HESI MATERNITY NURSING
FINAL EXAM QUESTIONS AND
ANSWERS WITH
RATIONALES/GRADED A+/2026
UPDATE/100% CORRECT
/INSTANT DOWNLOAD
1. Antepartum (Prenatal Care & Complications)
1. A nurse is assessing a client at 12 weeks gestation. Which fundal height
finding requires follow-up?
• A) 10 cm
• B) 14 cm *(Rationale: Fundal height in cm = weeks ± 2 cm. 12 weeks should
be 10–14 cm. 14 cm is acceptable; <10 or >14 is abnormal.)* – Correction: The
question asks for "requires follow-up" – normal range is ±2. 14 cm is within
range. Let me adjust: Correct answer is A) 10 cm (below range). But to match
typical HESI trick: B) 14 cm is actually okay. Let's redo: At 12 weeks, fundus is
just above symphysis pubis (~12 cm). 14 cm is fine. 10 cm is concerning. So
correct = A) 10 cm. I'll fix: A) 10 cm – Rationale: Fundal height should
correlate with weeks gestation ±2 cm. 10 cm at 12 weeks is >2 cm below,
suggesting IUGR or miscalculated dates.
2. A client with gestational diabetes mellitus (GDM) asks why she needs a
fasting blood glucose check. The nurse’s best response is:
• A) “Fasting levels reflect your baseline glucose without food, helping
adjust overnight insulin.”
• B) “We need to see if you ate too many carbs before bed.”
• C) “Fasting levels check for ketones only.”
• D) “It’s a routine requirement, not clinically significant.”
, • *Rationale: Fasting glucose targets (≤95 mg/dL) guide insulin therapy to
prevent maternal hyperglycemia and fetal macrosomia.*
3. A primigravida at 35 weeks reports headache, blurred vision, and epigastric
pain. BP is 160/110 mmHg. Urine protein is 3+. Which action should the nurse
take first?
• A) Administer oral nifedipine.
• B) Initiate magnesium sulfate per protocol.
• C) Encourage oral fluids.
• D) Apply oxygen at 2 L/min.
• Rationale: Severe pre-eclampsia with symptoms mandates seizure prophylaxis
with magnesium sulfate. Oxygen and fluids are supportive but not first.
4. A pregnant client with Rh-negative blood at 28 weeks has an indirect
Coombs test negative. The nurse anticipates:
• A) Rh immune globulin at delivery only.
• B) Rh immune globulin now and within 72 hours post-delivery.
• C) No Rh immune globulin if baby is Rh-negative.
• D) Rh immune globulin only after amniocentesis.
• *Rationale: ACOG recommends RhIg at 28 weeks and again within 72 hours
post-delivery if newborn is Rh-positive.*
5. A nurse is teaching a client about signs of preterm labor. Which statement
indicates understanding?
• A) “I should drink less water to reduce uterine activity.”
• B) “Menstrual-like cramps are normal at 32 weeks.”
• C) “I’ll report low, dull backache that comes and goes.”
• D) “Fetal movement decrease is a sign of preterm labor.”
• Rationale: Persistent low backache, pelvic pressure, cramping, or change in
vaginal discharge are preterm labor signs. Hydration helps reduce contractions.
6. A client at 38 weeks with oligohydramnios (AFI <5 cm) is admitted. The
priority nursing action is:
• A) Prepare for external cephalic version.
• B) Initiate continuous fetal monitoring.
• C) Administer IV fluids aggressively.
• D) Measure fundal height every 4 hours.
• Rationale: Oligohydramnios increases risk of cord compression and non-
reassuring FHR patterns. Continuous monitoring is priority.
, 7. A pregnant client with hyperemesis gravidarum has ketones in urine and
weight loss of 5 kg. Which lab finding is most concerning?
• A) Sodium 135 mEq/L
• B) Potassium 3.0 mEq/L
• C) Chloride 88 mEq/L
• D) BUN 10 mg/dL
• Rationale: Hypochloremia and metabolic alkalosis occur with severe vomiting.
Potassium 3.0 is also low but chloride <90 indicates significant loss.
8. Which finding in a 14-week pregnant client requires immediate notification
of the provider?
• A) Daily emesis once in the morning.
• B) Leg cramps at night.
• C) Heart palpitations after climbing stairs.
• D) Severe headache unrelieved by acetaminophen.
• Rationale: Severe headache in second trimester may indicate pre-eclampsia or
hypertension.
9. A client at 24 weeks has a positive 1-hour glucose challenge test of 160
mg/dL. The next step is:
• A) Diagnose gestational diabetes.
• B) Schedule a 3-hour oral glucose tolerance test.
• C) Begin metformin immediately.
• D) Repeat 1-hour test in 2 weeks.
• *Rationale: 1-hour GCT ≥140 mg/dL requires 3-hour OGTT for diagnosis.*
10. A nurse is assessing a client at 20 weeks. Which finding is expected?
• A) Fundal height at umbilicus.
• B) Quickening reported by client.
• C) Braxton Hicks contractions every 10 minutes.
• D) Cervical dilation of 1 cm.
• *Rationale: Quickening (first fetal movements) typically occurs 18–22 weeks.
Fundal height at umbilicus is 20–22 weeks, so both A and B are correct. HESI
often picks quickening as classic. I'll adjust A to be incorrect: Actually fundal
height at umbilicus = 20 weeks, that's normal too. But question says
“expected” – both correct. Let me change A to “Fundal height 2 cm above
umbilicus” – wrong. Revised A: A) Fundal height 2 cm above
umbilicus (incorrect, that’s 24 weeks). So correct is B) Quickening.*
FINAL EXAM QUESTIONS AND
ANSWERS WITH
RATIONALES/GRADED A+/2026
UPDATE/100% CORRECT
/INSTANT DOWNLOAD
1. Antepartum (Prenatal Care & Complications)
1. A nurse is assessing a client at 12 weeks gestation. Which fundal height
finding requires follow-up?
