterine oxytocin receptor
sites in response to excess exposure to oxytocin. Which of the following interventions would
be most appropriate?
a. Normal response; continue to increase oxytocin titration
b. Turn patient on side

c. Decrease or discontinue oxytocin infusion
Answer: c. Decrease or discontinue oxytocin infusion
Rationale:
Coupling or tripling on the uterine activity tracing suggests hyperstimulation of the uterus,
which can lead to fetal distress. The most appropriate intervention is to decrease or
discontinue the oxytocin infusion.
The most common tachyarrhythmia in fetuses, supraventricular tachycardia, typically occurs
at a rate of to bpm with minimal or absent variability.
a. 160-200
b. 200-240
c. 240-260
Answer: c. 240-260
Rationale:
Supraventricular tachycardia in fetuses typically occurs at a rate of 240-260 bpm with
minimal or absent variability.
In a patient with oxytocin-induced tachysystole with normal fetal heart tones, which of the
following should be the nurse's initial intervention?
a. Assist the patient to lateral position
b. Discontinue Pitocin
c. Administer IV fluid bolus
Answer: a. Assist the patient to lateral position
Rationale:
The initial intervention for tachysystole with normal fetal heart tones is to reposition the
patient to a lateral position to improve uterine perfusion.
In a patient with oxytocin-induced tachysystole with indeterminate or abnormal fetal heart
tones, which of the following should be the nurse's initial intervention?

a. Assist the patient to lateral position
b. Discontinue Pitocin
c. Administer IV fluid bolus
Answer: b. Discontinue Pitocin
Rationale:
If fetal heart tones are indeterminate or abnormal in the presence of oxytocin-induced
tachysystole, the initial intervention should be to discontinue the Pitocin infusion to prevent
further fetal distress.
Fetal hypoxia and acidemia are demonstrated by pH < _________ and base excess <
_________
Answer: < 7.15; < -8
Rationale:
A pH less than 7.15 and a base excess less than -8 indicate fetal hypoxia and acidemia,
indicating compromised fetal oxygenation.
Amnioinfusion is an appropriate intervention to attempt to resolve patterns of moderate to
severe late decelerations.
Answer: False
Rationale:
Late decelerations are often associated with uteroplacental insufficiency, and amnioinfusion
is not typically effective in resolving this pattern.
Amnioinfusion is an appropriate intervention to attempt to resolve patterns with absent
variability.
Answer: False
Rationale:
Amnioinfusion is not typically used to address absent variability but is rather employed to
address variable decelerations associated with oligohydramnios.

Amnioinfusion may be an appropriate intervention for patients with oligohydramnios in the
prevention of the development of variable decelerations.
Answer: False
Rationale:
While oligohydramnios may increase the risk of variable decelerations, amnioinfusion is not
commonly used for prevention but rather as a treatment for existing variable decelerations.
Meconium-stained amniotic fluid is an indication for amnioinfusion.
Answer: False
Rationale:
Meconium-stained amniotic fluid is not an indication for amnioinfusion. It may indicate fetal
distress, but the presence of meconium alone does not necessitate amnioinfusion.
Uterine resting tone may appear higher (25 to 40 mmHg) during amnioinfusion.
Answer: True
Rationale:
Amnioinfusion may increase uterine resting tone due to the additional volume in the uterine
cavity.
_________ denotes a decrease in oxygenation of the fetal tissues.
a. Hypercapnia
b. Hypoxia
c. Hypoxemia
Answer: b. Hypoxia
Rationale:
Hypoxia denotes a decrease in oxygenation of the fetal tissues.
_________ denotes a decrease in oxygen content of the fetal blood.
a. Hypercapnia

b. Hypoxia
c. Hypoxemia
Answer: c. Hypoxemia
Rationale:
Hypoxemia denotes a decrease in oxygen content of the fetal blood.
_________ denotes an increase in carbon dioxide in the fetal blood.
a. Hypercapnia
b. Hypoxia
c. Hypoxemia
Answer: a. Hypercapnia
Rationale:
Hypercapnia denotes an increase in carbon dioxide in the fetal blood.
_________ denotes an increase in hydrogen ions in the fetal blood.
a. Acidosis
b. Acidemia
c. Hypercapnia
Answer: b. Acidemia
Rationale:
Acidemia denotes an increase in hydrogen ions in the fetal blood.
_________ denotes an increase in hydrogen ions in the fetal tissues.
a. Acidosis
b. Acidemia
c. Hypercapnia
Answer: a. Acidosis

Rationale:
Acidosis denotes an increase in hydrogen ions in the fetal tissues.
_________ occurs when there is low bicarbonate (base excess) in the presence of normal
pressure of carbon dioxide (PCO2) values.
a. Metabolic acidosis
b. Respiratory acidosis
c. Metabolic alkalosis
Answer: a. Metabolic acidosis
Rationale:
Metabolic acidosis occurs when there is low bicarbonate in the presence of normal PCO 2
values.
_________ occurs when there is high PCO2 with normal bicarbonate levels.
a. Metabolic acidosis
b. Respiratory acidosis
c. Metabolic alkalosis
Answer: b. Respiratory acidosis
Rationale:
Respiratory acidosis occurs when there is high PCO2 with normal bicarbonate levels.
_________ occurs when the HCO3 concentration is lower than normal.
a. Base deficit
b. Base excess
c. Metabolic acidosis
Answer: a. Base deficit
Rationale:
Base deficit occurs when the HCO3 concentration is lower than normal.

_________ occurs when the HCO3 concentration is higher than normal.
a. Base deficit
b. Base excess
c. Metabolic acidosis
Answer: b. Base excess
Rationale:
Base excess occurs when the HCO3 concentration is higher than normal.
_________ is defined as the energy-consuming process of metabolism.
Answer: Anabolism
Rationale:
Anabolism is the energy-consuming process of metabolism.
_________ is defined as the energy-releasing process of metabolism.
Answer: Catabolism
Rationale:
Catabolism is the energy-releasing process of metabolism.
It is an appropriate intervention to perform fetal scalp stimulation during a deceleration.
Answer: False
Rationale:
Fetal scalp stimulation is not typically performed during a deceleration but rather during an
acceleration to assess fetal well-being.
Normal oxygen saturation for the fetus in labor is _________ % to _________ %. - 30% to
65% The normal mean value range for arterial pH is
a. 7.0-7.20
b. 7.20-7.29
c. 7.29-7.39

Answer: b. 7.20-7.29
Rationale:
The normal oxygen saturation for the fetus in labor is 30% to 65%. The normal mean value
range for arterial pH is 7.20-7.29.
The normal mean value range for arterial PCO2 is
a. 22-24
b. 35-40
c. 49-56
Answer: c. 49-56
Rationale:
The normal mean value range for arterial PCO2 is 49-56 mmHg.
The normal mean value range for arterial bicarbonate (HCO3) is
a. 22-24
b. 35-40
c. 49-56
Answer: a. 22-24
Rationale:
The normal mean value range for arterial bicarbonate (HCO3) is 22-24 mEq/L.
The normal mean value range for arterial base deficit is
a. 2.7-8.3
b. -3.0-2.5
c. 4.2-12.9
Answer: a. 2.7-8.3
Rationale:
The normal mean value range for arterial base deficit is 2.7-8.3 mEq/L.

The normal mean value range for arterial PO2 is
a. 22-24
b. 15-24
c. 49-56
Answer: b. 15-24
Rationale:
The normal mean value range for arterial PO2 is 15-24 mmHg.
pH 7.05
a. PO2 21
b. PCO2 72
c. HCO3 24
Answer: b. PCO2 72
Rationale:
A pH of 7.05 with a PCO2 of 72 mmHg indicates respiratory acidosis.
Base excess -12
a. Metabolic acidosis
b. Respiratory acidosis
c. Mixed acidosis
Answer: b. Respiratory acidosis
Rationale:
A base excess of -12 indicates respiratory acidosis.
pH 7.0
a. PO2 18
b. PCO2 54

c. HCO3 20
Base deficit 14
a. Metabolic acidosis
b. Respiratory acidosis
c. Mixed acidosis
Answer: a. Metabolic acidosis
Rationale:
A pH of 7.0 with a base deficit of 14 indicates metabolic acidosis.
pH 7.02
A PO2 17
b. PCO2 72
c. HCO3 19
Answer: c. HCO3 19
Rationale:
A pH of 7.02 with an HCO3 of 19 mEq/L indicates metabolic acidosis.
Base deficit 16
a. Metabolic acidosis
b. Respiratory acidosis
c. Mixed acidosis
Answer: c. Mixed acidosis
Rationale:
A base deficit of 16 indicates mixed acidosis, involving both metabolic and respiratory
components.
Which is a correct description of daily fetal movement counting?
a. Counting should not be started by low-risk mothers until 38 weeks of gestation

b. Fetal movement counting is not reliable because the methods of counting vary
c. The mother counts the number of movements over a specified length of time
Answer: c. The mother counts the number of movements over a specified length of time
Rationale:
Daily fetal movement counting involves the mother counting the number of fetal movements
over a specified length of time.
The BPP includes the assessment of FHR along with what other four components?
a. Amniotic fluid, fetal breathing, fetal movement, fetal tone
b. Amniotic fluid, fetal anomalies, fetal breathing, fetal movement
c. Estimated fetal weight, fetal breathing, fetal movement, placental grading
Answer: a. Amniotic fluid, fetal breathing, fetal movement, fetal tone
Rationale:
The BPP (Biophysical Profile) includes the assessment of fetal heart rate along with amniotic
fluid volume, fetal breathing, fetal movement, and fetal tone.
Which of the following might indicate a potential for chronic fetal hypoxemia?
a. Decreased amniotic fluid volume
b. Increased amniotic fluid volume
c. Intrauterine growth restriction
Answer: c. Intrauterine growth restriction
Rationale:
Intrauterine growth restriction may indicate chronic fetal hypoxemia due to placental
insufficiency.
With the finding of a single umbilical artery, what would you expect to observe with Doppler
flow studies?
a. Decreased blood perfusion from the fetus to the placenta

b. Decreased blood perfusion from the placenta to the fetus
c. Homeostatic dilation of the umbilical artery
Answer: a. Decreased blood perfusion from the fetus to the placenta
Rationale:
A single umbilical artery may indicate decreased blood perfusion from the fetus to the
placenta.
Primary benefits associated with the use of standardized terminology for fetal heart
monitoring interpretation include
a. Enhanced communication among health care providers and promotion of patient safety
b. Increased nursing time at the bedside and enhanced patient satisfaction
c. Increased likelihood of correctly diagnosing fetal acidosis during labor
Answer: a. Enhanced communication among health care providers and promotion of patient
safety
Rationale:
Standardized terminology for fetal heart monitoring interpretation enhances communication
among healthcare providers and promotes patient safety by ensuring consistent interpretation
and response to fetal heart rate patterns.
A patient presents with a small amount of thick dark blood clots who denies pain and whose
abdomen is soft to the touch. Which component of oxygen transport to the fetus could
potentially be compromised by this bleeding?
a. Affinity
b. Saturation
c. Delivery
Answer: c. Delivery
Rationale:
Bleeding during pregnancy can compromise oxygen delivery to the fetus by reducing the
amount of oxygen-rich blood reaching the placenta.

