NCC EFM (ELECTRONIC FETAL MONITORING CERTIFICATION)
STUDY GUIDE COMPLETE SOLUTION 2023/2024 CORRECT QUESTIONS AND
ANSWERS
1. Which of the following factors can have a negative effect on uterine blood flow?
A. Hypertension
B. Epidural
C. Hemorrhage
D. Diabetes
Answer: A. Hypertension
B. Epidural
C. Hemorrhage
D. Diabetes
2. 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
Answer: A. A decrease in the heart rate
3. The vagus nerve begins maturation 26 to 28 weeks. Its dominance results in what effect to
the FHR baseline?
A. Increases baseline
B. Decreases baseline
Answer: B. Decreases baseline
4. The most common artifact with the ultrasound transducer system for fetal heart rate is
increased variability.
Answer: True
5. All fetal monitors contain a logic system designed to reject artifact.
Answer: True
6. Fetal arrhythmias can be seen on both internal and external monitor tracings.
Answer: True
7. Variability and periodic changes can be detected with both internal and external monitoring.
Answer: True
8. Variable decelerations are a vagal response.
Answer: True
9. Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in
labor.
Answer: True
10. Etiology of a baseline FHR of 165bpm occurring for the last hour can be:
1. Maternal supine hypotension
2. Maternal fever
3. Maternal dehydration
4. Unknown
A. 1 and 2
B. 1, 2 and 3
C. 2, 3 and 4
Answer: C. 2, 3 and 4
11. 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
Answer: C. Uteroplacental insufficiency
12. 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
Answer: C. Fetus in breech presentation
13. Which of the following does not affect the degree of fetal activity?
A. Vibroacoustic stimulation
B. Smoking
C. Fetal position
D. Gestational age
Answer: A. Vibroacoustic stimulation
14. Umbilical cord influences that can alter blood flow include true knots, hematomas, and
number of umbilical vessels.
Answer: True
15. Low amplitude contractions are not an early sign of preterm labor.
Answer: False
16. Corticosteroid administration may cause an increase in FHR accelerations
Answer: False
17. Corticosteroid administration may cause an increase in FHR.
Answer: True
18. Contractions cause an increase in uterine venous pressure and a decrease in uterine artery
perfusion.
Answer: True
19. 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
Answer: B. Increase BP and decrease HR
20. 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
Answer: B. Gestational diabetes
21. All of the following are likely causes of prolonged decelerations except:
A. Uterine tachysystole
B. Prolapsed cord
C. Maternal hypotension
D. Maternal fever
Answer: D. Maternal fever
22. All of the following could likely cause minimal variability in FHR except
A. Magnesium sulfate administration
B. Fetal sleep cycle
C. Narcotic administration
D. Ephedrine administration
Answer: D. Ephedrine administration
23. When an IUPC has been placed, Montevideo units must be _________ or greater for
adequate cervical change to occur.
A. 100
B. 200
C. 300
D. 400
Answer: B. 200
24. What would be a suspected pH in a fetus whose FHTs included recurrent late decelerations
during labor?
A. 7.10
B. 7.26
C. 7.32
D. 7.41
Answer: A. 7.10
25. 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
D. Continue to observe and record the normal pattern
Answer: D. Continue to observe and record the normal pattern
26. Determining the FHR baseline requires the nurse to approximate the mean FHR rounded to
increments of 5 bpm during a ____ -minute window (excluding accelerations and decelerations).
A. 2
B. 5
C. 10
D. 20
Answer: C. 10
27. Which of the following interventions would best stimulate an acceleration in the FHR?
A. Provide juice to patient
B. Perform vaginal exam
C. Turn patient on left side
D. Vibroacoustic stimulation
Answer: B. Perform vaginal exam
28. The FHR is controlled by the
A. Sympathetic nervous system
B. Sinoatrial node
C. Atrioventricular node
D. Parasympathetic nervous system
Answer: B. Sinoatrial node
29. Fetal tachycardia is a normal compensatory response to transient fetal hypoxemia.
Answer: True
30. At how many weeks gestation should FHR variability be normal in manner?
A. 24 weeks
B. 28 weeks
C. 32 weeks
D. 36 weeks
Answer: B. 28 weeks
31. Reduced respiratory gas exchange from persistent decelerations may cause a rise in fetal
PCO2, which leads first to ______________, then ______________.
A. Respiratory alkalosis; metabolic acidosis
B. Respiratory acidosis; metabolic acidosis
C. Respiratory alkalosis; metabolic alkalosis
D. Respiratory acidosis; metabolic acidosis
Answer: B. Respiratory acidosis; metabolic acidosis
32. Decreased intervillious exchange of oxygenated blood resulting in fetal hypoxia is typically
present in __________.
