2026 OB MATERNITY HESI EXIT NEXTGEN TEST BANK |
Versions 1, 2 & 3 Complete | 100% Correct Answers &
Detailed Rationales | Pass Guaranteed - A+ Graded
VERSION 1
Category: Antepartum Care (25 Questions)
Unfolding Case Study: Preeclampsia with Severe Features
Scenario: A 32-year-old G1P0 at 34 weeks gestation presents to triage with complaints
of headache, visual disturbances, and right upper quadrant pain. Vital signs: BP 158/96,
HR 92, RR 18, temperature 37.1°C. Urine dipstick shows 2+ protein. Laboratory values:
Platelets 95,000/mm³, AST 78 U/L, ALT 85 U/L, LDH 650 U/L, creatinine 1.2 mg/dL.
Question 1 (Highlight - NGN Format):
The nurse reviews the client's electronic health record and admission assessment. Click
to highlight the three findings that indicate severe features of preeclampsia requiring
immediate intervention.
[EHR Excerpt - Select/highlight the following text in actual NEXUS format:]
● "Blood pressure 158/96 mmHg on two occasions 4 hours apart"
● "Client reports 'seeing spots' and 'flashes of light'"
● "Right upper quadrant pain rated 7/10, constant"
● "2+ proteinuria on urine dipstick"
● "Mild ankle edema present bilaterally"
● "Fetal heart rate 140 bpm with moderate variability"
Correct Answer: [Highlighted text indicating BP 158/96, visual disturbances, and RUQ
pain] [CORRECT]
,Rationale: The three findings indicating severe features preeclampsia are: (1) Blood
pressure ≥160/110 mmHg OR ≥140/90 on two occasions OR severe-range BP (158/96
is severe-range systolic >160 or diastolic >110), (2) Visual disturbances (scotomata,
flashing lights) indicating cerebral edema, and (3) Right upper quadrant pain indicating
liver capsule distension/impending rupture. While 2+ proteinuria confirms preeclampsia,
it alone does not indicate severe features. Mild ankle edema is common in pregnancy.
FHR 140 with moderate variability is reassuring. According to ACOG criteria, severe
features include: BP ≥160/110, thrombocytopenia <100,000, impaired liver function
(elevated transaminases), renal insufficiency (Cr >1.1), pulmonary edema, new-onset
cerebral/visual symptoms, or RUQ/epigastric pain. The combination of severe-range BP,
visual disturbances, and RUQ pain constitutes severe features requiring immediate
magnesium sulfate prophylaxis and delivery planning.
Question 2 (Bow-Tie - NGN Format):
Complete the bow-tie diagram by selecting the appropriate condition, priority nursing
actions, and parameters to monitor for this client.
CONDITION: [Drop-down selection]
● A. Mild Preeclampsia
● B. Severe Features Preeclampsia [CORRECT]
● C. Chronic Hypertension
● D. Gestational Hypertension
PRIORITY NURSING ACTIONS: [Select 3]
● A. Administer magnesium sulfate 4-6g IV loading dose [CORRECT]
● B. Maintain strict bedrest in left lateral position [CORRECT]
● C. Insert indwelling urinary catheter [CORRECT]
● D. Administer diuretics to reduce edema
● E. Encourage oral fluid intake of 3L/day
● F. Prepare for immediate vaginal delivery
,PARAMETERS TO MONITOR: [Select 3]
● A. Deep tendon reflexes (patellar) [CORRECT]
● B. Respiratory rate [CORRECT]
● C. Urine output [CORRECT]
● D. Blood glucose every 2 hours
● E. Fetal movement count every 4 hours
● F. Maternal weight daily
Correct Answers: Condition B; Actions A, B, C; Parameters A, B, C [CORRECT]
Rationale: This client has severe features preeclampsia based on BP 158/96
(severe-range), visual disturbances (cerebral involvement), and RUQ pain (hepatic
involvement). Priority actions include: (1) Magnesium sulfate for seizure prophylaxis per
ACOG guidelines—loading dose 4-6g IV over 20-30 minutes followed by 1-2g/hr
maintenance; (2) Bedrest in left lateral position to improve uteroplacental perfusion and
reduce BP; (3) Indwelling catheter to monitor urine output accurately, as oliguria
(<30mL/hr or <500mL/24hr) indicates worsening renal function and possible
magnesium toxicity. Diuretics are contraindicated as they further reduce intravascular
volume. Oral fluids are restricted (typically 100-125mL/hr) to prevent fluid overload.
