AWHONN Advanced Fetal Heart
Monitoring Course Practice Exam
(2026)
Q1: According to NICHD terminology, the normal fetal heart rate baseline is
defined as:
A. 100-150 bpm
B. 110-160 bpm [CORRECT]
C. 120-170 bpm
D. 100-180 bpm
Correct Answer: B
Rationale: NICHD defines normal baseline FHR as 110-160 bpm. Bradycardia is
<110 bpm and tachycardia is >160 bpm. This range reflects normal fetal
autonomic nervous system balance between sympathetic and parasympathetic
influences.
Q2: Which of the following correctly describes moderate fetal heart rate variability
per NICHD criteria?
A. Fluctuations ≤5 bpm from baseline
B. Fluctuations 6-25 bpm from baseline [CORRECT]
C. Fluctuations >25 bpm from baseline
D. Absence of fluctuation in baseline FHR
Correct Answer: B
Rationale: NICHD defines moderate variability as fluctuations of 6-25 bpm.
Minimal variability is ≤5 bpm, marked is >25 bpm, and absent variability shows no
fluctuation. Moderate variability indicates intact fetal central nervous system
oxygenation and is a reassuring finding.
Q3: Per NICHD three-tier classification, which criterion is required for a Category I
fetal heart rate tracing?
A. Presence of accelerations
,B. Baseline 110-160 bpm with moderate variability and absence of late or variable
decelerations [CORRECT]
C. Absent variability with recurrent late decelerations
D. Baseline tachycardia >160 bpm
Correct Answer: B
Rationale: Category I requires baseline 110-160 bpm, moderate variability, and no
late or variable decelerations. Accelerations may be present or absent. Early
decelerations may be present. This represents normal fetal acid-base status.
Q4: Uterine tachysystole is defined by NICHD/AHWONN as:
A. >4 contractions in 10 minutes averaged over 20 minutes
B. >5 contractions in 10 minutes averaged over 30 minutes [CORRECT]
C. Contractions lasting >90 seconds
D. Uterine resting tone >30 mmHg
Correct Answer: B
Rationale: Tachysystole is defined as >5 contractions in 10 minutes averaged
over 30 minutes. This applies to both spontaneous and oxytocin-induced labor.
Tachysystole may compromise fetal oxygenation by reducing uteroplacental
perfusion time.
Q5: A prolonged deceleration is defined as a deceleration lasting:
A. >1 minute but <2 minutes
B. ≥2 minutes but <10 minutes [CORRECT]
C. >5 minutes but <15 minutes
D. ≥10 minutes
Correct Answer: B
Rationale: A prolonged deceleration lasts ≥2 minutes but <10 minutes per NICHD
criteria. If a deceleration lasts ≥10 minutes, it constitutes a baseline change
(bradycardia). Prolonged decelerations require immediate evaluation for causes
such as cord compression, maternal hypotension, or uterine rupture.
FHR Monitoring Fundamentals (Recall/Application)
, Q6: Which monitoring method provides the most accurate assessment of uterine
contraction intensity?
A. External tocotransducer
B. Internal ultrasound transducer
C. Intrauterine pressure catheter (IUPC) [CORRECT]
D. Fetal scalp electrode
Correct Answer: C
Rationale: The IUPC measures intrauterine pressure in mmHg, providing
objective quantification of contraction intensity and resting tone. External
tocotransducers only measure frequency and approximate duration. Adequate
labor progress typically requires 200-250 Montevideo units.
Q7: When differentiating maternal heart rate from fetal heart rate, which finding
suggests the monitor is recording maternal rather than fetal heart rate?
A. Baseline 140 bpm with moderate variability
B. Baseline 110 bpm with accelerations to 160 bpm
C. Baseline 80 bpm with variability that increases during contractions [CORRECT]
D. Baseline 150 bpm with early decelerations
Correct Answer: C
Rationale: Maternal heart rate typically ranges 60-100 bpm and increases with
contractions due to exertion. Fetal baseline is 110-160 bpm. If the recorded rate
matches maternal pulse, shows maternal arrhythmia characteristics, or increases
with maternal activity, suspect maternal heart rate acquisition.
