HESI MATERNITY OB ADVANCED
FINAL EXAM STUDY GUIDE
QUESTIONS AND CORRECT ANSWERS
1. A nurse is monitoring a client receiving Magnesium Sulfate for preeclampsia. Which finding
should the nurse report to the provider immediately?
A. Blood pressure of 145/95 mmHg
B. Deep tendon reflexes of +2
C. Urine output of 20 mL/hr over the last 2 hours
D. Respiratory rate of 14 breaths/min
Answer: C
Conceptual Explanation: Magnesium sulfate is excreted by the kidneys. A urine output of
less than 30 mL/hr can lead to magnesium toxicity. Other signs of toxicity include loss of
DTRs and respiratory depression.
2. A client at 32 weeks gestation presents with painless, bright red vaginal bleeding. Which of
the following procedures is contraindicated?
A. Vaginal examination
B. External fetal monitoring
C. Abdominal ultrasound
,D. Obtaining a complete blood count
Answer: A
Conceptual Explanation: Painless bright red bleeding is indicative of placenta previa. A
vaginal exam can stimulate the placenta and cause catastrophic hemorrhage; it is strictly
contraindicated until the placental location is confirmed.
3. During a non-stress test (NST), the FHR accelerates 15 bpm above baseline for 15 seconds,
twice in a 20-minute period. How should the nurse document this?
A. Reactive NST
B. Non-reactive NST
C. Positive NST
D. Negative NST
Answer: A
Conceptual Explanation: A reactive non-stress test is a normal finding, defined as at least
two accelerations of 15 bpm lasting at least 15 seconds within a 20-minute window.
4. A nurse is caring for a client in the fourth stage of labor. The fundus is boggy and displaced
to the right of the midline. What is the priority nursing action?
A. Perform fundal massage
B. Assist the client to void
C. Administer oxytocin
, D. Notify the provider
Answer: B
Conceptual Explanation: A displaced fundus to the right is a classic sign of bladder
distention. A full bladder prevents the uterus from contracting, increasing the risk of
hemorrhage. Emptying the bladder is the priority.
5. Which laboratory value is expected in a client diagnosed with HELLP syndrome?
A. Increased Hemoglobin
B. Elevated ALT and AST levels
C. Elevated Platelets
D. Decreased Bilirubin
Answer: B
Conceptual Explanation: HELLP stands for Hemolysis, Elevated Liver enzymes, and Low
Platelets. Elevated liver enzymes (ALT/AST) indicate liver involvement.
6. A client is 4 hours postpartum and is experiencing heavy vaginal bleeding with firm fundus.
The nurse should suspect which of the following?
A. Uterine atony
B. Retained placental fragments
C. Inversion of the uterus
D. Vaginal or cervical laceration
FINAL EXAM STUDY GUIDE
QUESTIONS AND CORRECT ANSWERS
1. A nurse is monitoring a client receiving Magnesium Sulfate for preeclampsia. Which finding
should the nurse report to the provider immediately?
A. Blood pressure of 145/95 mmHg
B. Deep tendon reflexes of +2
C. Urine output of 20 mL/hr over the last 2 hours
D. Respiratory rate of 14 breaths/min
Answer: C
Conceptual Explanation: Magnesium sulfate is excreted by the kidneys. A urine output of
less than 30 mL/hr can lead to magnesium toxicity. Other signs of toxicity include loss of
DTRs and respiratory depression.
2. A client at 32 weeks gestation presents with painless, bright red vaginal bleeding. Which of
the following procedures is contraindicated?
A. Vaginal examination
B. External fetal monitoring
C. Abdominal ultrasound
,D. Obtaining a complete blood count
Answer: A
Conceptual Explanation: Painless bright red bleeding is indicative of placenta previa. A
vaginal exam can stimulate the placenta and cause catastrophic hemorrhage; it is strictly
contraindicated until the placental location is confirmed.
3. During a non-stress test (NST), the FHR accelerates 15 bpm above baseline for 15 seconds,
twice in a 20-minute period. How should the nurse document this?
A. Reactive NST
B. Non-reactive NST
C. Positive NST
D. Negative NST
Answer: A
Conceptual Explanation: A reactive non-stress test is a normal finding, defined as at least
two accelerations of 15 bpm lasting at least 15 seconds within a 20-minute window.
4. A nurse is caring for a client in the fourth stage of labor. The fundus is boggy and displaced
to the right of the midline. What is the priority nursing action?
A. Perform fundal massage
B. Assist the client to void
C. Administer oxytocin
, D. Notify the provider
Answer: B
Conceptual Explanation: A displaced fundus to the right is a classic sign of bladder
distention. A full bladder prevents the uterus from contracting, increasing the risk of
hemorrhage. Emptying the bladder is the priority.
5. Which laboratory value is expected in a client diagnosed with HELLP syndrome?
A. Increased Hemoglobin
B. Elevated ALT and AST levels
C. Elevated Platelets
D. Decreased Bilirubin
Answer: B
Conceptual Explanation: HELLP stands for Hemolysis, Elevated Liver enzymes, and Low
Platelets. Elevated liver enzymes (ALT/AST) indicate liver involvement.
6. A client is 4 hours postpartum and is experiencing heavy vaginal bleeding with firm fundus.
The nurse should suspect which of the following?
A. Uterine atony
B. Retained placental fragments
C. Inversion of the uterus
D. Vaginal or cervical laceration
