OB/NB SU Final Exam Questions and
Verified Answers with Rationale |
Latest Edition 2026/2027
Question 1
A 28 year old primigravida at 38 weeks of gestation presents to
the labor and delivery triage unit complaining of regular uterine
contractions occurring every four minutes, lasting 60 seconds,
and increasing in intensity. Vaginal examination reveals the
cervix is 6 centimeters dilated, 100 percent effaced, and the
presenting part is at zero station with vertex presentation. Which
of the following phases of the first stage of labor is this patient
currently experiencing?
A. Active phase
B. Latent phase
C. Transition phase
D. Second stage
Correct Answer: A
Rationale: The active phase of the first stage of labor is
traditionally defined as beginning at 6 centimeters of cervical
dilation and continuing until full dilation is achieved,
characterized by regular, progressive uterine contractions.
Question 2
,A 32 year old multiparous client at 39 weeks of gestation is
admitted in active labor. After two hours of regular contractions,
a repeat vaginal examination shows no change in cervical
dilation or station, and the contraction pattern is inadequate at
less than two contractions per 10 minutes with mild intensity.
Which of the following terms best describes this labor
abnormality?
A. Arrest of dilation
B. Hypotonic uterine dysfunction
C. Hypertonic uterine dysfunction
D. Precipitous labor
Correct Answer: B
Rationale: Hypotonic uterine dysfunction occurs when
contractions become weak, infrequent, or entirely ineffective
during the active phase of labor, often responding well to
oxytocin augmentation if cephalopelvic disproportion is ruled
out.
Question 3
A 26 year old primigravida at 40 weeks of gestation is being
monitored during the second stage of labor. The fetal heart rate
baseline is 140 beats per minute with moderate variability, no
accelerations, and recurrent late decelerations following each
contraction. The intrauterine pressure catheter indicates
adequate contraction frequency and strength. Which of the
following is the most appropriate initial nursing intervention?
A. Reposition the client to her left lateral side and
administer supplemental oxygen via non-rebreather mask
, B. Immediately prepare the client for an emergent primary
low transverse cesarean section
C. Increase the maintenance intravenous fluid infusion rate
and administer intravenous oxytocin
D. Perform an immediate artificial rupture of membranes to
assess amniotic fluid color
Correct Answer: A
Rationale: Late decelerations indicate uteroplacental
insufficiency. Initial conservative intrauterine resuscitation
measures include maternal repositioning to the left side,
discontinuing oxytocin if running, administering oxygen, and
correcting maternal hypotension.
Question 4
A 30 year old multipara gives birth vaginally to a vigorous
infant. Immediately following placental expulsion, the nurse
notes that the client's uterus is boggy and soft, located above the
umbilicus and displaced to the right, with a steady trickle of
bright red vaginal bleeding. Which of the following is the most
likely immediate cause of this postpartum hemorrhage?
A. Uterine atony secondary to bladder distention
B. Retained placental tissue fragments
C. Deep cervical laceration or vaginal wall tear
D. Acquired coagulopathy or von Willebrand disease
Correct Answer: A
Rationale: A boggy uterus that is displaced to the right is the
classic clinical sign of bladder distention, which prevents the
, myometrium from contracting effectively and leads to uterine
atony and postpartum hemorrhage.
Question 5
A 25 year old postpartum client on her second day following a
normal spontaneous vaginal delivery reports severe, constant
perineal pain and a feeling of pressure in her vagina. Physical
examination reveals a firm uterus centered at the umbilicus,
moderate lochia rubra, and a tense, exquisitely tender, purplish
swelling located on the right side of the vaginal introitus. Vital
signs show a blood pressure of 98 over 60 millimeters of
mercury and a pulse of 115 beats per minute. Which of the
following is the most likely diagnosis?
A. Vaginal hematoma
B. Perineal laceration degree two
C. Endometritis infection
D. Uterine inversion
Correct Answer: A
Rationale: A vaginal hematoma is characterized by severe,
unrelenting perineal or pelvic pain and a tense, tender bluish
swelling in the vaginal tissues, often accompanied by signs of
hypovolemia despite a firm, contracted uterus.
