HESI RN EXIT EXAM COMPREHENSIVE PRACTICE TEST BANK (2026/2027)
THE ULTIMATE ALL-IN-ONE PASS PACK DEAL
Core Blueprint Categories: Maternal-Newborn, Pediatrics, Pharmacology, Management of
Care, and Next-Gen (NGN) Clinical Judgment
QUESTION 1: MATERNAL-NEWBORN (COMPLICATIONS OF LABOR)
A nurse in the labor and delivery unit is caring for a client at 39 weeks gestation who is
receiving an intravenous oxytocin infusion for labor induction. The nurse notes a pattern of
late decelerations on the fetal monitor strip. Which action should the nurse take first?
A) Increase the rate of the oxytocin infusion to accelerate delivery.
B) Position the client in a supine position with a wedge under the right hip.
C) Discontinue the oxytocin infusion immediately.
D) Administer oxygen at 2 L/min via a standard nasal cannula.
Correct Answer: C
HESI Category: Physiological Adaptation / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: Late decelerations indicate uteroplacental insufficiency and fetal
hypoxia. The absolute priority action is to immediately stop the oxytocin infusion to
halt uterine contractions and restore oxygenated blood flow to the placenta.
Why others are incorrect: Increasing oxytocin (Option A) will worsen uterine
hyperstimulation and fetal distress. The client should be turned to a lateral position,
not supine (Option B), to avoid vena cava compression. Oxygen should be given at 8–
10 L/min via a non-rebreather mask, not 2 L via nasal cannula (Option D).
Test-Taking Tip: For any non-reassuring fetal heart rate pattern (late or severe
variable decelerations) while oxytocin is running, the first move is ALWAYS to turn off
the pump.
QUESTION 2: MATERNAL-NEWBORN (POSTPARTUM COMPLICATIONS)
A nurse is assessing a client who is two hours postpartum following a vaginal delivery of a
4.1 kg (9 lbs) infant. Upon palpation, the nurse notes that the client's fundus is boggy,
displaced to the right, and located two fingers above the umbilicus. Which action should the
nurse implement first?
A) Administer a prescribed dose of intramuscular methylergonovine.
B) Assist the client to the bathroom or bedpan to void.
C) Initiate a rapid continuous massage of the uterine fundus.
D) Notify the primary healthcare provider of suspected postpartum hemorrhage.
, HESI RN EXIT EXAM COMPREHENSIVE PRACTICE TEST BANK (2026/2027)
THE ULTIMATE ALL-IN-ONE PASS PACK DEAL
Core Blueprint Categories: Maternal-Newborn, Pediatrics, Pharmacology, Management of
Care, and Next-Gen (NGN) Clinical Judgment
Correct Answer: B
HESI Category: Reduction of Risk Potential / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: A fundus that is boggy AND displaced to the right or left indicates a
distended bladder. A full bladder pushes the uterus out of place and prevents it from
contracting effectively, causing uterine atony. Emptying the bladder will allow the
uterus to return to the midline and firm up.
Why others are incorrect: Fundal massage (Option C) is done for a midline boggy
uterus, but displacement must be fixed by voiding first. Uterotonics like
methylergonovine (Option A) are used if the uterus remains boggy after the bladder
is emptied. Provider notification (Option D) is done after initial nursing interventions
fail.
Test-Taking Tip: If the question states the uterus is displaced to the side, the answer
is almost always related to bladder distension or urination.
QUESTION 3: MATERNAL-NEWBORN (ANTEPARTUM COMPLICATIONS)
A nurse is assessing a pregnant client at 34 weeks gestation who presents to the triage unit
reporting sudden-onset, severe abdominal pain and dark red vaginal bleeding. Upon
assessment, the nurse notes that the client's abdomen is rigid and board-like to palpation.
Which condition should the nurse suspect?
A) Placenta Previa
B) Abruptio Placentae
C) Uterine Rupture
D) Incompetent Cervix
Correct Answer: B
HESI Category: Physiological Adaptation / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: Abruptio placentae (premature separation of the placenta) is
characterized by sudden, painful vaginal bleeding and a classic rigid, board-like
abdomen due to concealed intra-uterine hemorrhage.
