Luna Morales Focused Exam: Non-
Reassuring Fetal Status Results | Completed
Course
HCM 312 (HCM312)
1. Which fetal heart rate (FHR) pattern did Luna Morales exhibit that indicates
non-reassuring fetal status?
A. Early decelerations
B. Moderate variability
C. Recurrent late decelerations
D. Accelerations with contractions
✅ Correct Answer: C. Recurrent late decelerations
Rationale: Late decelerations indicate uteroplacental insufficiency, a sign of fetal hypoxia.
These are non-reassuring and warrant intervention.
2. What is the most immediate nursing action when non-reassuring FHR
patterns are observed?
A. Document the findings
B. Administer oxytocin
C. Reposition the mother
D. Increase epidural infusion
✅ Correct Answer: C. Reposition the mother
Rationale: Changing the mother’s position (usually to the left side) improves uteroplacental
blood flow and can resolve decelerations.
3. Which maternal condition most likely contributed to Luna Morales' non-
reassuring fetal status?
A. Dehydration
B. Recent epidural placement
C. Maternal hypotension
D. Multiparity
✅ Correct Answer: C. Maternal hypotension
Rationale: Epidural-induced hypotension can reduce placental perfusion, causing fetal hypoxia
and late decelerations.
,4. Which fetal heart rate variability pattern is considered most concerning?
A. Moderate variability
B. Absent variability
C. Minimal variability for 20 minutes
D. Marked variability
✅ Correct Answer: B. Absent variability
Rationale: Absent variability suggests severe fetal compromise and is a Category III tracing
requiring prompt evaluation.
5. What medication might be discontinued in response to non-reassuring fetal
heart patterns in this scenario?
A. Magnesium sulfate
B. Oxytocin
C. Epinephrine
D. Antibiotics
✅ Correct Answer: B. Oxytocin
Rationale: Oxytocin increases uterine contractions, which may worsen fetal distress. It is held to
reduce uterine stimulation.
6. What intrauterine resuscitation measure is most appropriate after
repositioning fails?
A. Administer terbutaline
B. Perform amniotomy
C. Start fundal pressure
D. Apply a fetal scalp electrode
✅ Correct Answer: A. Administer terbutaline
Rationale: Terbutaline relaxes the uterus, reducing hyperstimulation and allowing better fetal
oxygenation.
7. Which documentation is most appropriate after an episode of late
decelerations resolves?
, A. “Late decelerations noted, maternal repositioning initiated, resolved after intervention.”
B. “FHR baseline remains 150 bpm, moderate variability.”
C. “No interventions required.”
D. “Decels normal.”
✅ Correct Answer: A. “Late decelerations noted, maternal repositioning initiated,
resolved after intervention.”
Rationale: Accurate, timely documentation of both findings and interventions is essential for
legal and clinical communication.
8. What assessment finding would indicate fetal well-being following a prior non-
reassuring pattern?
A. Baseline of 160 bpm with absent variability
B. Baseline of 140 bpm with moderate variability and accelerations
C. Late decelerations persisting every 5 minutes
D. Minimal variability with variable decelerations
✅ Correct Answer: B. Baseline of 140 bpm with moderate variability and accelerations
Rationale: This is a reassuring FHR pattern suggesting good oxygenation and autonomic
function.
9. Which fetal monitor category indicates immediate need for intervention or
delivery?
A. Category I
B. Category II
C. Category III
D. Intermediate
✅ Correct Answer: C. Category III
Rationale: Category III tracings (e.g., absent variability with late decelerations) are predictive of
abnormal fetal acid-base status and require intervention.
10. What is the nurse’s priority if fetal bradycardia persists after maternal
repositioning, oxygen administration, and IV fluids?
A. Notify the provider immediately
B. Administer more fluids
Reassuring Fetal Status Results | Completed
Course
HCM 312 (HCM312)
1. Which fetal heart rate (FHR) pattern did Luna Morales exhibit that indicates
non-reassuring fetal status?
A. Early decelerations
B. Moderate variability
C. Recurrent late decelerations
D. Accelerations with contractions
✅ Correct Answer: C. Recurrent late decelerations
Rationale: Late decelerations indicate uteroplacental insufficiency, a sign of fetal hypoxia.
These are non-reassuring and warrant intervention.
2. What is the most immediate nursing action when non-reassuring FHR
patterns are observed?
A. Document the findings
B. Administer oxytocin
C. Reposition the mother
D. Increase epidural infusion
✅ Correct Answer: C. Reposition the mother
Rationale: Changing the mother’s position (usually to the left side) improves uteroplacental
blood flow and can resolve decelerations.
3. Which maternal condition most likely contributed to Luna Morales' non-
reassuring fetal status?
A. Dehydration
B. Recent epidural placement
C. Maternal hypotension
D. Multiparity
✅ Correct Answer: C. Maternal hypotension
Rationale: Epidural-induced hypotension can reduce placental perfusion, causing fetal hypoxia
and late decelerations.
,4. Which fetal heart rate variability pattern is considered most concerning?
A. Moderate variability
B. Absent variability
C. Minimal variability for 20 minutes
D. Marked variability
✅ Correct Answer: B. Absent variability
Rationale: Absent variability suggests severe fetal compromise and is a Category III tracing
requiring prompt evaluation.
5. What medication might be discontinued in response to non-reassuring fetal
heart patterns in this scenario?
A. Magnesium sulfate
B. Oxytocin
C. Epinephrine
D. Antibiotics
✅ Correct Answer: B. Oxytocin
Rationale: Oxytocin increases uterine contractions, which may worsen fetal distress. It is held to
reduce uterine stimulation.
6. What intrauterine resuscitation measure is most appropriate after
repositioning fails?
A. Administer terbutaline
B. Perform amniotomy
C. Start fundal pressure
D. Apply a fetal scalp electrode
✅ Correct Answer: A. Administer terbutaline
Rationale: Terbutaline relaxes the uterus, reducing hyperstimulation and allowing better fetal
oxygenation.
7. Which documentation is most appropriate after an episode of late
decelerations resolves?
, A. “Late decelerations noted, maternal repositioning initiated, resolved after intervention.”
B. “FHR baseline remains 150 bpm, moderate variability.”
C. “No interventions required.”
D. “Decels normal.”
✅ Correct Answer: A. “Late decelerations noted, maternal repositioning initiated,
resolved after intervention.”
Rationale: Accurate, timely documentation of both findings and interventions is essential for
legal and clinical communication.
8. What assessment finding would indicate fetal well-being following a prior non-
reassuring pattern?
A. Baseline of 160 bpm with absent variability
B. Baseline of 140 bpm with moderate variability and accelerations
C. Late decelerations persisting every 5 minutes
D. Minimal variability with variable decelerations
✅ Correct Answer: B. Baseline of 140 bpm with moderate variability and accelerations
Rationale: This is a reassuring FHR pattern suggesting good oxygenation and autonomic
function.
9. Which fetal monitor category indicates immediate need for intervention or
delivery?
A. Category I
B. Category II
C. Category III
D. Intermediate
✅ Correct Answer: C. Category III
Rationale: Category III tracings (e.g., absent variability with late decelerations) are predictive of
abnormal fetal acid-base status and require intervention.
10. What is the nurse’s priority if fetal bradycardia persists after maternal
repositioning, oxygen administration, and IV fluids?
A. Notify the provider immediately
B. Administer more fluids
