HESI OB Maternity Exam Prep 2026 | Complete HESI
Maternity Nursing Study Guide, Verified Practice Questions
& Answers with Detailed Rationales, Obstetrics & Maternal-
Newborn Nursing HESI Review Bundle for Nursing
Students
Question 1: A pregnant client at 32 weeks gestation reports experiencing occasional
headaches and blurred vision. Which assessment finding should the nurse prioritize?
A. Blood pressure of 110/70 mmHg
B. Weight gain of 1 pound this week
C. Blood pressure of 150/95 mmHg with 2+ proteinuria
D. Fetal heart rate of 140 beats per minute
CORRECT ANSWER: C. Blood pressure of 150/95 mmHg with 2+ proteinuria
Rationale: Headaches and blurred vision in the third trimester, combined with elevated blood
pressure and proteinuria, are classic signs of preeclampsia. This is a medical emergency
requiring immediate intervention to prevent progression to eclampsia or HELLP syndrome.
Options A, B, and D represent normal findings and do not indicate an acute complication.
Question 2: During the active phase of labor, a client's cervix is dilated to 6 cm. Which nursing
intervention is most appropriate at this time?
A. Encourage the client to push with each contraction
B. Administer oxygen via non-rebreather mask at 10 L/min
C. Provide comfort measures and encourage position changes
D. Prepare for immediate cesarean delivery
CORRECT ANSWER: C. Provide comfort measures and encourage position changes
Rationale: At 6 cm dilation, the client is in the active phase of the first stage of labor. Pushing is
not indicated until the second stage (complete dilation). Comfort measures, breathing
techniques, and position changes help manage pain and promote labor progression. Oxygen
administration and cesarean preparation are reserved for fetal distress or other complications
not indicated here.
Question 3: A newborn is assessed at 1 minute of life and has a heart rate of 90 bpm, slow
irregular respirations, some flexion of extremities, grimaces to stimulation, and a pink body
with blue extremities. What is the infant's Apgar score?
A. 4
B. 5
C. 6
D. 7
CORRECT ANSWER: B. 5
Rationale: The Apgar score assesses five criteria: heart rate (1 point for <100 bpm), respiratory
effort (1 point for slow/irregular), muscle tone (1 point for some flexion), reflex irritability (1
point for grimace), and color (1 point for acrocyanosis). Total = 1+1+1+1+1 = 5. A score of 4-6
indicates moderate difficulty requiring some resuscitative measures.
Question 4: Which statement by a client at 10 weeks gestation indicates understanding of
prenatal nutrition teaching?
,A. "I should limit my fluid intake to prevent swelling."
B. "I need to increase my caloric intake by 500 calories per day now."
C. "I will take my prenatal vitamin with breakfast every morning."
D. "I can continue drinking one cup of coffee daily without concern."
CORRECT ANSWER: C. "I will take my prenatal vitamin with breakfast every morning."
Rationale: Prenatal vitamins, especially those containing folic acid and iron, should be taken
consistently, ideally with food to enhance absorption and reduce nausea. Caloric increase of
500/day is not needed until the third trimester. Fluid restriction is not recommended; adequate
hydration is essential. Caffeine should be limited to <200 mg/day, but the safest approach is
avoidance; however, option C demonstrates the clearest understanding of essential prenatal
care.
Question 5: A postpartum client, 24 hours after vaginal delivery, has a firm fundus at the
umbilicus but reports heavy lochia with large clots. What is the nurse's priority action?
A. Massage the fundus gently
B. Administer prescribed oxytocin
C. Notify the healthcare provider immediately
D. Encourage the client to void
CORRECT ANSWER: A. Massage the fundus gently
Rationale: A firm fundus indicates the uterus is contracted, but heavy lochia with clots suggests
possible retained placental fragments or inadequate uterine tone in lower segments. Gentle
fundal massage helps expel clots and stimulate further contraction. If bleeding persists after
massage, then notify the provider. Oxytocin may be given per protocol, but massage is the
immediate nursing intervention. Encouraging voiding is important but not the priority with
active bleeding.
Question 6: Which finding in a client receiving magnesium sulfate for severe preeclampsia
requires immediate intervention?
