HESI MATERNITY OB EXAM
Versions 1, 2 & 3 — Comprehensive Obstetric & Newborn Care
2026/2027 | 225 QUESTIONS (75 PER VERSION) | GRADED A+
HESI Maternity OB Exam Practice Questions — Elsevier Evolve / Maternal-Child Nursing
Standards
Core Domains: Antepartum Care & Fetal Development, Intrapartum Care & Labor Management,
Postpartum Care & Maternal Recovery, Newborn Assessment & Care, High-Risk Pregnancy &
Pharmacology
Exam Structure
• Exact official question count: 75 multiple-choice questions (MCQ) per version × 3 versions =
225 questions total (per commonly cited HESI Maternity OB specifications and verified Elsevier
Evolve documentation)
• All questions presented in MCQ format with four options (A, B, C, D), single-best-answer unless
otherwise specified as SATA
• Item types: Standard MCQ, Select-All-That-Apply (SATA) clearly marked, fetal monitoring
interpretation, labor progression scenarios, newborn assessment items, and prioritization
decision-making questions
• Focus on evidence-based obstetric nursing interventions, AWHONN standards application, and
professional judgment aligned with NCLEX-RN test plan and maternal-child nursing
competencies
• Total testing time per version: 105 minutes (computer-based, proctored format via Elsevier
Evolve testing platform)
• Passing score per version: Typically 850 HESI score or 75–80% required for program
progression (56–60/75 correct per version)
Introduction
This HESI Maternity OB Exam Versions 1, 2 & 3 format for 2026/2027 reflects the standardized
competency assessments used to evaluate proficiency in foundational and advanced obstetric and
newborn care principles for pre-licensure nursing students. Each official examination version
consists of exactly 75 multiple-choice questions (MCQ) covering critical domains: antepartum
care and fetal development, intrapartum care and labor management, postpartum care and
maternal recovery, newborn assessment and care, high-risk pregnancy complications,
pharmacology in obstetrics, and scenario-based application. The exams measure knowledge
essential for safe, effective, and family-centered practice in maternal-child health settings, aligned
with current AWHONN standards, NCLEX-RN test plan, Elsevier HESI test blueprints, and
institutional nursing program learning outcomes.
Answer Format
All correct answers are presented in bold, each question appears in bold, and all rationales
explaining obstetric nursing interventions, fetal monitoring interpretation, labor management
protocols, and scenario-based professional reasoning are written in italic font
,Examination Overview (All 3 Versions)
Domain Questions/Version Key Topics Weight
Antepartum Care & 15 Prenatal Assessment, Fetal 20%
Fetal Development Growth/Development, Danger Signs,
Prenatal Testing, Nutrition,
Discomforts of Pregnancy
Intrapartum Care & 20 Stages of Labor, Fetal Heart Rate 27%
Labor Management Monitoring, Pain Management,
Nursing Interventions, Complications
of Labor
Postpartum Care & 15 Uterine Involution, Lochia 20%
Maternal Recovery Assessment, Breastfeeding Support,
Postpartum Complications, Mental
Health Screening
Newborn Assessment 15 APGAR Scoring, Physical 20%
& Care Assessment, Thermoregulation,
Feeding, Jaundice, Newborn
Screening
High-Risk Pregnancy 10 Preeclampsia, Gestational Diabetes, 13%
& Pharmacology Preterm Labor, Medication Safety,
Tocolytics, Magnesium Sulfate
Monitoring
VERSION 1 — Questions 1–75
Domain: Antepartum Care & Fetal Development
1. A 28-year-old G1P0 client at 12 weeks' gestation presents for her first prenatal
visit. Her last menstrual period (LMP) was March 3. Using Naegele's rule, what is
the estimated date of delivery (EDD)?
A. November 24
B. December 10
C. December 3
D. November 10
Correct Answer: B
Rationale: Naegele's rule calculates the EDD by subtracting 3 months from the first day of the
LMP and then adding 7 days and 1 year. Starting from March 3: subtracting 3 months gives
December 3, adding 7 days gives December 10. This is the standard method for estimating
delivery dates and is aligned with AWHONN guidelines for prenatal care. Option A and C are
miscalculations that do not follow the rule correctly. Option D incorrectly subtracts the 7 days
instead of adding them.
2. A nurse is reviewing the obstetric history of a client who is pregnant for the third
time. She had one full-term delivery at 39 weeks, one preterm delivery at 34 weeks,
and one spontaneous abortion at 10 weeks. Which of the following correctly
describes this client using the GTPAL system?
