NCC ELECTRONIC FETAL MONITORING CERTIFICATION EXAM
VERSION B 2023 BRAND NEW VERSION 100+ QUESTIONS AND
CORRECT ANSWERS|AGRADE
1. A nurse is explaining to a pregnant patient the purpose of electronic fetal monitoring. Which of
the following statements by the nurse is the most accurate way to describe the purpose of EFM?
a. "EFM is a diagnostic procedure that monitors your baby's heart rate or FHR and your uterine
contractions.
b. "EFM is a screening procedure that monitors your baby's heart rate or FHR and your uterine
contractions."
c. "EFM is a screening procedure that only monitors your baby's heart rate or FHR."
d. "EFM is a diagnostic procedure that only monitors the frequency, duration, and intensity of
your uterine contractions."
Answer: b. "EFM is a screening procedure that monitors your baby's heart rate or FHR and your
uterine contractions."
2. The nurse measures fetal well being during labor by paying attention to:
a. the response of the FHR to uterine contractions
b. mom's complaint of pain during the labor
c. the FHR only
d. the frequency, duration, and intensity of the mother's uterine contractions only
Answer: a. the response of the FHR to uterine contractions
3. A nursing student explains during her presentation that the 5 factors for adequate fetal
oxygenation include:
• adequate exchange of __________ and CO2 in the placenta
• an open ___________ path between the placenta and the fetus through vessels in the umbilical
cord
Answer: Oxygen
Vascular
4. Normal fetal circulatory and _________ carry functions
Answer: 1. normal maternal blood flow and volume to placenta
2. normal oxygen saturation in the maternal blood
• adequate exchange of oxygen and CO2 in the palcenta
• an open circulatory path between the placenta and the fetus through vessels in the umbillical
cord
• normal fetal circulatory and oxygen-carrying functions
5. While monitoring a baby's fetal well being using EFM, the nurse recognizes that the baby's
baseline fetal heart rate is identified as the:
a. average rate of a 30 minute segment that excludes periodic or episodic changes
b. average rate of a 10 minute segment that excludes periodic or episodic changes
c. average rate of a 20 minute segment that does not include periodic or episodic changes
Answer: b. average rate of a 10 minute segment that excludes periodic or episodic changes
6. A nurse determines that term baby's baseline fetal heart rate is 140 beats per minute. A nurse
explains to her patient that this fetal heart rate is:
a. abnormal because it is not in the normal range of 90-100 bears perm minute for a term or post
term fetus
b. normal because it is in the range of 110-160 bpm for a term or post term fetus
c. abnormal because it is not in the normal range of 160-200 bpm for a term or post term fetus
Answer: b. normal because it is in the range of 110-160 bpm for a term or post term fetus
7. The nurse documents that the baseline heart rate for a fetus is between 120-160 beats per
minute. Based on this finding, the nurse can determine that the fetus is:
a. post term
b. premature
c. both a and b
Answer: b. premature
8. While keeping track of a patient's uterine contractions, the nurse documents that the
measurements of the beginning of one contraction to the beginning of the next is occurring too
frequently at quicker than every 2 minutes. The nurse is measuring which of the following
aspects of a uterine contraction?
a. duration
b. frequency
c. intensity
d. resting tone or interval
Answer: b. frequency
9. One of the maternal nurses explains to a nursing student that the duration of a contraction,
which is measured from the beginning to the end of one contraction, usually lasts:
a. about 50 seconds or less
b. about 60 seconds, NO longer than 90 seconds
c. about 90 seconds or more
d. about 40 to 50 seconds
Answer: b. about 60 seconds, NO longer than 90 seconds
10. A nurse is assessing the relaxation or intrauterine pressures between contractions on a EFM
strip. The nurse is assessing which of the following components of the uterine contractions?
a. duration
b. frequency
c. intensity
d. resting tone or interval
Answer: d. resting tone or interval
11. Which of the following is the priority nursing action of a nurse preparing to begin EFM on a
patient?
a. place the tocotransducer on the patient's abdomen where the fundus is
b. explain the purpose of the EFM and the procedure of EFM Placement to the patient
c. begin using the ultrasound transducer to find the fetal heart rate
d. none of the above
Answer: b. explain the purpose of the EFM and the procedure of EFM Placement to the patient
12. The nurse is observing the peak of a contraction on a EFM strip and watching as mother, who
has a tocotransducer across her abdomen, scream out that she is in extreme pain. The nurse
knows that she is observing which aspect of the uterine
a. frequency
b. Duration
c. Intensity
d. resting tone or interval
Answer: c. Intensity
13. The nurse who is monitoring EFM realizes that suddenly there is no tracking of the FHR.
What is the nurse's priority action?
a. Immediately notify the physician.
b. Check placement of the ultrasound transducer and ensure correct placement for optimum
recording of fetal heart rate to see if the baby changed positions.
c. Administer 8-10 L/min of oxygen to the mom and turn on her left side because the fetus is
compromised.
