Maternal Newborn Nursing The Critical Components of Nursing Care 3rd Edition Roberta Durham Test Bank Download

Maternal-Newborn Nursing The Critical Components of Nursing Care 3rd Edition Roberta Durham
Maternal-Newborn Nursing The Critical Components

of Nursing Care 3rd Edition Roberta Durham Test
bank
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-of-nursing-care-3rd-edition-roberta-durham-test-bank/
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Chapter 9 Fetal Heart Rate Assessment
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. A nurse-preceptor is explaining to a new nurse about the tocodynamometer. The new nurse is
looking at the EFM paper and sees that, of the two tracked heart rates, the one on the bottom is in
the 80s; she is concerned that the fetal heart rate is bradycardic. Which of the following should the
nurse do first?
1. Give the mother oxygen to increase the fetal heart rate.
2. Immediately call the provider into the room.
3. Check to make sure that the maternal radial pulse is being recorded correctly.
4. Adjust the monitor on the maternal abdomen.
____ 2. While providing care for a patient, the nurse notices an erratic FHR recording. What action should
the nurse take next?
1. Help the patient move around to help obtain the signal.
2. Place the transducer in a different position.
3. Check the mother’s cervical progress to see if she is in the second stage of labor.
4. Remove some of the ultrasound gel from the transducer.
____ 3. An internal fetal monitor has been ordered for Chrissy, a 24-year-old G2P0010 at 38 weeks and 1
day gestation. Her medical history is significant for a history of pregnancy-induced hypertension.
Her laboratory values are as follows: H/H 11/30, O negative, RPR negative, GBS positive. Based
on Chrissy’s history and presentation, what action should the nurse take next?
1. Prepare Chrissy for the placement of an internal monitor.
2. Take the required two blood pressure readings every 15 minutes prior to insertion
of the internal fetal monitor due to her pregnancy-induced hypertension.
3. Discuss with the health care provider the fact that Chrissy’s blood type is O
negative and she should therefore receive Rhogam before insertion of an internal
monitor.
4. Discuss with the health care provider that Chrissy is GBS positive and therefore
should not receive an internal monitor.
____ 4. The nurse is looking at an EFM strip and sees that the patient is having contractions that are
measuring 150 MVU every 10 minutes for the past 2 hours and the fetus is in fetal distress. What
would this indicate for next steps?
1. The patients’ contractions are adequate, so the main focus should be on
resuscitating the fetus with maternal oxygen and maternal position change.
2. The patients’ contractions are inadequate; the provider could consider an
amnioinfusion through the IUPC, and once the fetus has improved, contractions
need to be augmented to be more effective.
3. The patients’ contractions are adequate, so the main focus should be on
determining her progress through cervical change.
4. The patients’ contractions are inadequate; the provider could consider augmenting
with Pitocin to be more effective.
Copyright © 2019 F. A. Davis Company

