NCC C-EFM Study Guide – Latest 2025/2026
Exam Prep & Practice Questions
Causes of fetal heart rate (FHR) changes not related directly to fetal oxygenation can
include fetal sleep cycles, extreme prematurity, and maternal conditions such as:
a. fever and infection
b. medication and positioning
c. substance abuse and fever - correct answera. fever and infection
are maternal conditions that can affect the fetal heart rate without being related to fetal
oxygenation.
Medication can trigger nonhypoxic changes in fetal heart rate, but maternal conditions
such as positioning can cause hypoxia through umbilical cord compression.
Maternal substance abuse could lead to hypoxia while a maternal fever is associated
with nonhypoxic fetal heart rate changes
The mechanism for placental transport of oxygen and carbon dioxide is
a. active transport
b. facilitated diffusion
c. passive diffusion - correct answerc. passive diffusion
A fetal death occurred less than a week after a negative contraction stress test. The
original finding would be considered
a. equivocal
b. false negative
c. false positive - correct answerb. false negative
According to Murta and colleagues, elevates arginine vasopressin levels are implicated
in
a. saltatory patterns
b. sinister heart patterns
c. sinosoidal patterns - correct answerc. sinosoidal patterns
A saltatory pattern which shows excessive fetal heart rate variability in brief intervals is
indicative of
a. compensation
b. deterioration
c. mild hypoxic stress - correct answerc. mild hypoxic stress
The quantification of bradycardia is based on
a. actual fetal heart rate in beats per minute
b. average of the baseline rate in ten minute period
c. duration of time the heart rate is below 90 - correct answera. actual fetal heart rate in
beats per minute
,Studies have shows pulse oximetry as an adjunct surveillance method has what impact
on the incidence of cesarean deliveries?
a. decreases the rate
b. has no effect
c. requires more study - correct answerb. has no effect
A tracing shows fetal bradycardia. The most likely cause for this fetal heart rate tracing
is
a. heart block
b. sleep
c. traumatic brain injury - correct answera. heart block
Many severely anemic. Rh-affected fetuses do not have a sinusoidal pattern but do
have a round blunted pattern and
a. absent accelerations
b. magnified variability peaks
c. fixed baseline rate - correct answera. absent accelerations
The STAN system of fetal monitoring persons a computer analysis of the fetal ECG
specific to the detection of changes in the
a. QRS amplitude
b. R-R interval
c. ST segment - correct answerc. ST segment
A prolonged deceleration resulting in a new baseline bradycardia may result from vagal
activity in response to fetal
a. anemia
b. heart block
c. hypoxia - correct answerc. hypoxia
Studies have shown that in the low risk population, electronic fetal monitoring vs.
auscultation regarding the incidence of perinatal mortality is
a. higher
b. lower
c. the same - correct answerc. the same
When the amplitude range of FHR is undetectable, it would be documented as
a. absent
b. decreased
c. indeterminate - correct answera. absent
If head compression leads to early decelerations, management should include
a. allowing the woman to rest
b. having the woman push with alternate contractions
c. repositioning the woman in the left lateral position - correct answerb. having the
woman push with alternate contractions
,Cerebral tissue acidosis is not likely in a fetus demonstrating late decelerations on a
fetal heart rate monitor if
a. baseline rate is normal
b. moderate variability is present
c. the decelerations are subtle - correct answerb. moderate variability is present
The irregularities of baseline variability represent the slight differences in the time
intervals and the calculated FHR that occur
a. beat to beat
b. in response to PO2 changes
c. with each electrical impulse - correct answera. beat to beat
Fetuses with aneuploidy, hypo plastic lungs, meningomyelocele or hydrocephalus
demonstrates FHR patters that typically
a. are no different from normal fetuses
b. often sinusoidal
c. show signs of worsening hypoxia with progressing labor - correct answera. are no
different from normal fetuses
Decelerations are considered recurrent if they occur with more than 50% of uterine
contractions within what time threshold?
