NCC Fetal Monitoring Practice part 2
Exam Questions with Correct Answers
Sally is a G4 P3 at 35 weeks' gestation. She has a BMI of 32. This puts her which
category?
A. Normal weight
B. Obese, Class I
c. Obese, Class 2
D. Overweight - Answer-B
Rationale: Obese Class I is a BMI between 30 and 34.9.
Doppler technology used by the US transducer in fetal monitoring primary detect:
a. actual FH sounds
B. Fetal breathing movements
c. fetal heart movements
d. maternal uterine activity - Answer-c. fetal heart movements
Rationale: The ultrasound transducer monitors fetal heart rate through use of high
frequency sound waves which detect movement of the fetal heart. These waves are
reflected back to the ultrasound transducer at different frequencies. The fetal monitor
calculates rate by measuring the shift in frequency between the emitted and reflected
waves, the "Doppler shift". The sound produced by the monitor is not the actual fetal
heart sound, but a digitized representation of it. Actual fetal heart sounds are heard
using a fetoscope or high quality stethoscope. The Toco detects maternal uterine
activity. Fetal breathing movements are not generally detectable using the ultrasound
transducer from a fetal monitor.
An advantage of the Toco Transducer when compared with the IUPC is
a. It is easily re-zero to atmospheric pressure
B. It is more accurate in quantifying uterine contraction pressures
C. It is not affected by maternal position changes
D. It may be used for both antepartum and intrapartum monitoring of uterine activity -
Answer-D. It may be used for both antepartum and intrapartum monitoring of uterine
Rationale: Because it is non-invasive and is held in place on the maternal abdomen with
belts, it may be used for both antepartum and intrapartum monitoring of uterine activity.
It can be affected by maternal position changes, which may require readjustment. It is
the lUPC which is more accurate in quantifying uterine pressures and which can be re-
zeroed to atmospheric pressure.
,The correct method for removal of a spiral electrode from the fetal scalp is to
a. cut the wire and rapidly put the wires apart so that electrode spins out of the fetal
scalp
b. pull the electrode straight out from the fetal scalp with a quick motion
c. rotate the electrode wires counter-clockwise until the electrode detaches and is easy
to remove
D. slide the guide tube back over the wire and use gloved fingers vaginally to twist the
electrode ot of the fetal scalp - Answer-c. rotate the electrode wires counter-clockwise
until the electrode detaches and is easy to remove
Since the spiral electrode is applied by clockwise rotation, removing it requires counter-
clockwise tion. Pulling the electrode from the fetal scalp may increase the chance of
infection and cause trauma to scalp. Cutting the wires and pulling them apart is not
recommended, since the rapidly rotating electrode y spin into adjacent tissues. The
guide tube is used to apply the electrode, but is then discarded.
When comparing the capabilities of the IUPC and Toco Transducer, the IUPC has the
advantage of being able to:
A. Accurately assess fetal heart rate variability
B. Measure actual uterine pressures during contractions and when at rest
C. Measure maternal blood pressure
D. Time frequency and duration of contractions - Answer-B. Measure actual uterine
pressures during contractions and when at rest
The IUPC measures actual intrauterine pressures in mm Hg with a pressure-sensitive
transducer.
1 contraction frequency and duration can be measured using an IUPC, the toco
transducer is also of measuring contraction frequency and duration. The IUPC does not
measure maternal blood. The ultrasound transducer and spiral electrode are used to
assess fetal heart rate variability.
A fetal heart rate tracing that is skipping between one baseline rate of 220 and another
baseline rate of 110 is most likely due to:
A. A defective ultrasound transducer or fetal spiral electrode
B. Double- counting of a normal fetal baseline rate
C. Fetal supraventricular tachycardia (SVT) with half-counting
D The monitor skinnina between fetal and maternal heart rates - Answer-C. Fetal
supraventricular tachycardia (SVT) with half-counting
Rationale: The fetal monitor may half-count very fast rates (above 180) and double very
slow rates (below 60).
,Because this is a very fast rate With a second baseline half as much, this is more likely
to be SVT with half-counting than a normal rate doubled. Although it is possible to have
a defective US or spiral electrode, it is not as likely as SVT with half-counting. A monitor
tracing skipping between maternal and fetal rates would be unlikely to be in those
ranges, as maternal rate is more likely to be below 100 unless febrile - but even with
fever, it would be unlikely to have the fetal rate at 220 and also to be double the
maternal rate in those ranges.
