HESI RN NGN Maternity Exam Questions | 100%
Correct Answers with Evidence-Based Rationales
(2026/2027 Edition)
SECTION 1: Antepartum Nursing Care
Question 1
A 32-year-old primigravida at 10 weeks gestation reports to the clinic with nausea and
vomiting. She states she has been unable to keep any food down for the past 24 hours
and has vomited 5 times. Assessment reveals dry mucous membranes, tachycardia (HR
110 bpm), and a 2-pound weight loss since her last visit one week ago. Which
assessment finding is the priority for the nurse to address?
A. Nausea and vomiting frequency
B. Maternal weight loss
C. Signs of dehydration
D. Fetal heart rate assessment
Correct Answer: C
Rationale: The client is exhibiting signs of dehydration (dry mucous membranes,
tachycardia, weight loss), which is the priority assessment finding. Dehydration in
hyperemesis gravidarum can lead to electrolyte imbalances, ketosis, and metabolic
alkalosis, posing risks to both maternal and fetal well-being. While nausea frequency (A)
and weight loss (B) are concerning, the physiological signs of dehydration indicate a
more immediate threat. Fetal heart rate assessment (D) is not typically performed at 10
weeks gestation via Doppler in the outpatient setting and is not the priority over
maternal stabilization.
Question 2
,A nurse is providing prenatal education to a group of pregnant clients. Which statement
by a client indicates a correct understanding of physiologic anemia of pregnancy?
A. "My hemoglobin dropped because I am not eating enough iron-rich foods."
B. "My blood volume increases more than my red blood cell mass, diluting my
hemoglobin."
C. "I need a blood transfusion because my hemoglobin is 10.5 g/dL at 28 weeks."
D. "Physiologic anemia means I have a vitamin B12 deficiency."
Correct Answer: B
Rationale: Physiologic anemia of pregnancy occurs because plasma volume increases
by approximately 40-50% while red blood cell mass increases by only 20-30%, resulting
in hemodilution. This is a normal adaptation, not a true anemia requiring intervention
unless hemoglobin falls below 10 g/dL or hematocrit below 30% in the second
trimester. Option A incorrectly attributes the cause to dietary deficiency. Option C is
incorrect because a hemoglobin of 10.5 g/dL at 28 weeks is within expected
parameters and does not require transfusion. Option D confuses physiologic anemia
with megaloblastic anemia.
Question 3
A pregnant client at 24 weeks gestation with pregestational type 1 diabetes is being
monitored in the antepartum clinic. Her fasting blood glucose has been consistently
105-115 mg/dL. The nurse recognizes that maintaining euglycemia is critical to prevent
which congenital anomaly?
A. Neural tube defects
B. Cardiac septal defects
C. Sacral agenesis
D. Cleft lip and palate
Correct Answer: C
,Rationale: Sacral agenesis (caudal regression syndrome) is the congenital anomaly
most specifically associated with poor glycemic control in pregestational diabetes,
particularly during organogenesis in the first trimester. While neural tube defects (A),
cardiac defects (B), and cleft lip/palate (D) can also occur with maternal diabetes,
sacral agenesis is considered the most pathognomonic anomaly. Maintaining HbA1c
<6.5% and fasting glucose <95 mg/dL reduces these risks.
Question 4
A 28-year-old G2P1001 at 32 weeks gestation presents to the clinic complaining of
persistent itching, particularly on her palms and soles. Laboratory studies reveal
elevated bile acids and normal liver enzymes. The nurse anticipates which immediate
intervention?
A. Schedule induction of labor at 37 weeks
B. Administer ursodeoxycholic acid and increase fetal surveillance
C. Recommend topical antihistamines and emollients
D. Order a hepatitis panel
Correct Answer: B
Rationale: The client is exhibiting classic signs of intrahepatic cholestasis of pregnancy
(ICP): pruritus of palms and soles in the third trimester with elevated bile acids.
