1
OB Maternity HESI Exit Exam 2026/2027 Actual
Exam - Versions 1, 2, 3 (165 Questions) with
Detailed Rationales | 100% Verified Graded A+
Pass Guaranteed - A+ Graded
[VERSION 1 - Complete Exam with NextGen Case Studies]
CASE STUDY 1: Antepartum Care & Complications
A 29-year-old G2P1001 at 28 weeks gestation presents to the prenatal clinic for a routine follow-
up. Her previous pregnancy resulted in a macrosomic infant (9 lbs 8 oz) delivered via cesarean
section. She has a body mass index (BMI) of 32. A 50-g glucose challenge test (GCT) reveals a
blood glucose level of 155 mg/dL. The provider diagnoses gestational diabetes mellitus (GDM)
and orders a 3-hour oral glucose tolerance test (OGTT), which confirms the diagnosis. The
patient is started on a prescribed diet and is instructed to perform fasting and postprandial blood
glucose monitoring four times daily.
Q1: Which of the following blood glucose values indicates that the patient’s GDM is not well-
controlled with diet alone, requiring pharmacological intervention?
A. Fasting blood glucose of 95 mg/dL
B. 1-hour postprandial blood glucose of 140 mg/dL
C. 2-hour postprandial blood glucose of 115 mg/dL
D. Fasting blood glucose of 80 mg/dL
A. Fasting blood glucose of 95 mg/dL [CORRECT]
Correct Answer: A
Rationale: The standard threshold for initiating pharmacotherapy in GDM is a fasting blood
glucose greater than or equal to 95 mg/dL. Additionally, a 1-hour postprandial level >140 mg/dL
or a 2-hour postprandial level >120 mg/dL would also indicate the need for medication. A fasting
level of 80 mg/dL and a 2-hour postprandial level of 115 mg/dL are within normal, well-
controlled limits.
Q2: The nurse is educating the patient on monitoring for hypoglycemia. Which of the following
symptoms should the patient be instructed to report? (Select all that apply)
,2
A. Diaphoresis
B. Blurred vision
C. Polyuria
D. Shakiness
E. Bradycardia
Correct Answer: A, B, D
Rationale: Hypoglycemia symptoms result from sympathetic nervous system activation
(diaphoresis, shakiness, tachycardia, not bradycardia) and cerebral glucose deprivation (blurred
vision, confusion, headache). Polyuria and polydipsia are classic symptoms of hyperglycemia,
not hypoglycemia.
Q3: The nurse must teach the patient how to perform self-administered blood glucose
monitoring. Identify the correct anatomical site for obtaining a capillary blood sample.
A. The central fleshy pad of the fingertip, perpendicular to the fingerprint
B. The radial aspect of the wrist
C. The tip of the finger directly over the nail bed
D. The antecubital space
A. The central fleshy pad of the fingertip, perpendicular to the fingerprint [CORRECT]
Correct Answer: A
Rationale: The correct site for capillary blood glucose monitoring is the side of the fingertip or
the central fleshy pad, sticking the needle perpendicular to the fingerprint lines to minimize pain
and ensure adequate blood flow. The wrist and antecubital space are not appropriate for capillary
sampling, and sticking directly over the nail bed is excessively painful and does not yield a good
capillary sample.
Q4: The provider determines that insulin therapy is required. Place the following steps for self-
administration of subcutaneous insulin in the correct order.
Inject the insulin
Clean the injection site with an alcohol swab
,3
Rotate the injection sites
Pinch a 1-inch fold of skin
Push the plunger all the way down and hold for 5 seconds
Select a site on the abdomen, avoiding a 2-inch radius around the umbilicus
A. 6, 2, 4, 1, 5, 3
B. 2, 6, 4, 1, 3, 5
C. 6, 3, 2, 4, 5, 1
D. 3, 6, 2, 4, 1, 5
A. 6, 2, 4, 1, 5, 3 [CORRECT]
Correct Answer: A
Rationale: The correct sequence begins with selecting an appropriate abdominal site away from
the umbilicus, followed by cleaning the site. The patient then pinches a skin fold, injects the
needle, pushes the plunger, and holds it to ensure full delivery, with site rotation being an
ongoing consideration throughout the dosing schedule.
Q5: At 32 weeks gestation, the nurse is calculating the patient's required daily caloric intake
based on her current weight of 85 kg. The recommended caloric requirement for a pregnant
patient with GDM is 30 kcal/kg/day. Calculate the total daily calories the nurse should educate
the patient to consume. (Fill in the blank)
Correct Answer: 2550
Rationale: The calculation is patient weight (85 kg) multiplied by the prescribed caloric
requirement (30 kcal/kg/day). 85 x 30 = 2550 calories per day.
