Fetal Heart Monitoring on the NCLEX
FHR baseline, variability, accelerations, decelerations, VEAL CHOP, and the nursing response sequence.
Strip interpretation shows up on nearly every NCLEX OB set. Know the numbers and the response sequence cold.
Baseline and variability
Baseline: 110-160 bpm, measured over 10 minutes between contractions. Variability: absent (undetectable), minimal (5 bpm or less), moderate (6-25 bpm, the reassuring finding), marked (>25 bpm). Moderate variability means an intact, oxygenated fetal CNS. Absent or minimal variability with decelerations is the worrisome combination.
Accelerations
At 32 weeks or more: rise of 15 bpm above baseline lasting 15 seconds. Before 32 weeks: 10 bpm for 10 seconds. Accelerations are always reassuring. Two in 20 minutes = reactive nonstress test.
Decelerations: VEAL CHOP
Variable → Cord compression. Abrupt, V- or W-shaped, not tied to contractions. Early → Head compression. Mirrors the contraction. Benign, no intervention. Accelerations → OK. Late → Placental insufficiency. Begins after the contraction peaks, returns to baseline after it ends. Never benign.
Nursing response to late or prolonged variable decels
In order: stop oxytocin if infusing → reposition to left or right lateral → IV fluid bolus → oxygen 8-10 L/min by nonrebreather → notify the provider. Document the strip and the response. For variables, position change comes first (shift the fetus off the cord). For lates, think perfusion: position, fluids, stop the drug that is overworking the uterus.
Frequently asked
Early decel on the strip. What do I do?
Nothing beyond continued monitoring. Head compression is expected in active labor. NCLEX loves offering oxygen as a wrong answer here.
Minimal variability but the mother just got IV opioids?
Expected for 30-60 minutes after the dose, and also during fetal sleep cycles. Correlate with the timeline before escalating.
What is a prolonged deceleration?
A drop of 15 bpm or more lasting 2 to 10 minutes. Longer than 10 minutes is a baseline change. Treat it as an emergency until explained.
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