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INP 402 EXAM – INTRAPARTUM NURSING
PRACTICE ASSESSMENT COMPLETE
QUESTIONS AND CORRECT ANSWERS
WITH DETAILED RATIONALES CURRENT
TESTING
SECTION 1: PHYSIOLOGY OF LABOR & NORMAL DELIVERY (Questions 1–30)
D
1. A client at 39 weeks gestation is admitted to the labor and delivery unit. The nurse
O
assesses the client and notes uterine contractions occurring every 5 minutes, lasting 45
seconds, with moderate intensity. The cervix is 4 cm dilated, 80% effaced, and the
N
presenting part is at 0 station. The nurse correctly identifies this client as being in which
O
phase of labor?
T
A. Latent phase of the first stage
C
B. Active phase of the first stage
O
C. Transition phase of the first stage
PY
D. Second stage of labor
Correct answer: B. Active phase of the first stage
Rationale: The first stage of labor is divided into latent, active, and transition phases. The active
phase is characterized by cervical dilation of 4-7 cm, more frequent and stronger contractions,
and fetal descent. With cervical dilation of 4 cm, the client is in the active phase. The latent phase
is 0-3 cm, transition is 8-10 cm, and the second stage begins at 10 cm (full dilation).
2. The nurse is assessing a laboring client and finds the cervix is 100% effaced and 10 cm
dilated. The client reports an overwhelming urge to bear down. The nurse should:
A. Instruct the client to pant to avoid pushing
B. Encourage the client to push with each contraction
C. Perform a vaginal exam to confirm complete dilation
D. Notify the healthcare provider immediately
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Correct answer: A. Instruct the client to pant to avoid pushing Rationale: The client is
exhibiting signs of complete dilation and the urge to push (second stage of labor). However,
before pushing, the nurse must verify complete dilation via a vaginal exam. Pushing before
complete dilation can cause cervical edema and injury. The nurse should instruct the client to
pant through the urge until the exam confirms full dilation.
3. Which of the following describes the mechanism of labor known as "internal rotation"?
A. The fetal head passes through the pelvic inlet
B. The fetal head rotates to align with the anteroposterior diameter of the pelvic outlet
C. The fetal head extends to navigate under the symphysis pubis
D. The fetal shoulders rotate to align with the pelvic inlet Correct answer: B. The fetal head
rotates to align with the anteroposterior diameter of the pelvic outlet
Rationale: Internal rotation is the mechanism by which the fetal head rotates from its
D
transverse position to align with the anteroposterior diameter of the pelvic outlet, preparing for
delivery.
O
4. The passage of the fetal presenting part through the cervix and vagina is termed:
N
A. Engagement
O
B. Descent
T
C. Flexion
C
D. Extension
O
Correct answer: B. Descent
Rationale: Descent is the downward movement of the fetal presenting part through the birth
PY
canal. Engagement occurs when the fetal head enters the pelvic inlet, flexion is the bending of
the fetal head, and extension is the straightening of the fetal head during delivery.
5. A client in active labor has a cervical exam that reveals the fetal head is at +2 station.
The nurse understands that this means:
A. The fetal head is 2 cm above the ischial spines
B. The fetal head is at the level of the ischial spines
C. The fetal head is 2 cm below the ischial spines
D. The fetal head is engaged in the pelvic inlet
Correct answer: C. The fetal head is 2 cm below the ischial spines
Rationale: Fetal station is measured in centimeters above or below the ischial spines. A station
of 0 is at the level of the spines. Positive numbers indicate descent below the spines, while
negative numbers indicate the presenting part is above the spines. +2 station means the fetal head
is 2 cm below the ischial spines.
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6. The nurse is assessing a laboring client and notes that the client's membranes have
ruptured. The nurse should first:
A. Assess the fetal heart rate
B. Note the color, amount, and odor of the fluid
C. Perform a vaginal exam
D. Notify the healthcare provider
Correct answer: A. Assess the fetal heart rate
Rationale: After membrane rupture, the priority is to assess the fetal heart rate to detect any
signs of cord compression or fetal distress. Following this, the nurse should assess the fluid
characteristics (color, amount, odor) and then notify the provider as indicated.
7. The normal baseline fetal heart rate in a term fetus is:
A. 100-120 beats per minute
D
B. 110-160 beats per minute
O
C. 120-180 beats per minute
D. 140-160 beats per minute
N
Correct answer: B. 110-160 beats per minute
O
Rationale: The normal baseline fetal heart rate (FHR) for a term fetus is 110-160 beats per
T
minute. Rates below 110 or above 160 may indicate fetal distress and require further assessment.
