EFM NCC PRACTISE EXAM| 102 QUESTIONS| WITH COMPLETE SOLUTIONS
Why use fetal monitoring? Correct Answer: Primary goal is to prevent fetal and maternal
morbidity and mortality (prevent injury and death to mother and/ or baby), to prevent bad patient
outcomes.
What percent of babies who experience a suboptimal event while being fetal monitored, develop
cerebral palsy? Correct Answer: 3% of babies with poor tracing develop cerebral palsy
What are most sentinel events due to? Correct Answer: Poor communication between providers.
Most errors are traceable back to communication errors.
Sentinel events Correct Answer: bad things that happen to patients due to a human or equipment
error, and not due to the reason that they came into the hospital (disease process)
Equipment Correct Answer: your hands (palpation) use fingertips, ultrasound transducer, FSE,
tocodynamometer, Intrauterine Pressure Catheter, Auscultation (fetoscope, hand held doppler
device).
What if you can not get contractions? Correct Answer: palpate and readjust
IUPC resting tone Correct Answer: 20-25
IUPC resting tone with aminoinfusion Correct Answer: should not be above 40, troubleshoot if
this is higher, weigh pads, make sure there is fluid return.
Not meant for meconium or thick mec, they are used for variables or recurrent variables Correct
Answer: amnioinfusion
Auscultation tools Correct Answer: intermittent monitoring, use fetoscope or hand help doppler
to trace.
Only true auscultation tool Correct Answer: fetoscope, the reason is it is the only tool that listens
to the open and close of the fetal heart valve
Using the doppler or fetoscope Correct Answer: count the FHR before, during, and after a
contraction. Document the baseline rate (range), regular vs irregular, increases or decreases. Do
NOT document variability, accels, or decels
doppler category 1 Correct Answer: normal FHR baseline, regular rhythm, presence of increases
from FHR baseline, no decreases from baseline
doppler category 2 Correct Answer: includes ANY of the following: irregular rhythm, presence
of FHR decreases, tachycardia, bradycardia (i feel the need to intervene, I feel like I can't walk
out of the room)
, doppler category 3 Correct Answer: there is none! auscultation because there is no variabile
determination with auscultation
goal of external EFM Correct Answer: external monitoring: goal is to detect fetal heart
movement (efm)
Autocorrelation Correct Answer: how the monitor adjusts with every third beat using a
mathematical formula, that it is still monitoring this baby. Detected what is normal for this baby
and is making the appropriate adjustments.
What does the FSE measure? Correct Answer: Directly monitors R to R ratio (with scalp lead),
definitively measures baby's heartbeat and when the heart is firing
Narrow R-R interval Correct Answer: fetal tachycardia
Prolonged R-R interval Correct Answer: fetal bradycardia
FSE contraindications Correct Answer: communicable diseases: hepatitis and HIV
Normal uterine activity Correct Answer: Normal activity: less than 5 ctx in a 10 minute period
averaged over a 30 minutes period (5,5,6 OK but 6,5,6 NOT OK)
Excessive uterine activity Correct Answer: Tachysystole (not hyperstim), hypertonus (with
IUPC resting tone does not go below 20 mmHG-IUPC, 20-25mmhg shouldn't be higher..if
higher usually due to inadequate relation time), inadequate relaxation time, tetanic
contractions(cxn greater than 2 minutes)
What do you do with tachysystole? Correct Answer: turn down pitocin (reposition etc)
Reduce blood flow through the intervillous space Correct Answer: Mild Contractions (30
mmHG)
No blood flow through the intervillous space Correct Answer: Moderate Contractions (50
mmHG)
Adequate MVUS Correct Answer: 200-300...greater than 200, spontaneous labor less than 280
for the first stage but up to 400 for the second stage. Typically less than 300 (so 200-300).
Importance of doing multiple interventions sooner than later Correct Answer: you see
tachysystole or deceleration, turn pitocin off & IV bolus & resposition. Multiple interventions
are important.