A. G3 T1 P1 A1 L2
B. G3 T1 P1 A0 L2
C. G4 T1 P1 A1 L2
, D. G3 T1 P1 A1 L1
Correct Answer: A
Rationale: The GTPAL system stands for Gravida (total pregnancies), Term births (>37 weeks),
Preterm births (20-37 weeks), Abortions/miscarriages (<20 weeks), and Living children. This
client has had 3 total pregnancies (G3), one term birth (T1), one preterm birth (P1), one
spontaneous abortion (A1), and two living children (L2). The preterm infant is also a living
child, so both are counted in L. Option B omits the abortion, Option C incorrectly counts gravida
as 4, and Option D only counts one living child.
3. A prenatal client at 28 weeks' gestation asks the nurse about the purpose of a 1-
hour glucose tolerance test. Which response by the nurse is most accurate?
A. It screens for type 1 diabetes mellitus that existed before pregnancy.
B. It screens for gestational diabetes mellitus, which can develop during pregnancy due to
placental hormones.
C. It confirms gestational diabetes and determines the insulin dosage needed.
D. It evaluates how well the fetal pancreas is producing insulin.
Correct Answer: B
Rationale: The 1-hour glucose tolerance test (50-g oral glucose load) is a screening tool for
gestational diabetes mellitus (GDM), a condition caused by insulin resistance from placental
hormones such as human placental lactogen and cortisol. It does not screen for pre-existing type
1 diabetes (A), does not confirm the diagnosis (C)-a 3-hour test is diagnostic-and is unrelated to
fetal pancreatic function (D). AWHONN recommends universal screening for GDM between 24
and 28 weeks' gestation.
4. A pregnant client at 20 weeks' gestation reports occasional headaches, nasal
stuffiness, and bleeding gums. Which statement by the nurse best addresses these
findings?
A. These symptoms suggest preeclampsia and require immediate evaluation of blood
pressure and proteinuria.
B. These are common physiological discomforts of pregnancy caused by hormonal changes
and increased blood volume.
C. Nasal stuffiness and bleeding gums are signs of a vitamin C deficiency that needs dietary
supplementation.
D. Headaches at 20 weeks are always concerning for neurological complications and
warrant an MRI.
Correct Answer: B
Rationale: Headaches, nasal stuffiness (epistaxis), and bleeding gums are expected
physiological discomforts of pregnancy. Increased estrogen causes vascular congestion of
mucous membranes, leading to nasal stuffiness and bleeding gums. Increased blood volume and
vasodilation contribute to headaches. While preeclampsia screening is ongoing, these isolated
symptoms without elevated blood pressure or proteinuria are not diagnostic. Vitamin C
deficiency is not the primary cause (C), and routine headaches at 20 weeks without red flags do
not warrant immediate MRI (D). Per AWHONN, these findings should be documented and
differentiated from danger signs.
5. Select All That Apply: A nurse is performing Leopold maneuvers on a client at 34
weeks' gestation. Which of the following are correct steps or findings associated
with Leopold maneuvers?
A. The first maneuver determines the presenting part in the fundus, typically identifying the
fetal breech or head.
B. The second maneuver determines the fetal back position by palpating the smooth, firm
surface on one side of the uterus.
C. The third maneuver determines the fetal part presenting over the pelvic inlet using the
Pawlik grip.
, D. Leopold maneuvers should be performed with the woman in a lithotomy position for best
results.
Correct Answer: A,B,C
Rationale: Leopold maneuvers consist of four systematic abdominal palpation techniques. The
first maneuver identifies the fetal part in the fundus (the breech if soft and irregular, the head if
firm and round). The second maneuver identifies the fetal back as a smooth, firm surface on one
side, with fetal limbs (small, knobby) felt on the opposite side. The third maneuver uses the
Pawlik grip to determine the presenting part at the pelvic inlet. The client should be in a supine
position with knees slightly flexed, NOT lithotomy (D), which is reserved for delivery. AWHONN
recommends Leopold maneuvers as a standard component of prenatal assessment.
6. A client at 35 weeks' gestation is scheduled for a nonstress test (NST). Which
result indicates a reactive (reassuring) NST?
A. Two or more fetal heart rate accelerations of at least 15 beats per minute above baseline,
each lasting at least 15 seconds, within a 20-minute period.
