AWHONN Intermediate Fetal Monitoring TEST Questions With 100% Correct Answers.

1. A nurse is assessing a fetal heart rate (FHR) tracing. The baseline rate is 135 bpm. Which component of the central nervous system (CNS) is primarily responsible for establishing this baseline? a) Sympathetic nervous system b) Parasympathetic nervous system (vagus nerve) c) Cerebral cortex d) Peripheral chemoreceptors Rationale: The correct answer is b. The baseline FHR is primarily regulated by the autonomic nervous system. The parasympathetic nervous system, via the vagus nerve, exerts a dominant tone that maintains the heart rate at a baseline of 110-160 bpm. Sympathetic stimulation increases heart rate but is generally counterbalanced. The cerebral cortex influences higher functions but not baseline rate directly, and chemoreceptors respond to oxygen and carbon dioxide changes, causing fluctuations rather than setting the baseline. 2. A patient at 38 weeks gestation is in active labor. The FHR tracing shows a baseline of 155 bpm with moderate variability. A contraction peaks, and 30 seconds after the peak, the FHR drops to 120 bpm and returns to baseline by the end of the contraction. This pattern is classified as: a) Early deceleration b) Late deceleration c) Variable deceleration d) Prolonged deceleration Rationale: The correct answer is b. This describes a late deceleration. The key identifier is the timing: the nadir (lowest point) of the FHR occurs after the peak of thecontraction, and the FHR returns to baseline after the contraction ends. This pattern is associated with uteroplacental insufficiency. 3. A nurse observes an FHR tracing with absent variability and recurrent late decelerations. The patient’s cervix is 7 cm dilated with no change over 2 hours. The priority nursing action is: a) Administer oxygen at 2 L/min via nasal cannula. b) Position the patient in a supine position to facilitate blood pressure. c) Discontinue oxytocin infusion if running. d) Prepare for immediate vacuum-assisted delivery. Rationale: The correct answer is c. This tracing is Category III (absent variability with recurrent late decelerations), indicating a non-reassuring fetal status. The first-line intervention to reduce uterine activity and improve placental perfusion is to stop oxytocin. Oxygen should be administered via high-flow facemask (8-10 L/min), not nasal cannula. Supine positioning worsens aortocaval compression; left lateral positioning is preferred. While delivery may be needed, preparation for immediate operative delivery comes after intrauterine resuscitation fails. 4. Fetal scalp stimulation resulting in an acceleration of the FHR indicates: a) Fetal metabolic acidemia b) Fetal hypoxia c) An intact central nervous system and absence of acidosis d) Maternal fever Rationale: The correct answer is c. A fetal scalp stimulation that elicits an acceleration of 15 bpm for 15 seconds is a reassuring sign. It suggests that the fetus is not acidotic and has an intact, responsive CNS. This test is often used to confirm fetal well-being when variability is absent or ambiguous, avoiding the need for fetal blood sampling. 5. A patient receiving epidural anesthesia experiences a sudden drop in blood pressure to 90/50 mm Hg. Which FHR pattern would the nurse anticipate secondary to this maternal hypotension?a) Early decelerations b) Increase in baseline variability c) Late decelerations d) Tachycardia with absent variability Rationale: The correct answer is c. Maternal hypotension reduces uterine blood flow and, consequently, oxygen transfer to the placenta. This leads to uteroplacental insufficiency, which manifests on the FHR tracing as late decelerations. Early decelerations are head compression. Variability is usually decreased, not increased, with hypoxia. 6. Umbilical cord compression is the primary etiology for which type of deceleration? a) Early deceleration b) Late deceleration c) Variable deceleration d) Sinusoidal pattern Rationale: The correct answer is c. Variable decelerations are caused by compression of the umbilical cord. This compression leads to a vagal response (if the cord is compressed suddenly) or a hypoxic response (if compression is sustained). Early decelerations are head compression, and late decelerations are uteroplacental insufficiency. 7. According to AWHONN standards, the baseline FHR must be determined over a segment of: a) 2 minutes b) 5 minutes c) 10 minutes d) 15 minutes Rationale: The correct answer is c. The baseline FHR is defined as the approximate mean FHR rounded to increments of 5 bpm during a 10-minute window, excludingaccelerations, decelerations, and periods of marked variability. It is a cornerstone of NICHD terminology. 