NCC EFM ELECTRONIC FETAL MONITORING EXAM
QUESTIONS WITH VERIFIED ANSWERS AND
RATIONALES AND A STUDY GUIDE VERIFIED
FOR GUARANTEED PASS
1. Which of the following factors can have a negative effect on uterine blood flow?
a. Hypertension
b. Epidural
c. Hemorrhage
d. Diabetes
e. All of the above – CORRECT ANSWER: e. All of the above
Rationale: Hypertension can reduce uteroplacental perfusion; epidurals can lead to
maternal hypotension; hemorrhage lowers circulating volume; diabetes causes vascular
changes. Each one can negatively impact uterine blood flow.
2. How does the fetus compensate for decreased maternal circulating volume?
a. Increases cardiac output by increasing stroke volume.
b. Increases cardiac output by increasing its heart rate. – CORRECT ANSWER
c. Increases cardiac output by increasing fetal movement.
Rationale: When maternal circulating volume is reduced, the fetus compensates
primarily by raising its heart rate (the most direct mechanism to increase cardiac output in
utero).
3. Stimulating the vagus nerve typically produces:
a. A decrease in the heart rate – CORRECT ANSWER
b. An increase in the heart rate
c. An increase in stroke volume
d. No change
Rationale: Vagal nerve stimulation releases acetylcholine, which slows conduction
through the sinoatrial (SA) node, thus decreasing the fetal heart rate.
4. What initially causes a chemoreceptor response?
a. Epidurals
b. Supine maternal position
c. Increased CO2 levels
d. Decreased O2 levels
e. A & C
f. A & B
1|Page
,NCC EFM ELECTRONIC FETAL MONITORING EXAM
QUESTIONS WITH VERIFIED ANSWERS AND
RATIONALES AND A STUDY GUIDE VERIFIED
FOR GUARANTEED PASS
g. C & D – CORRECT ANSWER
Rationale: Chemoreceptors respond primarily to changes in blood gases—rising CO2 or
falling O2. Thus, “C & D” (increased CO2 and decreased O2) triggers chemoreceptor
activity.
5. The vagus nerve begins maturation 26 to 28 weeks. Its dominance results in what
effect to the FHR baseline?
a. Increases baseline
b. Decreases baseline – CORRECT ANSWER
Rationale: As the vagus nerve matures, it exerts a slowing influence on the fetal heart
rate, thus lowering the baseline.
6. T/F: Oxygen exchange in the placenta takes place in the intervillous space. –
CORRECT ANSWER: True
Rationale: Maternal blood in the intervillous space bathes the chorionic villi, allowing
gas exchange (O2 and CO2) via diffusion.
7. T/F: The parasympathetic nervous system is a cardioaccelerator. – CORRECT
ANSWER: False
Rationale: The parasympathetic nervous system slows (decelerates) the heart rate; the
sympathetic system accelerates it.
8. T/F: Baroreceptors are stretch receptors which respond to increases or decreases in
blood pressure. – CORRECT ANSWER: True
Rationale: Baroreceptors sense pressure changes in the aortic arch and carotid sinuses.
Increased BP triggers a reflex slowing of the heart rate and vice versa.
9. T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart
rate: the ultrasound transducer and the fetal spiral electrode. – CORRECT
ANSWER: True
Rationale: External EFM uses an ultrasound transducer; internal EFM uses a fetal spiral
electrode to detect R-R intervals of the fetal ECG.
10. T/F: Variability can be determined with the fetoscope. – CORRECT ANSWER:
False
Rationale: A fetoscope can detect baseline rate and rhythm changes, but precise beat-to-
beat variability cannot be accurately assessed by simple auscultation.
,NCC EFM ELECTRONIC FETAL MONITORING EXAM
QUESTIONS WITH VERIFIED ANSWERS AND
RATIONALES AND A STUDY GUIDE VERIFIED
FOR GUARANTEED PASS
2|Page
, NCC EFM ELECTRONIC FETAL MONITORING EXAM
QUESTIONS WITH VERIFIED ANSWERS AND
RATIONALES AND A STUDY GUIDE VERIFIED
FOR GUARANTEED PASS
11. T/F: Because the ultrasound transducer and toco transducer are sealed units, they
can be dipped in warm water to make cleaning easier. – CORRECT ANSWER:
False
Rationale: Immersing the transducers could damage internal components. They are not
designed for submersion.
12. T/F: The most common artifact with the ultrasound transducer system for fetal
heart rate is increased variability. – CORRECT ANSWER: True
Rationale: Doubling/halving or erratic signals can appear as artificially “increased
variability” when the device loses a stable signal.
13. T/F: All fetal monitors contain a logic system designed to reject artifact. –
CORRECT ANSWER: True
Rationale: Modern monitors do include software (“logic”) algorithms to filter signal
noise/artifact from real FHR data.
14. T/F: The monitor should always be tested before starting a tracing, either external
or internal mode and labeled a test. – CORRECT ANSWER: True
Rationale: Ensuring equipment functionality prevents misinterpretations of faulty
signals.
15. T/F: The paper speed on the fetal monitor should always be set at 1 cm/min. –
CORRECT ANSWER: False
Rationale: Standard paper speed in the United States is 3 cm/min (per AWHONN,
ACOG). Some older machines offer 2 or 1 cm/min but 3 cm/min is typical.
16. T/F: Both internal and external monitoring methods are equally accurate means of
obtaining the fetal heart rate and contraction patterns. – CORRECT ANSWER:
False
Rationale: Internal methods (FSE, IUPC) generally provide more precise data on
FHR/contractions than external ultrasound and tocodynamometer.