Why would it be in your best interest to bolus, turn off pit, and reposition? Correct Answer: will
resolve tachysystole and decelerations faster
Why use fetal monitoring? Correct Answer: Primary goal is to prevent fetal and maternal
morbidity and mortality (prevent injury and death to mother and/ or baby), to prevent bad patient
outcomes.
What percent of babies who experience a suboptimal event while being fetal monitored, develop
cerebral palsy? Correct Answer: 3% of babies with poor tracing develop cerebral palsy
What are most sentinel events due to? Correct Answer: Poor communication between providers.
Most errors are traceable back to communication errors.
Sentinel events Correct Answer: bad things that happen to patients due to a human or equipment
error, and not due to the reason that they came into the hospital (disease process)
Equipment Correct Answer: your hands (palpation) use fingertips, ultrasound transducer, FSE,
tocodynamometer, Intrauterine Pressure Catheter, Auscultation (fetoscope, hand held doppler
device).
What if you can not get contractions? Correct Answer: palpate and readjust
IUPC resting tone Correct Answer: 20-25
IUPC resting tone with aminoinfusion Correct Answer: should not be above 40, troubleshoot if
this is higher, weigh pads, make sure there is fluid return.
Not meant for meconium or thick mec, they are used for variables or recurrent variables Correct
Answer: amnioinfusion
Auscultation tools Correct Answer: intermittent monitoring, use fetoscope or hand help doppler
to trace.
Only true auscultation tool Correct Answer: fetoscope, the reason is it is the only tool that listens
to the open and close of the fetal heart valve
Using the doppler or fetoscope Correct Answer: count the FHR before, during, and after a
contraction. Document the baseline rate (range), regular vs irregular, increases or decreases. Do
NOT document variability, accels, or decels
doppler category 1 Correct Answer: normal FHR baseline, regular rhythm, presence of increases
from FHR baseline, no decreases from baseline
doppler category 2 Correct Answer: includes ANY of the following: irregular rhythm, presence
of FHR decreases, tachycardia, bradycardia (i feel the need to intervene, I feel like I can't walk
out of the room)
, doppler category 3 Correct Answer: there is none! auscultation because there is no variabile
determination with auscultation
goal of external EFM Correct Answer: external monitoring: goal is to detect fetal heart
movement (efm)
Autocorrelation Correct Answer: how the monitor adjusts with every third beat using a
mathematical formula, that it is still monitoring this baby. Detected what is normal for this baby
and is making the appropriate adjustments.
What does the FSE measure? Correct Answer: Directly monitors R to R ratio (with scalp lead),
definitively measures baby's heartbeat and when the heart is firing
Narrow R-R interval Correct Answer: fetal tachycardia
Prolonged R-R interval Correct Answer: fetal bradycardia
FSE contraindications Correct Answer: communicable diseases: hepatitis and HIV
Normal uterine activity Correct Answer: Normal activity: less than 5 ctx in a 10 minute period
averaged over a 30 minutes period (5,5,6 OK but 6,5,6 NOT OK)
Excessive uterine activity Correct Answer: Tachysystole (not hyperstim), hypertonus (with
IUPC resting tone does not go below 20 mmHG-IUPC, 20-25mmhg shouldn't be higher..if
higher usually due to inadequate relation time), inadequate relaxation time, tetanic
contractions(cxn greater than 2 minutes)
What do you do with tachysystole? Correct Answer: turn down pitocin (reposition etc)
Reduce blood flow through the intervillous space Correct Answer: Mild Contractions (30
mmHG)
No blood flow through the intervillous space Correct Answer: Moderate Contractions (50
mmHG)
Adequate MVUS Correct Answer: 200-300...greater than 200, spontaneous labor less than 280
for the first stage but up to 400 for the second stage. Typically less than 300 (so 200-300).
Importance of doing multiple interventions sooner than later Correct Answer: you see
tachysystole or deceleration, turn pitocin off & IV bolus & resposition. Multiple interventions
are important.
Why would it be in your best interest to bolus, turn off pit, and reposition? Correct Answer: will
resolve tachysystole and decelerations faster
