AWHONN Fetal Heart monitoring basics
exam questions and answers
Which contraction characteristics can be assessed with a tocodynamometer?
a) Frequency
b) Duration
c) Intensity - ANSWER>>a) Frequency
b) Duration
All Fetuses of mothers in labor experience an interruption of the oxygenation
pathway at which point? - ANSWER>>Uterus
The FHR can be monitored using doppler ultrasound?
a) Throughout labor and delivery unless the use of a more accurate method is
clearly indicated
b) Internally
c) Only early in labor
d) The FHR cannot be monitored by doppler ultrasound - ANSWER>>a)
Throughout labor and delivery unless the use of a more accurate method is clearly
indicated
What is the normal range for FHR base line in a term infant?
a) 80-120 bpm
b) 110-160 bpm
c) 140-180bpm
d) it depends on the sex of the fetus - ANSWER>>b) 110-160 bpm
Trace the flow of oxygen from mother to fetus and back. - ANSWER>>Mother's
inhalation to lungs to mat. circulatory system to hemoglobin in RBC's to
bloodstream in uterus. Uterus to spiral arteries to placenta to intervillous space to
,travel via simple diffusion into the villi. The capillaries to the umb. vein to the
fetus.
The umb. artery sends waste (CO2) to the intervillous space to the mothers
venous system.
What factors impact maternal oxygen delivery? - ANSWER>>1. Mother (blood
plasma, cardiac output, hemoglobin concentration & O2 saturation)
2. Placenta/intervillous space (uterine contractions & calcification's)
3. Fetus (vagal response aka decel or cord compression)
By what % does maternal cardiac output increase above the non-pregnant state
and what position helps this uteroplacental blood flow? - ANSWER>>30-50%
lateral recumbent or semi-Fowler's
Define tachysystole contractions and the cause of. - ANSWER>>>5 contractions in
10 min (more frequently than Q 2 min) averaged over 30 min window.
Caused by oxytocin, aminoinfusion or in rare cases spontaneously.
List interventions for tachysystole contractions. - ANSWER>>Maintaining mat.
volume, mat. positioning, intravenous hydration. Decreasing mat. pain/anxiety.
1. Reposition pt to side.
2. Admin IV fluid bolus.
3. Admin 0.25mg terbutaline SQ.
4. Admin O2 10L via non rebreather face mask.
Describe passive diffusion as related to the maternal placental fetal system. -
ANSWER>>higher conc. to lower concentration.
1.Oxygen from maternal (higher) to fetal compartment (lower) to fetal hgb then
transported to fetal tissue.
2. CO2 returns to intervillous space by passive diffusion and is removed by the
mat. venous system.
,Maternal hypotension is a potential side effect of regional anesthesia and
analgesia. What nursing interventions could you use to raise the client's blood
pressure? Choose all that apply.
A) Place the woman in a supine position.
B) Place the woman in a lateral position.
C) Increase intravenous (IV) fluids.
D) Continuous Fetal Monitor
E) Administer ephedrine per MD order - ANSWER>>Place her in lateral position, &
increase IV fluids. If no improvement may need to give epi to increase vascular
tone.
Define maternal hypertension (gestational). - ANSWER>>systolic BP >= 140mm
hg, a diastolic BP>= 90 mm hg or MAP of >=105
What is the normal expected value for a term fetal HGB? - ANSWER>>17g/dl, fetal
hgb has a higher oxygen affinity than an adult to develop in an oxygen poor
environment. The fetal circulatory pattern ensures blood with higher O2 and
nutrition content is delivered to the vital organs (brain and heart) to tolerate the
stress of labor.
detail the umbilical cord - ANSWER>>1 vein, 2 arteries encased in wharton's jelly.
O2 (high content) travels via the vein
CO2 travels via 2 arteries back to placenta
Define cord compression. - ANSWER>>A decrease of blood flow and O2 delivery
to fetus & increases CO2 level in fetus.
