NUR 230 MATERNAL EXAM 2 — INTRAPARTUM NURSING
NUR 230 Maternal Exam 2 | Questions and Answers |
2026/2027 Update | 100% Correct - Galen
Galen College of Nursing | Maternal-Newborn Nursing
75 Questions | Aligned with ACOG, AWHONN, NCC, and NCSBN Clinical Judgment Model (2026/2027)
This comprehensive examination is designed for NUR 230 Maternal-Newborn Nursing students at Galen College of
Nursing preparing for Maternal Exam 2. The 75-question assessment covers intrapartum foundations, fetal monitoring,
stages and mechanisms of labor, pain management, intrapartum complications, operative and assisted delivery, and
immediate newborn and maternal transition. Questions are aligned with current 2026/2027 ACOG (American College of
Obstetricians and Gynecologists), AWHONN (Association of Women's Health, Obstetric and Neonatal Nurses), and
NCC (National Certification Corporation) fetal monitoring guidelines. The exam reflects the NCSBN Clinical Judgment
Measurement Model and includes NCLEX-style prioritization, fetal tracing interpretation, and emergency obstetric
scenarios. Cognitive level distribution: approximately 30% recall, 50% application, and 20% analysis. Question format:
80% scenario-based and 20% direct recall. Each question includes a verified correct answer with a detailed
intrapartum-specific rationale and test-taking strategy.
SECTION 1: Intrapartum Foundations (Labor Theories, Onset of Labor, &
Admission Assessment) — Q1–10
Q1. A nursing student is reviewing theories of labor onset. Which physiologic event is the PRIMARY mechanical
trigger for the initiation of labor in a term pregnancy?
A. Decreased estrogen production by the placenta
B. Stretching of the uterine muscle and pressure on the cervix [CORRECT]
C. Rising maternal progesterone levels late in the third trimester
D. Decreased fetal cortisol secretion from the adrenal cortex
Correct Answer: B
Rationale: The mechanical theory of labor onset holds that stretching of the uterine musculature and increased pressure on the
cervix (from the growing fetus and uterine contractions) initiate labor. Estrogen rises (not falls) late in pregnancy to increase
oxytocin receptor sensitivity. Progesterone normally DECREASES (progesterone withdrawal) to allow contractions. Fetal cortisol
INCREASES (not decreases) to stimulate placental estrogen production. Test-taking strategy: focus on mechanical forces —
'stretching' and 'pressure' are the key mechanical triggers.
Q2. A primigravida client at 39 weeks' gestation asks the nurse what hormone is responsible for softening the
cervix in preparation for labor. The nurse's best response identifies which hormone?
A. Oxytocin
B. Relaxin
C. Prostaglandins [CORRECT]
D. Prolactin
Correct Answer: C
Rationale: Prostaglandins (specifically PGE2 and PGF2alpha) play a central role in cervical ripening (softening and thinning) and
increasing myometrial contractility. Oxytocin stimulates uterine contractions during labor but is not the primary cervical-ripening
agent. Relaxin relaxes pelvic ligaments but does not directly soften the cervix. Prolactin prepares the breasts for lactation. ACOG
recognizes prostaglandin preparations (e.g., dinoprostone) for cervical ripening induction. Test-taking strategy: 'cervical
softening/ripening' = prostaglandins.
NUR 230 Maternal Exam 2 | 2026/2027 Update | Galen College of Nursing Page 1
, NUR 230 MATERNAL EXAM 2 — INTRAPARTUM NURSING
Q3. A client presents to the labor and delivery unit at 40 weeks' gestation reporting contractions every 5 minutes.
On admission, which vital sign finding requires IMMEDIATE nursing intervention before proceeding with the
vaginal exam?
A. Blood pressure 138/86 mmHg
B. Maternal heart rate 92 beats/minute
C. Temperature 38.2°C (100.8°F) [CORRECT]
D. Respiratory rate 20 breaths/minute
Correct Answer: C
Rationale: A maternal temperature of 38.0°C (100.4°F) or higher (chorioamnionitis threshold) is an obstetric emergency requiring
immediate notification of the provider, blood cultures, and likely antibiotic initiation. BP 138/86 is mildly elevated but below the
severe range (160/110) and warrants ongoing monitoring, not immediate intervention. HR 92 and RR 20 are within acceptable
labor parameters. AWHONN guidelines identify intrapartum fever as a sentinel event warranting prompt evaluation for
intra-amniotic infection. Test-taking strategy: select the finding that signals infection — temperature elevation is the immediate
priority.
