2026 NCC EFM CERTIFICATION EXAM PRACTICE QUESTIONS
AND CORRECT ANSWERS | VERIFIED ANSWERS | LATEST
UPDATE 2026/2027 | GRADED A+
Question 1: 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.
Question 2: 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: 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.
,Question 3: 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.
Question 4: 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
term fetus with no accelerations or decelerations, it may indicate possible fetal hypoxia or acidemia and
requires further evaluation.
Question 5: 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
Answer: E
Rationale: All of these factors—hypertension, epidural anesthesia, hemorrhage, and diabetes—can
negatively affect uterine blood flow by altering maternal perfusion pressure, causing vasoconstriction,
or reducing circulating volume.
Question 6: How does the fetus compensate for decreased maternal circulating volume?
A. Increases cardiac output by increasing stroke volume
B. Increases cardiac output by increasing its heart rate
C. Increases cardiac output by increasing fetal movement
Answer: B
Rationale: The fetus compensates for decreased maternal circulating volume (and thus decreased
oxygen delivery) primarily by increasing its heart rate to maintain cardiac output, as stroke volume is
relatively fixed in the fetus.
Question 7: 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
, Answer: A
Rationale: The vagus nerve (parasympathetic) releases acetylcholine at the sinoatrial node, which slows
the heart rate. Vagal stimulation leads to bradycardia.
Question 8: 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
Answer: G
Rationale: Chemoreceptors in the carotid bodies and aortic arch respond primarily to changes in blood
gases; increased CO₂ levels (hypercapnia) and decreased O₂ levels (hypoxemia) initially trigger a
chemoreceptor response.
Question 9: The vagus nerve begins maturation at 26 to 28 weeks. Its dominance results in what effect
on the FHR baseline?
A. Increases baseline
B. Decreases baseline
AND CORRECT ANSWERS | VERIFIED ANSWERS | LATEST
UPDATE 2026/2027 | GRADED A+
Question 1: 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.
Question 2: 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: 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.
,Question 3: 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.
Question 4: 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
term fetus with no accelerations or decelerations, it may indicate possible fetal hypoxia or acidemia and
requires further evaluation.
Question 5: 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
Answer: E
Rationale: All of these factors—hypertension, epidural anesthesia, hemorrhage, and diabetes—can
negatively affect uterine blood flow by altering maternal perfusion pressure, causing vasoconstriction,
or reducing circulating volume.
Question 6: How does the fetus compensate for decreased maternal circulating volume?
A. Increases cardiac output by increasing stroke volume
B. Increases cardiac output by increasing its heart rate
C. Increases cardiac output by increasing fetal movement
Answer: B
Rationale: The fetus compensates for decreased maternal circulating volume (and thus decreased
oxygen delivery) primarily by increasing its heart rate to maintain cardiac output, as stroke volume is
relatively fixed in the fetus.
Question 7: 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
, Answer: A
Rationale: The vagus nerve (parasympathetic) releases acetylcholine at the sinoatrial node, which slows
the heart rate. Vagal stimulation leads to bradycardia.
Question 8: 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
Answer: G
Rationale: Chemoreceptors in the carotid bodies and aortic arch respond primarily to changes in blood
gases; increased CO₂ levels (hypercapnia) and decreased O₂ levels (hypoxemia) initially trigger a
chemoreceptor response.
Question 9: The vagus nerve begins maturation at 26 to 28 weeks. Its dominance results in what effect
on the FHR baseline?
A. Increases baseline
B. Decreases baseline