Transient cord compression can be common in labor. Variable FHR decel's is
frequently associated with cord compression.
Explain persistent or recurrent cord compression concerns and what to look at. -
ANSWER>>May lead to hypoxemia and fetal acidemia. The depth of variable
deceleration's is not enough to determine degree. Evaluate oxygenation through
, baseline heart rate characteristics through rate, variability and presence or
absence of accelerations.
Explain transient interruptions in fetal oxygen supple during labor. - ANSWER>>A
normal part of labor. As contractions build increased uterine pressure prevents
blood from entering/leaving the intervillous space. During the peak the fetus
relies completely on its oxygen reserve (an aerobic challenge that is not an issue
for a health fetus.
Define Uteroplacental insufficiency (UPI) - ANSWER>>Chronic deficiency of
placenta function, usually from an interruption of oxygenation pathway due to
abruption, mat. hypo or hypertension or other issues. Infant is not tolerant of
contractions. Can result in fetal grow restrictions (FGR)
Auscultation of Fetal Heart Sounds tell you what information?
Where is the best place to listen? - ANSWER>>Assess baseline FHR
Determine rhythms (regular vs irregular)
ID accelerations and deceleration's but not the type of deceleration
(early/late/variable)
The fetal heartbeat is best heard over the fetal back.
Leopold's Maneuvers - ANSWER>>Palpation to determine presentation and
position of the fetus and aid in location of fetal heart sounds.
Head=hard, round, movable object
Buttocks=soft and irregular shape
Back=smooth, hard surface felt on one side of the abdomen
Irregular knobs and lumps on opposite side of abdomen may be hands, feet,
elbows, and knees
Handheld Fetal Doppler - ANSWER>>Uses sonar to track the fetal myocardium &
converts movement into sound. If placed incorrectly may pick up maternal heart.
Perform Leopold's maneuvers to find fetal back, locate heartbeat, count FHR,
check mothers pulse and compare.
exam questions and answers
Which contraction characteristics can be assessed with a tocodynamometer?
a) Frequency
b) Duration
c) Intensity - ANSWER>>a) Frequency
b) Duration
All Fetuses of mothers in labor experience an interruption of the oxygenation
pathway at which point? - ANSWER>>Uterus
The FHR can be monitored using doppler ultrasound?
a) Throughout labor and delivery unless the use of a more accurate method is
clearly indicated
b) Internally
c) Only early in labor
d) The FHR cannot be monitored by doppler ultrasound - ANSWER>>a)
Throughout labor and delivery unless the use of a more accurate method is clearly
indicated
What is the normal range for FHR base line in a term infant?
a) 80-120 bpm
b) 110-160 bpm
c) 140-180bpm
d) it depends on the sex of the fetus - ANSWER>>b) 110-160 bpm
Trace the flow of oxygen from mother to fetus and back. - ANSWER>>Mother's
inhalation to lungs to mat. circulatory system to hemoglobin in RBC's to
bloodstream in uterus. Uterus to spiral arteries to placenta to intervillous space to
,travel via simple diffusion into the villi. The capillaries to the umb. vein to the
fetus.
The umb. artery sends waste (CO2) to the intervillous space to the mothers
venous system.
What factors impact maternal oxygen delivery? - ANSWER>>1. Mother (blood
plasma, cardiac output, hemoglobin concentration & O2 saturation)
2. Placenta/intervillous space (uterine contractions & calcification's)
3. Fetus (vagal response aka decel or cord compression)
By what % does maternal cardiac output increase above the non-pregnant state
and what position helps this uteroplacental blood flow? - ANSWER>>30-50%
lateral recumbent or semi-Fowler's
Define tachysystole contractions and the cause of. - ANSWER>>>5 contractions in
10 min (more frequently than Q 2 min) averaged over 30 min window.
Caused by oxytocin, aminoinfusion or in rare cases spontaneously.
