Exam (elaborations)
NURS 8701 TEST 26 OB-GYN QUESTIONS AND ANSWERS LATEST 2O23/2024
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NURS 8701 TEST 26 OB-GYN QUESTIONS AND ANSWERS LATEST 2O23/2024
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Test 26 – ObstetricsA 29 year-old G1P0 at 41 weeks gestation presents for a prenatal visit. Her prenatal course is complicated by
tobacco abuse and intermittent prenatal care. Her last visit was at 35 weeks. Prenatal labs are unremarkable except
cervical culture positive for Chlamydia, which was treated, and a Pap smear with low-grade squamous intraepithelial
lesion. Ultrasound at 21 weeks was consistent with gestational age. Her vitals reveal a blood pressure of 128/76;
pulse 74; and temperature 98° F, 36.7°C . Fundal height is 39 cm with estimated fetal weight of 2700 gm. Cervix is
dilated to 1 cm, 50% effaced, -2 station. What is the next best step in the management of this patient?
a) Non-stress test
b) Vibroacoustic stimulation test
c) Oxytocin challenge test
d) Return visit in 1 week
e) Cesarean section
Correct!!! The non-stress test is an assessment of fetal well-being that measures the fetal heart rate response
to fetal movement. The normal or reactive non-stress test occurs when there are two fetal heart rate
accelerations of 15 beats/minute for 15 seconds within 20 minutes. Vibroacoustic stimulation is not
indicated unless the NST is non-reactive. Contraction stress test assesses uteroplacental insufficiency and
looks for persistent late decelerations after contractions (3/10 minutes); however, it is not necessary to
perform, as the non-stress test will assess fetal well being, also. Observation only would not be proper care
as the patient is post-term. In the presence of abnormal testing, labor would be induced or a Cesarean
section performed.
A 29 year-old G1P0 at 41 weeks gestation presents in early labor. The prenatal course was uncomplicated.
Ultrasound at 21 weeks was consistent with gestational age. Her vitals reveal a blood pressure of 128/76; pulse 74;
and she is afebrile. Fundal height is 36 cm with estimated fetal weight of 2700 gm. Cervix is dilated to 1 cm, 50%
effaced and the fetal vertex is at -2 station. The nurse calls you to evaluate the fetal tracing. Which statement best
describes the tracing seen below?
a) Normal fetal heart rate with good variability and regular contractions
b) Fetal tachycardia with good variability and regular contractions
c) Normal fetal heart rate with poor variability and regular contractions
d) Fetal tachycardia with poor variability and irregular contractions
e) Normal fetal heart rate with poor variability and irregular contractions
Correct!!! The baseline fetal heart rate is normal with good accelerations and regular contractions. There is
no tachycardia. This is a reassuring tracing.
A 19 year-old G3P0 with spontaneous rupture of membranes for 13 hours presented to labor delivery. She had no
prenatal care. Her vital signs are: blood pressure 120/70; pulse 72; afebrile; fundal height 36 cm; and estimated fetal
weight of 2700 gm. Cervix is dilated to 1 cm, 50% effaced, -2 station. Which statement best describes the tracing
seen below?
a) Normal fetal heart rate with good variability and regular contractions
b) Fetal tachycardia with good variability and regular contractions
c) Normal fetal heart rate with poor variability and irregular contractions
d) Fetal tachycardia with poor variability and regular contractions
,e) Normal fetal heart rate with good variability and irregular contractions
Correct!!! The baseline fetal heart rate is >160 with no accelerations or variability. There are regular
contractions. Prolonged periods of fetal tachycardia are frequently found with maternal fever or
chorioamnionitis.
-2-2
A 19 year-old G3P0020 with spontaneous rupture of membranes for 19 hours presents to labor delivery. She had no
prenatal care. Her vital signs are: blood pressure 120/70; pulse 72; febrile to 102° F , 38.9°C); fundal height 36 cm;
and estimated fetal weight of 2700 gm. Cervix is dilated to 1 cm, 50% effaced and -2 station. The fetal heart rate
tracing demonstrates regular contractions and fetal tachycardia of 180 beats/minute with poor variability. In this
patient, what is the most likely etiology of this fetal heart rate pattern?
a) Nuchal cord
b) Prematurity
c) Fetal anomalies
d) Chorioamnionitis
e) Oligohydramnios
Correct!!! Regular contractions with fetal tachycardia in the presence of prolonged ruptured membranes are
most likely due to infection (i.e. chorioamnionitis). In the presence of a nuchal cord and oligohydramnios,
the fetal heart rate tracing may show variable decelerations. There is no classic fetal heart rate pattern in
-2-2
pregnancies complicated by prematurity or fetal anomalies.
