NCC C-EFM Electronic Fetal Monitoring Certification Exam Actual Exam
2026/2027 – 125 Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
Section A: Pattern Recognition and Intervention (70%) — 87 Questions
Q1: A term gestation patient is in active labor. The FHR tracing shows a baseline of 145
bpm, moderate variability (10–15 bpm), and no decelerations. Accelerations are present
with fetal movement. According to NICHD terminology, this tracing is classified as:
A. Category II (Indeterminate)
B. Category III (Abnormal)
C. Category I (Normal) [CORRECT]
D. Category 0 (Non-reassuring)
Correct Answer: C
Rationale: This tracing meets all Category I criteria: baseline 110–160 bpm, moderate
variability, no late or variable decelerations, and presence or absence of accelerations
does not change the category. Category II requires some but not all reassuring features,
,while Category III requires absent/minimal variability with recurrent late/variable
decelerations or a sinusoidal pattern.
Q2: A patient at 38 weeks gestation receiving oxytocin for labor augmentation develops
recurrent late decelerations with moderate variability. The baseline remains 135 bpm.
The priority nursing action is:
A. Increase the oxytocin infusion rate to strengthen contractions
B. Prepare for immediate cesarean delivery
C. Discontinue the oxytocin infusion to reduce uterine activity and improve placental
perfusion [CORRECT]
D. Administer terbutaline 0.25 mg subcutaneously
Correct Answer: C
Rationale: Late decelerations indicate uteroplacental insufficiency. The initial nursing
action with oxytocin infusion is to discontinue the infusion to reduce uterine activity and
allow placental perfusion to improve. Increasing oxytocin worsens the problem, and
terbutaline is not the first-line intervention when oxytocin is the causative agent.
,Q3: During labor, the FHR tracing demonstrates abrupt, visually apparent decreases in
FHR with rapid onset-to-nadir time of <30 seconds. The decelerations vary in shape,
timing, and depth, and the nadir occurs at variable times relative to the peak of
contractions. These findings are consistent with:
A. Early decelerations
B. Late decelerations
C. Variable decelerations [CORRECT]
D. Prolonged decelerations
Correct Answer: C
Rationale: Variable decelerations are characterized by abrupt onset, rapid descent (<30
seconds), variable shape, and variable timing relative to contractions. They are caused
by mechanical umbilical cord compression and are the most frequently observed
intrapartum deceleration pattern. Early decelerations are gradual and mirror
contractions; late decelerations are gradual with delayed timing.
Q4: A patient at 40 weeks gestation has been on continuous EFM for 45 minutes. The
baseline is 150 bpm with minimal variability (3–5 bpm) and no accelerations. The
patient reports the fetus was very active prior to admission. The most appropriate next
step is:
, A. Immediately notify the provider for expedited delivery
B. Continue monitoring, as fetal sleep cycles at term can last up to 60 minutes
[CORRECT]
C. Perform scalp stimulation and if no acceleration, proceed to delivery
D. Administer oxygen at 10 L/min via non-rebreather mask
Correct Answer: B
Rationale: Fetal sleep cycles typically last 20–40 minutes and can extend up to 60
minutes at 40 weeks gestation. Absence of accelerations for >45 minutes at 32 weeks
warrants further evaluation, but at term, a 45-minute period without accelerations with
an otherwise normal baseline may reflect a sleep cycle. Scalp stimulation or immediate
delivery is premature without additional concerning findings.
Q5: The FHR tracing shows a smooth, sine-wave-like undulating pattern with an
amplitude of 5–15 bpm and a frequency of 3–5 cycles per minute. The baseline is 140
bpm with absent variability. This pattern is classified as:
A. Marked variability
B. Sinusoidal pattern [CORRECT]
C. Saltatory pattern
2026/2027 – 125 Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
Section A: Pattern Recognition and Intervention (70%) — 87 Questions
Q1: A term gestation patient is in active labor. The FHR tracing shows a baseline of 145
bpm, moderate variability (10–15 bpm), and no decelerations. Accelerations are present
with fetal movement. According to NICHD terminology, this tracing is classified as:
A. Category II (Indeterminate)
B. Category III (Abnormal)
C. Category I (Normal) [CORRECT]
D. Category 0 (Non-reassuring)
Correct Answer: C
Rationale: This tracing meets all Category I criteria: baseline 110–160 bpm, moderate
variability, no late or variable decelerations, and presence or absence of accelerations
does not change the category. Category II requires some but not all reassuring features,
,while Category III requires absent/minimal variability with recurrent late/variable
decelerations or a sinusoidal pattern.
Q2: A patient at 38 weeks gestation receiving oxytocin for labor augmentation develops
recurrent late decelerations with moderate variability. The baseline remains 135 bpm.
The priority nursing action is:
A. Increase the oxytocin infusion rate to strengthen contractions
B. Prepare for immediate cesarean delivery
C. Discontinue the oxytocin infusion to reduce uterine activity and improve placental
perfusion [CORRECT]
D. Administer terbutaline 0.25 mg subcutaneously
Correct Answer: C
Rationale: Late decelerations indicate uteroplacental insufficiency. The initial nursing
action with oxytocin infusion is to discontinue the infusion to reduce uterine activity and
allow placental perfusion to improve. Increasing oxytocin worsens the problem, and
terbutaline is not the first-line intervention when oxytocin is the causative agent.
,Q3: During labor, the FHR tracing demonstrates abrupt, visually apparent decreases in
FHR with rapid onset-to-nadir time of <30 seconds. The decelerations vary in shape,
timing, and depth, and the nadir occurs at variable times relative to the peak of
contractions. These findings are consistent with:
A. Early decelerations
B. Late decelerations
C. Variable decelerations [CORRECT]
D. Prolonged decelerations
Correct Answer: C
Rationale: Variable decelerations are characterized by abrupt onset, rapid descent (<30
seconds), variable shape, and variable timing relative to contractions. They are caused
by mechanical umbilical cord compression and are the most frequently observed
intrapartum deceleration pattern. Early decelerations are gradual and mirror
contractions; late decelerations are gradual with delayed timing.
Q4: A patient at 40 weeks gestation has been on continuous EFM for 45 minutes. The
baseline is 150 bpm with minimal variability (3–5 bpm) and no accelerations. The
patient reports the fetus was very active prior to admission. The most appropriate next
step is:
, A. Immediately notify the provider for expedited delivery
B. Continue monitoring, as fetal sleep cycles at term can last up to 60 minutes
[CORRECT]
C. Perform scalp stimulation and if no acceleration, proceed to delivery
D. Administer oxygen at 10 L/min via non-rebreather mask
Correct Answer: B
Rationale: Fetal sleep cycles typically last 20–40 minutes and can extend up to 60
minutes at 40 weeks gestation. Absence of accelerations for >45 minutes at 32 weeks
warrants further evaluation, but at term, a 45-minute period without accelerations with
an otherwise normal baseline may reflect a sleep cycle. Scalp stimulation or immediate
delivery is premature without additional concerning findings.
Q5: The FHR tracing shows a smooth, sine-wave-like undulating pattern with an
amplitude of 5–15 bpm and a frequency of 3–5 cycles per minute. The baseline is 140
bpm with absent variability. This pattern is classified as:
A. Marked variability
B. Sinusoidal pattern [CORRECT]
C. Saltatory pattern
