Labor & Delivery - 2026 Intrapartum Nursing: Exam 1 -
Questions with Correct Answers
100 questions
1. Fetal factors thought to help trigger labor include:
A. Decreased fetal growth only
B. Fetal hiccups
C. Fetal sleep cycles
D. Rising fetal cortisol and placental corticotropin-releasing hormone
Correct Answer: D. Rising fetal cortisol and placental corticotropin-releasing hormone
Rationale: Placental CRH has been called a placental clock. Hiccups and sleep cycles do not
trigger labor.
2. Effacement describes:
A. Opening of the cervix in centimeters
B. Descent of the fetus
C. Membrane rupture
D. Thinning and shortening of the cervix, expressed as a percentage
Correct Answer: D. Thinning and shortening of the cervix, expressed as a percentage
Rationale: Dilation is measured in centimeters from 0 to 10. Nulliparas typically efface before
dilating, while multiparas often do both together.
3. The diagonal conjugate is measured to estimate the:
A. Bishop score
B. Obstetric conjugate, the shortest anteroposterior diameter of the inlet, by subtracting about
1.5 to 2 cm
C. Fetal weight
D. Cervical length
Correct Answer: B. Obstetric conjugate, the shortest anteroposterior diameter of the inlet, by
subtracting about 1.5 to 2 cm
Rationale: It is measured from the sacral promontory to the lower border of the symphysis on
vaginal examination. It does not estimate fetal weight or the cervix.
,4. Fetal position "LOA" means that the fetal:
A. Occiput is directed toward the mother's left posterior pelvis
B. Occiput is directed toward the mother's left anterior pelvis
C. Sacrum is toward the mother's left anterior pelvis
D. Mentum (chin) is toward the mother's left anterior pelvis
Correct Answer: B. Occiput is directed toward the mother's left anterior pelvis
Rationale: The middle letter names the presenting landmark, here the occiput. Sacrum
identifies breech and mentum identifies face presentation.
5. Molding of the fetal head:
A. Is overlapping of the cranial bones that allows the head to adapt to the pelvis and usually
resolves within a few days
B. Is a skull fracture
C. Indicates brain damage
D. Requires surgery
Correct Answer: A. Is overlapping of the cranial bones that allows the head to adapt to the
pelvis and usually resolves within a few days
Rationale: Unfused sutures allow the bones to overlap. Excessive molding may suggest
cephalopelvic disproportion.
6. Before performing Leopold's maneuvers, the nurse should:
A. Have the patient empty the bladder and lie supine with knees slightly flexed and a hip wedge
B. Have the patient stand
C. Insert an indwelling catheter
D. Apply fundal pressure
Correct Answer: A. Have the patient empty the bladder and lie supine with knees slightly
flexed and a hip wedge
Rationale: An empty bladder improves comfort and accuracy, and the wedge prevents supine
hypotension. Fundal pressure is not part of the assessment.
,7. Crowning is the stage when:
A. The cervix reaches 6 cm
B. The placenta delivers
C. The largest diameter of the fetal head is encircled by the vulvar ring
D. The head is at station 0
Correct Answer: C. The largest diameter of the fetal head is encircled by the vulvar ring
Rationale: Crowning signals imminent birth. Controlled delivery of the head helps reduce
perineal trauma.
8. Leopold's maneuvers are performed to determine:
A. Cervical dilation
B. Membrane status
C. Fetal lie, presentation, position and engagement
D. Contraction strength
Correct Answer: C. Fetal lie, presentation, position and engagement
Rationale: They also help locate the fetal back for fetal heart auscultation. Cervical dilation
requires vaginal examination.
9. The latent phase of the first stage of labor is characterized by:
A. Rapid dilation of 1 cm per hour
B. The urge to push
C. Delivery of the placenta
D. Slow cervical change with irregular to more regular contractions, and it can last many hours
Correct Answer: D. Slow cervical change with irregular to more regular contractions, and it
can last many hours
Rationale: A prolonged latent phase alone is not an indication for cesarean birth. Rapid dilation
characterizes the active phase.
, 10. A meta-analysis and a large RCT found that immediate versus delayed pushing in nulliparas
with epidurals:
A. Showed delayed pushing doubled vaginal births
B. Did not differ in spontaneous vaginal birth rates, but delayed pushing increased infection and
hemorrhage
C. Showed immediate pushing caused more cesareans
D. Showed no differences at all in any outcome
Correct Answer: B. Did not differ in spontaneous vaginal birth rates, but delayed pushing
increased infection and hemorrhage
Rationale: The Cahill 2018 JAMA trial supports considering immediate pushing. Either approach
can be individualized.
11. A retained placenta is generally diagnosed if it has not delivered within about:
A. 30 minutes after birth with active management
B. 5 minutes
C. 4 hours
D. 24 hours
Correct Answer: A. 30 minutes after birth with active management
Rationale: Retained placenta increases hemorrhage risk. Manual removal may be required.
12. Schultze mechanism of placental delivery refers to:
A. The rough maternal side presenting first
B. The shiny fetal side presenting first
C. A retained placenta
D. Manual removal
Correct Answer: B. The shiny fetal side presenting first
Rationale: Schultze is the more common pattern. Duncan presents the maternal side first and
may involve more bleeding.