Q4. During admission vaginal examination of a laboring client, the nurse documents the following: cervix 6 cm
dilated, 80% effaced, presenting part at -1 station. The nurse correctly interprets these findings as indicating the
client is in which phase of labor?
A. Latent phase of the first stage
B. Active phase of the first stage [CORRECT]
C. Transition phase of the first stage
D. Second stage of labor
Correct Answer: B
Rationale: Per ACOG/AWHONN 2026 criteria, the active phase of the first stage of labor begins at 6 cm dilation (revised from
the traditional 4 cm). With 6 cm dilation, 80% effacement, and -1 station, the client is in the active phase. Latent phase is 0–6 cm.
Transition is the late active phase typically with 8–10 cm dilation. Second stage begins at complete (10 cm) dilation. Test-taking
strategy: remember '6 cm = active phase' per the revised ACOG Safe Labor Prevention guidelines.
Q5. When performing the FIRST Leopold's maneuver on a pregnant client at 38 weeks' gestation, which fetal
part is the nurse palpating to identify?
A. The fetal presenting part (head or breech) at the fundus [CORRECT]
B. The fetal back and small parts on either side of the uterus
C. The fetal presenting part above the symphysis pubis
D. The fetal attitude and degree of flexion of the head
Correct Answer: A
Rationale: The FIRST Leopold's maneuver identifies the fetal pole (presenting part) lying in the fundus — the head feels hard,
round, and mobile (ballotable), while the breech feels soft, irregular, and non-ballotable. The SECOND maneuver palpates the back
and small parts on the maternal abdomen sides. The THIRD maneuver identifies the presenting part above the symphysis pubis
(Pawlik's grip). The FOURTH maneuver confirms attitude and flexion. Test-taking strategy: 'fundus first' — the first maneuver
examines what is in the fundus.
Q6. Using Leopold's maneuvers, the nurse palpates a hard, round, ballotable mass in the fundus, the fetal back
along the maternal right side, and small parts on the maternal left side. The cephalic prominence is on the same
side as the small parts. Which fetal position should the nurse document?
A. Left occiput anterior (LOA)
B. Right occiput anterior (ROA)
C. Left occiput posterior (LOP)
D. Right occiput posterior (ROP) [CORRECT]
Correct Answer: D
NUR 230 Maternal Exam 2 | 2026/2027 Update | Galen College of Nursing Page 2
, NUR 230 MATERNAL EXAM 2 — INTRAPARTUM NURSING
Rationale: A hard, round, ballotable mass in the fundus = breech (so the head is the presenting part — cephalic). Fetal back on
maternal right + cephalic presentation = right occiput. The cephalic prominence (forehead) being on the SAME side as the small
parts (the side opposite the back) indicates the occiput is posterior (ROP). If the prominence were on the SAME side as the back, it
would be ROA. Test-taking strategy: occiput is on the SAME side as the back; anterior vs posterior depends on which side the
cephalic prominence (forehead) is — opposite the back = anterior, same as back = posterior.
Q7. A client calls the labor unit reporting contractions every 7 minutes that are mild in intensity. She states the
contractions ease when she walks around and are felt primarily in the lower abdomen. Which finding suggests
this is FALSE labor?
A. Contractions are regular at 7-minute intervals
B. Contractions are relieved by ambulation [CORRECT]
C. Cervical dilation of 3 cm on last prenatal visit
D. Bloody show noted on toilet paper this morning
Correct Answer: B
Rationale: True labor contractions INCREASE in frequency, duration, and intensity with ambulation and are typically felt in the
lower back radiating to the abdomen. Contractions that are RELIEVED by ambulation are characteristic of false labor (Braxton
Hicks). Regularity alone does not confirm true labor. Bloody show is suggestive but not definitive. The defining criterion is the
response to ambulation and cervical change. Test-taking strategy: 'walk it off' = false labor; contractions that intensify with walking
= true labor.