B. One fetal heart rate acceleration of 10 beats per minute lasting 10 seconds in a 30-minute
window.
C. Absence of any decelerations during a 40-minute observation period.
D. Variable decelerations present but with moderate baseline variability throughout the
tracing.
Correct Answer: A
Rationale: A reactive NST requires at least two accelerations of ≥15 bpm above baseline, each
lasting ≥15 seconds, within a 20-minute window. This indicates adequate fetal oxygenation and
neurological function. Option B describes a non-reassuring finding (insufficient accelerations).
Option C describes a nonreactive pattern without accelerations, which is concerning. Option D
describes variable decelerations that suggest cord compression and are not reassuring.
AWHONN defines these criteria as the standard for interpreting NST results.
7. A nurse is providing nutritional counseling to a pregnant client at 16 weeks'
gestation. The client states, "I've heard I need to eat a lot more because I'm eating
for two." Which response by the nurse is most appropriate?
A. Yes, you should double your caloric intake to meet the needs of the growing fetus.
B. You need an extra 300 calories per day in the second trimester and about 500 extra
calories per day in the third trimester.
C. Caloric intake does not change during pregnancy; focus instead on taking a daily prenatal
vitamin.
D. You should increase your protein intake to 200 grams per day to support fetal growth.
Correct Answer: B
Rationale: The Institute of Medicine and AWHONN guidelines recommend an additional 340
calories per day during the second trimester and approximately 452 additional calories during
the third trimester. Doubling caloric intake (A) is a common myth and would lead to excessive
weight gain. Caloric needs do increase (C is incorrect). While protein needs increase to 71 g/day,
200 grams is excessive and not evidence-based (D). The nurse should educate the client on
balanced, nutrient-dense food choices rather than eating significantly more.
8. A client at 16 weeks' gestation is considering genetic testing and asks the nurse
about the difference between amniocentesis and chorionic villus sampling (CVS).
Which statement by the nurse is most accurate?
A. CVS can be performed earlier than amniocentesis but does not detect neural tube defects.
B. Amniocentesis is performed at 10-13 weeks and carries a higher risk of miscarriage than
CVS.
C. Both procedures carry identical risks and can be performed at the same gestational age.
D. CVS can detect neural tube defects but cannot determine fetal sex.
Correct Answer: A
Versions 1, 2 & 3 — Comprehensive Obstetric & Newborn Care
2026/2027 | 225 QUESTIONS (75 PER VERSION) | GRADED A+
HESI Maternity OB Exam Practice Questions — Elsevier Evolve / Maternal-Child Nursing
Standards
Core Domains: Antepartum Care & Fetal Development, Intrapartum Care & Labor Management,
Postpartum Care & Maternal Recovery, Newborn Assessment & Care, High-Risk Pregnancy &
Pharmacology
Exam Structure
• Exact official question count: 75 multiple-choice questions (MCQ) per version × 3 versions =
225 questions total (per commonly cited HESI Maternity OB specifications and verified Elsevier
Evolve documentation)
• All questions presented in MCQ format with four options (A, B, C, D), single-best-answer unless
otherwise specified as SATA
• Item types: Standard MCQ, Select-All-That-Apply (SATA) clearly marked, fetal monitoring
interpretation, labor progression scenarios, newborn assessment items, and prioritization
decision-making questions
• Focus on evidence-based obstetric nursing interventions, AWHONN standards application, and
professional judgment aligned with NCLEX-RN test plan and maternal-child nursing
competencies
• Total testing time per version: 105 minutes (computer-based, proctored format via Elsevier
Evolve testing platform)
• Passing score per version: Typically 850 HESI score or 75–80% required for program
progression (56–60/75 correct per version)
Introduction
This HESI Maternity OB Exam Versions 1, 2 & 3 format for 2026/2027 reflects the standardized
competency assessments used to evaluate proficiency in foundational and advanced obstetric and
newborn care principles for pre-licensure nursing students. Each official examination version
consists of exactly 75 multiple-choice questions (MCQ) covering critical domains: antepartum
care and fetal development, intrapartum care and labor management, postpartum care and
maternal recovery, newborn assessment and care, high-risk pregnancy complications,
pharmacology in obstetrics, and scenario-based application. The exams measure knowledge
essential for safe, effective, and family-centered practice in maternal-child health settings, aligned
with current AWHONN standards, NCLEX-RN test plan, Elsevier HESI test blueprints, and
institutional nursing program learning outcomes.
