AWHONN Advanced FHM Course Exam Answers
(AWHONN's Advanced Fetal Heart Monitoring Course Exam Answers as of 12/2023)
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? - ANSW Variable decelerations
The single umbilical artery impacts which component of the oxygen transfer system? - ANSW
Oxygen delivery
Which of Silvia's findings indicates a potential for chronic fetal hypoxemia? - ANSW
Intrauterine growth restriction (IUGR)
With the finding of a single umbilical artery, what would you expect to occur with fetal
perfusion? - ANSW 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: - ANSW 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? - ANSW
Moderate variability
Refer to tracing A-1. Based on this tracing, a necessary intervention would be to: - ANSW
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:
- ANSW An oxygenated, neurologically intact fetus
Refer to tracing A-2. A high-priority intervention at this time is to: - ANSW 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? - ANSW 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? - ANSW Maximize utero-placental circulation
Refer to tracing A-3. The correct assessment of this tracing includes: - ANSW 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? - ANSW
Recurrent decelerations
(AWHONN's Advanced Fetal Heart Monitoring Course Exam Answers as of 12/2023)
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? - ANSW Variable decelerations
The single umbilical artery impacts which component of the oxygen transfer system? - ANSW
Oxygen delivery
Which of Silvia's findings indicates a potential for chronic fetal hypoxemia? - ANSW
Intrauterine growth restriction (IUGR)
With the finding of a single umbilical artery, what would you expect to occur with fetal
perfusion? - ANSW 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: - ANSW 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? - ANSW
Moderate variability
Refer to tracing A-1. Based on this tracing, a necessary intervention would be to: - ANSW
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:
- ANSW An oxygenated, neurologically intact fetus
Refer to tracing A-2. A high-priority intervention at this time is to: - ANSW 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? - ANSW 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? - ANSW Maximize utero-placental circulation
Refer to tracing A-3. The correct assessment of this tracing includes: - ANSW 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? - ANSW
Recurrent decelerations