A. Variable decelerations
B. Late decelerations
C. Early decelerations
D. Accelerations
Answer: B. Late decelerations
33. 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
Answer: D. 3, 2, 4, 1
34. FHTs with accelerations, no decelerations, and minimal variability would be categorized as
A. Category I
B. Category II
C. Category III
Answer: B. Category II
35. FHTs with minimal variability, absent accelerations, and a 3-minute prolonged deceleration
would be categorized as
A. Category I
B. Category II
C. Category III
Answer: B. Category II
36. 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
Answer: C. Triple screen positive for Trisomy 21
37. 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
Answer: D. Polyhydramnios
38. The normal FHR baseline
A. Decreases during labor
B. Fluctuates during labor
C. Increases during labor
Answer: B. Fluctuates during labor
39. Bradycardia in the second stage of labor following a previously normal tracing may be
caused by fetal
A. Hypoxemia
B. Rotation
C. Vagal stimulation
Answer: C. Vagal stimulation
40. Clinically significant fetal metabolic academia is indicated by an arterial cord gas pH of less
than or equal to 7.10 and a base deficit of
A. 3
B. 6
C. 12
Answer: C. 12
41. Fetal bradycardia can result during
A. The sleep state
B. Umbilical vein compression
C. Vagal stimulation
Answer: C. Vagal stimulation
42. While caring for a 235-lb laboring woman who is HIV-seropositive, the external FHR tracing
is difficult to obtain. An appropriate nursing action would be to
A. Apply a fetal scalp electrode
B. Auscultate for presence of FHR variability
C. Notify the attending midwife or physician
Answer: C. Notify the attending midwife or physician
43. Which IV fluid is most appropriate for maternal administration for intrauterine resuscitation?
A. Lactated Ringer's solution
B. D5L/R
C. Normal saline
Answer: C. Normal saline
44. An EFM tracing with absent variability and no decelerations would be classified as
A. Category I
B. Category II (indeterminate)
C. Category III
Answer: B. Category II (indeterminate)
45. An EFM tracing with absent variability and intermittent late decelerations would be
classified as
A. Category I
B. Category II
C. Category III
Answer: B. Category II
46. Maternal oxygen administration is appropriate in the context of
A. Recurrent variable decelerations/moderate variability
B. Intermittent late decelerations/minimal variability
C. Prolonged decelerations/moderate variability
Answer: B. Intermittent late decelerations/minimal variability
47. In the context of hypoxemia, fetal blood flow is shifted to the
A. Brain
B. Liver
C. Lungs
Answer: A. Brain
48. Baroreceptor-mediated decelerations are
A. Early
B. Late
C. Variable
Answer: C. Variable
49. An appropriate initial treatment for recurrent late decelerations with moderate variability
during first stage labor is
A. Amnioinfusion
B. Maternal repositioning
C. Oxygen at 10L per nonrebreather face mask
Answer: B. Maternal repositioning
50. Most fetal dysrhythmias are not life-threatening, except for __________, which may lead to
fetal congestive heart failure.
Answer: Supraventricular tachycardia
51. Medications, prematurity, fetal sleep, fetal dysrhythmia, anesthetic agents, or cardiac
anomalies may result in __________ variability.
Answer: Decreased
52. Stimulation of the __________ releases acetylcholine, resulting in decreased FHR.
Answer: Parasympathetic nervous system
53. The __________ maintains transmission of beat-to-beat variability.
Answer: Parasympathetic nervous system
54. Stimulation of the __________ releases catecholamines, resulting in increased FHR.
Answer: Sympathetic nervous system
55. Stimulation of _______________ results in abrupt decreases in FHR, CO, and BP.
Answer: Baroreceptors
56. Baroreceptors influence ____________ decelerations with moderate variability.
Answer: Variable
57. In comparing early and late decelerations, a distinguishing factor between the two is
A. Onset time to the nadir of the deceleration
B. The number of decelerations that occur
C. Timing in relation to contractions
Answer: C. Timing in relation to contractions
58. The underlying cause of early decelerations is decreased
A. Baroceptor response
B. Increased peripheral resistance
C. Vagal reflex
Answer: C. Vagal reflex
59. Glucose is transferred across the placenta via ____________.
Answer: Facilitated diffusion
60. Oxygen, carbon dioxide, water, electrolytes, urea, uric acid, fatty acids, fat-soluble vitamins,
narcotics barbiturates, anesthetics, and antibiotics are transferred across the placenta via.
Answer: Simple (passive) diffusion
61. Amino acids, water-soluble vitamins, calcium, phosphorus, iron, and iodine are transferred
across the placenta via ____________.
Answer: Active transport
62. Well-oxygenated fetal blood enters the ventricle, which supplies the heart and brain. Lessoxygenated blood enters the ventricle, which supplies the rest of the body.
Answer: Left; right
63. Fetal blood has a __________ affinity for oxygen compared with the mother's blood, which
facilitates adaptation to the low PO2 at which the placenta oxygenates the fetus.
A. Higher
B. Lower
Answer: A. Higher
64. The fetus has a __________ cardiac output and heart rate than the adult, resulting in rapid
circulation.
A. Higher
B. Lower
Answer: A. Higher
65. Which statement best describes the relationship between maternal and fetal hemoglobin
levels?
