NCC EFM Exam Breakdown & Study
Guide (Latest Update) Questions & Answers
Content on exam ✔✔-Pattern recognition & intervention: 70%
-Physiology: 11%
-Fetal assessment methods: 9%
-EFM equipment: 5%
-Professional issues: 5%
Pattern recognition & intervention ✔✔-FHR baseline ✓
-FHR variability ✓
-FHR accelerations ✓
-FHR decelerations ✓
-Normal uterine activity ✓
-Abnormal uterine activity ✓
-Fetal dysrhythmias ✓
-Maternal complications ✓
-Uteroplacental complications ✓
, NCC EFM Exam Breakdown & Study
Guide (Latest Update) Questions & Answers
-Fetal complications ✓
FHR Descriptors ✔✔1) Baseline
2) Variability
3) Presence of accels
4) Presence of decels
5) Changes in trends overtime
FHR Baseline ✔✔Average FHR rounded to nearest 5 during a 10 min window
-110 to 160
-excludes accels, decels, & marked variability
-must have 2 mins to identify as a baseline (doesn't need to be continuous)
Fetal Bradycardia ✔✔<110 for ≥10 min
-Causes: hypotension (ex: after epi), cord prolapse, head compression,
congenital defect, rapid
descent, abruption or rupture, tachysystole, post dates, hypoglycemia, lupus
(heart block)
, NCC EFM Exam Breakdown & Study
Guide (Latest Update) Questions & Answers
-With ↓ O2, blood will be shunted to brain, heart, & adrenals, eventually ↓ FHR
to ↓ O2
demands of heart muscle
-Verify not mom's HR, vaginal exam (r/o prolapse), resuscitate, evaluate
arrhythmia, expedite
delivery
Fetal Tachycardia ✔✔>160 for ≥10 min
-Causes: fetal anemia, maternal fever or infection, fetal immaturity (preterm),
SVT, maternal
anxiety (catecholamines), dehydration, hyperthyroid, hypoxia
-Med causes: terbutaline, catecholamines (epinephrine, norepi)
-Assess mom's temp & infection risk (GBS, PROM)
FHR Variability ✔✔Irregular in amplitude & frequency, quantified by peak to
trough
-Caused by sympathetic vs parasympathetic, r/t neuro maturity
-Less in preterm due to undeveloped CNS
, NCC EFM Exam Breakdown & Study
Guide (Latest Update) Questions & Answers
-Absent: undetectable, flat
-Minimal: ≤5 bpm but detectable
-Moderate: 6-25 bpm
-Marked: >25 bpm (indeterminate baseline), significance unknown
Minimal variability ✔✔≤5 bpm but detectable
Sleep, sedated, or sick
-Sleep cycle: 20-60 mins
-Sedated: CNS depressant (ex: mag), 1-2 hrs
-Sick (acidemia): unresolved w intervention
-Priority: maximize oxygenation (position, bolus, O2 if needed)
Moderate variability ✔✔6 to 25 bpm
-Reliably predicts the absence of metabolic acidosis (even w decels)
FHR Accelerations ✔✔Reliably predicts absence of metabolic acidemia
(spontaneous or
stimulated)
Guide (Latest Update) Questions & Answers
Content on exam ✔✔-Pattern recognition & intervention: 70%
-Physiology: 11%
-Fetal assessment methods: 9%
-EFM equipment: 5%
-Professional issues: 5%
Pattern recognition & intervention ✔✔-FHR baseline ✓
-FHR variability ✓
-FHR accelerations ✓
-FHR decelerations ✓
-Normal uterine activity ✓
-Abnormal uterine activity ✓
-Fetal dysrhythmias ✓
-Maternal complications ✓
-Uteroplacental complications ✓
, NCC EFM Exam Breakdown & Study
Guide (Latest Update) Questions & Answers
-Fetal complications ✓
FHR Descriptors ✔✔1) Baseline
2) Variability
3) Presence of accels
4) Presence of decels
5) Changes in trends overtime
FHR Baseline ✔✔Average FHR rounded to nearest 5 during a 10 min window
-110 to 160
-excludes accels, decels, & marked variability
-must have 2 mins to identify as a baseline (doesn't need to be continuous)
Fetal Bradycardia ✔✔<110 for ≥10 min
-Causes: hypotension (ex: after epi), cord prolapse, head compression,
congenital defect, rapid
descent, abruption or rupture, tachysystole, post dates, hypoglycemia, lupus
(heart block)
, NCC EFM Exam Breakdown & Study
Guide (Latest Update) Questions & Answers
-With ↓ O2, blood will be shunted to brain, heart, & adrenals, eventually ↓ FHR
to ↓ O2
demands of heart muscle
-Verify not mom's HR, vaginal exam (r/o prolapse), resuscitate, evaluate
arrhythmia, expedite
delivery
Fetal Tachycardia ✔✔>160 for ≥10 min
-Causes: fetal anemia, maternal fever or infection, fetal immaturity (preterm),
SVT, maternal
anxiety (catecholamines), dehydration, hyperthyroid, hypoxia
-Med causes: terbutaline, catecholamines (epinephrine, norepi)
-Assess mom's temp & infection risk (GBS, PROM)
FHR Variability ✔✔Irregular in amplitude & frequency, quantified by peak to
trough
-Caused by sympathetic vs parasympathetic, r/t neuro maturity
-Less in preterm due to undeveloped CNS
, NCC EFM Exam Breakdown & Study
Guide (Latest Update) Questions & Answers
-Absent: undetectable, flat
-Minimal: ≤5 bpm but detectable
-Moderate: 6-25 bpm
-Marked: >25 bpm (indeterminate baseline), significance unknown
Minimal variability ✔✔≤5 bpm but detectable
Sleep, sedated, or sick
-Sleep cycle: 20-60 mins
-Sedated: CNS depressant (ex: mag), 1-2 hrs
-Sick (acidemia): unresolved w intervention
-Priority: maximize oxygenation (position, bolus, O2 if needed)
Moderate variability ✔✔6 to 25 bpm
-Reliably predicts the absence of metabolic acidosis (even w decels)
FHR Accelerations ✔✔Reliably predicts absence of metabolic acidemia
(spontaneous or
stimulated)
