1
Santa Clara County Labor
and Delivery Nurse
Examination
Comprehensive
Examination – 150
Multiple-Choice Questions
a well detailed one 2025
/ 2026 written and
graded A+ upgraded
, 2
Instructions
This examination consists of 150 multiple-choice questions designed to assess the knowledge,
clinical judgment, and critical thinking skills required of Labor and Delivery nurses practicing in
Santa Clara County. Questions are written at an Advanced/Hard difficulty level for experienced
perinatal nursing professionals. Select the single best answer for each question. Each question
is followed by the correct answer and a detailed rationale.
SECTION A: ANTEPARTUM ASSESSMENT AND PRENATAL CARE (Questions 1–20)
1. A 34-year-old G3P2 at 36 weeks gestation presents to the SCVMC Labor and Delivery triage
unit with complaints of decreased fetal movement for the past 6 hours. The nurse obtains a
non-stress test (NST) that is non-reactive after 40 minutes. Which of the following is the
nurse's priority action?
A) Repeat the NST in 2 hours
B) Initiate a biophysical profile (BPP)
C) Notify the attending obstetrician immediately
D) Administer oral hydration and resume monitoring
Correct Answer: C
Rationale: A non-reactive NST after 40 minutes in a patient reporting decreased fetal movement
is concerning for fetal compromise and requires immediate physician notification. While a BPP
may be ordered, the priority is to alert the provider for further evaluation. Delaying notification
could compromise fetal outcomes. SCVMC policies emphasize immediate communication of
concerning fetal monitoring findings.
2. A 28-year-old G1P0 at 41 weeks gestation is admitted for induction of labor. The nurse
reviews the prenatal record and notes the patient has a BMI of 38, gestational diabetes diet-
, 3
controlled, and chronic hypertension. According to SCVMC high-risk perinatal protocols,
which of the following should the nurse anticipate being ordered?
A) Outpatient induction with oral misoprostol
B) Continuous electronic fetal monitoring with admission
C) Intermittent auscultation per protocol
D) Delayed induction until 42 weeks
Correct Answer: B
Rationale: Patients with maternal comorbidities including obesity, diabetes, and hypertension
require continuous electronic fetal monitoring upon admission. SCVMC has a Level III NICU and
specializes in high-risk perinatal care, necessitating comprehensive monitoring for patients with
multiple risk factors. Intermittent auscultation would be inappropriate given the high-risk status.
3. A 32-year-old G4P3 at 38 weeks presents with spontaneous rupture of membranes. The
nurse assesses the amniotic fluid and notes it is clear with a moderate amount. The nitrazine
test is positive. Which of the following actions should the nurse take FIRST?
A) Perform a sterile vaginal examination
B) Initiate continuous fetal monitoring
C) Assess cervical dilation and effacement
D) Document the time of rupture and fluid characteristics
Correct Answer: B
Rationale: Following spontaneous rupture of membranes, the priority is to initiate continuous
fetal monitoring to assess for fetal heart rate abnormalities indicating cord compression or
infection. SCVMC policy requires fetal spiral electrode (FSE) placement by RNs when indicated
after rupture of membranes. While documentation and cervical assessment are important, fetal
assessment is the priority.
4. The nurse is performing a limited OB ultrasound per SCVMC nursing policy. Which of the
following competencies must the nurse have completed prior to performing this procedure
independently?
A) Basic Life Support certification
B) Fetal spiral electrode competency
C) Limited OB ultrasound competency
D) Advanced Cardiac Life Support certification
, 4
Correct Answer: C
Rationale: SCVMC policy requires that nurses complete specific competency validation for
limited OB ultrasound prior to independent performance. The Labor and Delivery competency
list includes limited OB ultrasound as a required annual competency. Competency checks are
administered during annual OB updates.
5. A 25-year-old G2P1 at 39 weeks is admitted in early labor. The patient requests information
about pain management options. The nurse explains that epidural anesthesia is available.
According to SCVMC policy, which statement about sibling attendance during epidural
placement is correct?
A) Children may remain in the room during epidural placement
B) Children cannot attend epidural placement procedures
C) Only children over age 12 may attend
D) Siblings may attend if a designated adult is present
Correct Answer: B
Rationale: SCVMC Labor and Delivery policy explicitly states that children cannot attend
epidural placement procedures. This policy supports patient safety during invasive procedures.
While siblings may attend active labor and delivery with appropriate adult supervision, they are
excluded from certain procedures including epidural placement.
6. A 31-year-old G1P0 at 35 weeks presents with vaginal bleeding, abdominal pain, and a
board-like abdomen. The nurse suspects placental abruption. Which of the following findings
would MOST strongly support this diagnosis?
A) Painless vaginal bleeding
B) Hypertonic uterine contractions with frequent resting tone elevation
C) Fetal heart rate acceleration
D) Cervical dilation of 4 cm
Correct Answer: B
Rationale: Placental abruption is characterized by painful vaginal bleeding with a tense, board-
like abdomen and hypertonic contractions. Unlike placenta previa which presents with painless
bleeding, abruption involves uterine hypertonicity and fetal distress. SCVMC nurses must
recognize these distinguishing features for timely intervention.
