HESI PN MATERNAL-CHILD NURSING ACCURATE
COMPREHENSIVE PRACTICE EXAM WITH ALL
POSSIBLE APPROVED WELL ELABORATED
PRACTICE QUESTIONS AND 100% CORRECT
VERIFIED ANSWERS WITH DETAILED RATIONALES
PLUS EXPERT ANSWER KEY (100% CORRECT
VERIFIED SOLUTIONS) 2026-2027 CURRENTLY
UPDATED VERSION Q&A GUARANTEED PASS A+
INSTANT DOWNLOAD PDF
Question 1
A nurse is collecting data from a client who is at 36 weeks gestation and reports a
sudden gush of clear fluid from the vagina. Which action should the nurse take
first?
A. Obtain a sample of the fluid for Nitrazine testing
B. Place the client in a side-lying position
C. Prepare the client for an ultrasound
D. Perform a sterile vaginal examination
Correct Answer: B
Rationale: A sudden gush of fluid may indicate rupture of membranes. Placing the
client in a side-lying position reduces the risk of cord compression or prolapse and
should be done before any other assessment.
Question 2
A nurse is reinforcing teaching with a new mother about infant safety. Which
statement by the mother indicates a need for further instruction?
,A. “I will place my baby on the back to sleep.”
B. “I will keep soft pillows and blankets out of the crib.”
C. “I will use a crib with slats no more than 6 inches apart.”
D. “I will position the baby’s car seat rear-facing in the back seat.”
Correct Answer: C
Rationale: Crib slats should be no more than 2 3/8 inches apart to prevent the
infant’s head from becoming entrapped. Slats 6 inches apart are unsafe.
Question 3
A nurse is collecting data from a 2-day-old newborn. Which finding should the
nurse report to the healthcare provider?
A. Yellowish tint to the skin on the face
B. Milia on the nose and chin
C. Bluish discoloration of the hands and feet
D. A heart rate of 140 beats per minute
Correct Answer: A
Rationale: Jaundice appearing within the first 24 to 48 hours of life may indicate a
pathologic process, such as hemolytic disease. Milia, acrocyanosis, and a heart
rate of 140 are normal newborn findings.
Question 4
A nurse is assisting with the care of a client in the first stage of labor. The client’s
contractions are occurring every 2 minutes and lasting 90 seconds. The fetal heart
rate is 170 beats per minute with minimal variability. The nurse should identify
these findings as indicating which condition?
A. Normal labor progression
B. Uteroplacental insufficiency
C. Maternal exhaustion
D. Impending delivery
Correct Answer: B
Rationale: Contractions that are too frequent and prolonged decrease placental
perfusion. Fetal tachycardia with minimal variability suggests fetal distress related
to inadequate oxygenation.
,Question 5
A nurse is reinforcing teaching about breastfeeding with a client who is 2 days
postpartum. Which statement by the client indicates understanding?
A. “I should limit feedings to 10 minutes on each breast.”
B. “I should wake my baby for feedings every 4 hours.”
C. “I should ensure the baby’s mouth covers the nipple only.”
D. “I should feed the baby on demand, at least 8 to 12 times per day.”
Correct Answer: D
Rationale: Breastfed newborns should feed on demand, typically 8 to 12 times in
24 hours, to establish milk supply and support newborn nutrition.
Question 6
A nurse is caring for a client at 32 weeks gestation who reports a severe,
unrelenting headache and blurred vision. The nurse notes 3+ pitting edema of the
lower extremities. Which action should the nurse take first?
A. Administer acetaminophen as prescribed
B. Obtain a urine specimen for protein
C. Place the client in a dark, quiet room
D. Notify the registered nurse or healthcare provider
Correct Answer: D
Rationale: Severe headache, blurred vision, and edema suggest preeclampsia,
which can progress to eclampsia. The provider should be notified immediately for
further evaluation and treatment.
Question 7
A nurse is collecting data from a postpartum client who delivered 12 hours ago.
The nurse notes the fundus is boggy and displaced to the right of the umbilicus.
Which action should the nurse take first?
A. Assist the client to empty her bladder
B. Administer a prescribed analgesic
C. Massage the fundus firmly
D. Document the finding as normal
Correct Answer: A
Rationale: A full bladder displaces the uterus to the right and prevents effective
, contraction. Emptying the bladder is the first intervention before massaging the
fundus.
Question 8
A nurse is assisting a client who is at 39 weeks gestation and in active labor. The
client suddenly reports severe abdominal pain and the nurse observes a large
amount of dark red vaginal bleeding. Which action should the nurse take
immediately?
A. Perform a vaginal examination
B. Administer oxygen by face mask
C. Notify the healthcare provider
D. Insert an indwelling urinary catheter
Correct Answer: C
Rationale: Sudden severe pain with dark red bleeding suggests placental
abruption. A vaginal examination is contraindicated. The provider must be
notified immediately for emergency intervention.
Question 9
A nurse is collecting data from a newborn. Which finding indicates a need for
further evaluation?
A. Respiratory rate of 55 breaths per minute
B. Apical pulse of 120 beats per minute
C. Axillary temperature of 97.5 degrees Fahrenheit
D. Jaundice noted at 30 hours of age
Correct Answer: D
Rationale: Jaundice at 30 hours of age may be physiologic but requires continued
monitoring and possible bilirubin testing. The other findings are within normal
newborn limits.
Question 10
A nurse is reinforcing teaching with a client who is 28 weeks gestation and has
gestational diabetes. Which statement by the client indicates understanding of
the teaching?
