RN HESI Maternity Success Guide 2026: Comprehensive Exam Prep and Practice Questions

A newborn is 12 hours old and has a respiratory rate of 68 breaths/minute, nasal flaring, and grunting. What is the nurse's best action? A. Swaddle the infant and reassess later B. Document as normal newborn transition C. Notify the health-care provider immediately D. Feed the baby to calm them Rationale: Signs of respiratory distress (nasal flaring, grunting, tachypnea) require immediate medical intervention to prevent hypoxia. 13 Which newborn assessment finding should be reported to the provider? A. Overlapping cranial sutures B. Bulging fontanel when infant is quiet C. Epstein pearls D. Lanugo on shoulders Rationale: A bulging fontanel at rest may indicate increased intracranial pressure. The other options are normal findings. 13 A nurse observes a red, moist umbilical stump with foul-smelling discharge. What is the priority action? A. Clean with mild soap and water B. Notify the health-care provider – signs of omphalitis C. Apply antibiotic ointment and cover with gauze D. Allow it to air dry Rationale: This indicates umbilical cord infection (omphalitis), which can lead to sepsis – requires immediate medical intervention. 13 A newborn's mother asks why erythromycin ointment is applied to the baby's eyes. What is the best response? A. “It helps the baby see better.” B. “It prevents infection from bacteria in the birth canal.” C. “It keeps the eyes moist.” D. “It helps treat jaundice.” Rationale: Erythromycin prevents ophthalmia neonatorum caused by maternal gonorrhea or chlamydia. 13 A newborn has a cephalohematoma. Which statement by the nurse is correct? A. “This crosses the suture lines of the head.” B. “It may take weeks to resolve but usually needs no treatment.” C. “It is caused by infection and requires antibiotics.” D. “This is an emergency and must be drained.” Rationale: Cephalohematoma is bleeding between the periosteum and skull bone that doesn’t cross sutures and resolves on its own over weeks. 13 A nurse is teaching circumcision care. Which instruction is correct? A. Wash the penis vigorously with soap and water B. Apply petroleum jelly with each diaper change C. Keep the diaper loose and avoid contact D. Use alcohol wipes to clean the site Rationale: Petroleum jelly prevents the diaper from sticking to the circumcision site and promotes healing. 13 Which newborn is at the greatest risk for cold stress? A. Full-term, 2 hours old, with mild jaundice B. Infant who is breastfeeding every 3 hours C. Preterm infant with low birth weight D. Infant in skin-to-skin with mother Rationale: Preterm and low-birth-weight infants lack brown fat and adequate thermoregulation mechanisms, putting them at highest risk for cold stress. 13 A newborn has not voided in the first 24 hours after birth. What is the nurse’s priority action? A. Encourage more feedings B. Assess for urinary tract obstruction or dehydration C. Apply a warm cloth to the abdomen D. Document and reassess in 12 hours Rationale: By 24 hours, at least one urine output should be noted. Failure to do so may indicate renal or urinary issues. 13 A nurse notes a newborn with a high-pitched cry, tremors, irritability, and poor feeding. The mother had no prenatal care. What is the most likely cause? A. Hypoglycemia B. Neonatal abstinence syndrome (withdrawal) C. Physiologic jaundice D. Intracranial hemorrhage Rationale: These symptoms strongly indicate drug withdrawal in the newborn. 13 A newborn is placed under phototherapy for jaundice. Which nursing action is most important? A. Keep the eyes uncovered B. Monitor temperature and maintain hydration C. Apply baby oil to the skin D. Stop feedings during therapy Rationale: Phototherapy can cause dehydration and overheating, so hydration and temperature monitoring are essential. 13A healthy term infant is being discharged at 48 hours of age. When should the nurse instruct the mother to follow up with a bilirubin assessment? A. Within 24 hours B. Within 24–48 hours C. Within 5 days D. In 1 week Rationale: Infants discharged between 48–72 hours should follow up within 5 days for bilirubin assessment. Earlier or later evaluations may miss developing jaundice. 13 A term infant is 22 hours old with visible jaundice and a total serum bilirubin of 13 mg/dL. What action is most appropriate? A. Assure the parents this is temporary B. Document the findings C. Have the mother switch to bottle feeding D. Review the chart for history of a traumatic birth Rationale: Jaundice within the first 24 hours is pathological; birth trauma increases RBC breakdown. Documentation or reassurance alone is unsafe. 13 A mother is bottle-feeding her 1-week-old baby 120 mL every 2 hours. What is the best nursing action? A. Explain that this is too much volume at one time B. Have her demonstrate feeding technique C. Reassure her the baby is eating fine D. Weigh the baby Rationale: A 1-week-old infant’s stomach holds about 90 mL. Feeding 120 mL risks vomiting and overfeeding. 13 Why do infants become dehydrated more easily? A. Babies are tiny, so little fluid loss is harmful B. They lose more water through insensible losses C. Skipping a feeding is harmful D. Infants' long intestines have more surface area to lose water Rationale: A proportionally longer intestine increases water loss during diarrhea. The other explanations are incomplete or incorrect. 13 Which infant is at highest risk for hypoglycemia? A. Asian ethnic background B. Delayed feeding C. Infant with heat stress D. Maternal use of terbutaline Rationale: Terbutaline affects glucose regulation, increasing hypoglycemia risk. Ethnicity and delayed feeding are minor risk factors. 13 What finding indicates effective thermoregulation in a newborn? A. Axillary temperature is 98.1°F (36.7°C) B. Temperature fluctuations cease C. Baby stops shivering D. Rectal temperature is 101.0°F (38.3°C) Rationale: Normal newborn temperature is 97.7–98.6°F. Infants do not shiver to produce heat, and rectal temperature is not preferred. 13 A newborn has erythema toxicum rash. What should the nurse advise? A. Apply aloe vera B. Apply hormonal cream C. None; it will disappear within a month D. Vigorously wash the skin Rationale: Erythema toxicum is a benign rash requiring no treatment. Creams or harsh cleansing are unnecessary and harmful. 13 During a newborn assessment, which finding should be reported immediately? A. Heart murmur B. Absent bowel sounds C. Respiratory rate 64/min D. Temperature 98.2°F (36.8°C) Rationale: Absent bowel sounds indicate possible obstruction. Murmurs are common within 24 hours of life. 13 A newborn has diffuse scalp edema crossing suture lines after a difficult birth. What is the best action? A. Document the findings B. Measure head circumference every 12 hours C. Administer IV diuretics D. Transfer to NICU Rationale: This describes caput succedaneum, a benign condition requiring only documentation. 13