A. Urine output of 40 mL/hr
B. Deep tendon reflexes of 1+
C. Respiratory rate of 10 breaths per minute
D. Blood pressure of 140/90 mmHg
CORRECT ANSWER: C. Respiratory rate of 10 breaths per minute
Rationale: Magnesium sulfate is a CNS depressant; respiratory depression (<12 breaths/min) is
a sign of toxicity and requires immediate intervention, including stopping the infusion and
administering calcium gluconate. Urine output <30 mL/hr is concerning but 40 mL/hr is
acceptable. Diminished reflexes (1+) warrant monitoring but are not immediately life-
threatening. BP of 140/90 is elevated but not an acute magnesium toxicity sign.
Question 7: A client in labor asks about the purpose of the Leopold maneuvers. How should
the nurse respond?
A. "They determine the fetal heart rate pattern."
B. "They assess the position, presentation, and engagement of the fetus."
C. "They measure the strength and frequency of contractions."
D. "They evaluate cervical dilation and effacement."
,CORRECT ANSWER: B. "They assess the position, presentation, and engagement of the fetus."
Rationale: Leopold maneuvers are a systematic method of abdominal palpation used to
determine fetal lie, presentation, position, and engagement. Fetal heart rate is assessed via
Doppler or monitor; contractions are assessed via palpation or tocodynamometer; cervical
changes are determined by vaginal examination.
Question 8: Which intervention is most effective in preventing neonatal hypothermia
immediately after birth?
A. Place the newborn under a radiant warmer
B. Dry the newborn thoroughly and place skin-to-skin with the mother
C. Wrap the newborn in two warm blankets
D. Administer warmed intravenous fluids
CORRECT ANSWER: B. Dry the newborn thoroughly and place skin-to-skin with the mother
Rationale: Immediate drying and skin-to-skin contact with the mother is the most effective
method to prevent heat loss through evaporation and conduction, while also promoting
bonding and breastfeeding initiation. Radiant warmers are used if resuscitation is needed.
Blankets are secondary. IV fluids are not routinely given to healthy newborns.
Question 9: A pregnant client with type 1 diabetes is at 36 weeks gestation. Which statement
indicates the need for further teaching?
A. "I will monitor my blood glucose four times daily."
B. "I should expect my insulin needs to decrease after delivery."
C. "I need to have a non-stress test weekly starting now."
D. "I can skip my insulin if I'm not eating due to morning sickness."
CORRECT ANSWER: D. "I can skip my insulin if I'm not eating due to morning sickness."
Rationale: Insulin should never be skipped in type 1 diabetes, even with poor oral intake, as this
can lead to diabetic ketoacidosis. Dosing may be adjusted, but basal insulin is still required.
Options A, B, and C reflect accurate understanding of management: frequent glucose
monitoring, anticipated postpartum insulin reduction, and increased fetal surveillance in late
pregnancy.
Question 10: During a prenatal visit, a client at 28 weeks reports feeling faint when lying on
her back. What is the nurse's best response?
A. "This is normal; just stand up quickly when you feel dizzy."
B. "Lie on your left side to improve blood flow to the uterus."
C. "You should increase your iron intake immediately."
D. "This indicates you need bed rest for the remainder of pregnancy."
CORRECT ANSWER: B. "Lie on your left side to improve blood flow to the uterus."
Rationale: Supine hypotensive syndrome occurs when the gravid uterus compresses the inferior
vena cava in the supine position, reducing venous return and causing dizziness. Left lateral
positioning relieves this compression. Standing quickly could worsen dizziness. While anemia
can cause dizziness, the positional nature points to vena cava compression. Bed rest is not
indicated for this common, benign finding.
Question 11: A client receiving epidural anesthesia for labor develops hypotension. What is
the nurse's priority action?
, A. Administer prescribed ephedrine
B. Increase the IV fluid rate
C. Place the client in a left lateral position
D. Notify the anesthesiologist
CORRECT ANSWER: C. Place the client in a left lateral position
Rationale: Epidural anesthesia can cause sympathetic blockade leading to hypotension. The
immediate nursing action is to position the client laterally (preferably left) to displace the
uterus off the vena cava and improve venous return. IV fluids should be bolused per protocol,
and vasopressors like ephedrine may be given, but positioning is the fastest, first-line
intervention. Notification is important but not before initiating corrective action.
