NCC Electronic Fetal Monitoring (EFM) Certification Exam Question Bank with 450+ Questions and 100% Correct Answer (Updated 202

When the hydrogen ion content in the blood rises, the pH A. Lowers B. Neutralizes C. Rises --------- CORRECT 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 --------- CORRECT 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 --------- CORRECT ANSWER ----- A. Decreases variability NICHD guidelines apply only to A. Intrapartum patients B. Internal monitoring of fetal heart rate C. Interpreting tracings of good quality --------- CORRECT ANSWER ----- C. Interpreting tracings of good quality According to NICHD terminology, variability can be accurately accessed A. Visually, by determining the number of R to R intervals in a one minute period B. Visually, by determining the amplitude of the FHR change in bpm from the baseline C. Only when a fetal spiral electrode is in place --------- CORRECT ANSWER ----- B. Visually, by determining the amplitude of the FHR change in bpm from the baseline When looking at the fetal heart rate, the most important characteristic to determine the absence of metabolic acidemia is A. Absence of late decelerations B. Baseline rate within normal range C. Presence of moderate variability --------- CORRECT ANSWER ----- C. Presence of moderate 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 --------- CORRECT 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 --------- CORRECT 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 --------- CORRECT ANSWER ----- A. Early deceleration A risk of amnioinfusion is A. Prolonged labor B. Uterine overdistension C. Water intoxication --------- CORRECT ANSWER ----- B. Uterine overdistension A fetal heart rate pattern that the NICHD has identified as predictive of current or impending fetal asphyxia so severe that the fetus is at risk of neurologic damage or death is A. Baseline tachycardia with absent variability B. Minimal baseline variability with recurrent late decelerations C. Recurrent late or variable decelerations with absent variability --------- CORRECT ANSWER ----- C. Recurrent late or variable decelerations with absent variability A fetal heart rate pattern that can occur when there is a prolapsed cord is A. Marked variability B. Prolonged decelerations C. Tachycardia --------- CORRECT 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 --------- CORRECT 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 --------- CORRECT ANSWER ----- C. Possible cord compression A 42 week gestation woman has been diagnosed with oligohydramnios. Based on this, a FHR change that can be expected is A. Late deceleration B. Minimal variability C. Variable deceleration --------- CORRECT ANSWER ----- C. Variable deceleration Mono-mono zygotic twins are prone to what type of deceleration during labor? A. Early B. Late C. Variable --------- CORRECT ANSWER ----- C. Variable During labor, the recommended fetal heart rate assessment interval for auscultation is every A. 15-30 minutes in the active phase of the first stage and every 5-15 minutes in second stage B. 15 minutes no matter what stage of labor C. 60 minutes in the active phase of the first stage and every 30 minutes in second stage --------- CORRECT ANSWER ----- A. 15-30 minutes in the active phase of the first stage and every 5-15 minutes in second stage What fetal heart rate characteristics can be determined with auscultation? A. Baseline B. Early decelerations C. Variability --------- CORRECT ANSWER ----- A. Baseline When auscultating the fetal heart rate, the provider/nurse should simultaneously assess the maternal A. Blood pressure B. Pain level C. Radial pulse --------- CORRECT ANSWER ----- C. Radial pulse A woman has 10 fetal movements in one hour. This is considered what kind of movement? A. Decreased B. Excessive C. Normal --------- CORRECT 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 --------- CORRECT 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 --------- CORRECT ANSWER ----- C. Respiratory acidosis A fetus at 36 weeks receives a biophysical profile (BBP) score of 6. The amniotic fluid was scored as normal. The expected management is A. Immediate delivery B. Repeat the test in 24 hours C. Schedule the next test in one week --------- CORRECT ANSWER ----- B. Repeat the test in 24 hours A woman with gestational diabetes is 38 weeks gestation. Her Biophysical Profile score is 4. This indicates need for A. Follow up in one week B. Induction of labor C. Emergent cesarean section --------- CORRECT ANSWER ----- B. Induction of labor A 35 week gestation fetus is having an NST. The fetal heart rate baseline is 130 bpm. The nurse is using vibroacoustic stimulation to reduce the length of time needed to obtain the NST. Fetal well-being requires A. 1 acceleration to 145 bpm B. 2 accelerations to 140 bpm C. 2 