HESI High-Risk Pregnancy Exam –
Latest 2026 Edition||Questions And
Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Section 1: Hypertensive Disorders of Pregnancy (Questions 1–15)
1. A primigravida at 32 weeks gestation presents with BP 168/110 mmHg, 3+
proteinuria, severe headache, and epigastric pain. Which medication should
the nurse administer FIRST?
• A. Labetalol 20 mg IV push
• B. Magnesium sulfate 4 g IV loading dose
• C. Nifedipine 30 mg PO
• D. Hydralazine 5 mg IV push
Rationale: Severe preeclampsia with neurologic symptoms (headache, epigastric
pain) requires seizure prophylaxis. Magnesium sulfate is first-line.
Antihypertensives (labetalol/hydralazine) are given for sustained severe
hypertension but not before magnesium.
2. A patient with eclampsia has a seizure lasting 90 seconds. Post-ictal, the
fetal heart rate (FHR) is 70 bpm for 4 minutes. What is the priority nursing
action?
• A. Prepare for emergency cesarean section
• B. Initiate maternal left lateral positioning and high-flow oxygen
• C. Administer terbutaline 0.25 mg subcutaneously
• D. Increase magnesium sulfate infusion rate
Rationale: Post-seizure bradycardia is often due to maternal hypoxia and
hypocapnia. Positioning and oxygen improve uterine perfusion. Immediate C-
,section is not indicated unless bradycardia persists >10 minutes despite
resuscitation.
3. Which finding in a patient with chronic hypertension at 36 weeks would
indicate superimposed preeclampsia?
• A. BP 140/90 mmHg (baseline 130/80)
• B. Sudden onset of 2+ proteinuria
• C. Mild pedal edema
• D. Platelet count 180,000/mm³
Rationale: Superimposed preeclampsia = new-onset proteinuria after 20 weeks in
a chronic hypertensive OR sudden increase in BP/proteinuria/platelets <100,000.
Mild edema is normal in pregnancy.
4. A nurse is administering magnesium sulfate for severe preeclampsia. Which
assessment finding indicates toxicity?
• A. Deep tendon reflexes 2+
• B. Urine output 35 mL/hour
• C. Respiratory rate 10 breaths/minute
• D. Serum magnesium level 5 mg/dL
Rationale: Respiratory depression (<12/min) is a sign of magnesium toxicity.
Therapeutic range is 4–7 mg/dL. Reflexes 2+ are normal. Urine output should be
>30 mL/hour.
5. A patient with HELLP syndrome has a platelet count of 48,000/mm³. Which
nursing intervention is most important?
• A. Avoid intramuscular injections
• B. Administer enoxaparin for DVT prophylaxis
• C. Encourage ambulation
• D. Place patient on strict bed rest
Rationale: Severe thrombocytopenia increases bleeding risk. IM injections are
contraindicated. Enoxaparin is avoided. Bed rest is not protective against bleeding.
, 6. At 28 weeks, a patient’s BP is 150/96 mmHg. Urine protein is negative.
Which medication is safe for chronic hypertension in pregnancy?
• A. Lisinopril
• B. Losartan
• C. Labetalol
• D. Hydrochlorothiazide
Rationale: Labetalol (beta-blocker) is first-line for chronic hypertension in
pregnancy. ACE inhibitors (lisinopril) and ARBs (losartan) are teratogenic (renal
agenesis). Thiazides reduce plasma volume.
7. A postpartum patient with severe preeclampsia is on a magnesium sulfate
infusion. She has absent patellar reflexes and a decrease in urinary output to
20 mL over the last 2 hours. What is the nurse’s priority action?
• A. Call the respiratory therapist for a nebulizer
• B. Discontinue magnesium sulfate and prepare calcium gluconate
• C. Increase IV fluids to 200 mL/hour
• D. Administer furosemide 20 mg IV
Rationale: Absent reflexes + oliguria indicate magnesium toxicity. Stop infusion,
give calcium gluconate (antidote). Increasing fluids worsens toxicity.
8. Which laboratory finding is most concerning in a patient with suspected
preeclampsia?
• A. Hemoglobin 11 g/dL
• B. Creatinine 0.8 mg/dL
• C. Aspartate aminotransferase (AST) 120 units/L
• D. Uric acid 5.5 mg/dL
Rationale: Elevated AST indicates liver involvement (HELLP syndrome). Normal
AST is <40 units/L. Uric acid >6 mg/dL is common but less urgent.
9. A nurse is teaching a patient with chronic hypertension about signs of
superimposed preeclampsia. Which symptom should the patient report
immediately?