Q8. A client at 39 weeks' gestation presents to the labor unit reporting a 'gush of fluid' followed by a small
amount of pink-tinged mucus. The nurse confirms rupture of membranes with nitrazine paper (blue) and
ferning. The client asks what the pink mucus means. The nurse's best explanation is:
A. It indicates a vaginal infection that requires antibiotics
B. It is the bloody show, indicating cervical changes are occurring [CORRECT]
C. It suggests placental abruption and requires emergency cesarean
D. It is normal lochia and signifies the start of the postpartum period
Correct Answer: B
Rationale: Bloody show is the passage of the cervical mucus plug mixed with a small amount of blood as the cervix effaces and
dilates; it is a normal sign of impending labor. The pink-tinged mucus is not indicative of infection (which would present with foul
odor, fever, or purulent discharge). Placental abruption typically presents with sudden onset dark red vaginal bleeding and
abdominal pain/tenderness, often with non-reassuring FHR. Lochia occurs in the postpartum period, not intrapartum. Test-taking
strategy: 'pink mucus + cervical change' = bloody show.
Q9. The labor unit receives report on four clients. Which client should the nurse assess FIRST based on
maternal-fetal risk?
A. A primigravida at 4 cm dilation requesting an epidural
B. A multigravida at 7 cm dilation with contractions every 3 minutes
C. A client at 8 cm dilation with rupture of membranes showing meconium-stained fluid [CORRECT]
D. A client at 10 cm dilation who is beginning to bear down with each contraction
Correct Answer: C
Rationale: Meconium-stained amniotic fluid at 8 cm dilation signals potential fetal compromise requiring immediate assessment
of FHR variability, decelerations, and preparation for possible neonatal resuscitation (NRP). The client at 10 cm who is bearing
down is in second stage and requires nurse presence for delivery but is physiologically expected. The epidural request and active
labor multigravida are routine needs. Using the maternal-fetal risk framework, meconium indicates the highest immediate risk.
Test-taking strategy: any sign of fetal compromise (meconium, abnormal FHR, bleeding) is assessed first.
Q10. On admission to the labor unit, a client at 39 weeks' gestation has a baseline fetal heart rate of 165
beats/minute. Maternal temperature is 37.4°C, pulse 88, BP 124/78. Which action should the nurse take NEXT?
A. Administer 1000 mL IV fluid bolus of lactated Ringer's
NUR 230 Maternal Exam 2 | 2026/2027 Update | Galen College of Nursing Page 3
NUR 230 Maternal Exam 2 | Questions and Answers |
2026/2027 Update | 100% Correct - Galen
Galen College of Nursing | Maternal-Newborn Nursing
75 Questions | Aligned with ACOG, AWHONN, NCC, and NCSBN Clinical Judgment Model (2026/2027)
This comprehensive examination is designed for NUR 230 Maternal-Newborn Nursing students at Galen College of
Nursing preparing for Maternal Exam 2. The 75-question assessment covers intrapartum foundations, fetal monitoring,
stages and mechanisms of labor, pain management, intrapartum complications, operative and assisted delivery, and
immediate newborn and maternal transition. Questions are aligned with current 2026/2027 ACOG (American College of
Obstetricians and Gynecologists), AWHONN (Association of Women's Health, Obstetric and Neonatal Nurses), and
NCC (National Certification Corporation) fetal monitoring guidelines. The exam reflects the NCSBN Clinical Judgment
Measurement Model and includes NCLEX-style prioritization, fetal tracing interpretation, and emergency obstetric
scenarios. Cognitive level distribution: approximately 30% recall, 50% application, and 20% analysis. Question format:
80% scenario-based and 20% direct recall. Each question includes a verified correct answer with a detailed
intrapartum-specific rationale and test-taking strategy.
SECTION 1: Intrapartum Foundations (Labor Theories, Onset of Labor, &
Admission Assessment) — Q1–10
Q1. A nursing student is reviewing theories of labor onset. Which physiologic event is the PRIMARY mechanical
trigger for the initiation of labor in a term pregnancy?
A. Decreased estrogen production by the placenta
B. Stretching of the uterine muscle and pressure on the cervix [CORRECT]
C. Rising maternal progesterone levels late in the third trimester
D. Decreased fetal cortisol secretion from the adrenal cortex
Correct Answer: B
Rationale: The mechanical theory of labor onset holds that stretching of the uterine musculature and increased pressure on the
cervix (from the growing fetus and uterine contractions) initiate labor. Estrogen rises (not falls) late in pregnancy to increase
oxytocin receptor sensitivity. Progesterone normally DECREASES (progesterone withdrawal) to allow contractions. Fetal cortisol
INCREASES (not decreases) to stimulate placental estrogen production. Test-taking strategy: focus on mechanical forces —
'stretching' and 'pressure' are the key mechanical triggers.