accelerations to at least 145 bpm --------- CORRECT ANSWER ----- C. 2 accelerations to at least 145 bpm A woman desires a natural childbirth. The nurse puts pressure on her to get an epidural. This is an example of going against which ethical principle? A. Autonomy B. Beneficence C. Justice --------- CORRECT ANSWER ----- A. Autonomy One characteristic of a high reliability perinatal unit is A. Alarms can only be called by unit leaders B. Reliance on memorization of protocols C. The organization creates a safety-oriented culture --------- CORRECT ANSWER ----- C. The organization creates a safety-oriented culture One example of evidence-based practice related to fetal monitoring is A. Diagnosis of uterine rupture with an IUPC B. Intermittent auscultation for the low-risk patient C. Using electronic fetal monitoring to prevent cerebral palsy --------- CORRECT ANSWER ----- B. Intermittent auscultation for the low-risk patient Supporting the parents decision to choose no extraordinary measures on their baby who is about to deliver at 24 3/7 weeks gestation despite the nurses personal opinion is an example of A. Autonomy B. Beneficence C. Non-maleficence --------- CORRECT ANSWER ----- A. Autonomy _______ primarily function(s) to regulate respiratory activity and control circulation by responding to changes in arterial PO2, PCO2, and acid-base balance. A. Baroreceptors B. Chemoreceptors C. Cardioregulatory center --------- CORRECT ANSWER ----- B. Chemoreceptors _______ are protective stretch receptors located in the aortic arch and the carotid sinuses at the bifurcation of the external and internal carotid arteries. A. Baroreceptors B. Chemoreceptors C. Arteries --------- CORRECT ANSWER ----- A. Baroreceptors _______ respond to increases in fetal arterial blood pressure by detecting the amount of stretch and sending impulses via the vagus nerve to the midbrain, decreasing FHR, CO, and BP. A. Baroreceptors B. Chemoreceptors C. Veins --------- CORRECT ANSWER ----- A. Baroreceptors As a contraction beings, partial umbilical cord compression causes occlusion of the low-pressure 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 --------- CORRECT 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 --------- CORRECT ANSWER ----- B. Decrease Central _______ are located in the medulla oblongata; peripheral _______ are found in the carotid sinuses and aortic arch. A. Baroreceptors B. Chemoreceptors --------- CORRECT 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 --------- CORRECT ANSWER ----- A. Toward Because stroke volume in the fetus does not fluctuate significantly, fetal cardiac output is _______ fetal heart rate. A. Greater than B. Less than C. Approximately equal to --------- CORRECT ANSWER ----- C. Approximately equal to In _____ sleep, the fetus may be observed to have infrequent or absent body movements, normal FHR baseline, minimal variability, and a nonreactive NST, but may respond to external stimuli. Such typically occurs by 28 to 32 weeks' gestation. A. REM (active sleep state) B. Non-REM (quiet sleep state) --------- CORRECT ANSWER ----- B. Non-REM (quiet sleep state) Place the following steps for performing Leopold's maneuver in the appropriate order. 1. Assess location of fetal back 2. Determine the descent of the presenting part 3. Identify the presenting part 4. Assess part of the fetus in the upper uterus A. 1, 3, 2, 4 B. 2, 4, 1, 2 C. 4, 1, 3, 2 D. 4, 3, 2, 1 --------- CORRECT ANSWER ----- C. 4, 1, 3, 2 When the internal mode of monitoring (FSE, IUPC) is used, the information obtained on the uterine activity panel on the fetal monitor should be validated by the clinician by A. Asking the patient to report when she is feeling a contraction B. Ultrasound imaging C. Palpation --------- CORRECT ANSWER ----- C. Palpation Which of the following factors can have a negative effect on uterine blood flow? a. Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above --------- CORRECT ANSWER ----- e. All of the above How does the fetus compensate for decreased maternal circulating volume? a. Increases cardiac output by increasing stroke volume. b. Increases cardiac output by increasing it's heart rate. c. Increases cardiac output by increasing fetal movement. --------- CORRECT ANSWER ----- b. Increases cardiac output by increasing it's heart rate. Stimulating the vagus nerve typically produces: a. A decrease in the heart rate b. An increase in the heart rate c. An increase in stroke volume d. No change --------- CORRECT ANSWER ----- a. A decrease in the heart rate What initially causes a chemoreceptor response? a. Epidurals b. Supine maternal position c. Increased CO2 levels d. Decreased O2 levels e. A & C f. A & B g. C & D --------- CORRECT ANSWER ----- g. C & D The vagus nerve begins maturation 26 to 28 weeks. Its dominance results in what effect to the FHR baseline? a. Increases