What is the most appropriate physiologic goal for a patient whose tracing reveals a sinusoidal
baseline?
a. Maximize umbilical circulation
b. Maximize uteroplacental circulation
c. Reduce uterine activity
Answer: b. Maximize uteroplacental circulation
Rationale:
Sinusoidal baseline pattern is often associated with severe fetal anemia or hypoxemia.
Maximizing uteroplacental circulation helps optimize oxygen delivery to the fetus.
Compromised oxygenation
Answer: maximize uteroplacental circulation to promote perfusion and oxygenation
Rationale:
When oxygenation is compromised, maximizing uteroplacental circulation is essential to
promote adequate perfusion and oxygenation to the fetus.
When recurrent late decelerations are occurring, the correct physiologic interpretation of this
event is
a. Fetal myocardial acidosis is occurring
b. Fetal hypoxemia may be present
c. The fetus has oxygen reserves
Answer: b. Fetal hypoxemia may be present
Rationale:
Recurrent late decelerations indicate uteroplacental insufficiency, which may lead to fetal
hypoxemia.
Which intrinsic homeostatic response is the fetus demonstrating when abrupt variable
decelerations are present?
a. Baroreceptor

b. Catecholamine
c. Sympathetic
Answer: a. Baroreceptor
Rationale:
Abrupt variable decelerations are thought to be due to umbilical cord compression, and the
fetus's baroreceptor response triggers a compensatory increase in heart rate.
An amnioinfusion is intended to relieve which extrinsic factor that compromises oxygen
transport?
a. Excessive uterine compression
b. Structural abnormalities of the placenta
c. Umbilical cord compression
Answer: c. Umbilical cord compression
Rationale:
Amnioinfusion is used to relieve umbilical cord compression by diluting the concentration of
meconium or other substances in the amniotic fluid, which reduces the severity of cord
compression and improves fetal oxygenation.
The nurse wants to document her conversation with the attending physician during an
emergent situation. The best approach to documentation would be to
a. Continue providing care for the patient and write a late entry summarizing the conversation
after the cesarean is completed
b. Enter an objective transcription of the conversation in the electronic record while
colleagues are preparing the patient for surgery
c. Report the conversation to the charge nurse, who can make an entry in the medical record
Answer: a. Continue providing care for the patient and write a late entry summarizing the
conversation after the cesarean is completed
Rationale:

In an emergent situation, the priority is patient care. After the situation is resolved, the nurse
should write a late entry summarizing the conversation with the attending physician.
An infant was delivered via cesarean. Umbilical cord blood gases were: pH 6.88, PCO 2 114,
PO2 10, bicarbonate 15, base excess (-) 20. The initial neonatal hemocrit was 20% and the
hemoglobin was 8.Which interpretation of these umbilical cord and initial neonatal blood
results is correct?
a. Base buffers have been used to maintain oxygenation
b. The mother was probably hypoglycemic
c. The neonate is anemic
Answer: c. The neonate is anemic
Rationale:
A low hemoglobin and hematocrit indicate anemia in the neonate.
An infant was delivered via cesarean. Umbilical cord blood gases were: pH 6.88, PCO 2 114,
PO2 10, bicarbonate 15, base excess (-) 20. The initial neonatal hemocrit was 20% and the
hemoglobin was 8.These umbilical cord blood gases indicate
a. Asphyxia related to umbilical and placental abnormalities
b. Hypoxia related to neurological damage
c. Mixed acidosis
Answer: c. Mixed acidosis
Rationale:
The umbilical cord blood gases show a mixed metabolic and respiratory acidosis.
An infant was delivered via cesarean. Umbilical cord blood gases were: pH 6.88, PCO 2 114,
PO2 10, bicarbonate 15, base excess (-) 20. The initial neonatal hemocrit was 20% and the
hemoglobin was 8. Which phrase best describes acidemia?
a. A decrease of oxygen concentration in the blood
b. An increase in hydrogen ions in the blood
c. An increase of hydrogen ions in the tissues

Answer: b. An increase in hydrogen ions in the blood
Rationale:
Acidemia is characterized by an increase in hydrogen ions in the blood, resulting in a
decreased pH.
Which compromise in fetal oxygenation could be a result of a post-date pregnancy?
a. Increased saturation capacity
b. Increased fetal oxygen affinity
c. Decreased placental perfusion
Answer: c. Decreased placental perfusion
Rationale:
Post-date pregnancies are associated with decreased placental perfusion, which can
compromise fetal oxygenation.
What are the possible implications of an AFI of 3 cm for labor?
a. An amnioinfusion will be needed
b. Increased risk of uterine hyperstimulation
c. Potential umbilical cord compression
Answer: c. Potential umbilical cord compression
Rationale:
An AFI of 3 cm indicates oligohydramnios, which may increase the risk of umbilical cord
compression during labor.
Which is a characteristic of a negative CST?
a. Absence of late decelerations
b. Recurrent late decelerations
c. Reactive FHR tracing
Answer: a. Absence of late decelerations

Rationale:
A negative CST is characterized by an absence of late decelerations, indicating a reassuring
fetal response to uterine contractions.
Which FHR tracing features must be assessed to distinguish arrhythmias from artifact?
a. Shape and regularity of the spikes
b. Spikes and variability
c. Spikes and baseline
Answer: a. Shape and regularity of the spikes
Rationale:
To distinguish arrhythmias from artifact, it is important to assess the shape and regularity of
the spikes in the fetal heart rate tracing.
How might a fetal arrhythmia affect fetal oxygenation?
a. By increasing fetal oxygen affinity
b. By increasing sympathetic response
c. By reducing fetal perfusion
Answer: c. By reducing fetal perfusion
Rationale:
Fetal arrhythmias can reduce fetal perfusion, leading to decreased oxygen delivery to the
fetus.
Which medication is used to treat fetal arrhythmias?
a. Digoxin
b. Labetolol
c. Nifedipine
Answer: a. Digoxin
Rationale:

Digoxin is commonly used to treat fetal arrhythmias by promoting regular and effective
cardiac contraction.
Fetal hydrops may present on ultrasound as fetal scalp edema and increased abdominal fluid
as a result of
a. An increase in gestational age
b. Congestive heart failure
c. Sustained oligohydramnios
Answer: b. Congestive heart failure
Rationale:
Fetal hydrops, characterized by fetal scalp edema and increased abdominal fluid, is often a
result of congestive heart failure.
What might increase fetal oxygen consumption?
a. Hyperthermia
b. Umbilical cord compression
c. Uterine tachysystole
Answer: a. Hyperthermia
Rationale:
Hyperthermia increases maternal metabolism and, consequently, fetal oxygen consumption.
Adequacy of uterine resting tone measured by an IUPC should be validated by palpation.
Answer: True
Rationale:
Palpation is an essential part of uterine activity assessment and should be used to validate the
measurements obtained by an intrauterine pressure catheter (IUPC).
Which assessment or intervention would be least appropriate in a patient whose FHR tracing
revealed tachycardia and a prolonged deceleration?
a. Change maternal position to right lateral

b. Further assess fetal oxygenation with scalp stimulation
c. Perform a vaginal exam to assess fetal descent
Answer: b. Further assess fetal oxygenation with scalp stimulation
Rationale:
Scalp stimulation should not be performed during prolonged decelerations, as it may
exacerbate the deceleration.
Which of the following pieces of information would be of the highest priority to relay to the
neonatal team as they prepare for an emergency cesarean delivery?
a. FHR arrhythmia, meconium, length of labor
b. Gestational age, meconium, arrhythmia
c. Gravidity & parity, gestational age, maternal temperature
Answer: b. Gestational age, meconium, arrhythmia
Rationale:
Gestational age, presence of meconium, and fetal arrhythmia are critical pieces of
information for the neonatal team to prepare for the delivery and neonatal care.
What characteristics are necessary for a reactive NST in a G3P0 patient who is 25 6/7 weeks'
gestation?
a. Accelerations of 15 bpm above the baseline lasting at least 15 seconds above the baseline
b. Accelerations of 10 bpm above the baseline lasting at least 10 seconds above the baseline
c. Any acceleration greater than 10 bpm above the baseline
Answer: b. Accelerations of 10 bpm above the baseline lasting at least 10 seconds above the
baseline
Rationale:
For a reactive NST, accelerations of at least 10 bpm above the baseline lasting at least 10
seconds are required.

