National Certification Corporation (NCC)
Electronic Fetal Monitoring Examination
Questions And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A |
Instant Download Pdf
1. A 29-year-old primigravida at 40 weeks of gestation is in active labor. The
external fetal heart rate (FHR) tracing demonstrates a baseline of 135 beats
per minute (bpm), moderate variability, and accelerations present. The
patient's cervix is 6 cm dilated, and she is requesting an epidural for pain
management. Immediately following the administration of the epidural
bolus, the FHR tracing shows a decrease in the baseline to 110 bpm, a loss
of variability, and a sinusoidal-appearing pattern. The patient's blood
pressure is 90/60 mm Hg, and she reports feeling lightheaded. What is the
most appropriate initial nursing intervention for this patient?
A. Administer a bolus of intravenous crystalloid solution.
B. Place the patient in a left lateral position.
C. Administer oxygen via a non-rebreather face mask at 10 L/min.
D. Discontinue the epidural infusion and prepare for an emergency cesarean
section.
Answer: B
Rationale: The clinical scenario describes a classic presentation of aortocaval
compression exacerbated by the sympathectomy induced by the epidural bolus,
leading to maternal hypotension and subsequent uteroplacental insufficiency.
The fetal tracing showing a sinusoidal pattern, bradycardia, and loss of
variability is a critical sign of fetal hypoxia. The immediate priority is to relieve
the compression of the inferior vena cava and aorta by repositioning the patient
,to the left lateral position. This is the first-line, most rapid, and non-invasive
intervention to restore uterine blood flow. While administering a fluid bolus and
oxygen are also appropriate subsequent steps, the positioning is the immediate
and primary action to correct the physiological cause of the hypotension.
Discontinuing the epidural is not the first action, and preparing for cesarean is
premature without first attempting intrauterine resuscitation.
2. A fetal heart rate tracing shows a baseline rate of 155 bpm. The variability is
minimal. There are no accelerations present. Spontaneous late
decelerations are noted with a gradual decrease and return to baseline,
with the nadir of the deceleration occurring after the peak of the uterine
contraction. The patient is at 7 cm dilatation. What is the appropriate
interpretation and management of this tracing?
A. Category I; continue to monitor as this is a reassuring pattern.
B. Category II; suggest performing a fetal scalp stimulation to assess for fetal well-
being.
C. Category III; recommend immediate preparation for expedited delivery.
D. Category II; administer terbutaline to reduce uterine activity.
Answer: C
Rationale: The tracing describes a Category III fetal heart rate pattern. The
definition of a Category III tracing requires the presence of a sinusoidal pattern
OR an absent baseline variability AND any of the following: recurrent late
decelerations, recurrent variable decelerations, or bradycardia. This scenario
presents with minimal variability (which is less than moderate and categorized
as absent when no variability is present) and recurrent late decelerations, which
together meet the criteria for a Category III tracing. Category III tracings are
non-reassuring and indicate the potential for fetal acidemia; they require
immediate assessment and preparation for rapid intervention, which may
include expedited delivery. Category I requires moderate variability, which is
absent here. Category II would apply if the variability was moderate, or if the
decelerations were not recurrent.
, 3. A nurse is evaluating a fetal monitor tracing. The FHR baseline is 140 bpm.
The variability is described as fluctuating from 6 to 25 bpm. Accelerations
are present for 15 seconds and peak at 15 bpm above the baseline. There
are no decelerations. According to the NICHD guidelines, how should this
tracing be classified?
A. Category I
B. Category II
C. Category III
D. Indeterminate
Answer: A
Rationale: The criteria for a Category I fetal heart rate tracing are all of the
following: baseline rate between 110 and 160 bpm, moderate variability (6-25
bpm), accelerations present or absent, and no late or variable decelerations.
Early decelerations may be present or absent. The scenario describes a baseline
of 140 bpm, moderate variability (6-25 bpm), accelerations present, and no
decelerations. Therefore, it meets all the requirements for a Category I tracing,
which is a normal and reassuring pattern predicting a normal fetal acid-base
status at the time of observation.
4. A patient has an intrauterine pressure catheter (IUPC) in place. The nurse
notes that the resting tone is consistently measuring 30 mm Hg between
contractions. The contractions are occurring every 2-3 minutes and are
lasting 60-90 seconds, with a peak intensity of 80 mm Hg. Which of the
following is the primary concern with this uterine activity pattern?
