Labor & Delivery - 2026 Intrapartum Nursing: Final Exam
(Comprehensive) - Questions with Correct Answers
100 questions
1. Internal rotation during labor allows the fetal head to:
A. Be born
B. Exit the pelvis without turning
C. Return to its original position after birth
D. Turn so the sagittal suture aligns with the anteroposterior diameter of the pelvic outlet
Correct Answer: D. Turn so the sagittal suture aligns with the anteroposterior diameter of the
pelvic outlet
Rationale: The outlet's widest diameter is anteroposterior. Restitution, the return to alignment
with the shoulders, happens after the head is born.
2. Montevideo units (MVUs) are calculated by:
A. Counting contractions per hour
B. Multiplying FHR by contraction rate
C. Averaging maternal blood pressure
D. Adding the peak pressure minus baseline pressure of each contraction over 10 minutes
Correct Answer: D. Adding the peak pressure minus baseline pressure of each contraction
over 10 minutes
Rationale: 200 MVUs or more is generally considered adequate labor. External toco cannot
calculate MVUs.
3. An acceleration in a fetus of 32 weeks or more is defined as a rise of at least:
A. 10 beats/min for 10 seconds
B. 25 beats/min for 5 minutes
C. 5 beats/min for 5 seconds
D. 15 beats/min lasting 15 seconds or more
Correct Answer: D. 15 beats/min lasting 15 seconds or more
Rationale: Before 32 weeks the criterion is 10 beats/min for 10 seconds. Accelerations indicate
the absence of acidemia.
,4. When a patient with epidural analgesia develops fetal bradycardia, the nurse should check
for:
A. Maternal hypotension or uterine tachysystole
B. Fetal hiccups
C. Maternal hunger
D. Maternal temperature only
Correct Answer: A. Maternal hypotension or uterine tachysystole
Rationale: Epidural-related hypotension and tachysystole are common causes. Treating the
cause restores the rate.
5. Umbilical cord blood gas samples should be drawn from:
A. The placenta surface
B. A clamped segment of cord, from the artery and vein, into heparinized syringes
C. Maternal arm
D. The neonate's heel only
Correct Answer: B. A clamped segment of cord, from the artery and vein, into heparinized
syringes
Rationale: Arterial blood reflects fetal status and venous blood reflects placental function.
Paired samples confirm accuracy.
6. ACOG CPG No. 10 replaced which previous documents?
A. Practice Bulletins No. 106 and No. 116 and the 2022 oxygen practice advisory
B. Practice Bulletin No. 222
C. Committee Opinion No. 797
D. The NRP algorithm
Correct Answer: A. Practice Bulletins No. 106 and No. 116 and the 2022 oxygen practice
advisory
Rationale: The 2025 guideline consolidates FHR monitoring recommendations. The other
documents address different topics.
,7. The ARRIVE trial found that elective induction at 39 weeks in low-risk nulliparas:
A. Increased cesarean births
B. Reduced cesarean births without increasing adverse perinatal outcomes
C. Increased neonatal deaths
D. Increased infection
Correct Answer: B. Reduced cesarean births without increasing adverse perinatal outcomes
Rationale: This trial changed practice. Offering 39-week induction is reasonable.
8. Induction for premature rupture of membranes at term:
A. Reduces infection compared with prolonged expectant management
B. Increases infection
C. Is contraindicated
D. Requires waiting 72 hours
Correct Answer: A. Reduces infection compared with prolonged expectant management
Rationale: Prompt induction is preferred. Some patients may choose a short period of
expectant management.
9. The gate control theory of pain explains that:
A. Pain cannot be modified
B. Nonpainful stimuli such as massage can close the gate and reduce pain transmission
C. Only medications relieve pain
D. Pain is purely psychological
Correct Answer: B. Nonpainful stimuli such as massage can close the gate and reduce pain
transmission
Rationale: Counterpressure, massage and TENS are based on this theory. Pain has physical and
emotional components.
, 10. Local perineal infiltration is used for:
A. Cesarean birth
B. Contraction pain
C. Episiotomy or laceration repair
D. Induction
Correct Answer: C. Episiotomy or laceration repair
Rationale: It numbs the perineum. It does not affect labor progress.
11. Fundal pressure during the second stage:
A. Is recommended routinely
B. Is not recommended because of risks of uterine rupture and fetal injury
C. Speeds delivery safely
D. Prevents shoulder dystocia
Correct Answer: B. Is not recommended because of risks of uterine rupture and fetal injury
Rationale: Evidence shows no benefit. It may be harmful.
12. Delayed umbilical cord clamping in vigorous term and preterm infants is recommended for at
least:
A. 30 to 60 seconds
B. 5 seconds
C. 10 minutes
D. No delay
Correct Answer: A. 30 to 60 seconds
Rationale: Delayed clamping improves iron stores and, in preterm infants, reduces transfusions.
