HESI RN MATERNITY EXAM 2026/2027
NGN PRACTICE EXAM
Comprehensive 100+ Questions with
ANSWERs and Rationales
SECTION 1: ANTEPARTUM NURSING CARE & FETAL DEVELOPMENT
Question 1
A 32-year-old primigravida at 10 weeks gestation reports to the clinic with nausea and vomiting. She
states she has been unable to keep any food down for the past 24 hours and has vomited 5 times.
Assessment reveals dry mucous membranes, tachycardia (HR 110 bpm), and a 2-pound weight loss since
her last visit one week ago. Which assessment finding is the priority for the nurse to address?
A. Nausea and vomiting frequency
B. Maternal weight loss
C. Signs of dehydration
D. Fetal heart rate assessment
Correct ANSWER: C
Rationale: The client is exhibiting signs of dehydration (dry mucous membranes, tachycardia, weight
loss), which is the priority assessment finding. Dehydration in hyperemesis gravidarum can lead to
electrolyte imbalances, ketosis, and metabolic alkalosis, posing risks to both maternal and fetal well-
,being. While nausea frequency and weight loss are concerning, the physiological signs of dehydration
indicate a more immediate threat.
Question 2
A nurse is providing prenatal education to a group of pregnant clients. Which statement by a client
indicates a correct understanding of physiologic anemia of pregnancy?
A. "My hemoglobin dropped because I am not eating enough iron-rich foods."
B. "My blood volume increases more than my red blood cell mass, diluting my hemoglobin."
C. "I need a blood transfusion because my hemoglobin is 10.5 g/dL at 28 weeks."
D. "Physiologic anemia means I have a vitamin B12 deficiency."
Correct ANSWER: B
Rationale: Physiologic anemia of pregnancy occurs because plasma volume increases by approximately
40-50% while red blood cell mass increases by only 20-30%, resulting in hemodilution. This is a normal
adaptation, not a true anemia requiring intervention unless hemoglobin falls below 10 g/dL or
hematocrit below 30% in the second trimester.
Question 3
A pregnant client at 24 weeks gestation with pregestational type 1 diabetes is being monitored. Her
fasting blood glucose has been consistently 105-115 mg/dL. The nurse recognizes that maintaining
euglycemia is critical to prevent which congenital anomaly?
A. Neural tube defects
B. Cardiac septal defects
C. Sacral agenesis
D. Cleft lip and palate
Correct ANSWER: C
,Rationale: Sacral agenesis (caudal regression syndrome) is the congenital anomaly most specifically
associated with poor glycemic control in pregestational diabetes, particularly during organogenesis in
the first trimester. While neural tube defects, cardiac defects, and cleft lip/palate can also occur with
maternal diabetes, sacral agenesis is considered the most pathognomonic anomaly.
Question 4
A 28-year-old primigravida at 10 weeks gestation presents to the prenatal clinic. Which finding would
the nurse identify as a normal change of pregnancy?
A. Decreased cardiac output beginning in the first trimester
B. Increased glomerular filtration rate (GFR) and renal plasma flow
C. Decreased plasma volume throughout gestation
D. Increased hematocrit due to increased red blood cell production exceeding plasma expansion
Correct ANSWER: B
Rationale: During pregnancy, GFR increases by approximately 50% and renal plasma flow increases by
up to 80% due to increased renal perfusion and vasodilation. This is a normal physiological adaptation.
Cardiac output increases by 30-50% beginning in the first trimester, plasma volume increases by 40-50%,
and although red blood cell production increases, plasma volume expands at a greater rate, causing
physiologic anemia.
Question 5
A nurse is educating a pregnant client about foods to avoid during pregnancy to reduce the risk of
listeriosis. Which foods should the nurse include? (Select all that apply)
A. Unpasteurized soft cheeses (e.g., brie, feta, queso fresco)
B. Deli meats and hot dogs unless heated until steaming
C. Refrigerated smoked seafood
D. Pasteurized milk and yogurt
E. Thoroughly cooked chicken breast
, Correct ANSWERs: A, B, C
Rationale: Listeria monocytogenes can cross the placenta and cause miscarriage, stillbirth, or neonatal
infection. Unpasteurized soft cheeses, deli meats and hot dogs not heated to steaming, and refrigerated
smoked seafood are all high-risk foods for listeriosis and should be avoided. Pasteurized milk and yogurt
and thoroughly cooked chicken breast are safe because proper cooking temperatures kill Listeria.
Question 6
A pregnant client at 16 weeks gestation asks the nurse about the purpose of the quad marker screening
test. The nurse explains that this screening assesses for which conditions?
A. Neural tube defects, trisomy 18, and trisomy 21
B. Cystic fibrosis and sickle cell disease
C. Phenylketonuria and Tay-Sachs disease
D. Hemophilia A and Duchenne muscular dystrophy
Correct ANSWER: A
Rationale: The quad marker screen (also called quad screen or multiple marker screening) measures four
substances in maternal blood to assess the risk of neural tube defects, trisomy 18 (Edwards syndrome),
and trisomy 21 (Down syndrome).
Question 7
A client at 12 weeks gestation tells the nurse she has been experiencing nausea and vomiting every
morning. Which recommendation should the nurse provide?
