NCC EFM EXAM BREAKDOWN &
STUDY GUIDE QUESTIONS &
VERIFIED ANSWERS RATED 100%
CORRECT NEWEST VERSION
Content on exam - Correct Answer ✔✔ -Pattern recognition & intervention: 70%
-Physiology: 11%
-Fetal assessment methods: 9%
-EFM equipment: 5%
-Professional issues: 5%
Pattern recognition & intervention - Correct Answer ✔✔ -FHR baseline ✓
-FHR variability ✓
-FHR accelerations ✓
-FHR decelerations ✓
-Normal uterine activity ✓
-Abnormal uterine activity ✓
-Fetal dysrhythmias ✓
-Maternal complications ✓
-Uteroplacental complications ✓
-Fetal complications ✓
FHR Descriptors - Correct Answer ✔✔ 1) Baseline
2) Variability
3) Presence of accels
4) Presence of decels
5) Changes in trends overtime
FHR Baseline - Correct Answer ✔✔ Average FHR rounded to nearest 5 during a 10 min
window
-110 to 160
-excludes accels, decels, & marked variability
-must have 2 mins to identify as a baseline (doesn't need to be continuous)
Fetal Bradycardia - Correct Answer ✔✔ <110 for ≥10 min
-Causes: hypotension (ex: after epi), cord prolapse, head compression, congenital
defect, rapid descent, abruption or rupture, tachysystole, post dates, hypoglycemia,
lupus (heart block)
-With ↓ O2, blood will be shunted to brain, heart, & adrenals, eventually ↓ FHR to ↓ O2
demands of heart muscle
, -Verify not mom's HR, vaginal exam (r/o prolapse), resuscitate, evaluate arrhythmia,
expedite delivery
Fetal Tachycardia - Correct Answer ✔✔ >160 for ≥10 min
-Causes: fetal anemia, maternal fever or infection, fetal immaturity (preterm), SVT,
maternal anxiety (catecholamines), dehydration, hyperthyroid, hypoxia
-Med causes: terbutaline, catecholamines (epinephrine, norepi)
-Assess mom's temp & infection risk (GBS, PROM)
FHR Variability - Correct Answer ✔✔ Irregular in amplitude & frequency, quantified by
peak to trough
-Caused by sympathetic vs parasympathetic, r/t neuro maturity
-Less in preterm due to undeveloped CNS
-Absent: undetectable, flat
-Minimal: ≤5 bpm but detectable
-Moderate: 6-25 bpm
-Marked: >25 bpm (indeterminate baseline), significance unknown
Minimal variability - Correct Answer ✔✔ ≤5 bpm but detectable
Sleep, sedated, or sick
-Sleep cycle: 20-60 mins
-Sedated: CNS depressant (ex: mag), 1-2 hrs
-Sick (acidemia): unresolved w intervention
-Priority: maximize oxygenation (position, bolus, O2 if needed)
Moderate variability - Correct Answer ✔✔ 6 to 25 bpm
-Reliably predicts the absence of metabolic acidosis (even w decels)
FHR Accelerations - Correct Answer ✔✔ Reliably predicts absence of metabolic
acidemia (spontaneous or stimulated)
-Onset to peak in <30 sec
-For ≥32 wks: 15x15 (peak ≥15 bpm above baseline lasting ≥15 sec)
-For <32 wks: 10x10
-Prolonged accel: 2-9 mins (at 10 becomes change of baseline)
Early deceleration - Correct Answer ✔✔ Nadir aligns w contraction peak, gradual onset
(≥30 secs to nadir), benign vagal response
1) Pressure on fetal head
2) Increased intracranial pressure
3) Alteration in cerebral blood flow
4) Central vagal stimulation
5) FHR deceleration
Periodic vs Episodic - Correct Answer ✔✔ Periodic: caused by contractions
-recurrent: occurs w ≥50% of contractions in 20 min
-intermittent: w <50% of contractions in 20 mins