Immediate clamping is needed if resuscitation cannot proceed with the cord intact.
(Comprehensive) - Questions with Correct Answers
100 questions
1. Internal rotation during labor allows the fetal head to:
A. Be born
B. Exit the pelvis without turning
C. Return to its original position after birth
D. Turn so the sagittal suture aligns with the anteroposterior diameter of the pelvic outlet
Correct Answer: D. Turn so the sagittal suture aligns with the anteroposterior diameter of the
pelvic outlet
Rationale: The outlet's widest diameter is anteroposterior. Restitution, the return to alignment
with the shoulders, happens after the head is born.
2. Montevideo units (MVUs) are calculated by:
A. Counting contractions per hour
B. Multiplying FHR by contraction rate
C. Averaging maternal blood pressure
D. Adding the peak pressure minus baseline pressure of each contraction over 10 minutes
Correct Answer: D. Adding the peak pressure minus baseline pressure of each contraction
over 10 minutes
Rationale: 200 MVUs or more is generally considered adequate labor. External toco cannot
calculate MVUs.
3. An acceleration in a fetus of 32 weeks or more is defined as a rise of at least:
A. 10 beats/min for 10 seconds
B. 25 beats/min for 5 minutes
C. 5 beats/min for 5 seconds
D. 15 beats/min lasting 15 seconds or more
Correct Answer: D. 15 beats/min lasting 15 seconds or more
Rationale: Before 32 weeks the criterion is 10 beats/min for 10 seconds. Accelerations indicate
the absence of acidemia.
,4. When a patient with epidural analgesia develops fetal bradycardia, the nurse should check
for:
A. Maternal hypotension or uterine tachysystole
B. Fetal hiccups
C. Maternal hunger
D. Maternal temperature only
Correct Answer: A. Maternal hypotension or uterine tachysystole
Rationale: Epidural-related hypotension and tachysystole are common causes. Treating the
cause restores the rate.
5. Umbilical cord blood gas samples should be drawn from:
A. The placenta surface
B. A clamped segment of cord, from the artery and vein, into heparinized syringes
C. Maternal arm
D. The neonate's heel only
Correct Answer: B. A clamped segment of cord, from the artery and vein, into heparinized
syringes
Rationale: Arterial blood reflects fetal status and venous blood reflects placental function.
Paired samples confirm accuracy.
6. ACOG CPG No. 10 replaced which previous documents?
A. Practice Bulletins No. 106 and No. 116 and the 2022 oxygen practice advisory
B. Practice Bulletin No. 222
C. Committee Opinion No. 797
D. The NRP algorithm
Correct Answer: A. Practice Bulletins No. 106 and No. 116 and the 2022 oxygen practice
advisory
Rationale: The 2025 guideline consolidates FHR monitoring recommendations. The other
documents address different topics.
,7. The ARRIVE trial found that elective induction at 39 weeks in low-risk nulliparas:
A. Increased cesarean births
B. Reduced cesarean births without increasing adverse perinatal outcomes
C. Increased neonatal deaths
D. Increased infection
Correct Answer: B. Reduced cesarean births without increasing adverse perinatal outcomes
Rationale: This trial changed practice. Offering 39-week induction is reasonable.
8. Induction for premature rupture of membranes at term:
A. Reduces infection compared with prolonged expectant management
B. Increases infection
C. Is contraindicated
D. Requires waiting 72 hours
Correct Answer: A. Reduces infection compared with prolonged expectant management
Rationale: Prompt induction is preferred. Some patients may choose a short period of
expectant management.
9. The gate control theory of pain explains that:
A. Pain cannot be modified
B. Nonpainful stimuli such as massage can close the gate and reduce pain transmission
C. Only medications relieve pain
D. Pain is purely psychological
Correct Answer: B. Nonpainful stimuli such as massage can close the gate and reduce pain
transmission
Rationale: Counterpressure, massage and TENS are based on this theory. Pain has physical and
emotional components.
, 10. Local perineal infiltration is used for:
A. Cesarean birth
B. Contraction pain
C. Episiotomy or laceration repair
D. Induction
Correct Answer: C. Episiotomy or laceration repair
Rationale: It numbs the perineum. It does not affect labor progress.
11. Fundal pressure during the second stage:
A. Is recommended routinely
B. Is not recommended because of risks of uterine rupture and fetal injury
C. Speeds delivery safely
D. Prevents shoulder dystocia
Correct Answer: B. Is not recommended because of risks of uterine rupture and fetal injury
Rationale: Evidence shows no benefit. It may be harmful.
12. Delayed umbilical cord clamping in vigorous term and preterm infants is recommended for at
least:
A. 30 to 60 seconds
B. 5 seconds
C. 10 minutes
D. No delay
Correct Answer: A. 30 to 60 seconds
Rationale: Delayed clamping improves iron stores and, in preterm infants, reduces transfusions.
Immediate clamping is needed if resuscitation cannot proceed with the cord intact.
