NCC EFM Practice Exam – 127 Unique Questions [Q56-Q73]

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NCC EFM Practice Exam – 127 Unique Questions

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NO.56 Nonstress testing is used more frequently for antepartum testing than contraction stress testing because contraction stress testing has a:

Higher frequency of equivocal test results

Limited reporting option for the compromised fetus

Low predictability of fetal well-being within 7 days of a negative test

NO.57 A woman in active labor at 8 cm experiences spontaneous rupture of membranes and acute bright red vaginal bleeding. The uterus is soft and nontender to palpation. The fetal monitor tracing has been normal and now shows tachycardia followed by bradycardia with minimal variability. The maternal blood pressure is 130/76 mm Hg, and the pulse is 86 beats per minute. The most likely cause of these findings is:

Abruptio placenta

Placenta previa

Ruptured vasa previa

NO.58 When documenting the occurrence of late decelerations in the medical record, what should be charted?

Components of the tracing

Notation that the tracing was normal or abnormal

Tracing category

NO.59 A woman at 34-weeks gestation is in active labor after spontaneous rupture of membranes.
Accelerations should be documented as

absent

present 10×10

present 15×15

Comprehensive and Detailed Explanation From Exact Extract (No URLs)
For fetuses before 32-34 weeks, the National Certification Corporation (NCC) follows the physiologic standards established by AWHONN, Simpson & Creehan, Menihan, and Creasy & Resnik, which emphasize that preterm fetuses have less mature autonomic nervous system development, resulting in smaller and shorter accelerations.
According to the NCC C-EFM Exam Content Outline (Pattern Recognition & Intervention) and the AWHONN Fetal Heart Monitoring Principles (2022-2024):
* Preterm fetuses (<32 weeks) normally demonstrate 10 bpm × 10 sec accelerations.
* By approximately 32-34 weeks, accelerations may begin transitioning toward 15×15, but the accepted standard for documentation at 34 weeks remains 10×10, unless clearly meeting 15×15 criteria.
* NCC emphasizes using gestational-age-appropriate criteria for documenting accelerations, because autonomic reactivity increases gradually and is not fully comparable to term until after
32-34 weeks.
Menihan’s Electronic Fetal Monitoring also states that preterm fetuses “should be evaluated with the
10×10 rule until it is clear that the fetus is demonstrating mature 15×15 acceleratory capacity.” Simpson & Creehan reinforce this point, noting that accelerations in late preterm gestations “may not consistently reach 15 bpm for 15 seconds, and thus 10×10 remains the appropriate designation.” Since the patient is 34 weeks, the fetus is late-preterm and may not reliably meet the full 15×15 criteria; therefore, the correct documentation standard remains 10×10.
Thus, accelerations should be charted as:
“Present 10×10.”
References
* NCC C-EFM Candidate Guide 2025 – Content Domain: Pattern Recognition and Intervention
* AWHONN Fetal Heart Monitoring Principles & Practices, 2022-2024
* Menihan: Electronic Fetal Monitoring: Concepts and Applications
* Simpson & Creehan: Perinatal Nursing
* Miller: Fetal Monitoring Pocket Guide
* Creasy & Resnik: Maternal-Fetal Medicine

NO.60 This external tracing is from a 19-year-old (G1P0) at 39-weeks gestation. She is 6 cm dilated, 100% effaced, and -2 station. The fetus is in an occiput posterior position. She rates her pain as 8. She reports being lightheaded. She is most likely at risk for respiratory:

Acidosis

Alkalosis

Depression

NO.61 A woman in labor has been pushing for 4 hours. For the last 2 hours, there have been recurrent variable decelerations. Variability has evolved from moderate to minimal. Cervical exam is 10/100%
/+2, fetal head OP. There has been no fetal descent for the last 45 minutes. Based on the tracing shown, the most reasonable approach is

cesarean birth

continued pushing

vacuum-assisted vaginal birth

NO.62 The ratio of oxyhemoglobin to the total amount of hemoglobin available is called oxygen

affinity

carrying capacity

saturation

NO.63 When fetal arterial blood pressure increases, the baroreceptors send impulses to the vagus nerve resulting in:

