AWHONN Advanced FHM Course Exam Answers well defined and elaborated
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
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
