Preview Extract
NCC ELECTRONIC FETAL MONITORING
CERTIFICATION EXAM VERSION B 2023 BRAND NEW
VERSION 133 QUESTIONS AND CORRECT ANSWERS|AGRADE
1. A nurse is explaining to a pregnant patient the purpose of electronic fetal monitoring. Which
of the following statements by the nurse is the most accurate way to describe the purpose of
EFM?
a. "EFM is a diagnostic procedure that monitors your baby's heart rate or FHR and your uterine
contractions."
b. "EFM is a screening procedure that monitors your baby's heart rate or FHR and your uterine
contractions."
c. "EFM is a screening procedure that only monitors your baby's heart rate or FHR."
d. "EFM is a diagnostic procedure that only monitors the frequency, duration, and intensity of
your uterine contractions."
Answer: b. "EFM is a screening procedure that monitors your baby's heart rate or FHR and your
uterine contractions."
Rationale:
Electronic fetal monitoring (EFM) is a screening procedure used during labor to monitor the
baby's heart rate (FHR) and the mother's uterine contractions. It provides valuable information
about the baby's well-being and helps healthcare providers identify signs of distress.
2. The nurse measures fetal well-being during labor by paying attention to:
a. the response of the FHR to uterine contractions
b. mom's complaint of pain during labor
c. the FHR only
d. the frequency, duration, and intensity of the mother's uterine contractions only
Answer: a. the response of the FHR to uterine contractions
Rationale:
Monitoring the response of the fetal heart rate (FHR) to uterine contractions is a key aspect of
assessing fetal well-being during labor. Changes in the FHR pattern in response to contractions
can indicate fetal distress and may require further evaluation or intervention.
3. A nursing student explains during her presentation that the 5 factors for adequate fetal
oxygenation include:
• adequate exchange of __________ and CO2 in the placenta
• an open __________ path between the placenta and the fetus through vessels in the umbilical
cord
• normal fetal circulatory and __________ -carry functions
Answer:
1. normal maternal blood flow and volume to placenta
2. normal oxygen saturation in the maternal blood
3. adequate exchange of oxygen and CO2 in the placenta
4. an open circulatory path between the placenta and the fetus through vessels in the umbilical
cord
5. normal fetal circulatory and oxygen-carrying functions
Rationale:
Adequate fetal oxygenation is crucial for the baby's health and development. The factors listed
are essential for ensuring that the baby receives enough oxygen through the placenta and
umbilical cord. Any disruptions in these factors can lead to fetal distress or complications during
pregnancy and labor.
4. While monitoring a baby's fetal well-being using EFM, the nurse recognizes that the baby's
baseline fetal heart rate is identified as the:
a. average rate of a 30-minute segment that excludes periodic or episodic changes
b. average rate of a 10-minute segment that excludes periodic or episodic changes
c. average rate of a 20-minute segment that does not include periodic or episodic changes
Answer: b. average rate of a 10-minute segment that excludes periodic or episodic changes
Rationale:
The baseline fetal heart rate (FHR) is determined by calculating the average rate over a 10minute segment that excludes periodic or episodic changes. This provides a stable baseline for
assessing the FHR.
5. A nurse determines that a term baby's baseline fetal heart rate is 140 beats per minute. The
nurse explains to her patient that this fetal heart rate is:
a. abnormal because it is not in the normal range of 90-100 beats per minute for a term or postterm fetus
b. normal because it is in the range of 110-160 bpm for a term or post-term fetus
c. abnormal because it is not in the normal range of 160-200 bpm for a term or post-term fetus
Answer: b. normal because it is in the range of 110-160 bpm for a term or post-term fetus
Rationale:
A baseline fetal heart rate (FHR) of 140 beats per minute falls within the normal range of 110160 bpm for a term or post-term fetus. This indicates that the baby's heart rate is within the
expected range for its age and stage of development.
6. The nurse documents that the baseline heart rate for a fetus is between 120-160 beats per
minute. Based on this finding, the nurse can determine that the fetus is:
a. post-term
b. term
c. premature
d. both a and b
Answer: b. term
Rationale:
A baseline fetal heart rate (FHR) of 120-160 beats per minute is considered normal for a term
fetus. Term refers to a fetus that has reached full term and is therefore not premature or postterm.
7. While keeping track of a patient's uterine contractions, the nurse documents that the
measurements of the beginning of one contraction to the beginning of the next are occurring too
frequently at quicker than every 2 minutes. The nurse is measuring which of the following
aspects of a uterine contraction?
a. duration
b. frequency
c. intensity
d. resting tone or interval
Answer: b. frequency
Rationale:
The frequency of uterine contractions is measured by the time interval from the beginning of
one contraction to the beginning of the next. Contractions occurring more frequently than every
2 minutes may indicate a potential issue and should be monitored closely.
8. One of the maternal nurses explains to a nursing student that the duration of a contraction,
which is measured from the beginning to the end of one contraction, usually lasts:
a. about 50 seconds or less
b. about 60 seconds, NO longer than 90 seconds
c. about 90 seconds or more
d. about 40 to 50 seconds
Answer: b. about 60 seconds, NO longer than 90 seconds
Rationale:
The duration of a uterine contraction is typically around 60 seconds, but it should not last longer
than 90 seconds. Prolonged contractions can be concerning and may indicate issues such as
uterine hyperstimulation.
9. A nurse is assessing the relaxation or intrauterine pressures between contractions on an EFM
strip. The nurse is assessing which of the following components of the uterine contractions?
a. duration
b. frequency
c. intensity
d. resting tone or interval
Answer: d. resting tone or interval
Rationale:
The resting tone or interval between contractions is an essential component of uterine
contractions. It reflects the relaxation of the uterus between contractions, which is important for
fetal oxygenation and placental perfusion.
10. Which of the following is the priority nursing action of a nurse preparing to begin EFM on a
patient?
a. place the tocotransducer on the patient's abdomen where the fundus is
b. explain the purpose of the EFM and the procedure of EFM placement to the patient
c. begin using the ultrasound transducer to find the fetal heart rate
d. none of the above
Answer: b. explain the purpose of the EFM and the procedure of EFM placement to the patient
Rationale:
The priority nursing action before beginning EFM is to explain the purpose of the monitoring
and the procedure to the patient. This helps ensure the patient's understanding and cooperation,
which are essential for a successful monitoring process.
11. The nurse is observing the peak of a contraction on an EFM strip and watching as the
mother, who has a tocotransducer across her abdomen, screams out that she is in extreme pain.
The nurse knows that she is observing which aspect of the uterine contraction:
a. frequency
b. duration
c. intensity
d. resting tone or interval
Answer: c. intensity
Rationale:
The intensity of a uterine contraction refers to the strength or force of the contraction. It is often
assessed subjectively by the patient's perception of pain or discomfort.
12. The nurse who is monitoring EFM realizes that suddenly there is no tracking of the FHR.
What is the nurse's priority action?
a. Immediately notify the physician.
b. Check placement of the ultrasound transducer and ensure correct placement for optimum
recording of fetal heart rate to see if the baby changed positions.
c. Administer 8-10 L/min of oxygen to the mom and turn her on her left side because the fetus is
compromised.
Answer: b. Check placement of the ultrasound transducer and ensure correct placement for
optimum recording of fetal heart rate to see if the baby changed positions.
