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HESI MATERNITY OB EXAM VERSION 1
ACTUAL EXAM PREP 2026 ALL QUESTIONS
AND CORRECT DETAILED ANSWERS WITH
RATIONALES |TOP RATED VERSION FOR 2026
BY EXPERTS |NEW AND REVISED
1. A client at 28 weeks gestation with a history of two prior cesarean
deliveries presents with acute-onset severe epigastric pain, headache,
and blurred vision. Blood pressure is 172/110 mm Hg, and urine dipstick
shows 3+ protein. Laboratory results reveal platelet count of 85,000/µL,
AST 120 U/L, ALT 140 U/L, and creatinine 1.4 mg/dL. Which
pathophysiological mechanism is MOST directly implicated in this
clinical syndrome?
A. Excessive trophoblast invasion leading to uteroplacental
hyperperfusion
B. Systemic vasospasm and endothelial dysfunction with
microangiopathic hemolysis
C. Chronic placental ischemia causing compensatory maternal
hypertension
D. Autoimmune-mediated destruction of platelets and hepatocytes
Correct Answer: B
Rationale: This presentation is classic for HELLP syndrome
(Hemolysis, Elevated Liver enzymes, Low Platelets) occurring with
severe preeclampsia. The core pathophysiology involves systemic
vasospasm, endothelial activation, and microangiopathic hemolytic
anemia leading to platelet consumption and hepatic ischemia.
Preeclampsia is associated with shallow trophoblast invasion (not
excessive), and thrombocytopenia in HELLP is consumptive, not
autoimmune.
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2. A woman at 36 weeks gestation presents with painless vaginal
bleeding. What is the priority nursing action?
A. Assess maternal vital signs and fetal heart rate
B. Encourage ambulation
C. Perform a vaginal exam immediately
D. Administer oxytocin
Correct Answer: A
Rationale: Painless third-trimester bleeding may indicate placenta
previa. Vaginal exams can worsen bleeding; assessment of maternal-
fetal status is the first priority. Ambulation and oxytocin
administration are contraindicated without further assessment.
3. A postpartum client reports heavy lochia with large clots 2 hours after
delivery. What is the priority intervention?
A. Assess fundal firmness and massage if boggy
B. Encourage ambulation
C. Document findings only
D. Administer oral iron
Correct Answer: A
Rationale: Postpartum hemorrhage is most commonly caused by
uterine atony. Fundal assessment and massage can help the uterus
contract. Encouraging ambulation would worsen hemorrhage, and
oral iron does not address the acute bleeding.
4. A client at 32 weeks gestation is hospitalized with severe
preeclampsia, and magnesium sulfate is prescribed. Which assessment
finding indicates the therapeutic drug level has been achieved?
A. Decreased respiratory rate from 24 to 16
B. Respiratory rate below 12
C. Urine output less than 30 mL/hour
D. Absent deep tendon reflexes
Correct Answer: A
Rationale: Magnesium sulfate is a CNS depressant that helps prevent
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seizures. A decreased respiratory rate indicates the drug is effective.
Respiratory rate below 12, urine output less than 30 mL/hour, and
absent DTRs indicate toxic levels.
5. A primigravida at 38 weeks gestation is admitted with contractions
occurring every 3-5 minutes, lasting 60-70 seconds. She reports her
"water broke" 2 hours ago. The nurse notes clear fluid and a fetal heart
rate of 140 bpm with moderate variability. What is the most appropriate
nursing action?
A. Prepare for immediate cesarean delivery
B. Perform a sterile vaginal exam to assess cervical dilation
C. Administer prophylactic antibiotics
D. Initiate oxytocin infusion
Correct Answer: B
Rationale: This client is in active labor with ruptured membranes. A
sterile vaginal exam is indicated to assess cervical dilation, effacement,
and station. There is no indication for immediate cesarean delivery,
prophylactic antibiotics, or oxytocin without further assessment.