STUDY GUIDE QUESTIONS &
VERIFIED ANSWERS RATED 100%
CORRECT NEWEST VERSION
Content on exam - Correct Answer ✔✔ -Pattern recognition & intervention: 70%
-Physiology: 11%
-Fetal assessment methods: 9%
-EFM equipment: 5%
-Professional issues: 5%
Pattern recognition & intervention - Correct Answer ✔✔ -FHR baseline ✓
-FHR variability ✓
-FHR accelerations ✓
-FHR decelerations ✓
-Normal uterine activity ✓
-Abnormal uterine activity ✓
-Fetal dysrhythmias ✓
-Maternal complications ✓
-Uteroplacental complications ✓
-Fetal complications ✓
FHR Descriptors - Correct Answer ✔✔ 1) Baseline
2) Variability
3) Presence of accels
4) Presence of decels
5) Changes in trends overtime
FHR Baseline - Correct Answer ✔✔ Average FHR rounded to nearest 5 during a 10 min
window
-110 to 160
-excludes accels, decels, & marked variability
-must have 2 mins to identify as a baseline (doesn't need to be continuous)
Fetal Bradycardia - Correct Answer ✔✔ <110 for ≥10 min
-Causes: hypotension (ex: after epi), cord prolapse, head compression, congenital
defect, rapid descent, abruption or rupture, tachysystole, post dates, hypoglycemia,
lupus (heart block)
-With ↓ O2, blood will be shunted to brain, heart, & adrenals, eventually ↓ FHR to ↓ O2
demands of heart muscle
, -Verify not mom's HR, vaginal exam (r/o prolapse), resuscitate, evaluate arrhythmia,
expedite delivery
Fetal Tachycardia - Correct Answer ✔✔ >160 for ≥10 min
-Causes: fetal anemia, maternal fever or infection, fetal immaturity (preterm), SVT,
maternal anxiety (catecholamines), dehydration, hyperthyroid, hypoxia
-Med causes: terbutaline, catecholamines (epinephrine, norepi)
-Assess mom's temp & infection risk (GBS, PROM)
FHR Variability - Correct Answer ✔✔ Irregular in amplitude & frequency, quantified by
peak to trough
-Caused by sympathetic vs parasympathetic, r/t neuro maturity
-Less in preterm due to undeveloped CNS
-Absent: undetectable, flat
-Minimal: ≤5 bpm but detectable
-Moderate: 6-25 bpm
-Marked: >25 bpm (indeterminate baseline), significance unknown
Minimal variability - Correct Answer ✔✔ ≤5 bpm but detectable
Sleep, sedated, or sick
-Sleep cycle: 20-60 mins
-Sedated: CNS depressant (ex: mag), 1-2 hrs
-Sick (acidemia): unresolved w intervention
-Priority: maximize oxygenation (position, bolus, O2 if needed)
Moderate variability - Correct Answer ✔✔ 6 to 25 bpm
-Reliably predicts the absence of metabolic acidosis (even w decels)
FHR Accelerations - Correct Answer ✔✔ Reliably predicts absence of metabolic
acidemia (spontaneous or stimulated)
-Onset to peak in <30 sec
-For ≥32 wks: 15x15 (peak ≥15 bpm above baseline lasting ≥15 sec)
-For <32 wks: 10x10
-Prolonged accel: 2-9 mins (at 10 becomes change of baseline)
Early deceleration - Correct Answer ✔✔ Nadir aligns w contraction peak, gradual onset
(≥30 secs to nadir), benign vagal response
1) Pressure on fetal head
2) Increased intracranial pressure
3) Alteration in cerebral blood flow
4) Central vagal stimulation
5) FHR deceleration
Periodic vs Episodic - Correct Answer ✔✔ Periodic: caused by contractions
-recurrent: occurs w ≥50% of contractions in 20 min
-intermittent: w <50% of contractions in 20 mins
