,HESI RN Maternity Nursing Specialty Practice
Exam + 150 Maternal-Newborn Questions &
Rationales
1. A nurse is calculating the estimated date of delivery (EDD) using Naegele's rule for a client
whose last menstrual period began on January 15. What is the EDD?
A. October 22
B. October 15
C. October 8
D. November 1
Correct Answer: A. Naegele's rule: LMP + 7 days − 3 months. January 15 + 7 days = January 22.
January 22 − 3 months = October 22. The EDD is October 22.
Rationale: Naegele's rule assumes a 28-day menstrual cycle with ovulation on day 14. The nurse
should verify the EDD with ultrasound, which is most accurate in the first trimester.
2. A patient at 28 weeks of gestation has a hemoglobin of 10.8 g/dL. The nurse should:
A. Recognize this as physiologic anemia of pregnancy and monitor
B. Diagnose iron deficiency anemia and start iron supplements
C. Order a blood transfusion
D. Immediately refer to a hematologist
,Correct Answer: A. Physiologic anemia of pregnancy occurs due to an increase in plasma volume
that outpaces the increase in red blood cell mass, resulting in a relative decrease in hemoglobin.
Normal hemoglobin in pregnancy is 10.5–11.5 g/dL in the second trimester.
Rationale: This is normal hemodilution and does not require treatment unless hemoglobin
drops below 10.5 g/dL. The nurse should continue to monitor.
3. A patient at 24–28 weeks of gestation should be screened for gestational diabetes with:
A. 50-gram oral glucose challenge test (GCT)
B. Fasting glucose only
C. HbA1c
D. Urine glucose
Correct Answer: A. Gestational diabetes screening at 24–28 weeks: (1) 50-gram oral glucose
challenge test (1-hour glucose <140 mg/dL is normal). If elevated, a 100-gram OGTT is
performed.
Rationale: The 50-gram GCT is the standard screening tool. Two or more elevated values on the
100-gram OGTT diagnose gestational diabetes.
4. A client at 32 weeks of gestation reports sudden, painless, bright red vaginal bleeding. Which
condition should the nurse suspect?
, A. Placental abruption
B. Placenta previa
C. Preterm labor
D. Uterine rupture
Correct Answer: B. Painless bright red vaginal bleeding in the second or third trimester is
characteristic of placenta previa.
Rationale: Placental abruption typically presents with painful bleeding and a rigid, tender
uterus. Preterm labor presents with contractions. Uterine rupture is associated with severe
abdominal pain and fetal distress.
5. A nurse is assessing a client who is at 34 weeks of gestation and reports severe headache
unrelieved by acetaminophen. Which action should the nurse take first?
A. Administer the prescribed acetaminophen
B. Assess blood pressure and reflexes
C. Encourage the client to rest in a dark room
D. Notify the provider after completing the assessment
Correct Answer: B. A severe headache in the third trimester may indicate preeclampsia. The
nurse should assess blood pressure and deep tendon reflexes.
Rationale: Preeclampsia is characterized by hypertension, proteinuria, and organ dysfunction. A
severe headache is a warning sign of worsening preeclampsia.
Exam + 150 Maternal-Newborn Questions &
Rationales
1. A nurse is calculating the estimated date of delivery (EDD) using Naegele's rule for a client
whose last menstrual period began on January 15. What is the EDD?
A. October 22
B. October 15
C. October 8
D. November 1
Correct Answer: A. Naegele's rule: LMP + 7 days − 3 months. January 15 + 7 days = January 22.
January 22 − 3 months = October 22. The EDD is October 22.
Rationale: Naegele's rule assumes a 28-day menstrual cycle with ovulation on day 14. The nurse
should verify the EDD with ultrasound, which is most accurate in the first trimester.
2. A patient at 28 weeks of gestation has a hemoglobin of 10.8 g/dL. The nurse should:
A. Recognize this as physiologic anemia of pregnancy and monitor
B. Diagnose iron deficiency anemia and start iron supplements
C. Order a blood transfusion
D. Immediately refer to a hematologist
,Correct Answer: A. Physiologic anemia of pregnancy occurs due to an increase in plasma volume
that outpaces the increase in red blood cell mass, resulting in a relative decrease in hemoglobin.
Normal hemoglobin in pregnancy is 10.5–11.5 g/dL in the second trimester.
Rationale: This is normal hemodilution and does not require treatment unless hemoglobin
drops below 10.5 g/dL. The nurse should continue to monitor.
3. A patient at 24–28 weeks of gestation should be screened for gestational diabetes with:
A. 50-gram oral glucose challenge test (GCT)
B. Fasting glucose only
C. HbA1c
D. Urine glucose
Correct Answer: A. Gestational diabetes screening at 24–28 weeks: (1) 50-gram oral glucose
challenge test (1-hour glucose <140 mg/dL is normal). If elevated, a 100-gram OGTT is
performed.
Rationale: The 50-gram GCT is the standard screening tool. Two or more elevated values on the
100-gram OGTT diagnose gestational diabetes.
4. A client at 32 weeks of gestation reports sudden, painless, bright red vaginal bleeding. Which
condition should the nurse suspect?
, A. Placental abruption
B. Placenta previa
C. Preterm labor
D. Uterine rupture
Correct Answer: B. Painless bright red vaginal bleeding in the second or third trimester is
characteristic of placenta previa.
Rationale: Placental abruption typically presents with painful bleeding and a rigid, tender
uterus. Preterm labor presents with contractions. Uterine rupture is associated with severe
abdominal pain and fetal distress.
5. A nurse is assessing a client who is at 34 weeks of gestation and reports severe headache
unrelieved by acetaminophen. Which action should the nurse take first?
A. Administer the prescribed acetaminophen
B. Assess blood pressure and reflexes
C. Encourage the client to rest in a dark room
D. Notify the provider after completing the assessment
Correct Answer: B. A severe headache in the third trimester may indicate preeclampsia. The
nurse should assess blood pressure and deep tendon reflexes.
Rationale: Preeclampsia is characterized by hypertension, proteinuria, and organ dysfunction. A
severe headache is a warning sign of worsening preeclampsia.
