AWHONN Advanced Fetal Heart Monitoring Exam
Questions & Answers 2026 | 100 Practice Questions
with Complete Rationales | Fetal Monitoring, EFM &
C-EFM
SECTION 1 — FHR FUNDAMENTALS AND SYSTEMATIC INTERPRETATION
Question 1
A laboring patient has an electronic fetal monitoring tracing with a baseline of 135 beats/min.
The baseline remains stable for 10 minutes. How should the nurse interpret this baseline?
A. Bradycardia
B. Tachycardia
C. Normal baseline
D. Sinusoidal pattern
Correct answer: C
Rationale: A normal fetal heart rate baseline is generally 110–160 beats/min. A baseline of 135
beats/min is within the expected range. Baseline assessment should be performed over an
appropriate period and should exclude periodic or episodic changes.
Question 2
A fetal heart rate baseline is 105 beats/min and persists for 12 minutes. Which interpretation is
most appropriate?
A. Normal baseline
B. Fetal bradycardia
C. Fetal tachycardia
D. Moderate variability
Correct answer: B
Rationale: A persistent baseline below 110 beats/min is classified as fetal bradycardia. The nurse
should assess maternal and fetal conditions and evaluate the tracing in its clinical context.
Question 3
,A fetal heart rate baseline is 170 beats/min and persists for more than 10 minutes. Which finding
is present?
A. Fetal bradycardia
B. Fetal tachycardia
C. Normal baseline
D. Sinusoidal rhythm
Correct answer: B
Rationale: A baseline greater than 160 beats/min that persists for at least 10 minutes is fetal
tachycardia. Potential causes include maternal fever, medications, infection, fetal hypoxia, or
other physiologic stressors.
Question 4
Which feature is assessed when determining fetal heart rate variability?
A. Difference between maternal and fetal pulse
B. Fluctuations in the fetal heart rate around the baseline
C. Frequency of uterine contractions
D. Maternal blood pressure
Correct answer: B
Rationale: Variability represents fluctuations in the fetal heart rate around the baseline. It is an
important indicator of fetal autonomic nervous system activity and fetal status.
Question 5
A tracing demonstrates fetal heart rate fluctuations of 6–25 beats/min around the baseline. How
should the nurse classify the variability?
A. Absent
B. Minimal
C. Moderate
D. Marked
Correct answer: C
Rationale: Moderate variability is defined as fluctuations with an amplitude of 6–25 beats/min.
Moderate variability is generally considered reassuring when evaluated with the rest of the
tracing and clinical picture.
,Question 6
A fetal tracing shows no detectable fluctuation around the baseline. Which classification applies?
A. Absent variability
B. Minimal variability
C. Moderate variability
D. Marked variability
Correct answer: A
Rationale: Absent variability means there is no detectable variation in the fetal heart rate around
the baseline. Persistent absent variability may be concerning, particularly when accompanied by
other abnormal findings.
Question 7
A tracing demonstrates fluctuations of 3 beats/min around the baseline. Which classification is
appropriate?
A. Absent
B. Minimal
C. Moderate
D. Marked
Correct answer: B
Rationale: Minimal variability is greater than absent variability but does not exceed 5 beats/min.
Causes may include fetal sleep, medications, prematurity, or fetal hypoxia depending on the
clinical context.
Question 8
A fetal tracing demonstrates variability exceeding 25 beats/min for several minutes. How should
this be classified?
A. Absent variability
B. Minimal variability
C. Moderate variability
D. Marked variability
Correct answer: D
, Rationale: Marked variability is characterized by fluctuations greater than 25 beats/min. The
nurse should evaluate the entire clinical picture and assess whether the pattern represents a
transient or persistent change.
Question 9
Which finding is generally considered most reassuring regarding fetal autonomic function?
A. Persistent absent variability
B. Moderate variability
C. Persistent minimal variability
D. Persistent bradycardia
Correct answer: B
Rationale: Moderate variability is an important reassuring feature because it reflects intact fetal
autonomic function and is associated with adequate neurologic responsiveness.
Question 10
A nurse begins interpretation of a complex fetal monitoring tracing. Which approach is most
appropriate?
A. Look only at decelerations.
B. Determine the baseline, variability, accelerations, decelerations, and relationship to uterine
activity.
C. Determine the maternal pulse only.
D. Immediately call for operative delivery.
Correct answer: B
Rationale: Fetal monitoring should be interpreted systematically rather than based on a single
feature. AWHONN resources emphasize systematic assessment of baseline, variability,
accelerations, decelerations, uterine activity, maternal condition, and response to interventions.
SECTION 2 — ACCELERATIONS
Question 11
A fetal tracing shows an abrupt increase in fetal heart rate of 20 beats/min lasting 30 seconds.
