Obstetric Nurse Test Obstetric Nurse Intrapartum Fetal Monitoring 4 — Questions and Answers
Question 1: When should oxytocin be discontinued or decreased in response to an abnormal FHR tracing?
- Only if the patient requests it
- When Category III features are present or tachysystole occurs with FHR changes (Correct answer)
- After amnioinfusion has been attempted
- Only during the transition phase of labor
Correct answer: When Category III features are present or tachysystole occurs with FHR changes
Oxytocin should be reduced or discontinued when tachysystole with associated FHR changes or Category III patterns occur to reduce uterine activity and improve fetal oxygenation.
Question 2: Amnioinfusion is MOST commonly indicated for which fetal monitoring finding?
- Recurrent late decelerations
- Recurrent variable decelerations thought to be due to cord compression (Correct answer)
- Sinusoidal FHR pattern
- Fetal tachycardia above 180 bpm
Correct answer: Recurrent variable decelerations thought to be due to cord compression
Amnioinfusion instills saline into the uterine cavity to cushion the umbilical cord, relieving recurrent variable decelerations associated with oligohydramnios or cord compression.
Question 3: A patient's FHR tracing shows accelerations with fetal movement. According to ACOG, an acceleration in a fetus ≥32 weeks gestation is defined as a peak increase of at least:
- 10 bpm above baseline lasting ≥10 seconds
- 15 bpm above baseline lasting ≥15 seconds (Correct answer)
- 20 bpm above baseline lasting ≥20 seconds
- 10 bpm above baseline lasting ≥30 seconds
Correct answer: 15 bpm above baseline lasting ≥15 seconds
In fetuses ≥32 weeks, a qualifying acceleration must reach a peak ≥15 bpm above the baseline and last ≥15 seconds but <2 minutes.
Question 4: Which maternal condition is MOST likely to cause fetal tachycardia during intrapartum monitoring?
- Maternal hypothyroidism
- Maternal chorioamnionitis (Correct answer)
- Maternal hypoglycemia
- Maternal epidural analgesia
Correct answer: Maternal chorioamnionitis
Chorioamnionitis causes maternal and fetal fever and infection, leading to fetal tachycardia (>160 bpm) as the fetal heart responds to inflammatory mediators and elevated temperature.
Question 5: The nurse observes a FHR pattern where decelerations abruptly drop ≥15 bpm and vary in onset, depth, and duration with each contraction. This pattern is BEST described as:
- Late decelerations
- Early decelerations
- Variable decelerations (Correct answer)
- Prolonged decelerations
Correct answer: Variable decelerations
Variable decelerations are characterized by an abrupt onset (reaching nadir in <30 seconds), variable timing relative to contractions, and variable depth and duration.
Question 6: Which of the following findings on an EFM tracing is associated with fetal metabolic acidemia and requires immediate intervention?
- Moderate variability with accelerations
- Absent variability with recurrent late decelerations (Correct answer)
- Minimal variability with early decelerations
- Marked variability without decelerations
Correct answer: Absent variability with recurrent late decelerations
Absent variability combined with recurrent late decelerations is a Category III pattern strongly predictive of fetal metabolic acidemia, requiring immediate delivery.
Question 7: A nurse is assessing a patient with epidural analgesia who develops sudden maternal hypotension. What is the EXPECTED effect on the fetal heart rate?
- Fetal tachycardia due to increased catecholamines
- Fetal bradycardia or late decelerations due to decreased uteroplacental perfusion (Correct answer)
- No change because epidural does not cross the placenta
- Increased fetal variability due to sympathetic stimulation
Correct answer: Fetal bradycardia or late decelerations due to decreased uteroplacental perfusion
Maternal hypotension after epidural reduces uteroplacental blood flow, resulting in fetal bradycardia or late decelerations as placental gas exchange is impaired.
Obstetric Nurse Test Obstetric Nurse Intrapartum Fetal Monitoring 4
When should oxytocin be discontinued or decreased in response to an abnormal FHR tracing?