NCC EFM Exam Practice Questions With Answers - Latest Update 2023/2024 (VERIFIED)

A 36 week gestation patient is brought to triage by squad after an MVA on her back. She is not bleeding and denies pain. She is not short of breath, but c/o dizziness and nausea since they put her on the gurney. The most likely cause is A. Abruptio placenta B. Preterm labor C. Supine hypotension -Answer- C. Supine hypotension When the hydrogen ion content in the blood rises, the pH A. Lowers B. Neutralizes C. Rises -Answer- A. Lowers ***A woman receives terbutaline for an external version. You may expect what on the fetal heart tracing? A. Decrease in variability B. Increase in baseline C. No change -Answer- B. Increase in baseline What affect does magnesium sulfate have on the fetal heart rate? A. Decreases variability B. Increases variability C. No change -Answer- A. Decreases variability Sinusoidal pattern can be documented when A. Cycles are 4-6 beats per minute in frequency B. The pattern lasts 20 minutes or longer C. There is moderate or minimal variability -Answer- B. The pattern lasts 20 minutes or longer Vagal stimulation would be manifested as what type of fetal heart rate pattern? A. Acceleration B. Early deceleration C. Tachycardia -Answer- B. Early deceleration Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially when seen at the onset of labor? A. Early deceleration B. Late deceleration C. Variable deceleration -Answer- A. Early deceleration A risk of amnioinfusion is A. Prolonged labor B. Uterine overdistension C. Water intoxication -Answer- B. Uterine overdistension A fetal heart rate pattern that can occur when there is a prolapsed cord is A. Marked variability B. Prolonged decelerations C. Tachycardia -Answer- B. Prolonged decelerations The patient is in early labor with pitocin at 8 mu/min, and FHR is Category I. In the next 15 minutes, there are 18 uterine contractions. Recommended management is to A. Address contraction frequency by reducing pitocin dose B. Continue to increase pitocin as long as FHR is Category I C. Turn the patient on her side and initiate an IV fluid bolus -Answer- C. Turn the patient on her side and initiate an IV fluid bolus A woman at 38 weeks gestation is in labor. The labor has been uneventful, and the fetal heart tracings have been normal. Spontaneous rupture of membranes occurs; fetal heart rate drops to 90 beats per minute for four minutes and then resumes a normal pattern. The most likely etiology for this fetal heart rate change is A. Abnormal fetal presentation B. Impaired placental circulation C. Possible cord compression -Answer- C. Possible cord compression A woman has 10 fetal movements in one hour. This is considered what kind of movement? A. Decreased B. Excessive C. Normal -Answer- C. Normal If the pH is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? A. HCO3 B. PCO2 C. PO2 -Answer- B. PCO2 The following cord blood gasses are consistent with: pH 7.10, pCO2 70, pO2 25, base excess -10 A. Metabolic acidosis B. Mixed acidosis C. Respiratory acidosis -Answer- C. Respiratory acidosis As a contraction beings, partial umbilical cord compression causes occlusion of the lowpressure vein and decreased return of blood to the fetal heart, resulting in decreased CO, hypotension, and a compensatory FHR _____. A. Acceleration B. Early deceleration C. Late deceleration D. Variable deceleration -Answer- A. Acceleration With complete umbilical cord occlusion, the two umbilical arteries also become occluded, resulting in sudden fetal hypertension, stimulation of the baroreceptors, and a sudden _______ in FHR. A. Increase B. Decrease -Answer- B. Decrease Central _______ are located in the medulla oblongata; peripheral _______ are found in the carotid sinuses and aortic arch. A. Baroreceptors B. Chemoreceptors -Answer- B. Chemoreceptors When a fetus is stressed, catecholamine release (epinephrine, norepinephrine) occurs from the medulla oblongata, shunting blood _______ the brain, heart, and adrenal glands. A. Toward B. Away from -Answer- A. Toward T/F: A Doppler device used for intermittent auscultation of the