What does this represent in a fetus at or beyond 32 weeks?
Questions & Answers 2026 | 100 Practice Questions
with Complete Rationales | Fetal Monitoring, EFM &
C-EFM
SECTION 1 — FHR FUNDAMENTALS AND SYSTEMATIC INTERPRETATION
Question 1
A laboring patient has an electronic fetal monitoring tracing with a baseline of 135 beats/min.
The baseline remains stable for 10 minutes. How should the nurse interpret this baseline?
A. Bradycardia
B. Tachycardia
C. Normal baseline
D. Sinusoidal pattern
Correct answer: C
Rationale: A normal fetal heart rate baseline is generally 110–160 beats/min. A baseline of 135
beats/min is within the expected range. Baseline assessment should be performed over an
appropriate period and should exclude periodic or episodic changes.
Question 2
A fetal heart rate baseline is 105 beats/min and persists for 12 minutes. Which interpretation is
most appropriate?
A. Normal baseline
B. Fetal bradycardia
C. Fetal tachycardia
D. Moderate variability
Correct answer: B
Rationale: A persistent baseline below 110 beats/min is classified as fetal bradycardia. The nurse
should assess maternal and fetal conditions and evaluate the tracing in its clinical context.
Question 3
,A fetal heart rate baseline is 170 beats/min and persists for more than 10 minutes. Which finding
is present?
A. Fetal bradycardia
B. Fetal tachycardia
C. Normal baseline
D. Sinusoidal rhythm
Correct answer: B
Rationale: A baseline greater than 160 beats/min that persists for at least 10 minutes is fetal
tachycardia. Potential causes include maternal fever, medications, infection, fetal hypoxia, or
other physiologic stressors.
Question 4
Which feature is assessed when determining fetal heart rate variability?
A. Difference between maternal and fetal pulse
B. Fluctuations in the fetal heart rate around the baseline
C. Frequency of uterine contractions
D. Maternal blood pressure
Correct answer: B
Rationale: Variability represents fluctuations in the fetal heart rate around the baseline. It is an
important indicator of fetal autonomic nervous system activity and fetal status.
Question 5
A tracing demonstrates fetal heart rate fluctuations of 6–25 beats/min around the baseline. How
should the nurse classify the variability?
A. Absent
B. Minimal
C. Moderate
D. Marked
Correct answer: C
Rationale: Moderate variability is defined as fluctuations with an amplitude of 6–25 beats/min.
Moderate variability is generally considered reassuring when evaluated with the rest of the
tracing and clinical picture.
,Question 6
A fetal tracing shows no detectable fluctuation around the baseline. Which classification applies?
A. Absent variability
B. Minimal variability
C. Moderate variability
D. Marked variability
Correct answer: A
Rationale: Absent variability means there is no detectable variation in the fetal heart rate around
the baseline. Persistent absent variability may be concerning, particularly when accompanied by
other abnormal findings.
Question 7
A tracing demonstrates fluctuations of 3 beats/min around the baseline. Which classification is
appropriate?
A. Absent
B. Minimal
C. Moderate
D. Marked
Correct answer: B
Rationale: Minimal variability is greater than absent variability but does not exceed 5 beats/min.
Causes may include fetal sleep, medications, prematurity, or fetal hypoxia depending on the
clinical context.
Question 8
A fetal tracing demonstrates variability exceeding 25 beats/min for several minutes. How should
this be classified?
A. Absent variability
B. Minimal variability
C. Moderate variability
D. Marked variability
Correct answer: D
, Rationale: Marked variability is characterized by fluctuations greater than 25 beats/min. The
nurse should evaluate the entire clinical picture and assess whether the pattern represents a
transient or persistent change.
Question 9
Which finding is generally considered most reassuring regarding fetal autonomic function?
A. Persistent absent variability
B. Moderate variability
C. Persistent minimal variability
D. Persistent bradycardia
Correct answer: B
Rationale: Moderate variability is an important reassuring feature because it reflects intact fetal
autonomic function and is associated with adequate neurologic responsiveness.
Question 10
A nurse begins interpretation of a complex fetal monitoring tracing. Which approach is most
appropriate?
A. Look only at decelerations.
B. Determine the baseline, variability, accelerations, decelerations, and relationship to uterine
activity.
C. Determine the maternal pulse only.
D. Immediately call for operative delivery.
Correct answer: B
Rationale: Fetal monitoring should be interpreted systematically rather than based on a single
feature. AWHONN resources emphasize systematic assessment of baseline, variability,
accelerations, decelerations, uterine activity, maternal condition, and response to interventions.
SECTION 2 — ACCELERATIONS
Question 11
A fetal tracing shows an abrupt increase in fetal heart rate of 20 beats/min lasting 30 seconds.
What does this represent in a fetus at or beyond 32 weeks?