Questions with Correct Answers
100 questions
1. Fetal factors thought to help trigger labor include:
A. Decreased fetal growth only
B. Fetal hiccups
C. Fetal sleep cycles
D. Rising fetal cortisol and placental corticotropin-releasing hormone
Correct Answer: D. Rising fetal cortisol and placental corticotropin-releasing hormone
Rationale: Placental CRH has been called a placental clock. Hiccups and sleep cycles do not
trigger labor.
2. Effacement describes:
A. Opening of the cervix in centimeters
B. Descent of the fetus
C. Membrane rupture
D. Thinning and shortening of the cervix, expressed as a percentage
Correct Answer: D. Thinning and shortening of the cervix, expressed as a percentage
Rationale: Dilation is measured in centimeters from 0 to 10. Nulliparas typically efface before
dilating, while multiparas often do both together.
3. The diagonal conjugate is measured to estimate the:
A. Bishop score
B. Obstetric conjugate, the shortest anteroposterior diameter of the inlet, by subtracting about
1.5 to 2 cm
C. Fetal weight
D. Cervical length
Correct Answer: B. Obstetric conjugate, the shortest anteroposterior diameter of the inlet, by
subtracting about 1.5 to 2 cm
Rationale: It is measured from the sacral promontory to the lower border of the symphysis on
vaginal examination. It does not estimate fetal weight or the cervix.
,4. Fetal position "LOA" means that the fetal:
A. Occiput is directed toward the mother's left posterior pelvis
B. Occiput is directed toward the mother's left anterior pelvis
C. Sacrum is toward the mother's left anterior pelvis
D. Mentum (chin) is toward the mother's left anterior pelvis
Correct Answer: B. Occiput is directed toward the mother's left anterior pelvis
Rationale: The middle letter names the presenting landmark, here the occiput. Sacrum
identifies breech and mentum identifies face presentation.
5. Molding of the fetal head:
A. Is overlapping of the cranial bones that allows the head to adapt to the pelvis and usually
resolves within a few days
B. Is a skull fracture
C. Indicates brain damage
D. Requires surgery
Correct Answer: A. Is overlapping of the cranial bones that allows the head to adapt to the
pelvis and usually resolves within a few days
Rationale: Unfused sutures allow the bones to overlap. Excessive molding may suggest
cephalopelvic disproportion.
6. Before performing Leopold's maneuvers, the nurse should:
A. Have the patient empty the bladder and lie supine with knees slightly flexed and a hip wedge
B. Have the patient stand
C. Insert an indwelling catheter
D. Apply fundal pressure
Correct Answer: A. Have the patient empty the bladder and lie supine with knees slightly
flexed and a hip wedge
Rationale: An empty bladder improves comfort and accuracy, and the wedge prevents supine
hypotension. Fundal pressure is not part of the assessment.
,7. Crowning is the stage when:
A. The cervix reaches 6 cm
B. The placenta delivers
C. The largest diameter of the fetal head is encircled by the vulvar ring
D. The head is at station 0
Correct Answer: C. The largest diameter of the fetal head is encircled by the vulvar ring
Rationale: Crowning signals imminent birth. Controlled delivery of the head helps reduce
perineal trauma.
8. Leopold's maneuvers are performed to determine:
A. Cervical dilation
B. Membrane status
C. Fetal lie, presentation, position and engagement
D. Contraction strength
Correct Answer: C. Fetal lie, presentation, position and engagement
Rationale: They also help locate the fetal back for fetal heart auscultation. Cervical dilation
requires vaginal examination.
9. The latent phase of the first stage of labor is characterized by:
A. Rapid dilation of 1 cm per hour
B. The urge to push
C. Delivery of the placenta
D. Slow cervical change with irregular to more regular contractions, and it can last many hours
Correct Answer: D. Slow cervical change with irregular to more regular contractions, and it
can last many hours
Rationale: A prolonged latent phase alone is not an indication for cesarean birth. Rapid dilation
characterizes the active phase.
, 10. A meta-analysis and a large RCT found that immediate versus delayed pushing in nulliparas
with epidurals:
A. Showed delayed pushing doubled vaginal births
B. Did not differ in spontaneous vaginal birth rates, but delayed pushing increased infection and
hemorrhage
C. Showed immediate pushing caused more cesareans
D. Showed no differences at all in any outcome
Correct Answer: B. Did not differ in spontaneous vaginal birth rates, but delayed pushing
increased infection and hemorrhage
Rationale: The Cahill 2018 JAMA trial supports considering immediate pushing. Either approach
can be individualized.
11. A retained placenta is generally diagnosed if it has not delivered within about:
A. 30 minutes after birth with active management
B. 5 minutes
C. 4 hours
D. 24 hours
Correct Answer: A. 30 minutes after birth with active management
Rationale: Retained placenta increases hemorrhage risk. Manual removal may be required.
12. Schultze mechanism of placental delivery refers to:
A. The rough maternal side presenting first
B. The shiny fetal side presenting first
C. A retained placenta
D. Manual removal
Correct Answer: B. The shiny fetal side presenting first
Rationale: Schultze is the more common pattern. Duncan presents the maternal side first and
may involve more bleeding.