A. Fetal hemoglobin is higher than maternal hemoglobin
B. Maternal hemoglobin is higher than fetal hemoglobin
C. Maternal and fetal hemoglobin are the same
Answer: A. Fetal hemoglobin is higher than maternal hemoglobin
66. A 36 week gestation patient is brought to triage by squad after an MVA on her back. She is
not bleeding and denies pain. She is not short of breath, but c/o dizziness and nausea since they
put her on the gurney. The most likely cause is
A. Abruptio placenta
B. Preterm labor
C. Supine hypotension
Answer: C. Supine hypotension
67. When the hydrogen ion content in the blood rises, the pH
A. Lowers
B. Neutralizes
C. Rises
Answer: A. Lowers
68. A woman receives terbutaline for an external version. You may expect what on the fetal heart
tracing?
A. Decrease in variability
B. Increase in baseline
C. No change
Answer: B. Increase in baseline
69. What affect does magnesium sulfate have on the fetal heart rate?
A. Decreases variability
B. Increases variability
C. No change
Answer: A. Decreases variability
70. Sinusoidal pattern can be documented when
A. Cycles are 4-6 beats per minute in frequency
B. The pattern lasts 20 minutes or longer
C. There is moderate or minimal variability
Answer: B. The pattern lasts 20 minutes or longer
71. Vagal stimulation would be manifested as what type of fetal heart rate pattern?
A. Acceleration
B. Early deceleration
C. Tachycardia
Answer: B. Early deceleration
72. Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially
when seen at the onset of labor?
A. Early deceleration
B. Late deceleration
C. Variable deceleration
Answer: A. Early deceleration
73. A risk of amnioinfusion is
A. Prolonged labor
B. Uterine overdistension
C. Water intoxication
Answer: B. Uterine overdistension
74. A fetal heart rate pattern that can occur when there is a prolapsed cord is
A. Marked variability
B. Prolonged decelerations
C. Tachycardia
Answer: B. Prolonged decelerations
75. The patient is in early labor with pitocin at 8 mu/min, and FHR is Category I. In the next 15
minutes, there are 18 uterine contractions. Recommended management is to
A. Address contraction frequency by reducing pitocin dose
B. Continue to increase pitocin as long as FHR is Category I
C. Turn the patient on her side and initiate an IV fluid bolus
Answer: C. Turn the patient on her side and initiate an IV fluid bolus
76. A woman at 38 weeks gestation is in labor. The labor has been uneventful, and the fetal heart
tracings have been normal. Spontaneous rupture of membranes occurs; fetal heart rate drops to
90 beats per minute for four minutes and then resumes a normal pattern. The most likely etiology
for this fetal heart rate change is
A. Abnormal fetal presentation
B. Impaired placental circulation
C. Possible cord compression
Answer: C. Possible cord compression
77. A woman has 10 fetal movements in one hour. This is considered what kind of movement?
A. Decreased
B. Excessive
C. Normal
Answer: C. Normal
78. If the pH is low, what other blood gas parameter is used to determine if the acidosis is
respiratory or metabolic?
A. HCO3
B. PCO2
C. PO2
Answer: B. PCO2
79. The following cord blood gasses are consistent with: pH 7.10, pCO2 70, pO2 25, base excess
-10
A. Metabolic acidosis
B. Mixed acidosis
C. Respiratory acidosis
Answer: C. Respiratory acidosis
80. As a contraction beings, partial umbilical cord compression causes occlusion of the lowpressure vein and decreased return of blood to the fetal heart, resulting in decreased CO,
hypotension, and a compensatory FHR __________.
A. Acceleration
B. Early deceleration
C. Late deceleration
D. Variable deceleration
Answer: A. Acceleration
81. With complete umbilical cord occlusion, the two umbilical arteries also become occluded,
resulting in sudden fetal hypertension, stimulation of the baroreceptors, and a sudden
__________ in FHR.
A. Increase
B. Decrease
Answer: B. Decrease
82. Central __________ are located in the medulla oblongata; peripheral __________ are found
in the carotid sinuses and aortic arch.
A. Baroreceptors
B. Chemoreceptors
Answer: B. Chemoreceptors
83. When a fetus is stressed, catecholamine release (epinephrine, norepinephrine) occurs from
the medulla oblongata, shunting blood __________ the brain, heart, and adrenal glands.
A. Toward
B. Away from
Answer: A. Toward
84. A Doppler device used for intermittent auscultation of the fetal heart rate may be used to
identify rhythm irregularities, such as supraventricular tachycardia.
Answer: False
85. Use of a fetoscope for intermittent auscultation of the fetal heart rate may be used to detect
accelerations and decelerations from the baseline, and can clarify double-counting of halfcounting of baseline rate.
Answer: True
86. In the context of moderate variability, late decelerations are considered neurogenic in origin
and are typically amenable to intrauterine resuscitation techniques directed towards maximizing
uterine blood flow.
Answer: True
87. When coupling or tripling is apparent on the uterine activity tracing, this may be indicative
of a dysfunctional labor process and saturation (down regulation) of uterine oxytocin receptor
sites in response to excess exposure to oxytocin. Which of the following interventions would be
most appropriate?