____ 5. While reviewing the birth plan of an uncomplicated and healthy patient in active labor, the nurse
notices that she would like to have a natural labor and potentially experience hydrotherapy. Which
option should the nurse suggest for the patient?
1. IUPC to make sure that her contractions are adequate to keep labor progressing
2. FSE to make sure that her fetus is tolerating the hydrotherapy
3. Telemetry to allow for the patient to accomplish her birth plan
4. External EFM to make sure that there is continuous monitoring
____ 6. The nurse is explaining telemetry to the patient, who has just begun active labor. The patient
would like to have a labor in which she is mobile, able to change positions, and use hydrotherapy.
Which response by the nurse is most appropriate?
1. “Telemetry is used mostly for women who are laboring in bed and changing
positions every half hour or so.”
2. “Unfortunately, you will not be able to use the shower while using telemetry.”
3. “The nurses will need to come in and check your telemetry reading every half
hour.”
4. “We can start using telemetry now, and if there are no problems with the signal,
we can continue it throughout your labor until delivery.”
____ 7. The obstetric nurse is managing her patients while covering for another nurse who is on a break.
Which patient is the lowest priority?
1. A patient with a previous cesarean section
2. A patient with an epidural in place
3. A patient with decreased fetal activity
4. A patient with Category I FHR tracings
____ 8. The nurse preceptor is teaching a nursing student about the physiology of the fetal heart rate (FHR)
pattern. Which statement by the student indicates successful teaching about this concept?
1. “Vagus nerve stimulation increases FHR and helps maintain variability.”
2. “The sympathetic nervous system is responsible for heart rate variability.”
3. “Action of the FHR occurs through the absence of norepinephrine.”
4. “Baroreceptors are responsible for increasing FHR and fetal blood pressure.”
____ 9. The nurse-educator is instructing on the physiology of fetal heart rate (FHR) patterns. He is
showing the students an EFM strip, and there is a tracing that is classified as baseline 140 bpm,
moderate variability, accelerations, and 2 decelerations. A half hour later the baseline is 150 bpm,
there is minimal variability, accelerations, and 3 decelerations. Which of these findings would the
nurse attribute to the parasympathetic nervous system?
1. The baseline changes from 140 bpm to 150 bpm.
2. The change from moderate variability to minimal variability.
3. The consistent presence of accelerations.
4. The presence of 2 and then 3 decelerations.
____ 10. The nurse is monitoring the fetal heart rate (FHR) tracing and sees that her patient has a tracing
with a baseline of 120, moderate variability, with absence of decelerations and accelerations.
According to the National Institute of Child Health and Human Development tier system, what
category tracing does the patient’s fall into?
1. A Category I tracing

2. A Category II tracing
3. A Category III tracing
4. A Category IV tracing
____ 11. The nurse is using the Parer and Ikeda five-tier system. A co-worker is concerned about a patient
whose fetus has an acceptably low risk of acidemia and evidence of impending fetal asphyxia.
What is the next best step for the nurse?
1. Perform conservative measures.
2. Prepare for urgent delivery.
3. Assist provider in immediate delivery.
4. Increase surveillance of patient.
____ 12. The EFM tracing shows the following: FHR baseline 166 bpm, moderate variability, and recurrent
late decelerations to 100 bpm. Using the five-tier FHR interpretation system, how should the nurse
interpret this tracing?
1. Green: very low risk of evolution, no action
2. Red: unacceptably high risk of acidemia, deliver
3. Yellow: moderate risk of evolution, increase surveillance
4. Orange: acceptable low risk of acidemia, prepare for possible urgent delivery
____ 13. The nurse is monitoring a patient when the EFM strip conveys fetal bradycardia. Which action
would be the most urgent for the nurse to take?
1. Check the patient’s input and output.
2. Take a blood pressure to determine if the mother has hypotension.
3. Change the mother’s position from supine to left lateral.
4. Check the mother for vaginal bleeding and severe abdominal pain.
____ 14. The nurse is caring for a baby who is experiencing fetal tachycardia. Which action should the
nurse take next?
1. Perform fetal scalp stimulation for 5 seconds.
2. Check maternal allergies in the patient chart.
3. Apply heat packs to the maternal chest and head.
4. Stimulate the fetus with a vibroacoustic device.
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
____ 15. The nurse-educator is preparing a presentation on fetal heart monitoring. Which of the following
should be included? Select all that apply.
1. Intermittent auscultation should be performed every hour in the latent phase.
2. For Category I situations, intermittent electronic fetal monitoring (EFM) should be
performed for 10 to 30 minutes every 1 to 2.5 hours.
3. A patient with a previous cesarean section should have EFM for 10 to 30 minutes
every 1 to 2.5 hours.
4. A patient with membranes ruptured over 24 hours should be monitored during the
latent phase every 30 minutes, every 15 minutes during the active phase, and every
5 minutes during the second stage.