Question 12: Which assessment finding in a postpartum client suggests a developing
infection?
A. Temperature of 100.2°F (37.9°C) at 12 hours postpartum
B. Lochia rubra with a fleshy odor
C. Uterine tenderness on palpation with fever of 101.5°F (38.6°C) at 48 hours
D. Perineal edema and bruising
CORRECT ANSWER: C. Uterine tenderness on palpation with fever of 101.5°F (38.6°C) at 48
hours
Rationale: Fever >100.4°F (38°C) after the first 24 hours postpartum, especially with uterine
tenderness, suggests endometritis. A temperature of 100.2°F in the first 24 hours can be due to
dehydration. Lochia rubra with a fleshy (not foul) odor is normal. Perineal edema and bruising
are expected after vaginal delivery.
Question 13: A newborn is noted to have a heart rate of 80 bpm and is apneic at 5 minutes of
life. What is the next step in neonatal resuscitation?
A. Administer epinephrine via umbilical vein
B. Begin positive-pressure ventilation with a bag-mask device
C. Continue tactile stimulation
D. Initiate chest compressions
CORRECT ANSWER: B. Begin positive-pressure ventilation with a bag-mask device
Rationale: According to the Neonatal Resuscitation Program (NRP), if a newborn is apneic or
has a heart rate <100 bpm after initial steps (warm, dry, stimulate), the next step is to provide
positive-pressure ventilation. Chest compressions are initiated if the heart rate remains <60
bpm after 30 seconds of effective ventilation. Epinephrine is considered if the heart rate is still
<60 bpm after compressions and ventilation. Tactile stimulation is part of initial steps and is no
longer appropriate if the infant remains apneic.
Question 14: Which finding is a normal physiological change during pregnancy?
A. Decreased cardiac output
B. Increased glomerular filtration rate
C. Decreased respiratory rate
D. Increased hematocrit
CORRECT ANSWER: B. Increased glomerular filtration rate
Maternity Nursing Study Guide, Verified Practice Questions
& Answers with Detailed Rationales, Obstetrics & Maternal-
Newborn Nursing HESI Review Bundle for Nursing
Students
Question 1: A pregnant client at 32 weeks gestation reports experiencing occasional
headaches and blurred vision. Which assessment finding should the nurse prioritize?
A. Blood pressure of 110/70 mmHg
B. Weight gain of 1 pound this week
C. Blood pressure of 150/95 mmHg with 2+ proteinuria
D. Fetal heart rate of 140 beats per minute
CORRECT ANSWER: C. Blood pressure of 150/95 mmHg with 2+ proteinuria
Rationale: Headaches and blurred vision in the third trimester, combined with elevated blood
pressure and proteinuria, are classic signs of preeclampsia. This is a medical emergency
requiring immediate intervention to prevent progression to eclampsia or HELLP syndrome.
Options A, B, and D represent normal findings and do not indicate an acute complication.
Question 2: During the active phase of labor, a client's cervix is dilated to 6 cm. Which nursing
intervention is most appropriate at this time?
A. Encourage the client to push with each contraction
B. Administer oxygen via non-rebreather mask at 10 L/min
C. Provide comfort measures and encourage position changes
D. Prepare for immediate cesarean delivery
CORRECT ANSWER: C. Provide comfort measures and encourage position changes
Rationale: At 6 cm dilation, the client is in the active phase of the first stage of labor. Pushing is
not indicated until the second stage (complete dilation). Comfort measures, breathing
techniques, and position changes help manage pain and promote labor progression. Oxygen
administration and cesarean preparation are reserved for fetal distress or other complications
not indicated here.
Question 3: A newborn is assessed at 1 minute of life and has a heart rate of 90 bpm, slow
irregular respirations, some flexion of extremities, grimaces to stimulation, and a pink body
with blue extremities. What is the infant's Apgar score?
