Preparing for the C-EFM exam? Work these free sample questions first. Each mirrors the NCC Electronic Fetal Monitoring exam style — a clinical strip-reading scenario, one best answer, and a rationale that explains the physiology behind it.
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How close are these to the actual C-EFM?
Per NCC, the C-EFM is a 2-hour, 125-item exam: 100 scored plus 25 unscored pretest questions. It is dominated by one domain — Pattern Recognition and Intervention at 70% — with Physiology (11%), Fetal Assessment Methods (9%), EFM Equipment (5%), and Professional Issues (5%) filling the rest. In short: if you can read a tracing and pick the right next action, you pass. The samples below train exactly that.
Sample C-EFM questions
- A multipara at 33 weeks with severe preeclampsia is on magnesium sulfate at 2 g/hr. The FHR baseline is 135 bpm with minimal variability and no accelerations, and no decelerations. What best explains the tracing?
- A. Expected central nervous system depression from the medication
- B. Metabolic acidemia requiring immediate intervention
- C. A sleep cycle that has exceeded normal duration
- D. Severe chronic placental insufficiency and hypoxemia
Answer: A. Magnesium sulfate is a CNS depressant that crosses the placenta, commonly reducing variability and suppressing accelerations without indicating hypoxia or acidosis. With no decelerations present, the medication is the most likely explanation — document, keep watching, and resist over-treating a drug effect.
- A G1P0 at 38 weeks with severe preeclampsia on magnesium sulfate shows minimal variability and recurrent late decelerations. Coarse crackles are noted on auscultation. Which fluid-management action is correct?
- A. Administer a 1,000 mL fluid bolus immediately to improve placental perfusion
- B. Prioritize lateral positioning and restrict total IV intake to about 125 mL/hr
- C. Give IV labetalol 20 mg to rapidly improve uteroplacental blood flow
- D. Increase magnesium sulfate to 3 g/hr for seizure prophylaxis
Answer: B. Severe preeclampsia brings endothelial damage and low colloid oncotic pressure, so pulmonary edema is a standing threat — and the crackles say it is already starting. A large bolus would flood the lungs. Lateral positioning plus fluid restriction addresses both the tracing and the airway risk.
- A client at 37 weeks with suspected IUGR has a biophysical profile: NST non-reactive, three body movements, one episode of tone, no breathing movements, adequate fluid. What is the score and next step?
- A. Score 6/10; prepare for induction of labor
- B. Score 6/10; repeat the BPP in 24 hours
- C. Score 8/10; discharge with close follow-up
- D. Score 4/10; perform immediate cesarean section
Answer: A. Score it: NST 0, breathing 0, movement 2, tone 2, fluid 2 = 6/10 — equivocal. At term (37 weeks) with a growth-restricted fetus already suspected of chronic compromise, the balance tips toward delivery rather than another 24 hours of waiting; induction preparation is the standard move.
Want 600 more questions like these?
Our C-EFM prep course contains 5 timed simulators — 600 questions total, mapped to the NCC weights above, each with a full rationale. It is $19.99 once for lifetime access, and the free simulator lets you baseline before paying.
Unlock 600 C-EFM practice questions across 5 simulators — $19.99 lifetime →
Round out your prep with the C-EFM cheat sheet and the C-EFM study plan.
Frequently asked questions
How many questions is the C-EFM exam?
125 multiple-choice items in 2 hours — 100 scored and 25 unscored pretest questions used by NCC to calibrate future exams.
What is on the C-EFM exam?
Pattern Recognition and Intervention dominates at 70% of scoring; the remainder covers Physiology (11%), Fetal Assessment Methods (9%), EFM Equipment (5%), and Professional Issues (5%).
Who can take the C-EFM?
It is multidisciplinary: physicians, RNs, nurse practitioners, nurse midwives, midwives, physician assistants, and paramedics with an active unencumbered US or Canadian license who use EFM in practice.
How much does the C-EFM exam cost?
$210 total — a $50 non-refundable application fee plus a $160 testing fee, paid to NCC.
Sources & references
The exam facts on this page are drawn from official certifying-body materials, reviewed 2026-06-18 by the DrCertifications exam-prep team (10+ years in exam preparation and publishing).