Exam (elaborations)
Chapter 19 Fetal Health Surveillance During Labour
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Chapter 19 Fetal Health Surveillance During Labour
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Chapter 19: Fetal Health Surveillance During LabourMULTIPLE CHOICE
1. When is fetal bradycardia most common?
a. Intra-amniotic infection
b. Fetal anemia
c. Prolonged umbilical cord compression
d. Treatment with atropine
ANS: C
Fetal bradycardia can be considered a later sign of fetal hypoxia and is known to occur before
fetal death. Bradycardia can result from placental transfer of drugs, prolonged compression of
the umbilical cord, maternal hypothermia, and maternal hypotension. Intra-amniotic infection,
fetal anemia, and treatment with atropine would most likely result in fetal tachycardia.
DIF: Cognitive Level: Analysis REF: p. 500 | Table 19-5 OBJ:
Nursing Process: Assessment
2. While evaluating an external monitor tracing of a woman in active labour, the nurse notes that
the fetal heart rate (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 priority intervention?
a. Change the woman’s position.
b. Notify the care provider.
c. Assist with amnioinfusion.
d. Insert a scalp electrode.
ANS: A
Late decelerations may be caused by maternal supine hypotension syndrome. They usually are
corrected when the woman turns on 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, the nurse would continue with subsequent intrauterine resuscitation measures,
including notifying the 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
indicates variable deceleration. A fetal scalp electrode would provide accurate data for
evaluating the wellbeing of the fetus; however, this is not a nursing intervention that would
alleviate late decelerations, nor is it the nurse’s first priority.
DIF: Cognitive Level: Application REF: p. 503 | p. 505 | Box 19-5
, OBJ: Nursing Process: Implementation
3. Which is a cause of early decelerations?
a. Transient fetal head compression
b. Umbilical cord compression
c. Uteroplacental insufficiency
d. Spontaneous rupture of membranes
ANS: A
Early decelerations are the fetus’s response to fetal head compression. Variable decelerations
are associated with umbilical cord compression. Late decelerations are associated with
uteroplacental insufficiency. Spontaneous rupture of membranes has no bearing on the fetal
heart rate unless the umbilical cord prolapses, which would result in variable or prolonged
bradycardia.
DIF: Cognitive Level: Comprehension REF: p. 503 OBJ:
Nursing Process: Assessment
4. Which is true in relation to accelerations with fetal movement?
a. They are considered normal.
b. They are caused by umbilical cord
compression.
c. They warrant close observation.
d. They are caused by uteroplacental
insufficiency.
ANS: A
Episodic accelerations in the fetal heart rate (FHR) occur during fetal movement and are
indications of fetal well-being and are considered normal. FHR interpretation is classified as
normal, atypical, or abnormal. Umbilical cord compression results in variable decelerations in
the FHR. Accelerations in the FHR are an indication of fetal well-being and do not warrant close
observation. Uteroplacental insufficiency would result in late decelerations in the FHR.
DIF: Cognitive Level: Knowledge REF: p. 503 | Table 19-3 OBJ:
Nursing Process: Assessment
5. Which is a cause of variable fetal heart rate (FHR) decelerations?
, a. Altered fetal cerebral blood flow
b. Umbilical cord compression
c. Uteroplacental insufficiency
d. Fetal hypoxemia
ANS: B
Variable decelerations can occur any time during the uterine contracting phase and are caused
by compression of the umbilical cord. Altered fetal cerebral blood flow would result in early
decelerations in the FHR. Uteroplacental insufficiency would result in late decelerations in the
FHR. Fetal hypoxemia would result in tachycardia initially and then bradycardia if hypoxia
continues.
DIF: Cognitive Level: Knowledge REF: p. 506 | Box 19-6
OBJ: Nursing Process: Assessment
6. What should the nurse who is providing care for the labouring woman understand about late
fetal heart rate (FHR) decelerations?
a. Altered cerebral blood flow
b. Umbilical cord compression
c. Uteroplacental insufficiency
d. Meconium fluid
ANS: C
Uteroplacental insufficiency would result in late decelerations in the FHR. Altered fetal cerebral
blood flow would result in early decelerations in the FHR. Umbilical cord compression would
result in variable decelerations in the FHR. 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: Knowledge REF: p. 505 | Box 19-5 OBJ:
Nursing Process: Assessment
7. When providing care for the labouring woman, which fetal heart rate (FHR) deviation should
the nurse understand that amnioinfusion is used to treat?
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