C-EFM Final Exam | All Possible
Questions and Answers | Fall 2025/2026
Update | 100% Correct|| NEWEST
What effect does narcotics have on FHR? -CORRECTANSWER Decrease in variability
Decrease in frequency of accels
What do we need to visualize to fully understand a FHR EFM strip. -
CORRECTANSWER A complete description of the EFM tracing includes:
-Uterine contractions
-Baseline fetal heart rate
-Baseline variability
-Presence of accelerations
-Periodic or episodic decelerations
-Changes or trends of the fetal heart rate pattern over time
What is the definition of fetal heart rate monitoring? -CORRECTANSWER Traditional
auscultation or electronic fetal monitoring (EFM) which can involve
internal/external/combination of both.
EFM is based on VISUAL assessment of FHR patterns
,What is the goal of FHR monitoring? -CORRECTANSWER To prevent fetal injury that
might result from interruption of normal fetal oxygenation during labor
What are the two basic elements of fetal oxygenation? -CORRECTANSWER -Transfer
of oxygen from environment to fetus
-Fetal response to interruption of oxygen transfer
What are the types of external FHR monitors? -CORRECTANSWER -Doppler
Ultrasound (US)
-Intermittent Auscultation (IA)
How does a doppler ultrasound (US) work? -CORRECTANSWER Transmits high-
frequency sound waves to the moving interface of the fetal heart valves and deflects
these back to the device, converting them into an electronic signal that can be counted
Where is the optimal placement location for the EFM US? -CORRECTANSWER Over
the fetal back which is usually the point of maximum intensity
What are the limitations of using a doppler US for EFM? What to do to alleviate these
limitations? -CORRECTANSWER 1. Double count slow FHR <60 or half count fast FHR
>180:
-Assess FHR with fetoscope, stethoscope or doppler, check maternal pulse, reapply gel
& replace/relocate US, and consider FSE
,-Coincidental (same) FHRs on monitor for twins:
-Relocate US and label
What is the doppler effect? -CORRECTANSWER When US waves are reflected from a
moving interface and waves return at different frequencies
What is a transvaginal ultrasound and why is it used? -CORRECTANSWER Used to
detect fetal cardiac activity/cardiac sounds by 2D video or M-mode imaging. There is
closer proximity to uterus so good option for clinically difficult examinations (i.e. obese
patients)
What is intermittent auscultation (IA)? -CORRECTANSWER AUDITORY assessment in
which an instrument/device is used to count the number of fetal heart beats occurring in
a prescribed amount of time at specified intervals and in relation to uterine contractions.
Auscultation can assist with differentiating between MHR (note: always count maternal
radial pulse) and FHR when placing external US. Auscultation can clarify the presence
of irregular fetal rhythm
How can IA be done non-electronically? -CORRECTANSWER Using a stethoscope, a
DeLee-Hillis fetoscope or a Pinard stethoscope
-Ventricular heart valves are heard opening and closing (fetal heart sounds)
, If using a STETHoscope for IA, what special steps should be taken? -
CORRECTANSWER The end should be turned to domed/bell side then placed on
maternal abdomen over the fetal back
If using a FETOscope for IA, what special steps should be taken? -CORRECTANSWER
It should be worn on listener's head because bone conduction amplifies the fetal heart
sounds for counting
What is the "procedure" for using external fetal monitors? -CORRECTANSWER -
Leopolds
-Count maternal radial pulse
-Palpate abdomen for presence or absence of uterine activity
-Count FHR for 15-60 seconds between contractions & when fetus is not moving→
baseline determined & rhythm (regular vs irregular)
-Auscultate before, during and after contractions to identify fetal response→ assess for
absence or presence of increases or decreases in FHR
-Multiple count strategy: FHR counted during several 5-15 second increments
What is the definition of baseline FHR? -CORRECTANSWER Approximate mean FHR
rounded to increments of 5 bpm during a 10- minute segment, excluding accels, decels,
periods of marked variability (**Cannot be determined if tracing <10 min**)
Questions and Answers | Fall 2025/2026
Update | 100% Correct|| NEWEST
What effect does narcotics have on FHR? -CORRECTANSWER Decrease in variability
Decrease in frequency of accels
What do we need to visualize to fully understand a FHR EFM strip. -
CORRECTANSWER A complete description of the EFM tracing includes:
-Uterine contractions
-Baseline fetal heart rate
-Baseline variability
-Presence of accelerations
-Periodic or episodic decelerations
-Changes or trends of the fetal heart rate pattern over time
What is the definition of fetal heart rate monitoring? -CORRECTANSWER Traditional
auscultation or electronic fetal monitoring (EFM) which can involve
internal/external/combination of both.
