Question 1

A patient at 41 weeks' gestation is undergoing an induction of labor with an IV administration of oxytocin (Pitocin). The fetal heart rate starts to demonstrate a recurrent pattern of late decelerations with moderate variability. What is the nurse's priority action?

Accepted Answer

A)  Stop the infusion of Pitocin. 
B)  Reposition the patient from her right to her left side. 
C)  Perform a vaginal exam to assess for a prolapsed cord. 
D)  Prepare the patient for an emergency cesarean birth.

Question 2

Which maternal condition should be considered a contraindication for the application of internal monitoring devices?

Accepted Answer

A)  Unruptured membranes 
B)  Cervix dilated to 4 cm 
C)  Fetus has known heart defect 
D)  Maternal HIV

Question 3

Which clinical finding would be considered normal for a preterm fetus during the labor period?

Accepted Answer

A)  Baseline tachycardia 
B)  Baseline bradycardia 
C)  Fetal anemia 
D)  Acidosis

Question 4

A nurse documents that the fetal heart rate variability is marked. This indicates that the range is greater than how many beats per minute? Record your answer as a whole number. _____ bpm

Accepted Answer

The answer of A nurse documents that the fetal heart...

Question 5

Which of the following is the priority intervention for a supine patient whose monitor strip shows decelerations that begin after the peak of the contraction and return to the baseline after the contraction ends?

Accepted Answer

A)  Increase IV infusion. 
B)  Elevate lower extremities. 
C)  Reposition to left side-lying position. 
D)  Administer oxygen per face mask at 4 to 6 L/minute.

Question 6

The nurse is monitoring a patient in labor and notes this fetal heart rate pattern on the electronic fetal monitoring strip (see figure). Which is the most appropriate nursing action at this time?

Accepted Answer

A)  Decrease the rate of the IV fluids. 
B)  Document the fetal heart rate pattern. 
C)  Explain to the patient that the pattern is normal. 
D)  Perform a vaginal exam to detect a prolapsed cord.

Question 7

Which patient is a candidate for internal monitoring with an intrauterine pressure catheter?

Accepted Answer

A)  Obese patient whose contractions are 3 to 6 minutes apart, lasting 20 to 50 seconds 
B)  Gravida 1, para 0, whose contractions are 2 to 3 minutes apart, lasting 60 seconds 
C)  Multigravida whose contractions are 2 minutes apart, lasting 60 to 70 seconds 
D)  Gravida 2, para 1, in latent phase whose contractions are irregular and mild

Question 8

The nurse admits a laboring patient at term. On review of the prenatal record, the patient's pregnancy has been unremarkable and she is considered low risk. In planning the patient's care, at what interval will the nurse intermittently auscultate (IA) the fetal heart rate during the first stage of labor?

Accepted Answer

A)  Every 10 minutes 
B)  Every 15 minutes 
C)  Every 30 minutes 
D)  Every 60 minutes

Question 9

The nurse is monitoring a patient in labor and notes this fetal heart rate pattern on the electronic fetal monitoring strip (see figure). Which is the most appropriate nursing action?

Accepted Answer

A)  Administer oxygen with a face mask at 8 to 10 L/minute. 
B)  Reposition the fetal monitor ultrasound transducer. 
C)  Assist the patient to the bathroom to empty her bladder. 
D)  Continue to monitor the patient and fetal heart rate patterns.

Question 10

The nurse recognizes that fetal scalp stimulation may be prescribed to evaluate the response of the fetus to tactile stimulation. Which conditions contraindicate the use of fetal scalp stimulation? (Select all that apply.)

Accepted Answer

A)  Post-term fetus 
B)  Maternal fever 
C)  Placenta previa 
D)  Induction of labor 
E)  Prolonged rupture of membranes

Question 11

What is the most likely cause for this fetal heart rate pattern?

Accepted Answer

A)  Administration of an epidural for pain relief during labor 
B)  Cord compression 
C)  Breech position of fetus 
D)  Administration of meperidine (Demerol) for pain relief during labor

Question 12

Which of the following is the priority intervention for the patient in a left side-lying position whose monitor strip shows a deceleration that extends beyond the end of the contraction?

Accepted Answer

A)  Administer OS1U1B12S1U1B0 at 8 to 10 L/minute. 
B)  Decrease the IV rate to 100 mL/hour. 
C)  Reposition the ultrasound transducer. 
D)  Perform a vaginal exam to assess for cord prolapse.

Question 13

The nurse is instructing a nursing student on the application of fetal monitoring devices. Which method of assessing the fetal heart rate requires the use of a gel?

Accepted Answer

A)  Doppler 
B)  Fetoscope 
C)  Scalp electrode 
D)  Tocodynamometer

Question 14

Proper placement of the tocotransducer for electronic fetal monitoring is

Accepted Answer

A)  Inside the uterus. 
B)  On the fetal scalp. 
C)  Over the uterine fundus. 
D)  Over the mother's lower abdomen.

Question 15

When the deceleration pattern of the fetal heart rate mirrors the uterine contraction, which nursing action is indicated?

Accepted Answer

A)  Reposition the patient. 
B)  Apply a fetal scalp electrode. 
C)  Record this normal pattern. 
D)  Administer oxygen by nasal cannula.

Question 16

When evaluating the patient's progress, the nurse knows that four of the five fetal factors that interact to regulate the heart rate are (Select all that apply.)

Accepted Answer

A)  baroreceptors. 
B)  adrenal glands. 
C)  chemoreceptors. 
D)  uterine activity. 
E)  autonomic nervous system.

Question 17

The physician has ordered an amnioinfusion for the laboring patient. Which data supports the use of this therapeutic procedure?

Accepted Answer

A)  Presenting part not engaged 
B)  +4 meconium-stained amniotic fluid on artificial rupture of membranes (AROM) 
C)  Breech position of fetus 
D)  Twin gestation

Question 18

Which medications could potentially cause hyperstimulation of the uterus during labor? (Select all that apply.)

Accepted Answer

A)  Oxytocin (Pitocin) 
B)  Misoprostol (Cytotec) 
C)  Dinoprostone (Cervidil) 
D)  Methylergonovine maleate (Methergine)

Exam 14: Intrapartum Fetal Surveillance

A patient at 41 weeks' gestation is undergoing an induction of labor with an IV administration of oxytocin (Pitocin) . The fetal heart rate starts to demonstrate a recurrent pattern of late decelerations with moderate variability. What is the nurse's priority action?