List interventions for tachysystole contractions. - ANSWER>>Maintaining mat.
volume, mat. positioning, intravenous hydration. Decreasing mat. pain/anxiety.
1. Reposition pt to side.
2. Admin IV fluid bolus.
3. Admin 0.25mg terbutaline SQ.
4. Admin O2 10L via non rebreather face mask.
Describe passive diffusion as related to the maternal placental fetal system. -
ANSWER>>higher conc. to lower concentration.
1.Oxygen from maternal (higher) to fetal compartment (lower) to fetal hgb then
transported to fetal tissue.
2. CO2 returns to intervillous space by passive diffusion and is removed by the
mat. venous system.
,Maternal hypotension is a potential side effect of regional anesthesia and
analgesia. What nursing interventions could you use to raise the client's blood
pressure? Choose all that apply.
A) Place the woman in a supine position.
B) Place the woman in a lateral position.
C) Increase intravenous (IV) fluids.
D) Continuous Fetal Monitor
E) Administer ephedrine per MD order - ANSWER>>Place her in lateral position, &
increase IV fluids. If no improvement may need to give epi to increase vascular
tone.
Define maternal hypertension (gestational). - ANSWER>>systolic BP >= 140mm
hg, a diastolic BP>= 90 mm hg or MAP of >=105
What is the normal expected value for a term fetal HGB? - ANSWER>>17g/dl, fetal
hgb has a higher oxygen affinity than an adult to develop in an oxygen poor
environment. The fetal circulatory pattern ensures blood with higher O2 and
nutrition content is delivered to the vital organs (brain and heart) to tolerate the
stress of labor.
detail the umbilical cord - ANSWER>>1 vein, 2 arteries encased in wharton's jelly.
O2 (high content) travels via the vein
CO2 travels via 2 arteries back to placenta
Define cord compression. - ANSWER>>A decrease of blood flow and O2 delivery
to fetus & increases CO2 level in fetus.
Transient cord compression can be common in labor. Variable FHR decel's is
frequently associated with cord compression.
Explain persistent or recurrent cord compression concerns and what to look at. -
ANSWER>>May lead to hypoxemia and fetal acidemia. The depth of variable
deceleration's is not enough to determine degree. Evaluate oxygenation through
, baseline heart rate characteristics through rate, variability and presence or
absence of accelerations.
Explain transient interruptions in fetal oxygen supple during labor. - ANSWER>>A
normal part of labor. As contractions build increased uterine pressure prevents
blood from entering/leaving the intervillous space. During the peak the fetus
relies completely on its oxygen reserve (an aerobic challenge that is not an issue
for a health fetus.
Define Uteroplacental insufficiency (UPI) - ANSWER>>Chronic deficiency of
placenta function, usually from an interruption of oxygenation pathway due to
abruption, mat. hypo or hypertension or other issues. Infant is not tolerant of
contractions. Can result in fetal grow restrictions (FGR)
Auscultation of Fetal Heart Sounds tell you what information?
Where is the best place to listen? - ANSWER>>Assess baseline FHR
Determine rhythms (regular vs irregular)
ID accelerations and deceleration's but not the type of deceleration
(early/late/variable)
The fetal heartbeat is best heard over the fetal back.
Leopold's Maneuvers - ANSWER>>Palpation to determine presentation and
position of the fetus and aid in location of fetal heart sounds.
Head=hard, round, movable object
Buttocks=soft and irregular shape
Back=smooth, hard surface felt on one side of the abdomen
Irregular knobs and lumps on opposite side of abdomen may be hands, feet,
elbows, and knees
Handheld Fetal Doppler - ANSWER>>Uses sonar to track the fetal myocardium &
converts movement into sound. If placed incorrectly may pick up maternal heart.
Perform Leopold's maneuvers to find fetal back, locate heartbeat, count FHR,
check mothers pulse and compare.