A. Normal response; continue to increase oxytocin titration
B. Turn patient on side
C. Decrease or discontinue oxytocin infusion
Answer: C. Decrease or discontinue oxytocin infusion
88. The most common tachyarrhythmia in fetuses, supraventricular tachycardia, typically occurs
at a rate of _______ to ________ bpm with minimal or absent variability.
A. 160-200
B. 200-240
C. 240-260
Answer: C. 240-260
89. In a patient with oxytocin-induced tachysystole with normal fetal heart tones, which of the
following should be the nurse's initial intervention?
A. Assist the patient to lateral position
B. Discontinue Pitocin
C. Administer IV fluid bolus
Answer: A. Assist the patient to lateral position
90. In a patient with oxytocin-induced tachysystole with indeterminate or abnormal fetal heart
tones, which of the following should be the nurse's initial intervention?
A. Assist the patient to lateral position
B. Discontinue Pitocin
C. Administer IV fluid bolus
Answer: B. Discontinue Pitocin
91. Fetal hypoxia and acidemia are demonstrated by pH < ________ and base excess < ______.
Answer: < 7.15; < -8
92. Uterine resting tone may appear higher (25 to 40 mmHg) during amnioinfusion.
Answer: True
93. _________ denotes an increase in hydrogen ions in the fetal blood.
A. Acidosis
B. Acidemia
C. Hypercapnia
Answer: B. Acidemia
94. __________ occurs when there is low bicarbonate (base excess) in the presence of normal
pressure of carbon dioxide (PCO2) values.
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
Answer: A. Metabolic acidosis
95. __________ occurs when there is high PCO2 with normal bicarbonate levels.
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
Answer: B. Respiratory acidosis
96.__________ occurs when the HCO3 concentration is lower than normal.
A. Base deficit
B. Base excess
C. Metabolic acidosis
Answer: A. Base deficit
97. ________ occurs when the HCO3 concentration is higher than normal.
A. Base deficit
B. Base excess
C. Metabolic acidosis
Answer: B. Base excess
98. __________ is defined as the energy-consuming process of metabolism.
Answer: Anabolism
99. _________ is defined as the energy-releasing process of metabolism
Answer: Catabolism
100. Normal oxygen saturation for the fetus in labor is _____% to %_____.
Answer: 30% to 65%
101. pH 7.05
PO2 21
PCO2 72
HCO3 24
Base excess -12
A. Metabolic acidosis
B. Respiratory acidosis
C. Mixed acidosis
Answer: B. Respiratory acidosis
102. pH 7.0
PO2 18
PCO2 54
HCO3 20
Base deficit 14
A. Metabolic acidosis
B. Respiratory acidosis
C. Mixed acidosis
Answer: A. Metabolic acidosis
103. pH 7.02 PO2 17
PCO2 72
HCO3 19
Base deficit 16
A. Metabolic acidosis
B. Respiratory acidosis
C. Mixed acidosis
Answer: C. Mixed acidosis
104. With the finding of a single umbilical artery, what would you expect to observe with
Doppler flow studies?
A. Decreased blood perfusion from the fetus to the placenta
B. Decreased blood perfusion from the placenta to the fetus
C. Homeostatic dilation of the umbilical artery
Answer: A. Decreased blood perfusion from the fetus to the placenta
Two umbilical arteries flow from the fetus to the placenta
105. A patient presents with a small amount of thick dark blood clots who denies pain and whose
abdomen is soft to the touch. Which component of oxygen transport to the fetus could
potentially be compromised by this bleeding?
A. Affinity
B. Saturation
C. Delivery
Answer: C. Delivery
106. Which intrinsic homeostatic response is the fetus demonstrating when abrupt variable
decelerations are present?
A. Baroreceptor
B. Catecholamine
C. Sympathetic
Answer: A. Baroreceptor
107. An infant was delivered via cesarean. Umbilical cord blood gases were: pH 6.88, PCO2
114, PO2 10, bicarbonate 15, base excess (-) 20. The initial neonatal hemocrit was 20% and the
hemoglobin was 8.
Which interpretation of these umbilical cord and initial neonatal blood results is correct?
A. Base buffers have been used to maintain oxygenation
B. The mother was probably hypoglycemic
C. The neonate is anemic
Answer: C. The neonate is anemic
108. An infant was delivered via cesarean. Umbilical cord blood gases were: pH 6.88, PCO2
114, PO2 10, bicarbonate 15, base excess (-) 20. The initial neonatal hemocrit was 20% and the
hemoglobin was 8.
