Labor & Delivery - 2026 Intrapartum Nursing: Midterm Exam
(Units 1-7) - Questions with Correct Answers
100 questions
1. The most common and favorable fetal presentation is:
A. Frank breech
B. Shoulder
C. Brow
D. Cephalic vertex with the occiput leading
Correct Answer: D. Cephalic vertex with the occiput leading
Rationale: About 95% of term fetuses present vertex, which provides the smallest diameter
through the pelvis. Breech, shoulder and brow presentations increase the risk of complications.
2. Maternal white blood cell count in labor:
A. Always falls
B. Is unaffected
C. May rise to 20,000 to 25,000/mm3 without infection
D. Indicates infection when above 12,000/mm3
Correct Answer: C. May rise to 20,000 to 25,000/mm3 without infection
Rationale: Leukocytosis is a normal response to labor stress. Infection is assessed with clinical
signs, not WBC alone.
3. Hormonal theories of labor onset include:
A. Decreased prostaglandins
B. Increased progesterone dominance
C. Decreased oxytocin receptors
D. Changes in the estrogen-to-progesterone ratio, increased oxytocin receptors and
prostaglandins
Correct Answer: D. Changes in the estrogen-to-progesterone ratio, increased oxytocin
receptors and prostaglandins
Rationale: Progesterone withdrawal and prostaglandins promote contractions. The other
options would suppress labor.
,4. Footling breech increases the risk of:
A. Postterm pregnancy
B. Macrosomia
C. Polyhydramnios
D. Umbilical cord prolapse
Correct Answer: D. Umbilical cord prolapse
Rationale: The small presenting part does not fill the pelvis, leaving room for the cord. The
other conditions are not caused by presentation.
5. External rotation (restitution) of the fetal head after birth occurs as the:
A. Head realigns with the shoulders, which rotate to the anteroposterior diameter
B. Head flexes toward the chest
C. Fetus engages
D. Placenta separates
Correct Answer: A. Head realigns with the shoulders, which rotate to the anteroposterior
diameter
Rationale: This movement prepares for delivery of the shoulders. Engagement and placental
separation occur at different times.
6. Fetal attitude refers to:
A. The fetal heart rate pattern
B. The degree of flexion or extension of the fetal head and limbs
C. Fetal movement frequency
D. The side of the maternal pelvis the back faces
Correct Answer: B. The degree of flexion or extension of the fetal head and limbs
Rationale: General flexion with the chin on the chest is optimal because it presents the smallest
head diameter. Fetal position, not attitude, describes which side the occiput faces.
,7. Contractions of false labor typically:
A. Intensify with walking
B. Cause cervical change
C. Become closer together steadily
D. Remain irregular and decrease with rest, hydration or a change of activity
Correct Answer: D. Remain irregular and decrease with rest, hydration or a change of activity
Rationale: Braxton Hicks contractions do not change the cervix. Patients may still need
evaluation to confirm.
8. Bloody show is caused by:
A. Placental separation
B. Expulsion of the cervical mucus plug as the cervix begins to soften and dilate
C. Uterine rupture
D. Vaginal infection
Correct Answer: B. Expulsion of the cervical mucus plug as the cervix begins to soften and
dilate
Rationale: Pink or blood-tinged mucus is normal. Heavy bright red bleeding suggests a
complication such as previa or abruption.
9. Blood pressure measurement in labor should be taken:
A. Between contractions with the patient in a lateral or upright position
B. Only during contractions
C. Only in the supine position
D. Only once on admission
Correct Answer: A. Between contractions with the patient in a lateral or upright position
Rationale: Contractions transiently raise blood pressure. Supine positioning can cause
aortocaval compression.
, 10. Fetal lie describes:
A. The fetal part entering the pelvis first
B. The relationship of fetal parts to one another
C. The relationship of the fetal long axis to the maternal long axis
D. The level of the presenting part relative to the ischial spines
Correct Answer: C. The relationship of the fetal long axis to the maternal long axis
Rationale: Lie is longitudinal, transverse or oblique. Presentation, attitude and station are
separate terms that are often confused with it.
11. Cardinal movements of labor occur in the following order:
A. Descent, extension, engagement, flexion, expulsion and rotation
B. Engagement, descent, flexion, internal rotation, extension, external rotation (restitution) and
expulsion
C. Flexion, expulsion, engagement, rotation and descent
D. Extension, flexion, descent and engagement
Correct Answer: B. Engagement, descent, flexion, internal rotation, extension, external
rotation (restitution) and expulsion
Rationale: These movements let the fetus navigate the pelvis. Descent continues throughout,
but the sequence listed is the standard teaching order.
12. Gastric emptying during labor:
A. Is accelerated
B. Is delayed, increasing aspiration risk if general anesthesia is needed
C. Is unchanged
D. Stops completely
Correct Answer: B. Is delayed, increasing aspiration risk if general anesthesia is needed
Rationale: Clear liquids are generally allowed for low-risk patients. Solid food restrictions
depend on risk and institutional policy.