Ursodeoxycholic acid (UDCA) is the first-line treatment to reduce bile acids and relieve
pruritus. Increased fetal surveillance (non-stress tests and biophysical profiles) is
indicated due to the increased risk of sudden fetal death, particularly with bile acids >40
μmol/L. Delivery is typically recommended at 36-37 weeks (not 37 weeks as a blanket
statement without bile acid levels). Topical treatments (C) do not address the
underlying pathophysiology. Hepatitis panel (D) is not indicated with normal liver
enzymes.
Question 5
, A pregnant client at 18 weeks gestation is diagnosed with a low-lying placenta on
ultrasound, with the placental edge 1.5 cm from the internal os. The nurse should
include which instruction in the client's teaching plan?
A. "You will need complete bed rest for the remainder of your pregnancy."
B. "You should avoid sexual intercourse and report any vaginal bleeding immediately."
C. "A cesarean birth is scheduled for 37 weeks gestation."
D. "You will require weekly amniocentesis to monitor fetal lung maturity."
Correct Answer: B
Rationale: A low-lying placenta (placental edge within 2 cm but not covering the internal
os) may resolve as the uterus grows. Pelvic rest (no intercourse, no douching) and
bleeding precautions are standard instructions. Complete bed rest (A) is not
evidence-based and is no longer routinely recommended. Cesarean birth (C) is only
indicated if the placenta covers the internal os (placenta previa) at term. Amniocentesis
(D) is unrelated to placental location.
Question 6
A nurse is reviewing the laboratory results of a pregnant client at 28 weeks gestation.
Which finding requires immediate follow-up?
A. Hemoglobin 10.8 g/dL
B. Platelet count 85,000/mm³
C. White blood cell count 12,000/mm³
D. Blood glucose 140 mg/dL 1 hour after glucose challenge
Correct Answer: B
Rationale: A platelet count of 85,000/mm³ is thrombocytopenia and requires immediate
investigation for causes such as gestational thrombocytopenia, immune
thrombocytopenic purpura (ITP), or preeclampsia/HELLP syndrome. Hemoglobin 10.8
g/dL (A) is consistent with physiologic anemia of pregnancy. WBC 12,000/mm³ (C) is a
Correct Answers with Evidence-Based Rationales
(2026/2027 Edition)
SECTION 1: Antepartum Nursing Care
Question 1
A 32-year-old primigravida at 10 weeks gestation reports to the clinic with nausea and
vomiting. She states she has been unable to keep any food down for the past 24 hours
and has vomited 5 times. Assessment reveals dry mucous membranes, tachycardia (HR
110 bpm), and a 2-pound weight loss since her last visit one week ago. Which
assessment finding is the priority for the nurse to address?
A. Nausea and vomiting frequency
B. Maternal weight loss
C. Signs of dehydration
D. Fetal heart rate assessment
Correct Answer: C
Rationale: The client is exhibiting signs of dehydration (dry mucous membranes,
tachycardia, weight loss), which is the priority assessment finding. Dehydration in
hyperemesis gravidarum can lead to electrolyte imbalances, ketosis, and metabolic
alkalosis, posing risks to both maternal and fetal well-being. While nausea frequency (A)
and weight loss (B) are concerning, the physiological signs of dehydration indicate a
more immediate threat. Fetal heart rate assessment (D) is not typically performed at 10
weeks gestation via Doppler in the outpatient setting and is not the priority over
maternal stabilization.
Question 2
,A nurse is providing prenatal education to a group of pregnant clients. Which statement
by a client indicates a correct understanding of physiologic anemia of pregnancy?
A. "My hemoglobin dropped because I am not eating enough iron-rich foods."
B. "My blood volume increases more than my red blood cell mass, diluting my
hemoglobin."
C. "I need a blood transfusion because my hemoglobin is 10.5 g/dL at 28 weeks."
D. "Physiologic anemia means I have a vitamin B12 deficiency."
Correct Answer: B
Rationale: Physiologic anemia of pregnancy occurs because plasma volume increases
by approximately 40-50% while red blood cell mass increases by only 20-30%, resulting
in hemodilution. This is a normal adaptation, not a true anemia requiring intervention
unless hemoglobin falls below 10 g/dL or hematocrit below 30% in the second
trimester. Option A incorrectly attributes the cause to dietary deficiency. Option C is
incorrect because a hemoglobin of 10.5 g/dL at 28 weeks is within expected
parameters and does not require transfusion. Option D confuses physiologic anemia
with megaloblastic anemia.