Delivery timing depends on gestational age and severity but is not always immediate at
34 weeks. Monitoring parameters for magnesium sulfate therapy specifically include
deep tendon reflexes (absent reflexes indicate toxicity), respiratory rate (respiratory
depression occurs at toxic levels), and urine output (renal clearance of magnesium).
These parameters must be assessed every 15-30 minutes during loading dose and
hourly during maintenance. Blood glucose monitoring is not specific to magnesium
therapy. Fetal movement counts are important but not the priority monitoring for
magnesium toxicity. Daily weights are not practical in acute management.
Question 3 (Trend - NGN Format):
, The client is started on magnesium sulfate. Review the following trend data and identify
the priority nursing concern.
Table
Time BP DTRs RR Urine Output FHR
1400 158/96 2+ 18 45 mL/hr 140, mod var
1500 162/104 2+ 16 40 mL/hr 142, mod var
1600 168/110 1+ 14 25 mL/hr 138, min var
1615 172/114 0 10 15 mL/hr 130, min var with late decels
What is the nurse's priority action?
A. Continue magnesium sulfate infusion at current rate
B. Stop magnesium sulfate infusion immediately [CORRECT]
C. Administer calcium gluconate and increase magnesium rate
D. Notify provider but continue infusion
Correct Answer: B [CORRECT]
Rationale: The trend data demonstrates progressive magnesium sulfate toxicity. Key
indicators include: (1) Disappearing deep tendon reflexes (progressing from 2+ to
0/absent), (2) Respiratory depression (RR declining from 18 to 10 breaths/min—normal
is 12-20), (3) Oliguria (urine output dropping from 45 to 15 mL/hr—toxicity risk increases
when UO <30mL/hr), (4) Fetal heart rate changes showing minimal variability and late
decelerations indicating uteroplacental insufficiency. The therapeutic range for
magnesium is 4-8 mEq/L; loss of DTRs occurs at 8-10 mEq/L, respiratory depression at
10-12 mEq/L, and cardiac arrest at >12.5 mEq/L. The immediate priority is to STOP the
Versions 1, 2 & 3 Complete | 100% Correct Answers &
Detailed Rationales | Pass Guaranteed - A+ Graded
VERSION 1
Category: Antepartum Care (25 Questions)
Unfolding Case Study: Preeclampsia with Severe Features
Scenario: A 32-year-old G1P0 at 34 weeks gestation presents to triage with complaints
of headache, visual disturbances, and right upper quadrant pain. Vital signs: BP 158/96,
HR 92, RR 18, temperature 37.1°C. Urine dipstick shows 2+ protein. Laboratory values:
Platelets 95,000/mm³, AST 78 U/L, ALT 85 U/L, LDH 650 U/L, creatinine 1.2 mg/dL.
Question 1 (Highlight - NGN Format):
The nurse reviews the client's electronic health record and admission assessment. Click
to highlight the three findings that indicate severe features of preeclampsia requiring
immediate intervention.
[EHR Excerpt - Select/highlight the following text in actual NEXUS format:]
● "Blood pressure 158/96 mmHg on two occasions 4 hours apart"
● "Client reports 'seeing spots' and 'flashes of light'"
● "Right upper quadrant pain rated 7/10, constant"
● "2+ proteinuria on urine dipstick"
● "Mild ankle edema present bilaterally"
● "Fetal heart rate 140 bpm with moderate variability"
Correct Answer: [Highlighted text indicating BP 158/96, visual disturbances, and RUQ
pain] [CORRECT]
,Rationale: The three findings indicating severe features preeclampsia are: (1) Blood
pressure ≥160/110 mmHg OR ≥140/90 on two occasions OR severe-range BP (158/96
is severe-range systolic >160 or diastolic >110), (2) Visual disturbances (scotomata,
flashing lights) indicating cerebral edema, and (3) Right upper quadrant pain indicating
liver capsule distension/impending rupture. While 2+ proteinuria confirms preeclampsia,
it alone does not indicate severe features. Mild ankle edema is common in pregnancy.
