Maternity OB HESI 2026 Cram Guide:
Versions 1-3 –Practice Questions,
Correct Answers, and Clinical
Rationales
Q1. 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.
, Q2. 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.
Q3. 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.
, Q4. 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. Respiratory rate of 20 breaths/min
B. Urine output of 20 mL/hr
C. Decreased respiratory rate from 24 to 16
D. Absent deep tendon reflexes
Correct Answer: C
Rationale: Magnesium sulfate, a CNS depressant, helps prevent seizures. A
decreased respiratory rate indicates that the drug is effective. (Respiratory
rate below 12 indicates toxic effects.)
Q5. A client at 28 weeks gestation has a blood pressure of 150/100 mmHg,
2+ proteinuria, and reports persistent headache. What is the most likely
diagnosis?
A. Gestational hypertension
B. Chronic hypertension
C. Preeclampsia with severe features
D. HELLP syndrome
Correct Answer: C
Rationale: Preeclampsia with severe features is diagnosed when blood
pressure is ≥160/110 or lower BP is accompanied by severe features such
as persistent headache, visual changes, epigastric pain, or laboratory
abnormalities. Gestational hypertension lacks proteinuria.
, Q6. Which nursing intervention is most helpful in relieving postpartum
uterine contractions or "afterpains"?
A. Lying prone with a pillow on the abdomen
B. Ambulating frequently
C. Applying a cold pack to the abdomen
D. Administering oral analgesics
Correct Answer: A
Rationale: Lying prone keeps the fundus contracted and is especially useful
with multiparas, who commonly experience afterpains due to lack of uterine
tone.
Q7. Which maternal behavior is the nurse most likely to see when a new
mother receives her infant for the first time?
A. She immediately begins breastfeeding
B. She asks the nurse to take the baby back
C. Her arms and hands receive the infant and she then traces the infant's
profile with her fingertips
D. She examines the infant's genitalia first
Correct Answer: C
Rationale: Attachment/bonding theory indicates that most mothers will
demonstrate behaviors described in option C during the first visit with the
newborn.
Q8. An expectant father tells the nurse he fears that his wife is "losing her
mind." He states that she is constantly rubbing her abdomen and talking to
Versions 1-3 –Practice Questions,
Correct Answers, and Clinical
Rationales
Q1. 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.
, Q2. 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.
Q3. 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.
, Q4. 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. Respiratory rate of 20 breaths/min
B. Urine output of 20 mL/hr
C. Decreased respiratory rate from 24 to 16
D. Absent deep tendon reflexes
Correct Answer: C
Rationale: Magnesium sulfate, a CNS depressant, helps prevent seizures. A
decreased respiratory rate indicates that the drug is effective. (Respiratory
rate below 12 indicates toxic effects.)
Q5. A client at 28 weeks gestation has a blood pressure of 150/100 mmHg,
2+ proteinuria, and reports persistent headache. What is the most likely
diagnosis?
A. Gestational hypertension
B. Chronic hypertension
C. Preeclampsia with severe features
D. HELLP syndrome
Correct Answer: C
Rationale: Preeclampsia with severe features is diagnosed when blood
pressure is ≥160/110 or lower BP is accompanied by severe features such
as persistent headache, visual changes, epigastric pain, or laboratory
abnormalities. Gestational hypertension lacks proteinuria.
, Q6. Which nursing intervention is most helpful in relieving postpartum
uterine contractions or "afterpains"?
A. Lying prone with a pillow on the abdomen
B. Ambulating frequently
C. Applying a cold pack to the abdomen
D. Administering oral analgesics
Correct Answer: A
Rationale: Lying prone keeps the fundus contracted and is especially useful
with multiparas, who commonly experience afterpains due to lack of uterine
tone.
Q7. Which maternal behavior is the nurse most likely to see when a new
mother receives her infant for the first time?
A. She immediately begins breastfeeding
B. She asks the nurse to take the baby back
C. Her arms and hands receive the infant and she then traces the infant's
profile with her fingertips
D. She examines the infant's genitalia first
Correct Answer: C
Rationale: Attachment/bonding theory indicates that most mothers will
demonstrate behaviors described in option C during the first visit with the
newborn.
Q8. An expectant father tells the nurse he fears that his wife is "losing her
mind." He states that she is constantly rubbing her abdomen and talking to