A 19 year-old G1P0 at 41 weeks with spontaneous rupture of membranes for 13 hours presented to labor and
delivery. She had an uncomplicated prenatal course. Her vital signs are: blood pressure 120/70; pulse 72; afebrile;
fundal height 36 cm; and estimated fetal weight of 2700 gm. Cervix is dilated to 4 cm, 100% effaced, + 1 station.
What does the fetal heart rate tracing seen below show?
a) Late deceleration
b) Variable decelerations
c) Early decelerations
d) Sinusoidal rhythm
e) Normal fetal heart rate pattern
Correct!!! Early decelerations are physiologic caused by fetal head compression during uterine
contractions, resulting in vagal stimulation and slowing of the heart rate. This type of deceleration has a
uniform shape, with a slow onset that coincides with the start of the contraction and a slow return to the
baseline that coincides with the end of the contraction. Thus, it has the characteristic mirror image of the
contraction. A late deceleration is a symmetric fall in the fetal heart rate, beginning at or after the peak of
the uterine contraction and returning to baseline only after the contraction has ended. Late decelerations are
associated with uteroplacental insufficiency. Variable decelerations show an acute fall in the FHR with a
rapid down slope and a variable recovery phase. They are characteristically variable in duration, intensity,
and timing and may not bear a constant relationship to uterine contractions. The true sinusoidal pattern is a
, regular, smooth, undulating form typical of a sine wave that occurs with a frequency of two to five
cycles/minute and an amplitude range of five to 15 beats/minute. It is also characterized by a stable
baseline heart rate of 120 to 160 beats/minute and absent beat-to-beat variability.
A 19 year-old G1P0 at 42 weeks presents to labor and delivery with spontaneous rupture of membranes for 13 hours
and spontaneous onset of labor. Her vital signs are: blood pressure 120/70; pulse 72; afebrile; fundal height 36 cm;
and estimated fetal weight of 2700 gm. Cervix is dilated to 4 cm, 100% effaced, + 1 station. Which statement best
describes the tracing seen below?
a) Normal fetal heart rate pattern
b) Sinusoidal rhythm
c) Late deceleration
d) Variable decelerations
e) Early decelerations
Correct!!! Variable decelerations show an acute fall in the FHR, with a rapid down slope and a variable
recovery phase. They are characteristically variable in duration, intensity, and timing, and may not bear a
constant relationship to uterine contractions. Early decelerations are physiologic caused by fetal head
compression during uterine contraction, resulting in vagal stimulation and slowing of the heart rate. This
type of deceleration has a uniform shape, with a slow onset that coincides with the start of the contraction
and a slow return to the baseline that coincides with the end of the contraction. Thus, it has the
characteristic mirror image of the contraction. A late deceleration is a symmetric fall in the fetal heart rate,
beginning at or after the peak of the uterine contraction and returning to baseline only after the contraction
has ended. Late decelerations are associated with uteroplacental insufficiency. The true sinusoidal pattern is
a regular, smooth, undulating form typical of a sine wave that occurs with a frequency of two to five
cycles/minute and an amplitude range of five to 15 beats/minute. It is also characterized by a stable
baseline heart rate of 120 to 160 beats/minute and absent beat-to-beat variability.
A 19 year-old G1P0 at 39 weeks presents in labor. She denies ruptured membranes. Her prenatal course was
uncomplicated and ultrasound at 18 weeks revealed no fetal abnormalities. Her vital signs are: blood pressure
120/70; pulse 72; temperature 101.0° F, 38.3° C; fundal height 36 cm; and estimated fetal weight of 2900 gm.