Answer Format
All correct answers are presented in bold, each question appears in bold, and all rationales
explaining obstetric nursing interventions, fetal monitoring interpretation, labor management
protocols, and scenario-based professional reasoning are written in italic font
,Examination Overview (All 3 Versions)
Domain Questions/Version Key Topics Weight
Antepartum Care & 15 Prenatal Assessment, Fetal 20%
Fetal Development Growth/Development, Danger Signs,
Prenatal Testing, Nutrition,
Discomforts of Pregnancy
Intrapartum Care & 20 Stages of Labor, Fetal Heart Rate 27%
Labor Management Monitoring, Pain Management,
Nursing Interventions, Complications
of Labor
Postpartum Care & 15 Uterine Involution, Lochia 20%
Maternal Recovery Assessment, Breastfeeding Support,
Postpartum Complications, Mental
Health Screening
Newborn Assessment 15 APGAR Scoring, Physical 20%
& Care Assessment, Thermoregulation,
Feeding, Jaundice, Newborn
Screening
High-Risk Pregnancy 10 Preeclampsia, Gestational Diabetes, 13%
& Pharmacology Preterm Labor, Medication Safety,
Tocolytics, Magnesium Sulfate
Monitoring
VERSION 1 — Questions 1–75
Domain: Antepartum Care & Fetal Development
1. A 28-year-old G1P0 client at 12 weeks' gestation presents for her first prenatal
visit. Her last menstrual period (LMP) was March 3. Using Naegele's rule, what is
the estimated date of delivery (EDD)?
A. November 24
B. December 10
C. December 3
D. November 10
Correct Answer: B
Rationale: Naegele's rule calculates the EDD by subtracting 3 months from the first day of the
LMP and then adding 7 days and 1 year. Starting from March 3: subtracting 3 months gives
December 3, adding 7 days gives December 10. This is the standard method for estimating
delivery dates and is aligned with AWHONN guidelines for prenatal care. Option A and C are
miscalculations that do not follow the rule correctly. Option D incorrectly subtracts the 7 days
instead of adding them.
2. A nurse is reviewing the obstetric history of a client who is pregnant for the third
time. She had one full-term delivery at 39 weeks, one preterm delivery at 34 weeks,
and one spontaneous abortion at 10 weeks. Which of the following correctly
describes this client using the GTPAL system?
A. G3 T1 P1 A1 L2
B. G3 T1 P1 A0 L2
C. G4 T1 P1 A1 L2
, D. G3 T1 P1 A1 L1
Correct Answer: A
Rationale: The GTPAL system stands for Gravida (total pregnancies), Term births (>37 weeks),
Preterm births (20-37 weeks), Abortions/miscarriages (<20 weeks), and Living children. This
client has had 3 total pregnancies (G3), one term birth (T1), one preterm birth (P1), one
spontaneous abortion (A1), and two living children (L2). The preterm infant is also a living
child, so both are counted in L. Option B omits the abortion, Option C incorrectly counts gravida
as 4, and Option D only counts one living child.
3. A prenatal client at 28 weeks' gestation asks the nurse about the purpose of a 1-
hour glucose tolerance test. Which response by the nurse is most accurate?
A. It screens for type 1 diabetes mellitus that existed before pregnancy.
B. It screens for gestational diabetes mellitus, which can develop during pregnancy due to
placental hormones.
C. It confirms gestational diabetes and determines the insulin dosage needed.
D. It evaluates how well the fetal pancreas is producing insulin.
Correct Answer: B
Rationale: The 1-hour glucose tolerance test (50-g oral glucose load) is a screening tool for
gestational diabetes mellitus (GDM), a condition caused by insulin resistance from placental
hormones such as human placental lactogen and cortisol. It does not screen for pre-existing type
1 diabetes (A), does not confirm the diagnosis (C)-a 3-hour test is diagnostic-and is unrelated to
fetal pancreatic function (D). AWHONN recommends universal screening for GDM between 24
and 28 weeks' gestation.
4. A pregnant client at 20 weeks' gestation reports occasional headaches, nasal
stuffiness, and bleeding gums. Which statement by the nurse best addresses these
findings?
A. These symptoms suggest preeclampsia and require immediate evaluation of blood
pressure and proteinuria.
B. These are common physiological discomforts of pregnancy caused by hormonal changes
and increased blood volume.
C. Nasal stuffiness and bleeding gums are signs of a vitamin C deficiency that needs dietary
supplementation.
