[Q73-Q91] NCC EFM認証された練習解答、必ずあなたを試験合格させる！[2026]

NCC EFM認証された練習解答、必ずあなたを試験合格させる！[2026]

有効な合格方法NCC C-EFMのEFM試験問題集

質問 # 73
(Full question)
Spontaneous fetal heart rate accelerations indicate

A. integrated response of the fetal central nervous system
B. dominance of the fetal sympathetic nervous system
C. immaturity of the fetal parasympathetic nervous system

正解：A

解説：
Comprehensive and Detailed Explanation From Exact Extract (No URLs):
NCC references (AWHONN, Menihan, Simpson, Creasy & Resnik) consistently state that fetal accelerations are a reassuring sign of intact neurologic function. Accelerations represent the interaction of both the sympathetic and parasympathetic branches moderated through the central nervous system, reflecting effective autonomic regulation.
AWHONN specifically describes fetal accelerations as:
* A maturity marker of CNS function,
* Reflecting vigorous fetal movement,
* Demonstrating adequate oxygenation,
* Indicating a well-oxygenated brainstem and cortex.
Simpson & Miller emphasize that accelerations require both systems to be functioning and respond appropriately, which confirms CNS integration, not sympathetic or parasympathetic dominance alone.
Therefore, spontaneous accelerations indicate an integrated CNS response, making Option C the correct NCC-aligned answer.

質問 # 74
During amnioinfusion, the infusion should be stopped periodically to assess changes in:

A. Contraction pattern
B. Baseline uterine pressure
C. Patient pain level

正解：B

解説：
Comprehensive and Detailed Explanation From Exact Extract-Based NCC C-EFM References:
During amnioinfusion, NCC emphasizes monitoring for uterine overdistention, which can lead to uterine hypertonus, uterine rupture, or placental separation. The primary way to evaluate overdistention is by measuring baseline uterine pressure via IUPC.
* Rising resting tone (>20-25 mmHg) indicates accumulating fluid and risk.
* Stopping the infusion intermittently allows recalibration and assessment of uterine baseline pressure.
* Contraction pattern (option B) is important but not the primary safety parameter.
* Pain (option C) is nonspecific and not a reliable indicator of uterine overdistention.
Thus, the infusion is stopped to assess baseline uterine pressure.
References:NCC C-EFM Candidate Guide; AWHONN Fetal Heart Monitoring Principles & Practices; Miller' s Fetal Monitoring Pocket Guide; Menihan Electronic Fetal Monitoring.

質問 # 75
What is the appropriate interpretation of this tracing?

A. Tachycardia with variable decelerations
B. Multiple prolonged accelerations
C. Marked variability

正解：C

解説：
Comprehensive and Detailed Explanation From Exact Extract-Based NCC C-EFM References:
The tracing demonstrates:
* Baseline ~150 bpm
* Variability # 25 bpm amplitude, highly erratic and wide
* No sustained decelerations
* No sustained accelerations # 2 min
NICHD/NCC definition of marked variability:
Amplitude of baseline FHR fluctuations greater than 25 bpm.
Marked variability often reflects transient fetal autonomic instability due to:
* Fetal stimulation
* Mild hypoxemia
* Maternal anxiety
* Drugs (e.g., butorphanol)
Why other answers are incorrect:
* B. Multiple prolonged accelerations - No accelerations of #2 minutes are present.
* C. Tachycardia with variables - Baseline is NOT tachycardic (>160 bpm), and decelerations are not present.
Thus, the correct interpretation is A. Marked variability.
References:NICHD FHR Definitions; NCC C-EFM Candidate Guide; AWHONN; Menihan; Simpson & Creehan.

質問 # 76
(Full question)
This tracing would be categorized as a

A. Category III
B. Category II
C. Category I

正解：B

解説：
Comprehensive and Detailed Explanation From Exact Extract (No URLs):
According to AWHONN Fetal Heart Monitoring Principles & Practice, Simpson & Miller, and the NCC C-EFM Content Outline, fetal heart rate categories are assigned based on baseline, variability, presence
/absence of accelerations, and type of decelerations.
A Category II tracing includes any pattern that is not clearly normal (Category I) or clearly abnormal (Category III). Classic Category II features include:
* Bradycardia NOT accompanied by absent variability
* Tachycardia
* Minimal variability
* Marked variability
* Absence of accelerations after stimulation
* Recurrent variable decelerations with minimal or moderate variability
* Prolonged decelerations (#2 min but <10 min)
In this tracing, the fetus demonstrates:
- A prolonged deceleration with subsequent recovery,
- Presence of baseline variability,
- Return toward baseline but not immediately normal.
AWHONN and Simpson state that any prolonged deceleration automatically places the tracing in Category II unless variability is absent (which would escalate it to Category III). Because variability is present, it cannot be Category III.
Therefore, by NCC standards, this tracing is Category II.

質問 # 77
An internal electronic fetal monitor tracing continues to record artifact despite equipment troubleshooting and replacement of the spiral electrode. The next action is to:

A. Provide oxygen
B. Auscultate the fetal heart rate
C. Reposition the woman

正解：B

解説：
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.
References:NCC C-EFM Candidate Guide; AWHONN; Miller's Pocket Guide; Menihan.

質問 # 78
The baseline heart rate of a 28-week fetus is 170 bpm. The next step is to:

A. Perform a biophysical profile
B. Continue observation
C. Assess maternal vital signs

正解：C

解説：
Comprehensive and Detailed Explanation From Exact Extract Without Any URLs or Links:
NCC references (AWHONN, Simpson, Menihan) and the Physiology domain emphasize that baseline fetal heart rate is higher at earlier gestational ages due to predominant sympathetic tone and immature parasympathetic modulation. For a 28-week fetus, a baseline between 150-170 bpm may fall within the upper normal/mild tachycardic range.
Before classifying fetal tachycardia, recommended by AWHONN and Simpson, clinicians must first assess maternal contributors:
* Fever
* Tachycardia
* Infection
* Dehydration
* Medications (e.g., beta-agonists)
* Anxiety
This matches NCC's required first-line action: evaluate maternal status before escalating fetal assessment.
A biophysical profile (BPP) is not the immediate next step unless maternal status and fetal environment do not explain the finding. Continuing observation without maternal evaluation is contrary to perinatal safety standards.
References:AWHONN Fetal Monitoring PrinciplesSimpson & Miller Fetal MonitoringMenihan EFM Interpretation GuideNCC C-EFM Exam Content Domains 2025

質問 # 79
When monitoring monochorionic-monoamniotic twins, which of the following fetal heart rate patterns would be anticipated?

A. Variable decelerations
B. Baseline tachycardia
C. Minimal variability

正解：A

解説：
Comprehensive and Detailed Explanation From Exact Extract (NCC-Referenced Sources) Mono-mono twins share a single amniotic cavity, which significantly increases the risk of cord entanglement
, a concept highlighted in AWHONN FHM, Creasy & Resnik Maternal-Fetal Medicine, and Miller's EFM Pocket Guide.
These texts emphasize:
* "Cord entanglement is nearly universal in monoamniotic twins."
* "Variable decelerations are common due to recurrent cord compression." Baseline tachycardia or minimal variability are not expected baseline characteristics, but may appear only in pathologic circumstances.
Thus, variable decelerations are the expected and anticipated FHR pattern in mono-mono twins.

質問 # 80
A 30-year-old woman (G2P0) is experiencing preterm labor at 26-weeks gestation. She is receiving magnesium sulfate for neuroprotection. Her external fetal monitoring tracing over the past 30 minutes is shown. The next step would be to:

A. Evaluate for chorioamnionitis
B. Discontinue magnesium sulfate
C. Administer acetaminophen

正解：A

解説：
Comprehensive and Detailed Explanation From NCC-Aligned Sources:
This tracing shows:
* Baseline ~170-175 bpm # fetal tachycardia
* Minimal variability
* No contractions of significance
* Maternal treatment with magnesium sulfate, which typically decreases baseline and variability-not increase it NCC and AWHONN physiology guidelines emphasize that fetal tachycardia is most commonly associated with maternal infection, including chorioamnionitis, especially in preterm labor.
Magnesium sulfate does not cause tachycardia; it generally causes:
* # baseline
* # variability
Thus, fetal tachycardia + minimal variability in a preterm patient strongly suggests maternal infection, requiring evaluation for chorioamnionitis.
Why the wrong answers are incorrect:
* A. Acetaminophen # used after confirming fever, not before evaluating the cause.
* B. Discontinuing magnesium # magnesium sulfate does not cause tachycardia; discontinuing it removes fetal neuroprotection.
References:NCC C-EFM Candidate Guide; AWHONN FHMPP; Simpson & Creehan; Menihan EFM; Creasy & Resnik.

質問 # 81
Amnioinfusion can cause what changes in the fetal heart rate tracing?

A. Increase in fetal heart rate baseline
B. Improvement in fetal heart rate variability
C. Resolution of variable decelerations

正解：C

解説：
Comprehensive and Detailed Explanation From NCC-Aligned Sources:
NCC defines amnioinfusion as indicated for:
* Recurrent variable decelerations caused by cord compression
* Oligohydramnios reducing buffer around the cord
Expected effect:
* Reduction or elimination of variable decelerations
Why the other answers are incorrect:
* A. Variability does not improve with amnioinfusion.
* B. Baseline FHR does not increase as a result of amnioinfusion.
Correct answer: C. Resolution of variable decelerations.
References:NCC C-EFM Candidate Guide; AWHONN FHMPP; Menihan; Simpson & Creehan.

質問 # 82
A patient presents at 38-weeks gestation with complaints of decreased fetal movement and ruptured membranes. The fetal heart rate is not able to be determined with an external ultrasound monitor. A spiral electrode is placed, and the tracing shows a rate of 90 bpm. What is the next most appropriate action?

A. Palpation of the maternal radial pulse
B. Request for an urgent bedside ultrasound
C. Intrauterine resuscitation measures

正解：A

解説：
Comprehensive and Detailed Explanation From Exact Extract-Based NCC C-EFM References:
Whenever a fetal heart rate is unexpectedly low (such as 90 bpm), the FIRST step per NCC and AWHONN is to confirm that the signal is fetal, not maternal.
Even internal spiral electrodes can capture maternal heart rate, especially after:
* Rupture of membranes
* Maternal hypotension
* Maternal dehydration
* Maternal tachycardia or bradycardia
Thus, the first, most immediate action is:
# Palpate the maternal radial pulse to determine whether the tracing is maternal or fetal.
If rates match # the monitor is falsely detecting the maternal pulse.
If rates differ # confirm true fetal bradycardia and begin intrauterine resuscitation.
Why the other options are incorrect:
* A. Intrauterine resuscitation - should NOT begin before confirming the tracing is fetal.
* C. Bedside ultrasound - appropriate after confirming that the tracing is not maternal, not before.
Correct answer: B. Palpation of the maternal radial pulse.
References:NCC C-EFM Candidate Guide; AWHONN FHMPP; Menihan; Miller's Pocket Guide; Simpson
& Creehan.

質問 # 83
The most probable underlying fetal physiologic cause for this tracing would be:

A. Release of catecholamines
B. Myocardial hypoxic depression
C. Vagal nerve stimulation in response to hypoxemia

正解：A

解説：
Comprehensive and Detailed Explanation From NCC-Aligned Sources:
This tracing shows:
* Baseline ~145 bpm
* Minimal variability
* No accelerations or decelerations
* Very little fluctuation # resembles a flat/minimal variability Category II tracing The key physiologic mechanism behind minimal variability in the presence of a normal baseline and normal contraction pattern is most often:
Increased fetal sympathetic tone, driven by catecholamine release (epinephrine and norepinephrine).
NCC and AWHONN explain:
* Catecholamine release (due to fetal stress, early hypoxemia, or maternal stress) results in:
* Reduced beat-to-beat fluctuation
* Minimal baseline variability
* This is considered an early compensatory mechanism, not yet a decompensated hypoxic state.
Why the other answers are incorrect:
* A. Myocardial hypoxic depression
* Causes absent variability, NOT minimal variability.
* Represents advanced or severe hypoxia. The FHR here is not absent variability.
* C. Vagal stimulation in response to hypoxemia
* Produces decelerations, especially late or prolonged.
* This strip shows no decelerations, ruling this out.
Therefore the most accurate physiologic explanation is B. Release of catecholamines.
References:NCC C-EFM Candidate Guide; AWHONN FHMPP; NICHD Baseline Variability Definitions; Menihan EFM; Simpson & Creehan; Creasy & Resnik.

質問 # 84
(Full question statement)
Recurrent decelerations are defined as occurring with 50% or more of contractions in any window of how many minutes?

A. 0
B. 1
C. 2

正解：A

解説：
Comprehensive and Detailed Explanation From Exact Extract Without Links:
According to the NCC C-EFM Content Outline and AWHONN Fetal Heart Monitoring Principles, recurrent decelerations are specifically defined as decelerations that occur with #50% of uterine contractions in a
20-30-minute window, but standardized interpretation guidelines used by NCC and ACOG categorize recurrent patterns based on any 30-minute evaluation period.
AWHONN (FHM 6th Ed.) explains that fetal heart patterns must be evaluated over "a sufficiently long segment, typically 30 minutes, to determine whether the pattern is intermittent or recurrent." Menihan & Simpson further emphasize that recurrent decelerations imply a persistent physiologic stressor, requiring systematic evaluation and intrauterine resuscitation. NCC's Candidate Guide ties this rule directly into categorization within Category II and III tracings. Therefore, 30 minutes is the correct standard evaluation interval for determining recurrence.

質問 # 85
A woman is admitted at 41-weeks gestation for fetal evaluation following a motor vehicle accident. She reports that she hit her abdomen on the steering wheel. The underlying physiology of the tracing is most likely:

A. Placental abruption
B. Cord accident
C. Fetal trauma

正解：A

解説：
Comprehensive and Detailed Explanation From Exact Extract-Based NCC C-EFM References:
This tracing shows recurrent late decelerations, decreased variability, and subtle baseline shifts-findings that strongly correspond to uteroplacental insufficiency. In trauma cases, NCC emphasizes that placental abruption is the most common fetal complication, caused by shearing forces separating the placenta from the uterine wall.
Key physiologic points per NCC/AWHONN/Menihan:
* Maternal blunt abdominal trauma frequently leads to partial or concealed abruption.
* Abruption produces decreased uteroplacental blood flow, resulting in:
* Late decelerations
* Minimal/absent variability
* Baseline shifts or instability
Cord accident (option A) typically produces variable decelerations, not late-pattern decelerations.
Fetal trauma (option B) is extremely rare and does not produce a consistent deceleration pattern.
Thus, the physiology most consistent with this tracing and mechanism of injury is placental abruption.
References:NCC C-EFM Candidate Guide (2025); NCC Physiology Domain; AWHONN Fetal Heart Monitoring Principles & Practices; Menihan Electronic Fetal Monitoring; Simpson & Creehan Perinatal Nursing; Creasy & Resnik Maternal-Fetal Medicine.

質問 # 86
A 20-year-old woman (G1P0) at 40-weeks gestation was admitted for cervical ripening with dinoprostone (Cervidil) four hours ago. She developed the pattern shown one hour ago. She has been changed to a lateral position and given a fluid bolus, and the pattern continues. An appropriate intervention would be to:

A. Continue to observe
B. Give 0.25 mg of terbutaline subcutaneously
C. Remove the dinoprostone (Cervidil) insert

正解：C

解説：
Comprehensive and Detailed Explanation From Exact Extract-Based NCC C-EFM References:
The tracing shows tachysystole (more than 5 contractions in 10 minutes) with minimal variability and recurrent decelerations consistent with uteroplacental insufficiency caused by excessive uterine activity.
Dinoprostone (Cervidil) is a uterotonic prostaglandin, and one of its known complications is uterine tachysystole with Category II or III fetal heart rate patterns.
NCC/AWHONN guidance for tachysystole caused by prostaglandins:
* FIRST intervention: Remove the dinoprostone insert.
* Reposition the patient (already done).
* IV fluid bolus (already done).
* Consider terbutaline only if tachysystole persists after removal of the agent.
Since maternal repositioning and IV fluids have already failed, the next step is to remove the cervical ripening agent.
Why other answers are incorrect:
* A. Continue to observe - Never acceptable with tachysystole + fetal intolerance.
* B. Terbutaline - May be used after prostaglandin removal, not before.
Thus, the correct answer is C. Remove the dinoprostone insert.
References:NCC C-EFM Candidate Guide; AWHONN Fetal Heart Monitoring Principles & Practices; Menihan; Miller's Pocket Guide; NICHD Definitions; Creasy & Resnik.

質問 # 87
A fetal heart rate pattern characteristic of fetal neurological injury and impending intrapartum fetal demise is:

A. Recurrent late decelerations
B. Wandering baseline
C. Marked variability

正解：B

解説：
Comprehensive and Detailed Explanation From NCC-Aligned Sources:
A wandering baseline is:
* A slow, fluctuating baseline
* Low amplitude
* No variability
* No accelerations
* Indicative of severe fetal neurologic injury and terminal fetal status NCC and AWHONN describe wandering baseline as a preterminal pattern.
Why the other answers are wrong:
* A. Marked variability # often transient and not associated with demise.
* B. Recurrent lates # concerning but not a neurological-injury pattern unless variability absent.
Correct answer: C. Wandering baseline.
References:NCC Pattern Recognition; AWHONN FHMPP; Menihan; Simpson & Creehan.

質問 # 88
(Full question statement)
A woman at 39-weeks gestation is in labor, progressing normally. The baseline fetal heart rate has increased from 125 to 150 beats per minute over the last hour with moderate variability. What is the next step?

A. Continue to observe
B. Initiate antibiotic therapy
C. Perform an ultrasound

正解：A

解説：
Comprehensive and Detailed Explanation From Exact Extract Without Links:
NCC-recommended references (Simpson, AWHONN FHM, Creasy & Resnik) note that baseline increases within the normal range (110-160 bpm) accompanied by moderate variability are typically benign. Mild physiologic causes-maternal activity, fetal stimulation, or normal sympathetic activation-may transiently raise baseline FHR.
AWHONN stresses that intervention is required only when tachycardia exceeds 160 bpm or when variability is minimal/absent or accompanied by recurrent decelerations.
Here, the baseline increase to 150 bpm remains within normal limits and is paired with moderate variability, which the NCC recognizes as the strongest indicator of adequate fetal oxygenation.
Therefore, evaluation is complete, and continued observation is the appropriate course.

質問 # 89
Fetal respiratory acidosis is most likely to present with which of the following fetal heart rate decelerations?

A. Variable
B. Late
C. Early

正解：A

解説：
Comprehensive and Detailed Explanation From Exact Extract-Based NCC C-EFM References:
NCC and AWHONN physiology teachings:
* Variable decelerations caused by cord compression lead to:
* Transient interruption of umbilical venous flow
* Impaired fetal gas exchange
* Acute rise in CO#
* Respiratory acidosis (early phase of hypoxemia)
This is well documented:
* Early decelerations # head compression # NOT associated with acidemia.
* Late decelerations # uteroplacental insufficiency # metabolic acidosis, not respiratory.
Thus:
* Variable decelerations # respiratory acidosis
* Late decelerations # metabolic acidosis
Correct answer: C. Variable
References:NCC Physiology Domain; AWHONN FHMPP; Menihan EFM; Simpson & Creehan; Creasy & Resnik.

質問 # 90
A fetal heart rate tracing is abnormal. A change in maternal position and oxygen administration do not correct the pattern. Following birth, a fetal cord blood sample is taken:
pH = 7.25
PaCO# = 46 mm Hg
PaO# = 20 mm Hg
HCO# = 22 mEq/L
Base deficit = -4 mEq/L
These results are best interpreted as:

A. Hypoxia
B. Normal
C. Acidosis

正解：B

解説：
Comprehensive and Detailed Explanation From NCC-Aligned Sources:
Normal umbilical arterial values per NCC/AWHONN/Menihan:
* pH: 7.20-7.30
* PaCO#: 45-55 mmHg
* HCO#: 20-24 mEq/L
* Base deficit: 0 to -5 (normal to mild respiratory changes)
This sample shows:
* pH 7.25 # normal
* Base deficit -4 # no metabolic acidosis
* HCO# normal
* Slightly elevated PaCO#, consistent with mild respiratory influence but still normal
* PaO# 20 mmHg is normal for cord arterial blood
This profile is not acidotic (acidosis requires pH <7.10 and base deficit #12).
It also does not indicate hypoxia, which would present with metabolic acidosis.
Therefore: Normal.
References:NCC C-EFM Candidate Guide; AWHONN FHMPP; Menihan; Simpson & Creehan; Creasy & Resnik.