Q8: Montevideo units (MVU) are calculated by:
A. Multiplying contraction frequency by intensity
B. Adding the intensity of all contractions in 10 minutes [CORRECT]
C. Measuring the area under the contraction curve
D. Dividing peak pressure by resting tone
Correct Answer: B
Rationale: MVU equals the sum of contraction intensities above baseline resting
tone in a 10-minute window. Adequate labor requires 200-250 MVU. This
Monitoring Course Practice Exam
(2026)
Q1: According to NICHD terminology, the normal fetal heart rate baseline is
defined as:
A. 100-150 bpm
B. 110-160 bpm [CORRECT]
C. 120-170 bpm
D. 100-180 bpm
Correct Answer: B
Rationale: NICHD defines normal baseline FHR as 110-160 bpm. Bradycardia is
<110 bpm and tachycardia is >160 bpm. This range reflects normal fetal
autonomic nervous system balance between sympathetic and parasympathetic
influences.
Q2: Which of the following correctly describes moderate fetal heart rate variability
per NICHD criteria?
A. Fluctuations ≤5 bpm from baseline
B. Fluctuations 6-25 bpm from baseline [CORRECT]
C. Fluctuations >25 bpm from baseline
D. Absence of fluctuation in baseline FHR
Correct Answer: B
Rationale: NICHD defines moderate variability as fluctuations of 6-25 bpm.
Minimal variability is ≤5 bpm, marked is >25 bpm, and absent variability shows no
fluctuation. Moderate variability indicates intact fetal central nervous system
oxygenation and is a reassuring finding.
Q3: Per NICHD three-tier classification, which criterion is required for a Category I
fetal heart rate tracing?
A. Presence of accelerations
,B. Baseline 110-160 bpm with moderate variability and absence of late or variable
decelerations [CORRECT]
C. Absent variability with recurrent late decelerations
D. Baseline tachycardia >160 bpm
Correct Answer: B
Rationale: Category I requires baseline 110-160 bpm, moderate variability, and no
late or variable decelerations. Accelerations may be present or absent. Early
decelerations may be present. This represents normal fetal acid-base status.
Q4: Uterine tachysystole is defined by NICHD/AHWONN as:
A. >4 contractions in 10 minutes averaged over 20 minutes
B. >5 contractions in 10 minutes averaged over 30 minutes [CORRECT]
C. Contractions lasting >90 seconds
D. Uterine resting tone >30 mmHg
Correct Answer: B
Rationale: Tachysystole is defined as >5 contractions in 10 minutes averaged
over 30 minutes. This applies to both spontaneous and oxytocin-induced labor.
Tachysystole may compromise fetal oxygenation by reducing uteroplacental
perfusion time.
Q5: A prolonged deceleration is defined as a deceleration lasting:
A. >1 minute but <2 minutes
B. ≥2 minutes but <10 minutes [CORRECT]
C. >5 minutes but <15 minutes
D. ≥10 minutes
Correct Answer: B
Rationale: A prolonged deceleration lasts ≥2 minutes but <10 minutes per NICHD
criteria. If a deceleration lasts ≥10 minutes, it constitutes a baseline change
(bradycardia). Prolonged decelerations require immediate evaluation for causes
such as cord compression, maternal hypotension, or uterine rupture.
FHR Monitoring Fundamentals (Recall/Application)
, Q6: Which monitoring method provides the most accurate assessment of uterine
contraction intensity?
A. External tocotransducer
B. Internal ultrasound transducer
C. Intrauterine pressure catheter (IUPC) [CORRECT]
D. Fetal scalp electrode
Correct Answer: C
Rationale: The IUPC measures intrauterine pressure in mmHg, providing
objective quantification of contraction intensity and resting tone. External
tocotransducers only measure frequency and approximate duration. Adequate
labor progress typically requires 200-250 Montevideo units.
Q7: When differentiating maternal heart rate from fetal heart rate, which finding
suggests the monitor is recording maternal rather than fetal heart rate?
A. Baseline 140 bpm with moderate variability
B. Baseline 110 bpm with accelerations to 160 bpm
C. Baseline 80 bpm with variability that increases during contractions [CORRECT]
D. Baseline 150 bpm with early decelerations
Correct Answer: C
Rationale: Maternal heart rate typically ranges 60-100 bpm and increases with
contractions due to exertion. Fetal baseline is 110-160 bpm. If the recorded rate
matches maternal pulse, shows maternal arrhythmia characteristics, or increases
with maternal activity, suspect maternal heart rate acquisition.
Q8: Montevideo units (MVU) are calculated by:
A. Multiplying contraction frequency by intensity
B. Adding the intensity of all contractions in 10 minutes [CORRECT]
C. Measuring the area under the contraction curve
D. Dividing peak pressure by resting tone
Correct Answer: B
Rationale: MVU equals the sum of contraction intensities above baseline resting
tone in a 10-minute window. Adequate labor requires 200-250 MVU. This