5. A patient with fever should be monitored during the latent phase every 30 minutes,
every 15 minutes during the active phase, and every 5 minutes during the second
stage.
____ 16. The nurse is caring for a pregnant patient who expresses concern about the effects of electronic
fetal monitoring (EFM) on her labor and delivery. Which responses by the nurse would be
appropriate in this situation? Select all that apply.
1. “There is a reduced rate of seizures if a patient has EFM during labor.”
2. “There is a decrease in the incidence of cerebral palsy if a patient has EFM during
labor.”
3. “There is a link between decreased infant mortality and EFM during delivery.”
4. “There is a link between the rate of cesarean sections and continuous EFM.”
5. “There is an increase in operative vaginal births and the use of continuous EFM.”
____ 17. The nurse is obtaining a baseline fetal heart rate (FHR). At 1:00 pm the baseline FHR was 130, at
1:20 pm FHR baseline was 166, and at 1:40 pm the baseline FHR was 204. What should the nurse
assess from this trend of fetal baselines? Select all that apply.
1. The 1:00 pm FHR baseline warranted no further action.
2. The 1:20 pm FHR baseline warranted immediate fetal resuscitation.
3. The 1:00 pm FHR baseline warranted immediate maternal resuscitation
4. The 1:20 pm FHR baseline should be corrected immediately with delivery.
5. The 1:40 pm FHR baseline should be corrected immediately.
____ 18. The nursing preceptor is teaching the nursing student about fetal bradycardia. Which is true of the
maternal reasons for fetal bradycardia? Select all that apply.
1. A maternal fever in labor is usually due to dehydration and therefore should be
treated with a fluid bolus.
2. Administering terbutaline to the mother for uterine tachysystole; this is
self-limiting to when the drug is affecting the mother.
3. A urine toxicology screen may reveal recent cocaine use; the nurse should also
monitor for placental abruption.
4. Check the chart for a history of maternal mental illness, particularly maternal
anxiety; speak with the patient regarding her anxiety and take steps to ease her
anxieties.
5. Check the maternal blood pressure, as hypertension is linked to fetal tachycardia;
identify the on-call provider and correct with lisinopril as necessary.
____ 19. The nurse is caring for a 30-year-old woman who is G4P2012 at 38 weeks and 5 days gestation.
The nurse is watching her EFM strip and notices that for the past 10 minutes the fetus has shown
minimal variability. Which actions should the nurse perform? Select all that apply.
1. Check to see if the patients’ membranes have been ruptured, as there could be
potential cord compression.
2. Look to see what the patient’s position is and is she supine; change her to left side
lying.
3. Continue to watch the strip, but know that this could be due to fetal sleep.
4. Recognize that the fetus is 38 weeks and therefore this could be due to fetal
maturity.
5. Check the FHR and connect the minimal variability to fetal bradyasystole.

____ 20. Which actions indicate the is assessing uterine activity? Select all that apply.
1. Feeling the maternal abdomen in between contractions
2. Checking the EFM strip to determine if contractions are either 2 or 3 minutes apart
3. Evaluating that the EFM strip shows 200 MVU every 10 minutes.
4. Checking the EFM strip to see if the fetus has an elevation of 15 bpm over baseline
for 15 seconds twice in a 20-minute period
5. Evaluating that the EFM strip shows that each contraction lasts 1 minute

Chapter 9 Fetal Heart Rate Assessment
Answer Section
MULTIPLE CHOICE
1. ANS: 3
Chapter: Chapter 9 Fetal Heart Rate Assessment
Chapter Learning Objective: Define terms used in electronic fetal monitoring (EFM).
Page: 275
Heading: Modes or Types of Fetal and Uterine Monitoring > External Electronic Fetal and Uterine
Monitoring
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Ante/Intra/Post-partum
Difficulty: Moderate
Feedback
1 This is incorrect. The maternal heart rate is usually significantly lower than the
fetal heart rate and is therefore tracked underneath the fetal heart rate. It is
therefore important to check and make sure that the maternal heart rate is being
tracked correctly before beginning oxygen.
tracked correctly before calling in the provider.
3 This is correct. The maternal heart rate is usually significantly lower than the
tracked correctly before initiating any efforts for the fetus.
tracked correctly before adjusting the fetal monitor.
PTS: 1 CON: Ante/Intra/Post-partum

2. ANS: 2
Chapter Learning Objective: Define terms used in electronic fetal monitoring (EFM).
Page: 276
Heading: Modes or Types of Fetal and Uterine Monitoring: External Electronic Fetal and Uterine
Monitoring
Integrated Processes: Teaching and Learning
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application (Applying)

Feedback
1 This is incorrect. Fetal or maternal movement may cause erratic FHR
recordings; increasing movement would not improve the recording.
2 This is correct. Fetal or maternal movement may cause erratic FHR recordings,
and moving the transducer would help the recording if fetal movement causes it.
3 This is incorrect. Erratic FHR recordings are not usually due to moving into
second stage.
4 This is incorrect. A lack of gel can cause the recording to be erratic, and if this is
the case, more gel should be added, not less.