A. “I will avoid all carbohydrates in my diet.”
B. “I will check my blood glucose only when I feel dizzy.”
COMPREHENSIVE PRACTICE EXAM WITH ALL
POSSIBLE APPROVED WELL ELABORATED
PRACTICE QUESTIONS AND 100% CORRECT
VERIFIED ANSWERS WITH DETAILED RATIONALES
PLUS EXPERT ANSWER KEY (100% CORRECT
VERIFIED SOLUTIONS) 2026-2027 CURRENTLY
UPDATED VERSION Q&A GUARANTEED PASS A+
INSTANT DOWNLOAD PDF
Question 1
A nurse is collecting data from a client who is at 36 weeks gestation and reports a
sudden gush of clear fluid from the vagina. Which action should the nurse take
first?
A. Obtain a sample of the fluid for Nitrazine testing
B. Place the client in a side-lying position
C. Prepare the client for an ultrasound
D. Perform a sterile vaginal examination
Correct Answer: B
Rationale: A sudden gush of fluid may indicate rupture of membranes. Placing the
client in a side-lying position reduces the risk of cord compression or prolapse and
should be done before any other assessment.
Question 2
A nurse is reinforcing teaching with a new mother about infant safety. Which
statement by the mother indicates a need for further instruction?
,A. “I will place my baby on the back to sleep.”
B. “I will keep soft pillows and blankets out of the crib.”
C. “I will use a crib with slats no more than 6 inches apart.”
D. “I will position the baby’s car seat rear-facing in the back seat.”
Correct Answer: C
Rationale: Crib slats should be no more than 2 3/8 inches apart to prevent the
infant’s head from becoming entrapped. Slats 6 inches apart are unsafe.
Question 3
A nurse is collecting data from a 2-day-old newborn. Which finding should the
nurse report to the healthcare provider?
A. Yellowish tint to the skin on the face
B. Milia on the nose and chin
C. Bluish discoloration of the hands and feet
D. A heart rate of 140 beats per minute
Correct Answer: A
Rationale: Jaundice appearing within the first 24 to 48 hours of life may indicate a
pathologic process, such as hemolytic disease. Milia, acrocyanosis, and a heart
rate of 140 are normal newborn findings.
Question 4
A nurse is assisting with the care of a client in the first stage of labor. The client’s
contractions are occurring every 2 minutes and lasting 90 seconds. The fetal heart
rate is 170 beats per minute with minimal variability. The nurse should identify
these findings as indicating which condition?
A. Normal labor progression
B. Uteroplacental insufficiency
C. Maternal exhaustion
D. Impending delivery
Correct Answer: B
Rationale: Contractions that are too frequent and prolonged decrease placental
perfusion. Fetal tachycardia with minimal variability suggests fetal distress related
to inadequate oxygenation.
,Question 5
A nurse is reinforcing teaching about breastfeeding with a client who is 2 days
postpartum. Which statement by the client indicates understanding?
A. “I should limit feedings to 10 minutes on each breast.”
B. “I should wake my baby for feedings every 4 hours.”
C. “I should ensure the baby’s mouth covers the nipple only.”
D. “I should feed the baby on demand, at least 8 to 12 times per day.”
Correct Answer: D
Rationale: Breastfed newborns should feed on demand, typically 8 to 12 times in
24 hours, to establish milk supply and support newborn nutrition.
Question 6
A nurse is caring for a client at 32 weeks gestation who reports a severe,
unrelenting headache and blurred vision. The nurse notes 3+ pitting edema of the
lower extremities. Which action should the nurse take first?
A. Administer acetaminophen as prescribed
B. Obtain a urine specimen for protein
C. Place the client in a dark, quiet room
D. Notify the registered nurse or healthcare provider
Correct Answer: D
Rationale: Severe headache, blurred vision, and edema suggest preeclampsia,
which can progress to eclampsia. The provider should be notified immediately for
further evaluation and treatment.
Question 7
A nurse is collecting data from a postpartum client who delivered 12 hours ago.
The nurse notes the fundus is boggy and displaced to the right of the umbilicus.
Which action should the nurse take first?
A. Assist the client to empty her bladder
B. Administer a prescribed analgesic
C. Massage the fundus firmly
D. Document the finding as normal
Correct Answer: A
Rationale: A full bladder displaces the uterus to the right and prevents effective
, contraction. Emptying the bladder is the first intervention before massaging the
fundus.
Question 8
A nurse is assisting a client who is at 39 weeks gestation and in active labor. The
client suddenly reports severe abdominal pain and the nurse observes a large
amount of dark red vaginal bleeding. Which action should the nurse take
immediately?
A. Perform a vaginal examination
B. Administer oxygen by face mask
C. Notify the healthcare provider
D. Insert an indwelling urinary catheter
Correct Answer: C
Rationale: Sudden severe pain with dark red bleeding suggests placental
abruption. A vaginal examination is contraindicated. The provider must be
notified immediately for emergency intervention.
Question 9
A nurse is collecting data from a newborn. Which finding indicates a need for
further evaluation?
A. Respiratory rate of 55 breaths per minute
B. Apical pulse of 120 beats per minute
C. Axillary temperature of 97.5 degrees Fahrenheit
D. Jaundice noted at 30 hours of age
Correct Answer: D
Rationale: Jaundice at 30 hours of age may be physiologic but requires continued
monitoring and possible bilirubin testing. The other findings are within normal
newborn limits.
Question 10
A nurse is reinforcing teaching with a client who is 28 weeks gestation and has
gestational diabetes. Which statement by the client indicates understanding of
the teaching?
A. “I will avoid all carbohydrates in my diet.”
B. “I will check my blood glucose only when I feel dizzy.”
