NCC EFM Certification Exam ACTUAL
EXAM 2026/2027 | Electronic Fetal
Monitoring | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: NICHD Terminology & Definitions (25 Questions)
Q1: A fetal heart rate tracing shows a baseline of 155 bpm with fluctuations of 8-10 bpm above and
below the baseline. The fluctuations are irregular in amplitude and frequency. According to NICHD
terminology, how is the variability described?
A. Absent variability
B. Minimal variability
C. Moderate variability [CORRECT]
D. Marked variability
Correct Answer: C
Rationale: NICHD defines moderate variability as fluctuations in the baseline FHR of 6-25 bpm, which is a
reassuring sign of adequate fetal oxygenation and intact autonomic nervous system function.
Q2: A tracing demonstrates a baseline of 130 bpm with recurrent decelerations that begin after the peak
of the contraction, reach their nadir after the peak, and return to baseline after the contraction ends.
The shape is uniform and symmetrical. What is the correct NICHD classification?
A. Early decelerations
B. Variable decelerations
C. Late decelerations [CORRECT]
D. Prolonged decelerations
Correct Answer: C
,Rationale: Late decelerations are characterized by a gradual decrease in FHR with onset after the
contraction peak, nadir after the peak, and return to baseline after the contraction ends, indicating
uteroplacental insufficiency.
Q3: Which of the following FHR baseline rates falls within the NICHD-defined normal range?
A. 100 bpm
B. 118 bpm [CORRECT]
C. 162 bpm
D. 180 bpm
Correct Answer: B
Rationale: NICHD defines normal baseline FHR as 110-160 bpm; 118 bpm falls within this range, while
values below 110 are bradycardia and above 160 are tachycardia.
Q4: A tracing shows an abrupt increase in FHR from 140 to 165 bpm lasting 20 seconds before returning
to baseline. The acceleration meets all NICHD criteria. What is the minimum duration required for an
acceleration to be documented at gestational age ≥32 weeks?
A. 10 seconds
B. 15 seconds [CORRECT]
C. 20 seconds
D. 30 seconds
Correct Answer: B
Rationale: NICHD defines an acceleration at ≥32 weeks gestation as an abrupt increase in FHR with onset
to peak <30 seconds, with a peak ≥15 bpm above baseline lasting ≥15 seconds from onset to return.
Q5: A deceleration is observed with an abrupt onset, rapid drop to 90 bpm, and rapid return to baseline
within 30 seconds. The shape is variable and does not consistently mirror contractions. What is the
correct NICHD term?
A. Early deceleration
B. Late deceleration
C. Variable deceleration [CORRECT]
D. Prolonged deceleration
Correct Answer: C
,Rationale: Variable decelerations are defined by abrupt onset, rapid decrease to nadir <30 seconds,
variable relationship to contractions, and rapid return to baseline, typically caused by umbilical cord
compression.
Q6: According to NICHD, what is the maximum duration for a deceleration before it is classified as a
prolonged deceleration?
A. 1 minute
B. 2 minutes [CORRECT]
C. 5 minutes
D. 10 minutes
Correct Answer: B
Rationale: NICHD defines a prolonged deceleration as a decrease in FHR ≥15 bpm lasting ≥2 minutes but
<10 minutes; if it lasts ≥10 minutes, it represents a baseline change.
Q7: A tracing shows baseline 145 bpm with fluctuations of 3-5 bpm. According to NICHD terminology,
this variability is classified as:
A. Absent
B. Minimal [CORRECT]
C. Moderate
D. Marked
Correct Answer: B
Rationale: Minimal variability is defined as fluctuations in the baseline FHR of ≤5 bpm, which may
indicate fetal sleep cycles, medications, or early hypoxia.
Q8: Which of the following best describes "marked variability" per NICHD criteria?
A. Fluctuations of 6-10 bpm
B. Fluctuations of 11-25 bpm
C. Fluctuations >25 bpm [CORRECT]
D. Fluctuations >40 bpm
Correct Answer: C
, Rationale: Marked variability is defined as fluctuations in the baseline FHR >25 bpm, which is generally
considered benign but may occasionally precede fetal compromise.
Q9: A sinusoidal pattern is observed with baseline 135 bpm, absent variability, and smooth, sine wave-
like oscillations at 3-5 cycles per minute. This pattern is classified as:
A. Category I
B. Category II
C. Category III [CORRECT]
D. Indeterminate
Correct Answer: C
Rationale: A true sinusoidal pattern is classified as Category III by NICHD because it indicates severe fetal
anemia or hypoxia and requires immediate intervention.
Q10: According to NICHD, which of the following is NOT a required component for defining baseline
FHR?
A. Excluding periodic or episodic changes
B. Averaged over a 10-minute window
C. Must remain stable for at least 2 minutes
D. Must include accelerations [CORRECT]
Correct Answer: D
Rationale: NICHD baseline definition requires averaging over 10 minutes, excluding periodic/episodic
changes, with minimum 2 minutes of identifiable baseline; accelerations are not required for baseline
determination.
