HESI MATERNITY OB ADVANCED
CLINICAL COMPETENCY EXAM
2026/2027 QUESTIONS AND CORRECT
ANSWERS
1. A client at 32 weeks gestation is receiving Magnesium Sulfate for pre-eclampsia. Which
assessment finding should the nurse report to the healthcare provider immediately?
A. Deep tendon reflexes of 2+
B. Fetal heart rate of 140 beats/minute
C. Respiratory rate of 14 breaths/minute
D. Urinary output of 20 mL/hour
Answer: D
Conceptual Explanation: Magnesium sulfate is excreted by the kidneys. A urinary output
of less than 30 mL/hour indicates renal insufficiency, which increases the risk of
magnesium toxicity.
2. A nurse is caring for a client in the first stage of labor. The fetal heart rate monitor shows
late decelerations. Which action should the nurse take first?
A. Increase the rate of the oxytocin infusion
B. Administer oxygen via non-rebreather mask at 8-10 L/min
,C. Assist the client into a supine position
D. Prepare for immediate forceps delivery
Answer: B
Conceptual Explanation: Late decelerations indicate uteroplacental insufficiency.
Immediate interventions include repositioning the client to the side, increasing IV fluids,
and administering oxygen to improve fetal oxygenation.
3. Which clinical finding is most characteristic of a placental abruption?
A. Painless, bright red vaginal bleeding
B. Soft, non-tender abdomen
C. Rigid, board-like abdomen with severe pain
D. Fetal station at +2
Answer: C
Conceptual Explanation: Placental abruption involves the premature separation of the
placenta, leading to hemorrhage and a rigid, painful uterus. Painless bleeding is
characteristic of placenta previa.
4. A postpartum client is experiencing heavy vaginal bleeding and a boggy uterus 30 minutes
after delivery. What is the nurse’s priority action?
A. Perform fundal massage until firm
B. Administer 0.2 mg Methylergonovine IM
, C. Notify the healthcare provider
D. Catheterize the client to empty the bladder
Answer: A
Conceptual Explanation: The first intervention for uterine atony (boggy uterus) is fundal
massage to stimulate uterine contractions and stop bleeding.
5. A newborn’s 1-minute Apgar score is 6. The heart rate is 110 bpm, there is a weak cry,
some flexion of extremities, grimace when stimulated, and the body is pink with blue
extremities. Which score component was 1 point?
A. Muscle tone
B. Heart rate
C. Color
D. Reflex irritability
Answer: A
Conceptual Explanation: Heart rate >100 is 2 points. Weak cry is 1 point. Some flexion is
1 point. Grimace is 1 point. Acrocyanosis (pink body, blue limbs) is 1 point. Total score 6.
6. A client at 28 weeks gestation is Rh-negative. Which condition must be met for the client to
receive Rho(D) immune globulin?
A. The client must have a negative indirect Coombs test
B. The client must have a positive indirect Coombs test
CLINICAL COMPETENCY EXAM
2026/2027 QUESTIONS AND CORRECT
ANSWERS
1. A client at 32 weeks gestation is receiving Magnesium Sulfate for pre-eclampsia. Which
assessment finding should the nurse report to the healthcare provider immediately?
A. Deep tendon reflexes of 2+
B. Fetal heart rate of 140 beats/minute
C. Respiratory rate of 14 breaths/minute
D. Urinary output of 20 mL/hour
Answer: D
Conceptual Explanation: Magnesium sulfate is excreted by the kidneys. A urinary output
of less than 30 mL/hour indicates renal insufficiency, which increases the risk of
magnesium toxicity.
2. A nurse is caring for a client in the first stage of labor. The fetal heart rate monitor shows
late decelerations. Which action should the nurse take first?
A. Increase the rate of the oxytocin infusion
B. Administer oxygen via non-rebreather mask at 8-10 L/min
,C. Assist the client into a supine position
D. Prepare for immediate forceps delivery
Answer: B
Conceptual Explanation: Late decelerations indicate uteroplacental insufficiency.
Immediate interventions include repositioning the client to the side, increasing IV fluids,
and administering oxygen to improve fetal oxygenation.
3. Which clinical finding is most characteristic of a placental abruption?
A. Painless, bright red vaginal bleeding
B. Soft, non-tender abdomen
C. Rigid, board-like abdomen with severe pain
D. Fetal station at +2
Answer: C
Conceptual Explanation: Placental abruption involves the premature separation of the
placenta, leading to hemorrhage and a rigid, painful uterus. Painless bleeding is
characteristic of placenta previa.
4. A postpartum client is experiencing heavy vaginal bleeding and a boggy uterus 30 minutes
after delivery. What is the nurse’s priority action?
A. Perform fundal massage until firm
B. Administer 0.2 mg Methylergonovine IM
, C. Notify the healthcare provider
D. Catheterize the client to empty the bladder
Answer: A
Conceptual Explanation: The first intervention for uterine atony (boggy uterus) is fundal
massage to stimulate uterine contractions and stop bleeding.
5. A newborn’s 1-minute Apgar score is 6. The heart rate is 110 bpm, there is a weak cry,
some flexion of extremities, grimace when stimulated, and the body is pink with blue
extremities. Which score component was 1 point?
A. Muscle tone
B. Heart rate
C. Color
D. Reflex irritability
Answer: A
Conceptual Explanation: Heart rate >100 is 2 points. Weak cry is 1 point. Some flexion is
1 point. Grimace is 1 point. Acrocyanosis (pink body, blue limbs) is 1 point. Total score 6.
6. A client at 28 weeks gestation is Rh-negative. Which condition must be met for the client to
receive Rho(D) immune globulin?
A. The client must have a negative indirect Coombs test
B. The client must have a positive indirect Coombs test
