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HESI MATERNITY OB EXAM VERSION 3
ACTUAL EXAM PREP 2026 ALL QUESTIONS
AND CORRECT DETAILED ANSWERS WITH
RATIONALES |TOP RATED VERSION FOR 2026
BY EXPERTS |NEW AND REVISED
1. A client at 34 weeks gestation with severe preeclampsia is receiving
magnesium sulfate. The nurse assesses the client's respiratory rate as 10
breaths per minute, and deep tendon reflexes are absent. Which
medication should the nurse prepare to administer?
A. Naloxone
B. Calcium gluconate
C. Protamine sulfate
D. Vitamin K
Correct Answer: B
Rationale: Respiratory depression (rate <12) and absent deep tendon
reflexes are signs of magnesium toxicity. The antidote is calcium
gluconate. Naloxone is for opioid overdose, protamine sulfate for
heparin reversal, and Vitamin K for warfarin reversal.
2. A client at 39 weeks gestation is in active labor. The fetal heart
tracing shows recurrent late decelerations with minimal variability.
Which nursing action should the nurse implement first?
A. Increase the oxytocin infusion rate
B. Place the client in a left lateral position
C. Administer oxygen at 10 L/min via face mask
D. Notify the healthcare provider
Correct Answer: B
Rationale: Late decelerations indicate uteroplacental insufficiency.
The priority action is to improve placental perfusion by placing the
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client in a lateral position. Oxygen and notifying the provider are
subsequent steps. Increasing oxytocin would worsen the decelerations.
3. A client at 16 weeks gestation is scheduled for a maternal serum
alpha-fetoprotein (MSAFP) screening. The nurse explains that an
elevated MSAFP level may indicate which fetal condition?
A. Down syndrome
B. Neural tube defect
C. Trisomy 18
D. Hydrocephalus
Correct Answer: B
Rationale: Elevated MSAFP is associated with open neural tube
defects such as spina bifida and anencephaly. Low MSAFP is
associated with Down syndrome and Trisomy 18. Hydrocephalus may
be associated with elevated MSAFP but neural tube defects are the
classic indication.
4. A postpartum client who is 1 day post-cesarean delivery reports
severe incisional pain despite receiving prescribed analgesics. The nurse
notes a localized area of erythema and warmth at the incision site. What
is the priority nursing action?
A. Reassess pain in 30 minutes
B. Apply a warm compress to the incision
C. Notify the healthcare provider
D. Administer an additional dose of analgesic
Correct Answer: C
Rationale: Erythema and warmth at the incision site may indicate a
wound infection. The nurse should notify the healthcare provider for
further evaluation and possible antibiotic therapy. Applying a warm
compress without provider order could exacerbate infection, and
administering additional analgesic does not address the underlying
cause.
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5. A client at 37 weeks gestation is admitted with spontaneous rupture of
membranes. The fluid is clear, and the fetal heart rate is 145 bpm. The
client is G2P1 and has a history of a previous vaginal delivery. What is
the most appropriate nursing action?
A. Perform a sterile vaginal exam to assess cervical dilation
B. Administer prophylactic antibiotics
C. Prepare for cesarean delivery
D. Initiate oxytocin infusion
Correct Answer: A
Rationale: A sterile vaginal exam should be performed to assess
cervical dilation and effacement. There is no indication for antibiotics,
cesarean delivery, or oxytocin without further assessment. The client is
at term with a reassuring fetal heart rate, so expectant management is
appropriate.
6. A client at 28 weeks gestation with gestational diabetes is taught
about self-monitoring of blood glucose. Which statement by the client
indicates understanding?
A. "I should check my blood glucose before meals and 2 hours after
meals."
B. "I should check my blood glucose only in the morning."
C. "I should check my blood glucose after each meal only."
D. "I should check my blood glucose once a week."
Correct Answer: A
Rationale: Blood glucose monitoring for gestational diabetes typically
includes checking before meals and 2 hours after meals to assess
glycemic control. Monitoring only in the morning or after meals only
is insufficient, and once weekly is inadequate.
7. A laboring client with an epidural in place has a blood pressure of
88/54 mm Hg. The client reports feeling lightheaded and nauseated.
What is the priority nursing action?
A. Place the client in a left lateral position
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B. Increase the IV fluid rate
C. Administer ephedrine
D. Notify the anesthesia provider
Correct Answer: A
Rationale: Hypotension following epidural placement is managed by
positioning the client laterally to displace the uterus off the vena cava,
improving venous return. Increasing IV fluids, administering
ephedrine, and notifying the provider are subsequent steps if
repositioning is ineffective.
8. A client at 32 weeks gestation with preterm labor is prescribed
betamethasone. The nurse explains that the medication is given to:
A. Stop uterine contractions
B. Promote fetal lung maturity
C. Reduce maternal blood pressure
D. Prevent infection
Correct Answer: B
Rationale: Betamethasone is a corticosteroid administered to women
at risk for preterm delivery to accelerate fetal lung maturity by
stimulating surfactant production. Tocolytics stop contractions;
betamethasone does not reduce blood pressure or prevent infection.
9. A client at 40 weeks gestation is in active labor. The nurse notes that
the fetal heart rate baseline is 165 bpm. What is the most appropriate
nursing action?