A. The contraction frequency is too high.
B. The resting tone is elevated, indicating inadequate placental perfusion.
C. The contraction duration is too short.
D. The peak intensity is insufficient for adequate cervical dilation.
Answer: B
Rationale: Normal uterine resting tone should be less than 25 mm Hg. A resting
tone of 30 mm Hg is elevated, which can impair placental blood flow and lead to
, fetal hypoxia. This condition is often seen in uterine hyperstimulation or
tachysystole. While the frequency is high, the primary and most
pathophysiologically significant concern in this scenario is the elevated resting
tone. Elevated resting tone reduces the time for placental perfusion, increasing
the risk of fetal hypoxemia. The duration and intensity described are not the
primary concerns, as duration up to 90 seconds and intensity up to 80 mm Hg
are generally acceptable in active labor.
5. A nurse observes a fetal heart rate pattern with a baseline of 125 bpm.
There is a deceleration that has an abrupt onset and offset, a decrease of 30
bpm from the baseline, and lasts for 20 seconds. This deceleration is
variable in shape and is not consistently related to contractions. What is the
most probable physiological cause of this type of deceleration?
A. Fetal head compression.
B. Uteroplacental insufficiency.
C. Umbilical cord compression.
D. Maternal hypotension.
Answer: C
Ratiotionale: Variable decelerations are characterized by an abrupt decrease in
FHR from the baseline, with a rapid onset and recovery. Their variable shape
and timing in relation to uterine contractions are pathognomonic of umbilical
cord compression. The vagal response is triggered by compression of the
umbilical cord, leading to a reflex bradycardia. Fetal head compression typically
causes early decelerations, which are gradual in onset and offset. Uteroplacental
insufficiency results in late decelerations, which are also gradual and delayed
relative to the contraction. Maternal hypotension can lead to late decelerations
due to reduced blood flow, not the abrupt pattern seen here.
6. A patient is at 42 weeks of gestation and is undergoing a biophysical profile
(BPP) as part of a non-stress test (NST). The NST component of the BPP is
classified as reactive. The ultrasound assessment reveals one episode of
fetal breathing lasting 20 seconds, gross body movement, and a single
Electronic Fetal Monitoring Examination
Questions And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A |
Instant Download Pdf
1. A 29-year-old primigravida at 40 weeks of gestation is in active labor. The
external fetal heart rate (FHR) tracing demonstrates a baseline of 135 beats
per minute (bpm), moderate variability, and accelerations present. The
patient's cervix is 6 cm dilated, and she is requesting an epidural for pain
management. Immediately following the administration of the epidural
bolus, the FHR tracing shows a decrease in the baseline to 110 bpm, a loss
of variability, and a sinusoidal-appearing pattern. The patient's blood
pressure is 90/60 mm Hg, and she reports feeling lightheaded. What is the
most appropriate initial nursing intervention for this patient?
A. Administer a bolus of intravenous crystalloid solution.
B. Place the patient in a left lateral position.
C. Administer oxygen via a non-rebreather face mask at 10 L/min.
D. Discontinue the epidural infusion and prepare for an emergency cesarean
section.
Answer: B
Rationale: The clinical scenario describes a classic presentation of aortocaval
compression exacerbated by the sympathectomy induced by the epidural bolus,
leading to maternal hypotension and subsequent uteroplacental insufficiency.
The fetal tracing showing a sinusoidal pattern, bradycardia, and loss of
variability is a critical sign of fetal hypoxia. The immediate priority is to relieve
the compression of the inferior vena cava and aorta by repositioning the patient
,to the left lateral position. This is the first-line, most rapid, and non-invasive
intervention to restore uterine blood flow. While administering a fluid bolus and
oxygen are also appropriate subsequent steps, the positioning is the immediate
and primary action to correct the physiological cause of the hypotension.
Discontinuing the epidural is not the first action, and preparing for cesarean is
premature without first attempting intrauterine resuscitation.
2. A fetal heart rate tracing shows a baseline rate of 155 bpm. The variability is
minimal. There are no accelerations present. Spontaneous late
decelerations are noted with a gradual decrease and return to baseline,
with the nadir of the deceleration occurring after the peak of the uterine
contraction. The patient is at 7 cm dilatation. What is the appropriate
interpretation and management of this tracing?
