CEFM NCC (Electronic Fetal Monitoring
Certification) FINAL EXAM STUDY GUIDE
2025/2026 COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS || 100% GUARANTEED PASS
<RECENT VERSION>
1. Describe Fetal Heart Rate Monitoring - ANSWER ✓ EFM may be external,
internal or a combination
In the US, the majority of women have EFM during some or all of their
labors
Each modality has both pros and cons
2. Describe Doppler Ultrasound - ANSWER ✓ The doppler US transducer is
used to assess FHR characteristics and patterns. The transducer translates
sound wave reflections into waveforms which are interpreted by a computer
and then exported as an audible sound and a waveform pattern.
Problems: FHR artifact, doubling, halving, and detection of maternal heart
rate
Current ultrasound FHR signal processing uses autocorrelation techniques
and interpretation of EFM data is based on this assumption
3. Describe internal fetal electrode - ANSWER ✓ The FSE directly measures
the FHR by measuring R to R waves in successive QRS complexes. To
place an FSE, adequate cervical dilation (usually at least 2 cm) and ROM are
needed.
Contraindications: placenta previa, hemophilia, maternal HIV, herpes
infections, or when presenting part is not identifiable
Problems: artifact, slight risk of fetal infection/injury, doubling or halving of
the FHR, and pick up of the MHR with fetal demise
, Other relative contraindications: syphilis, gonorrhea (not recommended but
may be placed if a clear benefit to a mother and fetus can be demonstrated
by its use)
4. What are some important factors (risks) to consider when evaluating a fetal
heart rate strip? - ANSWER ✓ --*PNLs* (abnormal?)
--weight gain/loss
--Maternal age
--*Gestational age*
--*MATERNAL vital signs*
--*Membrane status*
--*Cervical exam*
5. What are the easiest ways for assessment of maternal oxygenation status? -
ANSWER ✓ *Pulse Ox* (& other vital signs, RR)
*Blood gas* (if indicated, asthma exacerbation)
*Lung soungs* (pneumonia, pulmonary edema?)
6. What effect can *HTN/Preeclampsia* have on the Placenta? - ANSWER ✓
*VASOCONSTRICTION*
which adversely effects placental perfusion and can lead to:
--*IUGR*
--*Infarcts* (decreases functional area of the placenta & functional capacity)
7. Placental Infarcts - ANSWER ✓ - Necrosis of placental villi
- Anechoic or Hypoechoic areas in placenta
8. Placental infarcts will do what to the placental function? - ANSWER ✓
*DECREASE functional area* of placenta
*DECREASE functional capacity*
9. What effect can *Diabetes* have on Placental perfusion? - ANSWER ✓
Secondary to *Maternal Vasculopathy* & HYPERglycemia* this can lead
to:
*reduced utero-placental perfusion* = *IUGR*
10.What can change for fetal energy demands when you have a "DIABETIC
mother" uncontrolled and there is *Fetal HYPERglycemia &
, HYPERinsulinemia*? - ANSWER ✓ Fetal hyperglycemia &
hyperinsulinemia can cause:
*Increased fetal O2 consumption* which may induce *fetal hypoxemia &
acidosis* if the O2 needs of the fetus are not met by the placenta.
11.What are some common conditions which could lead to a *POOR maternal
Oxygenation status*? - ANSWER ✓ Respiratory DEPRESSION (*Meds or
Seizure*)
*Pulmonary EMBOLISM*
*Pneumonia*
*Asthma*
*Atelectasis*
ARDS
*Smoking*
*ANEMIA*
12.What are some examples of *collagen-vascular diseases*? HOw does these
effect pregnancy? - ANSWER ✓ *Rheumatoid arthritis*
*Scleroderma*
*SLE* (lupus)
= maternal *vasocontriction* which can lead to interruptions in placental &
uterine blood flow
--'IUGR'
13.What fetal cardiac condition may you see in a mother with *SLE* (systemic
lupus erythematosis)? - ANSWER ✓ *Secondary Heart BLOCK*
14.When a fetus is developing hypoxemia . . . . . . in what order will the score
of the *BPP decrease*? - ANSWER ✓ 1. *Fetal Breathing Movements*
-->
2. *Accelerations* on NST
-->
3. *Decreased Fetal movements*
-->
4. *Fetal Tone* (is the last feature to go)
15.*Fetal SCALP STIMULATION* is a test for what? When should this be
performed? - ANSWER ✓ Test for *fetal oxygenation*
, Should be performed during a *period of normal baseline*
NEVER during a deceleration b/c this could be made WORSE.
16.How does *Fetal Sleep* affect a BPP? - ANSWER ✓ > *Active REM
Sleep*
- frequent feetal movements.
(have mod variability, accels - reactive NST)
*Quiet Sleep*
- *infrequent movements*
(*minimal variability - NON-reactive NST*)
17.The paper speed used with EFM in North America is:
a. 1cm/min
b. 2cm/min
c. 3cm/min - ANSWER ✓ C. 3cm/min
18.The US transducer on the EFM measures the
a. Electrical signal of the fetal heart
b. Mechanical movement of the fetal heart reflected off of
sound waves
c. R to R intervals of the fetal heart - ANSWER ✓ b.