A. Continue to monitor
B. Notify the healthcare provider
C. Administer oxygen
D. Place the client in a left lateral position
Correct Answer: B
Rationale: A baseline fetal heart rate of >160 bpm indicates fetal
tachycardia, which may be a sign of fetal distress, maternal fever, or
infection. The nurse should notify the healthcare provider for further
HESI MATERNITY OB EXAM VERSION 3
ACTUAL EXAM PREP 2026 ALL QUESTIONS
AND CORRECT DETAILED ANSWERS WITH
RATIONALES |TOP RATED VERSION FOR 2026
BY EXPERTS |NEW AND REVISED
1. A client at 34 weeks gestation with severe preeclampsia is receiving
magnesium sulfate. The nurse assesses the client's respiratory rate as 10
breaths per minute, and deep tendon reflexes are absent. Which
medication should the nurse prepare to administer?
A. Naloxone
B. Calcium gluconate
C. Protamine sulfate
D. Vitamin K
Correct Answer: B
Rationale: Respiratory depression (rate <12) and absent deep tendon
reflexes are signs of magnesium toxicity. The antidote is calcium
gluconate. Naloxone is for opioid overdose, protamine sulfate for
heparin reversal, and Vitamin K for warfarin reversal.
2. A client at 39 weeks gestation is in active labor. The fetal heart
tracing shows recurrent late decelerations with minimal variability.
Which nursing action should the nurse implement first?
A. Increase the oxytocin infusion rate
B. Place the client in a left lateral position
C. Administer oxygen at 10 L/min via face mask
D. Notify the healthcare provider
Correct Answer: B
Rationale: Late decelerations indicate uteroplacental insufficiency.
The priority action is to improve placental perfusion by placing the
,2|Page
client in a lateral position. Oxygen and notifying the provider are
subsequent steps. Increasing oxytocin would worsen the decelerations.
3. A client at 16 weeks gestation is scheduled for a maternal serum
alpha-fetoprotein (MSAFP) screening. The nurse explains that an
elevated MSAFP level may indicate which fetal condition?
A. Down syndrome
B. Neural tube defect
C. Trisomy 18
D. Hydrocephalus
Correct Answer: B
Rationale: Elevated MSAFP is associated with open neural tube
defects such as spina bifida and anencephaly. Low MSAFP is
associated with Down syndrome and Trisomy 18. Hydrocephalus may
be associated with elevated MSAFP but neural tube defects are the
classic indication.
4. A postpartum client who is 1 day post-cesarean delivery reports
severe incisional pain despite receiving prescribed analgesics. The nurse
notes a localized area of erythema and warmth at the incision site. What
is the priority nursing action?
A. Reassess pain in 30 minutes
B. Apply a warm compress to the incision
C. Notify the healthcare provider
D. Administer an additional dose of analgesic
Correct Answer: C
Rationale: Erythema and warmth at the incision site may indicate a
wound infection. The nurse should notify the healthcare provider for
further evaluation and possible antibiotic therapy. Applying a warm
compress without provider order could exacerbate infection, and
administering additional analgesic does not address the underlying
cause.
,3|Page
5. A client at 37 weeks gestation is admitted with spontaneous rupture of
membranes. The fluid is clear, and the fetal heart rate is 145 bpm. The
client is G2P1 and has a history of a previous vaginal delivery. What is
the most appropriate nursing action?
A. Perform a sterile vaginal exam to assess cervical dilation
B. Administer prophylactic antibiotics
C. Prepare for cesarean delivery
D. Initiate oxytocin infusion
Correct Answer: A
Rationale: A sterile vaginal exam should be performed to assess
cervical dilation and effacement. There is no indication for antibiotics,
cesarean delivery, or oxytocin without further assessment. The client is
at term with a reassuring fetal heart rate, so expectant management is
appropriate.
6. A client at 28 weeks gestation with gestational diabetes is taught
about self-monitoring of blood glucose. Which statement by the client
indicates understanding?
A. "I should check my blood glucose before meals and 2 hours after
meals."
B. "I should check my blood glucose only in the morning."
C. "I should check my blood glucose after each meal only."
D. "I should check my blood glucose once a week."
Correct Answer: A
Rationale: Blood glucose monitoring for gestational diabetes typically
includes checking before meals and 2 hours after meals to assess
glycemic control. Monitoring only in the morning or after meals only
is insufficient, and once weekly is inadequate.
7. A laboring client with an epidural in place has a blood pressure of
88/54 mm Hg. The client reports feeling lightheaded and nauseated.
What is the priority nursing action?
A. Place the client in a left lateral position
, 4|Page
B. Increase the IV fluid rate
C. Administer ephedrine
D. Notify the anesthesia provider
Correct Answer: A
Rationale: Hypotension following epidural placement is managed by
positioning the client laterally to displace the uterus off the vena cava,
improving venous return. Increasing IV fluids, administering
ephedrine, and notifying the provider are subsequent steps if
repositioning is ineffective.
8. A client at 32 weeks gestation with preterm labor is prescribed
betamethasone. The nurse explains that the medication is given to:
A. Stop uterine contractions
B. Promote fetal lung maturity
C. Reduce maternal blood pressure
D. Prevent infection
Correct Answer: B
Rationale: Betamethasone is a corticosteroid administered to women
at risk for preterm delivery to accelerate fetal lung maturity by
stimulating surfactant production. Tocolytics stop contractions;
betamethasone does not reduce blood pressure or prevent infection.
9. A client at 40 weeks gestation is in active labor. The nurse notes that
the fetal heart rate baseline is 165 bpm. What is the most appropriate
nursing action?
A. Continue to monitor
B. Notify the healthcare provider
C. Administer oxygen
D. Place the client in a left lateral position
Correct Answer: B
Rationale: A baseline fetal heart rate of >160 bpm indicates fetal
tachycardia, which may be a sign of fetal distress, maternal fever, or
infection. The nurse should notify the healthcare provider for further
