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2026 NCC EFM CERTIFICATION EXAM QUESTIONS AND
CORRECT ANSWERS | VERIFIED ANSWERS | LATEST
UPDATE 2026/2027 | GRADED A+.
Q1. According to NICHD terminology, a normal baseline fetal heart rate is:
A. 90-150 bpm
B. 110-160 bpm
C. 120-170 bpm
D. 100-150 bpm
Answer: B
Rationale: The NICHD defines a normal baseline FHR as 110-160 beats per minute. Tachycardia is >160
bpm; bradycardia is <110 bpm.
Q2. Baseline FHR is determined by approximating the mean FHR rounded to increments of 5 bpm during
a:
A. 2-minute window, excluding accelerations and decelerations
B. 10-minute window, excluding accelerations and decelerations
C. 5-minute window, including accelerations and decelerations
D. 20-minute window, including periods of marked variability
Answer: B
Rationale: The baseline is the mean FHR rounded to 5 bpm increments over a 10-minute segment,
excluding periodic or episodic changes, periods of marked variability, and segments of baseline that
differ by more than 25 bpm.
Q3. Moderate variability is defined as fluctuations in the baseline FHR of:
A. Undetectable to ≤5 bpm
B. 6-25 bpm
C. >25 bpm
D. Exactly 5 bpm
Answer: B
Rationale: Moderate variability (6-25 bpm amplitude) is the most reassuring pattern and indicates a
normally functioning autonomic nervous system with adequate fetal oxygenation.
Q4. Absent variability with no accelerations and no decelerations in a term fetus likely indicates:
A. Fetal sleep cycle
B. Normal fetal oxygenation
C. Possible fetal hypoxia or acidemia
D. Maternal medication effect (e.g., magnesium sulfate)
Answer: C
Rationale: While absent variability can be caused by fetal sleep cycle, medications, or prematurity, in a
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term fetus with no decelerations and no accelerations, it must be considered suspicious for fetal hypoxia
or metabolic acidemia until proven otherwise.
Q5. Sinusoidal pattern is defined as a smooth, sine wave-like undulating pattern with a cycle frequency
of 3-5 cycles per minute and an amplitude of:
A. 2-5 bpm
B. 5-15 bpm
C. 15-25 bpm
D. >25 bpm
Answer: B
Rationale: A sinusoidal pattern has an amplitude of 5-15 bpm, persists for ≥20 minutes, and has absent
variability. It is associated with severe fetal anemia, hydrops, or asphyxia and requires immediate
evaluation.
Q6. Acceleration of the FHR in a fetus ≥32 weeks gestation is defined as an abrupt increase of:
A. ≥10 bpm above baseline for ≥10 seconds
B. ≥15 bpm above baseline for ≥15 seconds
C. ≥20 bpm above baseline for ≥10 seconds
D. ≥10 bpm above baseline for ≥15 seconds
Answer: B
Rationale: For gestations ≥32 weeks, an acceleration is an abrupt increase of ≥15 bpm above baseline
lasting ≥15 seconds but <2 minutes from onset to return. For <32 weeks, criteria are ≥10 bpm for ≥10
seconds.
Q7. An acceleration lasting ≥2 minutes but <10 minutes is classified as:
A. A normal acceleration
B. A prolonged acceleration
C. A spontaneous acceleration
D. An episodic acceleration
Answer: B
Rationale: An acceleration lasting ≥2 minutes but <10 minutes is termed a prolonged acceleration. If it
lasts ≥10 minutes, it is considered a baseline change.
Q8. Bradycardia is defined as a baseline FHR:
A. <100 bpm for ≥5 minutes
B. <110 bpm for ≥10 minutes
C. <120 bpm for ≥10 minutes
D. <90 bpm for ≥5 minutes
Answer: B
Rationale: NICHD defines bradycardia as baseline FHR <110 bpm lasting for ≥10 minutes.