How long may a standard NST be extended in a term gestation if reactivity is not initially
demonstrated?
a. From the initial 20 min to 40 min
b. From the initial 20 min to 60 min
c. From the initial 30 min to 60 min
Answer: a. From the initial 20 min to 40 min
Rationale:
In a term gestation, if reactivity is not initially demonstrated, the NST may be extended to 40
minutes to allow for fetal sleep cycles.
Which is the most appropriate application of vibroacoustic stimulation (fetal acoustic
stimulation) in a standard NST?
a. The device is placed at the top of the maternal fundus
b. The mother uses a marker button to document the fetal movement response
c. The stimulation is applied after a baseline is established
Answer: c. The stimulation is applied after a baseline is established
Rationale:
Vibroacoustic stimulation is applied after a baseline is established during a standard NST to
evoke a fetal response.
Which of the following characteristics are most common in the preterm fetus?
a. Increased baseline rate and prolonged accelerations
b. Increased baseline rate and variable decelerations
c. Prolonged accelerations and variable decelerations
Answer: b. Increased baseline rate and variable decelerations
Rationale:
Preterm fetuses often have an increased baseline heart rate and variable decelerations, along
with decreased variability.

What typical characteristics of preterm uterine activity may be present in a patient
experiencing preterm labor?
a. An irritable uterus with wandering hypertonus
b. Low-amplitude high-frequency contractions
c. Tetanic contractions
Answer: b. Low-amplitude high-frequency contractions
Rationale:
Preterm uterine activity is often characterized by low-amplitude high-frequency contractions.
Which medications used with preterm labor can affect the FHR characteristics?
a. Terbutaline and antibiotics
b. Betamethasone and terbutaline
c. Antibiotics and narcotics
Answer: b. Betamethasone and terbutaline
Rationale:
Betamethasone and terbutaline, commonly used in preterm labor, can affect fetal heart rate
characteristics.
What characterizes a preterm fetal response to stress?
a. More frequently occurring late decelerations
b. More frequently occurring prolonged decelerations
c. More rapid deterioration from Category I to Category II or III
Answer: c. More rapid deterioration from Category I to Category II or III
Rationale:
Preterm fetuses tend to have a more rapid deterioration from Category I to Category II or III
in response to stress.

More likely to be subjected to hypoxia Clinical decision-making at the bedside should
include:
a. Communication with the primary care provider only during a crisis
b. Integration of physiologic concepts with maternal-fetal assessment findings
c. Reliance primarily on technology over bedside assessments
Answer: b. Integration of physiologic concepts with maternal-fetal assessment findings
Rationale:
Integrating physiologic concepts with maternal-fetal assessment findings allows for a
comprehensive understanding of the clinical situation, aiding in the identification and
management of fetal hypoxia.
In the United States, the paper speed on the monitor is set at
a. 1 cm/min
b. 2 cm/min
c. 3 cm/min
Answer: c. 3 cm/min
Rationale:
A paper speed of 3 cm/min is the standard setting for fetal monitoring in the United States.
This speed allows for accurate visualization and interpretation of fetal heart rate patterns.
A woman being monitored externally has a suspected fetal arrhythmia. The most appropriate
action is to
a. Insert a spiral electrode and turn off the logic
b. Turn the logic on if an external monitor is in place
c. Use a Doppler to listen to the ventricular rate
Answer: a. Insert a spiral electrode and turn off the logic
Rationale:

When an external fetal arrhythmia is suspected, the most appropriate action is to insert a
spiral electrode to obtain a more accurate fetal heart rate, and turn off the logic function of the
monitor to prevent incorrect interpretation of the arrhythmia.
The ultrasound transducer on the electronic fetal monitor measures the
a. Electrical signal of the fetal heart
b. Mechanical movements of the fetal heart reflected off of sound waves
c. R-to-R intervals of the fetal heart
Answer: b. Mechanical movements of the fetal heart reflected off of sound waves
Rationale:
The ultrasound transducer on the electronic fetal monitor measures mechanical movements of
the fetal heart reflected off of sound waves. This allows for accurate detection of fetal heart
rate.
The purpose of autocorrelation in external monitoring is to
a. Compare incoming waveforms for comparison
b. Decrease signal to noise levels
c. Distinguish fetal from maternal HR
Answer: a. Compare incoming waveforms for comparison
Rationale:
Autocorrelation in external monitoring is used to compare incoming waveforms to ensure
accuracy and consistency in detecting fetal heart rate and uterine contractions.
The area of maximum intensity of the FHR is usually the fetal
a. Back
b. Chest
c. Umbilicus
Answer: a. Back
Rationale:

The area of maximum intensity of the fetal heart rate is usually the fetal back. This is where
the fetal heart is closest to the maternal abdominal wall, allowing for the best detection of
fetal heart sounds.
Palpating the uterus is best performed by using the
a. Back of the hand
b. Fingertips
c. Palm
Answer: b. Fingertips
Rationale:
Palpating the uterus is best performed using the fingertips. This allows for better sensitivity in
detecting uterine contractions and assessing their strength and frequency.
What is the most sensitive method of assessing uterine activity?
a. IUPC
b. Manual palpation
c. Maternal perception
Answer: a. IUPC
Rationale:
The most sensitive method of assessing uterine activity is intrauterine pressure catheter
(IUPC). It provides continuous, accurate measurements of uterine contractions.
In comparison to maternal blood, the affinity of fetal blood for oxygen is
a. Higher
b. Lower
c. The same
Answer: a. Higher
Rationale:

Fetal blood has a higher affinity for oxygen compared to maternal blood, ensuring efficient
oxygen transfer across the placenta.
The process that requires energy to accomplish the passage of substances within the
intervillous space is
a. Active transport
b. Diffusion
c. Facilitated diffusion
Answer: a. Active transport
Rationale:
Active transport requires energy to move substances across the placental membrane within
the intervillous space.
The umbilical vein carries
a. Carbon dioxide from the fetus back to the placenta
b. Deoxygenated blood from the fetus to the placenta
c. Oxygenated blood from the placenta to the fetus
Answer: c. Oxygenated blood from the placenta to the fetus
Rationale:
The umbilical vein carries oxygenated blood from the placenta to the fetus, providing the
fetus with necessary oxygen and nutrients.
Fetal hypoxia is best described as a condition of
a. Decreased oxygen in the blood
b. Decreased oxygen in the tissue
c. Increased hydrogen ions in the blood
Answer: b. Decreased oxygen in the tissue
Rationale:

Fetal hypoxia is best described as a condition of decreased oxygen in the fetal tissues, which
can lead to fetal distress if not addressed promptly.
Stimulation of the parasympathetic nervous system causes the FHR to
a. Decrease
b. Increase
c. Remain the same
Answer: a. Decrease
Rationale:
Stimulation of the parasympathetic nervous system causes the fetal heart rate to decrease.
Chemoreceptors respond mainly to changes in
a. Blood pressure
b. Hormonal levels
c. Oxygen and carbon dioxide levels
Answer: c. Oxygen and carbon dioxide levels
Rationale:
Chemoreceptors are specialized cells that primarily respond to changes in oxygen and carbon
dioxide levels in the blood, signaling the need for adjustments in respiration and circulation.
The fetus responds to a significant drop of PO2 by
a. Increasing O2 consumption
b. Reducing lactic acid production
c. Shifting blood to vital organs
Answer: c. Shifting blood to vital organs
Rationale:
In response to a significant drop in oxygen (PO2), the fetus redirects blood flow to vital
organs like the brain and heart to ensure their oxygen supply.

Activation of fetal chemoreceptors results in which FHR change?
a. Decrease
b. Increase
c. No change
Answer: a. Decrease
Rationale:
Activation of fetal chemoreceptors due to changes in oxygen and carbon dioxide levels
typically results in a decrease in fetal heart rate.
Tachycardia is associated with increased
a. Parasympathetic tone
b. Sympathetic tone
c. Vagal response
Answer: b. Sympathetic tone
Rationale:
Tachycardia is associated with increased sympathetic tone, which leads to an increase in heart
rate.
A patient receiving oxytocin has 17 contractions in 30 minutes. According to the NICHD
guidelines, this is called
a. Hyperstimulation
b. Hypertonus
c. Tachysystole
Answer: c. Tachysystole
Rationale:
According to NICHD guidelines, having more than 5 contractions in 10 minutes, averaged
over 30 minutes, is termed tachysystole.

Maternal supine hypotension is caused mainly by compression of the
a. Inferior vena cava
b. Spiral arteries
c. Uterine vessels
Answer: a. Inferior vena cava
Rationale:
Maternal supine hypotension is primarily caused by compression of the inferior vena cava
when the mother lies on her back. This reduces venous return to the heart, leading to a drop in
blood pressure.
Which factor influences blood flow to the uterus?
a. Fetal arterial pressure
b. Intervillous space flow
c. Maternal arterial vasoconstriction
Answer: c. Maternal arterial vasoconstriction
Rationale:
Maternal arterial vasoconstriction influences blood flow to the uterus. Constriction of
maternal arteries reduces blood flow, whereas relaxation increases blood flow.
Betamethasone given to the mother can transiently affect the FHR by
a. Decreasing variability
b. Increasing variability
c. Lowering the baseline
Answer: a. Decreasing variability
Rationale:
Betamethasone administration to the mother can transiently decrease fetal heart rate
variability.

