Free NCC EFM Practice Exam with Questions & Answers | Set: 4

Comprehensive and Detailed Explanation From Exact Extract–Based NCC C-EFM References:

The tracing shows tachysystole with emerging late decelerations and minimal variability:

5 contractions in 10 minutes

Deceleration nadirs occur after the peak of the contraction (late pattern)

Variability begins to trend toward minimal

The tracing has deteriorated while on oxytocin 8 mU/min, a common threshold for overstimulation

NCC and AWHONN emphasize that when tachysystole occurs with any fetal intolerance, the first action is to reduce or stop oxytocin.

Key NCC principles:

Late decelerations + tachysystole = uteroplacental insufficiency caused by excessive uterine activity

Interventions:

Stop or reduce oxytocin

Maternal repositioning

IV fluid bolus

Possible oxygen if other measures fail

Why the other options are incorrect:

A. Continue to observe — not acceptable with late decels + tachysystole.

C. Place a spiral electrode — this corrects signal quality, not uterine overstimulation or fetal oxygenation.

Thus, the best initial response is B. Decrease the oxytocin.

Comprehensive and Detailed Explanation From Exact Extract–Based NCC C-EFM References:

NICHD/NCC definitions:

Prolonged deceleration: decrease in FHR ≥15 bpm lasting 2 to 10 minutes

Bradycardia: baseline FHR <110 bpm lasting ≥10 minutes

The differentiating factor is duration, not rate and not contraction relationship.

Before 10 minutes → prolonged deceleration

At or beyond 10 minutes → new baseline → bradycardia

Thus, the factor that differentiates the two is length of time it lasts.

Comprehensive and Detailed Explanation From NCC-Aligned Sources:

NICHD/NCC criteria:

Category I must have ALL of the following:

Baseline 110–160 bpm

Moderate variability

No late or variable decelerations

Early decelerations may be present or absent

Accelerations may be present or absent

Because this tracing has one variable deceleration, it fails Category I criterion (“no late or variable decelerations”).

Category III requires:

Absent variability with recurrent late decels, recurrent variables, or bradycardia, or

Sinusoidal pattern

Those findings are not present.

Therefore, any tracing that:

Has moderate variability and accelerations,

But includes a variable deceleration, and

Does not meet Category III criteria

…falls into the Category II (indeterminate) group.

Correct classification: B. Category II.

Comprehensive and Detailed Explanation From Exact Extract–Based NCC C-EFM References:

The fetal heart rate tracing demonstrates recurrent deep variable decelerations with a rapid drop in FHR, a V-shaped pattern, and slow return to baseline. These are classic signs of cord compression. According to NCC, AWHONN, Miller, Menihan, and Simpson, recurrent variable decelerations require immediate intrauterine resuscitative interventions before any decision regarding operative birth.

NCC-aligned intervention steps include:

Maternal repositioning (first-line for cord compression)

Reducing or stopping oxytocin if infusing

IV fluid bolus

Amnioinfusion (if appropriate and recurrent deep variables persist)

Oxygen only if other measures fail (per NCC/AWHONN updated guidance)

The cervix has remained unchanged at 5 cm for 3 hours (a prolonged latent or early active labor pattern), but the fetal tracing shows Category II—recurrent variable decelerations. Category II dictates corrective action, not immediate delivery unless it progresses to Category III.

Cesarean birth (option C) is reserved for:

Persistent Category III

Failure of intrauterine resuscitation

Proven fetal intoleranceNone of these conditions have been met yet.

Thus, the correct initial management is B. Perform intrauterine resuscitative measures.

Comprehensive and Detailed Explanation From Exact Extract–Based NCC C-EFM References:

Evaluation of a tracing during oxytocin induction requires analysis of fetal status (baseline, variability, accelerations, decelerations) and uterine activity, with attention to tachysystole and fetal intolerance. NCC, AWHONN, Miller, Menihan, Simpson, and the NICHD guidelines all emphasize that oxytocin must be adjusted based on fetal response and contraction frequency.

Baseline:

The fetal heart rate baseline is approximately 150 bpm, which is within the normal range of 110–160 bpm.

Variability:

The tracing shows minimal variability (approximately 1–4 bpm amplitude). Minimal variability for a sustained period is categorized as a Category II pattern under NCC/NICHD classification.

Accelerations:

No accelerations are present during the 20-minute representative segment.

Decelerations:

There are no recurrent variable, no recurrent late, and no prolonged decelerations.

Uterine Activity:

The tracing shows very frequent contractions—approximately every 1½ to 2 minutes, which meets the NCC definition of tachysystole when averaged over 10 minutes (more than 5 contractions in 10 minutes).

According to NCC and AWHONN standards, when tachysystole is present with minimal variability, oxytocin must be reduced or discontinued even in the absence of late decelerations.

Clinical decision-making (per NCC principles):

NCC emphasizes that management of Category II patterns during induction starts with intrauterine resuscitative measures, including decreasing or stopping oxytocin when uterine activity is excessive or fetal response is suboptimal. Minimal variability with tachysystole requires correction of uterine stimulation before escalating to invasive monitoring or considering operative birth.

Option B (place a spiral electrode) is not indicated because the pattern is clearly visible and the priority is correcting uterine overstimulation, not refining the tracing.

Option C (operative birth) is not indicated; there is no Category III pattern or recurrent decelerations.

Option A (discontinue oxytocin) is the correct first-line action according to NCC-aligned guidelines when tachysystole and minimal variability occur.

Comprehensive and Detailed Explanation From Exact Extract–Based NCC C-EFM References:

When internal monitoring continues to record artifact despite:

Changing the scalp electrode

Ensuring correct attachment

Checking cable connections

Confirming maternal movement is not the cause

NCC requires confirmation of fetal well-being using another modality.

The correct next step is direct auscultation with Doppler or fetoscope.

Why other answers are incorrect:

Oxygen is not indicated for equipment malfunction.

Repositioning does not resolve internal FHR artifact.

Thus, Auscultate the fetal heart rate is the appropriate next step.

Comprehensive and Detailed Explanation From NCC-Aligned Sources:

A nonreactive NST with no response to vibroacoustic stimulation indicates:

Possible fetal sleep cycle

Possible CNS depression

Possible hypoxemia

NCC, AWHONN, and MFM guidelines state the next step is a biophysical profile because:

It evaluates fetal tone, movement, breathing, amniotic fluid, and NST

Provides a complete assessment of fetal well-being

Is less invasive and more informative than immediate delivery decisions

Why the wrong answers are incorrect:

B. Cesarean birth — not indicated without confirming fetal compromise.

C. Induction of labor — not indicated until BPP clarifies fetal status.

Correct answer: A. Biophysical profile.