6. A nurse is assessing a client at 12 weeks gestation. Which finding
would require immediate follow-up?
A. Mild nausea and vomiting in the morning
B. Breast tenderness and enlargement
C. Dark brown vaginal discharge with no pain
D. Frequent urination without dysuria
Correct Answer: C
Rationale: Dark brown discharge may indicate old blood, which could
be a sign of threatened miscarriage or subchorionic hematoma.
Nausea, breast tenderness, and urinary frequency are normal early
pregnancy symptoms.
7. A laboring client with an epidural has a blood pressure drop from
120/80 to 90/60. What action should the nurse take first?
A. Increase the IV fluid rate
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B. Place the woman in a lateral position
C. Administer ephedrine
D. Notify the anesthesia provider
Correct Answer: B
Rationale: The nurse should immediately turn the woman to a lateral
position to displace the uterus off the vena cava, which improves
venous return and blood pressure. Increasing IV fluids, administering
ephedrine, and notifying the provider are subsequent steps if
repositioning is ineffective.
8. A client at 38 weeks gestation with preeclampsia has a blood pressure
of 160/110 mm Hg and reports a severe headache and blurred vision.
The nurse should first:
A. Administer oral labetalol
B. Place the client in a supine position
C. Initiate magnesium sulfate infusion per protocol
D. Notify the provider after completing an admission form
Correct Answer: C
Rationale: Severe preeclampsia with neurologic symptoms (headache,
blurred vision) requires immediate initiation of magnesium sulfate to
prevent seizures. Supine positioning is contraindicated; notification of
the provider should occur concurrently but not delay magnesium
administration.
9. A client in active labor is admitted with preeclampsia. Which
assessment finding is most significant in planning this client's care?
A. Blood pressure 150/92 mm Hg
B. 1+ proteinuria
C. Deep tendon reflexes 3+
D. Headache and blurred vision
Correct Answer: D
Rationale: Headache and blurred vision are signs of severe
preeclampsia indicating cerebral edema and risk of seizure. These
HESI MATERNITY OB EXAM VERSION 1
ACTUAL EXAM PREP 2026 ALL QUESTIONS
AND CORRECT DETAILED ANSWERS WITH
RATIONALES |TOP RATED VERSION FOR 2026
BY EXPERTS |NEW AND REVISED
1. A client at 28 weeks gestation with a history of two prior cesarean
deliveries presents with acute-onset severe epigastric pain, headache,
and blurred vision. Blood pressure is 172/110 mm Hg, and urine dipstick
shows 3+ protein. Laboratory results reveal platelet count of 85,000/µL,
AST 120 U/L, ALT 140 U/L, and creatinine 1.4 mg/dL. Which
pathophysiological mechanism is MOST directly implicated in this
clinical syndrome?
A. Excessive trophoblast invasion leading to uteroplacental
hyperperfusion
B. Systemic vasospasm and endothelial dysfunction with
microangiopathic hemolysis
C. Chronic placental ischemia causing compensatory maternal
hypertension
D. Autoimmune-mediated destruction of platelets and hepatocytes
Correct Answer: B
Rationale: This presentation is classic for HELLP syndrome
(Hemolysis, Elevated Liver enzymes, Low Platelets) occurring with
severe preeclampsia. The core pathophysiology involves systemic
vasospasm, endothelial activation, and microangiopathic hemolytic
anemia leading to platelet consumption and hepatic ischemia.
Preeclampsia is associated with shallow trophoblast invasion (not
excessive), and thrombocytopenia in HELLP is consumptive, not
autoimmune.
,2|Page
2. A woman at 36 weeks gestation presents with painless vaginal
bleeding. What is the priority nursing action?
A. Assess maternal vital signs and fetal heart rate
B. Encourage ambulation
C. Perform a vaginal exam immediately
D. Administer oxytocin
Correct Answer: A
Rationale: Painless third-trimester bleeding may indicate placenta
previa. Vaginal exams can worsen bleeding; assessment of maternal-
fetal status is the first priority. Ambulation and oxytocin
administration are contraindicated without further assessment.
