C-EFM Exam Prep: Electronic Fetal Monitoring (NCC) Study Guide + 480+ Practice Questions

16 of 100. A G1P0 client at 41 weeks gestation is receiving oxytocin for labor augmentation. The fetal heart rate (FHR) baseline is 155 bpm, and the variability amplitude fluctuates between 10 and 20 bpm. Recurrent late decelerations are noted with contractions. Which clinical conclusion is best supported by this specific variability pattern?

29 of 100. A G2P1 at 5 cm dilation has ruptured membranes. The fetal heart rate tracing shows a baseline of 135 bpm, moderate variability, and recurrent variable decelerations with V-shaped nadirs dropping 20 bpm below baseline.

28 of 100. A G1P0 patient at 5 cm dilation receives a combined spinal-epidural for labor analgesia. Ten minutes later, the fetal heart rate (FHR) baseline drops from 140 bpm to 90 bpm and sustains this rate for 3 minutes. The patient reports feeling lightheaded, and her blood pressure is 88/52 mmHg. Which intervention should be prioritized to resolve the FHR pattern?

27 of 100. A nurse is performing intermittent auscultation on a G1P0 patient at 5 cm dilation. The nurse identifies a baseline rate of 140 bpm with fluctuations in the rate and distinct increases of 15 bpm lasting 20 seconds. How should the nurse document these findings?

26 of 100. A patient at 41 weeks gestation has been in the second stage of labor for two hours. The current fetal heart rate tracing displays a baseline of 150 bpm with minimal variability and recurrent late decelerations. Despite executing comprehensive intrauterine resuscitation measures—including maternal repositioning, IV fluid bolus, and oxygen administration—the tracing remains unchanged for the past 30 minutes. Which clinical decision is prioritized?

25 of 100. A client at 33 weeks gestation is evaluated for decreased fetal movement. The NST is non-reactive. During the 30-minute ultrasound assessment, the nurse observes two discrete limb movements, one episode of hand extension with return to flexion, and a 4 cm deepest vertical pocket of amniotic fluid. No fetal breathing movements are visualized. What is the correct BPP score and interpretation?

24 of 100. A client at 40 weeks gestation is in the second stage of labor. The fetal heart rate tracing demonstrates recurrent variable decelerations. During a prolonged deceleration lasting 3 minutes with a nadir of 80 bpm, the provider initiates digital scalp stimulation to assess fetal status.

23 of 100. During monitoring of a twin gestation, the external transducers display heart rates of 135 bpm for Fetus A and 134 bpm for Fetus B. Both traces show moderate variability. To ensure the equipment is not tracking the same cardiac source for both channels, the specialist should:

21 of 100. During the second stage of labor, a patient is utilizing closed-glottis pushing (Valsalva) for 10 seconds, three times per contraction. The fetal heart rate tracing shows prolonged decelerations. Which statement accurately describes the physiologic impact of this pushing technique on uterine perfusion?

20 of 100. A patient at 34 weeks gestation is being monitored for suspected fetal supraventricular tachycardia (SVT). The external ultrasound tracing displays a stable baseline of 120 bpm with minimal variability. However, intermittent handheld Doppler auscultation reveals a rate of approximately 240 bpm. What processing limitation of the external monitor best explains this discrepancy?

19 of 100. A G2P1 at 39 weeks gestation presents in active labor with intact membranes and has received no medications. The electronic fetal monitoring (EFM) tracing displays a baseline of 140 bpm with a smooth, sine-wave-like undulating pattern, an amplitude of 10 bpm, and a frequency of 4 cycles per minute, persisting for 30 minutes. No accelerations are observed.

18 of 100. A Level III perinatal unit observes that while all staff use standard NICHD terminology, there is only 60% agreement (Kappa 0.4) between the night and day shifts regarding the classification of variability as “minimal” versus “moderate.” To improve inter-rater reliability, which action should the unit leadership prioritize?

17 of 100. A patient at 34 weeks gestation presents reporting a fall down a flight of stairs. The electronic fetal monitoring tracing reveals a baseline of 150 bpm, minimal variability, and recurrent late decelerations. The uterine activity channel records frequent, low-amplitude contractions with elevated resting tone (hypertonus). Which clinical condition is most consistent with this combination of fetal and uterine assessment findings?

1 of 100. A patient at 34 weeks gestation with Type 1 diabetes and diabetic nephropathy is being monitored. The fetal heart rate tracing demonstrates a baseline of 145 bpm, moderate variability, and intermittent variable decelerations. The nurse identifies that in the context of this maternal condition, these decelerations are most likely attributable to which pathophysiologic mechanism?

15 of 100. A patient is in active labor with a confirmed diagnosis of chorioamnionitis. The fetal heart rate baseline is 180 bpm. Over the past hour, the variability has decreased from moderate to minimal, and no accelerations are provoked with scalp stimulation. Which pathophysiological mechanism best explains the change to minimal variability in this clinical context?

14 of 100. A 41-week gestation patient in active labor has thick meconium-stained fluid. The fetal heart rate (FHR) tracing shows recurrent severe variable decelerations and minimal variability. The provider orders an amnioinfusion. Which rationale best supports this intervention in this specific clinical context?

12 of 100. A provider reviews paired umbilical cord blood gas samples following a delivery with suspected fetal compromise. The results are as follows: Sample A: pH 7.26, pCO2 42 mmHg, pO2 20 mmHg, Base Deficit 3.0 mmol/L. Sample B: pH 7.27, pCO2 40 mmHg, pO2 22 mmHg, Base Deficit 2.8 mmol/L. Based on widely accepted validation criteria, which conclusion is most appropriate?

11 of 100. A client in the latent phase of labor receives 10 mg morphine sulfate IM for therapeutic rest. Two hours later, the fetal heart rate shows minimal variability with no accelerations. The nurse notes the fetus was reactive prior to medication administration.

10 of 100. A provider performs an artificial rupture of membranes (AROM) on a patient at -2 station. Immediately following the procedure, the FHR drops abruptly to 70 bpm and persists at that level for 5 minutes. Fluid is clear. What is the most likely etiology for this prolonged deceleration?

9 of 100. A patient receiving oxytocin augmentation has a contraction pattern of 6 contractions in 10 minutes. The fetal heart rate tracing demonstrates recurrent late decelerations. How does this uterine activity pattern primarily compromise placental gas exchange?

8 of 100. A client at 37 weeks gestation with poorly controlled gestational diabetes is undergoing a contraction stress test (CST) due to a non-reactive non-stress test. The tracing reveals three spontaneous contractions lasting 50 seconds within a 10-minute window. The fetal heart rate baseline is 135 bpm with moderate variability and no late or variable decelerations are noted.

5 of 100. A neonate is delivered vaginally after a shoulder dystocia event and requires immediate resuscitation. The provider double-clamps a 20-cm segment of the umbilical cord immediately after birth, but the segment remains on the instrument table at room temperature for 50 minutes before the nurse is able to draw the samples. Which action is most appropriate regarding the analysis of these samples?

3 of 100. A patient at 39 weeks gestation is in active labor. The fetal spiral electrode tracing shows a baseline of 140 bpm with moderate variability and frequent premature beats followed by compensatory pauses. Accelerations are present, and there are no decelerations.

2 of 100. A patient at 37 weeks gestation presents with a complaint of decreased fetal movement. She reports counting twelve movements in two hours, but describes the movements as “weak rolls” rather than her usual “strong kicks.”