NCC EFM CERTIFICATION SCRIPT 2026
QUESTIONS WITH SOLUTIONS GRADED A+
◍ Wireless EFM.
Answer: Allows continuous monitoring of FHR and UA w/o the pt being
tethered to the bedside monitor. Improving maternal comfort and mobility.
◍ Fetal respiratory academia is indicated by a pH of 7.04 and a PCO2 of?.
Answer: >60
◍ Oxygen is transferred from mom to fetus via the placenta through?.
Answer: Passive (Simple) Diffusion
◍ Intermediate NST.
Answer: Tracing shows some accelerations but not enough to meet reactive
criteria.
◍ likely cause of fetal tachy w/ moderate variability in a term fetus?.
Answer: maternal fever
◍ Fetal dysrhythmias.
Answer: 1) SVT: 210-300 bpm-tx w digoxin (↑ dose to cross
placenta)-concern w hydrops, CHF (heart stress), ↑ O2 demand & use, ↓
stroke volume, demise2) Congenital heart block (<60 bpm): 3rd degree →
concern w hydrops, lupus, CHF3) Ectopic beats: extra beats heard, benign,
may be transient
◍ FHR variability is dependent upon?.
Answer: cerebral oxygen and intact CNS
◍ An abrupt rise in fetal bp can stimulate?.
Answer: variable decels
◍ Initiate treatment for recurrent late decels w/ moderate variability during 1st
, stage?.
Answer: maternal repositioning
◍ Intervillous space perfusion is dependent on?.
Answer: Adequate Uterine Blood Flow
◍ Intrauterine pressure catheter (IUPC).
Answer: A catheter that measures uterine pressure during labor-measures
intensity of contractions & resting tone-requires ROM & dilation-can be
used for amnioinfusion-insert to 35-45 cm mark-troubleshooting: verify
position (check markings, have pt cough), flush catheter, recalibrate-risks:
placental or uterine perforation, infection
◍ FHR pattern likely to develop w/severe fetal anemia?.
Answer: sinusoidal
◍ Imbalance definitions.
Answer: 1) Hypoxia: ↓ O2 in tissue2) Hypoxemia: ↓ O2 in blood3)
Acidosis: ↑ H+ in tissue4) Acidemia: ↑ H+ in blood5) Asphyxia: hypoxia w
metabolic acidosis (causes organ damage)
◍ Category III tracing.
Answer: Predictive of abnormal acid base balance at that
moment-Sinusoidal rhythm: has to last ≥20min, r/t anemia (previa, bleeding,
abruption)-Absent variability WITH one of the following: bradycardia,
recurrent late or recurrent variable decels-Decide for c/s within 30min
◍ Mechanisms of variable decelerations.
Answer: Abruptness r/t pressure changes1) Vein obstruction → reflex
tachy-↓ venous return & cardiac output → hypotens → baroreceptor reflex ↑
in FHR to maintain BP2) Arterial obstruction → decreased FHR-obstructed
blood flow back to placenta → HTN → baroreceptor reflex of slowing FHR
to maintain BP
◍ Auscultation.
Answer: Intermittently listening to fetal heart sounds w fetoscope or doppler
to assess FHR-Detects baseline, rhythm, increases & decreases from
, baseline-Cannot determine variability or classify decels-Use of fetoscope
can verify presence of arrhythmia (most accurate) & clarifies halving or
doubling-Listen to FHR before, during, & for 30 sec after contraction-Feel
for mom's radial pulse to differentiate
◍ toco detects changes in?.
Answer: the shape of the uterine wall
◍ primary goal in treatment of late decels?.
Answer: maximize uteroplacentel blood flow
◍ complete heart block increases fetal risk for?.
Answer: neonatal pacemaker
◍ if baseline FHR is indeterminate, refer to prior?.
Answer: 10 min. window
◍ Fetal metabolic acidemia is indicated by an umbilical artery cord blood gas
pH of 6.94 & BE of?.
Answer: >-12
◍ Quality improvement.
Answer: Actions that lead to measurable improvement outcomes in pt care
areas-Standard of care: how qualified providers should act to prevent injury
or harm-EBP: best available practices based on research, guidelines, &
expertise-Validity: accuracy-Reliability: consistency
◍ Hypertension (HTN).
