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HESI MATERNITY OB EXAM VERSION 2 2026/2027 |
Actual Exam Questions | Detailed Verified Answers | A+
Grade Assured | Pass Guaranteed
Section 1: Antepartum Complications & Prenatal Care (Q1-12)
Question 1
A 28-year-old primigravida at 10 weeks gestation is admitted with severe nausea and
vomiting, weight loss of 6 lbs in one week, and ketonuria. She is unable to tolerate
oral intake. The healthcare provider orders IV dextrose 5% in normal saline at 125
mL/hr. What is the nurse's priority intervention before initiating this infusion?
A. Administer thiamine 100 mg IV prior to dextrose infusion to prevent Wernicke's
encephalopathy [CORRECT]
B. Start the dextrose infusion immediately to correct maternal ketosis and prevent
fetal hypoglycemia
C. Obtain a serum glucose level and wait for results before administering any IV
fluids
D. Administer ondansetron 4 mg IV push first to control vomiting before starting
fluids
Rationale: Hyperemesis gravidarum with prolonged vomiting and poor nutritional
intake places the patient at high risk for thiamine (vitamin B1) deficiency.
Administering dextrose without thiamine supplementation can precipitate or worsen
Wernicke's encephalopathy because glucose metabolism increases thiamine
utilization. Thiamine 100 mg IV must be given before any dextrose-containing
solution per AWHONN and ACOG guidelines. Option B is dangerous without
thiamine. Option C delays necessary treatment. Option D addresses symptom control
but is not the priority over preventing neurological injury.
Correct Answer: A
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Question 2
A 32-year-old G3P2 at 34 weeks gestation presents to the emergency department
with sudden onset of severe abdominal pain and vaginal bleeding. Her abdomen is
rigid and tender. Fetal heart rate shows late decelerations. The nurse notes the
bleeding appears dark and clotted. Which action should the nurse take first?
A. Perform a sterile vaginal examination to assess cervical dilation
B. Prepare the patient for immediate cesarean delivery and initiate large-bore IV
access
C. Administer betamethasone 12 mg IM to promote fetal lung maturity
D. Apply external fetal monitoring and notify the provider of category II tracing
Rationale: The presentation of sudden severe abdominal pain, rigid uterus, dark
clotted bleeding, and late decelerations is classic for placental abruption with
concealed hemorrhage. This is a true obstetric emergency requiring immediate
delivery to prevent maternal hemorrhage, coagulopathy (DIC), and fetal demise.
Sterile vaginal exam is contraindicated in suspected abruption due to risk of
triggering catastrophic hemorrhage. Betamethasone is inappropriate at 34 weeks
with acute fetal compromise requiring immediate delivery. While fetal monitoring is
important, it does not take priority over preparing for emergent delivery.
Correct Answer: B
Question 3
A 30-year-old G2P1 at 28 weeks gestation is diagnosed with placenta previa after an
episode of painless, bright red vaginal bleeding. The bleeding has stopped, and both
mother and fetus are stable. Which instruction should the nurse include in the
discharge teaching plan?
A. "You may resume sexual intercourse once the bleeding has stopped for 48 hours."
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B. "Pelvic rest is essential—no intercourse, no tampons, and no douching until
delivery."
C. "You should perform daily kick counts and report fewer than 10 movements in 2
hours."
D. "Schedule a follow-up cervical cerclage placement at your next prenatal visit."
Rationale: Placenta previa requires strict pelvic rest (no vaginal intercourse, tampons,
or douching) to prevent disruption of the placental implantation site and recurrent
bleeding. Sexual activity is absolutely contraindicated (Option A is incorrect). While
kick counts are important, the specific threshold is typically fewer than 10
movements in 2 hours for women at this gestational age, but this is not the most
critical teaching point for placenta previa management. Cervical cerclage is
contraindicated in placenta previa. Pelvic rest is the cornerstone of conservative
management for stable placenta previa.
Correct Answer: B
Question 4
A 35-year-old G1P0 at 24 weeks gestation with type 1 diabetes mellitus presents for
her routine prenatal visit. Her fasting blood glucose is 142 mg/dL and her HbA1c is
7.8%. Which finding indicates the greatest risk to the fetus?