C
8. A client at 40 weeks gestation is in active labor. The nurse notes that the fetal heart rate
O
baseline is 140 bpm with moderate variability. This finding indicates:
A. Normal fetal oxygenation
PY
B. Possible fetal acidosis
C. Fetal sleep state
D. Maternal fever
Correct answer: A. Normal fetal oxygenation
Rationale: Moderate variability (6-25 bpm) is a reassuring finding indicating an intact fetal
central nervous system and adequate oxygenation. Fetal acidosis is associated with minimal or
absent variability.
9. During a vaginal exam, the nurse palpates the fetal buttocks.
The nurse correctly identifies this presentation as:
A. Cephalic presentation
B. Breech presentation
C. Shoulder presentation
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D. Face presentation
Correct answer: B. Breech presentation
Rationale: Breech presentation occurs when the fetal buttocks or feet are the presenting part.
Cephalic presentation is head first, shoulder presentation is transverse lie, and face
presentation is an extended cephalic presentation.
10. A client is 6 cm dilated with contractions every 3 minutes lasting 60 seconds. The fetal
heart rate is 130 bpm with moderate variability and no decelerations. The nurse should:
A. Prepare for immediate cesarean delivery
B. Continue to monitor and support the client
C. Apply oxygen at 10 L/min via non-rebreather mask
D. Notify the healthcare provider immediately
Correct answer: B. Continue to monitor and support the client Rationale: The client is
D
progressing normally through active labor with reassuring fetal heart rate findings. The nurse
should continue to monitor maternal-fetal status and provide supportive care. No immediate
O
interventions are indicated.
N
11. Which hormone is primarily responsible for initiating uterine contractions during
O
labor?
T
A. Estrogen
B. Progesterone
C
C. Oxytocin
O
D. Prostaglandin
PY
Correct answer: C. Oxytocin
Rationale: Oxytocin, released from the posterior pituitary, stimulates uterine contractions.
Prostaglandins also play a role in cervical ripening and uterine contractions, but oxytocin is the
primary hormone for initiating and augmenting labor.
12. The nurse is assessing a client in the transition phase of labor. Which finding is
expected? A. Cervical dilation of 8-10 cm
B. Contractions every 5-10 minutes
C. Intense urge to push
D. Cervical effacement of 50%
Correct answer: A. Cervical dilation of 8-10 cm
Rationale: The transition phase is characterized by cervical dilation of 8-10 cm, contractions
every 1-2 minutes lasting 60-90 seconds, and intense pain. The urge to push typically occurs
during the second stage (full dilation). Effacement of 50% is seen in the latent phase.
INP 402 EXAM – INTRAPARTUM NURSING
PRACTICE ASSESSMENT COMPLETE
QUESTIONS AND CORRECT ANSWERS
WITH DETAILED RATIONALES CURRENT
TESTING
SECTION 1: PHYSIOLOGY OF LABOR & NORMAL DELIVERY (Questions 1–30)
D
1. A client at 39 weeks gestation is admitted to the labor and delivery unit. The nurse
O
assesses the client and notes uterine contractions occurring every 5 minutes, lasting 45
seconds, with moderate intensity. The cervix is 4 cm dilated, 80% effaced, and the
N
presenting part is at 0 station. The nurse correctly identifies this client as being in which
O
phase of labor?
T
A. Latent phase of the first stage
C
B. Active phase of the first stage
O
C. Transition phase of the first stage
PY
D. Second stage of labor
Correct answer: B. Active phase of the first stage
Rationale: The first stage of labor is divided into latent, active, and transition phases. The active
phase is characterized by cervical dilation of 4-7 cm, more frequent and stronger contractions,
and fetal descent. With cervical dilation of 4 cm, the client is in the active phase. The latent phase
is 0-3 cm, transition is 8-10 cm, and the second stage begins at 10 cm (full dilation).
2. The nurse is assessing a laboring client and finds the cervix is 100% effaced and 10 cm
dilated. The client reports an overwhelming urge to bear down. The nurse should:
A. Instruct the client to pant to avoid pushing
B. Encourage the client to push with each contraction
C. Perform a vaginal exam to confirm complete dilation
D. Notify the healthcare provider immediately
, Page 2 of 38
Correct answer: A. Instruct the client to pant to avoid pushing Rationale: The client is
exhibiting signs of complete dilation and the urge to push (second stage of labor). However,
before pushing, the nurse must verify complete dilation via a vaginal exam. Pushing before
complete dilation can cause cervical edema and injury. The nurse should instruct the client to
pant through the urge until the exam confirms full dilation.
3. Which of the following describes the mechanism of labor known as "internal rotation"?
A. The fetal head passes through the pelvic inlet
B. The fetal head rotates to align with the anteroposterior diameter of the pelvic outlet
C. The fetal head extends to navigate under the symphysis pubis
D. The fetal shoulders rotate to align with the pelvic inlet Correct answer: B. The fetal head
rotates to align with the anteroposterior diameter of the pelvic outlet
Rationale: Internal rotation is the mechanism by which the fetal head rotates from its
D
transverse position to align with the anteroposterior diameter of the pelvic outlet, preparing for
delivery.