Answer: b. Check placement of the ultrasound transducer and ensure correct placement for
optimum recording of fetal heart rate to see if the baby changed positions.
14. A nurse is explaining to her 31 year old patient that she will be using external fetal
monitoring devices to keep track of the baby's FHR in relation to her uterine contractions. Which
of the following are external fetal monitoring devices? (select all that apply)
a. ultrasound transducer
b. intrauterine pressure catheter
c. tocotransducer
d. spiral electrode
Answer: a. ultrasound transducer
c. tocotransducer
15. The nurse is using the ultrasound transducer during the EFM of her 35 year old patient. The
patient asks her what the transducer is used for. What is the nurse's most appropriate response?
a. "The ultrasound transducer uses high frequency sound waves to convert the Fetal EKG
obtained from the presenting part, which is your baby's head."
b. "The ultrasound transducer uses high frequency sound waves to detect the flow of blood
through a vessel, which can be identified as your baby's heart rate."
c. "The ultrasound transducer uses high frequency sound waves to measure your uterine
contractions transabdominally."
Answer: b. "The ultrasound transducer uses high frequency sound waves to detect the flow of
blood through a vessel, which can be identified as your baby's heart rate."
16. The nurse informs a nursing student that which of the following methods of electronic fetal
monitoring does not require dilation or rupture of membranes, is completely non-invasive, and is
used during AP and IP?
a. external fetal monitoring
b. internal fetal monitoring
c. both a and b
Answer: a. external fetal monitoring
17. A nurse places which type of external fetal monitor over her patient's uterine fundus to
measure uterine activity transabdominally?
a. intrauterine pressure cathether
b. tocotransducer
c. ultrasound transducer
Answer: b. tocotransducer
18. A nurse explains to her 19 year old patient that she will be using methods of internal fetal
monitoring on her to monitor her baby's FHR in relation to her uterine contractions. Which of the
following internal fetal monitoring devices will the nurse use? (select all that apply)
a. intrauterine pressure catheter
b. tocotransducer
c. ultrasound transducer
d. spiral electrode
Answer: a. intrauterine pressure catheter
d. spiral electrode
19. The nurse holds a patient's hand as the doctor places a spiral electrode onto her baby's
presenting part, which was his face. The patient asks what the spiral electrode will detect and
why it needs to be used. The nurse's most appropriate response is:
a. "We are using the spiral electrode because it converts the fetal EKG (R wave) from the
presenting part so we can keep track of your baby's heart rate."
b. "We are using the spiral electrode because it measures how well your baby's lungs have
developed in utero."
c. ""We are using the spiral electrode because it measures your uterine activity and your baby's
FHR at the same time."
Answer: a. "We are using the spiral electrode because it converts the fetal EKG (R wave) from
the presenting part so we can keep track of your baby's heart rate."
20. Which of the following EFM devices can be used for a patient whose membranes ruptured
and has a cervix that is already 50% dilated to detect FHR?
a. tocotransducer
b. ultrasound transducer
c. spiral electrode
d. intrauterine pressure catheter
Answer: c. spiral electrode
21. The nurse explains to a patient that the intrauterine pressure catheter is being used to:
a. monitor her baby's FHR and her uterine contractions at the same time
b. monitor her baby's FHR and converting into an EKG wave
c. Monitor the frequency, duration, and pressure of her uterine contractions by measuring
intrauterine pressures and converting it to mm HG
Answer: c. Monitor the frequency, duration, and pressure of her uterine contractions by
measuring intrauterine pressures and converting it to mm HG
22. The doctor asks the nurse to pass him which specific device to infuse fluids into a mother
who has olgiohydraminos or low amniotic fluid during an aminocentesis procedure?