A. 4
B. 5
C. 6
D. 7
CORRECT ANSWER: B. 5
Rationale: The Apgar score assesses five criteria: heart rate (1 point for <100 bpm), respiratory
effort (1 point for slow/irregular), muscle tone (1 point for some flexion), reflex irritability (1
point for grimace), and color (1 point for acrocyanosis). Total = 1+1+1+1+1 = 5. A score of 4-6
indicates moderate difficulty requiring some resuscitative measures.
Question 4: Which statement by a client at 10 weeks gestation indicates understanding of
prenatal nutrition teaching?
,A. "I should limit my fluid intake to prevent swelling."
B. "I need to increase my caloric intake by 500 calories per day now."
C. "I will take my prenatal vitamin with breakfast every morning."
D. "I can continue drinking one cup of coffee daily without concern."
CORRECT ANSWER: C. "I will take my prenatal vitamin with breakfast every morning."
Rationale: Prenatal vitamins, especially those containing folic acid and iron, should be taken
consistently, ideally with food to enhance absorption and reduce nausea. Caloric increase of
500/day is not needed until the third trimester. Fluid restriction is not recommended; adequate
hydration is essential. Caffeine should be limited to <200 mg/day, but the safest approach is
avoidance; however, option C demonstrates the clearest understanding of essential prenatal
care.
Question 5: A postpartum client, 24 hours after vaginal delivery, has a firm fundus at the
umbilicus but reports heavy lochia with large clots. What is the nurse's priority action?
A. Massage the fundus gently
B. Administer prescribed oxytocin
C. Notify the healthcare provider immediately
D. Encourage the client to void
CORRECT ANSWER: A. Massage the fundus gently
Rationale: A firm fundus indicates the uterus is contracted, but heavy lochia with clots suggests
possible retained placental fragments or inadequate uterine tone in lower segments. Gentle
fundal massage helps expel clots and stimulate further contraction. If bleeding persists after
massage, then notify the provider. Oxytocin may be given per protocol, but massage is the
immediate nursing intervention. Encouraging voiding is important but not the priority with
active bleeding.
Question 6: Which finding in a client receiving magnesium sulfate for severe preeclampsia
requires immediate intervention?
A. Urine output of 40 mL/hr
B. Deep tendon reflexes of 1+
C. Respiratory rate of 10 breaths per minute
D. Blood pressure of 140/90 mmHg
CORRECT ANSWER: C. Respiratory rate of 10 breaths per minute
Rationale: Magnesium sulfate is a CNS depressant; respiratory depression (<12 breaths/min) is
a sign of toxicity and requires immediate intervention, including stopping the infusion and
administering calcium gluconate. Urine output <30 mL/hr is concerning but 40 mL/hr is
acceptable. Diminished reflexes (1+) warrant monitoring but are not immediately life-
threatening. BP of 140/90 is elevated but not an acute magnesium toxicity sign.
Question 7: A client in labor asks about the purpose of the Leopold maneuvers. How should
the nurse respond?
A. "They determine the fetal heart rate pattern."
B. "They assess the position, presentation, and engagement of the fetus."
C. "They measure the strength and frequency of contractions."
D. "They evaluate cervical dilation and effacement."
,CORRECT ANSWER: B. "They assess the position, presentation, and engagement of the fetus."
Rationale: Leopold maneuvers are a systematic method of abdominal palpation used to
determine fetal lie, presentation, position, and engagement. Fetal heart rate is assessed via
Doppler or monitor; contractions are assessed via palpation or tocodynamometer; cervical
changes are determined by vaginal examination.
Question 8: Which intervention is most effective in preventing neonatal hypothermia
immediately after birth?
A. Place the newborn under a radiant warmer
B. Dry the newborn thoroughly and place skin-to-skin with the mother
C. Wrap the newborn in two warm blankets
D. Administer warmed intravenous fluids
CORRECT ANSWER: B. Dry the newborn thoroughly and place skin-to-skin with the mother
Rationale: Immediate drying and skin-to-skin contact with the mother is the most effective
method to prevent heat loss through evaporation and conduction, while also promoting
bonding and breastfeeding initiation. Radiant warmers are used if resuscitation is needed.
Blankets are secondary. IV fluids are not routinely given to healthy newborns.