Rationale:
The first step when there is a loss of fetal heart rate (FHR) tracking is to check the placement of
the ultrasound transducer. Poor placement or movement of the transducer can lead to loss of
signal.
13. A nurse is explaining to her 31-year-old patient that she will be using external fetal
monitoring devices to keep track of the baby's FHR in relation to her uterine contractions.
Which of the following are external fetal monitoring devices? (select all that apply)
a. ultrasound transducer
b. intrauterine pressure catheter
c. tocotransducer
d. spiral electrode
Answer: a. ultrasound transducer,
c. tocotransducer
Rationale:
External fetal monitoring devices include the ultrasound transducer, which monitors the fetal
heart rate, and the tocotransducer, which monitors uterine contractions. Intrauterine pressure
catheters and spiral electrodes are used for internal fetal monitoring.
14. The nurse is using the ultrasound transducer during the EFM of her 35-year-old patient. The
patient asks her what the transducer is used for. What is the nurse's most appropriate response?
a. "The ultrasound transducer uses high-frequency sound waves to convert the fetal EKG
obtained from the presenting part, which is your baby's head."
b. "The ultrasound transducer uses high-frequency sound waves to detect the flow of blood
through a vessel, which can be identified as your baby's heart rate."
c. "The ultrasound transducer uses high-frequency sound waves to measure your uterine
contractions transabdominally."
Answer: b. "The ultrasound transducer uses high-frequency sound waves to detect the flow of
blood through a vessel, which can be identified as your baby's heart rate."
Rationale:
The ultrasound transducer in EFM is used to detect the flow of blood through blood vessels,
allowing for the measurement of the fetal heart rate.
15. The nurse informs a nursing student that which of the following methods of electronic fetal
monitoring does not require dilation or rupture of membranes, is completely noninvasive, and is
used during AP and IP?
a. external fetal monitoring
b. internal fetal monitoring
c. both a and b
Answer: a. external fetal monitoring
Rationale:
External fetal monitoring is noninvasive and does not require dilation or rupture of membranes.
It is used to monitor the fetal heart rate and uterine contractions during antepartum (AP) and
intrapartum (IP) periods. Internal fetal monitoring, on the other hand, involves placing a probe
directly on the fetal scalp and is invasive.
16. A nurse places which type of external fetal monitor over her patient's uterine fundus to
measure uterine activity transabdominally?
a. intrauterine pressure catheter
b. tocotransducer
c. ultrasound transducer
Answer: b. tocotransducer
Rationale:
A tocotransducer is a type of external fetal monitor that is placed over the patient's uterine
fundus to measure uterine activity transabdominally. It detects changes in pressure that occur
during uterine contractions.
17. A nurse explains to her 19-year-old patient that she will be using methods of internal fetal
monitoring on her to monitor her baby's FHR in relation to her uterine contractions. Which of
the following internal fetal monitoring devices will the nurse use? (select all that apply)
a. intrauterine pressure catheter
b. tocotransducer
c. ultrasound transducer
d. spiral electrode
Answer: a. intrauterine pressure catheter,
d. spiral electrode
Rationale:
Internal fetal monitoring involves the use of devices that are placed inside the uterus to directly
measure uterine activity and fetal heart rate. These devices include the intrauterine pressure
catheter and the spiral electrode.
18. The nurse holds a patient's hand as the doctor places a spiral electrode onto her baby's
presenting part, which was his face. The patient asks what the spiral electrode will detect and
why it needs to be used. The nurse's most appropriate response is:
a. "We are using the spiral electrode because it converts the fetal EKG (R wave) from the
presenting part so we can keep track of your baby's heart rate."
b. "We are using the spiral electrode because it measures how well your baby's lungs have
developed in utero."
c. "We are using the spiral electrode because it measures your uterine activity and your baby's
FHR at the same time."
Answer: a. "We are using the spiral electrode because it converts the fetal EKG (R wave) from
the presenting part so we can keep track of your baby's heart rate."
Rationale:
A spiral electrode is used for internal fetal monitoring and is placed on the baby's presenting part
to directly measure the fetal heart rate (FHR) by detecting the electrical activity of the fetal
heart.
19. Which of the following EFM devices can be used for a patient whose membranes ruptured
and has a cervix that is already 50% dilated to detect FHR?
a. tocotransducer
b. ultrasound transducer
c. spiral electrode
d. intrauterine pressure catheter
Answer: c. spiral electrode
Rationale:
A spiral electrode can be used for internal fetal monitoring in a patient whose membranes have
ruptured and has a dilated cervix. It can be safely inserted into the baby's presenting part to
detect the fetal heart rate.
20. The nurse explains to a patient that the intrauterine pressure catheter is being used to:
a. monitor her baby's FHR and her uterine contractions at the same time
b. monitor her baby's FHR and converting it into an EKG wave
c. Monitor the frequency, duration, and pressure of her uterine contractions by measuring
intrauterine pressures and converting it to mm HG
Answer: c. Monitor the frequency, duration, and pressure of her uterine contractions by
measuring intrauterine pressures and converting it to mm HG
Rationale:
The intrauterine pressure catheter (IUPC) is used for internal fetal monitoring and measures the
frequency, duration, and intensity of uterine contractions by measuring intrauterine pressures
and converting them to millimeters of mercury (mm Hg).
21. The doctor asks the nurse to pass him which specific device to infuse fluids into a mother
who has oligohydramnios or low amniotic fluid during an amniocentesis procedure?
a. intrauterine pressure catheter
b. tocotransducer
c. ultrasound transducer
d. spiral electrode
Answer: a. intrauterine pressure catheter
Rationale:
The intrauterine pressure catheter is used to infuse fluids into the uterus during an amniocentesis
procedure to help maintain amniotic fluid levels and prevent potential complications from
oligohydramnios.
22. After applying the spiral electrode onto the baby's head, the nurse needs to ensure that:
a. the spiral electrode wire is connected to the mom's plate on her chest and it is snapped to the
adhesive patch
b. the spiral electrode wire is connected to the mom's leg plate and it is snapped to the adhesive
patch
c. the spiral electrode wire is connected directly to the EFM machine
Answer: b. the spiral electrode wire is connected to the mom's leg plate and it is snapped to the
adhesive patch
Rationale:
Connecting the spiral electrode wire to the mom's leg plate and snapping it to the adhesive patch
ensures proper fetal monitoring and helps prevent dislodgement of the electrode during labor.
23. The nurse practitioner observes as a nursing student from the local university attempts to
remove a spiral electrode. What is the appropriate action of the nurse practitioner?
a. Intervene immediately and inform the patient to leave the spiral electrode or the MD or
midwife who are the only ones authorized to turn it counterclockwise and remove it.
b. Praise the student and encourage her to turn the spiral electrode counterclockwise to remove
it.
c. neither a nor b
Answer: a. Intervene immediately and inform the patient to leave the spiral electrode for the
MD or midwife who are the only ones authorized to turn it counterclockwise and remove it.
Rationale:
Only the MD or midwife should remove the spiral electrode to prevent injury or complications.
Informing the patient to wait for the authorized personnel ensures safe removal.