a. intrauterine pressure catheter
b. tocotransducer
c. ultrasound transducer
d. spiral electrode
Answer: a. intrauterine pressure catheter
23. After applying the spiral electrode onto the baby's head, the nurse needs to ensure that:
a. the spiral electrode wire is connected to the mom's plate on her chest and it is snapped to the
adhesive patch
b. the spiral electrode wire is connected to the mom's leg plate and it is snapped to the adhesive
patch
c. the spiral electrode wire is connected directly to the EFM machine
Answer: b. the spiral electrode wire is connected to the mom's leg plate and it is snapped to the
adhesive patch
24. The nurse practitioner observes as a nursing student from the local university attempts to
remove a spiral electrode. What is the appropiate action of the nurse practitioner?
a. Intervene immediately and inform the patient to leave the spiral electrode or the MD or
midwife who are the only ones authorized to turn it counterclockwise and remove it.
b. Praise the student and encourage her to turn the spiral electrode counterclockwise to remove it.
c. neither a or b
Answer: a. Intervene immediately and inform the patient to leave the spiral electrode for the MD
or midwife who are the only ones authorized to turn in counterclockwise and remove it.
25. When setting up an intrauterine pressure catheter on a patient, one of the appropriate nursing
actions should be to:
a. affix strap to patient's leg to prevent dislodgement
b. let strap remain detached from patient's leg to prevent pressure and an increased risk for a
blood clot
c. none of the above
Answer: a. affix strap to patient's leg to prevent dislodgement
26. When setting the resting tone of the intrauterine pressure catheter, the nurse would correctly
set the setting to:
a.10-20 mm Hg
b. 5-10 mm Hg
c. 30-40 mm Hg
Answer: b. 5-10 mm Hg
27. The nurse is monitoring a fetal heart rate and determines that the baseline fetal heart rate is
above 160 beats per minute for 5 minutes, or between 2-10 minutes. The nurse would consider
these findings to b:
a. bradycardia
b. tachycardia
c. variability
Answer: b. tachycardia
28. The nurse monitoring a baby's fetal heart rate on an EFM strip determines that the baby has
tachycardia. The nurse informs the mother that this is considered:
a. an EARLY sign of fetal hypoxia or prematurity
b. a LATE sign of fetal hypoxia
c. a normal finding of a thriving fetus
Answer: a. an EARLY sign of fetal hypoxia or prematurity
29. The nurse confirms that a baby is tachycardic and explains to the mother that this condition
can result from which of the following conditions: (select all that apply)
a. fetal or maternal infection
b. prolonged compression of the umbillical cord
c. maternal hyperthyrodism
d. fetal anemia
e. response to medications
f. maternal hypotension
g. possibly due to mother's anxiety
Answer: a. fetal or maternal infection
c. maternal hyperthyrodism
d. fetal anemia
e. response to medications
g. possibly due to mother's anxiety
30. A nurse determines that a baby's FHR is below 110 beats per minute. The nurse is concerned
and notifies the doctor by explaining that the fetus has:
a. tachycardia
b. bradycardia
Answer: b. bradycardia
31. A nurse determines that a baby has a baseline FHR of 100 bpm on a EFM strip. The nurse
explains to the mother that this is considered a:
a. an EARLY sign of fetal hypoxia or prematurity
b. a LATE sign of fetal hypoxia
c. a normal finding of a thriving fetus
Answer: b. a LATE sign of fetal hypoxia
32. While assessing a fetus's FHR with EFM, the nurse determines the baby's heart rate is 98
bpm. What is the primary nursing action that needs to be completed?
a. start and IV flow rate at 200 ml/hr with normal saline to increase fluid volume to transport
more blood to fetus
b. place on O2 mask on mom that flows 8-10 L/min
c. administer oxytocin to the patient to increase uterine contractions because this will increase
blood flow to baby and improve the baby's heart rate
Answer: b. place an O2 mask on mom that flows 8-10 L/min
33. The nurse is monitoring the FHR of her patient's baby and becomes concerned when she
observes which of the following results?
a. presence of variability of 6-25 bpm
b. absence of variability, which is considered no reassuring
c. a temporary decrease in variability while the fetus is in the sleep state
Answer: b. absence of variability, which is considered nonreassuring
34. The nurse is monitoring the FHR of the patient's baby. The nurse sees a temporary decrease
in variability but then the variability rises back to 20 bpm. The nurse does which of the following
actions:
a. Notify doctor because fetus could be compromised.
b. Record these as normal findings because a temp. decrease in variability is associated with the
fetus being in a sleeping state.
c. Turn mom onto her left side because the fetus may be lacking oxygen in utero.
