EFM Exam Dumps - Certified - Electronic Fetal Monitoring

Comprehensive and Detailed Explanation From Exact Extract NCC-Recommended Sources

NCC-recommended physiology references (AWHONN, Simpson & Creehan, Menihan, Creasy & Resnik) consistently state that the primary mechanism by which tachysystole affects fetal oxygenation is reduced uteroplacental perfusion, specifically through impaired intervillous space reperfusion.

During a normal contraction cycle, the fetus receives oxygen between contractions, when the uterus relaxes and maternal blood re-enters the intervillous space. AWHONN’s Fetal Heart Monitoring Principles & Practices explains that tachysystole—defined as more than five contractions in 10 minutes averaged over 30 minutes—shortens or eliminates the relaxation phase, preventing adequate placental reoxygenation.

Simpson & Creehan highlight that “tachysystole decreases uteroplacental blood flow and interferes with replenishment of oxygenated maternal blood in the intervillous space.” Menihan emphasizes that fetal hypoxemia in tachysystole results from interrupted perfusion, not from altered oxygen transport or maternal hemodynamic changes. Creasy & Resnik confirm that uterine overactivity reduces intervillous perfusion during contractions and impairs fetal oxygen exchange.

Thus, the physiologic problem is failure of the intervillous space to reperfuse, which compromises fetal oxygenation.

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 Exact Extract NCC-Recommended Sources

Sentinel events are defined by the Joint Commission as unexpected occurrences involving death, serious physical or psychological injury, or the risk thereof, and they require immediate investigation, root-cause analysis, and institutional response. They do not require confirmed malpractice or negligence.

AWHONN’s perinatal safety guidelines and NCC’s Professional Issues domain specify that sentinel events trigger mandatory reporting, analysis, system review, and corrective action plans. Simpson & Creehan emphasize that they are addressed through standardized safety processes, including interdisciplinary review.

Miller’s Pocket Guide notes that sentinel events are “events that require immediate investigation to prevent recurrence,” aligning with answer choice B.

Comprehensive and Detailed Explanation From NCC-Aligned Sources:

Contraction duration is defined as the length of time from the beginning of a contraction to the end of the same contraction (NICHD uterine activity definitions).

In the diagram:

Green arrow (B) spans one individual contraction from rise → peak → return to baseline.

Blue arrow (A) measures the interval between contractions (frequency).

Red arrow (C) measures peak-to-peak amplitude shape, not duration.

Therefore, the green arrow correctly identifies contraction duration.

Comprehensive and Detailed Explanation From NCC-Aligned Sources:

NICHD definitions:

A variable deceleration is identified by:

Abrupt onset(drop from baseline to nadir in <</b>30 seconds)

Depth ≥15 bpm

Duration ≥15 seconds and <</b>2 minutes

Variable timing relative to contractions

Variable shape (sharp drop, jagged descents, rapid recovery)

The scenario describes:

Abrupt drop from 125 → 80 bpm (rapid onset)

Lasting 90 seconds (still <</b>2 minutes)

Gradual return but still within variable range

Occurring during a contraction

Depth >15 bpm

This meets ALL criteria for a variable deceleration.

Why the other options are wrong:

A. Early deceleration

Requires gradual onset (>30 seconds).

Mirrors contraction shape.

Caused by head compression.

This decel is abrupt, so NOT early.

B. Prolonged deceleration

Requires ≥2 minutes and <</b>10 minutes.

This decel lasts 90 seconds, which is below the threshold.

Correct classification: Variable deceleration.