Page 1 of 36
ADVANCED AWHONN FETAL HEART
MONITORING PRACTICE EXAM QUESTIONS WITH
VERIFIED ANSWERS
Consistent systematic assessment of the fetal heart rate tracing is essential to
observe pattern evolution and identify tracings at are at an increased risk for
adverse fetal-acid base status, which includes -- ANSWER--Normal baseline
rate, absent variability, and recurrent variable decelerations
Silvia, a 28-year-old G1P0000 at 39 1/7 weeks by sonogram, and her partner
arrived at the labor unit at 0730 for scheduled induction for intrauterine grown
restriction (IUGR). Silvia's family history is negative for medical problems
except her mother's long-term history of diabetes. Silvia 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, 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).
The single umbilical artery impacts which component of the oxygen transfer
system? -- ANSWER--Oxygen delivery
, Page 2 of 36
Michelle is a 31-year-old G1P0 at 38 6/7 weeks who arrives to triage holding
her abdomen while moaning in pain. She is accompanied by her sister. The
nurse greets Michelle in triage and accompanies her to the evaluation room.
Michelle reports a history of normal blood pressure during the pregnancy,
opioid use disorder, and attendance at all her prenatal visits. Her abdominal pain
started approximately twelve hours ago and has increased in intensity. Michelle
reports that she had loose stools while having the abdominal pain and has kept
down water and electrolyte drinks all day but continues to feel the urge to have
a bowel movement. She states that her vaccinations are up-to-date and that there
is no history of recent illness in her home.
With Michelle's presenting history, what are the nurse's priority interventions in
Michelle's care: -- ANSWER--Initiate electronic fetal monitoring and reassess
Michelle's blood pressure in 15 minutes
Michelle's blood pressure continues to be elevated in the 165/105 to 180/110
ranges. Lab work is drawn and results are pending. Anticipated initial medical
care for Michelle includes: -- ANSWER--Antihypertensive therapy
The perinatal team discussed Michelle's clinical picture with Michelle and her
sister, including her abnormal lab results. Her epigastric pain remains severe.
The anticipated best plan of care includes admitting Michelle, continuing with
antihypertensive therapy, and: -- ANSWER--Starting magnesium sulfate
, Page 3 of 36
After a discussion with Michelle and her health care team. The decision is made
to admit Michelle for induction. Magnesium Sulfate is initiated, and oxytocin is
started at 2 mU/min. Over the next two hours, Michelle received 3 doses of IV
Labetalol and 1 dose of IV Hydralazine to reduce her blood pressure out of the
severe range. She received an epidural approximately 45 minutes ago and the
oxytocin is currently infusing at 10 mu/min.
What is the priority nursing intervention at this time? -- ANSWER--Assess
Michelle, evaluate her vital signs, and attempt intrauterine resuscitation
What category is the tracing? -- ANSWER--Category III
Upon entry into the room, Michelle is found to be in the high fowler's position.
Vital signs are as follows: BP 157/89, HR 134, RR 32, SPO2 86%, urine output
200mL for the last 2 hours.
What is the most likely physiologic cause of impaired Oxygen delivery in
Michelle's case? -- ANSWER--Pulmonary edema
A healthcare organization that reflects a culture of safety establishes an
environment that is -- ANSWER--Blame-free and uses non-threatening
processes in the presence of medical errors
, Page 4 of 36
Which of Silvia's findings indicates a potential for chronic fetal hypoxemia? --
ANSWER--Intrauterine growth restriction
With the finding of a single umbilical artery, what would you expect to occur
with fetal perfusion? -- ANSWER--Homeostatic dilation of the umbilical artery
Silvia's admission vital signs were BP 109/60, pulse 83 bpm, respirations
18/minute, temperature 97ºF (36.6ºC). 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 2mU/min. Within an hour, the rate was increased to 5mU/min.
Which is a correct assessment of the admission tracing? -- ANSWER--Baseline
FHR of 125 bpm, moderate variability, accelerations present
Based on this tracing, an appropriate next step would be to: -- ANSWER-
Readjust the toco
Oxytocin was infusing at 5mU/min when the provider arrived and ordered the
oxytocin increased to 8mU/min.