Answer: b. Record these as normal findings because a temp. decrease in variability is associated
with the fetus being in a sleeping state.
35. Which of the following conditions lead to decreased variability found in the FHR? (select all
that apply)
a. fetal hypoxemia
b. acidosis
c. prolonged cord compression
d. maternal hypotension
e. medications that depress the CNS, such as narcotics and analgesics
Answer: a. fetal hypoxemia
b. acidosis
e. medications that depress the CNS, such as narcotics and analgesics
36. A nurse monitors the heart rate of a fetus that is less than 110 bpm. The nurse identifies this
as bradycardia and would assess if the patient had which of the following conditions: (select all
that apply)
a. maternal hyperthyroidism
b. prolonged compression of umbillical cord
c. maternal hypothermia
d. maternal hypotension
e. maternal hypertension
Answer: b. prolonged compression of umbilical cord
d. maternal hypotension
c. maternal hypothermia
37. A maternal nurse is observing that a fetus has increases in FHR that are above the baseline
and greater than or equal to 15 bpm and lasting longer than or equal to 15 seconds in relation to
mom's uterine contractions. The nurses' priority action would be to:
a. Report this as a normal finding, known as accelerations that indicate the fetus is doing well.
b. Report this immediately to the doctor because this indicates that the fetus is compromised.
c. Administer mom oxygen from 8-10 l/min immediately and then notify doctor.
Answer: a. Report this as a normal finding, known as accelerations that indicate the fetus is
doing well.
38. The nurse identifies which type of fetal heart rate pattern that occurs with sympathetic
nervous response in breech presentation and occurs directly with contractions?
a. episodic
b. periodic
Answer: b. periodic
39. The nurse identifies variable decelerations in an FHR on a EFM strip. The nurse knows that
these type of patterns are known as_________ because they do not occur in relation to
contractions :
a. episodic
b. periodic
Answer: a. episodic
40. The nurse notices that on a EFM there is a gradual decrease in return to baseline of FHR that
is begins just as the mother's uterine contractions. The nurse documents this finding as:
a. a normal finding of early decelerations associated with head compression
b. a normal finding of early declarations associated with cord compression
c. a normal finding of late declarations associated with uteroplacental insufficiency
Answer: a. a normal finding of early decelerations associated with head compression
41. A nurse uses her gloved fingers to rub the head of the baby through the mother's abdomen,
also known as cranial vagal nerve stimulation. The nurse observes a gradual decrease in and
return to baseline of FHR and knows that this is a:
a. a normal finding of early decelerations associated with head compression
b. a normal finding of early declarations associated with cord compression
c. a normal finding of late declarations associated with uteroplacental insufficiency
Answer: a. a normal finding of early decelerations associated with head compression
42. The nurse is observing a declaration pattern of the FHR that is the mirror image of the
contraction and has started in the 1st stage of the mom's labor when she was 4- 7 cm. The
deceleration pattern continued through the mother's 2nd stage as she was pushing in active labor.
The nurse knows that this is indicative of:
a. early decelerations
b. late decelerations
c. variable declarations
Answer: a. early decelerations
43. The nurse is observing a pattern on the EFM that indicates a gradual decrease in a return to
baseline FHR that begins after the contraction has started. There was a decrease that is greater
than or equal to 15 bpm that lasts for greater than or equal to 15 seconds. The nurse records that
this pattern is:
a. a late deceleration associated with uteroplacental insufficiency
b. a late deceleration associated with head compression
c. a late deceleration associated with cord compression
Answer: a. a late deceleration associated with uteroplacental insufficiency
44. The nurse is monitoring an FHR and uterine contractions on a EFM strip. The nurse notices
that the lowest point of the deceleration occurs after the peak of the contraction. The nurse
documents this as a:
a. early deceleration
b. late deceleration
c. variable deceleration
Answer: b. late deceleration
45. A nurse informs a nursing student that if late deceleration are persistent and repetitive, it
indicates:
a. fetal hypoxemia stemming from insufficient placental perfusion
b. considered a normal finding and should not cause alarm
c. fetal hypoxemia stemming from cord compression
Answer: a. fetal hypoxemia stemming from insufficient placental perfusion
46. A nurse has tried multiple measures to increase a patient's baby's FHR. The nurse would
deem which of the following situations not correctable and omnious?