Question 9: A pregnant client with type 1 diabetes is at 36 weeks gestation. Which statement
indicates the need for further teaching?
A. "I will monitor my blood glucose four times daily."
B. "I should expect my insulin needs to decrease after delivery."
C. "I need to have a non-stress test weekly starting now."
D. "I can skip my insulin if I'm not eating due to morning sickness."
CORRECT ANSWER: D. "I can skip my insulin if I'm not eating due to morning sickness."
Rationale: Insulin should never be skipped in type 1 diabetes, even with poor oral intake, as this
can lead to diabetic ketoacidosis. Dosing may be adjusted, but basal insulin is still required.
Options A, B, and C reflect accurate understanding of management: frequent glucose
monitoring, anticipated postpartum insulin reduction, and increased fetal surveillance in late
pregnancy.
Question 10: During a prenatal visit, a client at 28 weeks reports feeling faint when lying on
her back. What is the nurse's best response?
A. "This is normal; just stand up quickly when you feel dizzy."
B. "Lie on your left side to improve blood flow to the uterus."
C. "You should increase your iron intake immediately."
D. "This indicates you need bed rest for the remainder of pregnancy."
CORRECT ANSWER: B. "Lie on your left side to improve blood flow to the uterus."
Rationale: Supine hypotensive syndrome occurs when the gravid uterus compresses the inferior
vena cava in the supine position, reducing venous return and causing dizziness. Left lateral
positioning relieves this compression. Standing quickly could worsen dizziness. While anemia
can cause dizziness, the positional nature points to vena cava compression. Bed rest is not
indicated for this common, benign finding.
Question 11: A client receiving epidural anesthesia for labor develops hypotension. What is
the nurse's priority action?
, A. Administer prescribed ephedrine
B. Increase the IV fluid rate
C. Place the client in a left lateral position
D. Notify the anesthesiologist
CORRECT ANSWER: C. Place the client in a left lateral position
Rationale: Epidural anesthesia can cause sympathetic blockade leading to hypotension. The
immediate nursing action is to position the client laterally (preferably left) to displace the
uterus off the vena cava and improve venous return. IV fluids should be bolused per protocol,
and vasopressors like ephedrine may be given, but positioning is the fastest, first-line
intervention. Notification is important but not before initiating corrective action.
Question 12: Which assessment finding in a postpartum client suggests a developing
infection?
A. Temperature of 100.2°F (37.9°C) at 12 hours postpartum
B. Lochia rubra with a fleshy odor
C. Uterine tenderness on palpation with fever of 101.5°F (38.6°C) at 48 hours
D. Perineal edema and bruising
CORRECT ANSWER: C. Uterine tenderness on palpation with fever of 101.5°F (38.6°C) at 48
hours
Rationale: Fever >100.4°F (38°C) after the first 24 hours postpartum, especially with uterine
tenderness, suggests endometritis. A temperature of 100.2°F in the first 24 hours can be due to
dehydration. Lochia rubra with a fleshy (not foul) odor is normal. Perineal edema and bruising
are expected after vaginal delivery.
Question 13: A newborn is noted to have a heart rate of 80 bpm and is apneic at 5 minutes of
life. What is the next step in neonatal resuscitation?
A. Administer epinephrine via umbilical vein
B. Begin positive-pressure ventilation with a bag-mask device
C. Continue tactile stimulation
D. Initiate chest compressions
CORRECT ANSWER: B. Begin positive-pressure ventilation with a bag-mask device
Rationale: According to the Neonatal Resuscitation Program (NRP), if a newborn is apneic or
has a heart rate <100 bpm after initial steps (warm, dry, stimulate), the next step is to provide
positive-pressure ventilation. Chest compressions are initiated if the heart rate remains <60
bpm after 30 seconds of effective ventilation. Epinephrine is considered if the heart rate is still
<60 bpm after compressions and ventilation. Tactile stimulation is part of initial steps and is no
longer appropriate if the infant remains apneic.
Question 14: Which finding is a normal physiological change during pregnancy?
A. Decreased cardiac output
B. Increased glomerular filtration rate
C. Decreased respiratory rate
D. Increased hematocrit
CORRECT ANSWER: B. Increased glomerular filtration rate