EFM is based on VISUAL assessment of FHR patterns
,What is the goal of FHR monitoring? -CORRECTANSWER To prevent fetal injury that
might result from interruption of normal fetal oxygenation during labor
What are the two basic elements of fetal oxygenation? -CORRECTANSWER -Transfer
of oxygen from environment to fetus
-Fetal response to interruption of oxygen transfer
What are the types of external FHR monitors? -CORRECTANSWER -Doppler
Ultrasound (US)
-Intermittent Auscultation (IA)
How does a doppler ultrasound (US) work? -CORRECTANSWER Transmits high-
frequency sound waves to the moving interface of the fetal heart valves and deflects
these back to the device, converting them into an electronic signal that can be counted
Where is the optimal placement location for the EFM US? -CORRECTANSWER Over
the fetal back which is usually the point of maximum intensity
What are the limitations of using a doppler US for EFM? What to do to alleviate these
limitations? -CORRECTANSWER 1. Double count slow FHR <60 or half count fast FHR
>180:
-Assess FHR with fetoscope, stethoscope or doppler, check maternal pulse, reapply gel
& replace/relocate US, and consider FSE
,-Coincidental (same) FHRs on monitor for twins:
-Relocate US and label
What is the doppler effect? -CORRECTANSWER When US waves are reflected from a
moving interface and waves return at different frequencies
What is a transvaginal ultrasound and why is it used? -CORRECTANSWER Used to
detect fetal cardiac activity/cardiac sounds by 2D video or M-mode imaging. There is
closer proximity to uterus so good option for clinically difficult examinations (i.e. obese
patients)
What is intermittent auscultation (IA)? -CORRECTANSWER AUDITORY assessment in
which an instrument/device is used to count the number of fetal heart beats occurring in
a prescribed amount of time at specified intervals and in relation to uterine contractions.
Auscultation can assist with differentiating between MHR (note: always count maternal
radial pulse) and FHR when placing external US. Auscultation can clarify the presence
of irregular fetal rhythm
How can IA be done non-electronically? -CORRECTANSWER Using a stethoscope, a
DeLee-Hillis fetoscope or a Pinard stethoscope
-Ventricular heart valves are heard opening and closing (fetal heart sounds)
, If using a STETHoscope for IA, what special steps should be taken? -
CORRECTANSWER The end should be turned to domed/bell side then placed on
maternal abdomen over the fetal back
If using a FETOscope for IA, what special steps should be taken? -CORRECTANSWER
It should be worn on listener's head because bone conduction amplifies the fetal heart
sounds for counting
What is the "procedure" for using external fetal monitors? -CORRECTANSWER -
Leopolds
-Count maternal radial pulse
-Palpate abdomen for presence or absence of uterine activity
-Count FHR for 15-60 seconds between contractions & when fetus is not moving→
baseline determined & rhythm (regular vs irregular)
-Auscultate before, during and after contractions to identify fetal response→ assess for
absence or presence of increases or decreases in FHR
-Multiple count strategy: FHR counted during several 5-15 second increments
What is the definition of baseline FHR? -CORRECTANSWER Approximate mean FHR
rounded to increments of 5 bpm during a 10- minute segment, excluding accels, decels,
periods of marked variability (**Cannot be determined if tracing <10 min**)
