Questions and Answers
What percentage of the NCC EFM exam focuses on pattern recognition & intervention?
What is the average fetal heart rate baseline during a 10-minute window?
110 to 160 bpm
Define minimal variability in fetal heart rate.
≤5 bpm but detectable
Moderate variability in FHR is defined as 6 to 25 bpm.
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What is FHR acceleration?
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What is a common treatment for fetal dysrhythmias like SVT?
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Which of the following are considered professional issues in NCC EFM?
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What does quality improvement in patient care refer to?
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The fetal heart rate should be assessed for a minimum of ______ minutes to identify a baseline.
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What causes signal ambiguity in EFM?
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Study Notes
Exam Content Overview
- Exam content divided into major categories:
- Pattern recognition & intervention: 70%
- Physiology: 11%
- Fetal assessment methods: 9%
- EFM equipment: 5%
- Professional issues: 5%
Pattern Recognition & Intervention
- Key components to assess during fetal monitoring include:
- Fetal heart rate (FHR) baseline
- FHR variability
- FHR accelerations
- FHR decelerations
- Normal and abnormal uterine activity
- Fetal dysrhythmias
- Maternal complications
- Uteroplacental complications
- Fetal complications
Fetal Heart Rate (FHR) Descriptors
- Primary descriptors used in assessing FHR:
- Baseline
- Variability
- Presence of accelerations
- Presence of decelerations
- Changes in trends over time
FHR Baseline
- Defined as the average FHR rounded to the nearest 5 bpm over a 10-minute window.
- Normal range is 110 to 160 bpm and must exclude accelerations, decelerations, and marked variability.
- A minimum of 2 minutes is needed to establish a baseline, which can be non-continuous.
Fetal Bradycardia
- Defined as a significant drop in FHR below normal ranges with a minimum threshold of 25 bpm.
- Clinical significance remains unclear with such an indeterminate baseline.
Variability in FHR
-
Minimal variability: ≤5 bpm, detectable; may indicate sleep, sedation, or illness.
- Sleep cycles last 20-60 minutes.
- Sedated states (due to CNS depressants like magnesium) last 1-2 hours.
- Illness (acidemia) remains unresolved and requires prioritizing oxygenation.
- Moderate variability: 6 to 25 bpm; signifies absence of metabolic acidosis, even in presence of decelerations.
FHR Accelerations
- Predicts absence of metabolic acidemia, whether spontaneous or stimulated.
- Defined by onset to peak occurring within 200 Montevideo Units (MVUs) and associated with 6 hours of inadequate contractions.
Fetal Dysrhythmias
-
SVT (Supraventricular Tachycardia): Heart rates range from 210 to 300 bpm; treatment includes digoxin.
- Associated risks: hydrops, congestive heart failure, increased oxygen demand.
- Congenital heart block: Ranges from 140 to 90 bpm; treatments involve calcium channel blockers, thiazides, and beta-blockers.
Cord Blood & Acid Base Balance
- Measures oxygenation at delivery.
- Base deficit or excess of +/-12 indicates immediate clinical implications, while normal bicarbonate levels suggest overall stability.
- Metabolic acidosis characterized by normal CO2 and decreased bicarbonate.
Intrauterine Pressure Catheter (IUPC)
- Measures uterine pressure during labor, assessing contraction intensity and resting tone.
- Requires rupture of membranes (ROM) and cervical dilation for insertion to the 35-45 cm mark.
- Risks include possible placental or uterine perforation and infection.
Artifacts in Monitoring
- Artifacts manifest as vertical lines in tracing, caused by interference during recording.
- Causes include vaginal exams, fetal movement, or connection issues; necessary to rule out arrhythmia.
Signal Ambiguity
- Occurs when EFM inadvertently picks up maternal heart rate or signals from another fetus.
- Verifying with pulse oximeter, internal scalp electrode (ISE), or fetoscope is essential.
Professional Issues in EFM
- Key components include:
- Legal considerations
- Ethical standards
- Patient safety
- Quality improvement practices
Legal Considerations
- Informed consent must include procedure risks, benefits, and alternatives.
- Consent is implied in emergencies and can be revoked at any time.
- Negligence defined as breach of duty leading to damages; malpractice denotes professional negligence causing harm.
Ethical Principles
- Core principles include:
- Autonomy: honoring patient decision-making
- Veracity: commitment to truthfulness
- Fidelity: obligation to uphold commitments
- Justice: ensuring equal treatment
- Beneficence & nonmaleficence: promoting good while preventing harm.
- Confidentiality and privacy protections.
Patient Safety Measures
- Sentinel events are critical safety events resulting in patient harm or death.
- Frequent communication breakdowns are major contributing factors; SBAR (Situation, Background, Assessment, Recommendation) can enhance communication.
Quality Improvement Initiatives
- Focus on measurable improvement in patient care outcomes.
- Standard of care represents expected provider actions to avoid harm.
- Evidence-based practice (EBP) refers to applying best practices supported by research and guidelines.
- Validity pertains to the accuracy of measures, whereas reliability concerns the consistency of results.
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Description
This quiz provides a comprehensive breakdown of the NCC EFM exam content, including key areas such as pattern recognition and intervention, physiology, fetal assessment methods, and more. Use these flashcards to enhance your understanding and prepare effectively for the exam.