(Units 1-7) - Questions with Correct Answers
100 questions
1. The most common and favorable fetal presentation is:
A. Frank breech
B. Shoulder
C. Brow
D. Cephalic vertex with the occiput leading
Correct Answer: D. Cephalic vertex with the occiput leading
Rationale: About 95% of term fetuses present vertex, which provides the smallest diameter
through the pelvis. Breech, shoulder and brow presentations increase the risk of complications.
2. Maternal white blood cell count in labor:
A. Always falls
B. Is unaffected
C. May rise to 20,000 to 25,000/mm3 without infection
D. Indicates infection when above 12,000/mm3
Correct Answer: C. May rise to 20,000 to 25,000/mm3 without infection
Rationale: Leukocytosis is a normal response to labor stress. Infection is assessed with clinical
signs, not WBC alone.
3. Hormonal theories of labor onset include:
A. Decreased prostaglandins
B. Increased progesterone dominance
C. Decreased oxytocin receptors
D. Changes in the estrogen-to-progesterone ratio, increased oxytocin receptors and
prostaglandins
Correct Answer: D. Changes in the estrogen-to-progesterone ratio, increased oxytocin
receptors and prostaglandins
Rationale: Progesterone withdrawal and prostaglandins promote contractions. The other
options would suppress labor.
,4. Footling breech increases the risk of:
A. Postterm pregnancy
B. Macrosomia
C. Polyhydramnios
D. Umbilical cord prolapse
Correct Answer: D. Umbilical cord prolapse
Rationale: The small presenting part does not fill the pelvis, leaving room for the cord. The
other conditions are not caused by presentation.
5. External rotation (restitution) of the fetal head after birth occurs as the:
A. Head realigns with the shoulders, which rotate to the anteroposterior diameter
B. Head flexes toward the chest
C. Fetus engages
D. Placenta separates
Correct Answer: A. Head realigns with the shoulders, which rotate to the anteroposterior
diameter
Rationale: This movement prepares for delivery of the shoulders. Engagement and placental
separation occur at different times.
6. Fetal attitude refers to:
A. The fetal heart rate pattern
B. The degree of flexion or extension of the fetal head and limbs
C. Fetal movement frequency
D. The side of the maternal pelvis the back faces
Correct Answer: B. The degree of flexion or extension of the fetal head and limbs
Rationale: General flexion with the chin on the chest is optimal because it presents the smallest
head diameter. Fetal position, not attitude, describes which side the occiput faces.
,7. Contractions of false labor typically:
A. Intensify with walking
B. Cause cervical change
C. Become closer together steadily
D. Remain irregular and decrease with rest, hydration or a change of activity
Correct Answer: D. Remain irregular and decrease with rest, hydration or a change of activity
Rationale: Braxton Hicks contractions do not change the cervix. Patients may still need
evaluation to confirm.
8. Bloody show is caused by:
A. Placental separation
B. Expulsion of the cervical mucus plug as the cervix begins to soften and dilate
C. Uterine rupture
D. Vaginal infection
Correct Answer: B. Expulsion of the cervical mucus plug as the cervix begins to soften and
dilate
Rationale: Pink or blood-tinged mucus is normal. Heavy bright red bleeding suggests a
complication such as previa or abruption.
9. Blood pressure measurement in labor should be taken:
A. Between contractions with the patient in a lateral or upright position
B. Only during contractions
C. Only in the supine position
D. Only once on admission
Correct Answer: A. Between contractions with the patient in a lateral or upright position
Rationale: Contractions transiently raise blood pressure. Supine positioning can cause
aortocaval compression.
, 10. Fetal lie describes:
A. The fetal part entering the pelvis first
B. The relationship of fetal parts to one another
C. The relationship of the fetal long axis to the maternal long axis
D. The level of the presenting part relative to the ischial spines
Correct Answer: C. The relationship of the fetal long axis to the maternal long axis
Rationale: Lie is longitudinal, transverse or oblique. Presentation, attitude and station are
separate terms that are often confused with it.
11. Cardinal movements of labor occur in the following order:
A. Descent, extension, engagement, flexion, expulsion and rotation
B. Engagement, descent, flexion, internal rotation, extension, external rotation (restitution) and
expulsion
C. Flexion, expulsion, engagement, rotation and descent
D. Extension, flexion, descent and engagement
Correct Answer: B. Engagement, descent, flexion, internal rotation, extension, external
rotation (restitution) and expulsion
Rationale: These movements let the fetus navigate the pelvis. Descent continues throughout,
but the sequence listed is the standard teaching order.
12. Gastric emptying during labor:
A. Is accelerated
B. Is delayed, increasing aspiration risk if general anesthesia is needed
C. Is unchanged
D. Stops completely
Correct Answer: B. Is delayed, increasing aspiration risk if general anesthesia is needed
Rationale: Clear liquids are generally allowed for low-risk patients. Solid food restrictions
depend on risk and institutional policy.