a. early decelerations associated with decreased variability and tachycardia
b. late decelerations associated with decreased variability and tachycardia
c. variable declerations associated with decreased variability and tachycardia
Answer: b. late decelerations associated with decreased variability and tachycardia
47. A nurse is observing her 42 year old patient who is having increased uterine contractions due
to IV oxytocin. The nurse notices that there has been a consistent pattern of late deceleration(s),
which indicate uteroplacental insufficiency. What is the nurse's primary action?
a. discontinue the oxytocin to slow down the uterine contractions and increase blood flow to the
fetus
b. Increase the IV and adminster vasopressors to increase the mother's blood pressure
c. adminster O2 to the mother at 8-10 L/min
Answer: a. discontinue the oxytocin to slow down the uterine contractions and increase blood
flow to the fetus
48. A nurse measures her patient's blood pressure while she is laying supine and documents that
it is extremely low at 100/50. The nurse also notices that the EFM strip indicates a consistent
pattern of late deceleration(s) of the fetus' heart rate, which indicates uteroplacental insufficiency.
What is the nurse's primary action?
a. discontinue the oxytocin to slow down the uterine contractions and increase blood flow to the
fetus
b. Increase the IV flow rate and adminster vasopressors to increase the mother's blood pressure
c. adminster O2 to the mother at 8-10 L/min
Answer: b. Increase the IV flow rate and adminster vasopressors to increase the mother's blood
pressure
49. While monitoring a mother and baby during EFM, the nurse notices that there are consistent
patterns of drops of the FHR from the baseline after the contraction has ended. The patient is
lying supine with her feet elevated. What is the primary nursing action at this time?
a. change maternal position to lateral to increase oxygenation to fetus
b. increase IV flow rate to 200 ml/hr to increase mom's blood pressure
c. notify the doctor and then increase the IV flow rate to 200 ml/hr to increase mom's blood
pressure
Answer: a. change maternal position to lateral to increase oxygenation to fetus
50. Nurse Janet notices an abrupt decrease in FHR below the baseline that is greater than or
equal to 15 bpm and lasts greater than or equal to 15 seconds. The nurse notes that these patterns
are not occurring in relation to contractions. What would the nurse document this finding as?
a. variable decelerations in relation to uteroplacental insufficiency
b. variable decelerations in relation to cord compression
c. variable decelerations in relation to increased oxygenation to fetus via placenta
Answer: b. variable decelerations in relation to cord compression
51. A nurse is monitoring a patient and her baby using EFM. The nurse notices and becomes
concern when she sees a consistent pattern of variable deceleration(s). She notices that the
mother is laying on her right side. What is the primary nursing action that needs to be
performed?
a. discontine oxytocin IV
b. encourage mom to move from side to side and go in a knee-chest position to relieve umbilical
cord compression
c. begin adminstering oxygen through a mask at levels 10-20 l/min
Answer: b. encourage mom to move from side to side and go in a knee-chest position to relieve
umbilical cord compression
52. A doctor has just completed an ultrasound on a patient that is at 35 weeks gestation. He
informs the nurse that the patient has very little amniotic fluid, which is causing the umbilical
cord to compress the baby's head. He asks the nurse to begin getting his equipment ready so that
he can correct the problem. What is the primary nursing action that needs to be completed?
a. discontine oxytocin IV
b. encourage mom to move from side to side and go in a knee-chest position to relieve umbilical
cord compression
c. begin administering oxygen through a mask at levels 10-20 l/min
d. finding an intrauterine pressure catheter, gloves, and the syringe needed to perform
amniocentesis to give the patient more fluid to increase her amniotic fluid levels and relieve
umbilical cord compression
Answer: d. finding an intrauterine pressure catheter, gloves, and the syringe needed to perform
amniocentesis to give the patient more fluid to increase her amniotic fluid levels and relieve
umbilical cord compression
53. A nurse monitoring FHR during an EFM documents that there is a decrease in FHR baseline
that is greater than or equal to 15 bpm and lasts more than 2 minutes but less than 10 minutes.