These umbilical cord blood gases indicate
A. Asphyxia related to umbilical and placental abnormalities
B. Hypoxia related to neurological damage
C. Mixed acidosis
Answer: C. Mixed acidosis
109. Which FHR tracing features must be assessed to distinguish arrhythmias from artifact?
A. Shape and regularity of the spikes
B. Spikes and variability
C. Spikes and baseline
Answer: A. Shape and regularity of the spikes
110. How might a fetal arrhythmia affect fetal oxygenation?
A. By increasing fetal oxygen affinity
B. By increasing sympathetic response
C. By reducing fetal perfusion
Answer: C. By reducing fetal perfusion
111. Which medication is used to treat fetal arrhythmias?
A. Digoxin
B. Labetolol
C. Nifedipine
Answer: A. Digoxin
112. Inotropic
Answer: promotes regular and effective cardiac contraction
113. Fetal hydrops may present on ultrasound as fetal scalp edema and increased abdominal
fluid as a results of
A. An increase in gestational age
B. Congestive heart failure
C. Sustained oligohydramnios
Answer: B. Congestive heart failure
114. What might increase fetal oxygen consumption?
A. Hyperthermia
B. Umbilical cord compression
C. Uterine tachysystole
Answer: A. Hyperthermia
Increases metabolism and oxygen consumption
115. Which assessment or intervention would be least appropriate in a patient whose FHR
tracing revealed tachycardia and a prolonged deceleration?
A. Change maternal position to right lateral
B. Further assess fetal oxygenation with scalp stimulation
C. Perform a vaginal exam to assess fetal descent
Answer: B. Further assess fetal oxygenation with scalp stimulation
Only used with normal baseline rate and never during decels; not an intervention
116. Which of the following pieces of information would be of highest priority to relay to the
neonatal team as they prepare for an emergency cesarean delivery?
A. FHR arrhythmia, meconium, length of labor
B. Gestational age, meconium, arrhythmia
C. Gravidity & parity, gestational age, maternal temperature
Answer: B. Gestational age, meconium, arrhythmia
117. Which medications used with preterm labor can affect the FHR characteristics?
A. Terbutaline and antibiotics
B. Betamethasone and terbutaline
C. Antibiotics and narcotics
Answer: B. Betamethasone and terbutaline
118. What characterizes a preterm fetal response to stress?
A. More frequently occurring late decelerations
B. More frequently occurring prolonged decelerations
C. More rapid deterioration from Category I to Category II or III
Answer: C. More rapid deterioration from Category I to Category II or III
More likely to be subjected to hypoxia
119. A woman being monitored externally has a suspected fetal arrhythmia. The most
appropriate action is to
A. Insert a spiral electrode and turn off the logic
B. Turn the logic on if an external monitor is in place
C. Use a Doppler to listen to the ventricular rate
Answer: A. Insert a spiral electrode and turn off the logic
120. The fetus responds to a significant drop of PO2 by
A. Increasing O2 consumption
B. Reducing lactic acid production
C. Shifting blood to vital organs
Answer: C. Shifting blood to vital organs
121. Which factor influences blood flow to the uterus?
A. Fetal arterial pressure
B. Intervillous space flow
C. Maternal arterial vasoconstriction
Answer: C. Maternal arterial vasoconstriction
122. Betamethasone given to the mother can transiently affect the FHR by
A. Decreasing variability
B. Increasing variability
C. Lowering the baseline
Answer: A. Decreasing variability
123. In a fetal heart rate tracing with marked variability, which of the following is likely the
cause?
A. Recent ephedrine administration
B. Recent epidural placement
C. Fetal acidemia
Answer: A. Recent ephedrine administration
124. A fetal heart rate change that can be seen after administration of butorphanol (Stadol) is
A. Bradycardia
B. Marked variability
C. Sinusoidal-appearing
Answer: C. Sinusoidal-appearing
125. The FHR pattern that is likely to be seen with maternal hypothermia is
A. Bradycardia
B. Marked variability
C. Tachycardia
Answer: A. Bradycardia
126. Baseline FHR variability is determined in what amount of time, excluding accelerations
and decelerations?
