NCC Updated EFM Exam Questions and Answers by arnie

Comprehensive and Detailed Explanation From Exact Extract (NCC-Referenced Sources)

AWHONN and Menihan clearly state that classification of decelerations is determined by their timing relative to uterine contractions:

Early decelerations: “mirror the contraction; onset, nadir, and recovery occur simultaneously with the contraction.”

Late decelerations: “begin after the contraction begins and return to baseline after the contraction ends.”

Depth is not a differentiating feature, as both early and late decelerations may vary in depth. The onset-to-nadir interval is used to differentiate variable vs. early/late, not early vs. late.

Thus, timing relative to contractions is the correct NCC-supported answer.

Comprehensive and Detailed Explanation From NCC-Aligned Physiologic References:

This strip shows:

Baseline around 150 bpm

Moderate variability

No decelerations

Consistent, strong contractions

A maternal report of severe pain (8/10) and feeling lightheaded

In labor, severe pain + anxiety + hyperventilation commonly cause maternal respiratory alkalosis.

NCC and AWHONN physiology guidance explain:

Hyperventilation → ↓ PaCO₂ → respiratory alkalosis

Symptoms include:

Lightheadedness

Tingling

Dizziness

Sometimes palpitations

This frequently occurs during painful contractions, especially with occiput posterior labor, which is notoriously more painful due to back pressure.

Why other answers are incorrect:

A. Respiratory acidosis occurs with hypoventilation—not present here.

C. Respiratory depression occurs with opioids, magnesium sulfate, or anesthesia—not part of this scenario.

Therefore, the correct answer is B. Alkalosis.