24. When setting up an intrauterine pressure catheter on a patient, one of the appropriate nursing
actions should be to:
a. affix strap to patient's leg to prevent dislodgement
b. let strap remain detached from patient's leg to prevent pressure and an increased risk for a
blood clot
c. none of the above
Answer: a. affix strap to patient's leg to prevent dislodgement
Rationale:
Affixing the strap to the patient's leg helps prevent dislodgement of the intrauterine pressure
catheter, ensuring accurate monitoring of uterine contractions.
25. When setting the resting tone of the intrauterine pressure catheter, the nurse would correctly
set the setting to:
a. 10-20 mm Hg
b. 5-10 mm Hg
c. 30-40 mm Hg
Answer: b. 5-10 mm Hg
Rationale:
The resting tone of the intrauterine pressure catheter is set to 5-10 mm Hg to establish a baseline
for uterine contractions and accurately monitor changes during labor.
26. The nurse is monitoring a fetal heart rate and determines that the baseline fetal heart rate is
above 160 beats per minute for 5 minutes, or between 2-10 minutes. The nurse would consider
these findings to be:
a. bradycardia
b. tachycardia
c. variability
Answer: b. tachycardia
Rationale:
A fetal heart rate above 160 beats per minute is considered tachycardia, which can indicate fetal
distress or other conditions requiring further evaluation.
27. The nurse monitoring a baby's fetal heart rate on an EFM strip determines that the baby has
tachycardia. The nurse informs the mother that this is considered:
a. an EARLY sign of fetal hypoxia or prematurity
b. a LATE sign of fetal hypoxia
c. a normal finding of a thriving fetus
Answer: a. an EARLY sign of fetal hypoxia or prematurity
Rationale:
Tachycardia in a fetus can be an early sign of fetal hypoxia or prematurity, indicating that the
fetus may not be receiving enough oxygen.
28. The nurse confirms that a baby is tachycardic and explains to the mother that this condition
can result from which of the following conditions: (select all that apply)
a. fetal or maternal infection
b. prolonged compression of the umbilical cord
c. maternal hyperthyroidism
d. fetal anemia
e. response to medications
f. maternal hypotension
g. possibly due to mother's anxiety
Answer: a. fetal or maternal infection
c. maternal hyperthyroidism
d. fetal anemia
e. response to medications
g. possibly due to mother's anxiety
Rationale:
Tachycardia in a fetus can result from various conditions, including infection, maternal
hyperthyroidism, fetal anemia, certain medications, and maternal anxiety.
29. A nurse determines that a baby's FHR is below 110 beats per minute. The nurse is concerned
and notifies the doctor by explaining that the fetus has:
a. tachycardia
b. bradycardia
Answer: b. bradycardia
Rationale:
A fetal heart rate below 110 beats per minute is considered bradycardia, which can indicate fetal
distress or other conditions requiring medical attention.
30. A nurse determines that a baby has a baseline FHR of 100 bpm on an EFM strip. The nurse
explains to the mother that this is considered a:
a. an EARLY sign of fetal hypoxia or prematurity
b. a LATE sign of fetal hypoxia
c. a normal finding of a thriving fetus
Answer: b. a LATE sign of fetal hypoxia
Rationale:
A baseline fetal heart rate of 100 bpm is considered a late sign of fetal hypoxia, indicating that
the fetus may not be receiving enough oxygen and further evaluation is needed.
31. While assessing a fetus's FHR with EFM, the nurse determines the baby's heart rate is 98
bpm. What is the primary nursing action that needs to be completed?
a. start an IV flow rate at 200 ml/hr with normal saline to increase fluid volume to transport
more blood to fetus
b. place an O2 mask on mom that flows 8-10 L/min
c. administer oxytocin to the patient to increase uterine contractions because this will increase
blood flow to baby and improve the baby's heart rate
Answer: b. place an O2 mask on mom that flows 8-10 L/min
Rationale:
A fetal heart rate of 98 bpm is concerning and may indicate fetal distress. Providing oxygen to
the mother can help improve oxygenation to the fetus.
32. The nurse is monitoring the FHR of her patient's baby and becomes concerned when she
observes which of the following results?
a. presence of variability of 6-25 bpm
b. absence of variability, which is considered nonreassuring
c. a temporary decrease in variability while the fetus is in the sleep state
Answer: b. absence of variability, which is considered nonreassuring
Rationale:
Absence of variability in the fetal heart rate is considered nonreassuring and may indicate fetal
distress.
33. The nurse is monitoring the FHR of the patient's baby. The nurse sees a temporary decrease
in variability but then the variability rises back to 20 bpm. The nurse does which of the
following actions:
a. Notify doctor because fetus could be compromised.
b. Record these as normal findings because a temporary decrease in variability is associated with
the fetus being in a sleeping state.
c. Turn mom onto her left side because the fetus may be lacking oxygen in utero.
Answer: b. Record these as normal findings because a temporary decrease in variability is
associated with the fetus being in a sleeping state.
Rationale:
A temporary decrease in variability can be a normal finding, especially when the fetus is in a
sleeping state. It is important to assess the overall pattern of variability.
34. Which of the following conditions lead to decreased variability found in the FHR? (select all
that apply)
a. fetal hypoxemia
b. acidosis
c. prolonged cord compression
d. maternal hypotension
e. medications that depress the CNS, such as narcotics and analgesics
Answer: a. fetal hypoxemia
b. acidosis
e. medications that depress the CNS, such as narcotics and analgesics
Rationale:
Decreased variability in the FHR can be caused by fetal hypoxemia, acidosis, and medications
that depress the central nervous system.
35. A nurse monitors the heart rate of a fetus that is less than 110 bpm. The nurse identifies this
as bradycardia and would assess if the patient had which of the following conditions: (select all
that apply)
a. maternal hyperthyroidism
b. prolonged compression of the umbilical cord
c. maternal hypothermia
d. maternal hypotension
e. maternal hypertension
Answer: b. prolonged compression of the umbilical cord
c. maternal hypothermia
d. maternal hypotension
Rationale:
Bradycardia in a fetus can be caused by prolonged compression of the umbilical cord, maternal
hypothermia, and maternal hypotension, among other factors. These conditions can lead to
decreased oxygenation to the fetus, resulting in bradycardia.
36. A maternal nurse is observing that a fetus has increases in FHR that are above the baseline
and greater than or equal to 15 bpm and lasting longer than or equal to 15 seconds in relation to
mom's uterine contractions. The nurse's priority action would be to:
a. Report this as a normal finding, known as accelerations that indicate the fetus is doing well.
b. Report this immediately to the doctor because this indicates that the fetus is compromised.
c. Administer mom oxygen from 8-10 l/min immediately and then notify the doctor.
Answer: a. Report this as a normal finding, known as accelerations that indicate the fetus is
doing well.
Rationale:
Accelerations in the fetal heart rate are a normal finding and indicate that the fetus is welloxygenated and responding appropriately to stimuli.
37. The nurse identifies which type of fetal heart rate pattern that occurs with sympathetic
nervous response in breech presentation and occurs directly with contractions?
a. episodic
b. periodic
Answer: b. periodic
Rationale:
Periodic changes in the fetal heart rate occur in response to uterine contractions and are
associated with the sympathetic nervous response, especially in breech presentations.
38. The nurse identifies variable decelerations in an FHR on an EFM strip. The nurse knows that
these types of patterns are known as __________ because they do not occur in relation to
contractions:
a. episodic
b. periodic
Answer: a. episodic
Rationale:
Episodic changes in the fetal heart rate, such as variable decelerations, do not occur in relation to
contractions and are often caused by umbilical cord compression.
