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AWHONN Advanced FHM Course Exam Answers
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AWHONN Advanced FHM Course Exam Answers
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AWHONN ADVANCED FHM COURSEEXAM ANSWERS LATEST UPDATE
sCASE 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-2. Oxytocin was infusing at 5 mU/min when the provider arrived and ordered the
oxytocin increased to 8 mU/min. A CORRECT INTERPRETATION OF THIS TRACING IS: - An oxygenated,
neurologically intact fetus
Refer to tracing A-2. A high-priority intervention at this time is to: - Readjust the toco
One hour later, the nurse observed two 3 cm sized, thick dark blood clots on the under pad. Silvia denied
pain and her abdomen was soft to palpation. Which component of oxygen transport to the fetus could
potentially be compromised by this bleeding? - Delivery
Refer to tracing A-3. Silvia's vital signs were BP 123/70, pulse 86 bpm, respirations 18/minute. The
oxytocin was infusing at 11 mU/min and VE findings were 3-4 cm, 80% effaced, -2 station, membranes
intact and cephalic presentation, with a moderate amount of blood on vaginal exam. WHICH OF THE
FOLLOWING IS AN APPROPRIATE PHYSIOLOGIC GOAL BASED ON TRACING A-3? - Maximize utero-
placental circulation
Refer to tracing A-3. The correct assessment of this tracing includes: - Sinusoidal pattern
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
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