Q2. A primigravida client at 39 weeks' gestation asks the nurse what hormone is responsible for softening the
cervix in preparation for labor. The nurse's best response identifies which hormone?
A. Oxytocin
B. Relaxin
C. Prostaglandins [CORRECT]
D. Prolactin
Correct Answer: C
Rationale: Prostaglandins (specifically PGE2 and PGF2alpha) play a central role in cervical ripening (softening and thinning) and
increasing myometrial contractility. Oxytocin stimulates uterine contractions during labor but is not the primary cervical-ripening
agent. Relaxin relaxes pelvic ligaments but does not directly soften the cervix. Prolactin prepares the breasts for lactation. ACOG
recognizes prostaglandin preparations (e.g., dinoprostone) for cervical ripening induction. Test-taking strategy: 'cervical
softening/ripening' = prostaglandins.
NUR 230 Maternal Exam 2 | 2026/2027 Update | Galen College of Nursing Page 1
, NUR 230 MATERNAL EXAM 2 — INTRAPARTUM NURSING
Q3. A client presents to the labor and delivery unit at 40 weeks' gestation reporting contractions every 5 minutes.
On admission, which vital sign finding requires IMMEDIATE nursing intervention before proceeding with the
vaginal exam?
A. Blood pressure 138/86 mmHg
B. Maternal heart rate 92 beats/minute
C. Temperature 38.2°C (100.8°F) [CORRECT]
D. Respiratory rate 20 breaths/minute
Correct Answer: C
Rationale: A maternal temperature of 38.0°C (100.4°F) or higher (chorioamnionitis threshold) is an obstetric emergency requiring
immediate notification of the provider, blood cultures, and likely antibiotic initiation. BP 138/86 is mildly elevated but below the
severe range (160/110) and warrants ongoing monitoring, not immediate intervention. HR 92 and RR 20 are within acceptable
labor parameters. AWHONN guidelines identify intrapartum fever as a sentinel event warranting prompt evaluation for
intra-amniotic infection. Test-taking strategy: select the finding that signals infection — temperature elevation is the immediate
priority.
Q4. During admission vaginal examination of a laboring client, the nurse documents the following: cervix 6 cm
dilated, 80% effaced, presenting part at -1 station. The nurse correctly interprets these findings as indicating the
client is in which phase of labor?
A. Latent phase of the first stage
B. Active phase of the first stage [CORRECT]
C. Transition phase of the first stage
D. Second stage of labor
Correct Answer: B
Rationale: Per ACOG/AWHONN 2026 criteria, the active phase of the first stage of labor begins at 6 cm dilation (revised from
the traditional 4 cm). With 6 cm dilation, 80% effacement, and -1 station, the client is in the active phase. Latent phase is 0–6 cm.
Transition is the late active phase typically with 8–10 cm dilation. Second stage begins at complete (10 cm) dilation. Test-taking
strategy: remember '6 cm = active phase' per the revised ACOG Safe Labor Prevention guidelines.
Q5. When performing the FIRST Leopold's maneuver on a pregnant client at 38 weeks' gestation, which fetal
part is the nurse palpating to identify?
A. The fetal presenting part (head or breech) at the fundus [CORRECT]
B. The fetal back and small parts on either side of the uterus
C. The fetal presenting part above the symphysis pubis
D. The fetal attitude and degree of flexion of the head
Correct Answer: A
Rationale: The FIRST Leopold's maneuver identifies the fetal pole (presenting part) lying in the fundus — the head feels hard,
round, and mobile (ballotable), while the breech feels soft, irregular, and non-ballotable. The SECOND maneuver palpates the back
and small parts on the maternal abdomen sides. The THIRD maneuver identifies the presenting part above the symphysis pubis
(Pawlik's grip). The FOURTH maneuver confirms attitude and flexion. Test-taking strategy: 'fundus first' — the first maneuver
examines what is in the fundus.
Q6. Using Leopold's maneuvers, the nurse palpates a hard, round, ballotable mass in the fundus, the fetal back
along the maternal right side, and small parts on the maternal left side. The cephalic prominence is on the same
side as the small parts. Which fetal position should the nurse document?
