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Free C-EFM Practice Questions

10 free, exam-style Certificate of Added Qualifications: Electronic Fetal Monitoring (C-EFM) practice questions with answers and explanations. No signup required. Work through them below, then take the full free C-EFM practice test to study every exam domain.

The C-EFM exam has 125 questions and runs 2 hours.

Question 1

A term fetus shows a baseline of 140 bpm, moderate variability, no late or variable decelerations, and occasional accelerations. How should this tracing be classified?

  1. Category I
  2. Category II
  3. Category III
  4. Indeterminate baseline
Show answer & explanation

Correct answer: A - Category I

Question 2

In the NICHD three-tier system, a sinusoidal pattern defines a Category III tracing. Absent baseline variability also defines Category III when it occurs together with which finding?

  1. Fetal tachycardia accompanied by moderate variability
  2. Marked variability occurring with early decelerations
  3. Recurrent late or variable decelerations, or bradycardia
  4. A single prolonged deceleration lasting under 10 minutes
Show answer & explanation

Correct answer: C - Recurrent late or variable decelerations, or bradycardia

Question 3

During the second stage of labor, the recorded rate accelerates with each maternal pushing effort and the tracing appears reassuring, but the rate is 95-105 bpm. What should the nurse suspect FIRST?

  1. The monitor is recording the maternal heart rate
  2. Fetal bradycardia requiring immediate delivery
  3. A benign accelerative pattern showing fetal well-being
  4. An early deceleration pattern from head compression
Show answer & explanation

Correct answer: A - The monitor is recording the maternal heart rate

Question 4

A gradual deceleration begins after the contraction starts, reaches its nadir AFTER the peak of the contraction, and returns to baseline once the contraction ends. This pattern indicates:

  1. Umbilical cord compression
  2. Fetal head compression
  3. Uteroplacental insufficiency
  4. A normal variant needing no evaluation
Show answer & explanation

Correct answer: C - Uteroplacental insufficiency

Question 5

A tracing shows abrupt decreases in FHR of about 20 bpm below baseline lasting 20-45 seconds, with an onset-to-nadir time under 30 seconds and variable timing relative to contractions. What is the most likely cause?

  1. Maternal fever with intra-amniotic infection
  2. Uteroplacental insufficiency at the placental bed
  3. Fetal head compression during rapid descent
  4. Umbilical cord compression
Show answer & explanation

Correct answer: D - Umbilical cord compression

Question 6

Which single FHR characteristic most reliably predicts the ABSENCE of fetal metabolic acidemia at the moment it is observed?

  1. A baseline rate within 110-160 bpm
  2. The presence of early decelerations
  3. A stable baseline showing minimal variability
  4. Moderate baseline variability
Show answer & explanation

Correct answer: D - Moderate baseline variability

Question 7

For a deceleration to be classified as recurrent, it must occur with what proportion of contractions within a 20-minute window?

  1. Every single contraction without exception
  2. At least 50% of contractions
  3. At least 25% of contractions
  4. More than 75% of contractions
Show answer & explanation

Correct answer: B - At least 50% of contractions

Question 8

Uterine tachysystole is correctly defined as:

  1. More than five contractions in 10 minutes, averaged over 30 minutes
  2. A resting tone greater than 25 mmHg between contractions
  3. Individual contractions each lasting longer than 90 seconds
  4. Any contraction pattern that produces late decelerations
Show answer & explanation

Correct answer: A - More than five contractions in 10 minutes, averaged over 30 minutes

Question 9

A patient with a previous low-transverse cesarean, now laboring on oxytocin, develops a sudden prolonged deceleration, loss of the previously regular contraction pattern, and a change in her pain. Which complication should be suspected FIRST?

  1. Placenta previa
  2. Amniotic fluid embolism
  3. Uterine rupture
  4. Chorioamnionitis
Show answer & explanation

Correct answer: C - Uterine rupture

Question 10

A laboring patient has recurrent variable decelerations attributed to cord compression, with documented oligohydramnios. After repositioning provides no improvement, which intervention MOST directly targets the underlying cause?

  1. Increasing the oxytocin infusion rate to strengthen labor
  2. Administering a 500 mL lactated Ringer's fluid bolus
  3. Applying a fetal scalp electrode for a clearer signal
  4. Amnioinfusion
Show answer & explanation

Correct answer: D - Amnioinfusion

What's on the C-EFM exam

The Certificate of Added Qualifications: Electronic Fetal Monitoring (C-EFM) exam is organized into 5 knowledge domains. These free practice questions are drawn from across them so you can see where you're strong and where to study:

  1. Electronic Monitoring Equipment 5% of exam
  2. Physiology 12% of exam
  3. Pattern Recognition, Causes, and Intervention 70% of exam
  4. Fetal Assessment Methods 8% of exam
  5. Professional Issues 5% of exam

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