1
HESI RN NGN Maternity Exam 2026/2027 –
Actual Exam Questions with Verified Answers &
Evidence-Based Rationales
Antepartum (Questions 1–15)
1. A client at 32 weeks gestation presents with painless, bright red vaginal bleeding. What is the
priority action?
• A) Perform a vaginal exam
• B) Prepare for immediate cesarean section
• C) Apply an external fetal monitor and obtain vital signs
• D) Administer oxytocin to augment labor
Answer: C
Rationale: Painless bleeding in the third trimester is classic for placenta previa until proven
otherwise. Vaginal exams are contraindicated because they can cause catastrophic hemorrhage.
The priority is maternal/fetal assessment (vitals, fetal heart rate) and preparation for possible
delivery.
2. A client with preeclampsia has a blood pressure of 158/102 mmHg and reports a headache and
blurred vision. Which medication should the nurse anticipate administering?
• A) Nifedipine
• B) Magnesium sulfate
• C) Labetalol
• D) Hydralazine
Answer: D
Rationale: Severe preeclampsia with neurological symptoms (headache, visual changes) requires
rapid BP reduction. Hydralazine or labetalol are preferred IV agents. Magnesium sulfate is for
seizure prophylaxis, not acute BP control.
3. A nurse is calculating an estimated date of birth (EDB) using Nagele's rule. The client's last
menstrual period (LMP) was May 20. What is the EDB?
• A) February 27
• B) February 20
, 2
• C) March 3
• D) August 27
Answer: A
Rationale: Nagele's rule: subtract 3 months (May → February) and add 7 days (20+7=27). EDB
= February 27.
4. A client at 28 weeks gestation fails the 1-hour glucose challenge test with a result of 155 mg/dL.
What is the next step?
• A) Diagnose gestational diabetes
• B) Repeat the 1-hour test in 2 weeks
• C) Order a 3-hour oral glucose tolerance test (OGTT)
• D) Start insulin therapy
Answer: C
Rationale: A 1-hour glucose result ≥130–140 mg/dL requires a 3-hour OGTT for definitive diagnosis
of gestational diabetes. A single elevated value does not confirm the diagnosis.
5. A primigravida at 10 weeks gestation reports frequent nausea and vomiting. Which suggestion
is most appropriate?
• A) Eat three large meals daily
• B) Drink fluids with meals
• C) Eat dry crackers before getting out of bed
• D) Lie flat after eating
Answer: C
Rationale: Dry crackers or toast before rising helps manage morning sickness by stabilizing blood
glucose and reducing gastric emptiness. Small, frequent meals and separating fluids from solids are
also recommended.
6. A client with ruptured membranes at 36 weeks reports a gush of fluid and fever of 101.2°F.
What is the priority?
• A) Check cervical dilation
• B) Administer antipyretics
• C) Start broad-spectrum antibiotics
• D) Perform a nitrazine test
, 3
Answer: C
Rationale: Fever + ruptured membranes = suspected chorioamnionitis. The priority is initiating
broad-spectrum antibiotics to prevent maternal and fetal sepsis. Delivery is often indicated.
7. A client at 20 weeks gestation is Rh-negative and unsensitized. Her partner is Rh-positive. Which
intervention is required?
• A) Administer RhIg at 28 weeks and within 72 hours of birth
• B) Administer RhIg now
• C) No intervention needed
• D) Administer RhIg only if the baby is Rh-positive at birth
Answer: A
Rationale: Standard prophylaxis: RhIg (RhoGAM) at 28 weeks gestation and again within 72 hours
postpartum if the newborn is Rh-positive. This prevents maternal sensitization.
8. A client with suspected ectopic pregnancy reports sharp, unilateral pelvic pain and scant dark
vaginal bleeding. Which finding would the nurse expect on assessment?
• A) Cervical dilation of 4 cm
• B) Rebound tenderness and guarding
• C) Painless uterine contractions
• D) Fetal heart tones audible by Doppler
Answer: B
Rationale: Ectopic pregnancy can cause peritoneal irritation leading to rebound tenderness and
guarding. Signs of hypovolemic shock (tachycardia, hypotension) may follow if rupture occurs.
Cervical dilation and FHR are not expected.
9. A client at 34 weeks with gestational diabetes is having a biophysical profile (BPP). Which
component is NOT part of the BPP?
• A) Fetal breathing movements
• B) Fetal tone
• C) Amniotic fluid volume
• D) Fetal heart rate variability
Answer: D
Rationale: A BPP includes: fetal breathing, fetal movement, fetal tone, amniotic fluid volume, and a
non-stress test (NST). Fetal heart rate variability is assessed via NST but is not a separate
component.