a. 10 minutes
b. 20 minutes
c. 30 minutes - correct answerb. 20 minutes
Regular frequency and amplitude of the FHR baseline are characteristic of
a. normal fetal heart rate baseline
b. a sinusoidal pattern
c. moderate variability - correct answerb. sinusoidal pattern
When a late deceleration occurs, a decrease in uterine blood flow leaves the fetus
unable to extract sufficient oxygen leading to
a. damage to fetal endothelial tissue
b. decreased fetal breathing movement
c. depressed myocardial action - correct answerc. depressed myocardial action
An acceleration that lasts for more than 10 minutes is called
a. a baseline change
b. a prolonged acceleration
c. tachycardia - correct answera. a baseline change
Administration of a narcotic to a woman in labor is likely to result in
a. late decelerations
b. minimal or even variability
c. smooth sine wave like activity - correct answerb. minimal or even variability
, As a predictor of significant neurologic morbidity such as cerebral palsy, EFM has
a. low false positive rate
b. negative predictive value
c. very poor specificity - correct answerc. very poor specificity
A tracing shows bradycardia with absent variability and no decals. The underlying cause
for this tracing is most consistent with
a. absent cerebral cortex
b. AV malformation
c. fetal hemorrhage - correct answera. absent cerebral cortex
With decelerations, the decrease or increase in FHR is calculated in relationship to
a. baseline
b. uterine intensity
c. variability - correct answera. baseline
Incorrect intermittent auscultation is rarely used in modern obstetrics because of cost
and
a. availability of nurses
b. inconsistent practice
c. patient demand for EFM - correct answera. availability of nurses
The paper speed used with electronic fetal monitors in America is
a. 1 cm/min
b. 2 cm/min
c. 3 cm/min - correct answerc. 3 cm/min
Tachycardia with minimal variability causes concern for
a. fetal acidemia
b. misplacement of ultrasound transducer
c. double counting go fetal heart rate - correct answera. fetal acidemia
The infant with identified bradycardia now has minimal variability. What is the most likely
intervention?
a. prompt delivery
b. administering oxytocin
c. vaginal exam - correct answera. prompt delivery
A change in fetal heart rate that is "periodic" occurs
a. once in a while
b. with contractions
c. not with contractions - correct answerb. with contractions
A change in fetal heart rate that is "episodic" occurs
a. once in a while
Exam Prep & Practice Questions
Causes of fetal heart rate (FHR) changes not related directly to fetal oxygenation can
include fetal sleep cycles, extreme prematurity, and maternal conditions such as:
a. fever and infection
b. medication and positioning
c. substance abuse and fever - correct answera. fever and infection
are maternal conditions that can affect the fetal heart rate without being related to fetal
oxygenation.
Medication can trigger nonhypoxic changes in fetal heart rate, but maternal conditions
such as positioning can cause hypoxia through umbilical cord compression.
Maternal substance abuse could lead to hypoxia while a maternal fever is associated
with nonhypoxic fetal heart rate changes
The mechanism for placental transport of oxygen and carbon dioxide is
a. active transport
b. facilitated diffusion
c. passive diffusion - correct answerc. passive diffusion
A fetal death occurred less than a week after a negative contraction stress test. The
original finding would be considered
a. equivocal
b. false negative
c. false positive - correct answerb. false negative
According to Murta and colleagues, elevates arginine vasopressin levels are implicated
in
a. saltatory patterns
b. sinister heart patterns
c. sinosoidal patterns - correct answerc. sinosoidal patterns
A saltatory pattern which shows excessive fetal heart rate variability in brief intervals is
indicative of
a. compensation
b. deterioration
c. mild hypoxic stress - correct answerc. mild hypoxic stress
The quantification of bradycardia is based on
a. actual fetal heart rate in beats per minute
b. average of the baseline rate in ten minute period
c. duration of time the heart rate is below 90 - correct answera. actual fetal heart rate in
beats per minute
,Studies have shows pulse oximetry as an adjunct surveillance method has what impact
on the incidence of cesarean deliveries?