In a fetal heart rate tracing with marked variability, which of the following is likely the
cause?
a. Recent ephedrine administration
b. Recent epidural placement
c. Fetal acidemia
Answer: a. Recent ephedrine administration
Rationale:
Marked variability in fetal heart rate tracing is often associated with maternal administration
of medications such as ephedrine.
The baseline can be established in a fetal heart rate tracing in which there is marked
variability.
Answer: False
Rationale:
False. A marked variability in fetal heart rate tracing makes it difficult to establish a baseline
since there are frequent accelerations and decelerations.
A fetal heart rate change that can be seen after administration of butorphanol (Stadol) is
a. Bradycardia
b. Marked variability
c. Sinusoidal-appearing
Answer: c. Sinusoidal-appearing
Rationale:
Butorphanol (Stadol) administration can lead to a sinusoidal-appearing fetal heart rate
pattern.
One fetal heart rate pattern that is associated with an abnormal acid-base status is
a. Minimal variability with no accelerations or decelerations
b. Recurrent variable decelerations with absent variability

c. Tachycardia with absent variability
Answer: b. Recurrent variable decelerations with absent variability
Rationale:
Recurrent variable decelerations with absent variability are associated with an abnormal acidbase status and fetal compromise.
The NICHD definitions are applicable to
a. Antepartum only
b. Antepartum and intrapartum
c. Intrapartum only
Answer: b. Antepartum and intrapartum
Rationale:
The NICHD definitions are applicable both antepartum and intrapartum for standardization of
fetal heart rate monitoring.
A wandering FHR baseline may be indicative of
a. Fetal seizure activity
b. Impending fetal death
c. Maternal medication administration
Answer: b. Impending fetal death
Rationale:
A wandering fetal heart rate baseline may indicate impending fetal death and is a cause for
concern.
The FHR pattern that is likely to be seen with maternal hypothermia is
a. Bradycardia
b. Marked variability
c. Tachycardia

Answer: a. Bradycardia
Rationale:
Maternal hypothermia can lead to fetal bradycardia as a compensatory response.
Baseline FHR variability is determined in what amount of time, excluding accelerations and
decelerations?
a. 10 min
b. 20 min
c. 30 min
Answer: a. 10 min
Rationale:
Baseline fetal heart rate variability is determined over a 10-minute window, excluding
accelerations and decelerations.
One possible cause of a sinusoidal FHR pattern from fetal hypoxemia is
a. Fetal anemia
b. Fetal thumb sucking
c. Maternal administration of a narcotic
Answer: a. Fetal anemia
Rationale:
Fetal anemia is a possible cause of a sinusoidal fetal heart rate pattern, especially when it is
due to severe hypoxemia.
Which of the following tachyarrhythmias can result in fetal hydrops?
a. Persistent supraventricular tachycardia
b. Premature atrial contractions
c. Sinus tachycardia
Answer: a. Persistent supraventricular tachycardia

Rationale:
Persistent supraventricular tachycardia can lead to fetal hydrops.
A preterm fetus with persistent supraventricular tachycardia that is not hydropic is best
treated with maternal administration of
a. Digoxin
b. Phenobarbital
c. Terbutaline
Answer: a. Digoxin
Rationale:
Maternal administration of digoxin is the treatment of choice for persistent supraventricular
tachycardia in a fetus that is not hydropic.
The maternal medical condition that predisposes the fetus to a heart block is
a. Lupus erythematosus
b. Marfan's disease
c. Mitral valve prolapse
Answer: a. Lupus erythematosus
Rationale:
Lupus erythematosus can predispose the fetus to heart block due to the transfer of maternal
antibodies.
The initial response in treating a primigravida being induced for preeclampsia who has a
seizure is
a. Administer terbutaline to slow down uterine activity
b. Initiate magnesium sulfate
c. Perform an immediate cesarean delivery
Answer: b. Initiate magnesium sulfate

Rationale:
The initial response to a seizure in a preeclamptic patient is to initiate magnesium sulfate
therapy to prevent further seizures (eclampsia) and to control blood pressure.
Which FHR sounds are counted with a stethoscope and a fetoscope?
a. Atrial
b. Atrial and ventricular
c. Ventricular
Answer: c. Ventricular
Rationale:
With a stethoscope or fetoscope, only the ventricular sounds are audible and counted for fetal
heart rate assessment.
When using auscultation to determine FHR baseline, the FHR should be counted after the
contractions for
a. 5-10 sec
b. 15-30 sec
c. 30-60 sec
Answer: c. 30-60 sec
Rationale:
When using auscultation to determine the fetal heart rate baseline, the FHR should be
counted for 30-60 seconds after the contractions.
Which of the following characteristics can be determined using FHR auscultation?
a. Baseline
b. Type of decelerations
c. Variability
Answer: a. Baseline

Rationale:
Fetal heart rate auscultation allows for determination of the baseline fetal heart rate.
One advantage of using a fetoscope is that it can
a. Allow more rapid detection of a baseline change
b. More accurately assess the FHR variability
c. Verify the presence of an irregular rhythm
Answer: c. Verify the presence of an irregular rhythm
Rationale:
A fetoscope allows for the verification of the presence of an irregular fetal heart rhythm.
According to ACOG, intermittent auscultation is appropriate for
a. All pregnancies
b. Neither complicated nor uncomplicated pregnancies
c. Uncomplicated pregnancies
Answer: c. Uncomplicated pregnancies
Rationale:
According to ACOG, intermittent auscultation is appropriate for uncomplicated pregnancies.
A woman who is 34 weeks' gestation is counting fetal movements each day. Today she
counted eight fetal movements in a two-hour period. Based on her kick counts, this woman
should
a. Continue counting for one more hour
b. Discontinue counting until tomorrow
c. Notify her provider for further evaluation
Answer: c. Notify her provider for further evaluation
Rationale:

Decreased fetal movements, such as counting less than ten movements in two hours, should
be reported to the healthcare provider for further evaluation.
A BPP score of 6 is considered
a. Abnormal
b. Normal
c. Equivocal
Answer: c. Equivocal
Rationale:
A BPP score of 6 is considered equivocal, requiring further evaluation or repeat testing.
A modified BPP reveals the following: reactive NST with moderate variability; AFI of 7. This
test would be interpreted as
a. Abnormal
b. Equivocal
c. Normal
Answer: c. Normal
Rationale:
A modified BPP with a reactive non-stress test and moderate amniotic fluid index (AFI) is
considered normal.
As fetal hypoxia (asphyxia) worsens, the last component of the BPP to disappear is fetal
a. Breathing
b. Movement
c. Tone
Answer: c. Tone
Rationale:

As fetal hypoxia worsens, the last component of the biophysical profile (BPP) to disappear is
fetal tone.
The legal term that describes a failure to meet the required standard of care is
a. Breach of duty
b. Negligence
c. Proximate cause
Answer: a. Breach of duty
Rationale:
The legal term that describes a failure to meet the required standard of care is "breach of
duty."
According to ACOG, in a patient without complications, the FHR tracing during the first
stage of labor should be reviewed approximately every
a. 5 min
b. 15 min
c. 30 min
Answer: c. 30 min
Rationale:
According to ACOG, in a patient without complications, the fetal heart rate tracing during the
first stage of labor should be reviewed approximately every 30 minutes.
According to ACOG, in a patient without complications, the FHR tracing during the second
stage of labor should be reviewed approximately every
a. 5 min
b. 15 min
c. 30 min
Answer: b. 15 min
Rationale:

According to ACOG, in a patient without complications, the fetal heart rate tracing during the
second stage of labor should be reviewed approximately every 15 minutes.
Since the widespread use of EFM, the rate of cerebral palsy has
a. Decreased
b. Increased
c. Remained the same
Answer: c. Remained the same
Rationale:
Despite the widespread use of electronic fetal monitoring (EFM), the rate of cerebral palsy
has remained unchanged.
Regarding the reliability of EFM, there is
a. Good interobserver reliability
b. Good intraobserver reliability
c. Poor interobserver and intraobserver reliability
Answer: c. Poor interobserver and intraobserver reliability
Rationale:
The reliability of electronic fetal monitoring (EFM) is characterized by poor interobserver
and intraobserver reliability.
The objective of intrapartum FHR monitoring is to assess for fetal
a. Acidemia
b. Oxygenation
c. Well-being
Answer: b. Oxygenation
Rationale:
The objective of intrapartum fetal heart rate monitoring is to assess fetal oxygenation.

At 32 weeks and beyond, FHR accelerations are defined as increases in FHR that must be at
least
a. 10 bpm above the baseline and the accel must last at least 10 sec
b. 15 bpm above the baseline and the accel must last at least 10 sec
c. 15 bpm above the baseline and the accel must last at least 15 sec
Answer: c. 15 bpm above the baseline and the accel must last at least 15 sec
Rationale:
At 32 weeks and beyond, fetal heart rate accelerations are defined as increases in FHR that
must be at least 15 bpm above the baseline and last at least 15 seconds.
Use of the terms "beat-to-beat" variability and "long-term" variability is not recommended by
the NICHD because in clinical practice
a. They are visually determined as a unit
b. Both signify an intact cerebral cortex
c. Clinical management is unchanged
Answer: a. They are visually determined as a unit
Rationale:
The NICHD does not recommend the use of the terms "beat-to-beat" variability and "longterm" variability because they are visually determined as a unit, and their separate
quantification is not necessary in clinical practice.
Variable decelerations in FHR are defined as visually apparent, abrupt decreases in FHR. The
time from onset to nadir is less than
a. 15 sec
b. 30 sec
c. 2 min
Answer: b. 30 sec
Rationale:

Variable decelerations in fetal heart rate are defined as visually apparent, abrupt decreases in
FHR with the time from onset to nadir less than 30 seconds.
According to NICHD definitions of FHR variability, which of the following is accurate?
a. Range 1-5 bpm = absent variability
b. Range 6-25 bpm = average variability
c. Range visually detectable but </=5 bpm = minimal variability
Answer: c. Range visually detectable but </=5 bpm = minimal variability
Rationale:
According to NICHD definitions, a range of visually detectable but </=5 bpm is considered
minimal variability.
Late decelerations of the FHR are associated most specifically with
a. Transient fetal tissue metabolic acidosis during a contraction
b. Transient fetal hypoxemia during a contraction
c. Transient fetal asphyxia during a contraction
Answer: b. Transient fetal hypoxemia during a contraction
Rationale:
Late decelerations of the fetal heart rate are most specifically associated with transient fetal
hypoxemia during a contraction.
Assessment of FHR variability
a. Requires a fetal scalp electrode
b. Includes quantification of beat-to-beat changes
c. Can be performed using an external monitor with autocorrelation technique
Answer: c. Can be performed using an external monitor with autocorrelation technique
Rationale:

Assessment of fetal heart rate variability can be performed using an external monitor with
autocorrelation technique.
Decelerations that occur with at least 50% of contractions in a 20-minute window are defined
as
a. Repetitive
b. Recurrent
c. Nonreassuring
Answer: b. Recurrent
Rationale:
Decelerations that occur with at least 50% of contractions in a 20-minute window are defined
as recurrent decelerations.
Which setting is most appropriate for fetal vibroacoustic stimulation?
a. 38 weeks, active labor, FHR baseline 140 bpm, minimal variability for 60 min, no accels,
no decels
b. 40 weeks, active labor, FHR baseline 150 bpm, moderate variability, prolonged decel to 60
bpm lasting 8 min
c. 34 weeks, frequent contractions without cervical change, FHR baseline 180 bpm, moderate
variability, late decels
Answer: a. 38 weeks, active labor, FHR baseline 140 bpm, minimal variability for 60 min,
no accels, no decels
Rationale:
The most appropriate setting for fetal vibroacoustic stimulation is when there is minimal
variability for 60 minutes with no accelerations or decelerations.
A complete description of an FHR tracing requires a qualitative and quantitative description
of all of the following except
a. Baseline rate
b. Beat-to-beat variability

c. Changes or trends in the FHR patterns over time
Answer: b. Beat-to-beat variability
Rationale:
A complete description of an FHR tracing requires a qualitative and quantitative description
of the baseline rate, changes or trends in the FHR patterns over time, but beat-to-beat
variability is not necessary.
A Category I FHR tracing requires which of the following?
a. Baseline rate 110-160 bpm
b. Accelerations
c. No late, variable, or early decelerations
Answer: a. Baseline rate 110-160 bpm
Rationale:
A Category I FHR tracing requires a baseline rate between 110-160 bpm, accelerations, and
the absence of late, variable, or early decelerations.
Which of the following would be classified as a Category III FHR tracing?
a. Baseline 180 bpm, minimal variability, no accels, recurrent late decels
b. Baseline rate 140 bpm, absent variability, recurrent late decels
c. Baseline 105 bpm, minimal variability, recurrent variable decels
Answer: b. Baseline rate 140 bpm, absent variability, recurrent late decels
Rationale:
A Category III FHR tracing is characterized by absent variability and recurrent late
decelerations, putting the fetus at risk.
Normal frequency of contractions is
a. </= 5 in 10 min averaged over 20 min
b. </= 6 in 10 min averaged over 30 min

c. </= 5 in 10 min averaged over 30 min
Answer: c. </= 5 in 10 min averaged over 30 min
Rationale:
According to ACOG guidelines, the normal frequency of contractions is considered to be </=
5 in 10 minutes averaged over 30 minutes.
Which of the following most closely approximates normal umbilical artery pH at term?
a. 7.0-7.1
b. 7.1-7.2
c. 7.2-7.3
Answer: c. 7.2-7.3
Rationale:
Normal umbilical artery pH at term most closely approximates the range of 7.2-7.3.
The "overshoot" FHR pattern is highly predictive of
a. Fetal hypoxia
b. Preexisting fetal neurological injury
c. None of the above
Answer: c. None of the above
Rationale:
The "overshoot" FHR pattern is not predictive of fetal hypoxia or preexisting fetal
neurological injury.
A key point regarding the occurrence of tachysystole is that
a. It requires FHR decelerations to be significant
b. It can occur in spontaneous or stimulated labor
c. It should be documented as hyperstimulation if oxytocin is being used
Answer: b. It can occur in spontaneous or stimulated labor

Rationale:
Tachysystole can occur in both spontaneous and stimulated labor.
A Category II tracing
a. Predicts abnormal fetal acid-base status
b. Excludes abnormal fetal acid-base status
c. Is not predictive of abnormal fetal acid-base status
Answer: c. Is not predictive of abnormal fetal acid-base status
Rationale:
Category II tracing is not predictive of abnormal fetal acid-base status.
Plans of the health care team with a patient with a sinusoidal FHR pattern may include
a. Administration of an NST
b. Administration of tocolytics
c. Kleinhauer-Betke lab test
Answer: c. Kleinhauer-Betke lab test
Rationale:
Sinusoidal FHR pattern may indicate fetal maternal hemorrhage, and a Kleinhauer-Betke lab
test is appropriate to determine the extent of the fetal-maternal hemorrhage.
Stimulation of the fetal vagus nerve will
a. Increase FHR
b. Decrease FHR
c. Initially increase, then decrease FHR
Answer: b. Decrease FHR
Rationale:
Stimulation of the fetal vagus nerve will decrease the fetal heart rate.
Which of the following is not true when assessing preterm fetuses?

a. FHR baseline may be in upper range of normal (150-160 bpm)
b. They may have fewer accels, and if <35 weeks, may be 10x10
c. Variability may be in lower range for moderate (6-10 bpm)
Answer: b. They may have fewer accels, and if <35 weeks, may be 10x10
Rationale:
Preterm fetuses may have fewer accelerations, but it is not specifically associated with a
10x10 pattern.
One of the side effects of terbutaline as a tocolytic is
a. Fetal bradycardia
b. Increased oxygen consumption
c. Marked variability
Answer: b. Increased oxygen consumption
Rationale:
One of the side effects of terbutaline as a tocolytic is increased maternal oxygen
consumption.
Common problems seen during monitoring of postterm fetuses include all of the following
except
a. Baseline may be 100-110bpm
b. Increased variables
c. Polyhydramnios
Answer: c. Polyhydramnios
Rationale:
Polyhydramnios is not a common problem seen during monitoring of postterm fetuses.
Which of the following is not commonly affected by corticosteroids?
a. Doppler flow studies

b. FHR baseline
c. Frequency of FHR accelerations
Answer: a. Doppler flow studies
Rationale:
Corticosteroids do not commonly affect Doppler flow studies.
A fetus of a diabetic mother may commonly develop
a. Polyhydramnios
b. Supraventricular tachycardia
c. Third-degree heart block
Answer: a. Polyhydramnios
Rationale:
Polyhydramnios is commonly associated with maternal diabetes due to increased fetal urine
production caused by fetal hyperglycemia.
The fetus of a mother with preeclampsia is at high risk for developing
a. Intrauterine growth restriction (IUGR)
b. Macrosomia
c. Polyhydramnios
Answer: a. Intrauterine growth restriction (IUGR)
Rationale:
Intrauterine growth restriction (IUGR) is a common complication in pregnancies complicated
by preeclampsia.
Maternal infection most often results in
a. Fetal tachycardia
b. Moderate variability
c. Placenta previa

Answer: a. Fetal tachycardia
Rationale:
Maternal infection often results in fetal tachycardia as a physiological response to the
infection.
Uncontrolled maternal hypertension is often a causative factor in
a. Postmaturity
b. Preterm contractions
c. Placental abruption
Answer: c. Placental abruption
Rationale:
Uncontrolled maternal hypertension can lead to placental abruption, which is a serious
complication of pregnancy characterized by the separation of the placenta from the uterine
wall.
EFM is an excellent test for determining the presence or absence of neurological injury.
a. Definitive
b. Diagnostic
c. Screening
Answer: c. Screening
Rationale:
EFM is a screening tool, not a definitive or diagnostic test, for neurological injury.
The primary assumption when using EFM is that it produces physiological changes that can
be detected by changes in the FHR.
a. Disruption of oxygen
b. Labor induction
c. Parity

Answer: a. Disruption of oxygen
Rationale:
The primary assumption when using EFM is that it detects physiological changes in the fetus,
particularly disruptions in oxygenation, which can be detected by changes in the FHR.
The primary difference between intermittent auscultation (IA) and EFM is
a. EFM is primarily a visual assessment
b. IA is associated with worse outcomes
c. IA is less labor-intensive than EFM
Answer: a. EFM is primarily a visual assessment
Rationale:
The primary difference between IA and EFM is that EFM is primarily a visual assessment of
the FHR tracing, whereas IA involves listening to the fetal heart sounds intermittently.
The tocodynamometer is completely unreliable for
a. Contraction duration
b. Contraction frequency
c. Contraction intensity
Answer: c. Contraction intensity
Rationale:
The tocodynamometer is unreliable for measuring contraction intensity.
High resting tone may occur with an IUPC because of all of the following except
a. Extraovular placement
b. Maternal BMI
c. Multiple gestations
Answer: b. Maternal BMI
Rationale:

Maternal BMI does not affect the resting tone measured by an IUPC.
All of the following are disadvantages of the ultrasound transducer for monitoring the FHR
except
a. It is noninvasive
b. It may half or double the actual FHR
c. It restricts patient movement
Answer: a. It is noninvasive
Rationale:
The ultrasound transducer is noninvasive and allows for continuous monitoring of the FHR.
The internal scalp electrode works by
a. Detecting heart motion
b. Measuring the R-to-R interval of the fetal ECG
c. Sensing the opening and closing of the fetal heart valves
Answer: b. Measuring the R-to- R interval of the fetal ECG
Rationale:
The internal scalp electrode measures the R-to-R interval of the fetal ECG to monitor the
FHR.
When educating the patient about the ultrasound transducer, the nurse should include the
following:
a. Contraction strength can alter the ability to monitor the FHR
b. If baby moves, the tracing may "drop" or become erratic
c. The ultrasound detects electrical activity of the fetal heart
Answer: b. If baby moves, the tracing may "drop" or become erratic
Rationale:

It's important to inform the patient that if the baby moves, the ultrasound transducer may lose
contact with the fetal heart, causing the tracing to become erratic or drop.
When educating the patient about the IUPC, the nurse should include the following:
a. Can't get out of bed
b. Does not accurately measure contraction strength
c. Measures the FHR more accurately
Answer: a. Can't get out of bed
Rationale:
When a patient has an IUPC, they should be informed that they won't be able to get out of
bed due to the monitoring device.
Intrinsic factors are those that are
a. External to the fetus
b. Internal to the fetus
c. Related to the mother
Answer: b. Internal to the fetus
Rationale:
Intrinsic factors are internal to the fetus and include factors such as fetal heart rate, fetal
oxygenation, and fetal movement.
The parasympathetic branch of the autonomic nervous system
a. Decreases FHR
b. Increases contractility of the fetal heart
c. Increases FHR
Answer: a. Decreases FHR
Rationale:
The parasympathetic branch of the autonomic nervous system decreases the fetal heart rate.