A. Eat a large meal before going to bed
B. Drink fluids with meals to stay hydrated
C. Eat dry crackers before getting out of bed in the morning
D. Avoid eating anything until the nausea subsides
NGN PRACTICE EXAM
Comprehensive 100+ Questions with
ANSWERs and Rationales
SECTION 1: ANTEPARTUM NURSING CARE & FETAL DEVELOPMENT
Question 1
A 32-year-old primigravida at 10 weeks gestation reports to the clinic with nausea and vomiting. She
states she has been unable to keep any food down for the past 24 hours and has vomited 5 times.
Assessment reveals dry mucous membranes, tachycardia (HR 110 bpm), and a 2-pound weight loss since
her last visit one week ago. Which assessment finding is the priority for the nurse to address?
A. Nausea and vomiting frequency
B. Maternal weight loss
C. Signs of dehydration
D. Fetal heart rate assessment
Correct ANSWER: C
Rationale: The client is exhibiting signs of dehydration (dry mucous membranes, tachycardia, weight
loss), which is the priority assessment finding. Dehydration in hyperemesis gravidarum can lead to
electrolyte imbalances, ketosis, and metabolic alkalosis, posing risks to both maternal and fetal well-
,being. While nausea frequency and weight loss are concerning, the physiological signs of dehydration
indicate a more immediate threat.
Question 2
A nurse is providing prenatal education to a group of pregnant clients. Which statement by a client
indicates a correct understanding of physiologic anemia of pregnancy?
A. "My hemoglobin dropped because I am not eating enough iron-rich foods."
B. "My blood volume increases more than my red blood cell mass, diluting my hemoglobin."
C. "I need a blood transfusion because my hemoglobin is 10.5 g/dL at 28 weeks."
D. "Physiologic anemia means I have a vitamin B12 deficiency."
Correct ANSWER: B
Rationale: Physiologic anemia of pregnancy occurs because plasma volume increases by approximately
40-50% while red blood cell mass increases by only 20-30%, resulting in hemodilution. This is a normal
adaptation, not a true anemia requiring intervention unless hemoglobin falls below 10 g/dL or
hematocrit below 30% in the second trimester.
Question 3
A pregnant client at 24 weeks gestation with pregestational type 1 diabetes is being monitored. Her
fasting blood glucose has been consistently 105-115 mg/dL. The nurse recognizes that maintaining
euglycemia is critical to prevent which congenital anomaly?
A. Neural tube defects
B. Cardiac septal defects
C. Sacral agenesis
D. Cleft lip and palate
Correct ANSWER: C
,Rationale: Sacral agenesis (caudal regression syndrome) is the congenital anomaly most specifically
associated with poor glycemic control in pregestational diabetes, particularly during organogenesis in
the first trimester. While neural tube defects, cardiac defects, and cleft lip/palate can also occur with
maternal diabetes, sacral agenesis is considered the most pathognomonic anomaly.
Question 4
A 28-year-old primigravida at 10 weeks gestation presents to the prenatal clinic. Which finding would
the nurse identify as a normal change of pregnancy?
A. Decreased cardiac output beginning in the first trimester
B. Increased glomerular filtration rate (GFR) and renal plasma flow
C. Decreased plasma volume throughout gestation
D. Increased hematocrit due to increased red blood cell production exceeding plasma expansion
Correct ANSWER: B
Rationale: During pregnancy, GFR increases by approximately 50% and renal plasma flow increases by
up to 80% due to increased renal perfusion and vasodilation. This is a normal physiological adaptation.
Cardiac output increases by 30-50% beginning in the first trimester, plasma volume increases by 40-50%,
and although red blood cell production increases, plasma volume expands at a greater rate, causing
physiologic anemia.
Question 5
A nurse is educating a pregnant client about foods to avoid during pregnancy to reduce the risk of
listeriosis. Which foods should the nurse include? (Select all that apply)
A. Unpasteurized soft cheeses (e.g., brie, feta, queso fresco)
B. Deli meats and hot dogs unless heated until steaming
C. Refrigerated smoked seafood
D. Pasteurized milk and yogurt
E. Thoroughly cooked chicken breast
, Correct ANSWERs: A, B, C
Rationale: Listeria monocytogenes can cross the placenta and cause miscarriage, stillbirth, or neonatal
infection. Unpasteurized soft cheeses, deli meats and hot dogs not heated to steaming, and refrigerated
smoked seafood are all high-risk foods for listeriosis and should be avoided. Pasteurized milk and yogurt
and thoroughly cooked chicken breast are safe because proper cooking temperatures kill Listeria.
Question 6
A pregnant client at 16 weeks gestation asks the nurse about the purpose of the quad marker screening
test. The nurse explains that this screening assesses for which conditions?
A. Neural tube defects, trisomy 18, and trisomy 21
B. Cystic fibrosis and sickle cell disease
C. Phenylketonuria and Tay-Sachs disease
D. Hemophilia A and Duchenne muscular dystrophy
Correct ANSWER: A
Rationale: The quad marker screen (also called quad screen or multiple marker screening) measures four
substances in maternal blood to assess the risk of neural tube defects, trisomy 18 (Edwards syndrome),
and trisomy 21 (Down syndrome).
Question 7
A client at 12 weeks gestation tells the nurse she has been experiencing nausea and vomiting every
morning. Which recommendation should the nurse provide?
A. Eat a large meal before going to bed
B. Drink fluids with meals to stay hydrated
C. Eat dry crackers before getting out of bed in the morning
D. Avoid eating anything until the nausea subsides
