1|Page
NCC EFM EXAM BREAKDOWN &
STUDY GUIDE|| COMPREHENSIVE
Q&A FOR CERTIFICATION SUCCESS
2026
Tachysystole - correct-answer ->5 contractions in 10 mins averaged over 30 min
window
-tetanic contractions: >90 secs
-position change
-500 LR to dilute uterotonic
-↓ pitocin (see protocol)
-tocolytic (terbutaline)
-O2 if decel
Tachysystole & pitocin - correct-answer -With fetal tolerance
-If not resolved in 15min, ↓ pit by 1/2
-If not resolved in another 15min, pause pit
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-If pit's off for <30 min, resume pit at 1/2 of current dose
-If off for >30 min, start @ initial order dose
With fetal intolerance: pit off immediately
Hypertonous labor - correct-answer -Frequent & painful but poor quality
contractions occurring in latent labor
-despite increased tone, not enough pressure to cause cx change
-indicative of CPD or malpresentation
-tx: comfort care, pitocin, AROM
Hypotonic labor - correct-answer -Weak & insufficient labor occurring during the
active phase
-inadequate, infrequent, & less intense contractions don't dilate or efface cx
-caused by tired uterus or overdistention (poly, multiple gestation, LGA)
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Arrest of labor - correct-answer ->6cm dilated w/ ROM & one of the following w
no cx change:
-4 hrs of adequate contractions (>200 MVUs)
-6 hrs of inadequate contractions
Fetal dysrhythmias - correct-answer -1) SVT: 210-300 bpm
-tx w digoxin (↑ dose to cross placenta)
-concern w hydrops, CHF (heart stress), ↑ O2 demand & use, ↓ stroke volume,
demise
2) Congenital heart block (<60 bpm): 3rd degree → concern w hydrops, lupus, CHF
3) Ectopic beats: extra beats heard, benign, may be transient
Lupus (SLE) - correct-answer -Can cause congenital 3rd degree heart block
-bradycardia
-autoimmune → inflammatory response → overgrowth of collagen in heart
muscle
-damages fetal conduction system of the heart, attacks fetal tissue
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-usually diagnosed in 2nd trimester
Preterm labor - correct-answer -Cx dilation bw 20-36.6 wks
-late preterm: 34-36.6 wks
-common risk factors: multiples, previous PTD (greatest), uterine or cx
abnormalities, infection, <18 months bw pregnancies, IUGR
-↓ reserve & ↓ parasympathetic maturity
-↑ baseline, ↓ variability, ↑ variable decels
Treatment for preterm labor - correct-answer -1) Steroids (BMZ, DMZ): allows for
synthesis of surfactant & ↓ intracranial hemorrhage risk
-most beneficial after 48 hrs, effects last 1-2 wks, can give 2nd round after 2 wks
-↑ FHR, ↓ variability & accels
-↑ blood sugar & fluid retention
2) Terbutaline (betamimetic): delays PTD by 2-3 days to give steroids
-SE: hyperglycemia, hypotension, tachycardia
-Not given w ↑HR, bleeding, uncontrolled diabetes
NCC EFM EXAM BREAKDOWN &
STUDY GUIDE|| COMPREHENSIVE
Q&A FOR CERTIFICATION SUCCESS
2026
Tachysystole - correct-answer ->5 contractions in 10 mins averaged over 30 min
window
-tetanic contractions: >90 secs
-position change
-500 LR to dilute uterotonic
-↓ pitocin (see protocol)
-tocolytic (terbutaline)
-O2 if decel
Tachysystole & pitocin - correct-answer -With fetal tolerance
-If not resolved in 15min, ↓ pit by 1/2
-If not resolved in another 15min, pause pit
,2|Page
-If pit's off for <30 min, resume pit at 1/2 of current dose
-If off for >30 min, start @ initial order dose
With fetal intolerance: pit off immediately
Hypertonous labor - correct-answer -Frequent & painful but poor quality
contractions occurring in latent labor
-despite increased tone, not enough pressure to cause cx change
-indicative of CPD or malpresentation
-tx: comfort care, pitocin, AROM
Hypotonic labor - correct-answer -Weak & insufficient labor occurring during the
active phase
-inadequate, infrequent, & less intense contractions don't dilate or efface cx
-caused by tired uterus or overdistention (poly, multiple gestation, LGA)
,3|Page
Arrest of labor - correct-answer ->6cm dilated w/ ROM & one of the following w
no cx change:
-4 hrs of adequate contractions (>200 MVUs)
-6 hrs of inadequate contractions
Fetal dysrhythmias - correct-answer -1) SVT: 210-300 bpm
-tx w digoxin (↑ dose to cross placenta)
-concern w hydrops, CHF (heart stress), ↑ O2 demand & use, ↓ stroke volume,
demise
2) Congenital heart block (<60 bpm): 3rd degree → concern w hydrops, lupus, CHF
3) Ectopic beats: extra beats heard, benign, may be transient
Lupus (SLE) - correct-answer -Can cause congenital 3rd degree heart block
-bradycardia
-autoimmune → inflammatory response → overgrowth of collagen in heart
muscle
-damages fetal conduction system of the heart, attacks fetal tissue
, 4|Page
-usually diagnosed in 2nd trimester
Preterm labor - correct-answer -Cx dilation bw 20-36.6 wks
-late preterm: 34-36.6 wks
-common risk factors: multiples, previous PTD (greatest), uterine or cx
abnormalities, infection, <18 months bw pregnancies, IUGR
-↓ reserve & ↓ parasympathetic maturity
-↑ baseline, ↓ variability, ↑ variable decels
Treatment for preterm labor - correct-answer -1) Steroids (BMZ, DMZ): allows for
synthesis of surfactant & ↓ intracranial hemorrhage risk
-most beneficial after 48 hrs, effects last 1-2 wks, can give 2nd round after 2 wks
-↑ FHR, ↓ variability & accels
-↑ blood sugar & fluid retention
2) Terbutaline (betamimetic): delays PTD by 2-3 days to give steroids
-SE: hyperglycemia, hypotension, tachycardia
-Not given w ↑HR, bleeding, uncontrolled diabetes