39. The nurse notices that on an EFM there is a gradual decrease in return to baseline of FHR
that begins just as the mother's uterine contractions. The nurse documents this finding as:
a. a normal finding of early decelerations associated with head compression
b. a normal finding of early decelerations associated with cord compression
c. a normal finding of late decelerations associated with uteroplacental insufficiency
Answer: a. a normal finding of early decelerations associated with head compression
Rationale:
Early decelerations are typically caused by head compression during contractions and are
considered a normal finding.
40. A nurse uses her gloved fingers to rub the head of the baby through the mother's abdomen,
also known as cranial vagal nerve stimulation. The nurse observes a gradual decrease in and
return to baseline of FHR and knows that this is a:
a. a normal finding of early decelerations associated with head compression
b. a normal finding of early decelerations associated with cord compression
c. a normal finding of late decelerations associated with uteroplacental insufficiency
Answer: a. a normal finding of early decelerations associated with head compression
Rationale:
Cranial vagal nerve stimulation can lead to early decelerations, which are considered a normal
response to head compression during labor.
41. The nurse is observing a deceleration pattern of the FHR that is the mirror image of the
contraction and has started in the 1st stage of the mom's labor when she was 4-7 cm. The
deceleration pattern continued through the mother's 2nd stage as she was pushing in active labor.
The nurse knows that this is indicative of:
a. early decelerations
b. late decelerations
c. variable decelerations
Answer: a. early decelerations
Rationale:
Early decelerations are a benign finding caused by head compression during contractions. They
mirror the contractions and are not associated with fetal compromise.
42. The nurse is observing a pattern on the EFM that indicates a gradual decrease in return to
baseline FHR that begins after the contraction has started. There was a decrease that is greater
than or equal to 15 bpm that lasts for greater than or equal to 15 seconds. The nurse records that
this pattern is:
a. a late deceleration associated with uteroplacental insufficiency
b. a late deceleration associated with head compression
c. a late deceleration associated with cord compression
Answer: a. a late deceleration associated with uteroplacental insufficiency
Rationale:
Late decelerations occur due to uteroplacental insufficiency, which can lead to decreased
oxygenation of the fetus.
43. The nurse is monitoring an FHR and uterine contractions on an EFM strip. The nurse notices
that the lowest point of the deceleration occurs after the peak of the contraction. The nurse
documents this as a:
a. early deceleration
b. late deceleration
c. variable deceleration
Answer: b. late deceleration
Rationale:
Late decelerations are characterized by the lowest point of the deceleration occurring after the
peak of the contraction, indicating uteroplacental insufficiency.
44. A nurse informs a nursing student that if late decelerations are persistent and repetitive, it
indicates:
a. fetal hypoxemia stemming from insufficient placental perfusion
b. considered a normal finding and should not cause alarm
c. fetal hypoxemia stemming from cord compression
Answer: a. fetal hypoxemia stemming from insufficient placental perfusion
Rationale:
Persistent and repetitive late decelerations indicate a more serious issue of fetal hypoxemia due
to insufficient placental perfusion, requiring prompt intervention.
45. A nurse has tried multiple measures to increase a patient's baby's FHR. The nurse would
deem which of the following situations not correctable and ominous?
a. early decelerations associated with decreased variability and tachycardia
b. late decelerations associated with decreased variability and tachycardia
c. variable decelerations associated with decreased variability and tachycardia
Answer: b. late decelerations associated with decreased variability and tachycardia
Rationale:
Late decelerations with decreased variability and tachycardia indicate uteroplacental
insufficiency, which is not correctable and indicates a serious issue requiring immediate
intervention.
46. A nurse is observing her 42-year-old patient who is having increased uterine contractions due
to IV oxytocin. The nurse notices that there has been a consistent pattern of late deceleration(s),
which indicate uteroplacental insufficiency. What is the nurse's primary action?
a. Discontinue the oxytocin to slow down the uterine contractions and increase blood flow to the
fetus
b. Increase the IV and administer vasopressors to increase the mother's blood pressure
c. Administer O2 to the mother at 8-10 L/min
Answer: a. Discontinue the oxytocin to slow down the uterine contractions and increase blood
flow to the fetus
Rationale:
Late decelerations are often caused by uteroplacental insufficiency, and discontinuing the
oxytocin can help reduce the frequency and intensity of contractions, improving blood flow to
the fetus.
47. A nurse measures her patient's blood pressure while she is lying supine and documents that it
is extremely low at 100/50. The nurse also notices that the EFM strip indicates a consistent
pattern of late deceleration(s) of the fetus' heart rate, which indicates uteroplacental
insufficiency. What is the nurse's primary action?
a. Discontinue the oxytocin to slow down the uterine contractions and increase blood flow to the
fetus
b. Increase the IV flow rate and administer vasopressors to increase the mother's blood pressure
c. Administer O2 to the mother at 8-10 L/min
Answer: b. Increase the IV flow rate and administer vasopressors to increase the mother's blood
pressure
Rationale:
Low blood pressure can indicate poor perfusion to the placenta, leading to late decelerations.
Increasing IV fluids and administering vasopressors can help improve perfusion and
oxygenation to the fetus.
48. While monitoring a mother and baby during EFM, the nurse notices that there are consistent
patterns of drops of the FHR from the baseline after the contraction has ended. The patient is
lying supine with her feet elevated. What is the primary nursing action at this time?
a. Change maternal position to lateral to increase oxygenation to fetus
b. Increase IV flow rate to 200 ml/hr to increase mom's blood pressure
c. Notify the doctor and then increase the IV flow rate to 200 ml/hr to increase mom's blood
pressure
Answer: a. Change maternal position to lateral to increase oxygenation to fetus
Rationale:
Changing the maternal position can help relieve pressure on the vena cava, improving blood
flow to the placenta and fetus.
49. Nurse Janet notices an abrupt decrease in FHR below the baseline that is greater than or
equal to 15 bpm and lasts greater than or equal to 15 seconds. The nurse notes that these patterns
are not occurring in relation to contractions. What would the nurse document this finding as?
a. Variable decelerations in relation to uteroplacental insufficiency
b. Variable decelerations in relation to cord compression
c. Variable decelerations in relation to increased oxygenation to fetus via placenta
Answer: b. Variable decelerations in relation to cord compression
Rationale:
Abrupt decreases in FHR not related to contractions are often caused by umbilical cord
compression.
50. A nurse is monitoring a patient and her baby using EFM. The nurse notices and becomes
concerned when she sees a consistent pattern of variable deceleration(s). She notices that the
mother is lying on her right side. What is the primary nursing action that needs to be performed?
a. Discontinue oxytocin IV
b. Encourage mom to move from side to side and go in a knee-chest position to relieve umbilical
cord compression
c. Begin administering oxygen through a mask at levels 10-20 l/min
Answer: b. Encourage mom to move from side to side and go in a knee-chest position to relieve
umbilical cord compression
Rationale:
Changing maternal position can help relieve pressure on the umbilical cord, potentially
alleviating variable decelerations.