HESI RN NGN Maternity Exam 2026/2027 –
Actual Exam Questions with Verified Answers &
Evidence-Based Rationales
Antepartum (Questions 1–15)
1. A client at 32 weeks gestation presents with painless, bright red vaginal bleeding. What is the
priority action?
• A) Perform a vaginal exam
• B) Prepare for immediate cesarean section
• C) Apply an external fetal monitor and obtain vital signs
• D) Administer oxytocin to augment labor
Answer: C
Rationale: Painless bleeding in the third trimester is classic for placenta previa until proven
otherwise. Vaginal exams are contraindicated because they can cause catastrophic hemorrhage.
The priority is maternal/fetal assessment (vitals, fetal heart rate) and preparation for possible
delivery.
2. A client with preeclampsia has a blood pressure of 158/102 mmHg and reports a headache and
blurred vision. Which medication should the nurse anticipate administering?
• A) Nifedipine
• B) Magnesium sulfate
• C) Labetalol
• D) Hydralazine
Answer: D
Rationale: Severe preeclampsia with neurological symptoms (headache, visual changes) requires
rapid BP reduction. Hydralazine or labetalol are preferred IV agents. Magnesium sulfate is for
seizure prophylaxis, not acute BP control.
3. A nurse is calculating an estimated date of birth (EDB) using Nagele's rule. The client's last
menstrual period (LMP) was May 20. What is the EDB?
• A) February 27
• B) February 20
, 2
• C) March 3
• D) August 27
Answer: A
Rationale: Nagele's rule: subtract 3 months (May → February) and add 7 days (20+7=27). EDB
= February 27.
4. A client at 28 weeks gestation fails the 1-hour glucose challenge test with a result of 155 mg/dL.
What is the next step?
• A) Diagnose gestational diabetes
• B) Repeat the 1-hour test in 2 weeks
• C) Order a 3-hour oral glucose tolerance test (OGTT)
• D) Start insulin therapy
Answer: C
Rationale: A 1-hour glucose result ≥130–140 mg/dL requires a 3-hour OGTT for definitive diagnosis
of gestational diabetes. A single elevated value does not confirm the diagnosis.
5. A primigravida at 10 weeks gestation reports frequent nausea and vomiting. Which suggestion
is most appropriate?
• A) Eat three large meals daily
• B) Drink fluids with meals
• C) Eat dry crackers before getting out of bed
• D) Lie flat after eating
Answer: C
Rationale: Dry crackers or toast before rising helps manage morning sickness by stabilizing blood
glucose and reducing gastric emptiness. Small, frequent meals and separating fluids from solids are
also recommended.
6. A client with ruptured membranes at 36 weeks reports a gush of fluid and fever of 101.2°F.
What is the priority?
• A) Check cervical dilation
• B) Administer antipyretics
• C) Start broad-spectrum antibiotics
• D) Perform a nitrazine test
, 3
Answer: C
Rationale: Fever + ruptured membranes = suspected chorioamnionitis. The priority is initiating
broad-spectrum antibiotics to prevent maternal and fetal sepsis. Delivery is often indicated.
7. A client at 20 weeks gestation is Rh-negative and unsensitized. Her partner is Rh-positive. Which
intervention is required?
• A) Administer RhIg at 28 weeks and within 72 hours of birth
• B) Administer RhIg now
• C) No intervention needed
• D) Administer RhIg only if the baby is Rh-positive at birth
Answer: A
Rationale: Standard prophylaxis: RhIg (RhoGAM) at 28 weeks gestation and again within 72 hours
postpartum if the newborn is Rh-positive. This prevents maternal sensitization.
8. A client with suspected ectopic pregnancy reports sharp, unilateral pelvic pain and scant dark
vaginal bleeding. Which finding would the nurse expect on assessment?
• A) Cervical dilation of 4 cm
• B) Rebound tenderness and guarding
• C) Painless uterine contractions
• D) Fetal heart tones audible by Doppler
Answer: B
Rationale: Ectopic pregnancy can cause peritoneal irritation leading to rebound tenderness and
guarding. Signs of hypovolemic shock (tachycardia, hypotension) may follow if rupture occurs.
Cervical dilation and FHR are not expected.
9. A client at 34 weeks with gestational diabetes is having a biophysical profile (BPP). Which
component is NOT part of the BPP?
• A) Fetal breathing movements
• B) Fetal tone
• C) Amniotic fluid volume
• D) Fetal heart rate variability
Answer: D
Rationale: A BPP includes: fetal breathing, fetal movement, fetal tone, amniotic fluid volume, and a
non-stress test (NST). Fetal heart rate variability is assessed via NST but is not a separate
component.