The nurse would document this finding as:
a. variable decelerations
b. prolonged decelerations
c. late decelerations
Answer: b. prolonged decelerations
54. A nurse is monitoring FHR during an EFM of a pregnant patient that is 26 weeks. The nurse
notices that there has been a persistent decrease in FHR below the baseline of greater than or
equal to 15 bpm that has lasted for longer than 10minutes. The nurse would record this in her
charting as:
a. A normal expected baseline change.
b. A new baseline change since the decrease in FHR lasted longer than 10 minutes.
c. A new baseline change since the baseline rate decrease was greater than or equal to 15 bpm.
Answer: b. A new baseline change since the decrease in FHR lasted longer than 10 minutes.
55. A nurse knows that which of the following are benign causes that can lead to prolonged
decelerations? (select all that apply)
a. vaginal exam
b. prolonged compression of cord
c. application of scalp electrode
d. rapid fetal descent
e. sustained maternal Valsalva maneuver
f. tetanic contractions
Answer: a. vaginal exam
c. application of scalp electrode
d. rapid fetal descent
e. sustained maternal Valsalva maneuver
f. tetanic contractions
56. A nurse is informing a nursing student about the problematic causes of prolonged
declarations. The nurse knows the nursing student understands this concept when she tells her
that which of the following problematic conditions lead to prolonged decelerations? (select all
that apply)
a. sudden cord prolapse
b. vaginal exam
c. maternal hypotension as a result of analgesia/anaesthesia
d. tetanic contractions
e. maternal hypoxia
f. placental abruption
g. rapid fetal descent
Answer: a. sudden cord prolaspe
c. maternal hypotension as a result of analgesia/anesthesia
d. tetanic contractions
e. maternal hypoxia
f. placental abruption
57. The nurse asks a nursing student what VEAL represents. The nursing student's proper
response was:
V
E
A
L ___________
Answer: Variable
Early
Acceleration
Late
58. The nurse asks a nursing student what CHOP represents. The nursing student's proper
response was:
C_________ H_________ O __________ P________
Answer: Cord compression
Head compression
Oxygenation
Placental Insufficiency
59. The nurse monitors an FHR that is 120 bpm, has a moderate variability of 22 bpm, and has
20 accelerations that are 15 seconds or more in length. The nurse determines that this baby can
be placed in which of the following categories?
a. Category 1- reassuring
b. Category 2- indeterminate- ambiguous
c. Category 3- abnormal-nonreassuring
Answer: a. Category 1- reassuring
Rationale: FHR is between 110-160 bpm, variability is between 6-25 bpm, and accelerations are
greater than 15 bpm and longer than 15 seconds
60. The nurse monitors an FHR and discovers that there is no variability present and there is a
smooth, undulating wave pattern on the screen. The nurse also notices there are recurrent late and
even variable deceleration occurring. The nurse determines that this baby can be placed in which
of the following categories?
a. Category 1- reassuring
b. Category 2- indeterminate- ambiguous
c. Category 3- abnormal-nonreassuring
Answer: c. Category 3- abnormal- nonreassuring
Rationale : sinusoidal pattern, absent variability, and recurrent late and variable deceleration
define Category 3
61. A nurse has been monitoring an FHR that has consistently displayed no variability and nonreassuring patterns. What should be the nurse's primary action?
a. Apply an oxygen mask to the mother that runs 8-10 L/min.
b. Stimulate the fetus scalp by rubbing it through the mother's abdomen with gloved fingers. The
nurse should also use vibroacusotic stimulation and play music that resembles sounds heard in
utero to increase the babies HR through stimulation.
c. Encourage and help mom to turn to a knee chest position to help relieve cord compression,
which will help increase baby's HR.
Answer: b. Stimulate the fetus scalp by rubbing it through the mother's abdomen with gloved
fingers. The nurse should also use vibroacusotic stimulation and play music that resembles
sounds heard in utero to increase the babies HR through stimulation.
62. What is Electronic Fetal Monitoring (EFM) and what does it do?
Answer: • Acquires a signal when the human ear cannot.
• Allows for visual representation of fetal heart rate and uterine muscle activity.
• Provides a continuous record and permits for archiving and tracing. (it interfaces with EHR)
63. Fetal Heart Rate (FHR) / Fetal Heart Tones (FHT) are regulated by what?
Answer: Regulated by the CNS (ANS), chemoreceptors, and baroreceptors within the fetus.
The brain and heart are working together.
64. What are some factors impacting the oxygen supply system for the fetus:
Answer: Maternal blood
Maternal oxygenation
Fetal circulation
Placenta blood flow / uterine activity
65. Uterine Activity (UA or UC):
Answer: also known as uterine contractions.