51. A doctor has just completed an ultrasound on a patient that is at 35 weeks gestation. He
informs the nurse that the patient has very little amniotic fluid, which is causing the umbilical
cord to compress the baby's head. He asks the nurse to begin getting his equipment ready so that
he can correct the problem. What is the primary nursing action that needs to be completed?
a. discontinue oxytocin IV
b. encourage mom to move from side to side and go in a knee-chest position to relieve umbilical
cord compression
c. begin administering oxygen through a mask at levels 10-20 l/min
d. finding an intrauterine pressure catheter, gloves, and the syringe needed to perform
amniocentesis to give the patient more fluid to increase her amniotic fluid levels and relieve
umbilical cord compression
Answer: d. finding an intrauterine pressure catheter, gloves, and the syringe needed to perform
amniocentesis to give the patient more fluid to increase her amniotic fluid levels and relieve
umbilical cord compression
Rationale:
The primary concern is to relieve the umbilical cord compression caused by the low amniotic
fluid levels. Amniocentesis can be performed to add more fluid, alleviating the compression on
the umbilical cord and the baby's head.
52. A nurse monitoring FHR during an EFM documents that there is a decrease in FHR baseline
that is greater than or equal to 15 bpm and lasts more than 2 minutes but less than 10 minutes.
The nurse would document this finding as:
a. variable decelerations
b. prolonged decelerations
c. late decelerations
Answer: b. prolonged decelerations
Rationale:
Prolonged decelerations are defined as a decrease in FHR baseline of greater than or equal to 15
bpm lasting more than 2 minutes but less than 10 minutes.
53. A nurse is monitoring FHR during an EFM of a pregnant patient that is 26 weeks. The nurse
notices that there has been a persistent decrease in FHR below the baseline of greater than or
equal to 15 bpm that has lasted for longer than 10 minutes. The nurse would record this in her
charting as:
a. A normal expected baseline change.
b. A new baseline change since the decrease in FHR lasted longer than 10 minutes.
c. A new baseline change since the baseline rate decrease was greater than or equal to 15 bpm.
Answer: b. A new baseline change since the decrease in FHR lasted longer than 10 minutes.
Rationale:
A persistent decrease in FHR below the baseline of greater than or equal to 15 bpm that lasts
longer than 10 minutes is considered a new baseline change.
54. A nurse knows that which of the following are benign causes that can lead to prolonged
decelerations? (select all that apply)
a. vaginal exam
b. prolonged compression of cord
c. application of scalp electrode
d. rapid fetal descent
e. sustained maternal Valsalva maneuver
f. tetanic contractions
Answer: a. vaginal exam,
c. application of scalp electrode,
d. rapid fetal descent,
e. sustained maternal Valsalva maneuver,
f. tetanic contractions
Rationale:
Benign causes of prolonged decelerations include vaginal exams, application of scalp electrodes,
rapid fetal descent, sustained maternal Valsalva maneuver, and tetanic contractions.
55. A nurse is informing a nursing student about the problematic causes of prolonged
decelerations. The nurse knows the nursing student understands this concept when she tells her
that which of the following problematic conditions lead to prolonged decelerations? (select all
that apply)
a. sudden cord prolapse
b. vaginal exam
c. maternal hypotension as a result of analgesia/anesthesia
d. tetanic contractions
e. maternal hypoxia
f. placental abruption
g. rapid fetal descent
Answer: a. sudden cord prolapse,
c. maternal hypotension as a result of analgesia/anesthesia,
d. tetanic contractions,
e. maternal hypoxia,
f. placental abruption
Rationale:
Problematic causes of prolonged decelerations include sudden cord prolapse, maternal
hypotension as a result of analgesia/anesthesia, tetanic contractions, maternal hypoxia, and
placental abruption.
56. The nurse asks a nursing student what VEAL represents. The nursing student's proper
response was:
V __________ E __________ A __________ L __________
Answer: Variable Early Acceleration Late
Rationale:
VEAL is a memory aid used in fetal heart rate monitoring. It helps to remember the associations
between fetal heart rate patterns and potential causes: Variable decelerations are associated with
Cord Compression, Early decelerations with Head Compression, Accelerations with
Oxygenation, and Late decelerations with Placental Insufficiency.
57. The nurse asks a nursing student what CHOP represents. The nursing student's proper
response was:
C __________ H __________ O __________ P __________
Answer: Cord compression Head compression Oxygenation Placental insufficiency
Rationale:
CHOP is another memory aid used in fetal heart rate monitoring to help remember potential
causes of decelerations.
58. The nurse monitors a FHR that is 120 bpm, has a moderate variability of 22 bpm, and has 20
accelerations that are 15 seconds or more in length. The nurse determines that this baby can be
placed in which of the following categories?
a. Category 1- reassuring
b. Category 2- indeterminate-ambiguous
c. Category 3- abnormal-nonreassuring
Answer: a. Category 1- reassuring
Rationale:
Category 1 FHR tracings are considered normal and reassuring. They include a baseline rate of
110-160 bpm, moderate variability, no late or variable decelerations, and accelerations with fetal
movement.
59. The nurse monitors a FHR and discovers that there is no variability present and there is a
smooth, undulating wave pattern on the screen. The nurse also notices there are recurrent late
and even variable decelerations occurring. The nurse determines that this baby can be placed in
which of the following categories?
a. Category 1- reassuring
b. Category 2- indeterminate-ambiguous
c. Category 3- abnormal-nonreassuring
Answer: c. Category 3- abnormal-nonreassuring
Rationale:
Category 3 FHR tracings are considered abnormal and nonreassuring. They include absent
variability, recurrent late decelerations, bradycardia, or sinusoidal pattern.
60. A nurse has been monitoring a FHR that has consistently displayed no variability and nonreassuring patterns. What should be the nurse's primary action?
a. Apply an oxygen mask to the mother that runs 8-10 L/min.
b. Stimulate the fetus scalp by rubbing it through the mother's abdomen with gloved fingers. The
nurse should also use vibroacusotic stimulation and play music that resembles sounds heard in
utero to increase the baby's HR through stimulation.
c. Encourage and help mom to turn to a knee-chest position to help relieve cord compression,
which will help increase baby's HR.
Answer: b. Stimulate the fetus scalp by rubbing it through the mother's abdomen with gloved
fingers. The nurse should also use vibroacusotic stimulation and play music that resembles
sounds heard in utero to increase the baby's HR through stimulation.
Rationale:
If FHR patterns are non-reassuring and there is no variability, stimulation of the fetus scalp can
help increase the baby's heart rate and improve the pattern.
61. What is Electronic Fetal Monitoring (EFM) and what does it do?
Answer: Electronic Fetal Monitoring (EFM) is a method used to continuously monitor the fetal
heart rate and uterine contractions during labor. It acquires a signal when the human ear cannot,
allows for visual representation of fetal heart rate and uterine muscle activity, and provides a
continuous record that can be archived and traced, interfacing with electronic health records
(EHR).
Rationale:
EFM is a standard tool used in labor and delivery to assess fetal well-being and monitor for
signs of fetal distress. It provides valuable information to healthcare providers to guide decisionmaking during labor and delivery.
62. Fetal Heart Rate (FHR) / Fetal Heart Tones (FHT) are regulated by what?
Answer: • Regulated by the CNS (ANS), chemoreceptors, and baroreceptors within the fetus.
The brain and heart are working together.
