NCC EFM Exam Questions and Answers: Fetal Heart Rate Monitoring, Exams of Nursing

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NCC EFM EXAM VERSION 1,2 AND 3

NEWEST 2025 ACTUAL EXAM COMPLETE

450 QUESTIONS AND CORRECT DETAILED

ANSWERS (VERIFIED ANSWERS)

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questions 2025/

NCC EFM EXAM VERSION 1

You recognize that an FHR tracing has been showing a decrease in variability for the last 45 minutes. Your first intervention should be to A. Encourage ambulation B. Administer oxygen C. Discontinue IV fluids D. Increase Pitocin rate - CORRECT ANSWER ✔✔B. Administer oxygen Resuscitation measures improves the baby's variability, but the FHR is still not reactive. You attempt fetal scalp stimulation (FSE) because you know that a well- oxygenated fetus will respond to FSE with a(n) A. Acceleration B. Deceleration C. Fetal movement D. Sleep pattern - CORRECT ANSWER ✔✔A. Acceleration You are evaluating a patient in the Prenatal Testing Department who has just completed a biophysical profile (BPP). You suspect that there could be chronic fetal asphyxia because the score is below A. 10

B. 6

C. 8 - CORRECT ANSWER ✔✔B. 6

When using a fetal scalp electrode (FSE), you notice an abnormally low FHR on the monitor. You should first A. Compare maternal pulse simultaneously with FHR B. Remove FSE C. Call the doctor immediately D. Turn off the monitor - CORRECT ANSWER ✔✔A. Compare maternal pulse simultaneously with FHR 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 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 ANSWER ✔✔b. 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

c. 2, 3 and 4 - CORRECT ANSWER ✔✔c. 2, 3 and 4 What is the most probable cause of recurrent late decelerations? a. Utero-placental insufficiency b. Head compression c. Cord compression d. Maternal position change - CORRECT ANSWER ✔✔a. 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 ANSWER ✔✔c. 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 ANSWER ✔✔d. 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 ANSWER ✔✔c. 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 ANSWER ✔✔a. 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 ANSWER ✔✔d. 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 ANSWER ✔✔b. 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 ANSWER ✔✔a. Contraction stress test A modified biophysical profile includes a nonstress test and:

B. Variability and accelerations C. Variability and decelerations D. Rate and variability - CORRECT ANSWER ✔✔B. Variability and accelerations T/F: Umbilical cord influences that can alter blood flow include true knots, hematomas, and number of umbilical vessels. - CORRECT ANSWER ✔✔True T/F: Low amplitude contractions are not an early sign of preterm labor. - CORRECT ANSWER ✔✔False T/F: Preterm contractions are usually painful. - CORRECT ANSWER ✔✔False T/F: Corticosteroid administration may cause an increase in FHR accelerations. - CORRECT ANSWER ✔✔False T/F: Corticosteroid administration may cause an increase in FHR. - CORRECT ANSWER ✔✔True T/F: Contractions cause an increase in uterine venous pressure and a decrease in uterine artery perfusion. - CORRECT ANSWER ✔✔True As a result of the intrinsic fetal response to oxygen deprivation, increased catecholamine levels cause the peripheral blood flow to decrease while the blood flow to vital organs increases. These flow changes along with increased catecholamine secretions have what effect on fetal blood pressure and fetal heart rate? A. Increase BP and increase HR B. Increase BP and decrease HR C. Decrease BP and increase HR

D. Decrease BP and decrease HR - CORRECT ANSWER ✔✔B. Increase BP and decrease HR All of the following might indicate a pseudosinusoidal pattern as opposed to a sinusoidal pattern, except: A. Recent administration of narcotics to mother B. Accelerations in FHR C. Moderate variability D. Frequency of oscillations of two to five cycles/min - CORRECT ANSWER ✔✔D. Frequency of oscillations of two to five cycles/min All of the following are appropriate interventions for fetal tachycardia except: A. Increase maternal IV fluid rate B. Assess maternal vital signs C. Perform SVE D. Administer oxygen - CORRECT ANSWER ✔✔C. Perform SVE During a term antepartum NST (non-stress test), you notice several variable decelerations that decrease at least 15 bpm and last at least 15 sec long. Which of the following is the least likely explanation? A. True knot B. Gestational diabetes C. Umbilical cord entanglement D. Oligohydramnios - CORRECT ANSWER ✔✔B. Gestational diabetes All of the following are likely causes of prolonged decelerations except: A. Uterine tachysystole B. Prolapsed cord C. Maternal hypotension