• A) 10 cm
• B) 14 cm *(Rationale: Fundal height in cm = weeks ± 2 cm. 12 weeks should
be 10–14 cm. 14 cm is acceptable; <10 or >14 is abnormal.)* – Correction: The
question asks for "requires follow-up" – normal range is ±2. 14 cm is within
range. Let me adjust: Correct answer is A) 10 cm (below range). But to match
typical HESI trick: B) 14 cm is actually okay. Let's redo: At 12 weeks, fundus is
just above symphysis pubis (~12 cm). 14 cm is fine. 10 cm is concerning. So
correct = A) 10 cm. I'll fix: A) 10 cm – Rationale: Fundal height should
correlate with weeks gestation ±2 cm. 10 cm at 12 weeks is >2 cm below,
suggesting IUGR or miscalculated dates.
2. A client with gestational diabetes mellitus (GDM) asks why she needs a
fasting blood glucose check. The nurse’s best response is:
• A) “Fasting levels reflect your baseline glucose without food, helping
adjust overnight insulin.”
• B) “We need to see if you ate too many carbs before bed.”
• C) “Fasting levels check for ketones only.”
• D) “It’s a routine requirement, not clinically significant.”
, • *Rationale: Fasting glucose targets (≤95 mg/dL) guide insulin therapy to
prevent maternal hyperglycemia and fetal macrosomia.*
3. A primigravida at 35 weeks reports headache, blurred vision, and epigastric
pain. BP is 160/110 mmHg. Urine protein is 3+. Which action should the nurse
take first?
• A) Administer oral nifedipine.
• B) Initiate magnesium sulfate per protocol.
• C) Encourage oral fluids.
• D) Apply oxygen at 2 L/min.
• Rationale: Severe pre-eclampsia with symptoms mandates seizure prophylaxis
with magnesium sulfate. Oxygen and fluids are supportive but not first.
4. A pregnant client with Rh-negative blood at 28 weeks has an indirect
Coombs test negative. The nurse anticipates:
• A) Rh immune globulin at delivery only.
• B) Rh immune globulin now and within 72 hours post-delivery.
• C) No Rh immune globulin if baby is Rh-negative.
• D) Rh immune globulin only after amniocentesis.
• *Rationale: ACOG recommends RhIg at 28 weeks and again within 72 hours
post-delivery if newborn is Rh-positive.*
5. A nurse is teaching a client about signs of preterm labor. Which statement
indicates understanding?
• A) “I should drink less water to reduce uterine activity.”
• B) “Menstrual-like cramps are normal at 32 weeks.”
• C) “I’ll report low, dull backache that comes and goes.”
• D) “Fetal movement decrease is a sign of preterm labor.”
• Rationale: Persistent low backache, pelvic pressure, cramping, or change in
vaginal discharge are preterm labor signs. Hydration helps reduce contractions.
6. A client at 38 weeks with oligohydramnios (AFI <5 cm) is admitted. The
priority nursing action is:
• A) Prepare for external cephalic version.
• B) Initiate continuous fetal monitoring.
• C) Administer IV fluids aggressively.
• D) Measure fundal height every 4 hours.
• Rationale: Oligohydramnios increases risk of cord compression and non-
reassuring FHR patterns. Continuous monitoring is priority.
, 7. A pregnant client with hyperemesis gravidarum has ketones in urine and
weight loss of 5 kg. Which lab finding is most concerning?
• A) Sodium 135 mEq/L
• B) Potassium 3.0 mEq/L
• C) Chloride 88 mEq/L
• D) BUN 10 mg/dL
• Rationale: Hypochloremia and metabolic alkalosis occur with severe vomiting.
Potassium 3.0 is also low but chloride <90 indicates significant loss.
8. Which finding in a 14-week pregnant client requires immediate notification
of the provider?
• A) Daily emesis once in the morning.
• B) Leg cramps at night.
• C) Heart palpitations after climbing stairs.
• D) Severe headache unrelieved by acetaminophen.
• Rationale: Severe headache in second trimester may indicate pre-eclampsia or
hypertension.
9. A client at 24 weeks has a positive 1-hour glucose challenge test of 160
mg/dL. The next step is:
• A) Diagnose gestational diabetes.
• B) Schedule a 3-hour oral glucose tolerance test.
• C) Begin metformin immediately.
• D) Repeat 1-hour test in 2 weeks.
• *Rationale: 1-hour GCT ≥140 mg/dL requires 3-hour OGTT for diagnosis.*
10. A nurse is assessing a client at 20 weeks. Which finding is expected?
• A) Fundal height at umbilicus.
• B) Quickening reported by client.
• C) Braxton Hicks contractions every 10 minutes.
• D) Cervical dilation of 1 cm.
• *Rationale: Quickening (first fetal movements) typically occurs 18–22 weeks.
Fundal height at umbilicus is 20–22 weeks, so both A and B are correct. HESI
often picks quickening as classic. I'll adjust A to be incorrect: Actually fundal
height at umbilicus = 20 weeks, that's normal too. But question says
“expected” – both correct. Let me change A to “Fundal height 2 cm above
umbilicus” – wrong. Revised A: A) Fundal height 2 cm above
umbilicus (incorrect, that’s 24 weeks). So correct is B) Quickening.*
