MATERNITY HESI CASE STUDY QUESTIONS | COMPLETE MATERNAL-NEWBORN
NURSING EXAM REVIEW QUESTIONS AND ANSWERS 2026/2027
The nurse performs the first assessment upon the client's arrival to the postpartum unit. Where would
the nurse expect to palpate the fundus?
a. 3 cm above the umbilicus.
b. 1 cm above the umbilicus.
c. To the right of the umbilicus.
d. Midway between the umbilicus and the pubic bone. - correct answer ✔✔b. 1 cm above the umbilicus.
For the first 12 hours, the fundus should be 1 to 2 cm above the umbilicus
Fifteen minutes after the initial assessment, the nurse finds the client disoriented and lying on her back
in a pool of vaginal blood, with the sheets beneath her saturated with blood.
Which action is most important for the nurse to implement immediately?
a. Take vital signs
b. Massage the fundus
c. Check the bladder
d. Increase the IV rate - correct answer ✔✔b. Massage the fundus.
Since a boggy fundus is the most likely reason for this client's hemorrhaging, massing the fundus is the
most important intervention. The nurse should also call for assistance due to the amount of blood that
has pooled under the client.
what is the most likely reason a postpartum patient would be hemorrhaging? - correct answer
✔✔uterine atony (a "boggy" fundus)
What should be assessed immediately after fundus is massaged and nurse has called for help? - correct
answer ✔✔Assess for bladder distention
--> The client is 2 hours post-delivery with an IV infusion at 125 mL/hour, which can contribute to
diuresis. A distended bladder impedes uterine contraction and contributes to excessive bleeding. After
the fundus is massaged, the bladder should be checked for distention.
When the nurse conducts a gestational age assessment, which findings may indicate postmaturity?
(Select all that apply. One, some, or all options may be correct.)
a. Testes descended, good rugae.
,b. Formed ears with instant recall.
c. Peeling, parchment-like skin.
d. Thin with loose skin and little subcutaneous fat.
e. Deep creases at the base of the toes extending to the heels. - correct answer ✔✔c. d. and e.
c. Peeling, parchment-like skin.
d. Thin with loose skin and little subcutaneous fat.
--> Subcutaneous fat, which had been used for nourishment, is lost prior to birth. This results in the
infant's low temperature.
e. Deep creases at the base of the toes extending to the heels.
--> Postterm infants develop deep creases on the feet, extending from the base
The infant has a reddish papular rash across his face. How should the nurse respond when the client asks
about the rash?
a. Don't worry about it. This rash will go away in a couple of days.
b. I see you are concerned, so I will call your pediatrician.
c. A newborn rash is very common, but it will disappear soon.
d. Good question. Let me take the infant's vital signs and examine him - correct answer ✔✔c. A newborn
rash is very common, but it will disappear soon.
--> The infant rash, erythema toxicum, is very common and usually disappears by the third day of life.
Which factor should alert the nurse to assess for the risk of jaundice? - correct answer ✔✔trauma at
birth
what is a normal bilirubin range for a newborn? - correct answer ✔✔5-6 mg/dL
Which instructions should the nurse include in the discharge planning regarding the infant's jaundice?
a. The phototherapy blanket is placed over the infant's clothing.
b. Holding the infant does not interrupt the phototherapy process.
c. A phototherapy blanket is more effective than the overhead lights.
, d. The length of time required for phototherapy intervention is decreased. - correct answer ✔✔b.
Holding the infant does not interrupt the phototherapy process.
--> Although diapers can be worn, the blanket is placed next to the skin on the trunk of the body to
expose as much skin as possible to the light.
--> The phototherapy blanket allows the infant to be held while the process is continued.
A client in her first trimester is concerned about how weight gain will affect her appearance and
questions the nurse concerning dietary restrictions. How much weight gain should the nurse point out
will be safe for this client with a low BMI? - correct answer ✔✔28 to 40 pounds
The recommendation for average weight gain is 25 to 35 lbs (11 to 16 kilograms).
The woman who is underweight with a low BMI should gain 28 to 40 pounds (13 to 18 kilograms).
Individuals with a high BMI should gain 15 to 25 pounds (7 to 11 kilograms).
The nurse is counseling a client with a BMI of 23 about weight gain during pregnancy. The nurse teaches
the client that during the second and third trimester of pregnancy, dietary intake should be increase by
how many calories per day above what she was eating prior to the pregnancy? - correct answer ✔✔300
extra calories per day
--> A BMI of 23 is considered a healthy weight. For clients at a healthy weight, 300 additional calories are
needed to support fetal growth in the second and third trimester of the pregnancy. If the client had been
underweight, more calories would have been recommended; if the client had been obese, less calories
would have been recommended.
The nurse is caring for a client who is having a high-risk pregnancy and requires genetic studies. Which
procedures will the nurse anticipate? Select all that apply.
a. Amniocentesis
b. Maternal serum alpha-fetoprotein screening
c. Chorionic villus sampling
d. Percutaneous umbilical blood sampling
e. Ultrasonography - correct answer ✔✔a. amniocentesis
c. Chorionic villus sampling
d. Percutaneous umbilical blood sampling
A pregnant client at 18 weeks' gestation has arrived for her routine prenatal visit. Which assessment
findings should the nurse prepare to document at this time? Select all that apply.
