Obstetric Nurse Test Obstetric Nurse Intrapartum Fetal Monitoring 5 — Questions and Answers
Question 1: A nurse documents 'baseline FHR 140 bpm, moderate variability, accelerations present, no decelerations.' According to NICHD classification, this tracing is:
- Category II — indeterminate
- Category I — normal (Correct answer)
- Category III — abnormal
- Nonreassuring and requires scalp stimulation
Correct answer: Category I — normal
A Category I tracing includes a baseline of 110–160 bpm, moderate variability, no late or variable decelerations, and presence of early decelerations or accelerations.
Question 2: Which of the following interventions is used to assess fetal response and rule out acidosis when the FHR tracing shows absent accelerations?
- Amnioinfusion
- Fetal scalp blood sampling or vibroacoustic stimulation (Correct answer)
- Maternal oxygen saturation monitoring
- Immediate cesarean section
Correct answer: Fetal scalp blood sampling or vibroacoustic stimulation
Vibroacoustic stimulation (VAS) or fetal scalp stimulation can elicit an acceleration, indicating the fetus is not acidotic and that the absent accelerations are likely due to a sleep state.
Question 3: In which of the following situations is continuous electronic fetal monitoring (EFM) MOST indicated over intermittent auscultation?
- Uncomplicated, low-risk labor at 39 weeks with spontaneous onset
- Patient with preeclampsia receiving oxytocin augmentation (Correct answer)
- Multiparous patient with a history of normal vaginal deliveries
- Patient ambulating in early latent-phase labor
Correct answer: Patient with preeclampsia receiving oxytocin augmentation
Continuous EFM is indicated for high-risk conditions such as preeclampsia, oxytocin use, VBAC, meconium, preterm labor, or any condition placing the fetus at increased risk.
Question 4: During transition, the nurse notes a 3-minute deceleration to 80 bpm followed by a return to baseline of 145 bpm. After repositioning and oxygen, the deceleration resolves. How should the nurse classify this event?
- Prolonged deceleration — Category II finding (Correct answer)
- Prolonged deceleration — Category III finding
- Baseline bradycardia requiring immediate delivery
- Early deceleration — benign finding
Correct answer: Prolonged deceleration — Category II finding
A deceleration lasting ≥2 but <10 minutes is a prolonged deceleration; since it resolved and no other Category III features are present, it remains a Category II finding requiring close surveillance.
Question 5: The nurse is caring for a laboring patient at 30 weeks gestation. An acceleration is considered reassuring in a preterm fetus if the FHR rises at least:
- 15 bpm lasting 15 seconds
- 10 bpm lasting 10 seconds (Correct answer)
- 20 bpm lasting 20 seconds
- 15 bpm lasting 30 seconds
Correct answer: 10 bpm lasting 10 seconds
For fetuses <32 weeks gestation, the acceleration threshold is ≥10 bpm above baseline lasting ≥10 seconds, reflecting the immaturity of the autonomic nervous system.
Question 6: A nurse calculates that the fetal heart rate has been 95 bpm for the past 12 minutes. This should be classified as:
- Bradycardia — a new baseline below 110 bpm (Correct answer)
- Prolonged deceleration because it is lasting under 15 minutes
- Normal fetal response to head compression
- Minimal variability artifact from external monitoring
Correct answer: Bradycardia — a new baseline below 110 bpm
A baseline FHR below 110 bpm lasting ≥10 minutes constitutes bradycardia; at 12 minutes, the 95 bpm rate is now the baseline and represents bradycardia.
Question 7: Which of the following actions is the nurse's responsibility when a Category III fetal heart rate tracing is identified?
- Continue current management and reassess in 30 minutes
- Initiate intrauterine resuscitation measures and notify the provider immediately for expedited delivery (Correct answer)
- Increase oxytocin to accelerate labor and hasten delivery
- Document the finding and wait for the next provider assessment
Correct answer: Initiate intrauterine resuscitation measures and notify the provider immediately for expedited delivery
Category III tracings require immediate provider notification, initiation of intrauterine resuscitation, and preparation for expedited delivery if the pattern does not resolve.
Obstetric Nurse Test Obstetric Nurse Intrapartum Fetal Monitoring 5
A nurse documents 'baseline FHR 140 bpm, moderate variability, accelerations present, no decelerations.' According to NICHD classification, this tracing is: