NURSING 404 OB EXAM 1 NCLEX QUESTION | FROM
QUESTION TO PERFECTION| STUDY WITH CONFIDENCE!
Course Code:
Course Title:
Programme:
Academic Year: 2026/2027
Duration: 2 Hours
Total Marks: 70%
Candidate Instructions:
1) Write your Registration Number on every answer booklet used.
2) Answer ALL questions in Section A and ANY TWO (2) questions in Section B.
3) Read each question carefully before answering.
4) Begin each question on a new page.
5) The marks for each question are indicated in brackets.
6) This paper consists of several printed pages, including this page.
7) Ensure your copy is complete before the examination begins.
8) Unauthorized materials and communication with other candidates are not permitted.
Turn Over.
APPHIA – Crafted with Care and Precision for Academic Excellence.
1
,1. The husband of a laboring woman asks the nurse how he can help his wife throughout the first
stage of labor. The nurse informs him that in addition to all that he's doing now, he could tell her
when the contractions are:
a. 2 minutes apart.
b. at their acme.
c. at their increment.
d. at their decrement. Answer: ANS: B
When the contraction is most intense, the coach can tell the laboring woman that this contraction
will be over soon to help her remain focused. Describing the frequency of the contractions is not
usually helpful. The increment occurs as the contraction begins in the fundus and spreads
through the uterus. Calling attention to this phase may cause the woman to become tense. The
woman does not need anyone to tell her that the contraction is decreasing in intensity.
PTS: 1 DIF: Cognitive Level: Understanding REF: 196, 197
2. The nurse is explaining to a group of nursing students what occurs during active labor as the
uterus contracts. Which statement explains the maternal-fetal exchange of oxygen and waste
products during a contraction?
a. Is not significantly affected
b. Increases as blood pressure decreases
c. Diminishes as the spiral arteries are compressed
d. Continues except when placental functions are reduced Answer: ANS: C
During labor contractions, the maternal blood supply to the placenta gradually stops as the spiral
arteries supplying the intervillous space are compressed by the contracting uterine muscle. The
exchange of oxygen and waste products is affected by contractions. The exchange of oxygen
and waste products decreases. The maternal blood supply to the placenta gradually stops with
contractions.
PTS: 1 DIF: Cognitive Level: Application REF: 199
3. The nurse is directing an unlicensed assistive personnel (UAP) to take maternal vital signs
between contractions. Which statement is the best rationale for assessing maternal vital signs
between contractions?
a. Vital signs taken during contractions are not accurate.
b. During a contraction, assessing fetal heart rate is the priority.
c. Maternal blood flow to the heart is reduced during contractions.
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
,d. Maternal circulating blood volume increases temporarily during contractions. Answer: ANS:
D
During uterine contractions, blood flow to the placenta temporarily stops, causing a relative
increase in the mother's blood volume, which in turn temporarily increases blood pressure and
slows the pulse. Vital signs are altered by contractions but are considered accurate for a period
of time. It is important to monitor the fetal response to contractions, but the question is
concerned with the maternal vital signs. Maternal blood flow is increased during a contraction.
PTS: 1 DIF: Cognitive Level: Application REF: 198
4. Uncontrolled maternal hyperventilation during labor results in:
a. metabolic acidosis.
b. metabolic alkalosis.
c. respiratory acidosis.
d. respiratory alkalosis. Answer: ANS: D
Rapid deep respirations cause the laboring woman to lose carbon dioxide through exhalation,
resulting in respiratory alkalosis. Hyperventilation does not cause respiratory acidosis,
metabolic acidosis, or metabolic alkalosis.
PTS: 1 DIF: Cognitive Level: Understanding REF: 198
5. Which mechanism of labor occurs when the largest diameter of the fetal presenting part
passes the pelvic inlet?
a. Extension
b. Engagement
c. Internal rotation
d. External rotation Answer: ANS: B
Engagement occurs when the presenting part fully enters the pelvic inlet. Extension occurs when
the fetal head meets resistance from the tissues of the pelvic floor and the fetal neck stops under
the symphysis. This causes the fetal head to extend. Internal rotation occurs when the fetus
enters the pelvic inlet. The rotation allows the longest fetal head diameter to conform to the
longest diameter of the maternal pelvis. External rotation occurs after the birth of the head. The
head then turns to the side so the shoulders can internally rotate and are positioned with their
transverse diameter in the anteroposterior diameter of the pelvic outlet.