Which of the following is the primary neurotransmitter of the sympathetic branch of the
autonomic nervous system?
a. Acetylcholine
b. Dopamine
c. Norepinephrine
Answer: c. Norepinephrine
Rationale:
Norepinephrine is the primary neurotransmitter of the sympathetic branch of the autonomic
nervous system.
Which of the following is the primary neurotransmitter of the parasympathetic branch of the
autonomic nervous system?
a. Acetylcholine
b. Dopamine
c. Norepinephrine
Answer: a. Acetylcholine
Rationale:
Acetylcholine is the primary neurotransmitter of the parasympathetic branch of the
autonomic nervous system.
Which of the following is responsible for variations in the FHR and fetal behavioral states?
a. Cerebellum
b. Cerebral cortex
c. Medulla oblongata
Answer: b. Cerebral cortex
Rationale:
The cerebral cortex is responsible for variations in the FHR and fetal behavioral states.

Extrinsic factors affecting the FHR include
a. Fetal baroreceptors
b. Fetal chemoreceptors
c. Maternal oxygen transport
Answer: c. Maternal oxygen transport
Rationale:
Maternal oxygen transport is an extrinsic factor affecting the FHR because adequate
oxygenation of the maternal blood is essential for maintaining fetal oxygenation and,
therefore, fetal heart rate.
When the umbilical vessels traverse the membranes to the placenta without any cord
protection, this is called
a. Placenta previa
b. Succenturiate lobe (SL)
c. Velamentous insertion
Answer: c. Velamentous insertion
Rationale:
Velamentous insertion occurs when the umbilical vessels traverse the membranes to the
placenta without the protection of Wharton's jelly or the umbilical cord.
Which of the following is the primary factor in uteroplacental blood flow?
a. Fetal heart rate
b. Maternal cardiac output
c. Maternal oxygen consumption
Answer: b. Maternal cardiac output
Rationale:
Maternal cardiac output is the primary factor in uteroplacental blood flow, as it determines
the amount of blood delivered to the placenta.

Chemoreceptors respond to changes in
a. Blood pressure
b. Pulse
c. Oxygenation
Answer: c. Oxygenation
Rationale:
Chemoreceptors respond to changes in oxygenation, detecting changes in oxygen levels and
stimulating the appropriate physiological responses.
Which of the following occurs when the parasympathetic branch of the autonomic nervous
system is stimulated?
a. Norepinephrine release
b. Slowed conduction to sinoatrial node
c. Increase in fetal heart rate
Answer: b. Slowed conduction to sinoatrial node
Rationale:
Stimulation of the parasympathetic nervous system slows conduction to the sinoatrial node,
leading to a decrease in fetal heart rate.
Which of the following is responsible for fetal muscle coordination?
a. Cerebellum
b. Cerebral cortex
c. Medulla oblongata
Answer: a. Cerebellum
Rationale:
The cerebellum is responsible for fetal muscle coordination and balance.
When the placenta covers the cervical os, this is called

a. Placenta previa
b. Succenturiate lobe (SL)
c. Velamentous insertion
Answer: a. Placenta previa
Rationale:
Placenta previa occurs when the placenta covers part or all of the cervical os.
An additional placental lobe is defined as
a. Placenta previa
b. Succenturiate lobe (SL)
c. Velamentous insertion
Answer: b. Succenturiate lobe (SL)
Rationale:
A succenturiate lobe (SL) is an additional placental lobe separate from the main placental
mass.
During periods of fetal tachycardia, FHR variability is usually diminished due to
a. The dominance of the parasympathetic nervous system
b. The dominance of the sympathetic nervous system
c. Stimulation of the fetal vagus nerve
Answer: a. The dominance of the parasympathetic nervous system
Rationale:
During fetal tachycardia, the parasympathetic nervous system dominates, leading to
diminished FHR variability.
The presence of moderate FHR variability is most specifically an excellent predictor of
a. Absence of fetal metabolic acidosis
b. Fetal movement

c. Fetal oxygenation
Answer: a. Absence of fetal metabolic acidosis
Rationale:
The presence of moderate FHR variability is a reassuring sign and is most specifically
associated with the absence of fetal metabolic acidosis.
All of the following can be used to describe episodic FHR changes except
a. Accelerations
b. Late decelerations
c. Variable decelerations
Answer: b. Late decelerations
Rationale:
Episodic FHR changes include accelerations and variable decelerations, but late decelerations
are not considered episodic.
Periodic accelerations can indicate all of the following except
a. Stimulation of fetal chemoreceptors
b. Tracing is a maternal tracing
c. Umbilical vein compression
Answer: a. Stimulation of fetal chemoreceptors
Rationale:
Periodic accelerations are associated with fetal movement or stimulation, maternal
contractions, or fetal stimulation. They are not caused by stimulation of fetal chemoreceptors.
A transient decrease in cerebral blood flow (increased cerebral blood pressure) during a
contraction may stimulate and may cause a(n) _
a. Baroreceptors; early deceleration
b. Baroreceptors; late deceleration

c. Chemoreceptors; early deceleration
Answer: a. Baroreceptors; early deceleration
Rationale:
A transient decrease in cerebral blood flow during a contraction stimulates the baroreceptors,
leading to an early deceleration.
The primary physiologic goal of interventions for late decelerations is to
a. Decrease maternal oxygen consumption
b. Maximize placental blood flow
c. Maximize umbilical circulation
Answer: b. Maximize placental blood flow
Rationale:
The primary goal of interventions for late decelerations is to maximize placental blood flow
and oxygen delivery to the fetus.
Which of the following is most responsible for producing FHR variability as the fetus grows?
a. Maturation of the parasympathetic nervous system
b. Maturation of the sympathetic nervous system
c. Release of maternal prostaglandins
Answer: a. Maturation of the parasympathetic nervous system
Rationale:
FHR variability increases as the fetus grows, mainly due to the maturation of the
parasympathetic nervous system.
Using the NICHD terminology, tachysystole is defined as
a. More than 5 contractions in 10 minutes averaged over a 20-minute period
b. More than 5 contractions in 15 minutes averaged over a 30-minute period
c. More than 5 contractions in 10 minutes averaged over a 30-minute period

Answer: c. More than 5 contractions in 10 minutes averaged over a 30-minute period
Rationale:
Tachysystole is defined by the NICHD as more than 5 contractions in 10 minutes averaged
over a 30-minute period.
When a patient reports that she is feeling contractions but the nurse does not note any on the
toco tracing, what is the first intervention that should be performed?
a. Ask the provider to place an IUPC
b. Reposition the toco
c. Palpate the uterus
Answer: c. Palpate the uterus
Rationale:
Palpating the uterus is the initial intervention to confirm the presence of contractions when
they are felt by the patient but not recorded on the toco tracing.
Which of the following represents the normal range for FHR baseline?
a. 120-160 bpm
b. 110-160 bpm
Answer: b. 110-160 bpm
Rationale:
The normal range for FHR baseline is 110-160 beats per minute (bpm).
Which of the following is not a type of supraventricular dysrhythmia?
a. Premature atrial contraction (PAC)
b. Premature ventricular contraction (PVC)
c. Supraventricular tachycardia (SVT)
Answer: b. Premature ventricular contraction (PVC)
Rationale:

Premature ventricular contraction (PVC) is not a supraventricular dysrhythmia; it is a
ventricular dysrhythmia.
Which is the most common type of fetal dysrhythmia?
a. Premature atrial contraction (PAC)
b. Premature ventricular contraction (PVC)
c. Third-degree heart block
Answer: a. Premature atrial contraction (PAC)
Rationale:
Premature atrial contraction (PAC) is the most common type of fetal dysrhythmia.
What is the most common cause of third-degree heart block in the fetus?
a. Maternal HIV infection
b. Maternal lupus
c. Tocolysis
Answer: b. Maternal lupus
Rationale:
Maternal lupus is the most common cause of third-degree heart block in the fetus.
All of the following are traits of fetal supraventricular tachycardia (SVT), but which is most
problematic?
a. Decreases diastolic filling time
b. Dramatically increases oxygen consumption
c. Often leads to ventricular tachycardia (VT)
Answer: c. Often leads to ventricular tachycardia (VT)
Rationale:
Although fetal SVT has several traits, it's most problematic because it often leads to
ventricular tachycardia (VT).

Which abnormal FHR pattern is most likely to lead to hydrops in the fetus?
a. Marked variability
b. A premature ventricular contraction (PVC)
c. Supraventricular tachycardia (SVT)
Answer: c. Supraventricular tachycardia (SVT)
Rationale:
Supraventricular tachycardia (SVT) is most likely to lead to fetal hydrops.
Which of the following is an irregular FHR pattern associated with normal conduction and
rate?
a. Premature atrial contractions (PACs)
b. Sinus arrhythmias
c. Sinus tachycardias
Answer: b. Sinus arrhythmias
Rationale:
Sinus arrhythmias are irregular FHR patterns associated with normal conduction and rate.
Which method of assessing FHR allows the clinician to hear the opening and closing of heart
valves, which helps detect dysrhythmias?
a. A fetoscope
b. An internal scalp electrode (FSE)
c. An ultrasound transducer
Answer: a. A fetoscope
Rationale:
A fetoscope allows the clinician to auscultate fetal heart sounds, including the opening and
closing of heart valves, which helps detect dysrhythmias.
Which method of assessment allows the clinician to visually see cardiac wall movements?