a. decreases the rate
b. has no effect
c. requires more study - correct answerb. has no effect
A tracing shows fetal bradycardia. The most likely cause for this fetal heart rate tracing
is
a. heart block
b. sleep
c. traumatic brain injury - correct answera. heart block
Many severely anemic. Rh-affected fetuses do not have a sinusoidal pattern but do
have a round blunted pattern and
a. absent accelerations
b. magnified variability peaks
c. fixed baseline rate - correct answera. absent accelerations
The STAN system of fetal monitoring persons a computer analysis of the fetal ECG
specific to the detection of changes in the
a. QRS amplitude
b. R-R interval
c. ST segment - correct answerc. ST segment
A prolonged deceleration resulting in a new baseline bradycardia may result from vagal
activity in response to fetal
a. anemia
b. heart block
c. hypoxia - correct answerc. hypoxia
Studies have shown that in the low risk population, electronic fetal monitoring vs.
auscultation regarding the incidence of perinatal mortality is
a. higher
b. lower
c. the same - correct answerc. the same
When the amplitude range of FHR is undetectable, it would be documented as
a. absent
b. decreased
c. indeterminate - correct answera. absent
If head compression leads to early decelerations, management should include
a. allowing the woman to rest
b. having the woman push with alternate contractions
c. repositioning the woman in the left lateral position - correct answerb. having the
woman push with alternate contractions
,Cerebral tissue acidosis is not likely in a fetus demonstrating late decelerations on a
fetal heart rate monitor if
a. baseline rate is normal
b. moderate variability is present
c. the decelerations are subtle - correct answerb. moderate variability is present
The irregularities of baseline variability represent the slight differences in the time
intervals and the calculated FHR that occur
a. beat to beat
b. in response to PO2 changes
c. with each electrical impulse - correct answera. beat to beat
Fetuses with aneuploidy, hypo plastic lungs, meningomyelocele or hydrocephalus
demonstrates FHR patters that typically
a. are no different from normal fetuses
b. often sinusoidal
c. show signs of worsening hypoxia with progressing labor - correct answera. are no
different from normal fetuses
Decelerations are considered recurrent if they occur with more than 50% of uterine
contractions within what time threshold?
a. 10 minutes
b. 20 minutes
c. 30 minutes - correct answerb. 20 minutes
Regular frequency and amplitude of the FHR baseline are characteristic of
a. normal fetal heart rate baseline
b. a sinusoidal pattern
c. moderate variability - correct answerb. sinusoidal pattern
When a late deceleration occurs, a decrease in uterine blood flow leaves the fetus
unable to extract sufficient oxygen leading to
a. damage to fetal endothelial tissue
b. decreased fetal breathing movement
c. depressed myocardial action - correct answerc. depressed myocardial action
An acceleration that lasts for more than 10 minutes is called
a. a baseline change
b. a prolonged acceleration
c. tachycardia - correct answera. a baseline change
Administration of a narcotic to a woman in labor is likely to result in
a. late decelerations
b. minimal or even variability
c. smooth sine wave like activity - correct answerb. minimal or even variability
, As a predictor of significant neurologic morbidity such as cerebral palsy, EFM has
a. low false positive rate
b. negative predictive value
c. very poor specificity - correct answerc. very poor specificity
A tracing shows bradycardia with absent variability and no decals. The underlying cause
for this tracing is most consistent with
a. absent cerebral cortex
b. AV malformation
c. fetal hemorrhage - correct answera. absent cerebral cortex
With decelerations, the decrease or increase in FHR is calculated in relationship to
a. baseline
b. uterine intensity
c. variability - correct answera. baseline
Incorrect intermittent auscultation is rarely used in modern obstetrics because of cost
and
a. availability of nurses
b. inconsistent practice
c. patient demand for EFM - correct answera. availability of nurses
The paper speed used with electronic fetal monitors in America is
a. 1 cm/min
b. 2 cm/min
c. 3 cm/min - correct answerc. 3 cm/min
Tachycardia with minimal variability causes concern for
a. fetal acidemia
b. misplacement of ultrasound transducer
c. double counting go fetal heart rate - correct answera. fetal acidemia
The infant with identified bradycardia now has minimal variability. What is the most likely
intervention?
a. prompt delivery
b. administering oxytocin
c. vaginal exam - correct answera. prompt delivery
A change in fetal heart rate that is "periodic" occurs
a. once in a while
b. with contractions
c. not with contractions - correct answerb. with contractions
A change in fetal heart rate that is "episodic" occurs
a. once in a while