A. 10 min
B. 20 min
C. 30 min
Answer: A. 10 min
127. Which of the following tachyarrhythmias can result in fetal hydrops?
A. Persistent supraventricular tachycardia
B. Premature atrial contractions
C. Sinus tachycardia
Answer: A. Persistent supraventricular tachycardia
128. A preterm fetus with persistent supraventricular tachycardia that is not hydropic is best
treated with maternal administration of
A. Digoxin
B. Phenobarbital
C. Terbutaline
Answer: A. Digoxin
129. The initial response in treating a primigravida being induced for preeclampsia who has a
seizure is
A. Administer terbutaline to slow down uterine activity
B. Initiate magnesium sulfate
C. Perform an immediate cesarean delivery
Answer: B. Initiate magnesium sulfate
130. Which FHR sounds are counted with a stethoscope and a fetoscope?
A. Atrial
B. Atrial and ventricular
C. Ventricular
Answer: C. Ventricular
131. When using auscultation to determine FHR baseline, the FHR should be counted after the
contractions for
A. 5-10 sec
B. 15-30 sec
C. 30-60 sec
Answer: C. 30-60 sec
132. A woman who is 34 weeks' gestation is counting fetal movements each day. Today she
counted eight fetal movements in a two-hour period. Based on her kick counts, this woman
should
A. Continue counting for one more hour
B. Discontinue counting until tomorrow
C. Notify her provider for further evaluation
Answer: C. Notify her provider for further evaluation
133. A BPP score of 6 is considered
A. Abnormal
B. Normal
C. Equivocal
Answer: C. Equivocal
134. As fetal hypoxia (asphyxia) worsens, the last component of the BPP to disappear is fetal
A. Breathing
B. Movement
C. Tone
Answer: C. Tone
135. The legal term that describes a failure to meet the required standard of care is
A. Breach of duty
B. Negligence
C. Proximate cause
Answer: A. Breach of duty
136. Regarding the reliability of EFM, there is
A. Good interobserver reliability
B. Good intraobserver reliability
C. Poor interobserver and intraobserver reliability
Answer: C. Poor interobserver and intraobserver reliability
137. The objective of intrapartum FHR monitoring is to assess for fetal
A. Acidemia
B. Oxygenation
C. Well-being
Answer: B. Oxygenation
138. Use of the terms "beat-to-beat" variability and "long-term" variability is not recommended
by the NICHD because in clinical practice
A. They are visually determined as a unit
B. Both signify an intact cerebral cortex
C. Clinical management is unchanged
Answer: A. They are visually determined as a unit
139. Late decelerations of the FHR are associated most specifically with
A. Transient fetal tissue metabolic acidosis during a contraction
B. Transient fetal hypoxemia during a contraction
C. Transient fetal asphyxia during a contraction
Answer: B. Transient fetal hypoxemia during a contraction
140. Assessment of FHR variability
A. Requires a fetal scalp electrode
B. Includes quantification of beat-to-beat changes
C. Can be performed using an external monitor with autocorrelation technique
Answer: C. Can be performed using an external monitor with autocorrelation technique
141. The "overshoot" FHR pattern is highly predictive of
A. Fetal hypoxia
B. Preexisting fetal neurological injury
C. None of the above
Answer: C. None of the above
142. A Category II tracing
A. Predicts abnormal fetal acid-base status
B. Excludes abnormal fetal acid-base status
C. Is not predictive of abnormal fetal acid-base status
Answer: C. Is not predictive of abnormal fetal acidbase status
143. Plans of the health care team with a patient with a sinusoidal FHR pattern may include
A. Administration of an NST
B. Administration of tocolytics
C. Kleinhauer-Betke lab test
Answer: C. Kleinhauer-Betke lab test
144. Stimulation of the fetal vagus nerve will
A. Increase FHR
B. Decrease FHR
C. Initially increase, then decrease FHR
Answer: B. Decrease FHR
145. Which of the following is not true when assessing preterm fetuses?
A. FHR baseline may be in upper range of normal (150-160 bpm)
B. They may have fewer accels, and if <35 weeks, may be 10x10
C. Variability may be in lower range for moderate (6-10 bpm)
Answer: B. They may have fewer accels, and if <35 weeks, may be 10x10
146. One of the side effects of terbutaline as a tocolytic is
A. Fetal bradycardia
B. Increased oxygen consumption
C. Marked variability
Answer: B. Increased oxygen consumption
147. Common problems seen during monitoring of post term fetuses include all of the following
except
A. Baseline may be 100-110bpm
B. Increased variables
C. Polyhydramnios
Answer: C. Polyhydramnios
148. Which of the following is not commonly affected by corticosteroids?
A. Doppler flow studies
B. FHR baseline
C. Frequency of FHR accelerations
Answer: A. Doppler flow studies
149. A fetus of a diabetic mother may commonly develop
A. Polyhydramnios
B. Supraventricular tachycardia
C. Third-degree heart block
Answer: A. Polyhydramnios
150. The fetus of a mother with preeclampsia is at high risk for developing
A. Intrauterine growth restriction (IUGR)
B. Macrosomia
C. Polyhydramnios
Answer: A. Intrauterine growth restriction (IUGR)
151. High resting tone may occur with an IUPC because of all of the following except
A. Extraovular placement
B. Maternal BMI
C. Multiple gestations
Answer: B. Maternal BMI
152. Which of the following is the primary neurotransmitter of the sympathetic branch of the
autonomic nervous system?
A. Acetylcholine
B. Dopamine
C. Norepinephrine
Answer: C. Norepinephrine
153. Which of the following is the primary neurotransmitter of the parasympathetic branch of
the autonomic nervous system?
A. Acetylcholine
B. Dopamine
C. Norepinephrine
Answer: A. Acetylcholine
154. Which of the following is responsible for variations in the FHR and fetal behavioral states?
A. Cerebellum
B. Cerebral cortex
C. Medulla oblongata
Answer: B. Cerebral cortex
155. When the umbilical vessels traverse the membranes to the placenta without any cord
protection, this is called
A. Placenta previa
B. Succenturiate lobe (SL)
C. Velamentous insertion
Answer: C. Velamentous insertion
156. Which of the following is the primary factor in uteroplacental blood flow?
A. Fetal heart rate
B. Maternal cardiac output
C. Maternal oxygen consumption
Answer: B. Maternal cardiac output
157. Which of the following occurs when the parasympathetic branch of the autonomic nervous
system is stimulated?