Latest 2026 Edition||Questions And
Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Section 1: Hypertensive Disorders of Pregnancy (Questions 1–15)
1. A primigravida at 32 weeks gestation presents with BP 168/110 mmHg, 3+
proteinuria, severe headache, and epigastric pain. Which medication should
the nurse administer FIRST?
• A. Labetalol 20 mg IV push
• B. Magnesium sulfate 4 g IV loading dose
• C. Nifedipine 30 mg PO
• D. Hydralazine 5 mg IV push
Rationale: Severe preeclampsia with neurologic symptoms (headache, epigastric
pain) requires seizure prophylaxis. Magnesium sulfate is first-line.
Antihypertensives (labetalol/hydralazine) are given for sustained severe
hypertension but not before magnesium.
2. A patient with eclampsia has a seizure lasting 90 seconds. Post-ictal, the
fetal heart rate (FHR) is 70 bpm for 4 minutes. What is the priority nursing
action?
• A. Prepare for emergency cesarean section
• B. Initiate maternal left lateral positioning and high-flow oxygen
• C. Administer terbutaline 0.25 mg subcutaneously
• D. Increase magnesium sulfate infusion rate
Rationale: Post-seizure bradycardia is often due to maternal hypoxia and
hypocapnia. Positioning and oxygen improve uterine perfusion. Immediate C-
,section is not indicated unless bradycardia persists >10 minutes despite
resuscitation.
3. Which finding in a patient with chronic hypertension at 36 weeks would
indicate superimposed preeclampsia?
• A. BP 140/90 mmHg (baseline 130/80)
• B. Sudden onset of 2+ proteinuria
• C. Mild pedal edema
• D. Platelet count 180,000/mm³
Rationale: Superimposed preeclampsia = new-onset proteinuria after 20 weeks in
a chronic hypertensive OR sudden increase in BP/proteinuria/platelets <100,000.
Mild edema is normal in pregnancy.
4. A nurse is administering magnesium sulfate for severe preeclampsia. Which
assessment finding indicates toxicity?
• A. Deep tendon reflexes 2+
• B. Urine output 35 mL/hour
• C. Respiratory rate 10 breaths/minute
• D. Serum magnesium level 5 mg/dL
Rationale: Respiratory depression (<12/min) is a sign of magnesium toxicity.
Therapeutic range is 4–7 mg/dL. Reflexes 2+ are normal. Urine output should be
>30 mL/hour.
5. A patient with HELLP syndrome has a platelet count of 48,000/mm³. Which
nursing intervention is most important?
• A. Avoid intramuscular injections
• B. Administer enoxaparin for DVT prophylaxis
• C. Encourage ambulation
• D. Place patient on strict bed rest
Rationale: Severe thrombocytopenia increases bleeding risk. IM injections are
contraindicated. Enoxaparin is avoided. Bed rest is not protective against bleeding.
, 6. At 28 weeks, a patient’s BP is 150/96 mmHg. Urine protein is negative.
Which medication is safe for chronic hypertension in pregnancy?
• A. Lisinopril
• B. Losartan
• C. Labetalol
• D. Hydrochlorothiazide
Rationale: Labetalol (beta-blocker) is first-line for chronic hypertension in
pregnancy. ACE inhibitors (lisinopril) and ARBs (losartan) are teratogenic (renal
agenesis). Thiazides reduce plasma volume.
7. A postpartum patient with severe preeclampsia is on a magnesium sulfate
infusion. She has absent patellar reflexes and a decrease in urinary output to
20 mL over the last 2 hours. What is the nurse’s priority action?
• A. Call the respiratory therapist for a nebulizer
• B. Discontinue magnesium sulfate and prepare calcium gluconate
• C. Increase IV fluids to 200 mL/hour
• D. Administer furosemide 20 mg IV
Rationale: Absent reflexes + oliguria indicate magnesium toxicity. Stop infusion,
give calcium gluconate (antidote). Increasing fluids worsens toxicity.
8. Which laboratory finding is most concerning in a patient with suspected
preeclampsia?
• A. Hemoglobin 11 g/dL
• B. Creatinine 0.8 mg/dL
• C. Aspartate aminotransferase (AST) 120 units/L
• D. Uric acid 5.5 mg/dL
Rationale: Elevated AST indicates liver involvement (HELLP syndrome). Normal
AST is <40 units/L. Uric acid >6 mg/dL is common but less urgent.
9. A nurse is teaching a patient with chronic hypertension about signs of
superimposed preeclampsia. Which symptom should the patient report
immediately?