CASE STUDY 2: Intrapartum Care & Labor Management
A 32-year-old G1P0000 at 34 weeks gestation is admitted to the labor and delivery unit with a
severe headache, visual disturbances (scotomas), and epigastric pain. Her blood pressure is
158/104 mmHg, and she has 2+ proteinuria on urinalysis. A diagnosis of severe preeclampsia is
made. Magnesium sulfate is ordered for seizure prophylaxis, and the provider plans to induce
labor. The external fetal monitor shows a baseline fetal heart rate of 145 bpm with moderate
variability and no decelerations.
, 4
Q6: Which of the following nursing interventions is the priority before initiating the magnesium
sulfate infusion?
A. Assessing deep tendon reflexes (DTRs) and obtaining a baseline respiratory rate
B. Administering a bolus of IV normal saline to prevent hypotension
C. Applying warm compresses to the patient's abdomen
D. Placing the patient in a left lateral Trendelenburg position
A. Assessing deep tendon reflexes (DTRs) and obtaining a baseline respiratory rate [CORRECT]
Correct Answer: A
Rationale: Magnesium sulfate is a high-alert medication that acts as a central nervous system
depressant and smooth muscle relaxant. Because its therapeutic and toxic ranges are very close,
the priority baseline assessments include respiratory rate (must be >12/min), deep tendon
reflexes (must be present, absence indicates toxicity), and checking for ankle clonus.
Q7: The nurse is preparing to administer the loading dose of magnesium sulfate. Which of the
following equipment must be immediately available at the bedside? (Select all that apply)
A. Calcium gluconate
B. Oxytocin (Pitocin)
C. Diazepam (Valium)
D. Narcotic antagonist (Naloxone)
E. Resuscitation bag and mask
Correct Answer: A, E
Rationale: Calcium gluconate is the specific antidote for magnesium sulfate toxicity and must be
at the bedside before the infusion starts. A resuscitation bag is standard for any high-risk labor.
Diazepam and oxytocin are not antidotes for magnesium toxicity, and naloxone is for opioid
reversal.
Q8: Place the following steps for initiating the magnesium sulfate infusion in the correct order.
Connect the secondary tubing to the primary IV line
Prime the secondary tubing with the magnesium sulfate solution
OB Maternity HESI Exit Exam 2026/2027 Actual
Exam - Versions 1, 2, 3 (165 Questions) with
Detailed Rationales | 100% Verified Graded A+
Pass Guaranteed - A+ Graded
[VERSION 1 - Complete Exam with NextGen Case Studies]
CASE STUDY 1: Antepartum Care & Complications
A 29-year-old G2P1001 at 28 weeks gestation presents to the prenatal clinic for a routine follow-
up. Her previous pregnancy resulted in a macrosomic infant (9 lbs 8 oz) delivered via cesarean
section. She has a body mass index (BMI) of 32. A 50-g glucose challenge test (GCT) reveals a
blood glucose level of 155 mg/dL. The provider diagnoses gestational diabetes mellitus (GDM)
and orders a 3-hour oral glucose tolerance test (OGTT), which confirms the diagnosis. The
patient is started on a prescribed diet and is instructed to perform fasting and postprandial blood
glucose monitoring four times daily.
Q1: Which of the following blood glucose values indicates that the patient’s GDM is not well-
controlled with diet alone, requiring pharmacological intervention?
A. Fasting blood glucose of 95 mg/dL
B. 1-hour postprandial blood glucose of 140 mg/dL
C. 2-hour postprandial blood glucose of 115 mg/dL
D. Fasting blood glucose of 80 mg/dL
A. Fasting blood glucose of 95 mg/dL [CORRECT]
Correct Answer: A
Rationale: The standard threshold for initiating pharmacotherapy in GDM is a fasting blood
glucose greater than or equal to 95 mg/dL. Additionally, a 1-hour postprandial level >140 mg/dL
or a 2-hour postprandial level >120 mg/dL would also indicate the need for medication. A fasting
level of 80 mg/dL and a 2-hour postprandial level of 115 mg/dL are within normal, well-
controlled limits.
Q2: The nurse is educating the patient on monitoring for hypoglycemia. Which of the following
symptoms should the patient be instructed to report? (Select all that apply)
,2
A. Diaphoresis
B. Blurred vision
C. Polyuria
D. Shakiness
E. Bradycardia
Correct Answer: A, B, D
Rationale: Hypoglycemia symptoms result from sympathetic nervous system activation
(diaphoresis, shakiness, tachycardia, not bradycardia) and cerebral glucose deprivation (blurred
vision, confusion, headache). Polyuria and polydipsia are classic symptoms of hyperglycemia,
not hypoglycemia.