8. Which finding is characteristic of a sinusoidal FHR pattern? a) Abrupt return to baseline after deceleration b) A smooth, undulating waveform with absent variability c) A saw-tooth pattern with variable amplitude d) Late decelerations following every contraction Rationale: The correct answer is b. A sinusoidal pattern is defined as a smooth, sinewave-like undulation with a frequency of 3-5 cycles per minute and absent variability. It is considered a non-reassuring pattern potentially associated with severe fetal anemia, fetal hypoxia, or feto-maternal hemorrhage. It is distinct from the “saw-tooth” pattern of variable decelerations. 9. A nurse is evaluating a patient in the second stage of labor. The FHR baseline is 140 bpm with moderate variability. During the patient’s pushing efforts, the nurse notes a sudden FHR drop to 80 bpm lasting 90 seconds, with a slow return to baseline. This is classified as: a) Recurrent variable decelerations b) A prolonged deceleration c) Atypical variable decelerations d) The normal fetal response to pushing Rationale: The correct answer is b. A prolonged deceleration is defined as a decrease in FHR from baseline of at least 15 bpm lasting between 2 and 10 minutes. If it lasts longer than 10 minutes, it becomes a baseline change. While decelerations can occur with pushing, a 90-second deceleration qualifies as prolonged and requires intervention (position change, oxygen, consider stopping pushing efforts temporarily). 10. Tocolysis is indicated in the setting of a Category III tracing primarily to: a) Increase maternal blood pressure b) Decrease fetal movement to conserve oxygenc) Reduce uterine activity to allow for reperfusion of the placenta d) Accelerate the progression of labor Rationale: The correct answer is c. When a Category III tracing (e.g., recurrent late decelerations) persists despite standard intrauterine resuscitation (position change, oxygen, IV fluids, stopping oxytocin), tocolytic medications (e.g., terbutaline) may be administered to stop uterine contractions. This allows time for the uterus to relax, restoring blood flow to the intervillous space and improving oxygen delivery to the fetus while preparations for delivery are made. 11. Which of the following is the most common cause of decreased FHR variability during labor? a) Fetal sleep cycles b) Maternal hyperthyroidism c) Fetal tachycardia d) Placenta previa Rationale: The correct answer is a. Fetal sleep cycles are the most common cause of temporary decreased variability. A normal sleep cycle lasts 20-40 minutes. If variability is minimal or absent but the fetus is not acidotic, stimulation (acoustic or scalp) should cause an acceleration, confirming well-being. The other options may cause changes but are less common than sleep cycles. 12. The primary goal of fetal heart rate monitoring is to: a) Prevent all decelerations during labor. b) Identify fetal gender. c) Identify the fetus at risk for hypoxic-ischemic encephalopathy. d) Detect fetal acidosis to allow for timely intervention. Rationale: The correct answer is d. The goal of EFM is to prevent fetal injury and death by identifying fetal hypoxemia that may lead to metabolic acidosis. By recognizing patterns associated with acidosis (Category III), clinicians can intervene (intrauterine resuscitation or delivery) before neurologic injury occurs.13. A patient’s FHR tracing shows a baseline of 165 bpm for 30 minutes. This finding is documented as: a) Normal baseline variability b) Tachycardia c) Bradycardia d) Sinusoidal pattern Rationale: The correct answer is b. Fetal tachycardia is defined as a baseline FHR greater than 160 bpm for at least 10 minutes. Causes include maternal fever, chorioamnionitis, fetal hypoxia, fetal arrhythmia, or medications (e.g., terbutaline). 14. The nurse understands that early decelerations are caused by: a) Uteroplacental insufficiency b) Fetal hypoxemia c) Vagal response due to head compression d) Umbilical cord compression Rationale: The correct answer is c. Early decelerations are a vagal response caused by fetal head compression during a contraction. The compression increases intracranial pressure, leading to a vagal nerve discharge that slows the heart rate. They are benign and reflect a mature CNS. 15. When evaluating variability, the nurse assesses the: a) Rate of the baseline b) Timing of decelerations relative to contractions c) Amplitude and frequency of fluctuations in the baseline d) Duration of accelerations Rationale: The correct answer is c. Variability refers to the irregular fluctuations in the baseline FHR. It is quantified by amplitude: absent (0-1 bpm), minimal (2-5 bpm), moderate (6-25 bpm), or marked (25 bpm). It reflects the interplay between the sympathetic and parasympathetic nervous systems and is a key indicator of fetal oxygenation.16. A nurse is reviewing a tracing. The FHR is 130 bpm. There are two contractions in 10 minutes. What is the contraction frequency? a) Every 2-3 minutes b) Every 3-4 minutes c) Every 5 minutes d) Every 1 minute Rationale: The correct answer is c. Frequency is measured from the beginning of one contraction to the beginning of the next. If there are two contractions in 10 minutes, the average interval is 5 minutes.