Answer: BP > 140/90-tx w Ca channel blockers, thiazides, BB-avoid ACE
inhibitors & ARBs (congenital defect)1) Chronic: present prior to
pregnancy-risk of superimposed preeclampsia, abruption, stroke (endothelial
damage to vessels), stress on L ventricle (to overcome pressure)2)
Gestational: begins after 20 wks, returns to normal PP (no proteinuria:
<300mg/<0.3 pcr)-↑ BP is sustained 6 hrs apart-risk of poor perfusion, SGA
◍ chemoreceptors respond mainly to?.
Answer: hypoxemia
, ◍ Fetal Hypoxia.
Answer: Low oxygen levels in the fetus. Caused by; Placental insufficiency,
maternal hypotension, uterine tachysystole, Cord Compression. EFM Signs:
Late Decels, Minimal/absent variability
◍ Tachysystole & pitocin.
Answer: With fetal tolerance-If not resolved in 15min, ↓ pit by 1/2-If not
resolved in another 15min, pause pit-If pit's off for <30 min, resume pit at
1/2 of current dose-If off for >30 min, start @ initial order doseWith fetal
intolerance: pit off immediately
◍ Arrest of labor.
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
◍ External tocodynamometer.
Answer: Detects changes in shape of the abdomen resulting from uterine
tension-place pressure sensor over the fundus at point of maximum
intensity-only monitors frequency & duration (does not monitor
intensity)-use in conjunction w palpation
◍ FHR characteristic most predictive of a vigorous baby at birth is?.
Answer: variability
◍ Moderate variability.
Answer: 6 to 25 bpm-Reliably predicts the absence of metabolic acidosis
(even w decels)
◍ Postdates pregnancy.
Answer: >42 wks-risk of oligo, ↓ placental perfusion, & meconium
aspiration-newborn appearance: peeling dry wrinkled skin, long nails,
thinner (weight loss)-↑ rate of c/s, recommended to induce at 41 wks-↑ late
decels (old placenta) & variables (oligo)
◍ The sympathetic branch of the ANS influences FHR to?.
Answer: increase
QUESTIONS WITH SOLUTIONS GRADED A+
◍ Wireless EFM.
Answer: Allows continuous monitoring of FHR and UA w/o the pt being
tethered to the bedside monitor. Improving maternal comfort and mobility.
◍ Fetal respiratory academia is indicated by a pH of 7.04 and a PCO2 of?.
Answer: >60
◍ Oxygen is transferred from mom to fetus via the placenta through?.
Answer: Passive (Simple) Diffusion
◍ Intermediate NST.
Answer: Tracing shows some accelerations but not enough to meet reactive
criteria.
◍ likely cause of fetal tachy w/ moderate variability in a term fetus?.
Answer: maternal fever
◍ Fetal dysrhythmias.
Answer: 1) SVT: 210-300 bpm-tx w digoxin (↑ dose to cross
placenta)-concern w hydrops, CHF (heart stress), ↑ O2 demand & use, ↓
stroke volume, demise2) Congenital heart block (<60 bpm): 3rd degree →
concern w hydrops, lupus, CHF3) Ectopic beats: extra beats heard, benign,
may be transient
◍ FHR variability is dependent upon?.
Answer: cerebral oxygen and intact CNS
◍ An abrupt rise in fetal bp can stimulate?.
Answer: variable decels
◍ Initiate treatment for recurrent late decels w/ moderate variability during 1st
, stage?.
Answer: maternal repositioning
◍ Intervillous space perfusion is dependent on?.
Answer: Adequate Uterine Blood Flow
◍ Intrauterine pressure catheter (IUPC).
Answer: A catheter that measures uterine pressure during labor-measures
intensity of contractions & resting tone-requires ROM & dilation-can be
used for amnioinfusion-insert to 35-45 cm mark-troubleshooting: verify
position (check markings, have pt cough), flush catheter, recalibrate-risks:
placental or uterine perforation, infection
◍ FHR pattern likely to develop w/severe fetal anemia?.
Answer: sinusoidal
◍ Imbalance definitions.