a. A fetal echocardiogram
b. A fetal pulse oximetry reading
c. A nonstress test (NST)
Answer: a. A fetal echocardiogram
Rationale:
A fetal echocardiogram allows the clinician to visualize cardiac wall movements, assisting in
the assessment of fetal cardiac activity.
_________ denotes the spontaneous, rhythmic depolarization of cardiac cells.
a. Automaticity
b. Excitability
c. Conductivity
Answer: a. Automaticity
Rationale:
Automaticity refers to the ability of cardiac cells to spontaneously and rhythmically
depolarize.
_________ denotes the readiness of cardiac cells to receive and respond to electrical stimuli.
a. Automaticity
b. Excitability
c. Conductivity
Answer: b. Excitability
Rationale:
Excitability refers to the readiness of cardiac cells to receive and respond to electrical stimuli.
_________ denotes the ability of cardiac cells to conduct electrical impulses from one cell to
another.
a. Automaticity

b. Excitability
c. Conductivity
Answer: c. Conductivity
Rationale:
Conductivity refers to the ability of cardiac cells to conduct electrical impulses from one cell
to another.
Which of the following is the most common type of fetal tachyarrhythmia?
a. Atrial flutter
b. Supraventricular tachycardia (SVT)
c. Premature ventricular contraction (PVC)
Answer: b. Supraventricular tachycardia (SVT)
Rationale:
Supraventricular tachycardia (SVT) is the most common type of fetal tachyarrhythmia.
Which of the following is one example of a fetal tachyarrhythmia?
a. Second-degree heart block, Type I
b. Atrial fibrillation
c. Premature atrial contraction (PAC)
Answer: b. Atrial fibrillation
Rationale:
Atrial fibrillation is an example of a fetal tachyarrhythmia.
(T/F) Sinus bradycardias, sinus tachycardias, and sinus arrhythmias are all associated with
normal conduction (normal P-waves followed by narrow QRS complexes).
Answer: True
Rationale:

True. Sinus bradycardias, sinus tachycardias, and sinus arrhythmias are associated with
normal conduction, characterized by normal P-waves followed by narrow QRS complexes.
(T/F) An internal scalp electrode will detect the actual fetal ECG.
Answer: True
(T/F) An internal scalp electrode can solely diagnose a fetal dysrhythmia.
Answer: False
Rationale:
False. While an internal scalp electrode can detect the actual fetal ECG, additional diagnostic
methods are typically needed to diagnose a fetal dysrhythmia.
_________ are patterns of abnormal FHR associated with variability in R-to-R intervals, but
with normal P-waves preceding normal QRS complexes.
a. Arrhythmias
b. Complete heart blocks
c. Dysrhythmias
Answer: a. Arrhythmias
Rationale:
Arrhythmias are patterns of abnormal FHR associated with variability in R-to-R intervals, but
with normal P-waves preceding normal QRS complexes.
_________ are abnormal FHR rhythms associated with disordered impulse formation,
conduction, or both.
a. Arrhythmias
b. Supraventricular tachycardias
c. Dysrhythmias
Answer: c. Dysrhythmias
Rationale:

Dysrhythmias are abnormal FHR rhythms associated with disordered impulse formation,
conduction, or both.
Which of the following fetal dysrhythmias may be related to maternal hyperthyroidism?
a. Sinus tachycardia
b. Premature atrial contractions (PACs)
c. Third-degree heart block
Answer: b. Premature atrial contractions (PACs)
Rationale:
Premature atrial contractions (PACs) may be related to maternal hyperthyroidism.
With _________ premature ventricular contractions (PVCs), the baseline and variability are
obscured.
a. Idioventricular
b. Bigeminal
c. Trigeminal
Answer: b. Bigeminal
Rationale:
With bigeminal premature ventricular contractions (PVCs), the baseline and variability are
obscured.
With_________ premature ventricular contractions (PVCs), the upward spikes will be
slightly longer than the downward spikes.
a. Idioventricular
b. Bigeminal
c. Trigeminal
Answer: c. Trigeminal
Rationale:

With trigeminal premature ventricular contractions (PVCs), the upward spikes will be slightly
longer than the downward spikes.
Which of the following dysrhythmias may progress to atrial fibrillation or atrial flutter?
a. Premature atrial contractions (PACs)
b. Supraventricular tachycardia (SVT)
c. Sinus tachycardia
Answer: b. Supraventricular tachycardia (SVT)
Rationale:
Supraventricular tachycardia (SVT) may progress to atrial fibrillation or atrial flutter.
Which of the following is not commonly caused by administration of indomethacin?
a. Decreased fetal urine (decreased amniotic fluid index [AFI])
b. Decreased FHR baseline
c. Increased variable decelerations
Answer: b. Decreased FHR baseline
Rationale:
Indomethacin administration is not commonly associated with a decreased FHR baseline.
Which of the following is not commonly caused by terbutaline administration?
a. Increased FHR baseline
b. Decreased FHR late decelerations
c. Increased maternal HR
Answer: b. Decreased FHR late decelerations
Rationale:
Terbutaline administration is not commonly associated with a decreased FHR late
decelerations.
Which of the following is not commonly caused by nifedipine administration?

a. Maternal hypotension
b. Decreased uterine blood flow
c. Increased FHR accelerations
Answer: c. Increased FHR accelerations
Rationale:
Nifedipine administration is not commonly associated with increased FHR accelerations.
Which of the following would likely be affected by betamethasone administration?
a. Fetal echocardiogram
b. Biophysical profile (BPP) score
c. Contraction stress test (CST)
Answer: b. Biophysical profile (BPP) score Fetal breathing decreased with betamethasone
administration
Rationale:
Betamethasone administration may affect the biophysical profile (BPP) score, as fetal
breathing decreases with betamethasone administration.
Which of the following is a common EFM finding when monitoring a preterm fetus?
a. Decreased baseline
b. Variable decelerations
c. Increased FHR variability
Answer: b. Variable decelerations
Rationale:
Variable decelerations are a common EFM finding when monitoring a preterm fetus.
Which of the following is most strongly correlated with placental abruption?
a. Uncontrolled gestational diabetes
b. Multiple gestation

c. Uncontrolled hypertension
Answer: c. Uncontrolled hypertension
Rationale:
Uncontrolled hypertension is most strongly correlated with placental abruption.
Which of the following is not typically associated with a postterm pregnancy?
a. Meconium-stained amniotic fluid
b. Presence of late decelerations in the fetal heart rate
c. Polyhydramnios
Answer: c. Polyhydramnios
Rationale:
Polyhydramnios is not typically associated with a postterm pregnancy.
Which of the following is the most appropriate method of monitoring a patient who is a
gestational diabetic?
a. Daily NSTs
b. Twice-weekly BPPs
c. Weekly contraction stress tests
Answer: b. Twice-weekly BPPs
Rationale:
Gestational diabetes increases the risk of intrauterine fetal compromise. Biophysical profile
(BPP) is a more comprehensive assessment, including fetal heart rate, fetal breathing
movements, fetal movement, fetal tone, and amniotic fluid volume. Twice-weekly BPPs
provide more frequent monitoring and are better suited to detect potential issues.
Which of the following is not commonly caused by magnesium sulfate?
a. Increased FHR baseline
b. Decreased FHR variability

c. Decreased FHR accelerations
Answer: a. Increased FHR baseline
Rationale:
Magnesium sulfate administration is commonly associated with decreased FHR variability
and decreased FHR accelerations, but not with an increased FHR baseline.
Which of the following FHR changes would not typically be seen in a mother with
chorioamnionitis?
a. Increased baseline
b. Increased variability
c. Decreased accelerations
Answer: b. Increased variability
Rationale:
Chorioamnionitis is associated with fetal distress, leading to decreased FHR variability,
decreased accelerations, and other signs of fetal compromise.
Which of the following is false regarding electronic fetal monitoring of twins?
a. Both twins must be monitored, as opposed to monitoring one twin at a time
b. Twins rarely have accelerations and decelerations simultaneously, and tracings should
appear distinctly different
c. Twins must be identified and monitored as A or B throughout the entire antenatal and
intrapartum periods
Answer: b. Twins rarely have accelerations and decelerations simultaneously, and tracings
should appear distinctly different
Rationale:
This statement is false. Twins often have simultaneous accelerations and decelerations, and
their tracings can appear similar.
pH 6.9, PO2 15, PCO2 55, HCO3 18, BE -22 The nurse reviews the arterial gas results and
concludes that the fetus had acidosis. With

a. Metabolic; lengthy
b. Metabolic; short
c. Respiratory; lengthy
Answer: a. Metabolic; lengthy
Rationale:
The low pH, low HCO3, and low BE indicate metabolic acidosis. The fact that the pH is
extremely low (6.9) suggests that the acidosis was of a lengthy duration.
Which of the following umbilical artery cord gases would most likely result in a fetus who
had a Category I strip, then had a cord prolapse and was delivered within 3 minutes?
a. pH 7.17, PO2 22, PCO2 70, HCO2 24, BE -5
b. pH 7.25, PO2 23, PCO2 46, HCO2 22, BE -8
c. pH 7.02, PO2 18, PCO2 56, HCO2 15, BE -18
Answer: a. pH 7.17, PO2 22, PCO2 70, HCO2 24, BE -5
Rationale:
This blood gas profile indicates a degree of acidosis but not as severe as option c. The
delivery occurred within 3 minutes; therefore, this acidosis was likely acute.
Cord blood gases from one of the umbilical arteries best represent
a. The status of fetal acid-base balance
b. The status of maternal oxygenation
c. The status of placental function
Answer: a. The status of fetal acid-base balance
Rationale:
Cord blood gases from one of the umbilical arteries best represent the status of fetal acid-base
balance.
A modified biophysical profile (mBPP) is considered normal if

a. NST is reactive and mother reports at least 10 fetal movements in 2 hours
b. NST is reactive and the amniotic fluid index (AFI) is greater than 5 cm
c. There are no decelerations following contractions
Answer: b. NST is reactive and the amniotic fluid index (AFI) is greater than 5 cm
Rationale:
A modified BPP includes a reactive NST and an amniotic fluid index (AFI) of more than 5
cm, so option B is correct.
Which of the following is not a component of a BPP?
a. Amniotic fluid index (AFI)
b. Fetal breathing
c. Nonstress test (NST)
Answer: a. Amniotic fluid index (AFI) (Should be volume, not index)
Rationale:
Correct. The component should be amniotic fluid volume, not index.
A contraction stress test (CST) is done. During the testing, there were three contractions in 10
minutes, no decels, the baseline was 145, and there was moderate variability. This is
interpreted as
a. Negative
b. Positive
c. Suspicious
Answer: a. Negative
Rationale:
A negative CST means no late decelerations are observed with contractions
.