A. Sympathetic nervous system B. Parasympathetic nervous system - CORRECT ANSWER ✔✔A. Sympathetic nervous system The ________, through stimulation of the vagus nerve, reduces FHR and maintains variability. A. Sympathetic nervous system B. Parasympathetic nervous system - CORRECT ANSWER ✔✔B. Parasympathetic nervous system What would be a suspected pH in a fetus whose FHTs included recurrent late decelerations during labor? A. 7. B. 7. C. 7. D. 7.41 - CORRECT ANSWER ✔✔A. 7. What is the most common cause of sinusoidal patterns? A. Prolapsed cord B. Rh incompatibility C. Recurrent late decelerations D. Oligohydramnios - CORRECT ANSWER ✔✔B. Rh incompatibility (Anemia!!!) Before ___ weeks of gestation, an increase in FHR that peaks at least 10 bpm above the baseline and lasts at least 10 seconds is considered an acceleration. A. 28 B. 30 C. 32 D. 36 - CORRECT ANSWER ✔✔C. 32

The expected response of the fetal heart rate to active fetal movement of a 31-week gestational age fetus is: a. Suppression of normal short term variability for 15 seconds b. Acceleration of at least 15 beats per minute for 15 seconds c. Acceleration followed by a 15-second deceleration of the heart rate d. Acceleration of at least 10 beats per minute for 10 seconds - CORRECT ANSWER ✔✔d. Acceleration of at least 10 beats per minute for 10 seconds The nurse notes a pattern of variable decelerations to 75 bpm on the fetal monitor. The initial nursing action is to: a. Reposition the woman b. Administer oxygen c. Increase the intravenous fluid infusion d. Stimulate the fetal scalp - CORRECT ANSWER ✔✔a. Reposition the woman The tocotransducer should be placed: a. In the suprapubic area b. In the fundal area c. Over the xiphoid process d. Within the uterus - CORRECT ANSWER ✔✔b. In the fundal area The nurse notes a pattern of decelerations on the fetal monitor that begins shortly after the contraction and returns to baseline just before the contraction is over. The correct nursing response is to: a. Give the woman oxygen by facemask at 8-10 L/min b. Position the woman on her opposite side c. Increase the rate of the woman's intravenous fluid

B. Fetal scalp sampling C. Uterine activity D. Direct Coombs - CORRECT ANSWER ✔✔A. Fetal heart rate T/F: Intrauterine pressure catheters (IUPCs) do not increase risk for infection when placed on patients with intact membranes. - CORRECT ANSWER ✔✔False Membranes must be ruptured for use; infection is a risk What are abnormal fetal heart rate tracings predictive of? A. Likelihood of spontaneous vaginal delivery B. Newborn condition at time of delivery C. Fetal acid-base abnormalities D. Fetal intrauterine growth - CORRECT ANSWER ✔✔C. Fetal acid-base abnormalities Which of the following is not an intervention that should be implemented in a patient with uterine tachysystole? A. Administer terbutaline B. Increase IV fluid rate C. Decrease or discontinue IV oxytocin D. Prepare patient for cesarean section - CORRECT ANSWER ✔✔D. Prepare patient for cesarean section Which of the following is most effective in determining the strength of a patient's contractions? A. Patient report B. Tocodynanamometer tracing C. RN palpation

D. Sterile vaginal exam during a contraction - CORRECT ANSWER ✔✔C. RN palpation The FHR is controlled by the A. Sympathetic nervous system B. Sinoatrial node C. Atrioventricular node D. Parasympathetic nervous system - CORRECT ANSWER ✔✔B. Sinoatrial node How do baseline heart rates differ in premature fetuses? A. They are often lower B. They are often higher C. They are less likely to have decelerations D. They experience longer accelerations - CORRECT ANSWER ✔✔B. They are often higher T/F: If etiology of fetal tachycardia is secondary to extrauterine infection, FHR will return to normal as maternal fever resolves. - CORRECT ANSWER ✔✔True T/F: Fetal tachycardia is a normal compensatory response to transient fetal hypoxemia. - CORRECT ANSWER ✔✔True Fetal heart rate bradycardia is defined as A. FHR <110bpm lasting 10 min or greater B. FHR <110bpm lasting 2 min or greater C. FHR <110bpm lasting 20 min or greater - CORRECT ANSWER ✔✔A. FHR <110bpm lasting 10 min or greater _______ variability warrants cesarean section delivery.