66. During contractions, what happens to blood flow to the fetus through the umbilical cord?
Answer: There is a temporary decrease in blood flow to the fetus through the umbilical cord.
67. The initiation of labor is the trigger of what?
Answer: Uterine contractions
68. What is the movement of contractions?
Answer: Contractions start at the fundus and waves down
69. What can cause a contraction but is not due to labor?
Answer: Dehydration
Internal bleeding
Irritating the uterine muscle
Infection within the pelvic region
70. CXT:
Answer: Contraction
71. True or false: the uterus contracting always indicates the cervix is dilating and labor has
started?
Answer: False, there are other things that can cause a contraction other than labor.
72. On the Fetal Heart Monitor Tracing what does the top graph represent and what does the
bottom graph represent?
Answer: Top graph: fetal heart rate Bottom graph: contractions
73. Where does the uterine activity monitor (toco transducer) go?
Answer: Top of the fundus.
This monitor represents uterine activity and reads muscle tone. It knows when tension is greater
and when tension eases up.
74. Other sounds you might accidentally pick up other than fetal heart beat when using external
EFM:
Answer:
• Baby moving
• Eating
• Ambulating
• Breathing
• Sneezing
• Coughing
• Puking
(Anything that causes an increase in muscle tone that is picked up on the uterine activity monitor.
Will look like a tiny little peak in the short 10 seconds whereas contraction looks like a
mountain).
75. Where does the ultrasound transducer go?
Answer: Placed over the area where fetal heart rate is best heard, usually below the umbilicus
This monitor is picking up sound echoing through abdomen from baby.
76. Other sounds you might accidentally pick up other than fetal heart beat when using
ultrasound transducer?
Answer: Bowel sounds
Umbilical cord (has an internal pulse)
77. Which is more accurate representing fetal well-being: external EFM or internal EFM?
Answer: Internal EFM -because this continuous monitoring is not interrupted by fetal or
maternal movement or affected by maternal size.
78. Internal EFM:
Answer: invasive procedure where membranes must be ruptured and the cervix dilated to
monitor UA and fetal heart rate with Intrauterine pressure Catheter and spiral electrode.
79. Disadvantage to internal EFM:
Answer: Risk for infection
80. Fetal Scalp Electrode (FSE):
Answer: A spiral wire that can be placed on the scalp of the fetus to monitor their heart rate to
ensure their well being.
81. Intrauterine Pressure Catheter (IUPC):
Answer: A catheter that can be placed through the cervix into the uterus to measure uterine
pressure during labor (uterine activity and pressure).
82. The tip of the IUPC can record pressure changes measuring in ________
Answer: millimetres of mercury
83. MVU:
Answer: Montevideo Units - a measure of frequency and intensity of contractions using the
IUPC
84. If we have an MVU that is greater than or equal to 200 in a 10 minute strip, what do we start
to assume?
Answer: We start thinking that it is an adequate contraction pattern that should be starting a
change to the cervix.
85. Describe what a mild, moderate and a strong contraction feels like when you as the nurse
physically palpates the uterus during a contraction:
Answer: Mild contraction: feels like cartilage on nose.
Moderate contraction: feels like chin.
Strong contraction: feels like forehead.
86. __________ is the beginning of the first contraction to the beginning of the next contraction.
Answer: Frequency
87. _____________ is when we count how long the contraction is.
Answer: Duration
88. Baseline Fetal Heart Rate (FHR):
Answer: 110-160 bpm in a term fetus
89. Fetal Tachycardia:
Answer: FHR greater than 160 bpm lasting more than 10 minutes.
90. Causes of fetal tachycardia:
Answer: • immature fetus (< 32 weeks).
• maternal fever / infection.
• tobacco / illicit drugs.
91. Why would an immature fetus (< 32 weeks) have tachycardia?
Answer: Sympathetic (fight or flight) is the system that is developing first in our brain (which
increases HR) and then parasympathetic (which slows us down) develops second.
92. Fetal Bradycardia:
Answer: FHR 32 weeks, peak 15 bpm above baseline lasting 15 seconds.
< 32 weeks, peak 10 bpm above baseline lasting 10 seconds.
107. Accelerations indicate what?
Answer: An intact CNS (accelerations are good b/c they give us good information that the baby
is tolerating the internal environment, is well oxygenated, and there is a good placenta).
