Sherpath: Chapter 15, Fetal Assessment During LaborFetal and Uterine Monitoring

Question 1 of 6

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Place the steps in the order in which they would be applied to perform Leopold maneuvers.

1. Palpate the uterine fundus.
2. Palpate for the fetal back.
3. Palpate the suprapubic area to confirm presentation.
4. Determine if head is flexed (vertex) or extended (face).

Leopold maneuvers are performed to identify fetal presentation and position and to help the nurse locate the fetal back, which is the area of maximal intensity for the fetal heart rate. The nurse first palpates the uterine fundus, then palpates for the fetal back. Then the nurse palpates the suprapubic area to confirm presentation. The nurse would finally determine if the head is flexed or extended.

Question 2 of 6

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Which clinical conditions must be met before placing a fetal scalp monitor?

• • Patient should not be in laborThe fetal scalp monitor may be placed once the patient’s membranes have ruptured and the patient is experiencing cervical dilation.
• • Absence of fetal scalp hairFetal scalp hair is not a contraindication to fetal scalp monitoring. However, the fetal scalp monitor may become tangled in the fetal hair.
• Correct
  • Cervix should be at least 2 cm dilatedThe fetal scalp monitor may be placed once the patient’s cervix has dilated to at least 2 cm. The cervix must be dilated enough to allow contact with the fetal scalp.
• Correct
  • The patient’s membranes must be rupturedThe fetal scalp monitor can be used once the patient’s membranes have ruptured to allow contact with the fetal scalp.
• • High fetal presentationThe fetal presentation must be low enough to allow placement of the fetal scalp monitor.

Question 3 of 6

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Which maternal or fetal condition might require an amnioinfusion?

• • The mother has polyhydramnios (excess amniotic fluid).Polyhydramnios is a condition in which there is excess amniotic fluid. Amnioinfusion would increase the volume of amniotic fluid; therefore amnioinfusion in a patient with polyhydramnios is contraindicated.
• • The fetal heart rate (FHR) is 140 beats/min.An FHR of 140 beats/min is normal and would not require an amnioinfusion.
• • The patient’s blood pressure has dropped.Amnioinfusion is performed in response to fetal changes, not maternal blood pressure changes.
• Correct
  • The fetus has experienced umbilical cord compression.One common indication for amnioinfusion is umbilical cord compression. Instillation of sterile fluid often relieves the compression.

Question 4 of 6

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Which education would the nurse provide a patient who is worried that the intrauterine catheter will hurt the baby?

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  • “The catheter is placed in the uterus next to the baby.”By providing information about the safety and location of the catheter, the nurse can decrease the patient’s anxiety and provide reassurance.
• • “Don’t be nervous; everything will be fine!”When explaining equipment use, the nurse would not try to pacify the patient but rather would use a response that validates or reassures the patient.
• • “The catheter attaches only to the outer layer of skin on the baby’s head.”The intrauterine catheter does not attach to the fetal scalp. The fetal scalp electrode attaches to the fetal scalp.
• • “This is the equipment needed for high-risk pregnancies.”In explaining the equipment use to a patient, the nurse would avoid calling a pregnancy high-risk, even if it truly is high-risk, to avoid causing further anxiety.

Question 5 of 6

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Match the fetal surveillance method to its corresponding advantage.

• Fetal scalp electrode
• Intrauterine pressure catheter
• External electronic fetal monitoring

Question 6 of 6

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Which are the advantages of external electronic fetal monitoring (EFM)?

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  • Suitable for most patients in laborExternal EFM is a noninvasive method for continuously monitoring fetal heart rate and uterine contractions. It is safe to use in high-risk pregnancies.
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  • Visualization of heart rate patternExternal EFM provides visualization of the fetal heart rate pattern in response to uterine contractions.
• • Allows measurement of contraction intensityInternal EFM uses intrauterine pressure catheters to measure contraction intensity.
• • Uninterrupted by fetal or patient movementInternal EFM is uninterrupted by fetal or patient movement. Disruption of electronic fetal monitoring by fetal or patient movement is a known disadvantage of external EFM.
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  • Allows mobility if connected to mobile unitMobile external EFM units allow patients to remain mobile, as the unit may be wheeled during ambulation.