PTS: 1 DIF: Cognitive Level: Understanding REF: 209
6. The laboring client asks the nurse how the labor contractions work to dilate the cervix. The
best response by the nurse is that labor contractions facilitate cervical dilation by:
a. promoting blood flow to the cervix.
APPHIA – Crafted with Care and Precision for Academic Excellence.
3
, b. contracting the lower uterine segment.
c. enlarging the internal size of the uterus.
d. pulling the cervix over the fetus and amniotic sac. Answer: ANS: D
Effective uterine contractions pull the cervix upward at the same time the fetus and amniotic sac
are pushed downward. Blood flow decreases to the uterus during a contraction. The contractions
are stronger at the fundus. The internal size becomes smaller with the contractions; this helps
push the fetus down.
PTS: 1 DIF: Cognitive Level: Application REF: 198
7. Pregnant clients can usually tolerate the normal blood loss associated with childbirth because
they have:
a. higher hematocrit.
b. increased leukocytes.
c. increased blood volume.
d. a lower fibrinogen level. Answer: ANS: C
Women have a significant increase in blood volume during pregnancy. After birth, the additional
circulating volume is no longer necessary. The hematocrit decreases with pregnancy because of
the high fluid volume. Leukocyte levels increase during labor, but that is not the reason for the
toleration of blood loss. Fibrinogen levels increase with pregnancy.
PTS: 1 DIF: Cognitive Level: Understanding REF: 198
8. The nurse is assessing the duration of a client's labor contractions. Which action does the
nurse implement to assess the duration of labor contractions?
a. Assess the strongest intensity of each contraction.
b. Assess uterine relaxation between two contractions.
c. Assess from the beginning to the end of each contraction.
d. Assess from the beginning of one contraction to the beginning of the next. Answer: ANS: C
Duration of labor contractions is the average length of contractions from beginning to end.
Assessing the strongest intensity of each contraction assesses the strength or intensity of the
contractions. Assessing uterine relaxation between two contractions is the interval of the
contraction phase. Assessing from the beginning of one contraction to the beginning of the next
is the frequency of the contractions.
PTS: 1 DIF: Cognitive Level: Application REF: 196, 197
9. Which event is the best indicator of true labor?
a. Bloody show
APPHIA – Crafted with Care and Precision for Academic Excellence.
4
QUESTION TO PERFECTION| STUDY WITH CONFIDENCE!
Course Code:
Course Title:
Programme:
Academic Year: 2026/2027
Duration: 2 Hours
Total Marks: 70%
Candidate Instructions:
1) Write your Registration Number on every answer booklet used.
2) Answer ALL questions in Section A and ANY TWO (2) questions in Section B.
3) Read each question carefully before answering.
4) Begin each question on a new page.
5) The marks for each question are indicated in brackets.
6) This paper consists of several printed pages, including this page.
7) Ensure your copy is complete before the examination begins.
8) Unauthorized materials and communication with other candidates are not permitted.
Turn Over.
APPHIA – Crafted with Care and Precision for Academic Excellence.
1
,1. The husband of a laboring woman asks the nurse how he can help his wife throughout the first
stage of labor. The nurse informs him that in addition to all that he's doing now, he could tell her
when the contractions are:
a. 2 minutes apart.
b. at their acme.
c. at their increment.
d. at their decrement. Answer: ANS: B
When the contraction is most intense, the coach can tell the laboring woman that this contraction
will be over soon to help her remain focused. Describing the frequency of the contractions is not
usually helpful. The increment occurs as the contraction begins in the fundus and spreads
through the uterus. Calling attention to this phase may cause the woman to become tense. The
woman does not need anyone to tell her that the contraction is decreasing in intensity.
PTS: 1 DIF: Cognitive Level: Understanding REF: 196, 197
2. The nurse is explaining to a group of nursing students what occurs during active labor as the
uterus contracts. Which statement explains the maternal-fetal exchange of oxygen and waste
products during a contraction?
a. Is not significantly affected
b. Increases as blood pressure decreases
c. Diminishes as the spiral arteries are compressed
d. Continues except when placental functions are reduced Answer: ANS: C
During labor contractions, the maternal blood supply to the placenta gradually stops as the spiral
arteries supplying the intervillous space are compressed by the contracting uterine muscle. The
exchange of oxygen and waste products is affected by contractions. The exchange of oxygen
and waste products decreases. The maternal blood supply to the placenta gradually stops with
contractions.