17. T/F: The external toco is usually placed over the uterine fundus to pick up
contractions. – CORRECT ANSWER: True
QUESTIONS WITH VERIFIED ANSWERS AND
RATIONALES AND A STUDY GUIDE VERIFIED
FOR GUARANTEED PASS
1. Which of the following factors can have a negative effect on uterine blood flow?
a. Hypertension
b. Epidural
c. Hemorrhage
d. Diabetes
e. All of the above – CORRECT ANSWER: e. All of the above
Rationale: Hypertension can reduce uteroplacental perfusion; epidurals can lead to
maternal hypotension; hemorrhage lowers circulating volume; diabetes causes vascular
changes. Each one can negatively impact uterine blood flow.
2. How does the fetus compensate for decreased maternal circulating volume?
a. Increases cardiac output by increasing stroke volume.
b. Increases cardiac output by increasing its heart rate. – CORRECT ANSWER
c. Increases cardiac output by increasing fetal movement.
Rationale: When maternal circulating volume is reduced, the fetus compensates
primarily by raising its heart rate (the most direct mechanism to increase cardiac output in
utero).
3. Stimulating the vagus nerve typically produces:
a. A decrease in the heart rate – CORRECT ANSWER
b. An increase in the heart rate
c. An increase in stroke volume
d. No change
Rationale: Vagal nerve stimulation releases acetylcholine, which slows conduction
through the sinoatrial (SA) node, thus decreasing the fetal heart rate.
4. What initially causes a chemoreceptor response?
a. Epidurals
b. Supine maternal position
c. Increased CO2 levels
d. Decreased O2 levels
e. A & C
f. A & B
1|Page
,NCC EFM ELECTRONIC FETAL MONITORING EXAM
QUESTIONS WITH VERIFIED ANSWERS AND
RATIONALES AND A STUDY GUIDE VERIFIED
FOR GUARANTEED PASS
g. C & D – CORRECT ANSWER
Rationale: Chemoreceptors respond primarily to changes in blood gases—rising CO2 or
falling O2. Thus, “C & D” (increased CO2 and decreased O2) triggers chemoreceptor
activity.
5. The vagus nerve begins maturation 26 to 28 weeks. Its dominance results in what
effect to the FHR baseline?
a. Increases baseline
b. Decreases baseline – CORRECT ANSWER
Rationale: As the vagus nerve matures, it exerts a slowing influence on the fetal heart
rate, thus lowering the baseline.
6. T/F: Oxygen exchange in the placenta takes place in the intervillous space. –
CORRECT ANSWER: True
Rationale: Maternal blood in the intervillous space bathes the chorionic villi, allowing
gas exchange (O2 and CO2) via diffusion.
7. T/F: The parasympathetic nervous system is a cardioaccelerator. – CORRECT
ANSWER: False
Rationale: The parasympathetic nervous system slows (decelerates) the heart rate; the
sympathetic system accelerates it.
8. T/F: Baroreceptors are stretch receptors which respond to increases or decreases in
blood pressure. – CORRECT ANSWER: True
Rationale: Baroreceptors sense pressure changes in the aortic arch and carotid sinuses.
Increased BP triggers a reflex slowing of the heart rate and vice versa.
9. T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart
rate: the ultrasound transducer and the fetal spiral electrode. – CORRECT
ANSWER: True
Rationale: External EFM uses an ultrasound transducer; internal EFM uses a fetal spiral
electrode to detect R-R intervals of the fetal ECG.
10. T/F: Variability can be determined with the fetoscope. – CORRECT ANSWER:
False
Rationale: A fetoscope can detect baseline rate and rhythm changes, but precise beat-to-
beat variability cannot be accurately assessed by simple auscultation.
,NCC EFM ELECTRONIC FETAL MONITORING EXAM
QUESTIONS WITH VERIFIED ANSWERS AND
RATIONALES AND A STUDY GUIDE VERIFIED
FOR GUARANTEED PASS
2|Page
, NCC EFM ELECTRONIC FETAL MONITORING EXAM
QUESTIONS WITH VERIFIED ANSWERS AND
RATIONALES AND A STUDY GUIDE VERIFIED
FOR GUARANTEED PASS
11. T/F: Because the ultrasound transducer and toco transducer are sealed units, they
can be dipped in warm water to make cleaning easier. – CORRECT ANSWER:
False
Rationale: Immersing the transducers could damage internal components. They are not
designed for submersion.
12. T/F: The most common artifact with the ultrasound transducer system for fetal
heart rate is increased variability. – CORRECT ANSWER: True
Rationale: Doubling/halving or erratic signals can appear as artificially “increased
variability” when the device loses a stable signal.
13. T/F: All fetal monitors contain a logic system designed to reject artifact. –
CORRECT ANSWER: True
Rationale: Modern monitors do include software (“logic”) algorithms to filter signal
noise/artifact from real FHR data.
14. T/F: The monitor should always be tested before starting a tracing, either external
or internal mode and labeled a test. – CORRECT ANSWER: True
Rationale: Ensuring equipment functionality prevents misinterpretations of faulty
signals.
15. T/F: The paper speed on the fetal monitor should always be set at 1 cm/min. –
CORRECT ANSWER: False
Rationale: Standard paper speed in the United States is 3 cm/min (per AWHONN,
ACOG). Some older machines offer 2 or 1 cm/min but 3 cm/min is typical.
16. T/F: Both internal and external monitoring methods are equally accurate means of
obtaining the fetal heart rate and contraction patterns. – CORRECT ANSWER:
False
Rationale: Internal methods (FSE, IUPC) generally provide more precise data on
FHR/contractions than external ultrasound and tocodynamometer.
17. T/F: The external toco is usually placed over the uterine fundus to pick up
contractions. – CORRECT ANSWER: True
