During labor, fetal well-being is determined by the response of the ___ to uterine contractions.
fetal heart rate
For intermittentauscultation, the nurse uses a ___, ___, ___ or ___ to assess fetal heart rate and ___ bto assess uterine activity.
Pinard stethoscope
Doppler ultrasound device
Ultrasound stethoscope
DeLee-Hillis fetoscope
palpation
The baseline fetal heart rateis the average rate during a ___, excluding ___, ___, and ___.
10-minute segment
periodic or episodic changes
periods of marked variability
baseline segments that differ bymore than 25 beats/minute
Fetal tachycardia is a baselinefetal heart rate greater than ___ (for 10 minutes or longer part of the definition of "baseline").
160 beats/minute
Fetal bradyycardia is a baselinefetal heart rate less than ___ (for 10 minutes or longer part of the definition of "baseline").
110 beats/minute
Changes in fetal heart rate are either ___, those associated with uterine contractions, or ___, those not associated with uterine contractions.
periodic
episodic
amnioinfusion
Infusion of normal saline or lactated Ringer's solution through an intrauterine catheter into the uterine cavity in an attempt to increase the fluid around the umbilical cord and prevent compression during uterine contractions
deceleration
Slowing of FHR attributed to a parasympathetic response and described in relation to uterine contractions.
early deceleration
A visually apparent gradual decrease of FHR before the peak of a contraction and return to baseline as the contraction ends; caused by fetal head compression
late deceleration
A visually apparent gradual decrease of FHR, with the lowest point of the deceleration occurring after the peak of the contraction and returning to baseline after the contraction ends; caused by uteroplacental insufficiency
prolonged deceleration
A visually apparent decrease (may be either gradual or abrupt) in FHR of at least 15 beats/min below the baseline and lasting more than 2 minutes but less than 10 minutes
variable deceleration
A visually apparent abrupt decrease in FHR below the baseline occurring any time during the uterine contracting phase; caused by compression ofthe umbilical cord
episodic changes
Changes from baseline patterns in the FHR that are not associated with uterine contractions
hypoxemia
Reduction in arterial oxygen pressure resulting in metabolic acidosis by forcing anaerobic glycolysis, pulmonary vasoconstriction, and direct cellular damage
When assessing a fetal heart rate (FHR) tracing, the nurse notes a decrease in the baseline rate from 155 to 110. The rate of 110 persists for more than 10 minutes. The nurse could attribute this decrease in baseline to:
C. Initiation of epidural anesthesia that resulted in maternal hypotension.
Fetal bradycardia is the pattern described; it results from the hypoxia that would occur when uteroplacental perfusion is reduced by maternal hypotension. The woman receiving epidural anesthesia needs to be well hydrated before and during induction of the anesthesia to maintain an adequate cardiac output and blood pressure.
T/F: When assessing a fetal heart rate (FHR) tracing, the nurse notes a decrease in the baseline rate from 155 to 110. The rate of 110 persists for more than 10 minutes. The nurse could attribute this decrease in baseline to maternal hyperthyroidism.
F: Hyperthyroidism would result in baseline tachycardia.
T/F A maternal fever could cause fetal tachycardia but not bradycardia.
True
T/F: When assessing a fetal heart rate (FHR) tracing, the nurse notes a decrease in the baseline rate from 155 to 110. The rate of 110 persists for more than 10 minutes. The nurse could attribute this decrease in baseline to alteration in maternal position from semirecumbent to lateral.
F: Assumption of a lateral position enhances placental perfusion and should result in a reassuring FHR pattern.
On review of a fetal monitor tracing, the nurse notes that for several contractions the fetal heart rate decelerates as a contraction begins and returns to baseline just before it ends. The nurse should:
D. Describe the finding in the nurse's notes.
An early decelerationpattern from head compression is described. No action other than documentation of the finding is required because this is an expected reactionto compression of the fetal head as it passes through the cervix.
T/F: On review of a fetal monitor tracing, the nurse notes that for several contractions the fetal heart rate decelerates as a contraction begins and returns to baseline just before it ends. The nurse should reposition the woman onto her side.
F: Early decelerations (ending before contraction ends) cause fetal head compression which is EXPECTED.
Repositioning the woman on her side would be implemented whennonreassuring or ominous changes were noted.
Which finding meets the criteria of a reassuring fetal heart rate (FHR) pattern?
B. Variability averages between 6 to 10 beats/min.
Variability indicates a well-oxygenated fetus with a functioning autonomic nervous system.
Mild late deceleration patterns occur with some contractions. Are these reassuring fetal heart rate (FHR) patterns?
NO - Late deceleration patterns are never reassuring.
Early and mild variable decelerations are expected, reassuring findings.
Late deceleration patterns are noted when assessing the monitor tracing of a woman whose labor is being induced with an infusion of Pitocin. The woman is in a side-lying position, and her vital signs are stable and fall within a normal range. Contractions are intense, last 90 seconds, and occur every 1½ to 2 minutes. The nurse's immediate action would be to:
D. Stop the Pitocin.
Late deceleration patterns noted are most likely related to alteration in uteroplacental perfusion associated with the strong contractions described. The immediate action would be to stop the Pitocin infusion because Pitocin is an oxytocic that stimulates the uterus to contract.
T/F: Late deceleration patterns are noted when assessing the monitor tracing of a woman whose labor is being induced with an infusion of Pitocin. The woman is in a side-lying position, and her vital signs are stable and fall within a normal range. Contractions are intense, last 90 seconds, and occur every 1½ to 2 minutes. The nurse's immediate action would be elevate the woman's legs.
F: Elevation of her legs would be appropriate if hypotension were present.
T/F: Late deceleration patterns are noted when assessing the monitor tracing of a woman whose labor is being induced with an infusion of Pitocin. The woman is in a side-lying position, and her vital signs are stable and fall within a normal range. Contractions are intense, last 90 seconds, and occur every 1½ to 2 minutes. The nurse's immediate action would be to administer oxygen via a tight mask at 8 to 10 L/min.
F: Oxygen is appropriate but not the immediate action to be taken.
The nurse providing care for the laboring woman should understand that accelerations with fetal movement:
D .Are caused by uteroplacental insufficiency.
C. Are reassuring.
Episodic accelerations in the fetal heart rate (FHR) occur during fetal movement and are indications of fetal well-being.
T/F: Umbilical cord compression results in variable decelerations in the FHR.
True
Uteroplacental insufficiency would or would notresult in late decelerations in the FHR.
would
When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that:
A. The examiner’s hand should be placed over the fundus before, during, and after contractions.
The assessment is done by palpation; duration, frequency, intensity, and resting tone must be assessed.
T/F: The frequency and duration of contractions is measured in seconds for consistency.
F: The duration of contractions is measured in seconds; the frequency is measured in minutes.
T/F: The intensity of contractions usually is described as mild, moderate, or strong.
True
T/F: When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that the resting tone between contractions is described as either placid or turbulent.
F: The resting tone usually is characterized as soft or relaxed.
The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by:
D. Change in position.
Maternal supine hypotension syndrome is caused by the weight and pressure of the gravid uterus on the ascending vena cava when the woman is in a supine position. This reduces venous return to the woman’s heart, as well as cardiac output, and subsequently reduces her blood pressure. The nurse can encourage the woman to change positions and avoid the supine position.
Oxytocin administration may reduce or may increase maternal cardiac output.
may reduce
T/F: The nurse caring for a laboring woman is aware that maternal cardiac output may be decreased by regional anesthesia.
True
T/F: The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by intravenous analgesic.
F: Intravenous analgesic may reduce maternal cardiac output.
Fetal well-being during labor is assessed by:
A. The response of the fetal heart rate (FHR) to uterine contractions (UCs).
Fetal well-being during labor can be measured by the response of the FHR to UCs. In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110 to 160 beats/min with no periodic changes, a moderate baseline variability, and accelerations with fetal movement.
T/F: Fetal well-being during labor is assessed by accelerations in the FHR.
F: Although FHR accelerations are a reassuring pattern, they are only one component of the criteria by which fetal well-being is assessed.
Fetal well-being during labor can be measured by the response of the FHR to UCs. In general, reassuring FHR patterns are characterized by 4 things... (or 6)
FHR baseline in the range of 110 to 160 beats/min
No periodic changes
Early decelerations present or absent
Late or variable decelerations absent
Moderate baseline variability
Accelerations with fetal movement.
Which correctly matches the type of deceleration with its likely cause?
C. Late deceleration—uteroplacental inefficiency
T/F: Early deceleration is caused by head compression.
True
T/F: Early deceleration is caused by umbilical cord compression
F: Early deceleration is caused by head compression.
T/F: Late deceleration is caused by uteroplacental inefficiency.
True
T/F: Late deceleration is caused by head compression.
F: Late deceleration is caused by uteroplacental inefficiency.
T/F: Variable deceleration is caused by umbilical cord compression.
True
T/F: Variable deceleration is caused by benign or critical causes.
F: Variable deceleration is caused by umbilical cord compression.
T/F: Prolonged deceleration has a variety of either benign or critical causes.
True
T/F: Prolonged deceleration is caused by uteroplacental inefficiency.
F: Prolonged deceleration has a variety of either benign or critical causes.
The most common cause of decreased variability in the fetal heart rate (FHR) that lasts 30 minutes or less is:
B. Fetal sleep cycles.
A temporary decrease in variability can occur when the fetus is in a sleep state. These sleep states do not usually last longer than 30 minutes.
T/F: Altered fetal cerebral blood flow would result in early decelerations in the FHR.
True: Early deceleration is caused by head compression or "Altered fetal cerebral blood flow"
Fetal hypoxemia would be evidenced by ___ initially and then ___. A persistent decrease or loss of FHR variability may be seen.
tachycardia
bradycardia
T/F: Umbilical cord compression would result in variable accelerations in the FHR.
F: Umbilical cord compression would result in variable decelerationsin the FHR.
You are evaluating the fetal monitor tracing of your patient, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase intravenous (IV) fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the fetal heart rate remains in the 80s. What additional nursing measures should you take?
D. Notify the care provider immediately.
T/F: You are evaluating the fetal monitor tracing of your patient, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase intravenous (IV) fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the fetal heart rate remains in the 80s. What additional nursing measures should you take? Insert a Foley catheter.
F: the FHR were to continue in a nonreassuring pattern, a cesarean section may be warranted, which would require a Foley catheter. However, the physician must make that determination.
T/F: The Valsalva maneuver can be described as the process of making a forceful bearing-down attempt while holding one’s breath with a closed glottis and tightening the abdominal muscles. During the second stage of labor, when the woman is ready to push, this is considered the optimal method to enhance movement of the fetus down the birth canal.
F: This process stimulates the parasympathetic division of the autonomic nervous system and will produce a vagal response (decrease in heart rate and blood pressure).An alternative method would include instructing the woman to perform open-mouth and open-glottis breathing and pushing.