Q11: A deceleration begins simultaneously with the onset of contraction, reaches its lowest point at the
peak of contraction, and returns to baseline by the end of contraction. The shape is gradual and
symmetrical. This describes:
A. Early deceleration [CORRECT]
B. Late deceleration
C. Variable deceleration
D. Prolonged deceleration
Correct Answer: A
EXAM 2026/2027 | Electronic Fetal
Monitoring | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: NICHD Terminology & Definitions (25 Questions)
Q1: A fetal heart rate tracing shows a baseline of 155 bpm with fluctuations of 8-10 bpm above and
below the baseline. The fluctuations are irregular in amplitude and frequency. According to NICHD
terminology, how is the variability described?
A. Absent variability
B. Minimal variability
C. Moderate variability [CORRECT]
D. Marked variability
Correct Answer: C
Rationale: NICHD defines moderate variability as fluctuations in the baseline FHR of 6-25 bpm, which is a
reassuring sign of adequate fetal oxygenation and intact autonomic nervous system function.
Q2: A tracing demonstrates a baseline of 130 bpm with recurrent decelerations that begin after the peak
of the contraction, reach their nadir after the peak, and return to baseline after the contraction ends.
The shape is uniform and symmetrical. What is the correct NICHD classification?
A. Early decelerations
B. Variable decelerations
C. Late decelerations [CORRECT]
D. Prolonged decelerations
Correct Answer: C
,Rationale: Late decelerations are characterized by a gradual decrease in FHR with onset after the
contraction peak, nadir after the peak, and return to baseline after the contraction ends, indicating
uteroplacental insufficiency.
Q3: Which of the following FHR baseline rates falls within the NICHD-defined normal range?
A. 100 bpm
B. 118 bpm [CORRECT]
C. 162 bpm
D. 180 bpm
Correct Answer: B
Rationale: NICHD defines normal baseline FHR as 110-160 bpm; 118 bpm falls within this range, while
values below 110 are bradycardia and above 160 are tachycardia.
Q4: A tracing shows an abrupt increase in FHR from 140 to 165 bpm lasting 20 seconds before returning
to baseline. The acceleration meets all NICHD criteria. What is the minimum duration required for an
acceleration to be documented at gestational age ≥32 weeks?
A. 10 seconds
B. 15 seconds [CORRECT]
C. 20 seconds
D. 30 seconds
Correct Answer: B
Rationale: NICHD defines an acceleration at ≥32 weeks gestation as an abrupt increase in FHR with onset
to peak <30 seconds, with a peak ≥15 bpm above baseline lasting ≥15 seconds from onset to return.
Q5: A deceleration is observed with an abrupt onset, rapid drop to 90 bpm, and rapid return to baseline
within 30 seconds. The shape is variable and does not consistently mirror contractions. What is the
correct NICHD term?
A. Early deceleration
B. Late deceleration
C. Variable deceleration [CORRECT]
D. Prolonged deceleration
Correct Answer: C
,Rationale: Variable decelerations are defined by abrupt onset, rapid decrease to nadir <30 seconds,
variable relationship to contractions, and rapid return to baseline, typically caused by umbilical cord
compression.
Q6: According to NICHD, what is the maximum duration for a deceleration before it is classified as a
prolonged deceleration?
A. 1 minute
B. 2 minutes [CORRECT]
C. 5 minutes
D. 10 minutes
Correct Answer: B
Rationale: NICHD defines a prolonged deceleration as a decrease in FHR ≥15 bpm lasting ≥2 minutes but
<10 minutes; if it lasts ≥10 minutes, it represents a baseline change.
Q7: A tracing shows baseline 145 bpm with fluctuations of 3-5 bpm. According to NICHD terminology,
this variability is classified as:
A. Absent
B. Minimal [CORRECT]
C. Moderate
D. Marked
Correct Answer: B
Rationale: Minimal variability is defined as fluctuations in the baseline FHR of ≤5 bpm, which may
indicate fetal sleep cycles, medications, or early hypoxia.
Q8: Which of the following best describes "marked variability" per NICHD criteria?
A. Fluctuations of 6-10 bpm
B. Fluctuations of 11-25 bpm
C. Fluctuations >25 bpm [CORRECT]
D. Fluctuations >40 bpm
Correct Answer: C
, Rationale: Marked variability is defined as fluctuations in the baseline FHR >25 bpm, which is generally
considered benign but may occasionally precede fetal compromise.
Q9: A sinusoidal pattern is observed with baseline 135 bpm, absent variability, and smooth, sine wave-
like oscillations at 3-5 cycles per minute. This pattern is classified as:
A. Category I
B. Category II
C. Category III [CORRECT]
D. Indeterminate
Correct Answer: C
Rationale: A true sinusoidal pattern is classified as Category III by NICHD because it indicates severe fetal
anemia or hypoxia and requires immediate intervention.
Q10: According to NICHD, which of the following is NOT a required component for defining baseline
FHR?
A. Excluding periodic or episodic changes
B. Averaged over a 10-minute window
C. Must remain stable for at least 2 minutes
D. Must include accelerations [CORRECT]
Correct Answer: D
Rationale: NICHD baseline definition requires averaging over 10 minutes, excluding periodic/episodic
changes, with minimum 2 minutes of identifiable baseline; accelerations are not required for baseline
determination.
Q11: A deceleration begins simultaneously with the onset of contraction, reaches its lowest point at the
peak of contraction, and returns to baseline by the end of contraction. The shape is gradual and
symmetrical. This describes:
A. Early deceleration [CORRECT]
B. Late deceleration
C. Variable deceleration
D. Prolonged deceleration
Correct Answer: A