A. Category I; continue to monitor as this is a reassuring pattern.
B. Category II; suggest performing a fetal scalp stimulation to assess for fetal well-
being.
C. Category III; recommend immediate preparation for expedited delivery.
D. Category II; administer terbutaline to reduce uterine activity.
Answer: C
Rationale: The tracing describes a Category III fetal heart rate pattern. The
definition of a Category III tracing requires the presence of a sinusoidal pattern
OR an absent baseline variability AND any of the following: recurrent late
decelerations, recurrent variable decelerations, or bradycardia. This scenario
presents with minimal variability (which is less than moderate and categorized
as absent when no variability is present) and recurrent late decelerations, which
together meet the criteria for a Category III tracing. Category III tracings are
non-reassuring and indicate the potential for fetal acidemia; they require
immediate assessment and preparation for rapid intervention, which may
include expedited delivery. Category I requires moderate variability, which is
absent here. Category II would apply if the variability was moderate, or if the
decelerations were not recurrent.
, 3. A nurse is evaluating a fetal monitor tracing. The FHR baseline is 140 bpm.
The variability is described as fluctuating from 6 to 25 bpm. Accelerations
are present for 15 seconds and peak at 15 bpm above the baseline. There
are no decelerations. According to the NICHD guidelines, how should this
tracing be classified?
A. Category I
B. Category II
C. Category III
D. Indeterminate
Answer: A
Rationale: The criteria for a Category I fetal heart rate tracing are all of the
following: baseline rate between 110 and 160 bpm, moderate variability (6-25
bpm), accelerations present or absent, and no late or variable decelerations.
Early decelerations may be present or absent. The scenario describes a baseline
of 140 bpm, moderate variability (6-25 bpm), accelerations present, and no
decelerations. Therefore, it meets all the requirements for a Category I tracing,
which is a normal and reassuring pattern predicting a normal fetal acid-base
status at the time of observation.
4. A patient has an intrauterine pressure catheter (IUPC) in place. The nurse
notes that the resting tone is consistently measuring 30 mm Hg between
contractions. The contractions are occurring every 2-3 minutes and are
lasting 60-90 seconds, with a peak intensity of 80 mm Hg. Which of the
following is the primary concern with this uterine activity pattern?
A. The contraction frequency is too high.
B. The resting tone is elevated, indicating inadequate placental perfusion.
C. The contraction duration is too short.
D. The peak intensity is insufficient for adequate cervical dilation.
Answer: B
Rationale: Normal uterine resting tone should be less than 25 mm Hg. A resting
tone of 30 mm Hg is elevated, which can impair placental blood flow and lead to
, fetal hypoxia. This condition is often seen in uterine hyperstimulation or
tachysystole. While the frequency is high, the primary and most
pathophysiologically significant concern in this scenario is the elevated resting
tone. Elevated resting tone reduces the time for placental perfusion, increasing
the risk of fetal hypoxemia. The duration and intensity described are not the
primary concerns, as duration up to 90 seconds and intensity up to 80 mm Hg
are generally acceptable in active labor.
5. A nurse observes a fetal heart rate pattern with a baseline of 125 bpm.
There is a deceleration that has an abrupt onset and offset, a decrease of 30
bpm from the baseline, and lasts for 20 seconds. This deceleration is
variable in shape and is not consistently related to contractions. What is the
most probable physiological cause of this type of deceleration?
A. Fetal head compression.
B. Uteroplacental insufficiency.
C. Umbilical cord compression.
D. Maternal hypotension.
Answer: C
Ratiotionale: Variable decelerations are characterized by an abrupt decrease in
FHR from the baseline, with a rapid onset and recovery. Their variable shape
and timing in relation to uterine contractions are pathognomonic of umbilical
cord compression. The vagal response is triggered by compression of the
umbilical cord, leading to a reflex bradycardia. Fetal head compression typically
causes early decelerations, which are gradual in onset and offset. Uteroplacental
insufficiency results in late decelerations, which are also gradual and delayed
relative to the contraction. Maternal hypotension can lead to late decelerations
due to reduced blood flow, not the abrupt pattern seen here.
6. A patient is at 42 weeks of gestation and is undergoing a biophysical profile
(BPP) as part of a non-stress test (NST). The NST component of the BPP is
classified as reactive. The ultrasound assessment reveals one episode of
fetal breathing lasting 20 seconds, gross body movement, and a single