Answer: 1) Hypoxia: ↓ O2 in tissue2) Hypoxemia: ↓ O2 in blood3)
Acidosis: ↑ H+ in tissue4) Acidemia: ↑ H+ in blood5) Asphyxia: hypoxia w
metabolic acidosis (causes organ damage)
◍ Category III tracing.
Answer: Predictive of abnormal acid base balance at that
moment-Sinusoidal rhythm: has to last ≥20min, r/t anemia (previa, bleeding,
abruption)-Absent variability WITH one of the following: bradycardia,
recurrent late or recurrent variable decels-Decide for c/s within 30min
◍ Mechanisms of variable decelerations.
Answer: Abruptness r/t pressure changes1) Vein obstruction → reflex
tachy-↓ venous return & cardiac output → hypotens → baroreceptor reflex ↑
in FHR to maintain BP2) Arterial obstruction → decreased FHR-obstructed
blood flow back to placenta → HTN → baroreceptor reflex of slowing FHR
to maintain BP
◍ Auscultation.
Answer: Intermittently listening to fetal heart sounds w fetoscope or doppler
to assess FHR-Detects baseline, rhythm, increases & decreases from
, baseline-Cannot determine variability or classify decels-Use of fetoscope
can verify presence of arrhythmia (most accurate) & clarifies halving or
doubling-Listen to FHR before, during, & for 30 sec after contraction-Feel
for mom's radial pulse to differentiate
◍ toco detects changes in?.
Answer: the shape of the uterine wall
◍ primary goal in treatment of late decels?.
Answer: maximize uteroplacentel blood flow
◍ complete heart block increases fetal risk for?.
Answer: neonatal pacemaker
◍ if baseline FHR is indeterminate, refer to prior?.
Answer: 10 min. window
◍ Fetal metabolic acidemia is indicated by an umbilical artery cord blood gas
pH of 6.94 & BE of?.
Answer: >-12
◍ Quality improvement.
Answer: Actions that lead to measurable improvement outcomes in pt care
areas-Standard of care: how qualified providers should act to prevent injury
or harm-EBP: best available practices based on research, guidelines, &
expertise-Validity: accuracy-Reliability: consistency
◍ Hypertension (HTN).
Answer: BP > 140/90-tx w Ca channel blockers, thiazides, BB-avoid ACE
inhibitors & ARBs (congenital defect)1) Chronic: present prior to
pregnancy-risk of superimposed preeclampsia, abruption, stroke (endothelial
damage to vessels), stress on L ventricle (to overcome pressure)2)
Gestational: begins after 20 wks, returns to normal PP (no proteinuria:
<300mg/<0.3 pcr)-↑ BP is sustained 6 hrs apart-risk of poor perfusion, SGA
◍ chemoreceptors respond mainly to?.
Answer: hypoxemia
, ◍ Fetal Hypoxia.
Answer: Low oxygen levels in the fetus. Caused by; Placental insufficiency,
maternal hypotension, uterine tachysystole, Cord Compression. EFM Signs:
Late Decels, Minimal/absent variability
◍ Tachysystole & pitocin.
Answer: With fetal tolerance-If not resolved in 15min, ↓ pit by 1/2-If not
resolved in another 15min, pause pit-If pit's off for <30 min, resume pit at
1/2 of current dose-If off for >30 min, start @ initial order doseWith fetal
intolerance: pit off immediately
◍ Arrest of labor.
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
◍ External tocodynamometer.
Answer: Detects changes in shape of the abdomen resulting from uterine
tension-place pressure sensor over the fundus at point of maximum
intensity-only monitors frequency & duration (does not monitor
intensity)-use in conjunction w palpation
◍ FHR characteristic most predictive of a vigorous baby at birth is?.
Answer: variability
◍ Moderate variability.
Answer: 6 to 25 bpm-Reliably predicts the absence of metabolic acidosis
(even w decels)
◍ Postdates pregnancy.
Answer: >42 wks-risk of oligo, ↓ placental perfusion, & meconium
aspiration-newborn appearance: peeling dry wrinkled skin, long nails,
thinner (weight loss)-↑ rate of c/s, recommended to induce at 41 wks-↑ late
decels (old placenta) & variables (oligo)
◍ The sympathetic branch of the ANS influences FHR to?.
Answer: increase