Cervix is dilated to 4 cm, 100% effaced and at +1 station. At spontaneous rupture of the membranes, light
meconium-stained fluid was noted. Soon after the fetal heart rate tracing revealed variable decelerations with good
beat-to-beat variability. What is the most likely cause for the variable decelerations?
a) Umbilical cord compression
b) Meconium
c) Maternal fever
d) Uteroplacental insufficiency
e) Maternal drugs
Correct!!! Variable decelerations are reflex mediated usually associated with umbilical cord compression as
a result of cord wrapped around fetal parts, fetal anomalies or oligohydramnios. The presence of light
meconium-stained fluid is not associated with a specific fetal heart rate tracing. Uteroplacental
insufficiency is associated with late decelerations. Maternal drugs may cause loss of variability.
A 29 year-old G1P0 at 42 weeks presents in labor. She denies ruptured membranes. Her prenatal course was
complicated by chronic hypertension. Her vital signs are: blood pressure 130/80; pulse 72; afebrile; fundal height 36
cm; and estimated fetal weight of 2100 gm. Cervix is dilated to 4 cm, 100% effaced, +1 station. The fetal heart rate
, tracing is shown below. What is the most likely diagnosis?
a) Normal fetal heart rate pattern
b) Sinusoidal rhythm
c) Late deceleration
d) Variable decelerations
e) Early decelerations
Correct!!! Late decelerations are a symmetric fall in the fetal heart rate, beginning at or after the peak of the
uterine contraction and returning to baseline only after the contraction has ended. Late decelerations are
associated with uteroplacental insufficiency. Variable decelerations show an acute fall in the FHR with a
rapid down slope and a variable recovery phase. They are characteristically variable in duration, intensity,
and timing and may not bear a constant relationship to uterine contractions. Early decelerations are
physiologic caused by fetal head compression during uterine contraction, resulting in vagal stimulation and
slowing of the heart rate. This type of deceleration has a uniform shape, with a slow onset that coincides
with the start of the contraction and a slow return to the baseline that coincides with the end of the
contraction. Thus, it has the characteristic mirror image of the contraction. The true sinusoidal pattern is a
regular, smooth, undulating form typical of a sine wave that occurs with a frequency of two to five
cycles/minute and an amplitude range of five to 15 beats/minute. It is also characterized by a stable
baseline heart rate of 120 to 160 beats/minute and absent beat-to-beat variability.
A 29 year-old G1P0 at 42 weeks presents in labor. She denies ruptured membranes. Her prenatal course was
complicated by chronic hypertension. Her vital signs are: blood pressure 130/80; pulse 72; afebrile; fundal height 36
cm; and estimated fetal weight of 2400 gm. Cervix is dilated to 4 cm, 100% effaced, -1 station, and bulging bag of
water. The fetal heart rate tracing reveals 5 contractions in 10 minutes and repetitive late decelerations. What is the
most likely cause of her late decelerations?
a) Uteroplacental insufficiency
b) Umbilical cord compression
c) Uterine hyperstimulation
d) Occiput posterior position
e) Fetal head compression
Correct!!! Late decelerations when viewed as repetitive and/or with decreased variability are an ominous
sign. The can be associated with uteroplacental insufficiency as a result of decreased uterine perfusion or
placental function, thus leading to fetal hypoxia and acidemia. Common causes include chronic
hypertension and postdate pregnancies. Variable decelerations are associated with cord compression.
Uterine hyperstimulation may cause prolonged bradycardia. Occiput posterior position should not be the
cause of late decelerations. Fetal head compression may be associated with early decelerations.
A 29 year-old G1P0 at 42 weeks presents to labor and delivery because of intermittent contractions. She denies
ruptured membranes. Her prenatal course was uncomplicated. Her vital signs are: blood pressure 140/96; pulse 72;
afebrile; fundal height 32 cm; and estimated fetal weight of 2900 gm. Cervix is closed, 25% effaced, -2 station. The
fetal heart rate tracing shows occasional late decelerations. Of the following, what is the next best step in
management?
a) Maternal left lateral position
b) Intrauterine resuscitation with terbutaline
c) Start an amnioinfusion
d) Begin magnesium sulfate
e) Augment labor with oxytocin
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