Mechanical movement of the fetal heart reflected off of
sound waves
19.The purpose of the autocorrelation in external monitoring is to
a. Compare incoming waveforms for comparison
b. Decrease signal to noise levels
c. Distinguish fetal from maternal heart rate - ANSWER ✓
a. Compare incoming waveforms for comparison
20.The area of maximum intensity of FHR is usually the fetal
a. Back
b. Chest
c. Umbilicus - ANSWER ✓ a. Back
21.Palpating the uterus is best performed by using the
a. Back of hand
Certification) FINAL EXAM STUDY GUIDE
2025/2026 COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS || 100% GUARANTEED PASS
<RECENT VERSION>
1. Describe Fetal Heart Rate Monitoring - ANSWER ✓ EFM may be external,
internal or a combination
In the US, the majority of women have EFM during some or all of their
labors
Each modality has both pros and cons
2. Describe Doppler Ultrasound - ANSWER ✓ The doppler US transducer is
used to assess FHR characteristics and patterns. The transducer translates
sound wave reflections into waveforms which are interpreted by a computer
and then exported as an audible sound and a waveform pattern.
Problems: FHR artifact, doubling, halving, and detection of maternal heart
rate
Current ultrasound FHR signal processing uses autocorrelation techniques
and interpretation of EFM data is based on this assumption
3. Describe internal fetal electrode - ANSWER ✓ The FSE directly measures
the FHR by measuring R to R waves in successive QRS complexes. To
place an FSE, adequate cervical dilation (usually at least 2 cm) and ROM are
needed.
Contraindications: placenta previa, hemophilia, maternal HIV, herpes
infections, or when presenting part is not identifiable
Problems: artifact, slight risk of fetal infection/injury, doubling or halving of
the FHR, and pick up of the MHR with fetal demise
, Other relative contraindications: syphilis, gonorrhea (not recommended but
may be placed if a clear benefit to a mother and fetus can be demonstrated
by its use)
4. What are some important factors (risks) to consider when evaluating a fetal
heart rate strip? - ANSWER ✓ --*PNLs* (abnormal?)
--weight gain/loss
--Maternal age
--*Gestational age*
--*MATERNAL vital signs*
--*Membrane status*
--*Cervical exam*
5. What are the easiest ways for assessment of maternal oxygenation status? -
ANSWER ✓ *Pulse Ox* (& other vital signs, RR)
*Blood gas* (if indicated, asthma exacerbation)
*Lung soungs* (pneumonia, pulmonary edema?)
6. What effect can *HTN/Preeclampsia* have on the Placenta? - ANSWER ✓
*VASOCONSTRICTION*
which adversely effects placental perfusion and can lead to:
--*IUGR*
--*Infarcts* (decreases functional area of the placenta & functional capacity)
7. Placental Infarcts - ANSWER ✓ - Necrosis of placental villi
- Anechoic or Hypoechoic areas in placenta
8. Placental infarcts will do what to the placental function? - ANSWER ✓
*DECREASE functional area* of placenta
*DECREASE functional capacity*
9. What effect can *Diabetes* have on Placental perfusion? - ANSWER ✓
Secondary to *Maternal Vasculopathy* & HYPERglycemia* this can lead
to:
*reduced utero-placental perfusion* = *IUGR*
10.What can change for fetal energy demands when you have a "DIABETIC
mother" uncontrolled and there is *Fetal HYPERglycemia &
, HYPERinsulinemia*? - ANSWER ✓ Fetal hyperglycemia &
hyperinsulinemia can cause:
*Increased fetal O2 consumption* which may induce *fetal hypoxemia &
acidosis* if the O2 needs of the fetus are not met by the placenta.
11.What are some common conditions which could lead to a *POOR maternal
Oxygenation status*? - ANSWER ✓ Respiratory DEPRESSION (*Meds or
Seizure*)
*Pulmonary EMBOLISM*
*Pneumonia*
*Asthma*
*Atelectasis*
ARDS
*Smoking*
*ANEMIA*
12.What are some examples of *collagen-vascular diseases*? HOw does these
effect pregnancy? - ANSWER ✓ *Rheumatoid arthritis*
*Scleroderma*
*SLE* (lupus)
= maternal *vasocontriction* which can lead to interruptions in placental &
uterine blood flow
--'IUGR'
13.What fetal cardiac condition may you see in a mother with *SLE* (systemic
lupus erythematosis)? - ANSWER ✓ *Secondary Heart BLOCK*
14.When a fetus is developing hypoxemia . . . . . . in what order will the score
of the *BPP decrease*? - ANSWER ✓ 1. *Fetal Breathing Movements*
-->
2. *Accelerations* on NST
-->
3. *Decreased Fetal movements*
-->
4. *Fetal Tone* (is the last feature to go)
15.*Fetal SCALP STIMULATION* is a test for what? When should this be
performed? - ANSWER ✓ Test for *fetal oxygenation*
, Should be performed during a *period of normal baseline*
NEVER during a deceleration b/c this could be made WORSE.
16.How does *Fetal Sleep* affect a BPP? - ANSWER ✓ > *Active REM
Sleep*
- frequent feetal movements.
(have mod variability, accels - reactive NST)
*Quiet Sleep*
- *infrequent movements*
(*minimal variability - NON-reactive NST*)
17.The paper speed used with EFM in North America is:
a. 1cm/min
b. 2cm/min
c. 3cm/min - ANSWER ✓ C. 3cm/min
18.The US transducer on the EFM measures the
a. Electrical signal of the fetal heart
b. Mechanical movement of the fetal heart reflected off of
sound waves
c. R to R intervals of the fetal heart - ANSWER ✓ b.
Mechanical movement of the fetal heart reflected off of
sound waves
19.The purpose of the autocorrelation in external monitoring is to
a. Compare incoming waveforms for comparison
b. Decrease signal to noise levels
c. Distinguish fetal from maternal heart rate - ANSWER ✓
a. Compare incoming waveforms for comparison
20.The area of maximum intensity of FHR is usually the fetal
a. Back
b. Chest
c. Umbilicus - ANSWER ✓ a. Back
21.Palpating the uterus is best performed by using the
a. Back of hand
