Chapter 18 Fetal Assessment During Labor

Chapter 18  Fetal Assessment During Labor

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. What is the most likely cause for early decelerations in the fetal heart rate (FHR) pattern?
a.
Altered fetal cerebral blood flow
b.
Umbilical cord compression
c.
Uteroplacental insufficiency
d.
Spontaneous rupture of membranes

ANS: A
Early decelerations are the fetus’ response to fetal head compression; these are considered benign, and interventions are not necessary. Variable decelerations are associated with umbilical cord compression. Late decelerations are associated with uteroplacental insufficiency. Spontaneous rupture of membranes has no bearing on the FHR unless the umbilical cord prolapses, which would result in variable or prolonged bradycardia.

DIF: Cognitive Level: Understand REF: p. 410
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity, Health Promotion and Maintenance

2. Which clinical finding or intervention might be considered the rationale for fetal tachycardia to occur?
a.
Maternal fever
b.
Umbilical cord prolapse
c.
Regional anesthesia
d.
Magnesium sulfate administration

ANS: A
Fetal tachycardia can be considered an early sign of fetal hypoxemia and may also result from maternal or fetal infection. Umbilical cord prolapse, regional anesthesia, and the administration of magnesium sulfate will each more likely result in fetal bradycardia, not tachycardia.

DIF: Cognitive Level: Understand REF: p. 419
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity, Health Promotion and Maintenance

3. While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the 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. What is the nurse’s first priority?
a.
Change the woman’s position.
b.
Notify the health care provider.
c.
Assist with amnioinfusion
d.
Insert a scalp electrode.

ANS: A
Late FHR decelerations may be caused by maternal supine hypotension syndrome. These decelerations are usually corrected when the woman turns onto her side to displace the weight of the gravid uterus from the vena cava. If the fetus does not respond to primary nursing interventions for late decelerations, then the nurse should continue with subsequent intrauterine resuscitation measures and notify the health care provider. 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 will reveal variable decelerations. Although a fetal scalp electrode will provide accurate data for evaluating the well-being of the fetus, it is not a nursing intervention that will alleviate late decelerations nor is it the nurse’s first priority.

DIF: Cognitive Level: Apply REF: p. 422
TOP: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity, Health Promotion and Maintenance

4. What is the most likely cause for variable FHR decelerations?
a.
Altered fetal cerebral blood flow
b.
Umbilical cord compression
c.
Uteroplacental insufficiency
d.
Fetal hypoxemia

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

DIF: Cognitive Level: Remember REF: p. 422
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity, Health Promotion and Maintenance

5. The nurse providing care for a high-risk laboring woman is alert for late FHR decelerations. Which clinical finding might be the cause for these late decelerations?
a.
Altered cerebral blood flow
b.
Umbilical cord compression
c.
Uteroplacental insufficiency
d.
Meconium fluid

ANS: C
Uteroplacental insufficiency results in late FHR decelerations. Altered fetal cerebral blood flow results in early FHR decelerations. Umbilical cord compression results in variable FHR decelerations. Meconium-stained fluid may or may not produce changes in the FHR, depending on the gestational age of the fetus and whether other causative factors associated with fetal distress are present.

DIF: Cognitive Level: Understand REF: p. 421
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity, Health Promotion and Maintenance