PTS: 1 DIF: Cognitive Level: Application REF: 199
3. The nurse is directing an unlicensed assistive personnel (UAP) to take maternal vital signs
between contractions. Which statement is the best rationale for assessing maternal vital signs
between contractions?
a. Vital signs taken during contractions are not accurate.
b. During a contraction, assessing fetal heart rate is the priority.
c. Maternal blood flow to the heart is reduced during contractions.
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
,d. Maternal circulating blood volume increases temporarily during contractions. Answer: ANS:
D
During uterine contractions, blood flow to the placenta temporarily stops, causing a relative
increase in the mother's blood volume, which in turn temporarily increases blood pressure and
slows the pulse. Vital signs are altered by contractions but are considered accurate for a period
of time. It is important to monitor the fetal response to contractions, but the question is
concerned with the maternal vital signs. Maternal blood flow is increased during a contraction.
PTS: 1 DIF: Cognitive Level: Application REF: 198
4. Uncontrolled maternal hyperventilation during labor results in:
a. metabolic acidosis.
b. metabolic alkalosis.
c. respiratory acidosis.
d. respiratory alkalosis. Answer: ANS: D
Rapid deep respirations cause the laboring woman to lose carbon dioxide through exhalation,
resulting in respiratory alkalosis. Hyperventilation does not cause respiratory acidosis,
metabolic acidosis, or metabolic alkalosis.
PTS: 1 DIF: Cognitive Level: Understanding REF: 198
5. Which mechanism of labor occurs when the largest diameter of the fetal presenting part
passes the pelvic inlet?
a. Extension
b. Engagement
c. Internal rotation
d. External rotation Answer: ANS: B
Engagement occurs when the presenting part fully enters the pelvic inlet. Extension occurs when
the fetal head meets resistance from the tissues of the pelvic floor and the fetal neck stops under
the symphysis. This causes the fetal head to extend. Internal rotation occurs when the fetus
enters the pelvic inlet. The rotation allows the longest fetal head diameter to conform to the
longest diameter of the maternal pelvis. External rotation occurs after the birth of the head. The
head then turns to the side so the shoulders can internally rotate and are positioned with their
transverse diameter in the anteroposterior diameter of the pelvic outlet.
PTS: 1 DIF: Cognitive Level: Understanding REF: 209
6. The laboring client asks the nurse how the labor contractions work to dilate the cervix. The
best response by the nurse is that labor contractions facilitate cervical dilation by:
a. promoting blood flow to the cervix.
APPHIA – Crafted with Care and Precision for Academic Excellence.
3
, b. contracting the lower uterine segment.
c. enlarging the internal size of the uterus.
d. pulling the cervix over the fetus and amniotic sac. Answer: ANS: D
Effective uterine contractions pull the cervix upward at the same time the fetus and amniotic sac
are pushed downward. Blood flow decreases to the uterus during a contraction. The contractions
are stronger at the fundus. The internal size becomes smaller with the contractions; this helps
push the fetus down.
PTS: 1 DIF: Cognitive Level: Application REF: 198
7. Pregnant clients can usually tolerate the normal blood loss associated with childbirth because
they have:
a. higher hematocrit.
b. increased leukocytes.
c. increased blood volume.
d. a lower fibrinogen level. Answer: ANS: C
Women have a significant increase in blood volume during pregnancy. After birth, the additional
circulating volume is no longer necessary. The hematocrit decreases with pregnancy because of
the high fluid volume. Leukocyte levels increase during labor, but that is not the reason for the
toleration of blood loss. Fibrinogen levels increase with pregnancy.
PTS: 1 DIF: Cognitive Level: Understanding REF: 198
8. The nurse is assessing the duration of a client's labor contractions. Which action does the
nurse implement to assess the duration of labor contractions?
a. Assess the strongest intensity of each contraction.
b. Assess uterine relaxation between two contractions.
c. Assess from the beginning to the end of each contraction.
d. Assess from the beginning of one contraction to the beginning of the next. Answer: ANS: C
Duration of labor contractions is the average length of contractions from beginning to end.
Assessing the strongest intensity of each contraction assesses the strength or intensity of the
contractions. Assessing uterine relaxation between two contractions is the interval of the
contraction phase. Assessing from the beginning of one contraction to the beginning of the next
is the frequency of the contractions.
PTS: 1 DIF: Cognitive Level: Application REF: 196, 197
9. Which event is the best indicator of true labor?
a. Bloody show
APPHIA – Crafted with Care and Precision for Academic Excellence.
4