A. Variable decelerations B. Late decelerations C. Early decelerations D. Accelerations - CORRECT ANSWER ✔✔B. Late decelerations Place the following interventions for a sinusoidal FHR in the correct order:

1. Prepare for cesarean delivery
2. Place patient in lateral position
3. Determine if pattern is related to narcotic analgesic administration
4. Provide oxygen via face mask A. 4, 2, 3, 1 B. 3, 1, 2, 4 C. 4, 3, 2, 1 D. 3, 2, 4, 1 - CORRECT ANSWER ✔✔D. 3, 2, 4, 1 The _____ is the source of all fetal oxygenation. A. Placenta B. Umbilical cord C. Mother D. Amniotic fluid - CORRECT ANSWER ✔✔C. Mother FHTs with recurrent variable decelerations, no accelerations, and minimal variability would be categorized as A. Category I B. Category II C. Category III - CORRECT ANSWER ✔✔B. Category II

FHTs with absent variability and bradycardia would be categorized as A. Category I B. Category II C. Category III - CORRECT ANSWER ✔✔C. Category III FHTs with moderate variability, no accelerations, and early decelerations would be categorized as A. Category I B. Category II C. Category III - CORRECT ANSWER ✔✔A. Category I FHTs with accelerations, no decelerations, and minimal variability would be categorized as A. Category I B. Category II C. Category III - CORRECT ANSWER ✔✔B. Category II Sinusoidal pattern is categorized as A. Category I B. Category II C. Category III - CORRECT ANSWER ✔✔B. Category III FHTs with absent variability and no accelerations or decelerations would be categorized as A. Category I B. Category II C. Category III - CORRECT ANSWER ✔✔B. Category II

A prolonged acceleration lasts greater than ___ minutes and less than ___ minutes. A. 2; 10 B. 2; 20 C. 10; 20 D. 10; 20 - CORRECT ANSWER ✔✔A. 2; 10 _______ FHR patterns are those associated with uterine contractions. A. Periodic B. Episodic C. Recurrent D. Irregular - CORRECT ANSWER ✔✔A. Periodic _______ FHR patterns are those that are not associated with uterine contractions. A. Periodic B. Episodic C. Recurrent D. Irregular - CORRECT ANSWER ✔✔B. Episodic Which of the following is not a likely cause of a sinusoidal FHR pattern? A. Chronic fetal bleeding B. Fetal hypoxia or anemia C. Triple screen positive for Trisomy 21 D. Fetal isoimmunization - CORRECT ANSWER ✔✔C. Triple screen positive for Trisomy 21 Which of the following factors is not likely to cause uteroplacental insufficiency?

A. Late-term gestation B. Preeclampsia C. Gestational diabetes D. Polyhydramnios E. Maternal smoking or drug use - CORRECT ANSWER ✔✔D. Polyhydramnios Which of the following are considered determinants of fetal well-being? (Select all that apply). A. Absence of decelerations in FHR B. Palpation of fetal movement C. Presence of accelerations in FHR D. Moderate variability in FHR E. Presence of early decelerations in second stage - CORRECT ANSWER ✔✔C. Presence of accelerations in FHR D. Moderate variability in FHR When auscultation is used for fetal assessment during labor for a low-risk woman, the FHR should be auscultated in the first stage of labor every A. 5 min B. 15-30 min C. 60 min - CORRECT ANSWER ✔✔B. 15-30 min For a low-risk woman in the second stage of labor, the FHR should be auscultated every A. 5-15 min B. 30 min C. 60 min - CORRECT ANSWER ✔✔A. 5-15 min