NCC ELECTRONIC FETAL MONITORING
(EFM) CERTIFICATION REAL EXAM –
PRACTICE TEST & QUESTION BANK 2026|
INSTANT PDF DOWNLOAND
Overview:
This comprehensive 200-question Real exam is designed to prepare nurses, midwives, and
healthcare professionals for the NCC EFM Certification Exam 2026. The questions reflect
current clinical guidelines, evidence-based practice, and AWHONN standards.
The question bank covers:
Fetal Heart Rate (FHR) Monitoring
o Baseline, variability, accelerations, decelerations
o Interpretation of tracings
Types of Decelerations
o Early, late, variable, sinusoidal
Fetal Assessment Tools
o Nonstress Test (NST)
o Contraction Stress Test (CST)
o Biophysical Profile (BPP)
o Modified BPP
Maternal-Fetal Interventions
o Position changes
o Oxygen administration
o IV fluid management
o Pitocin adjustments
High-Risk Pregnancy Scenarios
o Uteroplacental insufficiency
o Fetal hypoxia
o Tachycardia and bradycardia management
Antepartum and Intrapartum Fetal Surveillance
o Indications, interpretation, and clinical decision-making
Fetal Resuscitation Measures
o Fetal scalp stimulation (FSE)
o Maternal interventions to improve oxygenation
, 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
Answer: b. Change maternal position
Rationale: Variable decelerations are usually caused by umbilical cord
compression. Changing maternal position can relieve pressure and improve fetal
oxygenation.
Etiology of a baseline FHR of 165 bpm 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
Answer: c. 2, 3 and 4
Rationale: Maternal fever, dehydration, or idiopathic causes may result in
fetal tachycardia. Supine hypotension usually causes bradycardia.
What is the most probable cause of recurrent late decelerations?
a. Utero-placental insufficiency
b. Head compression
c. Cord compression
d. Maternal position change
Answer: a. Utero-placental insufficiency
Rationale: Late decelerations are indicative of fetal hypoxemia due to impaired
uteroplacental blood flow.
The most prevalent risk factor associated with fetal death before labor is:
a. Low socioeconomic status
b. Fetal malpresentation
c. Uteroplacental insufficiency
,d. Uterine anomalies
Answer: c. Uteroplacental insufficiency
Rationale: Uteroplacental insufficiency is the leading cause of antepartum fetal
demise.
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
Answer: d. Maternal HCG levels
Rationale: Maternal HCG levels are not used for monitoring fetal well-being; they
are primarily used for pregnancy confirmation.
Which condition is not an indication for antepartum fetal surveillance?
a. Gestational hypertension
b. Diabetes in pregnancy
c. Fetus in breech presentation
d. Decreased fetal movement
Answer: c. Fetus in breech presentation
Rationale: Breech presentation alone is not an indication for surveillance unless
combined with other risk factors.
Which of the following does not affect the degree of fetal activity?
a. Vibroacoustic stimulation
b. Smoking
c. Fetal position
d. Gestational age
Answer: a. Vibroacoustic stimulation
Rationale: Vibroacoustic stimulation is used to elicit fetal responses, not a
determinant of baseline fetal activity.
To be considered reactive, a nonstress test must have:
a. 4 accelerations in 20 minutes
b. 2 accelerations in 10 minutes
c. 4 accelerations in 40 minutes
d. 2 accelerations in 20 minutes
Answer: d. 2 accelerations in 20 minutes
Rationale: A reactive NST requires at least 2 fetal heart rate accelerations of ≥15
bpm lasting ≥15 seconds over 20 minutes.
, If a nonstress test is nonreactive after 40 minutes, the next step should be:
a. Home fetal movement counts
b. Biophysical profile or contraction stress test
c. Repeat NST within a week
d. Admit for delivery
Answer: b. Biophysical profile or contraction stress test
Rationale: Nonreactive NST warrants further testing to assess fetal well-being.
All of the following are components of a biophysical profile except:
a. Contraction stress test
b. Fetal breathing assessment
c. Amniotic fluid volume
d. Fetal movement assessment
Answer: a. Contraction stress test
Rationale: A standard BPP uses ultrasound assessment; contraction stress testing
is separate.
A modified biophysical profile includes a nonstress test and:
a. Contraction stress test
b. Ultrasound assessment of fetal movement
c. Ultrasound assessment of amniotic fluid volume
d. Fetal movement counts
Answer: c. Ultrasound assessment of amniotic fluid volume
Rationale: Modified BPP focuses on NST and AFI to quickly assess fetal well-
being.
For a contraction stress test to be interpretable, minimum contractions
required are:
a. 5 in 10 min
b. 3 in 10 min
c. 4 in 10 min
d. 2 in 10 min
Answer: b. 3 in 10 min
Rationale: Adequate contractions ensure sufficient stress to evaluate fetal
response.