Rationale:
The fetal heart rate is regulated by the central nervous system (autonomic nervous system),
chemoreceptors, and baroreceptors within the fetus. These mechanisms help maintain a stable
heart rate in response to various stimuli.
63. What are some factors impacting the oxygen supply system for the fetus?
Answer: • Maternal blood
• Maternal oxygenation
• Fetal circulation
• Placenta blood flow / uterine activity
Rationale:
The oxygen supply system for the fetus is influenced by various factors, including the amount of
oxygen in maternal blood, the mother's overall oxygenation, the efficiency of fetal circulation,
and the blood flow to the placenta, which can be affected by uterine activity.
64. Uterine Activity (UA or UC):
Answer: also known as uterine contractions.
Rationale:
Uterine activity, also known as uterine contractions, plays a crucial role in labor and delivery.
These contractions help facilitate the progress of labor by pushing the fetus down the birth canal.
65. During contractions, what happens to blood flow to the fetus through the umbilical cord?
Answer: There is a temporary decrease in blood flow to the fetus through the umbilical cord.
Rationale:
During contractions, the blood flow to the fetus through the umbilical cord is temporarily
reduced. This reduction in blood flow is normal and is part of the physiological process of labor.
66. The initiation of labor is the trigger of what?
Answer: Uterine contractions
Rationale:
The initiation of labor is triggered by uterine contractions. These contractions help soften and
thin out the cervix (cervical effacement) and push the baby down the birth canal (cervical
dilation).
67. What is the movement of contractions?
Answer: Contractions involve a wave-like motion of the uterine muscles, starting at the top of
the uterus and moving downward.
Rationale:
Contractions during labor involve a rhythmic, wave-like motion of the uterine muscles. This
movement helps push the baby through the birth canal and is essential for the progress of labor.
68. What can cause a contraction but is not due to labor?
Answer: • Dehydration
• Internal bleeding
• Irritating the uterine muscle
• Infection within the pelvic region
Rationale:
Contractions can be caused by factors other than labor, such as dehydration, internal bleeding,
irritation of the uterine muscle, or pelvic infections.
69. CXT:
Answer: Contraction
Rationale:
CXT is an abbreviation for contraction.
True or False:
70. The uterus contracting always indicates the cervix is dilating and labor has started?
Answer: False, there are other things that can cause a contraction other than labor.
Rationale:
Contractions can occur for reasons other than labor, such as false labor (Braxton Hicks
contractions), dehydration, or irritants.
70a. On the Fetal Heart Monitor Tracing what does the top graph represent and what does the
bottom graph represent?
Answer: Top graph: fetal heart rate Bottom graph: contractions
Rationale:
The top graph on a fetal heart monitor tracing represents the fetal heart rate, while the bottom
graph represents uterine contractions.
71. Where does the uterine activity monitor (toco transducer) go?
Answer: Top of the fundus.
• this monitor represents uterine activity and reads muscle tone. It knows when tension is greater
and when tension eases up.
Rationale:
The toco transducer, which monitors uterine activity, is typically placed on the top of the fundus,
where it can accurately measure uterine contractions.
72. Other sounds you might accidentally pick up other than fetal heart beat when using external
EFM:
Answer: Baby moving
• Eating
• Ambulating
• Breathing
• Sneezing
• Coughing
• Puking
(Anything that causes an increase in muscle tone that is picked up on the uterine activity
monitor. Will look like a tiny little peak in the short 10 seconds whereas contraction looks like a
mountain).
Rationale:
External fetal monitoring can sometimes pick up sounds other than the fetal heartbeat, such as
maternal movements or activities, which can create false readings on the uterine activity
monitor.
73. Where does the ultrasound transducer go?
Answer: Placed over the area where fetal heart rate is best heard, usually below the umbilicus.
This monitor is picking up sound echoing through the abdomen from the baby.
Rationale:
The ultrasound transducer is placed over the area where the fetal heart rate is best heard to
ensure accurate monitoring. Placing it below the umbilicus helps in picking up sound echoes
from the baby's heart, providing a clear and accurate reading.
74. Other sounds you might accidentally pick up other than fetal heartbeat when using the
ultrasound transducer?
Answer: Bowel sounds and umbilical cord sounds (has an internal pulse).
Rationale:
While using the ultrasound transducer, there is a possibility of picking up other sounds such as
bowel sounds or sounds from the umbilical cord, which has an internal pulse. It's important to
distinguish these sounds from the fetal heartbeat for accurate monitoring.
75. Which is more accurate representing fetal well-being: external EFM or internal EFM?
Answer: Internal EFM - because this continuous monitoring is not interrupted by fetal or
maternal movement or affected by maternal size.
Rationale:
Internal EFM, which involves placing a catheter and electrode inside the uterus, is more accurate
in representing fetal well-being compared to external EFM. This is because internal EFM is not
affected by fetal or maternal movement or maternal size, providing a continuous and accurate
monitoring of the fetal heart rate and uterine contractions.
76. Internal EFM:
Answer: An invasive procedure where membranes must be ruptured and the cervix dilated to
monitor uterine activity and fetal heart rate with an intrauterine pressure catheter and spiral
electrode.
Rationale:
Internal EFM requires the rupture of membranes and dilation of the cervix to insert an
intrauterine pressure catheter and a spiral electrode. This invasive procedure allows for direct
and accurate monitoring of uterine activity and fetal heart rate, providing valuable information
for assessing fetal well-being.
77. Disadvantage to internal EFM:
Answer: Risk for infection.
Rationale:
One disadvantage of internal EFM is the risk of infection. Since the procedure involves inserting
catheters and electrodes into the uterus, there is a potential for introducing bacteria, which can
lead to infections. This risk must be carefully considered and managed during the monitoring
process.
78. Fetal Scalp Electrode (FSE):
Answer: A spiral wire that can be placed on the scalp of the fetus to monitor their heart rate to
ensure their well-being.
Rationale:
The Fetal Scalp Electrode (FSE) is a small spiral wire that is gently attached to the scalp of the
fetus during labor. It provides a direct and more accurate measurement of the fetal heart rate,
which is important for assessing the well-being of the fetus during labor and delivery.
79. Intrauterine Pressure Catheter (IUPC):
Answer: A catheter that can be placed through the cervix into the uterus to measure uterine
pressure during labor (uterine activity and pressure).
Rationale:
The Intrauterine Pressure Catheter (IUPC) is a flexible tube that is inserted through the cervix
into the uterus during labor. It is used to measure the strength and frequency of contractions,
providing valuable information about the progress of labor and the well-being of the fetus.
80. The tip of the IUPC can record pressure changes measuring in ____________
Answer: millimeters of mercury
Rationale:
The tip of the Intrauterine Pressure Catheter (IUPC) can record pressure changes in millimeters
of mercury (mmHg). This measurement helps healthcare providers assess the strength of
contractions and the effectiveness of labor.
81. MVU:
Answer: Montevideo Units - a measure of frequency and intensity of contractions using the
IUPC
Rationale:
Montevideo Units (MVUs) are a measure of the frequency and intensity of uterine contractions
during labor. They are calculated based on the pressure changes recorded by the Intrauterine
Pressure Catheter (IUPC) and provide an indication of the strength of contractions.
82. If we have an MVU that is greater than or equal to 200 in a 10-minute strip, what do we start
to assume?
Answer: That labor is progressing normally and contractions are adequate for cervical dilation
and effacement.