Why others are incorrect: Placenta previa (Option A) presents with painless, bright
red vaginal bleeding, and the abdomen remains soft. Uterine rupture (Option C)
causes sudden chest or scapular pain and a loss of fetal station, usually during active
, HESI RN EXIT EXAM COMPREHENSIVE PRACTICE TEST BANK (2026/2027)
THE ULTIMATE ALL-IN-ONE PASS PACK DEAL
Core Blueprint Categories: Maternal-Newborn, Pediatrics, Pharmacology, Management of
Care, and Next-Gen (NGN) Clinical Judgment
labor. An incompetent cervix (Option D) causes painless cervical dilation in the
second trimester.
Test-Taking Tip: Remember the classic contrast: Previa = Painless, bright red.
Abruption = Abdominal pain, dark red, rigid board.
QUESTION 4: MATERNAL-NEWBORN (GESTATIONAL HYPERTENSION)
A client at 36 weeks gestation is admitted to the high-risk OB unit with severe preeclampsia.
The nurse is monitoring the client during an intravenous infusion of magnesium sulfate.
Which assessment finding requires the nurse to hold the infusion and notify the healthcare
provider immediately?
A) Deep tendon reflexes rated as 1+ sluggish.
B) Urinary output of 20 mL over the last hour.
C) Respiratory rate of 14 breaths per minute.
D) Serum magnesium level of 5.5 mEq/L.
Correct Answer: B
HESI Category: Reduction of Risk Potential / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: Oliguria (urine output less than 30 mL/hour) indicates renal
impairment, which prevents the kidneys from excreting magnesium sulfate. This will
cause the drug to rapidly accumulate to toxic levels.
Why others are incorrect: A respiratory rate of 14 (Option C) is safe, though a drop
below 12 signals toxicity. A serum magnesium level of 5.5 mEq/L (Option D) is within
the therapeutic range (4–7 mEq/L). Sluggish 1+ DTRs (Option A) warrant close
monitoring, but absent (0) DTRs are the definitive toxic sign.
Test-Taking Tip: Magnesium toxicity causes general depression: low reflexes, low
respirations, and low urine output. Watch urine output closely since magnesium is
exclusively cleared by the kidneys.
, HESI RN EXIT EXAM COMPREHENSIVE PRACTICE TEST BANK (2026/2027)
THE ULTIMATE ALL-IN-ONE PASS PACK DEAL
Core Blueprint Categories: Maternal-Newborn, Pediatrics, Pharmacology, Management of
Care, and Next-Gen (NGN) Clinical Judgment
QUESTION 5: MATERNAL-NEWBORN (PHARMACOLOGY)
A nurse is preparing to administer intramuscular methylergonovine maleate to a postpartum
client experiencing uterine atony. Which vital sign must the nurse assess immediately before
administering this medication?
A) Temperature
B) Heart rate
C) Respiratory rate
D) Blood pressure
Correct Answer: D
HESI Category: Pharmacology and Parenteral Therapies / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: Methylergonovine is an ergot alkaloid that causes smooth muscle
contraction to treat postpartum hemorrhage. It causes vasoconstriction and can
trigger a severe hypertensive crisis. It is strictly contraindicated in clients with
preeclampsia or a baseline blood pressure ≥ 140/90 mmHg.
Why others are incorrect: Temperature, heart rate, and respiratory rate (Options A,
B, and C) are not absolute contraindication baselines for methylergonovine
administration.
Test-Taking Tip: Remember the clear drug boundaries for PPH: Methylergonovine =
Check Maximum Blood Pressure. Avoid if hypertensive.
QUESTION 6: MATERNAL-NEWBORN (NEWBORN CARE)
The nurse evaluates a newborn 1 minute after birth. The infant has a heart rate of 110 bpm,
exhibits a weak cry with hyperextended, flexed extremities, grimaces in response to
suctioning, and has a pink body with blue hands and feet. What APGAR score should the
nurse assign?
