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NCC Electronic Fetal Monitoring Certification Exam Prep 2025/2026 | Complete Study Guide with Verified Questions and Answers

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Ace your NCC Electronic Fetal Monitoring (EFM) Certification Exam with this comprehensive 2025/2026 study guide and practice set — designed to help you master fetal heart rate interpretation, maternal-fetal physiology, and intrapartum monitoring essentials. This resource provides verified exam-style questions with correct answers and detailed rationales, reflecting the most current NCC exam standards and clinical guidelines. Perfect for labor & delivery nurses, midwives, and perinatal professionals preparing for certification or refreshing EFM skills. What’s Inside: Updated 2025/2026 EFM questions and answers Comprehensive explanations and rationales for each question Coverage of fetal heart rate patterns, uterine activity, accelerations, decelerations, and interventions Realistic clinical case scenarios for deeper understanding Ideal for exam review, continuing education, and EFM recertification prep Gain the confidence and clinical insight needed to excel in fetal monitoring and pass your NCC EFM Certification Exam on your first attempt!

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NCC Electronic Fetal Monitoring Certification Exam Prep 2025/2026 |
Complete Study Guide with Verified Questions and Answers

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 answere. 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 answerb. 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 answera. 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 answerg. 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 answerb. Decreases baseline

T/F: Oxygen exchange in the placenta takes place in the intervillous space. - correct
answerTrue

T/F: The parasympathetic nervous system is a cardioaccelerator. - correct answerFalse

T/F: Baroreceptors are stretch receptors which respond to increases or decreases in
blood pressure. - correct answerTrue

,T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart rate:
the ultrasound transducer and the fetal spiral electrode. - correct answerTrue

T/F: Variability can be determined with the fetoscope. - correct answerFalse

T/F: Because the ultrasound transducer and toco transducer are sealed units, they can
be dipped in warm water to make cleaning easier. - correct answerFalse

T/F: The most common artifact with the ultrasound transducer system for fetal heart rate
is increased variability. - correct answerTrue

T/F: All fetal monitors contain a logic system designed to reject artifact. - correct
answerTrue

T/F: The monitor should always be tested before starting a tracing, either external or
internal mode and labeled a test. - correct answerTrue

T/F: The paper speed on the fetal monitor should always be set at 1cm/min. - correct
answerFalse

T/F: Both internal and external monitoring methods are equally accurate means of
obtaining the fetal heart rate and contraction patterns. - correct answerFalse

T/F: The external toco is usually placed over the uterine fundus to pick up contractions.
- correct answerTrue

T/F: The external toco gives measurable uterine pressure. - correct answerFalse

T/F: The fetal spiral electrode can be placed when vaginal bleeding of unknown origin is
present. - correct answerFalse

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 answerTrue

T/F: The spiral electrode is used to more accurately determine the frequency, duration,
and intensity of uterine contractions. - correct answerFalse

T/F: The heart rate from a well-applied fetal spiral electrode can only be fetal, not
maternal. - correct answerFalse

T/F: The intrauterine catheter is used to pick up the fetal heart rate. - correct
answerFalse

T/F: The internal spiral electrode may pick up the maternal heart rate if the baby has
died. - correct answerTrue

,T/F: Fetal arrhythmias can be seen on both internal and external monitor tracings. -
correct answerTrue

T/F: Variability and periodic changes can be detected with both internal and external
monitoring. - correct answerTrue

T/F: Variable decelerations are a result of cord compression. - correct answerTrue

T/F: The presence of FHR accelerations in the intrapartum and antepartum periods is a
sign of adequate fetal oxygenation. - correct answerTrue

T/F: Variable decelerations are a vagal response. - correct answerTrue

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 answerTrue

T/F: The fetal heart rate baseline can be determined during periods of marked
variability. - correct answerFalse

T/F: Anything that affects maternal blood flow (cardiac output) can affect the blood flow
through the placenta. - correct answerTrue

T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration
pattern in labor. - correct answerTrue

T/F: Minimal variability is always an indicator of hypoxia and a Cesarean section is
indicated. - correct answerFalse

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 answerb. 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 answerc. 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 answera. 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 - correct answerc. Uteroplacental insufficiency

Which of the following is NOT used for antepartum fetal surveillance?
a. Fetal movement counting
b. Antepartum fetal heart rate testing
c. Biophysical profile testing
d. Maternal HCG levels - correct answerd. Maternal HCG levels

Which of the following conditions is not an indication for antepartum fetal surveillance?
a. Gestational hypertension
b. Diabetes in pregnancy
c. Fetus in breech presentation
d. Decreased fetal movement - correct answerc. Fetus in breech presentation

Which of the following does not affect the degree of fetal activity?
a. Vibroacoustic stimulation
b. Smoking
c. Fetal position
d. Gestational age - correct answera. Vibroacoustic stimulation

To be considered reactive, a nonstress test must have:
a. 4 fetal heart rate accelerations in a 20 minute window
b. 2 fetal heart rate accelerations in a 10 minute window
c. 4 fetal heart rate accelerations in a 40 minute window
d. 2 fetal heart rate accelerations in a 20 minute window - correct answerd. 2 fetal heart
rate accelerations in a 20 minute window

If a nonstress test is nonreactive after 40 minutes, the next step should be:
a. Have the client go home and do fetal movement counts
b. Do a biophysical profile or contraction stress test
c. Repeat the nonstress test within a week
d. Admit the client for delivery - correct answerb. Do a biophysical profile or contraction
stress test

All of the following are components of a biophysical profile except:
a. Contraction stress test

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