fetal heart rate may be used to identify rhythm irregularities, such as supraventricular tachycardia. -AnswerFalse T/F: Use of a fetoscope for intermittent auscultation of the fetal heart rate may be used to detect accelerations and decelerations from the baseline, and can clarify doublecounting of half-counting of baseline rate. -Answer- True T/F: In the context of moderate variability, late decelerations are considered neurogenic in origin and are typically amenable to intrauterine resuscitation techniques directed towards maximizing uterine blood flow. -Answer- True When coupling or tripling is apparent on the uterine activity tracing, this may be indicative of a dysfunctional labor process and saturation (down regulation) of uterine oxytocin receptor sites in response to excess exposure to oxytocin. Which of the following interventions would be most appropriate? A. Normal response; continue to increase oxytocin titration B. Turn patient on side C. Decrease or discontinue oxytocin infusion -Answer- C. Decrease or discontinue oxytocin infusion The most common tachyarrhythmia in fetuses, supraventricular tachycardia, typically occurs at a rate of _____ to _____ bpm with minimal or absent variability. A. 160-200 B. 200-240 C. 240-260 -Answer- C. 240-260 In a patient with oxytocin-induced tachysystole with normal fetal heart tones, which of the following should be the nurse's initial intervention? A. Assist the patient to lateral position B. Discontinue Pitocin C. Administer IV fluid bolus -Answer- A. Assist the patient to lateral position In a patient with oxytocin-induced tachysystole with indeterminate or abnormal fetal heart tones, which of the following should be the nurse's initial intervention? A. Assist the patient to lateral position B. Discontinue Pitocin C. Administer IV fluid bolus -Answer- B. Discontinue Pitocin Fetal hypoxia and acidemia are demonstrated by pH _____ and base excess _____. -Answer- 7.15; -8 T/F: Uterine resting tone may appear higher (25 to 40 mmHg) during amnioinfusion. - Answer- True _______ denotes an increase in hydrogen ions in the fetal blood. A. Acidosis B. Acidemia C. Hypercapnia -Answer- B. Acidemia _______ _______ occurs when there is low bicarbonate (base excess) in the presence of normal pressure of carbon dioxide (PCO2) values. A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis -Answer- A. Metabolic acidosis _______ _______ occurs when there is high PCO2 with normal bicarbonate levels. A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis -Answer- B. Respiratory acidosis _______ _______ occurs when the HCO3 concentration is lower than normal. A. Base deficit B. Base excess C. Metabolic acidosis -Answer- A. Base deficit _______ _______ occurs when the HCO3 concentration is higher than normal. A. Base deficit B. Base excess C. Metabolic acidosis -Answer- B. Base excess _______ is defined as the energy-consuming process of metabolism. -AnswerAnabolism _______ is defined as the energy-releasing process of metabolism. -AnswerCatabolism Normal oxygen saturation for the fetus in labor is ___% to ___%. -Answer- 30% to 65% pH 7.05 PO2 21 PCO2 72 HCO3 24 Base excess -12 A. Metabolic acidosis B. Respiratory acidosis C. Mixed acidosis -Answer- B. Respiratory acidosis pH 7.0 PO2 18 PCO2 54 HCO3 20 Base deficit 14 A. Metabolic acidosis B. Respiratory acidosis C. Mixed acidosis -Answer- A. Metabolic acidosis pH 7.02 PO2 17 PCO2 72 HCO3 19 Base deficit 16 A. Metabolic acidosis B. Respiratory acidosis C. Mixed acidosis -Answer- C. Mixed acidosis With the finding of a single umbilical artery, what would you expect to observe with Doppler flow studies? A. Decreased blood perfusion from the fetus to the placenta B. Decreased blood perfusion from the placenta to the fetus C. Homeostatic dilation of the umbilical artery -Answer- A. Decreased blood perfusion from the fetus to the placenta Two umbilical arteries flow from the fetus to the placenta A patient presents with a small amount of thick dark blood clots who denies pain and whose abdomen is soft to the touch. Which component of oxygen transport to the fetus could potentially be compromised by this bleeding? A. Affinity B. Saturation C. Delivery -Answer- C. Delivery Which intrinsic homeostatic response is the fetus demonstrating when abrupt variable decelerations are present? A. Baroreceptor B. Catecholamine C. Sympathetic -Answer- A. Baroreceptor An infant was delivered via cesarean. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. The initial neonatal hemocrit was 20% and the hemoglobin was 8. Which interpretation of these umbilical cord and initial neonatal blood results is correct? A. Base buffers have been used to maintain oxygenation B. The mother was probably hypoglycemic C. The neonate is anemic -Answer- C. The neonate is anemic An infant was delivered via cesarean. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. The initial neonatal hemocrit was 20% and the hemoglobin was 8. These umbilical cord blood gases indicate A. Asphyxia related to umbilical and placental abnormalities B. Hypoxia related to neurological damage C. Mixed acidosis -Answer- C. Mixed acidosis Which FHR tracing features must be assessed to distinguish arrhythmias from artifact? A. Shape and regularity of the spikes B. Spikes and variability C. Spikes and baseline -Answer- A. Shape and regularity of the spikes How might a fetal arrhythmia affect fetal oxygenation? A. By increasing fetal oxygen affinity B. By increasing sympathetic response C. By reducing fetal perfusion -Answer- C. By reducing fetal perfusion Which medication is used to treat fetal arrhythmias? A. Digoxin B. Labetolol C. Nifedipine -Answer- A. Digoxin Inotropic - promotes regular and effective cardiac contraction Fetal hydrops may present on ultrasound as fetal scalp edema and increased abdominal fluid as a results of A. An increase in gestational age B. Congestive heart failure C. Sustained oligohydramnios -Answer- B. Congestive heart failure What might increase fetal oxygen consumption? A. Hyperthermia B. Umbilical cord compression C. Uterine tachysystole -Answer- A. Hyperthermia Increases metabolism and oxygen consumption Which assessment or intervention would be least appropriate in a patient whose FHR tracing revealed tachycardia and a prolonged deceleration? A. Change maternal position to right lateral B. Further assess fetal oxygenation with scalp stimulation C. Perform a vaginal exam to assess fetal descent -Answer- B. Further assess fetal oxygenation with scalp stimulation Only used with normal baseline rate and never during decels; not an intervention Which of the following pieces of information would be of highest priority to relay to the neonatal team as they prepare for an emergency cesarean delivery? A. FHR arrhythmia, meconium, length of labor B. Gestational age, meconium, arrhythmia C. Gravidity & parity, gestational age, maternal temperature -Answer- B. Gestational age, meconium, arrhythmia Which medications used with preterm labor can affect the FHR characteristics? A. Terbutaline and antibiotics B. Betamethasone and terbutaline C. Antibiotics and narcotics -Answer- B. Betamethasone and terbutaline What characterizes a preterm fetal response to stress? A. More frequently occurring late decelerations B. More frequently occurring prolonged decelerations C. More rapid deterioration from Category I to Category II or III -Answer- C. More rapid deterioration from Category I to Category II or III More likely to be subjected to hypoxia ***A woman being monitored externally has a suspected fetal arrhythmia. The most appropriate action is to A. Insert a spiral electrode and turn off the logic B. Turn the logic on if an external monitor is in place C. Use a Doppler to listen to the ventricular rate -Answer- A. Insert a spiral electrode and turn off the logic *** The fetus responds to a significant drop of PO2 by A. Increasing O2 consumption B. Reducing lactic acid production C. Shifting blood to vital organs -Answer- C. Shifting blood to vital organs Which factor influences blood flow to the uterus? A. Fetal arterial pressure B. Intervillous space flow C. Maternal arterial vasoconstriction -Answer- C. Maternal arterial vasoconstriction