Decreased heart rate

Decreased PO#

Reflex tachycardia

NO.64 The fetal heart rate tracing shown demonstrates:

Accelerations

Category II tracing

Marked variability

Comprehensive and Detailed Explanation From Exact Extract-Based NCC C-EFM References:
NCC C-EFM uses NICHD terminology to describe key FHR characteristics: baseline, variability, accelerations, and decelerations. In this strip, the following findings are present:
* Baseline:The baseline appears approximately 135-145 bpm, which is within the normal 110-160 bpm range described in NCC and AWHONN materials.
* Variability:Beat-to-beat fluctuation is within 6-25 bpm, which meets the definition of moderate variability. NCC and NICHD define moderate variability as amplitude range of 6-25 bpm; this is associated with adequate fetal oxygenation and a normal fetal acid-base status.
* Accelerations:The tracing shows distinct increases in FHR above the baseline by at least 15 bpm lasting 15 seconds or more but less than 2 minutes. NCC and NICHD define an acceleration in a term fetus precisely as “a visually apparent abrupt increase in FHR, with peak #15 bpm above baseline, lasting #15 seconds and <2 minutes.” The pattern shown fits this definition clearly.
* Category determination:A tracing with normal baseline, moderate variability, and accelerations without decelerations is classified as Category I, not Category II. Category II is reserved for tracings that are not clearly Category I or III, such as minimal or marked variability, recurrent variables, or prolonged decelerations.
* Marked variability consideration:Marked variability is defined as amplitude >25 bpm. While the tracing is somewhat jagged, the fluctuation does not sustain >25 bpm amplitude over a 10-minute segment and instead remains in the moderate range, so it does not meet criteria for marked variability.
Given these observations, the most accurate description of the tracing from the options provided is that it demonstrates accelerations.
References:NCC C-EFM Candidate Guide (2025); NCC Content Outline; NICHD Three-Tier FHR Interpretation System; AWHONN Fetal Heart Monitoring Principles & Practices; Miller’s Fetal Monitoring Pocket Guide; Menihan Electronic Fetal Monitoring; Simpson & Creehan Perinatal Nursing; Creasy & Resnik Maternal-Fetal Medicine.

NO.65 In documenting auscultation of the fetal heart rate, it is important to record findings in relationship to:

Fetal position

Stage of labor

Uterine activity

NO.66 Accelerations that last 10 minutes or more are considered:

A baseline change

Baseline variability

Tachycardia

NO.67 Based on the tracing shown, the first action should be to

administer vibroacoustic stimulation

assess maternal temperature

palpate for contractions

NO.68 During amnioinfusion, the infusion should be stopped periodically to assess changes in:

Baseline uterine pressure

Contraction pattern

Patient pain level

NO.69 This fetal heart rate tracing is from a woman in the second stage of labor. This tracing is best interpreted as:

Intermittent late decelerations

Variable decelerations

Wandering baseline

NO.70 The tracing shown is a:

Category I

Category II

Category III

NO.71 The tracing shown is from a woman at 28-weeks gestation in the post-anesthesia care unit (PACU) after an appendectomy. She is alert and awake. Based on this fetal heart rate pattern, the most appropriate intervention is:

Administer terbutaline

Continued monitoring

Perform cesarean birth

NO.72 (Full question)
Spontaneous fetal heart rate accelerations indicate

dominance of the fetal sympathetic nervous system

immaturity of the fetal parasympathetic nervous system

integrated response of the fetal central nervous system

NO.73 An internal electronic fetal monitor tracing continues to record artifact despite equipment troubleshooting and replacement of the spiral electrode. The next action is to:

Auscultate the fetal heart rate

Provide oxygen

Reposition the woman