Q9. Tachycardia is defined as a baseline FHR:
A. >150 bpm for ≥10 minutes
B. >160 bpm for ≥10 minutes
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C. >170 bpm for ≥5 minutes
D. >160 bpm for ≥5 minutes
Answer: B
Rationale: Tachycardia is baseline FHR >160 bpm lasting for ≥10 minutes.
Q10. The most common cause of fetal tachycardia is:
A. Fetal anemia
B. Maternal fever or chorioamnionitis
C. Fetal heart failure
D. Maternal hypotension
Answer: B
Rationale: Maternal fever, chorioamnionitis, and infection are the most frequent causes of fetal
tachycardia. Other causes include fetal hypoxia, drugs (e.g., terbutaline, atropine), and fetal
arrhythmias.
Q11. When evaluating a fetal heart rate tracing, the primary measure of fetal oxygenation status is:
A. Baseline rate
B. Presence of accelerations
C. Moderate variability
D. Absence of decelerations
Answer: C
Rationale: Moderate variability is the single most reliable indicator of adequate fetal oxygenation and
normal acid-base balance. It reflects an intact autonomic nervous system.
Q12. The NICHD three-tier fetal heart rate interpretation system categorizes tracings as:
A. Category I, II, and III
B. Normal, suspicious, and pathologic
C. Reassuring, non-reassuring, and ominous
D. Category A, B, and C
Answer: A
Rationale: The NICHD system uses three categories: Category I (normal), Category II (indeterminate),
and Category III (abnormal, requiring prompt evaluation and intervention).
Q13. Which of the following is a Category I tracing? (Select all that apply.)
A. Baseline 120 bpm, moderate variability, accelerations present, no decelerations
B. Baseline 145 bpm, minimal variability, no accelerations, early decelerations
C. Baseline 130 bpm, moderate variability, accelerations present, early decelerations
D. Baseline 155 bpm, moderate variability, no accelerations, no decelerations
Answer: A, C, D
Rationale: Category I includes all of the following: baseline 110-160 bpm, moderate variability,
accelerations may be present or absent, no late or variable decelerations, and early decelerations may
be present or absent. B is not Category I because of minimal variability.
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2026 NCC EFM CERTIFICATION EXAM QUESTIONS AND
CORRECT ANSWERS | VERIFIED ANSWERS | LATEST
UPDATE 2026/2027 | GRADED A+.
Q1. According to NICHD terminology, a normal baseline fetal heart rate is:
A. 90-150 bpm
B. 110-160 bpm
C. 120-170 bpm
D. 100-150 bpm
Answer: B
Rationale: The NICHD defines a normal baseline FHR as 110-160 beats per minute. Tachycardia is >160
bpm; bradycardia is <110 bpm.
Q2. Baseline FHR is determined by approximating the mean FHR rounded to increments of 5 bpm during
a:
A. 2-minute window, excluding accelerations and decelerations
B. 10-minute window, excluding accelerations and decelerations
C. 5-minute window, including accelerations and decelerations
D. 20-minute window, including periods of marked variability
Answer: B
Rationale: The baseline is the mean FHR rounded to 5 bpm increments over a 10-minute segment,
excluding periodic or episodic changes, periods of marked variability, and segments of baseline that
differ by more than 25 bpm.
Q3. Moderate variability is defined as fluctuations in the baseline FHR of:
A. Undetectable to ≤5 bpm
B. 6-25 bpm
C. >25 bpm
D. Exactly 5 bpm
Answer: B
Rationale: Moderate variability (6-25 bpm amplitude) is the most reassuring pattern and indicates a
normally functioning autonomic nervous system with adequate fetal oxygenation.
Q4. Absent variability with no accelerations and no decelerations in a term fetus likely indicates:
A. Fetal sleep cycle
B. Normal fetal oxygenation
C. Possible fetal hypoxia or acidemia
D. Maternal medication effect (e.g., magnesium sulfate)
Answer: C
Rationale: While absent variability can be caused by fetal sleep cycle, medications, or prematurity, in a
pg. 1
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term fetus with no decelerations and no accelerations, it must be considered suspicious for fetal hypoxia
or metabolic acidemia until proven otherwise.