108. Early Decelerations - Fetal Heart Rate
Answer: Decrease in FHR mirroring the contraction.
109. Decrease in FHR mirroring the contraction.
Answer: Early Deceleration
110. Early Deceleration equates to_____________
Answer: head compression
(as the contraction is going up, the pressure is getting greater and greater on the baby's head,
therefore the baby has a vagal nerve response which is to lower the baby's heart rate. as the
pressure releases off of its head the heart rate goes back up).
111. When do we hope/want to see early deceleration during the labor process?
Answer: Towards the end of labor (8cm or 9cm)
112. Early deceleration at 3 cm might be telling us what?
Answer: The baby might not be able to fit through that pelvis
113. Late Decelerations - Fetal Heart Rate:
Answer: Decrease in FHR starting after as the contraction peaks.
114. Decrease in FHR starting after as the contraction peaks.
Answer: Late Deceleration
115. Late Decelerations are equivalent to :
Answer: Uteroplacental insufficiency (no oxygen / lack of oxygen is being carried over from
mom to baby).
116. True or False: Late Decelerations are a concern?
Answer: True: they are reason why we might have to perform a C-section instead of a vaginal.
birth.
117. Episodic Patterns / changes:
Answer: Patterns or changes not associated with uterine contractions (there doesn't need to be
uterine contractions present for changes to occur).
118. Episodic patterns include:
Answer: • Variable decelerations
• Sinusoidal Pattern
• Prolonged deceleration
119. Variable Decelerations:
Answer: Abrupt or sudden decrease in FHR.
120. Variable deceleration is due to:
Answer: cord compression (cord could be around the baby's neck or cord could be around the
baby's arm).
121. Sinusoidal Pattern:
Answer: Smooth wave-like pattern of regular frequency and amplitude.
• "False" pattern
• "True" pattern
122. Sinusoidal "False" pattern is due to:
Answer: recent drug use / medication for pain management
123. Sinusoidal "True" pattern is due to:
Answer: severe anaemia / hypoxia / acidosis
124. Prolonged deceleration:
Answer: A visually apparent decrease (may be either gradual or abrupt) in FHR of at least 15
beats/min below the baseline and lasting more than 2 minutes but less than 10 minutes.
125. Triggers for why a baby goes into Prolonged Deceleration:
Answer: Prolonged vagal nerve response (due to water breaking and the baby is used to the nice
cushion around their head and now it’s being pressed on pelvic bones).
126. Intrauterine Resuscitation interventions (what are the things we are going to do first to
provide better blood flow to the uterus, better oxygen within that blood flow, and there isn't any
pressure on the umbilical cord)
Answer: • Discontinuation of oxytocin -Reposition -Increase IV fluids
• Oxygen via mask (10L nonrebreather)
• Call physician (for Terbutaline injection prn)
127. Interventions we do not need a doctor’s note:
Answer: • D/C oxytocin -Reposition
• Increase IV fluids
• Oxygen via mask
128. What intervention should we do first in order to improve uterine blood flow, improve
umbilical cord circulation, and improve oxygenation?
Answer: Discontinuation of oxytocin!
129. VEAL CHOP:
Answer: V- Variable
E- Early Decels
A- Accelerations
L-Late Decels
C- Cord Compression
H- Head Compression
O - OK
P - Placental insufficiency
130. Category I FHR Tracings:
Answer: • baseline HR 110-160 (normal)
• moderate FHR variability
• accelerations present
• early decelerations present or absent
• late or variable decelerations absent
131. Category II FHR Tracings:
Answer: • bradycardia or tachycardia
• minimal, absent, or marked variability
• accelerations absent
• periodic or episodic decelerations present
132. Category III FHR Tracings:
Answer: • absent or minimal variability
• recurrent late decelerations
• recurrent variable deceleration present
• sinusoidal pattern identified
133. Nurse's Role with EFM:
Answer: • Application of fetal monitor
• Assessment of maternal status
• Provision of patient education on fetal monitoring
• Interpretation of fetal heart tracing
• Communication with healthcare provider
• Initiation of intrauterine resuscitation interventions
• Documentation
134. Reasons for antepartum fetal surveillance at a doctors office:
Answer: •hypertensive conditions
• gestational or pre-gestational diabetes
• history of previous fetal loss
• fetal growth less than expected
• altered amniotic fluid level
• multiple gestation
• tobacco use