3. ANS: 4
Chapter Learning Objective: Identify the modes of fetal heart rate assessment: auscultation,
palpation, EFM.
Page: 276
Heading: Modes or Types of Fetal and Uterine Monitoring > Internal Electronic Fetal and Uterine
Monitoring
Feedback
1 This in incorrect. Chrissy is GBS positive and therefore cannot receive an
internal monitor.
2 This is incorrect. There are no required blood pressure readings for a
pregnancy-induced hypertensive patient prior to the insertion of an internal
monitor.
3 This is incorrect. Chrissy does not need to receive Rhogam prior to the insertion
of an internal monitor. She should have received it earlier in the pregnancy, but
it should have no effect on an internal monitor.
4 This is correct. GBS positivity is a contraindication to the placement of an
internal monitor.

4. ANS: 2
palpation, EFM.
Page: 277

Heading: Modes or Types of Fetal and Uterine Monitoring > Internal Electronic Fetal and Uterine
Monitoring
Feedback
1 This is incorrect. Although the fetus should be resuscitated, the patients’
contractions are inadequate.
2 This is correct. The patients’ contractions are inadequate, so the provider could
consider an amnioinfusion through the IUPC. Then, once the fetus has
improved, contractions need to be augmented to be more effective.
3 This is incorrect. The patients’ contractions are inadequate, and determining her
progress through cervical change would not improve the mother’s or fetus’s
condition.
4 This is incorrect. Although the patients’ contractions are inadequate,
augmenting the patients’ contractions with Pitocin might put more undue stress
on the fetus.

5. ANS: 3
Chapter Learning Objective: Describe the components of fetal heart rate (FHR) and uterine
contraction (UC) patterns essential to interpretation of monitor strips.
Page: 277
Heading: Modes or Types of Fetal and Uterine Monitoring> Telemetry
Feedback
1 This is incorrect. An intrauterine pressure catheter (IUPC) is only used in a
patient who is bed bound, which would not allow for a patient to move around
or use hydrotherapy.
2 This is incorrect. A fetal scalp electrode (FSE) is only used in a patient who is
bed bound, which would not allow for a patient to move around or use
hydrotherapy.
3 This is correct. Telemetry would allow for continuous monitoring while
allowing patients free movement and the ability to use hydrotherapy.
4 This is incorrect. External EFM is best used in a patient who is bed bound,
which would not allow for a patient to move around or use hydrotherapy.

6. ANS: 4
Page: 277
Heading: Modes or Types of Fetal and Uterine Monitoring > Telemetry
Concept: Patient-Centered Care
Feedback
1 This is incorrect. The patient will be able to walk while using telemetry.
2 This is incorrect. The patient will be able to bathe while using telemetry.
3 This is incorrect. Nurses can assess the patient remotely.
4 This is correct. Telemetry can be used in all phases of labor.
PTS: 1 CON: Patient-Centered Care

7. ANS: 4
Page: 277
Heading: AWHONN Standards for Frequency of Assessment of FHR
Integrated Processes: Caring
Difficulty: Difficult
Feedback
1 This is incorrect. A patient with a previous cesarean section needs to be
monitored every 30 minutes during the latent phase, every 15 minutes during the
active phase, and every 5 minutes during the second stage.
2 This is incorrect. A patient with an epidural in place needs to be monitored
every 30 minutes during the latent phase, every 15 minutes during the active
phase, and every 5 minutes during the second stage.
3 This is incorrect. A patient with decreased fetal activity needs to be monitored
every 30 minutes during the latent phase, every 15 minutes during the active
phase, and every 5 minutes during the second stage.
4 This is correct. This patient is low risk.