A. Left occiput anterior (LOA)
B. Right occiput anterior (ROA)
C. Left occiput posterior (LOP)
D. Right occiput posterior (ROP) [CORRECT]
Correct Answer: D
NUR 230 Maternal Exam 2 | 2026/2027 Update | Galen College of Nursing Page 2
, NUR 230 MATERNAL EXAM 2 — INTRAPARTUM NURSING
Rationale: A hard, round, ballotable mass in the fundus = breech (so the head is the presenting part — cephalic). Fetal back on
maternal right + cephalic presentation = right occiput. The cephalic prominence (forehead) being on the SAME side as the small
parts (the side opposite the back) indicates the occiput is posterior (ROP). If the prominence were on the SAME side as the back, it
would be ROA. Test-taking strategy: occiput is on the SAME side as the back; anterior vs posterior depends on which side the
cephalic prominence (forehead) is — opposite the back = anterior, same as back = posterior.
Q7. A client calls the labor unit reporting contractions every 7 minutes that are mild in intensity. She states the
contractions ease when she walks around and are felt primarily in the lower abdomen. Which finding suggests
this is FALSE labor?
A. Contractions are regular at 7-minute intervals
B. Contractions are relieved by ambulation [CORRECT]
C. Cervical dilation of 3 cm on last prenatal visit
D. Bloody show noted on toilet paper this morning
Correct Answer: B
Rationale: True labor contractions INCREASE in frequency, duration, and intensity with ambulation and are typically felt in the
lower back radiating to the abdomen. Contractions that are RELIEVED by ambulation are characteristic of false labor (Braxton
Hicks). Regularity alone does not confirm true labor. Bloody show is suggestive but not definitive. The defining criterion is the
response to ambulation and cervical change. Test-taking strategy: 'walk it off' = false labor; contractions that intensify with walking
= true labor.
Q8. A client at 39 weeks' gestation presents to the labor unit reporting a 'gush of fluid' followed by a small
amount of pink-tinged mucus. The nurse confirms rupture of membranes with nitrazine paper (blue) and
ferning. The client asks what the pink mucus means. The nurse's best explanation is:
A. It indicates a vaginal infection that requires antibiotics
B. It is the bloody show, indicating cervical changes are occurring [CORRECT]
C. It suggests placental abruption and requires emergency cesarean
D. It is normal lochia and signifies the start of the postpartum period
Correct Answer: B
Rationale: Bloody show is the passage of the cervical mucus plug mixed with a small amount of blood as the cervix effaces and
dilates; it is a normal sign of impending labor. The pink-tinged mucus is not indicative of infection (which would present with foul
odor, fever, or purulent discharge). Placental abruption typically presents with sudden onset dark red vaginal bleeding and
abdominal pain/tenderness, often with non-reassuring FHR. Lochia occurs in the postpartum period, not intrapartum. Test-taking
strategy: 'pink mucus + cervical change' = bloody show.
Q9. The labor unit receives report on four clients. Which client should the nurse assess FIRST based on
maternal-fetal risk?
A. A primigravida at 4 cm dilation requesting an epidural
B. A multigravida at 7 cm dilation with contractions every 3 minutes
C. A client at 8 cm dilation with rupture of membranes showing meconium-stained fluid [CORRECT]
D. A client at 10 cm dilation who is beginning to bear down with each contraction
Correct Answer: C
Rationale: Meconium-stained amniotic fluid at 8 cm dilation signals potential fetal compromise requiring immediate assessment
of FHR variability, decelerations, and preparation for possible neonatal resuscitation (NRP). The client at 10 cm who is bearing
down is in second stage and requires nurse presence for delivery but is physiologically expected. The epidural request and active
labor multigravida are routine needs. Using the maternal-fetal risk framework, meconium indicates the highest immediate risk.
Test-taking strategy: any sign of fetal compromise (meconium, abnormal FHR, bleeding) is assessed first.
Q10. On admission to the labor unit, a client at 39 weeks' gestation has a baseline fetal heart rate of 165
beats/minute. Maternal temperature is 37.4°C, pulse 88, BP 124/78. Which action should the nurse take NEXT?
A. Administer 1000 mL IV fluid bolus of lactated Ringer's
NUR 230 Maternal Exam 2 | 2026/2027 Update | Galen College of Nursing Page 3