Fundal height of approximately 18 cm
Quickening
Insomnia
Braxton Hicks contractions
Leg cramps - correct answer ✔✔Fundal height of approximately 18 cm
Quickening
NURSING EXAM REVIEW QUESTIONS AND ANSWERS 2026/2027
The nurse performs the first assessment upon the client's arrival to the postpartum unit. Where would
the nurse expect to palpate the fundus?
a. 3 cm above the umbilicus.
b. 1 cm above the umbilicus.
c. To the right of the umbilicus.
d. Midway between the umbilicus and the pubic bone. - correct answer ✔✔b. 1 cm above the umbilicus.
For the first 12 hours, the fundus should be 1 to 2 cm above the umbilicus
Fifteen minutes after the initial assessment, the nurse finds the client disoriented and lying on her back
in a pool of vaginal blood, with the sheets beneath her saturated with blood.
Which action is most important for the nurse to implement immediately?
a. Take vital signs
b. Massage the fundus
c. Check the bladder
d. Increase the IV rate - correct answer ✔✔b. Massage the fundus.
Since a boggy fundus is the most likely reason for this client's hemorrhaging, massing the fundus is the
most important intervention. The nurse should also call for assistance due to the amount of blood that
has pooled under the client.
what is the most likely reason a postpartum patient would be hemorrhaging? - correct answer
✔✔uterine atony (a "boggy" fundus)
What should be assessed immediately after fundus is massaged and nurse has called for help? - correct
answer ✔✔Assess for bladder distention
--> The client is 2 hours post-delivery with an IV infusion at 125 mL/hour, which can contribute to
diuresis. A distended bladder impedes uterine contraction and contributes to excessive bleeding. After
the fundus is massaged, the bladder should be checked for distention.
When the nurse conducts a gestational age assessment, which findings may indicate postmaturity?
(Select all that apply. One, some, or all options may be correct.)
a. Testes descended, good rugae.
,b. Formed ears with instant recall.
c. Peeling, parchment-like skin.
d. Thin with loose skin and little subcutaneous fat.
e. Deep creases at the base of the toes extending to the heels. - correct answer ✔✔c. d. and e.
c. Peeling, parchment-like skin.
d. Thin with loose skin and little subcutaneous fat.
--> Subcutaneous fat, which had been used for nourishment, is lost prior to birth. This results in the
infant's low temperature.
e. Deep creases at the base of the toes extending to the heels.
--> Postterm infants develop deep creases on the feet, extending from the base
The infant has a reddish papular rash across his face. How should the nurse respond when the client asks
about the rash?
a. Don't worry about it. This rash will go away in a couple of days.
b. I see you are concerned, so I will call your pediatrician.
c. A newborn rash is very common, but it will disappear soon.
d. Good question. Let me take the infant's vital signs and examine him - correct answer ✔✔c. A newborn
rash is very common, but it will disappear soon.
--> The infant rash, erythema toxicum, is very common and usually disappears by the third day of life.
Which factor should alert the nurse to assess for the risk of jaundice? - correct answer ✔✔trauma at
birth
what is a normal bilirubin range for a newborn? - correct answer ✔✔5-6 mg/dL
Which instructions should the nurse include in the discharge planning regarding the infant's jaundice?
a. The phototherapy blanket is placed over the infant's clothing.
b. Holding the infant does not interrupt the phototherapy process.
c. A phototherapy blanket is more effective than the overhead lights.
, d. The length of time required for phototherapy intervention is decreased. - correct answer ✔✔b.
Holding the infant does not interrupt the phototherapy process.
--> Although diapers can be worn, the blanket is placed next to the skin on the trunk of the body to
expose as much skin as possible to the light.
--> The phototherapy blanket allows the infant to be held while the process is continued.
A client in her first trimester is concerned about how weight gain will affect her appearance and
questions the nurse concerning dietary restrictions. How much weight gain should the nurse point out
will be safe for this client with a low BMI? - correct answer ✔✔28 to 40 pounds
The recommendation for average weight gain is 25 to 35 lbs (11 to 16 kilograms).
The woman who is underweight with a low BMI should gain 28 to 40 pounds (13 to 18 kilograms).
Individuals with a high BMI should gain 15 to 25 pounds (7 to 11 kilograms).
The nurse is counseling a client with a BMI of 23 about weight gain during pregnancy. The nurse teaches
the client that during the second and third trimester of pregnancy, dietary intake should be increase by
how many calories per day above what she was eating prior to the pregnancy? - correct answer ✔✔300
extra calories per day
--> A BMI of 23 is considered a healthy weight. For clients at a healthy weight, 300 additional calories are
needed to support fetal growth in the second and third trimester of the pregnancy. If the client had been
underweight, more calories would have been recommended; if the client had been obese, less calories
would have been recommended.
The nurse is caring for a client who is having a high-risk pregnancy and requires genetic studies. Which
procedures will the nurse anticipate? Select all that apply.
a. Amniocentesis
b. Maternal serum alpha-fetoprotein screening
c. Chorionic villus sampling
d. Percutaneous umbilical blood sampling
e. Ultrasonography - correct answer ✔✔a. amniocentesis
c. Chorionic villus sampling
d. Percutaneous umbilical blood sampling
A pregnant client at 18 weeks' gestation has arrived for her routine prenatal visit. Which assessment
findings should the nurse prepare to document at this time? Select all that apply.
Fundal height of approximately 18 cm
Quickening
Insomnia
Braxton Hicks contractions
Leg cramps - correct answer ✔✔Fundal height of approximately 18 cm
Quickening
