NCC EFM Certification Exam Questions and
Answers Latest Update 2025-2026 Graded A+.
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 answeree. All of the above
How does the fetus compensate for decreased maternal circulating volume?
a. Increases cardiac output by increasing stroke volume.
b. Increases cardiac output by increasing it's heart rate.
c. Increases cardiac output by increasing fetal movement. - correct answereb. Increases
cardiac output by increasing it's heart rate.
Stimulating the vagus nerve typically produces:
a. A decrease in the heart rate
b. An increase in the heart rate
c. An increase in stroke volume
d. No change - correct answerea. A decrease in the heart rate
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
g. C & D - correct answereg. C & D
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 answereb. Decreases baseline
T/F: Oxygen exchange in the placenta takes place in the intervillous space. - correct
answereTrue
T/F: The parasympathetic nervous system is a cardioaccelerator. - correct
answereFalse
T/F: Baroreceptors are stretch receptors which respond to increases or decreases in
blood pressure. - correct answereTrue
T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart rate:
the ultrasound transducer and the fetal spiral electrode. - correct answereTrue
T/F: Variability can be determined with the fetoscope. - correct answereFalse
, NCC EFM Certification
T/F: Because the ultrasound transducer and toco transducer are sealed units, they can
be dipped in warm water to make cleaning easier. - correct answereFalse
T/F: The most common artifact with the ultrasound transducer system for fetal heart rate
is increased variability. - correct answereTrue
T/F: All fetal monitors contain a logic system designed to reject artifact. - correct
answereTrue
T/F: The monitor should always be tested before starting a tracing, either external or
internal mode and labeled a test. - correct answereTrue
T/F: The paper speed on the fetal monitor should always be set at 1cm/min. - correct
answereFalse
T/F: Both internal and external monitoring methods are equally accurate means of
obtaining the fetal heart rate and contraction patterns. - correct answereFalse
T/F: The external toco is usually placed over the uterine fundus to pick up contractions.
- correct answereTrue
T/F: The external toco gives measurable uterine pressure. - correct answereFalse
T/F: The fetal spiral electrode can be placed when vaginal bleeding of unknown origin is
present. - correct answereFalse
T/F: The ultrasound transducer is usually placed on the side of the uterus over the
baby's back, as the fetal heart is heard best there. - correct answereTrue
T/F: The spiral electrode is used to more accurately determine the frequency, duration,
and intensity of uterine contractions. - correct answereFalse
T/F: The heart rate from a well-applied fetal spiral electrode can only be fetal, not
maternal. - correct answereFalse
T/F: The intrauterine catheter is used to pick up the fetal heart rate. - correct
answereFalse
T/F: The internal spiral electrode may pick up the maternal heart rate if the baby has
died. - correct answereTrue
T/F: Fetal arrhythmias can be seen on both internal and external monitor tracings. -
correct answereTrue
, NCC EFM Certification
T/F: Variability and periodic changes can be detected with both internal and external
monitoring. - correct answereTrue
T/F: Variable decelerations are a result of cord compression. - correct answereTrue
T/F: The presence of FHR accelerations in the intrapartum and antepartum periods is a
sign of adequate fetal oxygenation. - correct answereTrue
T/F: Variable decelerations are a vagal response. - correct answereTrue
T/F: Late decelerations have a gradual decrease in FHR (onset to nadir 30 seconds)
and are delayed in timing with the nadir of the deceleration occurring after the peak of
the contraction. - correct answereTrue
T/F: The fetal heart rate baseline can be determined during periods of marked
variability. - correct answereFalse
T/F: Anything that affects maternal blood flow (cardiac output) can affect the blood flow
through the placenta. - correct answereTrue
T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration
pattern in labor. - correct answereTrue
T/F: Minimal variability is always an indicator of hypoxia and a Cesarean section is
indicated. - correct answereFalse
What is your first intervention in management of a patient experiencing variable
decelerations?
a. Immediate delivery
b. Change maternal position
c. No treatment indicated
d. Oxygen
e. Stop oxytocin infusion - correct answereb. Change maternal position
Etiology of a baseline FHR of 165bpm occurring for the last hour can be:
1. Maternal supine hypotension
2. Maternal fever
3. Maternal dehydration
4. Unknown
a. 1 and 2
b. 1, 2 and 3
c. 2, 3 and 4 - correct answerec. 2, 3 and 4
What is the most probable cause of recurrent late decelerations?
