AWHONN Advanced FHM Course Exam with all Correct & 100%
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CASE STUDY A) SILVIA. Silvia, a 28-year-old G1P0000 at 39 1/7 weeks by sonogram, and her
partner arrived on the labor unit at 0730 for scheduled induction for IUGR/FGR. Silvia's family
history is negative for medical problems with the exception of her mother's long-term history of
diabetes. Silvia has no history of medical problems and she has never had any surgeries. She
developed gestational diabetes with this pregnancy, but her other prenatal labs were all normal.
During one of the ultrasound examinations performed to evaluate the IUGR/FGR, a single
umbilical artery was noted. On her most recent biophysical profile (BPP), the amniotic fluid
index (AFI) was 11 cm (AFI less than 5 cm is defined as oligohydramnios) and the estimated fetal
weight (EFW) was 2524 grams (7th percentile). WHAT FETAL HEART RATE DECELERATION IS
MORE LIKELY TO OCCUR IN THE PRESENCE OF SILVIA'S SINGLE UMBILICAL ARTERY? ✔Correct
Answer-Variable decelerations
The single umbilical artery impacts which component of the oxygen transfer system?
✔Correct Answer-Oxygen delivery
Which of Silvia's findings indicates a potential for chronic fetal hypoxemia? ✔Correct Answer-
Intrauterine growth restriction (IUGR)
With the finding of a single umbilical artery, what would you expect to occur with fetal
perfusion? ✔Correct Answer-Decreased blood perfusion from the fetus to the placenta
Silvia's admission vital signs were BP 109/60, pulse 83 bpm, respirations 18/minute,
temperature 97F (36.6C). Vaginal examination findings were 2-3 cm dilated, 50% effaced, -1
station, membranes intact, and cephalic presentation. External electronic fetal monitor devices
were placed (ultrasound and tocodynamometer). She denied having contractions, vaginal
leaking or bleeding. Following this admission tracing, oxytocin was ordered and initiated at 2
mU/min. Within an hour, the rate was increased to 5 mU/min. PRIMARY BENEFITS ASSOCIATED
WITH THE USE OF STANDARDIZED TERMINOLOGY FOR FHM INTERPRETATION IN THE CLINICAL
SETTING INCLUDE: ✔Correct Answer-Enhanced communication among health care providers
and promotion of patient safety
Refer to tracing A-1. Which is the correct assessment of the admission tracing? ✔Correct
Answer-Moderate variability
Refer to tracing A-1. Based on this tracing, a necessary intervention would be to: ✔Correct
Answer-Readjust the toco
, Refer to tracing A-2. Oxytocin was infusing at 5 mU/min when the provider arrived and ordered
the oxytocin increased to 8 mU/min. A CORRECT INTERPRETATION OF THIS TRACING IS:
✔Correct Answer-An oxygenated, neurologically intact fetus
Refer to tracing A-2. A high-priority intervention at this time is to: ✔Correct Answer-Readjust
the toco
One hour later, the nurse observed two 3 cm sized, thick dark blood clots on the under pad.
Silvia denied pain and her abdomen was soft to palpation. Which component of oxygen
transport to the fetus could potentially be compromised by this bleeding? ✔Correct Answer-
Delivery
Refer to tracing A-3. Silvia's vital signs were BP 123/70, pulse 86 bpm, respirations 18/minute.
The oxytocin was infusing at 11 mU/min and VE findings were 3-4 cm, 80% effaced, -2 station,
membranes intact and cephalic presentation, with a moderate amount of blood on vaginal
exam. WHICH OF THE FOLLOWING IS AN APPROPRIATE PHYSIOLOGIC GOAL BASED ON TRACING
A-3? ✔Correct Answer-Maximize utero-placental circulation
Refer to tracing A-3. The correct assessment of this tracing includes: ✔Correct Answer-
Sinusoidal pattern
Refer to tracing A-4. At the time of tracing 4, the resident performed an AROM and fluid was
clear. A vaginal exam indicated the cervix was unchanged. The resident placed a fetal spiral
electrode and had difficulty placing an IUPC. The nurse could palpate contractions but could not
determine the frequency and duration by palpation. The oxytocin was discontinued, an
intravenous fluid bolus was administered, and Silvia was repositioned. WHAT FHR
CHARACTERISTICS SHOULD THE NURSE REPORT TO THE PROVIDER? ✔Correct Answer-
Recurrent decelerations
Refer to tracing A-4. The correct physiologic interpretation of this tracing is: ✔Correct Answer-
Fetal hypoxemia may be present
Refer to tracing A-5. At 1332, the resident successfully placed the IUPC and an amnioinfusion
was initiated at 1430. The resident telephoned the provider to report the initiation of the
amnioinfusion. WHICH INTRINSIC HOMEOSTATIC RESPONSE IS THE FETUS DEMONSTRATING?