Q5. Sinusoidal pattern is defined as a smooth, sine wave-like undulating pattern with a cycle frequency
of 3-5 cycles per minute and an amplitude of:
A. 2-5 bpm
B. 5-15 bpm
C. 15-25 bpm
D. >25 bpm
Answer: B
Rationale: A sinusoidal pattern has an amplitude of 5-15 bpm, persists for ≥20 minutes, and has absent
variability. It is associated with severe fetal anemia, hydrops, or asphyxia and requires immediate
evaluation.
Q6. Acceleration of the FHR in a fetus ≥32 weeks gestation is defined as an abrupt increase of:
A. ≥10 bpm above baseline for ≥10 seconds
B. ≥15 bpm above baseline for ≥15 seconds
C. ≥20 bpm above baseline for ≥10 seconds
D. ≥10 bpm above baseline for ≥15 seconds
Answer: B
Rationale: For gestations ≥32 weeks, an acceleration is an abrupt increase of ≥15 bpm above baseline
lasting ≥15 seconds but <2 minutes from onset to return. For <32 weeks, criteria are ≥10 bpm for ≥10
seconds.
Q7. An acceleration lasting ≥2 minutes but <10 minutes is classified as:
A. A normal acceleration
B. A prolonged acceleration
C. A spontaneous acceleration
D. An episodic acceleration
Answer: B
Rationale: An acceleration lasting ≥2 minutes but <10 minutes is termed a prolonged acceleration. If it
lasts ≥10 minutes, it is considered a baseline change.
Q8. Bradycardia is defined as a baseline FHR:
A. <100 bpm for ≥5 minutes
B. <110 bpm for ≥10 minutes
C. <120 bpm for ≥10 minutes
D. <90 bpm for ≥5 minutes
Answer: B
Rationale: NICHD defines bradycardia as baseline FHR <110 bpm lasting for ≥10 minutes.
Q9. Tachycardia is defined as a baseline FHR:
A. >150 bpm for ≥10 minutes
B. >160 bpm for ≥10 minutes
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C. >170 bpm for ≥5 minutes
D. >160 bpm for ≥5 minutes
Answer: B
Rationale: Tachycardia is baseline FHR >160 bpm lasting for ≥10 minutes.
Q10. The most common cause of fetal tachycardia is:
A. Fetal anemia
B. Maternal fever or chorioamnionitis
C. Fetal heart failure
D. Maternal hypotension
Answer: B
Rationale: Maternal fever, chorioamnionitis, and infection are the most frequent causes of fetal
tachycardia. Other causes include fetal hypoxia, drugs (e.g., terbutaline, atropine), and fetal
arrhythmias.
Q11. When evaluating a fetal heart rate tracing, the primary measure of fetal oxygenation status is:
A. Baseline rate
B. Presence of accelerations
C. Moderate variability
D. Absence of decelerations
Answer: C
Rationale: Moderate variability is the single most reliable indicator of adequate fetal oxygenation and
normal acid-base balance. It reflects an intact autonomic nervous system.
Q12. The NICHD three-tier fetal heart rate interpretation system categorizes tracings as:
A. Category I, II, and III
B. Normal, suspicious, and pathologic
C. Reassuring, non-reassuring, and ominous
D. Category A, B, and C
Answer: A
Rationale: The NICHD system uses three categories: Category I (normal), Category II (indeterminate),
and Category III (abnormal, requiring prompt evaluation and intervention).
Q13. Which of the following is a Category I tracing? (Select all that apply.)
A. Baseline 120 bpm, moderate variability, accelerations present, no decelerations
B. Baseline 145 bpm, minimal variability, no accelerations, early decelerations
C. Baseline 130 bpm, moderate variability, accelerations present, early decelerations
D. Baseline 155 bpm, moderate variability, no accelerations, no decelerations
Answer: A, C, D
Rationale: Category I includes all of the following: baseline 110-160 bpm, moderate variability,
accelerations may be present or absent, no late or variable decelerations, and early decelerations may
be present or absent. B is not Category I because of minimal variability.
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