ADVANCED AWHONN FETAL HEART
MONITORING PRACTICE EXAM QUESTIONS WITH
VERIFIED ANSWERS
Consistent systematic assessment of the fetal heart rate tracing is essential to
observe pattern evolution and identify tracings at are at an increased risk for
adverse fetal-acid base status, which includes -- ANSWER--Normal baseline
rate, absent variability, and recurrent variable decelerations
Silvia, a 28-year-old G1P0000 at 39 1/7 weeks by sonogram, and her partner
arrived at the labor unit at 0730 for scheduled induction for intrauterine grown
restriction (IUGR). Silvia's family history is negative for medical problems
except her mother's long-term history of diabetes. Silvia 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, 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).
The single umbilical artery impacts which component of the oxygen transfer
system? -- ANSWER--Oxygen delivery
, Page 2 of 36
Michelle is a 31-year-old G1P0 at 38 6/7 weeks who arrives to triage holding
her abdomen while moaning in pain. She is accompanied by her sister. The
nurse greets Michelle in triage and accompanies her to the evaluation room.
Michelle reports a history of normal blood pressure during the pregnancy,
opioid use disorder, and attendance at all her prenatal visits. Her abdominal pain
started approximately twelve hours ago and has increased in intensity. Michelle
reports that she had loose stools while having the abdominal pain and has kept
down water and electrolyte drinks all day but continues to feel the urge to have
a bowel movement. She states that her vaccinations are up-to-date and that there
is no history of recent illness in her home.
With Michelle's presenting history, what are the nurse's priority interventions in
Michelle's care: -- ANSWER--Initiate electronic fetal monitoring and reassess
Michelle's blood pressure in 15 minutes
Michelle's blood pressure continues to be elevated in the 165/105 to 180/110
ranges. Lab work is drawn and results are pending. Anticipated initial medical
care for Michelle includes: -- ANSWER--Antihypertensive therapy
The perinatal team discussed Michelle's clinical picture with Michelle and her
sister, including her abnormal lab results. Her epigastric pain remains severe.
The anticipated best plan of care includes admitting Michelle, continuing with
antihypertensive therapy, and: -- ANSWER--Starting magnesium sulfate
, Page 3 of 36
After a discussion with Michelle and her health care team. The decision is made
to admit Michelle for induction. Magnesium Sulfate is initiated, and oxytocin is
started at 2 mU/min. Over the next two hours, Michelle received 3 doses of IV
Labetalol and 1 dose of IV Hydralazine to reduce her blood pressure out of the
severe range. She received an epidural approximately 45 minutes ago and the
oxytocin is currently infusing at 10 mu/min.
What is the priority nursing intervention at this time? -- ANSWER--Assess
Michelle, evaluate her vital signs, and attempt intrauterine resuscitation
What category is the tracing? -- ANSWER--Category III
Upon entry into the room, Michelle is found to be in the high fowler's position.
Vital signs are as follows: BP 157/89, HR 134, RR 32, SPO2 86%, urine output
200mL for the last 2 hours.
What is the most likely physiologic cause of impaired Oxygen delivery in
Michelle's case? -- ANSWER--Pulmonary edema
A healthcare organization that reflects a culture of safety establishes an
environment that is -- ANSWER--Blame-free and uses non-threatening
processes in the presence of medical errors
, Page 4 of 36
Which of Silvia's findings indicates a potential for chronic fetal hypoxemia? --
ANSWER--Intrauterine growth restriction
With the finding of a single umbilical artery, what would you expect to occur
with fetal perfusion? -- ANSWER--Homeostatic dilation of the umbilical artery
Silvia's admission vital signs were BP 109/60, pulse 83 bpm, respirations
18/minute, temperature 97ºF (36.6ºC). 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 2mU/min. Within an hour, the rate was increased to 5mU/min.
Which is a correct assessment of the admission tracing? -- ANSWER--Baseline
FHR of 125 bpm, moderate variability, accelerations present
Based on this tracing, an appropriate next step would be to: -- ANSWER-
Readjust the toco
Oxytocin was infusing at 5mU/min when the provider arrived and ordered the
oxytocin increased to 8mU/min.
