Obstetric Nurse Test Obstetric Nurse Intrapartum Fetal Monitoring 2 — Questions and Answers
Question 1: A fetal heart rate tracing shows a sinusoidal pattern persisting for 20 minutes. What is the most likely cause?
- Fetal sleep cycle
- Severe fetal anemia or hypoxia (Correct answer)
- Maternal narcotic administration
- Fetal hiccups
Correct answer: Severe fetal anemia or hypoxia
A true sinusoidal pattern lasting ≥20 minutes is associated with severe fetal anemia (e.g., Rh isoimmunization) or hypoxia and requires immediate evaluation.
Question 2: During active labor, the fetal heart rate baseline is 175 bpm for 15 minutes with moderate variability and accelerations. How should the nurse classify this?
- Category I — normal
- Category II — indeterminate due to tachycardia (Correct answer)
- Category III — abnormal
- Normal finding requiring no documentation
Correct answer: Category II — indeterminate due to tachycardia
Tachycardia (>160 bpm) with otherwise reassuring features places the tracing in Category II, requiring continued evaluation and investigation of the cause.
Question 3: What is the primary physiologic mechanism responsible for early decelerations during labor?
- Umbilical cord compression
- Uteroplacental insufficiency
- Vagal response to head compression during contractions (Correct answer)
- Fetal baroreceptor activation from hypertension
Correct answer: Vagal response to head compression during contractions
Early decelerations result from vagal stimulation caused by fetal head compression against the cervix or pelvis during contractions.
Question 4: A gravida presents with uterine contractions every 2 minutes lasting 90 seconds each. The FHR shows late decelerations after each contraction. What condition does this uterine pattern suggest?
- Normal active labor pattern
- Uterine hyperstimulation (tachysystole) (Correct answer)
- Precipitate labor
- Uterine atony
Correct answer: Uterine hyperstimulation (tachysystole)
Tachysystole is defined as more than 5 contractions in 10 minutes averaged over 30 minutes, and prolonged contractions reduce placental perfusion, causing late decelerations.
Question 5: Which intervention is the FIRST priority when variable decelerations are identified on the fetal monitor?
- Prepare for immediate cesarean delivery
- Administer oxygen at 10 L/min via non-rebreather mask
- Change maternal position to relieve cord compression (Correct answer)
- Perform amnioinfusion
Correct answer: Change maternal position to relieve cord compression
Position change (lateral, Trendelenburg, or knee-chest) is the first intrauterine resuscitation step to relieve suspected umbilical cord compression causing variable decelerations.
Question 6: When performing a vaginal exam and the nurse detects a pulsating cord at the cervix, what is the immediate priority action?
- Withdraw the hand and call for a stat cesarean
- Elevate the presenting part manually and call for help (Correct answer)
- Apply fundal pressure to expedite delivery
- Place the patient in the lithotomy position
Correct answer: Elevate the presenting part manually and call for help
Umbilical cord prolapse requires the nurse to manually elevate the fetal presenting part to relieve cord compression while emergency cesarean delivery is arranged.
Question 7: A Category II FHR tracing with recurrent late decelerations and minimal variability is observed. Which intervention bundle should the nurse initiate?
- Increase oxytocin infusion and reposition
- Lateral positioning, O2 via face mask, IV fluid bolus, and notify provider (Correct answer)
- Prepare for immediate vacuum-assisted delivery
- Administer terbutaline and continue monitoring
Correct answer: Lateral positioning, O2 via face mask, IV fluid bolus, and notify provider
The standard intrauterine resuscitation bundle includes lateral positioning, supplemental oxygen, IV fluid bolus, and provider notification to improve uteroplacental blood flow.
Obstetric Nurse Test Obstetric Nurse Intrapartum Fetal Monitoring 2
A fetal heart rate tracing shows a sinusoidal pattern persisting for 20 minutes.
What is the most likely cause?