A) 6
B) 7
C) 8
D) 9
THE ULTIMATE ALL-IN-ONE PASS PACK DEAL
Core Blueprint Categories: Maternal-Newborn, Pediatrics, Pharmacology, Management of
Care, and Next-Gen (NGN) Clinical Judgment
QUESTION 1: MATERNAL-NEWBORN (COMPLICATIONS OF LABOR)
A nurse in the labor and delivery unit is caring for a client at 39 weeks gestation who is
receiving an intravenous oxytocin infusion for labor induction. The nurse notes a pattern of
late decelerations on the fetal monitor strip. Which action should the nurse take first?
A) Increase the rate of the oxytocin infusion to accelerate delivery.
B) Position the client in a supine position with a wedge under the right hip.
C) Discontinue the oxytocin infusion immediately.
D) Administer oxygen at 2 L/min via a standard nasal cannula.
Correct Answer: C
HESI Category: Physiological Adaptation / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: Late decelerations indicate uteroplacental insufficiency and fetal
hypoxia. The absolute priority action is to immediately stop the oxytocin infusion to
halt uterine contractions and restore oxygenated blood flow to the placenta.
Why others are incorrect: Increasing oxytocin (Option A) will worsen uterine
hyperstimulation and fetal distress. The client should be turned to a lateral position,
not supine (Option B), to avoid vena cava compression. Oxygen should be given at 8–
10 L/min via a non-rebreather mask, not 2 L via nasal cannula (Option D).
Test-Taking Tip: For any non-reassuring fetal heart rate pattern (late or severe
variable decelerations) while oxytocin is running, the first move is ALWAYS to turn off
the pump.
QUESTION 2: MATERNAL-NEWBORN (POSTPARTUM COMPLICATIONS)
A nurse is assessing a client who is two hours postpartum following a vaginal delivery of a
4.1 kg (9 lbs) infant. Upon palpation, the nurse notes that the client's fundus is boggy,
displaced to the right, and located two fingers above the umbilicus. Which action should the
nurse implement first?
A) Administer a prescribed dose of intramuscular methylergonovine.
B) Assist the client to the bathroom or bedpan to void.
C) Initiate a rapid continuous massage of the uterine fundus.
D) Notify the primary healthcare provider of suspected postpartum hemorrhage.
, HESI RN EXIT EXAM COMPREHENSIVE PRACTICE TEST BANK (2026/2027)
THE ULTIMATE ALL-IN-ONE PASS PACK DEAL
Core Blueprint Categories: Maternal-Newborn, Pediatrics, Pharmacology, Management of
Care, and Next-Gen (NGN) Clinical Judgment
Correct Answer: B
HESI Category: Reduction of Risk Potential / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: A fundus that is boggy AND displaced to the right or left indicates a
distended bladder. A full bladder pushes the uterus out of place and prevents it from
contracting effectively, causing uterine atony. Emptying the bladder will allow the
uterus to return to the midline and firm up.
Why others are incorrect: Fundal massage (Option C) is done for a midline boggy
uterus, but displacement must be fixed by voiding first. Uterotonics like
methylergonovine (Option A) are used if the uterus remains boggy after the bladder
is emptied. Provider notification (Option D) is done after initial nursing interventions
fail.
Test-Taking Tip: If the question states the uterus is displaced to the side, the answer
is almost always related to bladder distension or urination.
QUESTION 3: MATERNAL-NEWBORN (ANTEPARTUM COMPLICATIONS)
A nurse is assessing a pregnant client at 34 weeks gestation who presents to the triage unit
reporting sudden-onset, severe abdominal pain and dark red vaginal bleeding. Upon
assessment, the nurse notes that the client's abdomen is rigid and board-like to palpation.
Which condition should the nurse suspect?
A) Placenta Previa
B) Abruptio Placentae
C) Uterine Rupture
D) Incompetent Cervix
Correct Answer: B
HESI Category: Physiological Adaptation / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: Abruptio placentae (premature separation of the placenta) is
characterized by sudden, painful vaginal bleeding and a classic rigid, board-like
abdomen due to concealed intra-uterine hemorrhage.