Which of the following is most likely to result in absent end diastolic flow during umbilical
artery velocimetry?
a. Preeclampsia
b. Preterm labor
c. Previous cesarean delivery
Answer: a. Preeclampsia
Rationale:
Absent or reversed end-diastolic flow in umbilical artery velocimetry is a sign of placental
insufficiency and is more commonly associated with preeclampsia.
Which of the following best describes a condition in which there is decreased oxygen in the
tissues?
a. Acidosis
b. Hypoxemia
c. Hypoxia
Answer: c. Hypoxia
Rationale:
Hypoxia is a condition in which there is a decreased level of oxygen in tissues.
What is the maximum amount of time allotted for a nonstress test?
a. 20 minutes
b. 40 minutes
c. 60 minutes
Answer: b. 40 minutes
Rationale:
Typically, a nonstress test should last about 20 to 40 minutes.
A nonstress test (NST) is nonreactive after 40 minutes. The nurse should

a. Call the physician to plan for a possible induction
b. Call the physician to arrange for a BPP or CST
c. Perform vibroacoustic stimulation and monitor the patient for 20 additional minutes
Answer: b. Call the physician to arrange for a BPP or CST
Rationale:
A nonreactive NST after 40 minutes necessitates further evaluation, usually with a
biophysical profile (BPP) or a contraction stress test (CST), to determine fetal well-being.
Contractions during a contraction stress test (CST) may be spontaneous or induced with
oxytocin or nipple stimulation.
Answer: True
Rationale:
Contractions during a CST can be either spontaneous or induced with oxytocin or nipple
stimulation, depending on the clinical situation.
A contraction stress test (CST) is performed. Late decelerations were noted in three out of the
five contractions in 10 minutes. This is interpreted as
a. Positive
b. Negative
c. Suspicious
Answer: a. Positive
Rationale:
Late decelerations in more than 50% of contractions during a CST are considered positive
and indicate fetal compromise.
A contraction stress test (CST) is performed. Late decelerations were noted in two out of the
five contractions in 10 minutes. This is interpreted as
a. Positive
b. Negative

c. Suspicious
Answer: c. Suspicious
Rationale:
Late decelerations in fewer than 50% of contractions during a CST are considered suspicious
and warrant further evaluation.
A contraction stress test (CST) is performed. Two variable decelerations were seen on the
FHR tracing and there were four contractions in 10 minutes. This is interpreted as
a. Positive
b. Negative
c. Suspicious
Answer: b. Negative
Rationale:
Variable decelerations alone are not considered abnormal during a CST. If there are no late or
prolonged decelerations, the test is considered negative.
A contraction stress test (CST) is performed. No decelerations were noted with the two
contractions that occurred over 10 minutes. This is interpreted as
a. Positive
b. Negative
c. Unsatisfactory
Answer: c. Unsatisfactory
Rationale:
An unsatisfactory CST result occurs when an inadequate number of contractions or an
insufficient duration of monitoring is obtained.
A patient has a reactive NST and negative CST. Select the appropriate follow-up.
a. Prepare the patient for delivery
b. Repeat in 24 hours

c. Repeat in one week
Answer: c. Repeat in one week
Rationale:
With a reactive NST and negative CST, the fetus is considered healthy, but continued
monitoring is warranted. Repeating the test in one week is appropriate.
A patient has a nonreactive NST and negative CST. Select the appropriate follow-up.
a. Prepare the patient for delivery
b. Repeat in 24 hours
c. Repeat in one week
Answer: b. Repeat in 24 hours
Rationale:
A nonreactive NST indicates the need for further evaluation. Repeating the NST in 24 hours
allows for additional assessment of fetal well-being.
For a patient with a suspicious or unsatisfactory CST, select the appropriate follow-up.
a. Prepare the patient for delivery
b. Repeat in 24 hours
c. Repeat in one week
Answer: b. Repeat in 24 hours
Rationale:
A suspicious or unsatisfactory CST result requires further evaluation. Repeating the test in 24
hours allows for a more definitive assessment of fetal well-being.
In a patient whose CST reveals late decelerations with three out of the four induced
contractions, which of the following would be the least appropriate plan for treatment?
a. Obtain a physician order for BPP
b. Prepare for possible induction of labor

c. Repeat CST in 24 hours
Answer: c. Repeat CST in 24 hours
Rationale:
With late decelerations in the majority of contractions, repeating the CST in 24 hours is
insufficient. Immediate further evaluation or intervention is warranted.
For a patient at 38 weeks' gestation with a BPP score of 6, select the most appropriate course
of action.
a. Repeat in one week
b. Consider induction of labor
c. Prepare for cesarean delivery
Answer: b. Consider induction of labor
Rationale:
A BPP score of 6 indicates the need for close monitoring. Given the gestational age, induction
of labor is an appropriate consideration.
For a patient at 35 weeks' gestation with a BPP score of 4, select the most appropriate course
of action.
a. Repeat in 24 hours
b. Obtain a physician order for CST
c. Prepare for probable induction of labor
Answer: c. Prepare for probable induction of labor
Rationale:
A BPP score of 4 indicates fetal compromise and warrants immediate intervention, such as
induction of labor.
Vibroacoustic stimulation may be less effective for preterm fetuses or when membranes have
been ruptured.
Answer: True

Rationale:
True. Vibroacoustic stimulation may be less effective for preterm fetuses or when membranes
have been ruptured due to reduced transmission of sound to the fetus.
_________ cord blood sampling is predictive of uteroplacental function.
a. Arterial
b. Venous
c. Maternal
Answer: b. Venous
Rationale:
Venous cord blood sampling is predictive of uteroplacental function and fetal condition at
birth.
Metabolic acidosis is more easily reversible and potentially less detrimental to the fetus when
compared to respiratory acidosis.
Answer: False
Rationale:
False. Metabolic acidosis is often more severe and less reversible than respiratory acidosis. It
can be caused by conditions such as hypoxia, hypoperfusion, or metabolic disorders, and it
can have serious consequences for the fetus.
There is a strong correlation between arterial cord blood gas results and Apgar scores.
Answer: False
Rationale:
False. While arterial cord blood gas results provide valuable information about fetal acid-base
status, there is not always a strong correlation with Apgar scores. Apgar scores are based on
the newborn's overall condition at birth, including heart rate, respiratory effort, muscle tone,
reflex irritability, and color.
Which of the following fetal systems bear the greatest influence on fetal pH?
a. Heart and lungs

b. Lungs and kidneys
c. Sympathetic and parasympathetic nervous systems
Answer: b. Lungs and kidneys
Rationale:
The lungs and kidneys play a crucial role in regulating fetal pH. The lungs regulate fetal
oxygenation and carbon dioxide elimination, while the kidneys regulate acid-base balance by
excreting metabolic waste products. Therefore, these two systems have the greatest influence
on fetal pH.
Your patient is a 41-year-old diabetic primigravida. You have just performed a vaginal exam:
6/90/-1. The fetus has been having late decels with absent to minimal variability and no
accels for one hour, despite interventions to improve the tracing.
The most appropriate next step in the management of this patient is
a. Administer a tocolytic agent
b. Prepare the patient for immediate delivery
c. Increase the rate of the oxytocin infusion
Answer: b. Prepare the patient for immediate delivery
Rationale:
The combination of late decelerations, absent to minimal variability, and the lack of
accelerations indicates fetal compromise. In this situation, immediate delivery is warranted to
prevent further fetal compromise or distress.
The provider arrives on the unit and states that she will remain on the floor, and writes orders
to start oxytocin. You inform the physician that you are not comfortable starting oxytocin
based on maternal history, SVE, and FHR tracing. The provider insists that you should start
oxytocin. What is your response?
Answer: c. Tell the physician that you decline to start the oxytocin, and notify the physician
that you are activating your chain of command.
Rationale:

As the nurse responsible for the patient's care, if you believe that starting oxytocin is not in
the best interest of the patient based on your assessment, it is your duty to advocate for the
patient's safety. Declining to follow the order and activating the chain of command ensures
that appropriate actions are taken to address the situation.
All of the following are components of liability except
a. Breach of duty
b. Chain of command
c. Damages/loss
Answer: b. Chain of command
Rationale:
Chain of command is a hierarchical structure used for communication and decision-making
within healthcare organizations. It is not a component of liability.
If the EFM pattern you see does not fit any of the definitions for the NICHD, you should
a. Choose the term closest to the pattern you see
b. Describe the tracing in detail
c. Do not chart the tracing, as there is no correlating terminology to match it
Answer: b. Describe the tracing in detail
Rationale:
It is essential to accurately describe any EFM pattern that does not fit the NICHD
classifications. Detailed documentation ensures that all relevant information is recorded and
can be used for further assessment and decision-making.
When using SBAR communication, the "R" involves
a. Making a recommendation
b. Reporting pertinent lab results
c. Reviewing the patient's medical history
Answer: a. Making a recommendation

Rationale:
In SBAR communication, the "R" stands for "Recommendation." After providing the
Situation, Background, and Assessment, making a recommendation is the final step to ensure
clear and effective communication.
Which of the following is considered using the chain of command?
a. Asking the patient to talk with the provider directly
b. Notifying the charge nurse
c. Writing a variance report
Answer: b. Notifying the charge nurse
Rationale:
Using the chain of command involves escalating concerns or issues through the appropriate
channels within the healthcare organization. Notifying the charge nurse is an example of
using the chain of command.
Elements of a malpractice claim include all of the following except
a. Breach of duty
b. Deposition
c. Injury or loss
Answer: b. Deposition
Rationale:
A deposition is a legal proceeding in which sworn testimony is given and recorded outside of
the courtroom. While depositions may be part of the legal process in a malpractice claim,
they are not considered elements of the claim itself.

Document Details

  • Subject: Nursing
  • Exam Authority: ATI
  • Semester/Year: 2023

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