Rationale:
An MVU greater than or equal to 200 in a 10-minute strip indicates that uterine contractions are
strong and frequent enough to facilitate cervical dilation and effacement, suggesting that labor is
progressing normally. This is a positive sign of labor progression and fetal well-being.
83. Describe what a mild, moderate, and a strong contraction feels like when you as the nurse
physically palpate the uterus during a contraction:
Answer:
• Mild contraction: feels like cartilage on the nose.
• Moderate contraction: feels like the chin.
• Strong contraction: feels like the forehead.
Rationale:
Palpating the uterus during contractions helps assess the strength of contractions. Comparing the
feeling to different parts of the face provides a subjective scale for nurses to communicate the
strength of contractions to other healthcare providers.
84. ___________ is the beginning of the first contraction to the beginning of the next
contraction.
Answer: Frequency
Rationale:
Frequency refers to the time from the beginning of one contraction to the beginning of the next
contraction. It is an important measure in assessing the progress of labor and the well-being of
the fetus.
85. ____________ is when we count how long the contraction is.
Answer: Duration
Rationale:
Duration refers to the length of time that a contraction lasts. It is measured from the beginning of
a contraction to the end of the same contraction. Duration is important in determining the
strength and effectiveness of contractions.
86. Baseline Fetal Heart Rate (FHR):
Answer: 110-160 bpm in a term fetus
Rationale:
The baseline fetal heart rate (FHR) is the average heart rate of the fetus over a 10-minute period,
excluding periodic or episodic changes, such as accelerations or decelerations. In a term fetus,
the baseline FHR is typically between 110 and 160 beats per minute (bpm).
87. Fetal Tachycardia:
Answer: FHR greater than 160 bpm lasting more than 10 minutes.
Rationale:
Fetal tachycardia is defined as a fetal heart rate (FHR) greater than 160 beats per minute (bpm)
lasting more than 10 minutes. It can be a sign of fetal distress or other underlying issues that
require monitoring and potential intervention.
88. Causes of fetal tachycardia:
Answer:
• Immature fetus (< 32 weeks).
• Maternal fever/infection.
• Tobacco/illicit drugs.
Rationale:
Fetal tachycardia can be caused by various factors, including an immature fetus (less than 32
weeks gestation), maternal fever or infection, and maternal use of tobacco or illicit drugs. These
factors can lead to an increase in the fetal heart rate.
89. Why would an immature fetus (< 32 weeks) have tachycardia?
Answer: Sympathetic (fight or flight) is the system that is developing first in our brain (which
increases HR) and then parasympathetic (which slows us down) develops second.
Rationale:
In an immature fetus, the sympathetic nervous system (which controls the "fight or flight"
response) may be more developed than the parasympathetic nervous system (which slows heart
rate). This imbalance can lead to tachycardia in response to various stimuli.
90. Fetal Bradycardia:
Answer: FHR 32 weeks, peak 15 bpm above baseline lasting 15 seconds.
• < 32 weeks, peak 10 bpm above baseline lasting 10 seconds.
Rationale:
The height of the peak of an acceleration in fetal heart rate is related to gestational age. After 32
weeks, a peak of 15 beats per minute (bpm) above the baseline lasting 15 seconds is considered
normal. Before 32 weeks, a peak of 10 bpm above the baseline lasting 10 seconds is considered
normal.
105. Accelerations indicate what?
Answer: An intact CNS (accelerations are good because they give us good information that the
baby is tolerating the internal environment, is well oxygenated, and there is a good placenta).
Rationale:
Accelerations in fetal heart rate indicate an intact central nervous system (CNS) and are
considered a reassuring sign during labor. They suggest that the baby is tolerating the internal
environment well, is well oxygenated, and has a good placental function.
106. Early Decelerations - Fetal Heart Rate
Answer: Decrease in FHR mirroring the contraction.
Rationale:
Early decelerations in fetal heart rate are characterized by a decrease in heart rate that mirrors
the onset, nadir, and recovery of a contraction. These decelerations are typically benign and are
caused by head compression during contractions.
107. Decrease in FHR mirroring the contraction.
Answer: Early Deceleration
Rationale:
Early decelerations in fetal heart rate are characterized by a decrease in heart rate that mirrors
the onset, nadir, and recovery of a contraction. They are typically caused by head compression
during contractions and are considered benign.
108. Early Deceleration equates to _________________
Answer: Head compression (as the contraction is going up, the pressure is getting greater and
greater on the baby's head, therefore the baby has a vagal nerve response which is to lower the
baby's heart rate. As the pressure releases off of its head, the heart rate goes back up).
Rationale:
Early decelerations in fetal heart rate are caused by head compression during contractions. As
the contraction increases pressure on the baby's head, the baby's vagal nerve responds by
lowering the heart rate. Once the pressure is released, the heart rate returns to baseline.
109. When do we hope/want to see early deceleration during the labor process?
Answer: Towards the end of labor (8cm or 9cm)
Rationale:
Early decelerations towards the end of labor, around 8-9 centimeters dilation, are considered
normal and indicate that the baby's head is descending into the birth canal. This is a reassuring
sign of progress in labor.
110. Early deceleration at 3 cm might be telling us what?
Answer: The baby might not be able to fit through that pelvis
Rationale:
Early decelerations at 3 centimeters dilation might indicate that the baby's head is not fitting
through the pelvis properly. This can be a sign of cephalopelvic disproportion (CPD), where the
baby's head is too large to pass through the mother's pelvis.
111. Late Decelerations - Fetal Heart Rate:
Answer: Decrease in FHR starting after as the contraction peaks.
Rationale:
Late decelerations in fetal heart rate are characterized by a decrease in heart rate that starts after
the peak of a contraction. They are caused by uteroplacental insufficiency and are considered
non-reassuring signs of fetal distress.
112. Decrease in FHR starting after as the contraction peaks.
Answer: Late Deceleration
Rationale:
Late decelerations in fetal heart rate are characterized by a decrease in heart rate that starts after
the peak of a contraction. They are caused by uteroplacental insufficiency and are considered
non-reassuring signs of fetal distress.
113. Late Decelerations are equivalent to :
Answer: Uteroplacental insufficiency (no oxygen / lack of oxygen is being carried over from
mom to baby).
Rationale:
Late decelerations in fetal heart rate occur after the peak of the contraction and can indicate
uteroplacental insufficiency, where there is a decrease in oxygen transfer from the mother to the
baby through the placenta. This can lead to fetal hypoxia and acidosis, which is a serious
concern during labor and delivery.
True or False:
114. Late Decelerations are a concern?
Answer: True: they are the reason why we might have to perform a C-section instead of a
vaginal birth.
Rationale:
Late decelerations indicate uteroplacental insufficiency, which can lead to fetal hypoxia and
acidosis. If late decelerations are severe or prolonged, they can be a sign that the baby is not
tolerating labor well and may require delivery by C-section to prevent fetal distress.
115. Episodic Patterns/changes:
Answer: Patterns or changes not associated with uterine contractions (there doesn't need to be
uterine contractions present for changes to occur).
Rationale:
Episodic patterns or changes refer to changes in fetal heart rate that occur independently of
uterine contractions. These changes can include accelerations, decelerations, or other
irregularities in the fetal heart rate pattern.