O
4. The passage of the fetal presenting part through the cervix and vagina is termed:
N
A. Engagement
O
B. Descent
T
C. Flexion
C
D. Extension
O
Correct answer: B. Descent
Rationale: Descent is the downward movement of the fetal presenting part through the birth
PY
canal. Engagement occurs when the fetal head enters the pelvic inlet, flexion is the bending of
the fetal head, and extension is the straightening of the fetal head during delivery.
5. A client in active labor has a cervical exam that reveals the fetal head is at +2 station.
The nurse understands that this means:
A. The fetal head is 2 cm above the ischial spines
B. The fetal head is at the level of the ischial spines
C. The fetal head is 2 cm below the ischial spines
D. The fetal head is engaged in the pelvic inlet
Correct answer: C. The fetal head is 2 cm below the ischial spines
Rationale: Fetal station is measured in centimeters above or below the ischial spines. A station
of 0 is at the level of the spines. Positive numbers indicate descent below the spines, while
negative numbers indicate the presenting part is above the spines. +2 station means the fetal head
is 2 cm below the ischial spines.
, Page 3 of 38
6. The nurse is assessing a laboring client and notes that the client's membranes have
ruptured. The nurse should first:
A. Assess the fetal heart rate
B. Note the color, amount, and odor of the fluid
C. Perform a vaginal exam
D. Notify the healthcare provider
Correct answer: A. Assess the fetal heart rate
Rationale: After membrane rupture, the priority is to assess the fetal heart rate to detect any
signs of cord compression or fetal distress. Following this, the nurse should assess the fluid
characteristics (color, amount, odor) and then notify the provider as indicated.
7. The normal baseline fetal heart rate in a term fetus is:
A. 100-120 beats per minute
D
B. 110-160 beats per minute
O
C. 120-180 beats per minute
D. 140-160 beats per minute
N
Correct answer: B. 110-160 beats per minute
O
Rationale: The normal baseline fetal heart rate (FHR) for a term fetus is 110-160 beats per
T
minute. Rates below 110 or above 160 may indicate fetal distress and require further assessment.
C
8. A client at 40 weeks gestation is in active labor. The nurse notes that the fetal heart rate
O
baseline is 140 bpm with moderate variability. This finding indicates:
A. Normal fetal oxygenation
PY
B. Possible fetal acidosis
C. Fetal sleep state
D. Maternal fever
Correct answer: A. Normal fetal oxygenation
Rationale: Moderate variability (6-25 bpm) is a reassuring finding indicating an intact fetal
central nervous system and adequate oxygenation. Fetal acidosis is associated with minimal or
absent variability.
9. During a vaginal exam, the nurse palpates the fetal buttocks.
The nurse correctly identifies this presentation as:
A. Cephalic presentation
B. Breech presentation
C. Shoulder presentation
, Page 4 of 38
D. Face presentation
Correct answer: B. Breech presentation
Rationale: Breech presentation occurs when the fetal buttocks or feet are the presenting part.
Cephalic presentation is head first, shoulder presentation is transverse lie, and face
presentation is an extended cephalic presentation.
10. A client is 6 cm dilated with contractions every 3 minutes lasting 60 seconds. The fetal
heart rate is 130 bpm with moderate variability and no decelerations. The nurse should:
A. Prepare for immediate cesarean delivery
B. Continue to monitor and support the client
C. Apply oxygen at 10 L/min via non-rebreather mask
D. Notify the healthcare provider immediately
Correct answer: B. Continue to monitor and support the client Rationale: The client is
D
progressing normally through active labor with reassuring fetal heart rate findings. The nurse
should continue to monitor maternal-fetal status and provide supportive care. No immediate
O
interventions are indicated.
N
11. Which hormone is primarily responsible for initiating uterine contractions during
O
labor?
T
A. Estrogen
B. Progesterone
C
C. Oxytocin
O
D. Prostaglandin
PY
Correct answer: C. Oxytocin
Rationale: Oxytocin, released from the posterior pituitary, stimulates uterine contractions.
Prostaglandins also play a role in cervical ripening and uterine contractions, but oxytocin is the
primary hormone for initiating and augmenting labor.
12. The nurse is assessing a client in the transition phase of labor. Which finding is
expected? A. Cervical dilation of 8-10 cm
B. Contractions every 5-10 minutes
C. Intense urge to push
D. Cervical effacement of 50%
Correct answer: A. Cervical dilation of 8-10 cm
Rationale: The transition phase is characterized by cervical dilation of 8-10 cm, contractions
every 1-2 minutes lasting 60-90 seconds, and intense pain. The urge to push typically occurs
during the second stage (full dilation). Effacement of 50% is seen in the latent phase.