a. Utero-placental insufficiency
b. Head compression
, NCC EFM Certification
c. Cord compression
d. Maternal position change - correct answerea. Utero-placental insufficiency
The most prevalent risk factor associated with fetal death before the onset of labor is:
a. Low socioeconomic status
b. Fetal malpresentation
c. Uteroplacental insufficiency
d. Uterine anomalies - correct answerec. Uteroplacental insufficiency
Which of the following is NOT used for antepartum fetal surveillance?
a. Fetal movement counting
b. Antepartum fetal heart rate testing
c. Biophysical profile testing
d. Maternal HCG levels - correct answered. Maternal HCG levels
Which of the following conditions is not an indication for antepartum fetal surveillance?
a. Gestational hypertension
b. Diabetes in pregnancy
c. Fetus in breech presentation
d. Decreased fetal movement - correct answerec. Fetus in breech presentation
Which of the following does not affect the degree of fetal activity?
a. Vibroacoustic stimulation
b. Smoking
c. Fetal position
d. Gestational age - correct answerea. Vibroacoustic stimulation
To be considered reactive, a nonstress test must have:
a. 4 fetal heart rate accelerations in a 20 minute window
b. 2 fetal heart rate accelerations in a 10 minute window
c. 4 fetal heart rate accelerations in a 40 minute window
d. 2 fetal heart rate accelerations in a 20 minute window - correct answered. 2 fetal
heart rate accelerations in a 20 minute window
If a nonstress test is nonreactive after 40 minutes, the next step should be:
a. Have the client go home and do fetal movement counts
b. Do a biophysical profile or contraction stress test
c. Repeat the nonstress test within a week
d. Admit the client for delivery - correct answereb. Do a biophysical profile or contraction
stress test
All of the following are components of a biophysical profile except:
a. Contraction stress test
b. Assessment of fetal breathing
c. Amniotic fluid volume measurement
d. Fetal movement assessment - correct answerea. Contraction stress test
Answers Latest Update 2025-2026 Graded A+.
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 answeree. All of the above
How does the fetus compensate for decreased maternal circulating volume?
a. Increases cardiac output by increasing stroke volume.
b. Increases cardiac output by increasing it's heart rate.
c. Increases cardiac output by increasing fetal movement. - correct answereb. Increases
cardiac output by increasing it's heart rate.
Stimulating the vagus nerve typically produces:
a. A decrease in the heart rate
b. An increase in the heart rate
c. An increase in stroke volume
d. No change - correct answerea. A decrease in the heart rate
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
g. C & D - correct answereg. C & D
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 answereb. Decreases baseline
T/F: Oxygen exchange in the placenta takes place in the intervillous space. - correct
answereTrue
T/F: The parasympathetic nervous system is a cardioaccelerator. - correct
answereFalse
T/F: Baroreceptors are stretch receptors which respond to increases or decreases in
blood pressure. - correct answereTrue
T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart rate:
the ultrasound transducer and the fetal spiral electrode. - correct answereTrue
T/F: Variability can be determined with the fetoscope. - correct answereFalse
, NCC EFM Certification
T/F: Because the ultrasound transducer and toco transducer are sealed units, they can
be dipped in warm water to make cleaning easier. - correct answereFalse
T/F: The most common artifact with the ultrasound transducer system for fetal heart rate
is increased variability. - correct answereTrue
T/F: All fetal monitors contain a logic system designed to reject artifact. - correct
answereTrue
T/F: The monitor should always be tested before starting a tracing, either external or
internal mode and labeled a test. - correct answereTrue
T/F: The paper speed on the fetal monitor should always be set at 1cm/min. - correct
answereFalse
T/F: Both internal and external monitoring methods are equally accurate means of
obtaining the fetal heart rate and contraction patterns. - correct answereFalse
T/F: The external toco is usually placed over the uterine fundus to pick up contractions.