A negative contraction stress test is:
a. No contractions
b. Late decelerations >50% contractions
c. No late decelerations with contractions
(EFM) CERTIFICATION REAL EXAM –
PRACTICE TEST & QUESTION BANK 2026|
INSTANT PDF DOWNLOAND
Overview:
This comprehensive 200-question Real exam is designed to prepare nurses, midwives, and
healthcare professionals for the NCC EFM Certification Exam 2026. The questions reflect
current clinical guidelines, evidence-based practice, and AWHONN standards.
The question bank covers:
Fetal Heart Rate (FHR) Monitoring
o Baseline, variability, accelerations, decelerations
o Interpretation of tracings
Types of Decelerations
o Early, late, variable, sinusoidal
Fetal Assessment Tools
o Nonstress Test (NST)
o Contraction Stress Test (CST)
o Biophysical Profile (BPP)
o Modified BPP
Maternal-Fetal Interventions
o Position changes
o Oxygen administration
o IV fluid management
o Pitocin adjustments
High-Risk Pregnancy Scenarios
o Uteroplacental insufficiency
o Fetal hypoxia
o Tachycardia and bradycardia management
Antepartum and Intrapartum Fetal Surveillance
o Indications, interpretation, and clinical decision-making
Fetal Resuscitation Measures
o Fetal scalp stimulation (FSE)
o Maternal interventions to improve oxygenation
, 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
Answer: b. Change maternal position
Rationale: Variable decelerations are usually caused by umbilical cord
compression. Changing maternal position can relieve pressure and improve fetal
oxygenation.
Etiology of a baseline FHR of 165 bpm 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
Answer: c. 2, 3 and 4
Rationale: Maternal fever, dehydration, or idiopathic causes may result in
fetal tachycardia. Supine hypotension usually causes bradycardia.
What is the most probable cause of recurrent late decelerations?
a. Utero-placental insufficiency
b. Head compression
c. Cord compression
d. Maternal position change
Answer: a. Utero-placental insufficiency
Rationale: Late decelerations are indicative of fetal hypoxemia due to impaired
uteroplacental blood flow.
The most prevalent risk factor associated with fetal death before labor is:
a. Low socioeconomic status
b. Fetal malpresentation
c. Uteroplacental insufficiency
,d. Uterine anomalies
Answer: c. Uteroplacental insufficiency
Rationale: Uteroplacental insufficiency is the leading cause of antepartum fetal
demise.
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
Answer: d. Maternal HCG levels
Rationale: Maternal HCG levels are not used for monitoring fetal well-being; they
are primarily used for pregnancy confirmation.
Which condition is not an indication for antepartum fetal surveillance?
a. Gestational hypertension
b. Diabetes in pregnancy
c. Fetus in breech presentation
d. Decreased fetal movement
Answer: c. Fetus in breech presentation
Rationale: Breech presentation alone is not an indication for surveillance unless
combined with other risk factors.
Which of the following does not affect the degree of fetal activity?
a. Vibroacoustic stimulation
b. Smoking
c. Fetal position
d. Gestational age
Answer: a. Vibroacoustic stimulation
Rationale: Vibroacoustic stimulation is used to elicit fetal responses, not a
determinant of baseline fetal activity.
To be considered reactive, a nonstress test must have:
a. 4 accelerations in 20 minutes
b. 2 accelerations in 10 minutes
c. 4 accelerations in 40 minutes
d. 2 accelerations in 20 minutes
Answer: d. 2 accelerations in 20 minutes
Rationale: A reactive NST requires at least 2 fetal heart rate accelerations of ≥15
bpm lasting ≥15 seconds over 20 minutes.
, If a nonstress test is nonreactive after 40 minutes, the next step should be:
a. Home fetal movement counts
b. Biophysical profile or contraction stress test
c. Repeat NST within a week
d. Admit for delivery
Answer: b. Biophysical profile or contraction stress test
Rationale: Nonreactive NST warrants further testing to assess fetal well-being.
All of the following are components of a biophysical profile except:
a. Contraction stress test
b. Fetal breathing assessment
c. Amniotic fluid volume
d. Fetal movement assessment
Answer: a. Contraction stress test
Rationale: A standard BPP uses ultrasound assessment; contraction stress testing
is separate.
A modified biophysical profile includes a nonstress test and:
a. Contraction stress test
b. Ultrasound assessment of fetal movement
c. Ultrasound assessment of amniotic fluid volume
d. Fetal movement counts
Answer: c. Ultrasound assessment of amniotic fluid volume
Rationale: Modified BPP focuses on NST and AFI to quickly assess fetal well-
being.
For a contraction stress test to be interpretable, minimum contractions
required are:
a. 5 in 10 min
b. 3 in 10 min
c. 4 in 10 min
d. 2 in 10 min
Answer: b. 3 in 10 min
Rationale: Adequate contractions ensure sufficient stress to evaluate fetal
response.
A negative contraction stress test is:
a. No contractions
b. Late decelerations >50% contractions
c. No late decelerations with contractions