Which of the following nursing actions would be highest priority to troubleshoot the
situation described in question #5?
A Auscultate the fetal heart rate with a fetoscope or high quality stethoscope
B. Check the maternal puise
C. Notify the patient's provider
D. Replace the ultrasound transducer or spiral electrode - Answer-A
Rationale: Since the FHR is skipping between 2 rates, one a very high one, first priority
is to determine fetal tus by verifying the true fetal heart rate. If an arrhythmia is
suspected, the provider would then be contacted, but an attempt must first be made to
verify the fetal rate. Checking the maternal pulse would be other action to be done, but
no] as high a priority in this situation as verifying fetal rate. If a defective US or E is
identified after verifying fetal rate, it could then be replaced.
Mona is a G 1 P 0 patient in labor at 38 weeks gestation. She had spontaneous rupture
of membranes with clear fluid 4 hours ago, and her cervix is currently 4 centimeters
dilated and 90% effaced, with the fetal vertex at -1 station. She has no risk factors with
the exception of obesity, weighing 287 pounds. The nurse has needed to frequently
reposition both toco and US to obtain an adequate tracing. The physician has ordered
oxytocin to be started to augment labor and has placed a spiral electrode and IUPC.
To assure the IUPC is properly placed, the nurse should:
A Ask the patient to begin rhythmic breathing during her next contraction
B. Ask the patient to cough or "bear down*
C. Ask the patient to turn on her side
D. Look for a continuous fetal heart rate tracing - Answer-B.
Rationale: Asking the patient to cough or bear down should produce a spike on the
contraction channel in se to the increased pressure of a cough or Valsalva if the IUPC is
properly placed. Rhythmic breathing thing to do with the IUPC, and turning to the side
does not check for proper placement. It is spiral de that is checked for placement by
looking for a continuous fetal heart rate tracing. on # 10
to placement of the internal monitoring components, the nurse planned to de education
to Mcna. Which of the following would provide the most accurate helpful information to
Mona to help her understand the reason for applying nal monitoring components?
, Prior to placement of the internal monitoring components, the nurse planned to provide
education to Mona. Which of the following would provide the most accurate and helpful
information to Mona to help her understand the reason for applying internal monitoring
components?
A "Mona, the doctor is going to do a vaginal exam to put in a couple of wires so we can
take off these belts on your belly to make you more comfortable*
B. "Mona, we are going to start oxytocin, so we need to put in internal fetal monitor parts
to see how your baby is doing in response to that medication*
C. *Mona, we need to see what your baby is doing better, so the doctor is going to put
in a spiral electrode and an IUPC so we can get a better fetal monitor tracing*
D. "Mona, when you are in labor, it is important to be able to see how your baby is
responding to the stress of labor. It is becoming more difficult to be able to see the
baby's - Answer-D. "Mona, when you are in labor, it is important to be able to see how
your baby is responding to the stress of labor. It is becoming more difficult to be able to
see the babys heart rate tracing and how your contractions are affecting the baby. The
doctor would like to do a vaginal exam to put a wire called a spiral electrode on the
baby's head to get a better view of baby's responses on the monitor, and a catheter,
called an IUPC, into your uterus to get a better picture of your contractions to compare
with what the baby's heart rate is doing.
Rationale: The last explanation is more complete and given in terminology
understandable to the patient with a rationale for the change in monitoring methods.
Answer A is not the real reason for the change. Answer B is not as full an explanation
as D, and the patient may not understand "internal monitoring parts". Answer C is to the
point, but may not be as understandable using terminology the patient may not be
familiar with.
Exchange of respiratory gasses, nutrients, and waste products between mother and
fetus takes place in the:
A Fetal lungs
B. Placental intervillous space
C. Umbilical cord
D. Uterine circulation - Answer-B. Placental intervillous space
Rationale: The intervillous space of the placenta is where the blood-blood barrier allows
exchange of oxygen, carbon dioxide, nutrients, and waste products across the
membranes that separate the maternal and fetal circulations. The fetal lungs do not yet
have the capability to exchange gasses. The umbilical cord carries these substances
back and forth, but there is no actual exchange between maternal and fetal circulations
in the cord. The uterine circulation brings oxygen and nutrients to the placenta and