- correct answereTrue
T/F: The external toco gives measurable uterine pressure. - correct answereFalse
T/F: The fetal spiral electrode can be placed when vaginal bleeding of unknown origin is
present. - correct answereFalse
T/F: The ultrasound transducer is usually placed on the side of the uterus over the
baby's back, as the fetal heart is heard best there. - correct answereTrue
T/F: The spiral electrode is used to more accurately determine the frequency, duration,
and intensity of uterine contractions. - correct answereFalse
T/F: The heart rate from a well-applied fetal spiral electrode can only be fetal, not
maternal. - correct answereFalse
T/F: The intrauterine catheter is used to pick up the fetal heart rate. - correct
answereFalse
T/F: The internal spiral electrode may pick up the maternal heart rate if the baby has
died. - correct answereTrue
T/F: Fetal arrhythmias can be seen on both internal and external monitor tracings. -
correct answereTrue
, NCC EFM Certification
T/F: Variability and periodic changes can be detected with both internal and external
monitoring. - correct answereTrue
T/F: Variable decelerations are a result of cord compression. - correct answereTrue
T/F: The presence of FHR accelerations in the intrapartum and antepartum periods is a
sign of adequate fetal oxygenation. - correct answereTrue
T/F: Variable decelerations are a vagal response. - correct answereTrue
T/F: Late decelerations have a gradual decrease in FHR (onset to nadir 30 seconds)
and are delayed in timing with the nadir of the deceleration occurring after the peak of
the contraction. - correct answereTrue
T/F: The fetal heart rate baseline can be determined during periods of marked
variability. - correct answereFalse
T/F: Anything that affects maternal blood flow (cardiac output) can affect the blood flow
through the placenta. - correct answereTrue
T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration
pattern in labor. - correct answereTrue
T/F: Minimal variability is always an indicator of hypoxia and a Cesarean section is
indicated. - correct answereFalse
What is your first intervention in management of a patient experiencing variable
decelerations?
a. Immediate delivery
b. Change maternal position
c. No treatment indicated
d. Oxygen
e. Stop oxytocin infusion - correct answereb. Change maternal position
Etiology of a baseline FHR of 165bpm occurring for the last hour can be:
1. Maternal supine hypotension
2. Maternal fever
3. Maternal dehydration
4. Unknown
a. 1 and 2
b. 1, 2 and 3
c. 2, 3 and 4 - correct answerec. 2, 3 and 4
What is the most probable cause of recurrent late decelerations?
a. Utero-placental insufficiency
b. Head compression
, NCC EFM Certification
c. Cord compression
d. Maternal position change - correct answerea. Utero-placental insufficiency
The most prevalent risk factor associated with fetal death before the onset of labor is:
a. Low socioeconomic status
b. Fetal malpresentation
c. Uteroplacental insufficiency
d. Uterine anomalies - correct answerec. Uteroplacental insufficiency
Which of the following is NOT used for antepartum fetal surveillance?
a. Fetal movement counting
b. Antepartum fetal heart rate testing
c. Biophysical profile testing
d. Maternal HCG levels - correct answered. Maternal HCG levels
Which of the following conditions is not an indication for antepartum fetal surveillance?
a. Gestational hypertension
b. Diabetes in pregnancy
c. Fetus in breech presentation
d. Decreased fetal movement - correct answerec. Fetus in breech presentation
Which of the following does not affect the degree of fetal activity?
a. Vibroacoustic stimulation
b. Smoking
c. Fetal position
d. Gestational age - correct answerea. Vibroacoustic stimulation
To be considered reactive, a nonstress test must have:
a. 4 fetal heart rate accelerations in a 20 minute window
b. 2 fetal heart rate accelerations in a 10 minute window
c. 4 fetal heart rate accelerations in a 40 minute window
d. 2 fetal heart rate accelerations in a 20 minute window - correct answered. 2 fetal
heart rate accelerations in a 20 minute window
If a nonstress test is nonreactive after 40 minutes, the next step should be:
a. Have the client go home and do fetal movement counts
b. Do a biophysical profile or contraction stress test
c. Repeat the nonstress test within a week
d. Admit the client for delivery - correct answereb. Do a biophysical profile or contraction
stress test
All of the following are components of a biophysical profile except:
a. Contraction stress test
b. Assessment of fetal breathing
c. Amniotic fluid volume measurement
d. Fetal movement assessment - correct answerea. Contraction stress test