Q3: The nurse must teach the patient how to perform self-administered blood glucose
monitoring. Identify the correct anatomical site for obtaining a capillary blood sample.
A. The central fleshy pad of the fingertip, perpendicular to the fingerprint
B. The radial aspect of the wrist
C. The tip of the finger directly over the nail bed
D. The antecubital space
A. The central fleshy pad of the fingertip, perpendicular to the fingerprint [CORRECT]
Correct Answer: A
Rationale: The correct site for capillary blood glucose monitoring is the side of the fingertip or
the central fleshy pad, sticking the needle perpendicular to the fingerprint lines to minimize pain
and ensure adequate blood flow. The wrist and antecubital space are not appropriate for capillary
sampling, and sticking directly over the nail bed is excessively painful and does not yield a good
capillary sample.
Q4: The provider determines that insulin therapy is required. Place the following steps for self-
administration of subcutaneous insulin in the correct order.
Inject the insulin
Clean the injection site with an alcohol swab
,3
Rotate the injection sites
Pinch a 1-inch fold of skin
Push the plunger all the way down and hold for 5 seconds
Select a site on the abdomen, avoiding a 2-inch radius around the umbilicus
A. 6, 2, 4, 1, 5, 3
B. 2, 6, 4, 1, 3, 5
C. 6, 3, 2, 4, 5, 1
D. 3, 6, 2, 4, 1, 5
A. 6, 2, 4, 1, 5, 3 [CORRECT]
Correct Answer: A
Rationale: The correct sequence begins with selecting an appropriate abdominal site away from
the umbilicus, followed by cleaning the site. The patient then pinches a skin fold, injects the
needle, pushes the plunger, and holds it to ensure full delivery, with site rotation being an
ongoing consideration throughout the dosing schedule.
Q5: At 32 weeks gestation, the nurse is calculating the patient's required daily caloric intake
based on her current weight of 85 kg. The recommended caloric requirement for a pregnant
patient with GDM is 30 kcal/kg/day. Calculate the total daily calories the nurse should educate
the patient to consume. (Fill in the blank)
Correct Answer: 2550
Rationale: The calculation is patient weight (85 kg) multiplied by the prescribed caloric
requirement (30 kcal/kg/day). 85 x 30 = 2550 calories per day.
CASE STUDY 2: Intrapartum Care & Labor Management
A 32-year-old G1P0000 at 34 weeks gestation is admitted to the labor and delivery unit with a
severe headache, visual disturbances (scotomas), and epigastric pain. Her blood pressure is
158/104 mmHg, and she has 2+ proteinuria on urinalysis. A diagnosis of severe preeclampsia is
made. Magnesium sulfate is ordered for seizure prophylaxis, and the provider plans to induce
labor. The external fetal monitor shows a baseline fetal heart rate of 145 bpm with moderate
variability and no decelerations.
, 4
Q6: Which of the following nursing interventions is the priority before initiating the magnesium
sulfate infusion?
A. Assessing deep tendon reflexes (DTRs) and obtaining a baseline respiratory rate
B. Administering a bolus of IV normal saline to prevent hypotension
C. Applying warm compresses to the patient's abdomen
D. Placing the patient in a left lateral Trendelenburg position
A. Assessing deep tendon reflexes (DTRs) and obtaining a baseline respiratory rate [CORRECT]
Correct Answer: A
Rationale: Magnesium sulfate is a high-alert medication that acts as a central nervous system
depressant and smooth muscle relaxant. Because its therapeutic and toxic ranges are very close,
the priority baseline assessments include respiratory rate (must be >12/min), deep tendon
reflexes (must be present, absence indicates toxicity), and checking for ankle clonus.
Q7: The nurse is preparing to administer the loading dose of magnesium sulfate. Which of the
following equipment must be immediately available at the bedside? (Select all that apply)
A. Calcium gluconate
B. Oxytocin (Pitocin)
C. Diazepam (Valium)
D. Narcotic antagonist (Naloxone)
E. Resuscitation bag and mask
Correct Answer: A, E
Rationale: Calcium gluconate is the specific antidote for magnesium sulfate toxicity and must be
at the bedside before the infusion starts. A resuscitation bag is standard for any high-risk labor.
Diazepam and oxytocin are not antidotes for magnesium toxicity, and naloxone is for opioid
reversal.
Q8: Place the following steps for initiating the magnesium sulfate infusion in the correct order.
Connect the secondary tubing to the primary IV line
Prime the secondary tubing with the magnesium sulfate solution