Why others are incorrect: Placenta previa (Option A) presents with painless, bright
red vaginal bleeding, and the abdomen remains soft. Uterine rupture (Option C)
causes sudden chest or scapular pain and a loss of fetal station, usually during active
, HESI RN EXIT EXAM COMPREHENSIVE PRACTICE TEST BANK (2026/2027)
THE ULTIMATE ALL-IN-ONE PASS PACK DEAL
Core Blueprint Categories: Maternal-Newborn, Pediatrics, Pharmacology, Management of
Care, and Next-Gen (NGN) Clinical Judgment
labor. An incompetent cervix (Option D) causes painless cervical dilation in the
second trimester.
Test-Taking Tip: Remember the classic contrast: Previa = Painless, bright red.
Abruption = Abdominal pain, dark red, rigid board.
QUESTION 4: MATERNAL-NEWBORN (GESTATIONAL HYPERTENSION)
A client at 36 weeks gestation is admitted to the high-risk OB unit with severe preeclampsia.
The nurse is monitoring the client during an intravenous infusion of magnesium sulfate.
Which assessment finding requires the nurse to hold the infusion and notify the healthcare
provider immediately?
A) Deep tendon reflexes rated as 1+ sluggish.
B) Urinary output of 20 mL over the last hour.
C) Respiratory rate of 14 breaths per minute.
D) Serum magnesium level of 5.5 mEq/L.
Correct Answer: B
HESI Category: Reduction of Risk Potential / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: Oliguria (urine output less than 30 mL/hour) indicates renal
impairment, which prevents the kidneys from excreting magnesium sulfate. This will
cause the drug to rapidly accumulate to toxic levels.
Why others are incorrect: A respiratory rate of 14 (Option C) is safe, though a drop
below 12 signals toxicity. A serum magnesium level of 5.5 mEq/L (Option D) is within
the therapeutic range (4–7 mEq/L). Sluggish 1+ DTRs (Option A) warrant close
monitoring, but absent (0) DTRs are the definitive toxic sign.
Test-Taking Tip: Magnesium toxicity causes general depression: low reflexes, low
respirations, and low urine output. Watch urine output closely since magnesium is
exclusively cleared by the kidneys.
, HESI RN EXIT EXAM COMPREHENSIVE PRACTICE TEST BANK (2026/2027)
THE ULTIMATE ALL-IN-ONE PASS PACK DEAL
Core Blueprint Categories: Maternal-Newborn, Pediatrics, Pharmacology, Management of
Care, and Next-Gen (NGN) Clinical Judgment
QUESTION 5: MATERNAL-NEWBORN (PHARMACOLOGY)
A nurse is preparing to administer intramuscular methylergonovine maleate to a postpartum
client experiencing uterine atony. Which vital sign must the nurse assess immediately before
administering this medication?
A) Temperature
B) Heart rate
C) Respiratory rate
D) Blood pressure
Correct Answer: D
HESI Category: Pharmacology and Parenteral Therapies / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: Methylergonovine is an ergot alkaloid that causes smooth muscle
contraction to treat postpartum hemorrhage. It causes vasoconstriction and can
trigger a severe hypertensive crisis. It is strictly contraindicated in clients with
preeclampsia or a baseline blood pressure ≥ 140/90 mmHg.
Why others are incorrect: Temperature, heart rate, and respiratory rate (Options A,
B, and C) are not absolute contraindication baselines for methylergonovine
administration.
Test-Taking Tip: Remember the clear drug boundaries for PPH: Methylergonovine =
Check Maximum Blood Pressure. Avoid if hypertensive.
QUESTION 6: MATERNAL-NEWBORN (NEWBORN CARE)
The nurse evaluates a newborn 1 minute after birth. The infant has a heart rate of 110 bpm,
exhibits a weak cry with hyperextended, flexed extremities, grimaces in response to
suctioning, and has a pink body with blue hands and feet. What APGAR score should the
nurse assign?
A) 6
B) 7
C) 8
D) 9