A. Norepinephrine release
B. Slowed conduction to sinoatrial node
C. Increase in fetal heart rate
Answer: B. Slowed conduction to sinoatrial node
158. Which of the following is responsible for fetal muscle coordination?
A. Cerebellum
B. Cerebral cortex
C. Medulla oblongata
Answer: A. Cerebellum
159. During periods of fetal tachycardia, FHR variability is usually diminished due to
A. The dominance of the parasympathetic nervous system
B. The dominance of the sympathetic nervous system
C. Stimulation of the fetal vagus nerve
Answer: A. The dominance of the parasympathetic nervous system
160. Periodic accelerations can indicate all of the following except
A. Stimulation of fetal chemoreceptors
B. Tracing is a maternal tracing
C. Umbilical vein compression
Answer: A. Stimulation of fetal chemoreceptors
161. A transient decrease in cerebral blood flow (increased cerebral blood pressure) during a
contraction may stimulate _____ and may cause a(n) _______
A. Baroreceptors; early deceleration
B. Baroreceptors; late deceleration
C. Chemoreceptors; early deceleration
Answer: A. Baroreceptors; early deceleration
162. The primary physiologic goal of interventions for late decelerations is to
A. Decrease maternal oxygen consumption
B. Maximize placental blood flow
C. Maximize umbilical circulation
Answer: B. Maximize placental blood flow
163. Which of the following is most responsible for producing FHR variability as the fetus
grows?
A. Maturation of the parasympathetic nervous system
B. Maturation of the sympathetic nervous system
C. Release of maternal prostaglandins
Answer: A. Maturation of the parasympathetic nervous system
164. Which of the following is not a type of supraventricular dysrhythmia?
A. Premature atrial contraction (PAC)
B. Premature ventricular contraction (PVC)
C. Supraventricular tachycardia (SVT)
Answer: B. Premature ventricular contraction (PVC)
165. Which is the most common type of fetal dysrhythmia?
A. Premature atrial contraction (PAC)
B. Premature ventricular contraction (PVC)
C. Third-degree heart block
Answer: A. Premature atrial contraction (PAC)
166. All of the following are traits of fetal supraventricular tachycardia (SVT), but which is most
problematic?
A. Decreases diastolic filling time
B. Dramatically increases oxygen consumption
C. Often leads to ventricular tachycardia (VT)
Answer: C. Often leads to ventricular tachycardia (VT)
167. Which abnormal FHR pattern is most likely to lead to hydrops in the fetus?
A. Marked variability
B. A premature ventricular contraction (PVC)
C. Supraventricular tachycardia (SVT)
Answer: C. Supraventricular tachycardia (SVT)
168. Which of the following is an irregular FHR pattern associated with normal conduction and
rate?
A. Premature atrial contractions (PACs)
B. Sinus arrhythmias
C. Sinus tachycardias
Answer: B. Sinus arrhythmias
169. Which of the following is one example of a fetal tachyarrhythmia?
A. Second-degree heart block, Type I
B. Atrial fibrillation
C. Premature atrial contraction (PAC)
Answer: B. Atrial fibrillation
170. Sinus bradycardias, sinus tachycardias, and sinus arrhythmias are all associated with
normal conduction (normal P-waves followed by narrow QRS complexes).
Answer: True
171. An internal scalp electrode will detect the actual fetal ECG.
Answer: True
171a. An internal scalp electrode can solely diagnose a fetal dysrhythmia.
Answer: False
172. _______ are patterns of abnormal FHR associated with variability in R-to-R intervals, but
with normal Pwaves preceding normal QRS complexes.
A. Arrhythmias
B. Complete heart blocks
C. Dysrhythmias
Answer: A. Arrhythmias
173. _________ are abnormal FHR rhythms associated with disordered impulse formation,
conduction, or both.
A. Arrhythmias
B. Supraventricular tachycardias
C. Dysrhythmias
Answer: C. Dysrhythmias
174. Which of the following fetal dysrhythmias may be related to maternal hyperthyroidism?
A. Sinus tachycardia
B. Premature atrial contractions (PACs)
C. Third-degree heart block
Answer: B. Premature atrial contractions (PACs)
175. With ________ premature ventricular contractions (PVCs), the baseline and variability are
obscured.
A. Idioventricular
B. Bigeminal
C. Trigeminal
Answer: B. Bigeminal
176. With ___________ premature ventricular contractions (PVCs), the upward spikes will be
slightly longer than the downward spikes.
