NCC EFM Exam Breakdown & Study
Guide Questions with correct answers
Content |on |exam |- |correct |answer--Pattern |recognition |& |intervention: |70%
-Physiology: |11%
-Fetal |assessment |methods: |9%
-EFM |equipment: |5%
-Professional |issues: |5%
Pattern |recognition |& |intervention |- |correct |answer--FHR |baseline |✓
-FHR |variability |✓
-FHR |accelerations |✓
-FHR |decelerations |✓
-Normal |uterine |activity |✓
-Abnormal |uterine |activity |✓
-Fetal |dysrhythmias |✓
-Maternal |complications |✓
-Uteroplacental |complications |✓
-Fetal |complications |✓
FHR |Descriptors |- |correct |answer-1) |Baseline
2) |Variability
3) |Presence |of |accels
4) |Presence |of |decels
5) |Changes |in |trends |overtime
FHR |Baseline |- |correct |answer-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 |- |correct |answer-<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)
-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 |- |correct |answer->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 |- |correct |answer-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
-Absent: |undetectable, |flat
-Minimal: |≤5 |bpm |but |detectable
-Moderate: |6-25 |bpm
-Marked: |>25 |bpm |(indeterminate |baseline), |significance |unknown
Minimal |variability |- |correct |answer-≤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 |- |correct |answer-6 |to |25 |bpm
-Reliably |predicts |the |absence |of |metabolic |acidosis |(even |w |decels)
FHR |Accelerations |- |correct |answer-Reliably |predicts |absence |of |metabolic |acidemia |(spontaneous |or |
stimulated)
-Onset |to |peak |in |<30 |sec
-For |≥32 |wks: |15x15 |(peak |≥15 |bpm |above |baseline |lasting |≥15 |sec)
-For |<32 |wks: |10x10
-Prolonged |accel: |2-9 |mins |(at |10 |becomes |change |of |baseline)
Early |deceleration |- |correct |answer-Nadir |aligns |w |contraction |peak, |gradual |onset |(≥30 |secs |to |nadir),
|benign |vagal |response
1) |Pressure |on |fetal |head
2) |Increased |intracranial |pressure
3) |Alteration |in |cerebral |blood |flow
4) |Central |vagal |stimulation
5) |FHR |deceleration
Periodic |vs |Episodic |- |correct |answer-Periodic: |caused |by |contractions
-recurrent: |occurs |w |≥50% |of |contractions |in |20 |min
-intermittent: |w |<50% |of |contractions |in |20 |mins
Episodic: |spontaneous
Variable |deceleration |- |correct |answer-Caused |by |cord |compression
-Interventions: |position |change, |amnioinfusion
-Abrupt |onset: |<30 |seconds |from |onset |to |nadir |dropping |≥15 |bpm |lasting |15 |secs |to |<2min
-Transient |rise |in |PCO2 |& |fall |in |PO2
Guide Questions with correct answers
Content |on |exam |- |correct |answer--Pattern |recognition |& |intervention: |70%
-Physiology: |11%
-Fetal |assessment |methods: |9%
-EFM |equipment: |5%
-Professional |issues: |5%
Pattern |recognition |& |intervention |- |correct |answer--FHR |baseline |✓
-FHR |variability |✓
-FHR |accelerations |✓
-FHR |decelerations |✓
-Normal |uterine |activity |✓
-Abnormal |uterine |activity |✓
-Fetal |dysrhythmias |✓
-Maternal |complications |✓
-Uteroplacental |complications |✓
-Fetal |complications |✓
FHR |Descriptors |- |correct |answer-1) |Baseline
2) |Variability
3) |Presence |of |accels
4) |Presence |of |decels
5) |Changes |in |trends |overtime
FHR |Baseline |- |correct |answer-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 |- |correct |answer-<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)
-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 |- |correct |answer->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 |- |correct |answer-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
-Absent: |undetectable, |flat
-Minimal: |≤5 |bpm |but |detectable
-Moderate: |6-25 |bpm
-Marked: |>25 |bpm |(indeterminate |baseline), |significance |unknown
Minimal |variability |- |correct |answer-≤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 |- |correct |answer-6 |to |25 |bpm
-Reliably |predicts |the |absence |of |metabolic |acidosis |(even |w |decels)
FHR |Accelerations |- |correct |answer-Reliably |predicts |absence |of |metabolic |acidemia |(spontaneous |or |
stimulated)
-Onset |to |peak |in |<30 |sec
-For |≥32 |wks: |15x15 |(peak |≥15 |bpm |above |baseline |lasting |≥15 |sec)
-For |<32 |wks: |10x10
-Prolonged |accel: |2-9 |mins |(at |10 |becomes |change |of |baseline)
Early |deceleration |- |correct |answer-Nadir |aligns |w |contraction |peak, |gradual |onset |(≥30 |secs |to |nadir),
|benign |vagal |response
1) |Pressure |on |fetal |head
2) |Increased |intracranial |pressure
3) |Alteration |in |cerebral |blood |flow
4) |Central |vagal |stimulation
5) |FHR |deceleration
Periodic |vs |Episodic |- |correct |answer-Periodic: |caused |by |contractions
-recurrent: |occurs |w |≥50% |of |contractions |in |20 |min
-intermittent: |w |<50% |of |contractions |in |20 |mins
Episodic: |spontaneous
Variable |deceleration |- |correct |answer-Caused |by |cord |compression
-Interventions: |position |change, |amnioinfusion
-Abrupt |onset: |<30 |seconds |from |onset |to |nadir |dropping |≥15 |bpm |lasting |15 |secs |to |<2min
-Transient |rise |in |PCO2 |& |fall |in |PO2