FHR 140 with moderate variability is reassuring. According to ACOG criteria, severe
features include: BP ≥160/110, thrombocytopenia <100,000, impaired liver function
(elevated transaminases), renal insufficiency (Cr >1.1), pulmonary edema, new-onset
cerebral/visual symptoms, or RUQ/epigastric pain. The combination of severe-range BP,
visual disturbances, and RUQ pain constitutes severe features requiring immediate
magnesium sulfate prophylaxis and delivery planning.
Question 2 (Bow-Tie - NGN Format):
Complete the bow-tie diagram by selecting the appropriate condition, priority nursing
actions, and parameters to monitor for this client.
CONDITION: [Drop-down selection]
● A. Mild Preeclampsia
● B. Severe Features Preeclampsia [CORRECT]
● C. Chronic Hypertension
● D. Gestational Hypertension
PRIORITY NURSING ACTIONS: [Select 3]
● A. Administer magnesium sulfate 4-6g IV loading dose [CORRECT]
● B. Maintain strict bedrest in left lateral position [CORRECT]
● C. Insert indwelling urinary catheter [CORRECT]
● D. Administer diuretics to reduce edema
● E. Encourage oral fluid intake of 3L/day
● F. Prepare for immediate vaginal delivery
,PARAMETERS TO MONITOR: [Select 3]
● A. Deep tendon reflexes (patellar) [CORRECT]
● B. Respiratory rate [CORRECT]
● C. Urine output [CORRECT]
● D. Blood glucose every 2 hours
● E. Fetal movement count every 4 hours
● F. Maternal weight daily
Correct Answers: Condition B; Actions A, B, C; Parameters A, B, C [CORRECT]
Rationale: This client has severe features preeclampsia based on BP 158/96
(severe-range), visual disturbances (cerebral involvement), and RUQ pain (hepatic
involvement). Priority actions include: (1) Magnesium sulfate for seizure prophylaxis per
ACOG guidelines—loading dose 4-6g IV over 20-30 minutes followed by 1-2g/hr
maintenance; (2) Bedrest in left lateral position to improve uteroplacental perfusion and
reduce BP; (3) Indwelling catheter to monitor urine output accurately, as oliguria
(<30mL/hr or <500mL/24hr) indicates worsening renal function and possible
magnesium toxicity. Diuretics are contraindicated as they further reduce intravascular
volume. Oral fluids are restricted (typically 100-125mL/hr) to prevent fluid overload.
Delivery timing depends on gestational age and severity but is not always immediate at
34 weeks. Monitoring parameters for magnesium sulfate therapy specifically include
deep tendon reflexes (absent reflexes indicate toxicity), respiratory rate (respiratory
depression occurs at toxic levels), and urine output (renal clearance of magnesium).
These parameters must be assessed every 15-30 minutes during loading dose and
hourly during maintenance. Blood glucose monitoring is not specific to magnesium
therapy. Fetal movement counts are important but not the priority monitoring for
magnesium toxicity. Daily weights are not practical in acute management.
Question 3 (Trend - NGN Format):
, The client is started on magnesium sulfate. Review the following trend data and identify
the priority nursing concern.
Table
Time BP DTRs RR Urine Output FHR
1400 158/96 2+ 18 45 mL/hr 140, mod var
1500 162/104 2+ 16 40 mL/hr 142, mod var
1600 168/110 1+ 14 25 mL/hr 138, min var
1615 172/114 0 10 15 mL/hr 130, min var with late decels
What is the nurse's priority action?
A. Continue magnesium sulfate infusion at current rate
B. Stop magnesium sulfate infusion immediately [CORRECT]
C. Administer calcium gluconate and increase magnesium rate
D. Notify provider but continue infusion
Correct Answer: B [CORRECT]
Rationale: The trend data demonstrates progressive magnesium sulfate toxicity. Key
indicators include: (1) Disappearing deep tendon reflexes (progressing from 2+ to
0/absent), (2) Respiratory depression (RR declining from 18 to 10 breaths/min—normal
is 12-20), (3) Oliguria (urine output dropping from 45 to 15 mL/hr—toxicity risk increases
when UO <30mL/hr), (4) Fetal heart rate changes showing minimal variability and late
decelerations indicating uteroplacental insufficiency. The therapeutic range for
magnesium is 4-8 mEq/L; loss of DTRs occurs at 8-10 mEq/L, respiratory depression at
10-12 mEq/L, and cardiac arrest at >12.5 mEq/L. The immediate priority is to STOP the
