1
HESI Maternity (OB) & Pediatrics ACTUAL EXAM
TEST BANK 2026/2027 | 300 Verified Questions and
Answers | Complete with Solutions | Latest Update |
Pass Guaranteed - A+ Graded
PART 1: MATERNITY & NEWBORN (150 of the 300 items)
Section 1: Antepartum (Questions 1 – 40)
1. A 32-yr-old G2P1 at 16 weeks presents with BP 158/98 mmHg, 2+ proteinuria, platelets
95 000 µL⁻¹. Which action is priority?
A. Start labetalol 200 mg PO BID
B. Admit for magnesium sulfate seizure prophylaxis
C. Schedule office follow-up in 1 week
D. Begin low-dose aspirin 81 mg daily
Correct Answer: B
Rationale: Thrombocytopenia + severe-range BP = severe preeclampsia at any
gestational age (ACOG 2026). Immediate hospitalization for IV MgSO₄ seizure
prophylaxis is indicated; delivery will probably be required within days.
2. (SATA) Which factors place a pregnant client at highest risk for congenital CMV
transmission? (Select 3)
A. First-trimester primary CMV infection
B. Maternal HIV co-infection
C. Day-care worker exposure
D. History of prior CMV infection
E. Breast-feeding a previous child
Correct Answer: A, B, C
Rationale: Primary infection in the 1st trimester carries a 30–40 % fetal transmission
rate; immunocompromise ↑ viral shedding; toddler saliva/urine exposure is the main
occupational risk.
3. A G1P0 at 12 weeks reports darkening facial pigmentation. Which instruction is best?
A. “Apply topical tretinoin nightly.”
B. “Avoid sun exposure; use SPF 50.”
C. “Take 10 000 IU vitamin A daily.”
,2
D. “This will resolve within 1 week postpartum.”
Correct Answer: B
Rationale: Chloasma/melasma is estrogen-driven; tretinoin is category C and teratogenic;
hyperpigmentation fades months (not 1 week) after birth.
4. (Calculation) A client at 30 weeks weighs 70 kg; her pre-pregnancy BMI was 23. Per
2026 IOM guidelines, her recommended total weight-gain range is:
A. 6.8–11.3 kg
B. 11.5–16 kg
C. 12.7–18.1 kg
D. 5–9 kg
Correct Answer: B
Rationale: Normal BMI (18.5–24.9) target 25–35 lb (11.5–16 kg).
5. Which laboratory value change is physiologic in a healthy pregnancy?
A. ↓ Serum creatinine 20 %
B. ↑ Hematocrit 15 %
C. ↓ Free T₄ by 25 %
D. ↑ BUN by 30 %
Correct Answer: A
Rationale: 50 % ↑ GFR → ↓ creatinine; hemodilution ↓ Hct 3–4 %; free T₄ remains
stable; BUN ↓ 25 %.
6. A G3P2 at 10 weeks has β-hCG 120 000 mIU mL⁻¹, no fetal pole, “snow-storm” pattern
on US. Priority nursing diagnosis is:
A. Acute pain
B. Risk for deficient fluid volume
C. Risk for infection
D. Deficient knowledge
Correct Answer: B
Rationale: Molar pregnancy → excessive bleeding post-evacuation; anticipate large fluid
loss.
7. (ORD) Sequence nursing actions for a newly diagnosed GDM client at 26 weeks:
1. Arrange nutritional counseling
2. Teach daily fetal movement counts
3. Schedule 32-week growth US
4. Initiate bedtime NPH insulin
Correct Order: 1-2-3-4
,3
Rationale: Diet/exercise first; surveillance; pharmacologic therapy only if fasting
>95 mg dL⁻¹.
8. Which medication requires a negative pregnancy test before dispensing to a reproductive-
age client?
A. Acetaminophen
B. Isotretinoin
C. Metformin
D. Ondansetron
Correct Answer: B
Rationale: iPLEDGE REMS; major teratogen.
9. A client on enoxaparin for antiphospholipid syndrome asks about regional analgesia.
Which advice is accurate?
A. “Stop the shot 2 h before epidural.”
B. “Hold 24 h before planned induction.”
C. “Switch to unfractionated heparin at 36 weeks.”
D. “No change needed; epidural is safe.”
Correct Answer: C
Rationale: LMWH half-life 12 h; must discontinue ≥24 h before neuraxial block; UFH
has shorter half-life and is reversible.
10. (SATA) Which findings indicate hyperemesis gravidarum rather than typical morning
sickness? (Select 3)
A. Ketones 4+ in urine
B. 5 % weight loss
C. Hypochloremic metabolic alkalosis
D. Nausea relieved by crackers
E. Salivary amylase ↑
Correct Answer: A, B, C
Rationale: Severe dehydration, electrolyte derangement and >5 % weight loss define HG.