A. Risk of macrosomia requiring cesarean delivery
B. Risk of congenital cardiac anomalies
C. Risk of intrauterine growth restriction
D. Risk of neural tube defects
Rationale: While all options represent potential complications of maternal diabetes,
congenital cardiac anomalies are the most common structural malformation in
infants of diabetic mothers and occur during the first trimester when glycemic
control is critical. An HbA1c of 7.8% indicates suboptimal glycemic control. Neural
tube defects (Option D) are also associated with poor glycemic control but are less
common than cardiac anomalies. Macrosomia (Option A) typically develops in the
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third trimester with ongoing hyperglycemia. IUGR (Option C) is more associated with
vascular complications of diabetes rather than glycemic control alone.
Correct Answer: B
Question 5
A 29-year-old G2P1 at 16 weeks gestation is considering prenatal diagnostic testing.
She had a positive cell-free DNA screening for trisomy 21. The nurse is counseling
her about confirmatory testing options. Which statement by the nurse is most
accurate?
A. "Chorionic villus sampling can be performed now at 16 weeks and carries a lower
miscarriage risk than amniocentesis."
B. "Amniocentesis is typically performed between 15-20 weeks and is the
recommended confirmatory test at your gestational age."
C. "Cell-free DNA is diagnostic, so no further testing is needed unless you want to
confirm the fetal sex."
D. "You should wait until 24 weeks for a detailed anatomy ultrasound, which will
provide a definitive diagnosis."
Rationale: Cell-free DNA (cfDNA) is a screening test, not diagnostic. Amniocentesis is
performed at 15-20 weeks gestation and is the appropriate confirmatory diagnostic
test at 16 weeks. Chorionic villus sampling (Option A) is performed at 10-13 weeks
and is no longer appropriate at 16 weeks. Option C is incorrect because cfDNA is
screening, not diagnostic. Option D is incorrect because ultrasound cannot provide a
definitive chromosomal diagnosis.
Correct Answer: B
Question 6
HESI MATERNITY OB EXAM VERSION 2 2026/2027 |
Actual Exam Questions | Detailed Verified Answers | A+
Grade Assured | Pass Guaranteed
Section 1: Antepartum Complications & Prenatal Care (Q1-12)
Question 1
A 28-year-old primigravida at 10 weeks gestation is admitted with severe nausea and
vomiting, weight loss of 6 lbs in one week, and ketonuria. She is unable to tolerate
oral intake. The healthcare provider orders IV dextrose 5% in normal saline at 125
mL/hr. What is the nurse's priority intervention before initiating this infusion?
A. Administer thiamine 100 mg IV prior to dextrose infusion to prevent Wernicke's
encephalopathy [CORRECT]
B. Start the dextrose infusion immediately to correct maternal ketosis and prevent
fetal hypoglycemia
C. Obtain a serum glucose level and wait for results before administering any IV
fluids
D. Administer ondansetron 4 mg IV push first to control vomiting before starting
fluids
Rationale: Hyperemesis gravidarum with prolonged vomiting and poor nutritional
intake places the patient at high risk for thiamine (vitamin B1) deficiency.
Administering dextrose without thiamine supplementation can precipitate or worsen
Wernicke's encephalopathy because glucose metabolism increases thiamine
utilization. Thiamine 100 mg IV must be given before any dextrose-containing
solution per AWHONN and ACOG guidelines. Option B is dangerous without
thiamine. Option C delays necessary treatment. Option D addresses symptom control
but is not the priority over preventing neurological injury.
Correct Answer: A
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Question 2
A 32-year-old G3P2 at 34 weeks gestation presents to the emergency department
with sudden onset of severe abdominal pain and vaginal bleeding. Her abdomen is
rigid and tender. Fetal heart rate shows late decelerations. The nurse notes the
bleeding appears dark and clotted. Which action should the nurse take first?