Santa Clara County Labor
and Delivery Nurse
Examination
Comprehensive
Examination – 150
Multiple-Choice Questions
a well detailed one 2025
/ 2026 written and
graded A+ upgraded
, 2
Instructions
This examination consists of 150 multiple-choice questions designed to assess the knowledge,
clinical judgment, and critical thinking skills required of Labor and Delivery nurses practicing in
Santa Clara County. Questions are written at an Advanced/Hard difficulty level for experienced
perinatal nursing professionals. Select the single best answer for each question. Each question
is followed by the correct answer and a detailed rationale.
SECTION A: ANTEPARTUM ASSESSMENT AND PRENATAL CARE (Questions 1–20)
1. A 34-year-old G3P2 at 36 weeks gestation presents to the SCVMC Labor and Delivery triage
unit with complaints of decreased fetal movement for the past 6 hours. The nurse obtains a
non-stress test (NST) that is non-reactive after 40 minutes. Which of the following is the
nurse's priority action?
A) Repeat the NST in 2 hours
B) Initiate a biophysical profile (BPP)
C) Notify the attending obstetrician immediately
D) Administer oral hydration and resume monitoring
Correct Answer: C
Rationale: A non-reactive NST after 40 minutes in a patient reporting decreased fetal movement
is concerning for fetal compromise and requires immediate physician notification. While a BPP
may be ordered, the priority is to alert the provider for further evaluation. Delaying notification
could compromise fetal outcomes. SCVMC policies emphasize immediate communication of
concerning fetal monitoring findings.
2. A 28-year-old G1P0 at 41 weeks gestation is admitted for induction of labor. The nurse
reviews the prenatal record and notes the patient has a BMI of 38, gestational diabetes diet-
, 3
controlled, and chronic hypertension. According to SCVMC high-risk perinatal protocols,
which of the following should the nurse anticipate being ordered?
A) Outpatient induction with oral misoprostol
B) Continuous electronic fetal monitoring with admission
C) Intermittent auscultation per protocol
D) Delayed induction until 42 weeks
Correct Answer: B
Rationale: Patients with maternal comorbidities including obesity, diabetes, and hypertension
require continuous electronic fetal monitoring upon admission. SCVMC has a Level III NICU and
specializes in high-risk perinatal care, necessitating comprehensive monitoring for patients with
multiple risk factors. Intermittent auscultation would be inappropriate given the high-risk status.
3. A 32-year-old G4P3 at 38 weeks presents with spontaneous rupture of membranes. The
nurse assesses the amniotic fluid and notes it is clear with a moderate amount. The nitrazine
test is positive. Which of the following actions should the nurse take FIRST?
A) Perform a sterile vaginal examination
B) Initiate continuous fetal monitoring
C) Assess cervical dilation and effacement
D) Document the time of rupture and fluid characteristics
Correct Answer: B
Rationale: Following spontaneous rupture of membranes, the priority is to initiate continuous
fetal monitoring to assess for fetal heart rate abnormalities indicating cord compression or
infection. SCVMC policy requires fetal spiral electrode (FSE) placement by RNs when indicated
after rupture of membranes. While documentation and cervical assessment are important, fetal
assessment is the priority.
4. The nurse is performing a limited OB ultrasound per SCVMC nursing policy. Which of the
following competencies must the nurse have completed prior to performing this procedure
independently?
A) Basic Life Support certification
B) Fetal spiral electrode competency
C) Limited OB ultrasound competency
D) Advanced Cardiac Life Support certification
, 4
Correct Answer: C
Rationale: SCVMC policy requires that nurses complete specific competency validation for
limited OB ultrasound prior to independent performance. The Labor and Delivery competency
list includes limited OB ultrasound as a required annual competency. Competency checks are
administered during annual OB updates.
5. A 25-year-old G2P1 at 39 weeks is admitted in early labor. The patient requests information
about pain management options. The nurse explains that epidural anesthesia is available.
According to SCVMC policy, which statement about sibling attendance during epidural
placement is correct?
A) Children may remain in the room during epidural placement
B) Children cannot attend epidural placement procedures
C) Only children over age 12 may attend
D) Siblings may attend if a designated adult is present
Correct Answer: B
Rationale: SCVMC Labor and Delivery policy explicitly states that children cannot attend
epidural placement procedures. This policy supports patient safety during invasive procedures.
While siblings may attend active labor and delivery with appropriate adult supervision, they are
excluded from certain procedures including epidural placement.
6. A 31-year-old G1P0 at 35 weeks presents with vaginal bleeding, abdominal pain, and a
board-like abdomen. The nurse suspects placental abruption. Which of the following findings
would MOST strongly support this diagnosis?
A) Painless vaginal bleeding
B) Hypertonic uterine contractions with frequent resting tone elevation
C) Fetal heart rate acceleration
D) Cervical dilation of 4 cm
Correct Answer: B
Rationale: Placental abruption is characterized by painful vaginal bleeding with a tense, board-
like abdomen and hypertonic contractions. Unlike placenta previa which presents with painless
bleeding, abruption involves uterine hypertonicity and fetal distress. SCVMC nurses must
recognize these distinguishing features for timely intervention.