D. Headaches at 20 weeks are always concerning for neurological complications and
warrant an MRI.
Correct Answer: B
Rationale: Headaches, nasal stuffiness (epistaxis), and bleeding gums are expected
physiological discomforts of pregnancy. Increased estrogen causes vascular congestion of
mucous membranes, leading to nasal stuffiness and bleeding gums. Increased blood volume and
vasodilation contribute to headaches. While preeclampsia screening is ongoing, these isolated
symptoms without elevated blood pressure or proteinuria are not diagnostic. Vitamin C
deficiency is not the primary cause (C), and routine headaches at 20 weeks without red flags do
not warrant immediate MRI (D). Per AWHONN, these findings should be documented and
differentiated from danger signs.
5. Select All That Apply: A nurse is performing Leopold maneuvers on a client at 34
weeks' gestation. Which of the following are correct steps or findings associated
with Leopold maneuvers?
A. The first maneuver determines the presenting part in the fundus, typically identifying the
fetal breech or head.
B. The second maneuver determines the fetal back position by palpating the smooth, firm
surface on one side of the uterus.
C. The third maneuver determines the fetal part presenting over the pelvic inlet using the
Pawlik grip.
, D. Leopold maneuvers should be performed with the woman in a lithotomy position for best
results.
Correct Answer: A,B,C
Rationale: Leopold maneuvers consist of four systematic abdominal palpation techniques. The
first maneuver identifies the fetal part in the fundus (the breech if soft and irregular, the head if
firm and round). The second maneuver identifies the fetal back as a smooth, firm surface on one
side, with fetal limbs (small, knobby) felt on the opposite side. The third maneuver uses the
Pawlik grip to determine the presenting part at the pelvic inlet. The client should be in a supine
position with knees slightly flexed, NOT lithotomy (D), which is reserved for delivery. AWHONN
recommends Leopold maneuvers as a standard component of prenatal assessment.
6. A client at 35 weeks' gestation is scheduled for a nonstress test (NST). Which
result indicates a reactive (reassuring) NST?
A. Two or more fetal heart rate accelerations of at least 15 beats per minute above baseline,
each lasting at least 15 seconds, within a 20-minute period.
B. One fetal heart rate acceleration of 10 beats per minute lasting 10 seconds in a 30-minute
window.
C. Absence of any decelerations during a 40-minute observation period.
D. Variable decelerations present but with moderate baseline variability throughout the
tracing.
Correct Answer: A
Rationale: A reactive NST requires at least two accelerations of ≥15 bpm above baseline, each
lasting ≥15 seconds, within a 20-minute window. This indicates adequate fetal oxygenation and
neurological function. Option B describes a non-reassuring finding (insufficient accelerations).
Option C describes a nonreactive pattern without accelerations, which is concerning. Option D
describes variable decelerations that suggest cord compression and are not reassuring.
AWHONN defines these criteria as the standard for interpreting NST results.
7. A nurse is providing nutritional counseling to a pregnant client at 16 weeks'
gestation. The client states, "I've heard I need to eat a lot more because I'm eating
for two." Which response by the nurse is most appropriate?
A. Yes, you should double your caloric intake to meet the needs of the growing fetus.
B. You need an extra 300 calories per day in the second trimester and about 500 extra
calories per day in the third trimester.
C. Caloric intake does not change during pregnancy; focus instead on taking a daily prenatal
vitamin.
D. You should increase your protein intake to 200 grams per day to support fetal growth.
Correct Answer: B
Rationale: The Institute of Medicine and AWHONN guidelines recommend an additional 340
calories per day during the second trimester and approximately 452 additional calories during
the third trimester. Doubling caloric intake (A) is a common myth and would lead to excessive
weight gain. Caloric needs do increase (C is incorrect). While protein needs increase to 71 g/day,
200 grams is excessive and not evidence-based (D). The nurse should educate the client on
balanced, nutrient-dense food choices rather than eating significantly more.
8. A client at 16 weeks' gestation is considering genetic testing and asks the nurse
about the difference between amniocentesis and chorionic villus sampling (CVS).
Which statement by the nurse is most accurate?
A. CVS can be performed earlier than amniocentesis but does not detect neural tube defects.
B. Amniocentesis is performed at 10-13 weeks and carries a higher risk of miscarriage than
CVS.
C. Both procedures carry identical risks and can be performed at the same gestational age.
D. CVS can detect neural tube defects but cannot determine fetal sex.
Correct Answer: A