116. Episodic patterns include:
Answer: Variable decelerations, Sinusoidal Pattern, Prolonged deceleration.
Rationale:
Episodic patterns refer to specific patterns or changes in the fetal heart rate that are not
associated with uterine contractions. These patterns include variable decelerations, which are
caused by umbilical cord compression, sinusoidal patterns, which are smooth wave-like patterns,
and prolonged decelerations, which are visually apparent decreases in fetal heart rate lasting
more than 2 minutes but less than 10 minutes.
117. Variable Decelerations:
Answer: Abrupt or sudden decrease in FHR.
Rationale:
Variable decelerations are caused by umbilical cord compression, leading to an abrupt or sudden
decrease in the fetal heart rate. These decelerations are typically transient and are often
associated with contractions.
118. Variable deceleration is due to:
Answer: cord compression (cord could be around the baby's neck or cord could be around the
baby's arm).
Rationale:
Variable decelerations are caused by compression of the umbilical cord, which can occur if the
cord is wrapped around the baby's neck or if the baby's arm is compressing the cord during
labor.
119. Sinusoidal Pattern:
Answer: Smooth wave-like pattern of regular frequency and amplitude.
• "False" pattern
• "True" pattern
Rationale:
Sinusoidal pattern refers to a smooth, wave-like pattern of regular frequency and amplitude seen
in the fetal heart rate tracing. This pattern can be either a "false" pattern, which is caused by
recent drug use or medication for pain management, or a "true" pattern, which is caused by
severe anemia, hypoxia, or acidosis.
120. Sinusoidal "False" pattern is due to:
Answer: recent drug use / medication for pain management
Rationale:
The "false" sinusoidal pattern is caused by recent drug use or medication for pain management,
which can affect the fetal heart rate pattern and create the appearance of a sinusoidal pattern on
the fetal heart rate tracing.
121. Sinusoidal "True" pattern is due to:
Answer: severe anemia / hypoxia / acidosis
Rationale:
The "true" sinusoidal pattern is caused by severe anemia, hypoxia, or acidosis, which can lead to
a smooth, wave-like pattern of regular frequency and amplitude in the fetal heart rate tracing.
122. Prolonged deceleration:
Answer: A visually apparent decrease (may be either gradual or abrupt) in FHR of at least 15
beats/min below the baseline and lasting more than 2 minutes but less than 10 minutes.
Rationale:
Prolonged deceleration is defined as a visually apparent decrease in the fetal heart rate of at least
15 beats/min below the baseline that lasts more than 2 minutes but less than 10 minutes. This
can be caused by various factors, including uteroplacental insufficiency, cord compression, or
other fetal distress.
123. Triggers for why a baby goes into Prolonged Deceleration:
Answer: Prolonged vagal nerve response (due to water breaking and the baby is used to the nice
cushion around their head and now it's being pressed on pelvic bones).
Rationale:
Prolonged deceleration can occur due to a vagal response, which is often triggered by the
pressure on the baby's head after the water breaks and the cushioning effect of the amniotic fluid
is lost. This response can lead to a decrease in heart rate.
124. Intrauterine Resuscitation interventions (what are the things we are going to do first to
provide better blood flow to the uterus, better oxygen within that blood flow, and there isn't any
pressure on the umbilical cord):
Answer: Discontinuation of oxytocin, Reposition, Increase IV fluids, Oxygen via mask (10L
nonrebreather), Call physician (for Terbutaline injection prn)
Rationale:
Discontinuation of oxytocin helps reduce the intensity of contractions, which can improve blood
flow to the uterus and oxygenation. Repositioning can relieve pressure on the umbilical cord.
Increasing IV fluids can improve blood flow and oxygen delivery. Oxygen via mask increases
oxygen supply to the mother and, subsequently, the baby.
125. Interventions we do not need a doctor's note:
Answer: D/C oxytocin, Reposition, Increase IV fluids, Oxygen via mask
Rationale:
These interventions, such as discontinuation of oxytocin, repositioning, increasing IV fluids, and
providing oxygen via mask, are standard procedures that can be initiated by the nursing staff
without requiring a doctor's note. They aim to improve blood flow, oxygenation, and reduce
pressure on the umbilical cord.
126. What intervention should we do first in order to improve uterine blood flow, improve
umbilical cord circulation, and improve oxygenation?
Answer: Discontinuation of oxytocin!
Rationale:
Discontinuation of oxytocin is crucial to reducing uterine contractions, which can improve blood
flow to the uterus and umbilical cord circulation. This intervention can also enhance
oxygenation by reducing the pressure on the placenta.
127. VEAL CHOP:
Answer: V- Variable, C- Cord Compression, E- Early Decels, H- Head Compression, AAccelerations, O - OK, L-Late Decels, P - Placental insufficiency
Rationale:
VEAL CHOP is a mnemonic used to interpret fetal heart rate (FHR) patterns during labor. It
helps healthcare providers identify the cause of FHR changes. For example, "V" stands for
variable decelerations, which are often associated with cord compression.
128. Category I FHR Tracings:
Answer: Baseline HR 110-160 (normal), Moderate FHR variability, Accelerations present,
Early decelerations present or absent, Late or variable decelerations absent
Rationale:
Category I FHR tracings are considered normal and indicate that the fetus is tolerating labor
well. They show a normal baseline heart rate, moderate variability, and the presence of
accelerations, with early or no decelerations.
129. Category II FHR Tracings:
Answer: Bradycardia or tachycardia, Minimal, absent, or marked variability, Accelerations
absent, Periodic or episodic decelerations present
Rationale:
Category II FHR tracings are indeterminate and require further evaluation. They may indicate
fetal distress or a compromise in fetal oxygenation. These tracings show abnormalities such as
bradycardia or tachycardia, minimal variability, and the absence of accelerations.
130. Category III FHR Tracings:
Answer: Absent or minimal variability, Recurrent late decelerations, Recurrent variable
deceleration present, Sinusoidal pattern identified
Rationale:
Category III FHR tracings are abnormal and indicate fetal distress. They require immediate
intervention. These tracings show absent or minimal variability, recurrent late decelerations,
recurrent variable decelerations, or a sinusoidal pattern, which are all signs of compromised fetal
oxygenation.
131. Nurse's Role with EFM:
Answer: Application of fetal monitor, Assessment of maternal status, Provision of patient
education on fetal monitoring, Interpretation of fetal heart tracing, Communication with
healthcare provider, Initiation of intrauterine resuscitation interventions, Documentation
Rationale:
The nurse plays a crucial role in electronic fetal monitoring (EFM) by applying the monitor,
assessing the mother and baby's status, educating the patient about fetal monitoring, interpreting
FHR tracings, communicating findings to the healthcare provider, initiating interventions as
needed, and documenting all observations and interventions.
132. Reasons for antepartum fetal surveillance at a doctor's office:
Answer: Hypertensive conditions, Gestational or pre-gestational diabetes, History of previous
fetal loss, Fetal growth less than expected, Altered amniotic fluid level, Multiple gestation,
Tobacco use
Rationale:
Antepartum fetal surveillance is conducted in high-risk pregnancies to monitor fetal well-being.
Conditions such as hypertensive disorders, diabetes, history of fetal loss, fetal growth restriction,
abnormal amniotic fluid levels, multiple gestation, and tobacco use can increase the risk of fetal
complications, making surveillance necessary.