11. A 19-yr-old at 12 weeks is rubella non-immune. The nurse teaches:
A. “Receive MMR today.”
B. “Get MMR in the postpartum unit before discharge.”
C. “Avoid crowded places until birth.”
D. “Rubella vaccine is safe after 20 weeks.”
Correct Answer: B
Rationale: Live vaccine is contraindicated in pregnancy; administer immediately
postpartum.
12. Which teratogen is linked to fetal cardiac defects (VSD, TOF) in the 1st trimester?
A. Lithium
, 4
B. Methimazole
C. Valproic acid
D. Warfarin
Correct Answer: A
Rationale: Lithium ↑ Ebstein anomaly & other defects; valproate → NTD; warfarin →
nasal hypoplasia.
13. A G1P0 BMI 42 is counselled about 2026 ACOG recommendations. Which statement is
correct?
A. “Gain 15–25 lb to improve outcomes.”
B. “Lose 10 lb during pregnancy.”
C. “Limit gain to 5–9 kg.”
D. “No restriction needed; eat for two.”
Correct Answer: C
Rationale: Class III obesity target 5–9 kg (11–20 lb).
14. (Calculation) A client’s quad screen shows AFP 2.8 MoM. Her baseline risk for ONTD is
1:1000. New risk is:
A. 1:500
B. 1:357
C. 1:100
D. 1:2500
Correct Answer: B
Rationale: 2.8-fold increase → 1000 ÷ 2.8 ≈ 357.
15. A G2P1 with prior classical C/S at 24 weeks presents contracting every 3 min, cervix 4
cm/90 %/-1. Which order is priority?
A. Administer nifedipine 10 mg PO
B. Start magnesium sulfate 6 g load
C. Prepare for emergent classical C/S
D. Give betamethasone 12 mg IM
Correct Answer: C
Rationale: Prior classical incision ↑ rupture risk; fetus previable → immediate delivery
only if maternal indication.
16. (SATA) Which vaccines are safe in all trimesters? (Select 2)
A. Tdap
B. Inactivated influenza
C. HPV9
D. Varicella
E. COVID-19 mRNA
Correct Answer: A, B
HESI Maternity (OB) & Pediatrics ACTUAL EXAM
TEST BANK 2026/2027 | 300 Verified Questions and
Answers | Complete with Solutions | Latest Update |
Pass Guaranteed - A+ Graded
PART 1: MATERNITY & NEWBORN (150 of the 300 items)
Section 1: Antepartum (Questions 1 – 40)
1. A 32-yr-old G2P1 at 16 weeks presents with BP 158/98 mmHg, 2+ proteinuria, platelets
95 000 µL⁻¹. Which action is priority?
A. Start labetalol 200 mg PO BID
B. Admit for magnesium sulfate seizure prophylaxis
C. Schedule office follow-up in 1 week
D. Begin low-dose aspirin 81 mg daily
Correct Answer: B
Rationale: Thrombocytopenia + severe-range BP = severe preeclampsia at any
gestational age (ACOG 2026). Immediate hospitalization for IV MgSO₄ seizure
prophylaxis is indicated; delivery will probably be required within days.
2. (SATA) Which factors place a pregnant client at highest risk for congenital CMV
transmission? (Select 3)
A. First-trimester primary CMV infection
B. Maternal HIV co-infection
C. Day-care worker exposure
D. History of prior CMV infection
E. Breast-feeding a previous child
Correct Answer: A, B, C
Rationale: Primary infection in the 1st trimester carries a 30–40 % fetal transmission
rate; immunocompromise ↑ viral shedding; toddler saliva/urine exposure is the main
occupational risk.
3. A G1P0 at 12 weeks reports darkening facial pigmentation. Which instruction is best?
A. “Apply topical tretinoin nightly.”
B. “Avoid sun exposure; use SPF 50.”
C. “Take 10 000 IU vitamin A daily.”
,2
D. “This will resolve within 1 week postpartum.”
Correct Answer: B
Rationale: Chloasma/melasma is estrogen-driven; tretinoin is category C and teratogenic;
hyperpigmentation fades months (not 1 week) after birth.
4. (Calculation) A client at 30 weeks weighs 70 kg; her pre-pregnancy BMI was 23. Per
2026 IOM guidelines, her recommended total weight-gain range is:
A. 6.8–11.3 kg
B. 11.5–16 kg
C. 12.7–18.1 kg
D. 5–9 kg
Correct Answer: B
Rationale: Normal BMI (18.5–24.9) target 25–35 lb (11.5–16 kg).