baseline b. Decreases baseline --------- CORRECT ANSWER ----- b. Decreases baseline T/F: Oxygen exchange in the placenta takes place in the intervillous space. --------- CORRECT ANSWER ----- True T/F: The parasympathetic nervous system is a cardioaccelerator. --------- CORRECT ANSWER ----- False T/F: Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure. --------- CORRECT ANSWER ----- True T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart rate: the ultrasound transducer and the fetal spiral electrode. --------- CORRECT ANSWER ----- True T/F: Variability can be determined with the fetoscope. --------- CORRECT ANSWER ----- False T/F: Because the ultrasound transducer and toco transducer are sealed units, they can be dipped in warm water to make cleaning easier. --------- CORRECT ANSWER ----- False T/F: The most common artifact with the ultrasound transducer system for fetal heart rate is increased variability. --------- CORRECT ANSWER ----- True T/F: All fetal monitors contain a logic system designed to reject artifact. --------- CORRECT ANSWER ----- True T/F: The monitor should always be tested before starting a tracing, either external or internal mode and labeled a test. --------- CORRECT ANSWER ----- True T/F: The paper speed on the fetal monitor should always be set at 1cm/min. --------- CORRECT ANSWER ----- False T/F: Both internal and external monitoring methods are equally accurate means of obtaining the fetal heart rate and contraction patterns. --------- CORRECT ANSWER ----- False T/F: The external toco is usually placed over the uterine fundus to pick up contractions. --------- CORRECT ANSWER ----- True T/F: The external toco gives measurable uterine pressure. --------- CORRECT ANSWER ----- False T/F: The fetal spiral electrode can be placed when vaginal bleeding of unknown origin is present. --------- CORRECT ANSWER ----- False T/F: The ultrasound transducer is usually placed on the side of the uterus over the baby's back, as the fetal heart is heard best there. --------- CORRECT ANSWER ----- True T/F: The spiral electrode is used to more accurately determine the frequency, duration, and intensity of uterine contractions. --------- CORRECT ANSWER ----- False T/F: The heart rate from a well-applied fetal spiral electrode can only be fetal, not maternal. --------- CORRECT ANSWER ----- False T/F: The intrauterine catheter is used to pick up the fetal heart rate. --------- CORRECT ANSWER ----- False T/F: The internal spiral electrode may pick up the maternal heart rate if the baby has died. --------- CORRECT ANSWER ----- True T/F: Fetal arrhythmias can be seen on both internal and external monitor tracings. --------- CORRECT ANSWER ----- True T/F: Variability and periodic changes can be detected with both internal and external monitoring. --------- CORRECT ANSWER ----- True T/F: Variable decelerations are a result of cord compression. --------- CORRECT ANSWER ----- True T/F: The presence of FHR accelerations in the intrapartum and antepartum periods is a sign of adequate fetal oxygenation. --------- CORRECT ANSWER ----- True T/F: Variable decelerations are a vagal response. --------- CORRECT ANSWER ----- True T/F: Late decelerations have a gradual decrease in FHR (onset to nadir 30 seconds) and are delayed in timing with the nadir of the deceleration occurring after the peak of the contraction. --------- CORRECT ANSWER ----- True T/F: The fetal heart rate baseline can be determined during periods of marked variability. --------- CORRECT ANSWER ----- False T/F: Anything that affects maternal blood flow (cardiac output) can affect the blood flow through the placenta. --------- CORRECT ANSWER ----- True T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor. --------- CORRECT ANSWER ----- True T/F: Minimal variability is always an indicator of hypoxia and a Cesarean section is indicated. --------- CORRECT ANSWER ----- False What is your first intervention in management of a patient experiencing variable decelerations? a. Immediate delivery b. Change maternal position c. No treatment indicated d. Oxygen e. Stop oxytocin infusion --------- CORRECT ANSWER ----- b. Change maternal position Etiology of a baseline FHR of 165bpm occurring for the last hour can be: 1. Maternal supine hypotension 2. Maternal fever 3. Maternal dehydration 4. Unknown a. 1 and 2 b. 1, 2 and 3 c. 2, 3 and 4 --------- CORRECT ANSWER ----- c. 2, 3 and 4 What is the most probable cause of recurrent late decelerations? a. Utero-placental insufficiency b. Head compression c. Cord compression d. Maternal position change --------- CORRECT ANSWER ----- a. Utero-placental insufficiency The most prevalent risk factor associated with fetal death before the onset of labor is: a. Low socioeconomic status b. Fetal malpresentation c. Uteroplacental insufficiency d. Uterine anomalies --------- CORRE