A. Idioventricular
B. Bigeminal
C. Trigeminal
Answer: C. Trigeminal
177. Which of the following dysrhythmias may progress to atrial fibrillation or atrial flutter?
A. Premature atrial contractions (PACs)
B. Supraventricular tachycardia (SVT)
C. Sinus tachycardia
Answer: B. Supraventricular tachycardia (SVT)
178. Which of the following is not commonly caused by administration of indomethacin?
A. Decreased fetal urine (decreased amniotic fluid index [AFI])
B. Decreased FHR baseline
C. Increased variable decelerations
Answer: B. Decreased FHR baseline
179. Which of the following is not commonly caused by terbutaline administration?
A. Increased FHR baseline
B. Decreased FHR late decelerations
C. Increased maternal HR
Answer: B. Decreased FHR late decelerations
180. Which of the following is not commonly caused by nifedipine administration?
A. Maternal hypotension
B. Decreased uterine blood flow
C. Increased FHR accelerations
Answer: C. Increased FHR accelerations
181. Which of the following would likely be affected by betamethasone administration?
A. Fetal echocardiogram
B. Biophysical profile (BPP) score
C. Contraction stress test (CST)
Answer: B. Biophysical profile (BPP) score
Fetal breathing decreased with betamethasone administration
182. Which of the following is not typically associated with a post term pregnancy?
A. Meconium-stained amniotic fluid
B. Presence of late decelerations in the fetal heart rate
C. Polyhydramnios
Answer: C. Polyhydramnios
183. Which of the following is the most appropriate method of monitoring a patient who is a
gestational diabetic?
A. Daily NSTs
B. Twice-weekly BPPs
C. Weekly contraction stress tests
Answer: B. Twice-weekly BPPs
184. Which of the following is not commonly caused by magnesium sulfate?
A. Increased FHR baseline
B. Decreased FHR variability
C. Decreased FHR accelerations
Answer: A. Increased FHR baseline
pH 6.9, PO2 15, PCO2 55, HCO3 18, BE -22
185. The nurse reviews the arterial gas results and concludes that the fetus had _________
acidosis. With results such as these, you would expect a _______ resuscitation.
A. Metabolic; lengthy
B. Metabolic; short
C. Respiratory; lengthy
Answer: A. Metabolic; lengthy
186. Which of the following umbilical artery cord gases would most likely result in a fetus who
had a Category I strip, then had a cord prolapse and was delivered within 3 minutes?
A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5
B. pH 7.25, PO2 23, PCO2 46, HCO3 22, BE -8
C. pH 7.02, PO2 18, PCO2 56, HCO3 15, BE -18
Answer: A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5
187. Which of the following is most likely to result in absent end diastolic flow during umbilical
artery velocimetry?
A. Preeclampsia
B. Preterm labor
C. Previous cesarean delivery
Answer: A. Preeclampsia
188. A contraction stress test (CST) is performed. Late decelerations were noted in two out of
the five contractions in 10 minutes. This is interpreted as
A. Positive
B. Negative
C. Suspicious
Answer: C. Suspicious
189. A contraction stress test (CST) is performed. Two variable decelerations were seen on the
FHR tracing and there were four contractions in 10 minutes. This is interpreted as
A. Positive
B. Negative
C. Suspicious
Answer: B. Negative
190. A contraction stress test (CST) is performed. No decelerations were noted with the two
contractions that occurred over 10 minutes. This is interpreted as
A. Positive
B. Negative
C. Unsatisfactory
Answer: C. Unsatisfactory
191. In a patient whose CST reveals late decelerations with three out of the four induced
contractions, which of the following would be the least appropriate plan for treatment?
A. Obtain physician order for BPP
B. Prepare for possible induction of labor
C. Repeat CST in 24 hours
Answer: C. Repeat CST in 24 hours
192. For a patient at 38 weeks' gestation with a BPP score of 6, select the most appropriate
course of action.
A. Repeat in one week
B. Consider induction of labor
C. Prepare for cesarean delivery
Answer: B. Consider induction of labor
193. For a patient at 35 weeks' gestation with a BPP score of 4, select the most appropriate
course of action.
A. Repeat in 24 hours
B. Obtain physician order for CST
C. Prepare for probable induction of labor
Answer: C. Prepare for probable induction of labor
194. Vibroacoustic stimulation may be less effective for preterm fetuses or when membranes
have been ruptured.
Answer: True
195. _______ cord blood sampling is predictive of uteroplacental function.
A. Arterial
B. Venous
C. Maternal
Answer: B. Venous
196. Metabolic acidosis is more easily reversible and potentially less detrimental to the fetus
when compared to respiratory acidosis.
Answer: False
197. There is a strong correlation between arterial cord blood gas results and Apgar scores.
Answer: False
198. Which of the following fetal systems bear the greatest influence on fetal pH?
A. Heart and lungs
B. Lungs and kidneys
C. Sympathetic and parasympathetic nervous systems
Answer: B. Lungs and kidneys
199. All of the following are components of liability except
A. Breach of duty
B. Chain of command
C. Damages/loss
Answer: B. Chain of command
200. Elements of a malpractice claim include all of the following except
A. Breach of duty
B. Deposition
C. Injury or loss
Answer: B. Deposition
201. pH 6.86
pCO2 28
pO2 2.1
HCO3 4.0
B.D. 42
The umbilical arterial cord blood gas values reflect
A. metabolic acidemia
B. mixed acidemia
C. respiratory acidemia
Answer: A. Metabolic acidemia