5. Which laboratory value change is physiologic in a healthy pregnancy?
A. ↓ Serum creatinine 20 %
B. ↑ Hematocrit 15 %
C. ↓ Free T₄ by 25 %
D. ↑ BUN by 30 %
Correct Answer: A
Rationale: 50 % ↑ GFR → ↓ creatinine; hemodilution ↓ Hct 3–4 %; free T₄ remains
stable; BUN ↓ 25 %.
6. A G3P2 at 10 weeks has β-hCG 120 000 mIU mL⁻¹, no fetal pole, “snow-storm” pattern
on US. Priority nursing diagnosis is:
A. Acute pain
B. Risk for deficient fluid volume
C. Risk for infection
D. Deficient knowledge
Correct Answer: B
Rationale: Molar pregnancy → excessive bleeding post-evacuation; anticipate large fluid
loss.
7. (ORD) Sequence nursing actions for a newly diagnosed GDM client at 26 weeks:
1. Arrange nutritional counseling
2. Teach daily fetal movement counts
3. Schedule 32-week growth US
4. Initiate bedtime NPH insulin
Correct Order: 1-2-3-4
,3
Rationale: Diet/exercise first; surveillance; pharmacologic therapy only if fasting
>95 mg dL⁻¹.
8. Which medication requires a negative pregnancy test before dispensing to a reproductive-
age client?
A. Acetaminophen
B. Isotretinoin
C. Metformin
D. Ondansetron
Correct Answer: B
Rationale: iPLEDGE REMS; major teratogen.
9. A client on enoxaparin for antiphospholipid syndrome asks about regional analgesia.
Which advice is accurate?
A. “Stop the shot 2 h before epidural.”
B. “Hold 24 h before planned induction.”
C. “Switch to unfractionated heparin at 36 weeks.”
D. “No change needed; epidural is safe.”
Correct Answer: C
Rationale: LMWH half-life 12 h; must discontinue ≥24 h before neuraxial block; UFH
has shorter half-life and is reversible.
10. (SATA) Which findings indicate hyperemesis gravidarum rather than typical morning
sickness? (Select 3)
A. Ketones 4+ in urine
B. 5 % weight loss
C. Hypochloremic metabolic alkalosis
D. Nausea relieved by crackers
E. Salivary amylase ↑
Correct Answer: A, B, C
Rationale: Severe dehydration, electrolyte derangement and >5 % weight loss define HG.
11. A 19-yr-old at 12 weeks is rubella non-immune. The nurse teaches:
A. “Receive MMR today.”
B. “Get MMR in the postpartum unit before discharge.”
C. “Avoid crowded places until birth.”
D. “Rubella vaccine is safe after 20 weeks.”
Correct Answer: B
Rationale: Live vaccine is contraindicated in pregnancy; administer immediately
postpartum.
12. Which teratogen is linked to fetal cardiac defects (VSD, TOF) in the 1st trimester?
A. Lithium
, 4
B. Methimazole
C. Valproic acid
D. Warfarin
Correct Answer: A
Rationale: Lithium ↑ Ebstein anomaly & other defects; valproate → NTD; warfarin →
nasal hypoplasia.
13. A G1P0 BMI 42 is counselled about 2026 ACOG recommendations. Which statement is
correct?
A. “Gain 15–25 lb to improve outcomes.”
B. “Lose 10 lb during pregnancy.”
C. “Limit gain to 5–9 kg.”
D. “No restriction needed; eat for two.”
Correct Answer: C
Rationale: Class III obesity target 5–9 kg (11–20 lb).
14. (Calculation) A client’s quad screen shows AFP 2.8 MoM. Her baseline risk for ONTD is
1:1000. New risk is:
A. 1:500
B. 1:357
C. 1:100
D. 1:2500
Correct Answer: B
Rationale: 2.8-fold increase → 1000 ÷ 2.8 ≈ 357.
15. A G2P1 with prior classical C/S at 24 weeks presents contracting every 3 min, cervix 4
cm/90 %/-1. Which order is priority?
A. Administer nifedipine 10 mg PO
B. Start magnesium sulfate 6 g load
C. Prepare for emergent classical C/S
D. Give betamethasone 12 mg IM
Correct Answer: C
Rationale: Prior classical incision ↑ rupture risk; fetus previable → immediate delivery
only if maternal indication.
16. (SATA) Which vaccines are safe in all trimesters? (Select 2)
A. Tdap
B. Inactivated influenza
C. HPV9
D. Varicella
E. COVID-19 mRNA
Correct Answer: A, B