8. ANS: 2
Chapter Learning Objective: Articulate the physiology of FHR patterns.
Pages: 279
Heading: Influences on Fetal Heart Rate > Autonomic Nervous System
Concept: Patient-Centered Care
Feedback
1 This is incorrect. Vagus nerve stimulation slows FHR and helps maintain
variability.
2 This is correct. The sympathetic nervous system is responsible for heart rate
variability.
3 This is incorrect. Action occurs through the release of norepinephrine.
4 This is incorrect. Baroreceptors are stretch receptors that protect homeostasis
and regulate heart rate by stimulating a vagal response and decreasing FHR,
fetal blood pressure, and cardiac output.
PTS: 1 CON: Patient-Centered Care

9. ANS: 4
Page: 279
Heading: Influences on Fetal Heart Rate > Automatic Nervous System
Feedback
1 This is incorrect. The sympathetic nervous system is responsible for increasing
the FHR and FHR variability.
2 This is incorrect. The central nervous system is responsible for variations in
FHR and variability related to fetal activity.
3 This is incorrect. The sympathetic nervous system is responsible for increasing
FHR.
4 This is correct. The parasympathetic nervous system is responsible for slowing
the FHR and maintaining variability.

10. ANS: 1
Chapter Learning Objective: Distinguish between Category I, II, and III patterns and appropriate
nursing actions based on these interpretations.
Page: 281
Heading: Fetal Reserves > NICHD Criteria for Interpretation of FHR Patterns
Feedback
1 This is correct. This is a normal tracing.
2 This is incorrect. A Category II is an indeterminate tracing, and the patient’s
tracing has normal components
3 This is incorrect. A Category III tracing is an abnormal tracing, and the patient’s
tracing has normal components
4 This is incorrect. There is no such category as a Category IV tracing.

11. ANS: 2
Chapter Learning Objective: Distinguish between Category I, II, and III patterns and appropriate
nursing actions based on these interpretations.
Page: 282
Feedback
1 This is incorrect. Blue indicates a 0 risk of acidemia. In these cases, the nurse
should inform the health care provider and perform conservative measures.
2 This is correct. Orange indicates an acceptably low risk of acidemia and
preparation for possible urgent delivery.
3 This is incorrect. Red indicates an unacceptably high risk of acidemia and the
need for immediate delivery.
4 This is incorrect. Yellow indicates 0 risk of acidemia. The recommendation is
for increased surveillance and conservative measures.

12. ANS: 4

Page: 282
Feedback
1 This is incorrect. Based on the five-tier FHR interpretation system, this tracing
is classified as orange, which means there is an acceptable low risk of acidemia
and the nurse should prepare for possible urgent delivery.
4 This is correct. Based on the five-tier FHR interpretation system, this tracing is
classified as orange, which means there is an acceptable low risk of acidemia

13. ANS: 4
Page: 285
Heading: FHR and Contraction Pattern Interpretation > Baseline Fetal Heart Rate
Feedback
1 This is incorrect. Dehydration is a possible cause of fetal bradycardia but is not
the most urgent action.
2 This is incorrect. Hypotension is a possible cause of fetal bradycardia but is not
the most urgent action.
3 This is incorrect. Supine position is a possible cause of fetal bradycardia, so it
may help to place the patient in a left lateral position, but it is not the most
urgent action.

4 This is correct. Placental abruption is a possible cause of fetal bradycardia and is
an emergency.

14. ANS: 2
Page: 286
Heading: FHR and Contraction Pattern Interpretation > Baseline Fetal Heart Rate > Medical
Management
Feedback
1 This is incorrect. Fetal scalp stimulation should be used for fetal bradycardia.
2 This is correct. Fetal tachycardia can be caused by maternal or fetal infection
and antibiotics may be administered; typically, penicillin is administered and a
penicillin allergy would require a different medication.
3 This is incorrect. Fetal tachycardia can be caused by maternal fever. Heat
application would increase maternal temperature.
4 This is incorrect. Fetal movement can cause fetal tachycardia; a vibroacoustic
device would cause fetal movement and is therefore unnecessary.
MULTIPLE RESPONSE
15. ANS: 1, 2, 4, 5
palpation, EFM.
Page: 277
Feedback
1 This is correct. Intermittent auscultation should be done every hour in the latent phase.
2 This is correct. For Category I situations, intermittent EFM should be done for 10 to 30