Question 6
A 34 year old G2P1 client at 34 weeks of gestation presents with
sudden, painless vaginal bleeding of bright red blood. She
reports no uterine contractions or pain. Transabdominal
ultrasound confirms the placenta is implanted over the internal
Verified Answers with Rationale |
Latest Edition 2026/2027
Question 1
A 28 year old primigravida at 38 weeks of gestation presents to
the labor and delivery triage unit complaining of regular uterine
contractions occurring every four minutes, lasting 60 seconds,
and increasing in intensity. Vaginal examination reveals the
cervix is 6 centimeters dilated, 100 percent effaced, and the
presenting part is at zero station with vertex presentation. Which
of the following phases of the first stage of labor is this patient
currently experiencing?
A. Active phase
B. Latent phase
C. Transition phase
D. Second stage
Correct Answer: A
Rationale: The active phase of the first stage of labor is
traditionally defined as beginning at 6 centimeters of cervical
dilation and continuing until full dilation is achieved,
characterized by regular, progressive uterine contractions.
Question 2
,A 32 year old multiparous client at 39 weeks of gestation is
admitted in active labor. After two hours of regular contractions,
a repeat vaginal examination shows no change in cervical
dilation or station, and the contraction pattern is inadequate at
less than two contractions per 10 minutes with mild intensity.
Which of the following terms best describes this labor
abnormality?
A. Arrest of dilation
B. Hypotonic uterine dysfunction
C. Hypertonic uterine dysfunction
D. Precipitous labor
Correct Answer: B
Rationale: Hypotonic uterine dysfunction occurs when
contractions become weak, infrequent, or entirely ineffective
during the active phase of labor, often responding well to
oxytocin augmentation if cephalopelvic disproportion is ruled
out.
Question 3
A 26 year old primigravida at 40 weeks of gestation is being
monitored during the second stage of labor. The fetal heart rate
baseline is 140 beats per minute with moderate variability, no
accelerations, and recurrent late decelerations following each
contraction. The intrauterine pressure catheter indicates
adequate contraction frequency and strength. Which of the
following is the most appropriate initial nursing intervention?
A. Reposition the client to her left lateral side and
administer supplemental oxygen via non-rebreather mask
, B. Immediately prepare the client for an emergent primary
low transverse cesarean section
C. Increase the maintenance intravenous fluid infusion rate
and administer intravenous oxytocin
D. Perform an immediate artificial rupture of membranes to
assess amniotic fluid color
Correct Answer: A
Rationale: Late decelerations indicate uteroplacental
insufficiency. Initial conservative intrauterine resuscitation
measures include maternal repositioning to the left side,
discontinuing oxytocin if running, administering oxygen, and
correcting maternal hypotension.
Question 4
A 30 year old multipara gives birth vaginally to a vigorous
infant. Immediately following placental expulsion, the nurse
notes that the client's uterus is boggy and soft, located above the
umbilicus and displaced to the right, with a steady trickle of
bright red vaginal bleeding. Which of the following is the most
likely immediate cause of this postpartum hemorrhage?
A. Uterine atony secondary to bladder distention
B. Retained placental tissue fragments
C. Deep cervical laceration or vaginal wall tear
D. Acquired coagulopathy or von Willebrand disease
Correct Answer: A
Rationale: A boggy uterus that is displaced to the right is the
classic clinical sign of bladder distention, which prevents the
, myometrium from contracting effectively and leads to uterine
atony and postpartum hemorrhage.
Question 5
A 25 year old postpartum client on her second day following a
normal spontaneous vaginal delivery reports severe, constant
perineal pain and a feeling of pressure in her vagina. Physical
examination reveals a firm uterus centered at the umbilicus,
moderate lochia rubra, and a tense, exquisitely tender, purplish
swelling located on the right side of the vaginal introitus. Vital
signs show a blood pressure of 98 over 60 millimeters of
mercury and a pulse of 115 beats per minute. Which of the
following is the most likely diagnosis?
A. Vaginal hematoma
B. Perineal laceration degree two
C. Endometritis infection
D. Uterine inversion
Correct Answer: A
Rationale: A vaginal hematoma is characterized by severe,
unrelenting perineal or pelvic pain and a tense, tender bluish
swelling in the vaginal tissues, often accompanied by signs of
hypovolemia despite a firm, contracted uterus.
Question 6
A 34 year old G2P1 client at 34 weeks of gestation presents with
sudden, painless vaginal bleeding of bright red blood. She
reports no uterine contractions or pain. Transabdominal
ultrasound confirms the placenta is implanted over the internal
