Normal baseline FHR is 110 to 160 bpm; moderate variability (6 to 25 bpm) is the single best sign of fetal oxygenation.
Before you read
Test yourself first: 5 questions
Question 1 of 5
An intrauterine pressure catheter (IUPC) is placed for a client with labor dystocia. What is the primary advantage of the IUPC over external monitoring?
Answer: A. An IUPC directly measures the intensity (strength) of uterine contractions in millimeters of mercury and the resting tone of the uterus, which external monitoring cannot quantify. It requires ruptured membranes for placement.
Question 2 of 5
A client is prescribed 3% sodium chloride for symptomatic hyponatremia. Which nursing action is essential during this infusion?
Answer: B. 3% sodium chloride is a hypertonic solution that must be given slowly with frequent neurologic checks and serum sodium monitoring. Rapid correction risks osmotic demyelination, so close monitoring is essential.
Question 3 of 5
The nurse is caring for a client immediately after IV alteplase (tPA) was administered for an ischemic stroke. Which assessment finding requires IMMEDIATE intervention?
Answer: A. A sudden severe headache, acute hypertension, nausea/vomiting, or a decline in level of consciousness after tPA suggests intracranial hemorrhage, the most serious complication of thrombolysis. The infusion should be stopped and the provider notified. Mild gum oozing warrants monitoring, and an improving facial droop is the desired effect. A heart rate of 88 is normal.
Question 4 of 5
A client in labor has external fetal monitoring with a tocotransducer. What information does the tocotransducer provide?
Answer: B. The external tocotransducer detects the frequency and duration of uterine contractions by sensing abdominal tightening. It does not measure the intensity (strength) of contractions; an intrauterine pressure catheter is needed for that.
Question 5 of 5
A nurse is monitoring a client receiving large-volume crystalloid resuscitation for hemorrhagic shock. Which finding best indicates that perfusion is improving?
Answer: A. Urine output of at least 0.5 mL/kg/hr (about 30 mL/hr in an adult) indicates adequate renal perfusion and is a reliable marker of improving end-organ perfusion. Rising lactate, worsening capillary refill, and falling blood pressure would indicate continued hypoperfusion.
Keep the streak going with more questions like these, each with a full rationale.
What is fetal heart rate monitoring basics?
The goal is to identify adequate oxygenation versus distress. The classic mnemonic VEAL CHOP links pattern to cause: Variable-Cord, Early-Head, Accelerations-OK, Late-Placental insufficiency.
Key points to remember
- Normal baseline FHR is 110 to 160 bpm; moderate variability (6 to 25 bpm) is the single best sign of fetal oxygenation.
- Early decelerations mirror the contraction and are caused by fetal head compression; they are benign and need no intervention.
- Variable decelerations are abrupt, V- or U-shaped drops caused by umbilical cord compression.
- Late decelerations begin after the contraction peak and return after it ends, indicating uteroplacental insufficiency; they are the most ominous pattern.
- Accelerations (15 bpm above baseline for 15 seconds) are reassuring and reflect a well-oxygenated fetus.
Nursing priorities
- For late or variable decelerations, immediately reposition the client to the left side to improve perfusion.
- Apply oxygen at 10 L/min via non-rebreather mask and increase the IV fluid rate for nonreassuring patterns.
- Stop oxytocin if it is infusing during late decelerations or tachysystole.
- Perform a sterile vaginal exam to rule out cord prolapse with variable decelerations.
- Notify the provider and document interventions and fetal response.
Patient teaching
- Lying on your left side improves blood flow to the baby and is often the first comfort measure.
- Some heart rate changes are normal with contractions; the nurse is watching the pattern, not single beats.
Red flags: report now
- Recurrent late decelerations, minimal or absent variability, or fetal bradycardia under 110 bpm require immediate provider notification.
- Sudden prolonged deceleration after membrane rupture may signal cord prolapse, an obstetric emergency.
- Never leave a client with a Category III (sinusoidal or absent variability with recurrent decels) tracing unattended.
References
Clinical references for this topic