Question 3
A pregnant client at 24 weeks gestation with pregestational type 1 diabetes is being
monitored in the antepartum clinic. Her fasting blood glucose has been consistently
105-115 mg/dL. The nurse recognizes that maintaining euglycemia is critical to prevent
which congenital anomaly?
A. Neural tube defects
B. Cardiac septal defects
C. Sacral agenesis
D. Cleft lip and palate
Correct Answer: C
,Rationale: Sacral agenesis (caudal regression syndrome) is the congenital anomaly
most specifically associated with poor glycemic control in pregestational diabetes,
particularly during organogenesis in the first trimester. While neural tube defects (A),
cardiac defects (B), and cleft lip/palate (D) can also occur with maternal diabetes,
sacral agenesis is considered the most pathognomonic anomaly. Maintaining HbA1c
<6.5% and fasting glucose <95 mg/dL reduces these risks.
Question 4
A 28-year-old G2P1001 at 32 weeks gestation presents to the clinic complaining of
persistent itching, particularly on her palms and soles. Laboratory studies reveal
elevated bile acids and normal liver enzymes. The nurse anticipates which immediate
intervention?
A. Schedule induction of labor at 37 weeks
B. Administer ursodeoxycholic acid and increase fetal surveillance
C. Recommend topical antihistamines and emollients
D. Order a hepatitis panel
Correct Answer: B
Rationale: The client is exhibiting classic signs of intrahepatic cholestasis of pregnancy
(ICP): pruritus of palms and soles in the third trimester with elevated bile acids.
Ursodeoxycholic acid (UDCA) is the first-line treatment to reduce bile acids and relieve
pruritus. Increased fetal surveillance (non-stress tests and biophysical profiles) is
indicated due to the increased risk of sudden fetal death, particularly with bile acids >40
μmol/L. Delivery is typically recommended at 36-37 weeks (not 37 weeks as a blanket
statement without bile acid levels). Topical treatments (C) do not address the
underlying pathophysiology. Hepatitis panel (D) is not indicated with normal liver
enzymes.
Question 5
, A pregnant client at 18 weeks gestation is diagnosed with a low-lying placenta on
ultrasound, with the placental edge 1.5 cm from the internal os. The nurse should
include which instruction in the client's teaching plan?
A. "You will need complete bed rest for the remainder of your pregnancy."
B. "You should avoid sexual intercourse and report any vaginal bleeding immediately."
C. "A cesarean birth is scheduled for 37 weeks gestation."
D. "You will require weekly amniocentesis to monitor fetal lung maturity."
Correct Answer: B
Rationale: A low-lying placenta (placental edge within 2 cm but not covering the internal
os) may resolve as the uterus grows. Pelvic rest (no intercourse, no douching) and
bleeding precautions are standard instructions. Complete bed rest (A) is not
evidence-based and is no longer routinely recommended. Cesarean birth (C) is only
indicated if the placenta covers the internal os (placenta previa) at term. Amniocentesis
(D) is unrelated to placental location.
Question 6
A nurse is reviewing the laboratory results of a pregnant client at 28 weeks gestation.
Which finding requires immediate follow-up?
A. Hemoglobin 10.8 g/dL
B. Platelet count 85,000/mm³
C. White blood cell count 12,000/mm³
D. Blood glucose 140 mg/dL 1 hour after glucose challenge
Correct Answer: B
Rationale: A platelet count of 85,000/mm³ is thrombocytopenia and requires immediate
investigation for causes such as gestational thrombocytopenia, immune
thrombocytopenic purpura (ITP), or preeclampsia/HELLP syndrome. Hemoglobin 10.8
g/dL (A) is consistent with physiologic anemia of pregnancy. WBC 12,000/mm³ (C) is a
