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The pattern on the fetal heart rate tracing shown is likely due to
A. placental insufficiency
B. fetal head compression
C. umbilical cord compression
Answer: C
Explanation:
Comprehensive and Detailed Explanation From Exact Extract Sources:
The tracing demonstrates an abrupt-onset, sharp, V-shaped deceleration, occurring simultaneously with or slightly after a contraction-classic for variable decelerations, which are caused by umbilical cord compression.
According to AWHONN Fetal Heart Monitoring Principles & Practices, variable decelerations are defined by:
* "Abrupt decreases in FHR below baseline of at least 15 bpm, lasting at least 15 seconds and less than 2 minutes."
* "Most commonly associated with umbilical cord compression, whether transient or recurrent." Physiology reference (Simpson & Miller, Pocket Guide):
* Compression of the umbilical vein causes a brief acceleration.
* Compression of the umbilical arteries triggers a vagal response, producing a rapid deceleration.
* This creates the characteristic sharp 'V', 'U', or 'W' shape on the monitor.
Placental insufficiency (Choice B) produces late decelerations, which are gradual, not abrupt.
Fetal head compression (Choice A) produces early decelerations, which mirror contractions and have a gradual pattern.
Thus, the tracing is most consistent with variable decelerations caused by umbilical cord compression.
References:AWHONN Fetal Heart Monitoring Principles & Practices;Simpson - Fetal Monitoring;Menihan
- Electronic Fetal Monitoring;Miller's EFM Pocket Guide;NCC C-EFM Content Outline - Pattern Recognition Domain.
NEW QUESTION # 76
(Full question)
This tracing would be categorized as a
A. Category III
B. Category II
C. Category I
Answer: B
Explanation:
Comprehensive and Detailed Explanation From Exact Extract (No URLs):
According to AWHONN Fetal Heart Monitoring Principles & Practice, Simpson & Miller, and the NCC C-EFM Content Outline, fetal heart rate categories are assigned based on baseline, variability, presence
/absence of accelerations, and type of decelerations.
A Category II tracing includes any pattern that is not clearly normal (Category I) or clearly abnormal (Category III). Classic Category II features include:
* Bradycardia NOT accompanied by absent variability
* Tachycardia
* Minimal variability
* Marked variability
* Absence of accelerations after stimulation
* Recurrent variable decelerations with minimal or moderate variability
* Prolonged decelerations (#2 min but <10 min)
In this tracing, the fetus demonstrates:
- A prolonged deceleration with subsequent recovery,
- Presence of baseline variability,
- Return toward baseline but not immediately normal.
AWHONN and Simpson state that any prolonged deceleration automatically places the tracing in Category II unless variability is absent (which would escalate it to Category III). Because variability is present, it cannot be Category III.
Therefore, by NCC standards, this tracing is Category II.
NEW QUESTION # 77
A 30-year-old woman (G2P0) is experiencing preterm labor at 26-weeks gestation. She is receiving magnesium sulfate for neuroprotection. Her external fetal monitoring tracing over the past 30 minutes is shown. The next step would be to:
A. Discontinue magnesium sulfate
B. Evaluate for chorioamnionitis
C. Administer acetaminophen
Answer: B
Explanation:
Comprehensive and Detailed Explanation From NCC-Aligned Sources:
This tracing shows:
* Baseline ~170-175 bpm # fetal tachycardia
* Minimal variability
* No contractions of significance
* Maternal treatment with magnesium sulfate, which typically decreases baseline and variability-not increase it NCC and AWHONN physiology guidelines emphasize that fetal tachycardia is most commonly associated with maternal infection, including chorioamnionitis, especially in preterm labor.
Magnesium sulfate does not cause tachycardia; it generally causes:
* # baseline
* # variability
Thus, fetal tachycardia + minimal variability in a preterm patient strongly suggests maternal infection, requiring evaluation for chorioamnionitis.
Why the wrong answers are incorrect:
* A. Acetaminophen # used after confirming fever, not before evaluating the cause.
* B. Discontinuing magnesium # magnesium sulfate does not cause tachycardia; discontinuing it removes fetal neuroprotection.
References:NCC C-EFM Candidate Guide; AWHONN FHMPP; Simpson & Creehan; Menihan EFM; Creasy & Resnik.
NEW QUESTION # 78
A fetal heart rate tracing is abnormal. A change in maternal position and oxygen administration do not correct the pattern. Following birth, a fetal cord blood sample is taken:
pH = 7.25
PaCO# = 46 mm Hg
PaO# = 20 mm Hg
HCO# = 22 mEq/L
Base deficit = -4 mEq/L
These results are best interpreted as:
A. Hypoxia
B. Normal
C. Acidosis
Answer: B
Explanation:
Comprehensive and Detailed Explanation From NCC-Aligned Sources:
Normal umbilical arterial values per NCC/AWHONN/Menihan:
* pH: 7.20-7.30
* PaCO#: 45-55 mmHg
* HCO#: 20-24 mEq/L
* Base deficit: 0 to -5 (normal to mild respiratory changes)
This sample shows:
* pH 7.25 # normal
* Base deficit -4 # no metabolic acidosis
* HCO# normal
* Slightly elevated PaCO#, consistent with mild respiratory influence but still normal
* PaO# 20 mmHg is normal for cord arterial blood
This profile is not acidotic (acidosis requires pH <7.10 and base deficit #12).
It also does not indicate hypoxia, which would present with metabolic acidosis.
Therefore: Normal.
References:NCC C-EFM Candidate Guide; AWHONN FHMPP; Menihan; Simpson & Creehan; Creasy & Resnik.
NEW QUESTION # 79
A woman reports 12 fetal movements over one hour. The best recommendation is to:
A. Instruct her to count again the next day
B. Continue to monitor for one hour
C. Administer a nonstress test
Answer: A
Explanation:
Comprehensive and Detailed Explanation From Exact Extract-Based NCC C-EFM References:
NCC and AWHONN consider fetal movement counts normal when:
* #10 distinct movements occur within 2 hours
* Or #4 movements in 1 hour for certain protocols
* Or #10 movements in 1 hour (common triage threshold)
This patient reports 12 movements in 1 hour, which is reassuring and requires no further testing.
Thus, recommending she continue daily kick counts at home is appropriate.
Why the other options are incorrect:
* A. NST is not needed because movements are normal.
* B. Continue to monitor is unnecessary; the test is already reassuring.
Correct choice: C. Count again the next day.
References:NCC C-EFM Candidate Guide; AWHONN Fetal Assessment guidelines; Simpson & Creehan.
NEW QUESTION # 80
......
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