Chapter 11 Fetal Assessment during Labor

Chapter 11  Fetal Assessment during Labor

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. The nurse providing care for the laboring woman should understand that variable fetal heart rate (FHR) decelerations are caused by:
a.
Altered fetal cerebral blood flow.
b.
Umbilical cord compression.
c.
Uteroplacental insufficiency.
d.
Fetal hypoxemia.

ANS: B

Feedback
A
Altered fetal cerebral blood flow would result in early decelerations in the FHR.
B
Variable decelerations can occur any time during the uterine contracting phase and are caused by compression of the umbilical cord.
C
Uteroplacental insufficiency would result in late decelerations in the FHR.
D
Fetal hypoxemia would result in tachycardia initially and then bradycardia if hypoxia continues.

DIF: Cognitive Level: Knowledge REF: 326
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

2. While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. The nurse’s first priority is to:
a.
Change the woman’s position.
b.
Notify the care provider.
c.
Assist with amnioinfusion.
d.
Insert a scalp electrode.

ANS: A

Feedback
A
Late decelerations may be caused by maternal supine hypotension syndrome. They usually are corrected when the woman turns on her side to displace the weight of the gravid uterus from the vena cava.
B
If the fetus does not respond to primary nursing interventions for late decelerations, the nurse would continue with subsequent intrauterine resuscitation measures, including notifying the care provider.
C
An amnioinfusion may be used to relieve pressure on an umbilical cord that has not prolapsed. The FHR pattern associated with this situation most likely reveals variable deceleration.
D
A fetal scalp electrode would provide accurate data for evaluating the well-being of the fetus; however, this is not a nursing intervention that would alleviate late decelerations, nor is it the nurse’s first priority.

DIF: Cognitive Level: Application REF: 326
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Implementation

3. The nurse caring for the laboring woman should understand that early decelerations are caused by:
a.
Altered fetal cerebral blood flow.
b.
Umbilical cord compression.
c.
Uteroplacental insufficiency.
d.
Spontaneous rupture of membranes.

ANS: A

Feedback
A
Early decelerations are the fetus’s response to fetal head compression.
B
Variable decelerations are associated with umbilical cord compression.
C
Late decelerations are associated with uteroplacental insufficiency.
D
Spontaneous rupture of membranes has no bearing on the fetal heart rate unless the umbilical cord prolapses, which would result in variable or prolonged bradycardia.

DIF: Cognitive Level: Comprehension REF: 325
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

4. What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken.
a.
Call the provider, reposition the mother, and perform a vaginal examination.
b.
Administer oxygen by face mask, assist the woman to a side-lying position, and increase maternal blood volume by increasing the rate of the primary IV.
c.
Administer oxygen to the mother, increase IV fluid, and notify the care provider.
d.
Perform a vaginal examination, reposition the mother, and provide oxygen via face mask.

ANS: B

Feedback
A
The nurse should initiate intrauterine resuscitation in an ABC manner, similar to basic life support. The first priority is to optimize oxygenation of the circulatory volume by providing oxygen via face mask. The second action is to open the maternal and fetal vascular systems by repositioning the mother for improved perfusion. The third step is to increase blood volume by increasing the IV fluid. If these interventions do not resolve the fetal heart rate issue quickly, the primary provider should be notified immediately.
B
These are the correct nursing actions for intrauterine resuscitation.
C
The nurse should initiate intrauterine resuscitation in an ABC manner, similar to basic life support. The first priority is to optimize oxygenation of the circulatory volume by providing oxygen via face mask. The second action is to open the maternal and fetal vascular systems by repositioning the mother for improved perfusion. The third step is to increase blood volume by increasing the IV fluid. If these interventions do not resolve the fetal heart rate issue quickly, the primary provider should be notified immediately.
D
The nurse should initiate intrauterine resuscitation in an ABC manner, similar to basic life support. The first priority is to optimize oxygenation of the circulatory volume by providing oxygen via face mask. The second action is to open the maternal and fetal vascular systems by repositioning the mother for improved perfusion. The third step is to increase blood volume by increasing the IV fluid. If these interventions do not resolve the fetal heart rate issue quickly, the primary provider should be notified immediately.

DIF: Cognitive Level: Evaluation REF: 330
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Implementation

5. The nurse caring for the woman in labor should understand that maternal hypotension can result in:
a.
Early decelerations.
b.
Fetal dysrhythmias.
c.
Uteroplacental insufficiency.
d.
Spontaneous rupture of membranes.

ANS: C

Feedback
A
Maternal hypotension is not associated with early decelerations.
B
Maternal hypotension is not associated with fetal dysrhythmias.
C
Low maternal blood pressure reduces placental blood flow during uterine contractions, resulting in fetal hypoxemia.
D
Maternal hypotension is not associated with SROM.

DIF: Cognitive Level: Comprehension REF: 326
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment