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AWHONN's Advanced Fetal Heart Monitoring
(FHM) Course Exam| Questions and Answers,
100% Correct| Updated 2024- 2025
CASE STUDY A) SILVIA. Silvia, a 28-year-old G1P0000 at 39 1/7 weeks by sonogram, and her partner arrived on the labor unit at 0730 for scheduled induction for IUGR/FGR. Silvia's family history is negative for medical problems with the exception of her mother's long-term history of diabetes. Silvia has no history of medical problems and she has never had any surgeries. She developed gestational diabetes with this pregnancy, but her other prenatal labs were all normal. During one of the ultrasound examinations performed to evaluate the IUGR/FGR, a single umbilical artery was noted. On her most recent biophysical profile (BPP), the amniotic fluid index (AFI) was 11 cm (AFI less than 5 cm is defined as oligohydramnios) and the estimated fetal weight (EFW) was 2524 grams (7th percentile). WHAT FETAL HEART RATE DECELERATION IS MORE LIKELY TO OCCUR IN THE PRESENCE OF SILVIA'S SINGLE UMBILICAL ARTERY? Variable decelerations The single umbilical artery impacts which component of the oxygen transfer system? Oxygen delivery
Which of Silvia's findings indicates a potential for chronic fetal hypoxemia? Intrauterine growth restriction (IUGR) With the finding of a single umbilical artery, what would you expect to occur with fetal perfusion? Decreased blood perfusion from the fetus to the placenta Silvia's admission vital signs were BP 109/60, pulse 83 bpm, respirations 18/minute, temperature 97F (36.6C). Vaginal examination findings were 2-3 cm dilated, 50% effaced, - 1 station, membranes intact, and cephalic presentation. External electronic fetal monitor devices were placed (ultrasound and tocodynamometer). She denied having contractions, vaginal leaking or bleeding. Following this admission tracing, oxytocin was ordered and initiated at 2 mU/min. Within an hour, the rate was increased to 5 mU/min. PRIMARY BENEFITS ASSOCIATED WITH THE USE OF STANDARDIZED TERMINOLOGY FOR FHM INTERPRETATION IN THE CLINICAL SETTING INCLUDE: Enhanced communication among health care providers and promotion of patient safety Refer to tracing A-1. Which is the correct assessment of the admission tracing? Moderate variability Refer to tracing A-1. Based on this tracing, a necessary intervention would be to: Readjust the toco
Refer to tracing A-4. At the time of tracing 4, the resident performed an AROM and fluid was clear. A vaginal exam indicated the cervix was unchanged. The resident placed a fetal spiral electrode and had difficulty placing an IUPC. The nurse could palpate contractions but could not determine the frequency and duration by palpation. The oxytocin was discontinued, an intravenous fluid bolus was administered, and Silvia was repositioned. WHAT FHR CHARACTERISTICS SHOULD THE NURSE REPORT TO THE PROVIDER? Recurrent decelerations Refer to tracing A-4. The correct physiologic interpretation of this tracing is: Fetal hypoxemia may be present Refer to tracing A-5. At 1332, the resident successfully placed the IUPC and an amnioinfusion was initiated at 1430. The resident telephoned the provider to report the initiation of the amnioinfusion. WHICH INTRINSIC HOMEOSTATIC RESPONSE IS THE FETUS DEMONSTRATING? Baroreceptor Refer to tracing A-5. An amnioinfusion is intended to relieve which extrinsic factor that compromises oxygen transport? Umbilical cord compression At 1410, the nurse again telephoned the provider to report Silvia's status, including two more dark red blood clots and absent variability with recurrent decelerations,
and asked the provider to come to the bedside for evaluation. The provider indicated she was "on the way to the hospital" and ordered an emergency cesarean to be started by the senior resident. Silvia was prepped for cesarean birth. The nurse is planning to document her telephone report to the attending physician. Given the emergent situation, the best approach to documentation would be: Continue providing care for Silvia and write a late entry summarizing the conversation after the cesarean is completed What additional action should the nurse take to minimize risk, based on this case scenario? Ensure that the neonatal team is notified of the circumstances and is present for the birth The provider delivered a male infant by cesarean birth at 1447 and noted bloody amniotic fluid at delivery. Apgar scores were 3/3/3 at 1/5/10 minutes. The infant was visibly pale. Inspection of the placenta revealed a velamentous insertion of the umbilical cord and a ruptured fetal vessel. The umbilical cord gases were: pH 6.88/PCO2 114 mmHg/PO2 10 mmHg/bicarb 15/base excess - 20 mEq/L. The initial hematocrit was 20% and the hemoglobin was 8. WHICH INTERPRETATION OF THSE UMBILICAL CORD AND INITIAL NEONATAL BLOOD RESULTS IS CORRECT? The neonate is anemic
Decreased placental perfusion What are the possible implications of an oligohydramnios for labor? Potential umbilical cord compression If Nell's low-lying placenta had not resolved prior to labor and she experienced a large amount of bright red vaginal bleeding, possibly indicating hemorrhage, what FHM characteristic could occur? Sinusoidal FHR pattern What clinical intervention is supported by Nell's gestational age and risk factors? Continuous EFM monitoring throughout the night The prostaglandin was removed at 0600 and Nell took a shower and ate a light breakfast. An oxytocin infusion was then initiated at 2 mU/min. From 0730 to 0900 the FHR baseline was 150 bpm, moderate variability, occasional periodic variable decelerations and contractions every 2-5 minutes lasting 30-60 second, mild to moderate by palpation. Nell was coping well and reported her pain as a 2 on a scale of 1-10 during contractions. SVE 2/80/-2. Vital signs: 108/67, HR 119, RR 16, and T 98.2F (36.8C). Oxytocin was infusing at 10 mU/min. At 0925 Nell's provider performed AROM with return of thick, particulate yellow-green meconium. A fetal spiral electrode was placed. Refer to tracing B-1. Based on review of the tracing, the nurse's primary intervention is: Auscultate the FHR with a doppler to confirm arrhythmia
Refer to tracing B-1. In Nell's tracing, what do the FHR spikes likely represent? FHR arrhythmia or artifact Refer to tracing B-1. Which is a correct interpretation of Nell's tracing? Normal baseline rate and possible arrhythmia How could a fetal arrhythmia affect fetal oxygenation? By reducing fetal perfusion Fetal hydrops may present on ultrasound as fetal scalp edema and increased abdominal fluid as a result of which fetal condition? Congestive heart failure The FSE was removed due to the increased challenges evaluating the tracing with the arrhythmia. At 1030, oxytocin was infusing at 13 mU/min and SVE was 2- 3/90//-2. Nell's vital signs were 100/66, HR 122, RR 18, T 101.2F (38.4C). She has not voided and was offered a bedpan. Nell voided 350 mL of amber colored urine. Refer to tracing B-2. What would increase oxygen consumption in Nell's fetus? Hyperthermia Refer to tracing B-2. What is the correct interpretation of fetal oxygenation status from this tracing? The FHR characteristics are indicative of an indeterminate status Refer to tracing B-2. Which assessment or intervention would be effective for increasing fetal oxygenation at this time?
echocardiogram and was discharged to home with mother. What is the most plausible explanation for the neonate's normal sinus rhythm at birth? The source of the ectopic fetal cardiac stimulation had resolved CASE STUDY C) HELEN. Helen, a 23 year-old G3 P0020 at 25&6 comes to L&D with a chief complaint of "backache and cramping". Helen is a thin, young woman and her prenatal record indicates she was born prematurely. She's had 2 SABs and multiple uterine/vaginal infections, including treatment for dysplasia with a LEEP procedure. She began prenatal care at 16 weeks and attended 2 appointments due to transportation issues. Following a swab of the fluid in her vagina, which was negative for ferning, SVE findings were 2/70/-3, cephalic presentation. Helen denies recent sexual intercourse. States her baby is active today. FHR is auscultated at 156 bpm and external EFM components are placed. Demographic, obstetric, and socioeconomic factors provide essential information to enable individualized intrapartum care planning. BASED ON STATISTICAL REPORTS AND CURRENT PUBLISHED LITERATURE, BLACK WOMEN HAVE A HIGHER INCIDENCE OF: Preterm birth If visualized, what characteristics of Helen's EFM tracing would be indicative of uninterrupted fetal oxygenation?
Accelerations of 10 bpm above baseline lasting at least 10 seconds above baseline, moderate variability, and no FHR decelerations What other assessment parameters are advisable given Helen's history and presenting statements? Vital signs, notation of vaginal bleeding Helen's nurse uses the SBAR framework for communicating patient information to colleagues. What do the letters SBAR stand for? S-situation B-background A-assessment R-recommendation Refer to tracing C-1. Helen's fetal monitoring continues using external components. Which of the following characteristics are most common in the preterm fetus? Baseline rates at high normal and variable decelerations Refer to tracing C-1. What typical characteristics of preterm uterine activity are present in Helen's tracing? Low amplitude, high frequency contractions Which medications used with preterm labor can affect FHR characteristics? Betamethasone and terbutaline What characterizes a preterm fetal response to interruptions in oxygenation? More rapid deterioration from Category I to Category II or III Clinical decision-making at the bedside should include:
anticipated best plan of care includes admitting Michelle, continuing with antihypertensive therapy, and; Starting magnesium sulfate