minutes every 1 to 2.5 hours.
3 This is incorrect. A patient with a previous cesarean section should be monitored during
the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5
minutes during the second stage.
4 This is correct. A patient with membranes ruptured over 24 hours should be monitored
during the latent phase every 30 minutes, every 15 minutes during the active phase, and
every 5 minutes during the second stage.
5 This is correct. A patient with fever should be monitored during the latent phase every
30 minutes, every 15 minutes during the active phase, and every 5 minutes during the
second stage.

16. ANS: 1, 4, 5
palpation, EFM.
Page: 278
Feedback
1 This is correct. EFM during labor is associated with reduced rates of neonatal seizures.
2 This is incorrect. EFM during labor has not been shown to reduce cerebral palsy.
3 This is incorrect. EFM during labor has not been shown to reduce infant mortality.
4 This is correct. Continuous EFM increases the rate of cesarean sections.
5 This is correct. Continuous EFM increases the rate of operative vaginal births.

17. ANS: 1, 5
Page: 283
Feedback

1 This is correct. The normal range is 110 to 160 bpm.
2 This is incorrect. FHR baseline above 160 bpm for at least 10 minutes is tachycardic;
however, maternal position change may correct the problem before fetal resuscitation.
3 This is incorrect. The normal range is 110 to 160 bpm and therefore no maternal
resuscitation was needed at that time.
4 This is incorrect. An FHR that is tachycardic should be corrected but other measured
should be performed before delivery.
5 This is correct. If tachycardia persists above 200 to 220 bpm, fetal demise may occur.

18. ANS: 2, 3, 4, 5
Page: 285
Heading: FHR and Contraction Pattern Interpretation> Baseline Fetal Heart Rate
Feedback
1 This is incorrect. Maternal fever is usually caused by an infectious agent. Antibiotics,
antipyretics, and ice packs should be used to combat it.
2 This is correct. Terbutaline is given to mothers for uterine tachysystole in labor, and its
effect is limited to how quickly the drug is cleared from the maternal system.
3 This is correct. Illicit drugs such as cocaine can cause fetal tachycardia and additionally
can cause placental abruption.
4 This is correct. Fetal tachycardia can be linked to maternal anxiety, and taking steps to
reduce it can correct the FHR.
5 This is incorrect. There is no link between hypertension and fetal tachycardia.
Additionally, lisinopril is an ACE inhibitor that is not recommended in pregnancy.

19. ANS: 1, 2, 3
Page: 286
Heading: FHR and Contraction Pattern Interpretation > Baseline Fetal Heart Rate

Maternal-Newborn Nursing The Critical Components of Nursing Care 3rd Edition Roberta Durham
Feedback
1 This is correct. Minimal variability can be caused by cord compression.
2 This is correct. Minimal variability can be caused by maternal supine hypotension.
3 This is correct. Minimal variability can be caused by fetal sleep.
4 This is incorrect. Minimal variability can be caused by fetal prematurity.
5 This is incorrect. Minimal variability can be caused by tachysystole.

20. ANS: 1, 2, 3, 5
palpation, EFM.
Page: 295
Heading: FHR and Contraction Pattern Interpretation > Uterine Activity and Contraction Patterns
Feedback
1 This is correct. Resting tone is an interpretation of uterine activity.
2 This is correct. Frequency is an interpretation of uterine activity.
3 This is correct. Intensity is an interpretation of uterine activity.
4 This is incorrect. Accelerations are an interpretation of periodic and episodic fetal
changes.
5 This is correct. Duration of uterine contractions is an interpretation of uterine activity.
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PTS: 1 CON: Ante/Intra/Post-partum

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PTS: 1 CON: Ante/Intra/Post-partum

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PTS: 1 CON: Patient-Centered Care

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