A. Perform a sterile vaginal examination to assess cervical dilation
B. Prepare the patient for immediate cesarean delivery and initiate large-bore IV
access
C. Administer betamethasone 12 mg IM to promote fetal lung maturity
D. Apply external fetal monitoring and notify the provider of category II tracing
Rationale: The presentation of sudden severe abdominal pain, rigid uterus, dark
clotted bleeding, and late decelerations is classic for placental abruption with
concealed hemorrhage. This is a true obstetric emergency requiring immediate
delivery to prevent maternal hemorrhage, coagulopathy (DIC), and fetal demise.
Sterile vaginal exam is contraindicated in suspected abruption due to risk of
triggering catastrophic hemorrhage. Betamethasone is inappropriate at 34 weeks
with acute fetal compromise requiring immediate delivery. While fetal monitoring is
important, it does not take priority over preparing for emergent delivery.
Correct Answer: B
Question 3
A 30-year-old G2P1 at 28 weeks gestation is diagnosed with placenta previa after an
episode of painless, bright red vaginal bleeding. The bleeding has stopped, and both
mother and fetus are stable. Which instruction should the nurse include in the
discharge teaching plan?
A. "You may resume sexual intercourse once the bleeding has stopped for 48 hours."
,3
B. "Pelvic rest is essential—no intercourse, no tampons, and no douching until
delivery."
C. "You should perform daily kick counts and report fewer than 10 movements in 2
hours."
D. "Schedule a follow-up cervical cerclage placement at your next prenatal visit."
Rationale: Placenta previa requires strict pelvic rest (no vaginal intercourse, tampons,
or douching) to prevent disruption of the placental implantation site and recurrent
bleeding. Sexual activity is absolutely contraindicated (Option A is incorrect). While
kick counts are important, the specific threshold is typically fewer than 10
movements in 2 hours for women at this gestational age, but this is not the most
critical teaching point for placenta previa management. Cervical cerclage is
contraindicated in placenta previa. Pelvic rest is the cornerstone of conservative
management for stable placenta previa.
Correct Answer: B
Question 4
A 35-year-old G1P0 at 24 weeks gestation with type 1 diabetes mellitus presents for
her routine prenatal visit. Her fasting blood glucose is 142 mg/dL and her HbA1c is
7.8%. Which finding indicates the greatest risk to the fetus?
A. Risk of macrosomia requiring cesarean delivery
B. Risk of congenital cardiac anomalies
C. Risk of intrauterine growth restriction
D. Risk of neural tube defects
Rationale: While all options represent potential complications of maternal diabetes,
congenital cardiac anomalies are the most common structural malformation in
infants of diabetic mothers and occur during the first trimester when glycemic
control is critical. An HbA1c of 7.8% indicates suboptimal glycemic control. Neural
tube defects (Option D) are also associated with poor glycemic control but are less
common than cardiac anomalies. Macrosomia (Option A) typically develops in the
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third trimester with ongoing hyperglycemia. IUGR (Option C) is more associated with
vascular complications of diabetes rather than glycemic control alone.
Correct Answer: B
Question 5
A 29-year-old G2P1 at 16 weeks gestation is considering prenatal diagnostic testing.
She had a positive cell-free DNA screening for trisomy 21. The nurse is counseling
her about confirmatory testing options. Which statement by the nurse is most
accurate?
A. "Chorionic villus sampling can be performed now at 16 weeks and carries a lower
miscarriage risk than amniocentesis."
B. "Amniocentesis is typically performed between 15-20 weeks and is the
recommended confirmatory test at your gestational age."
C. "Cell-free DNA is diagnostic, so no further testing is needed unless you want to
confirm the fetal sex."
D. "You should wait until 24 weeks for a detailed anatomy ultrasound, which will
provide a definitive diagnosis."
Rationale: Cell-free DNA (cfDNA) is a screening test, not diagnostic. Amniocentesis is
performed at 15-20 weeks gestation and is the appropriate confirmatory diagnostic
test at 16 weeks. Chorionic villus sampling (Option A) is performed at 10-13 weeks
and is no longer appropriate at 16 weeks. Option C is incorrect because cfDNA is
screening, not diagnostic. Option D is incorrect because ultrasound cannot provide a
definitive chromosomal diagnosis.
Correct Answer: B
Question 6