✔Correct Answer-Baroreceptor
Refer to tracing A-5. An amnioinfusion is intended to relieve which extrinsic factor that
compromises oxygen transport? ✔Correct Answer-Umbilical cord compression
At 1410, the nurse again telephoned the provider to report Silvia's status, including two more
dark red blood clots and absent variability with recurrent decelerations, and asked the provider
to come to the bedside for evaluation. The provider indicated she was "on the way to the
hospital" and ordered an emergency cesarean to be started by the senior resident. Silvia was
Verified Answers |Latest Version |Already Graded A+
CASE STUDY A) SILVIA. Silvia, a 28-year-old G1P0000 at 39 1/7 weeks by sonogram, and her
partner arrived on the labor unit at 0730 for scheduled induction for IUGR/FGR. Silvia's family
history is negative for medical problems with the exception of her mother's long-term history of
diabetes. Silvia has no history of medical problems and she has never had any surgeries. She
developed gestational diabetes with this pregnancy, but her other prenatal labs were all normal.
During one of the ultrasound examinations performed to evaluate the IUGR/FGR, a single
umbilical artery was noted. On her most recent biophysical profile (BPP), the amniotic fluid
index (AFI) was 11 cm (AFI less than 5 cm is defined as oligohydramnios) and the estimated fetal
weight (EFW) was 2524 grams (7th percentile). WHAT FETAL HEART RATE DECELERATION IS
MORE LIKELY TO OCCUR IN THE PRESENCE OF SILVIA'S SINGLE UMBILICAL ARTERY? ✔Correct
Answer-Variable decelerations
The single umbilical artery impacts which component of the oxygen transfer system?
✔Correct Answer-Oxygen delivery
Which of Silvia's findings indicates a potential for chronic fetal hypoxemia? ✔Correct Answer-
Intrauterine growth restriction (IUGR)
With the finding of a single umbilical artery, what would you expect to occur with fetal
perfusion? ✔Correct Answer-Decreased blood perfusion from the fetus to the placenta
Silvia's admission vital signs were BP 109/60, pulse 83 bpm, respirations 18/minute,
temperature 97F (36.6C). Vaginal examination findings were 2-3 cm dilated, 50% effaced, -1
station, membranes intact, and cephalic presentation. External electronic fetal monitor devices
were placed (ultrasound and tocodynamometer). She denied having contractions, vaginal
leaking or bleeding. Following this admission tracing, oxytocin was ordered and initiated at 2
mU/min. Within an hour, the rate was increased to 5 mU/min. PRIMARY BENEFITS ASSOCIATED
WITH THE USE OF STANDARDIZED TERMINOLOGY FOR FHM INTERPRETATION IN THE CLINICAL
SETTING INCLUDE: ✔Correct Answer-Enhanced communication among health care providers
and promotion of patient safety
Refer to tracing A-1. Which is the correct assessment of the admission tracing? ✔Correct
Answer-Moderate variability
Refer to tracing A-1. Based on this tracing, a necessary intervention would be to: ✔Correct
Answer-Readjust the toco
, Refer to tracing A-2. Oxytocin was infusing at 5 mU/min when the provider arrived and ordered
the oxytocin increased to 8 mU/min. A CORRECT INTERPRETATION OF THIS TRACING IS:
✔Correct Answer-An oxygenated, neurologically intact fetus
Refer to tracing A-2. A high-priority intervention at this time is to: ✔Correct Answer-Readjust
the toco
One hour later, the nurse observed two 3 cm sized, thick dark blood clots on the under pad.
Silvia denied pain and her abdomen was soft to palpation. Which component of oxygen
transport to the fetus could potentially be compromised by this bleeding? ✔Correct Answer-
Delivery
Refer to tracing A-3. Silvia's vital signs were BP 123/70, pulse 86 bpm, respirations 18/minute.
The oxytocin was infusing at 11 mU/min and VE findings were 3-4 cm, 80% effaced, -2 station,
membranes intact and cephalic presentation, with a moderate amount of blood on vaginal
exam. WHICH OF THE FOLLOWING IS AN APPROPRIATE PHYSIOLOGIC GOAL BASED ON TRACING
A-3? ✔Correct Answer-Maximize utero-placental circulation
Refer to tracing A-3. The correct assessment of this tracing includes: ✔Correct Answer-
Sinusoidal pattern
Refer to tracing A-4. At the time of tracing 4, the resident performed an AROM and fluid was
clear. A vaginal exam indicated the cervix was unchanged. The resident placed a fetal spiral
electrode and had difficulty placing an IUPC. The nurse could palpate contractions but could not
determine the frequency and duration by palpation. The oxytocin was discontinued, an
intravenous fluid bolus was administered, and Silvia was repositioned. WHAT FHR
CHARACTERISTICS SHOULD THE NURSE REPORT TO THE PROVIDER? ✔Correct Answer-
Recurrent decelerations
Refer to tracing A-4. The correct physiologic interpretation of this tracing is: ✔Correct Answer-
Fetal hypoxemia may be present
Refer to tracing A-5. At 1332, the resident successfully placed the IUPC and an amnioinfusion
was initiated at 1430. The resident telephoned the provider to report the initiation of the
amnioinfusion. WHICH INTRINSIC HOMEOSTATIC RESPONSE IS THE FETUS DEMONSTRATING?
✔Correct Answer-Baroreceptor
Refer to tracing A-5. An amnioinfusion is intended to relieve which extrinsic factor that
compromises oxygen transport? ✔Correct Answer-Umbilical cord compression
At 1410, the nurse again telephoned the provider to report Silvia's status, including two more
dark red blood clots and absent variability with recurrent decelerations, and asked the provider
to come to the bedside for evaluation. The provider indicated she was "on the way to the
hospital" and ordered an emergency cesarean to be started by the senior resident. Silvia was