3. A postpartum client reports heavy lochia with large clots 2 hours after
delivery. What is the priority intervention?
A. Assess fundal firmness and massage if boggy
B. Encourage ambulation
C. Document findings only
D. Administer oral iron
Correct Answer: A
Rationale: Postpartum hemorrhage is most commonly caused by
uterine atony. Fundal assessment and massage can help the uterus
contract. Encouraging ambulation would worsen hemorrhage, and
oral iron does not address the acute bleeding.
4. A client at 32 weeks gestation is hospitalized with severe
preeclampsia, and magnesium sulfate is prescribed. Which assessment
finding indicates the therapeutic drug level has been achieved?
A. Decreased respiratory rate from 24 to 16
B. Respiratory rate below 12
C. Urine output less than 30 mL/hour
D. Absent deep tendon reflexes
Correct Answer: A
Rationale: Magnesium sulfate is a CNS depressant that helps prevent
,3|Page
seizures. A decreased respiratory rate indicates the drug is effective.
Respiratory rate below 12, urine output less than 30 mL/hour, and
absent DTRs indicate toxic levels.
5. A primigravida at 38 weeks gestation is admitted with contractions
occurring every 3-5 minutes, lasting 60-70 seconds. She reports her
"water broke" 2 hours ago. The nurse notes clear fluid and a fetal heart
rate of 140 bpm with moderate variability. What is the most appropriate
nursing action?
A. Prepare for immediate cesarean delivery
B. Perform a sterile vaginal exam to assess cervical dilation
C. Administer prophylactic antibiotics
D. Initiate oxytocin infusion
Correct Answer: B
Rationale: This client is in active labor with ruptured membranes. A
sterile vaginal exam is indicated to assess cervical dilation, effacement,
and station. There is no indication for immediate cesarean delivery,
prophylactic antibiotics, or oxytocin without further assessment.
6. A nurse is assessing a client at 12 weeks gestation. Which finding
would require immediate follow-up?
A. Mild nausea and vomiting in the morning
B. Breast tenderness and enlargement
C. Dark brown vaginal discharge with no pain
D. Frequent urination without dysuria
Correct Answer: C
Rationale: Dark brown discharge may indicate old blood, which could
be a sign of threatened miscarriage or subchorionic hematoma.
Nausea, breast tenderness, and urinary frequency are normal early
pregnancy symptoms.
7. A laboring client with an epidural has a blood pressure drop from
120/80 to 90/60. What action should the nurse take first?
A. Increase the IV fluid rate
, 4|Page
B. Place the woman in a lateral position
C. Administer ephedrine
D. Notify the anesthesia provider
Correct Answer: B
Rationale: The nurse should immediately turn the woman to a lateral
position to displace the uterus off the vena cava, which improves
venous return and blood pressure. Increasing IV fluids, administering
ephedrine, and notifying the provider are subsequent steps if
repositioning is ineffective.
8. A client at 38 weeks gestation with preeclampsia has a blood pressure
of 160/110 mm Hg and reports a severe headache and blurred vision.
The nurse should first:
A. Administer oral labetalol
B. Place the client in a supine position
C. Initiate magnesium sulfate infusion per protocol
D. Notify the provider after completing an admission form
Correct Answer: C
Rationale: Severe preeclampsia with neurologic symptoms (headache,
blurred vision) requires immediate initiation of magnesium sulfate to
prevent seizures. Supine positioning is contraindicated; notification of
the provider should occur concurrently but not delay magnesium
administration.
9. A client in active labor is admitted with preeclampsia. Which
assessment finding is most significant in planning this client's care?
A. Blood pressure 150/92 mm Hg
B. 1+ proteinuria
C. Deep tendon reflexes 3+
D. Headache and blurred vision
Correct Answer: D
Rationale: Headache and blurred vision are signs of severe
preeclampsia indicating cerebral edema and risk of seizure. These
