Maternity HESI Test bank (combined
red Hesi and other sources)
2026-2027 Updated
** Expert-Verified Explanation
** Questions with Verified Answer
** New Edition
** 100% Guaranteed Pass
** 100% Correct Answers
,An expectant father tells the nurse he fears that his wife D) Reassure him that normal maternal-fetal bonding is occurring.
is "losing her mind." He states that she is constantly
rubbing her abdomen and talking to the baby and that Rationale:
she actually reprimands the baby when it moves too These behaviors are positive signs of maternal-fetal bonding and do not reflect
much. Which recommendation should the nurse make to ambivalence. No intervention is needed. Quickening, the first perception of fetal
this expectant father? movement, occurs at 17 to 20 weeks of gestation and begins a new phase of
prenatal bonding during the second trimester. Options A and C are not necessary
A.Suggest that his wife seek professional counseling to because the behaviors displayed are normal.
deal with her symptoms.
B.Explain that his wife is exhibiting ambivalence about
the pregnancy.
C. Ask him to report similar abnormal behaviors at the
next prenatal visit.
D.Reassure him that normal maternal-fetal bonding is
occurring.
The nurse is preparing a laboring client for an C. Fetal heart rate (FHR)
amniotomy. Immediately after the procedure is
completed, it is most important for the nurse to obtain Rationale:
which information? The FHR should be assessed before and after the procedure to detect changes
that may indicate the presence of cord compression or prolapse. An amniotomy
A.Maternal blood pressure (artificial rupture of membranes [AROM]) is used to stimulate labor when the
condition of the cervix is favorable. The fluid should be assessed for color, odor,
B.Maternal temperature and consistency. Option A should be assessed every 15 to 20 minutes during
labor but is not specific for AROM. Option B is monitored hourly after the
C.Fetal heart rate (FHR) membranes are ruptured to detect the development of amnionitis. Option D
should be determined for all clients in labor.
D.White blood cell count (WBC)
A nurse receives a shift change report for a newborn who B. Skin color that is slightly jaundiced
is 12 hours post-vaginal delivery. In developing a plan of
care, the nurse should give the highest priority to which Rationale: Jaundice, a yellow skin coloration, is caused by elevated levels of
finding? bilirubin, which should be further evaluated in a newborn <24 hours old.
Acrocyanosis (blue color of the hands and feet) is a common finding in
A.Cyanosis of the hands and feet newborns; it occurs because the capillary system is immature. Milia are small
white papules present on the nose and chin that are caused by sebaceous gland
B.Skin color that is slightly jaundiced blockage and disappear in a few weeks. Small red patches on the cheeks and
trunk are called erythema toxicum neonatorum, a common finding in newborns.
C.Tiny white papules on the nose or chin
D.Red patches on the cheeks and trunk
A breastfeeding postpartum client is diagnosed with A.Breastfeed the infant, ensuring that both breasts are completely emptied.
mastitis, and antibiotic therapy is prescribed. Which
instruction should the nurse provide to this client? Rationale:Mastitis, caused by plugged milk ducts, is related to breast
engorgement, and breastfeeding during mastitis facilitates the complete
A.Breastfeed the infant, ensuring that both breasts are emptying of engorged breasts, eliminating the pressure on the inflamed breast
completely emptied. tissue. Option B is less painful but does not facilitate complete emptying of the
breast tissue. Option C will not relieve the engorgement on the affected side.
B.Feed expressed breast milk to avoid the pain of the Option D will not decrease antibiotic effects on the infant.
infant latching onto the infected breast.
C.Breastfeed on the unaffected breast only until the
mastitis subsides.
D.Dilute expressed breast milk with sterile water to
reduce the antibiotic effect on the infant.
A 38-week primigravida who works as a secretary and C.Move about every hour.
sits at a computer 8 hours each day tells the nurse that
her feet have begun to swell. Which instruction will aid in Rationale:
the prevention of pooling of blood in the lower Pooling of blood in the lower extremities results from the enlarged uterus exerting
extremities? pressure on the pelvic veins. Moving about every hour will relieve pressure on
the pelvic veins and increase venous return. Option A would increase venous
A.Wear support stockings. return from varicose veins in the lower extremities but would be of little help with
swelling. Option B might be helpful with generalized edema but is not specific for
B.Reduce salt in the diet. edematous lower extremities. Option D does not address venous return, and
there is no indication in the question that constrictive clothing is a problem.
C.Move about every hour.
D.Avoid constrictive clothing.
,Twenty-four hours after admission to the newborn A.Cephalhematoma, which is caused by forceps trauma
nursery, a full-term male infant develops localized
swelling on the right side of his head. In a newborn, what Rationale: Cephalhematoma, a slight abnormal variation of the newborn, usually
is the most likely cause of this accumulation of blood arises within the first 24 hours after delivery. Trauma from delivery causes
between the periosteum and skull that does not cross the capillary bleeding between the periosteum and skull. Option C is a cranial
suture line? distortion lasting 5 to 7 days, caused by pressure on the cranium during vaginal
delivery, and is a common variation of the newborn. Options B and D both
A.Cephalhematoma, which is caused by forceps trauma involve intracranial bleeding and could not be detected by physical assessment
alone.
B.Subarachnoid hematoma, which requires immediate
drainage
C.Molding, which is caused by pressure during labor
D.Subdural hematoma, which can result in lifelong
damage
Prior to discharge, what instructions should the nurse C.Allow the cord to air-dry as much as possible.
give to parents regarding the newborn's umbilical cord
care at home? Rationale:Recent studies have indicated that air drying or plain water application
may be equal to or more effective than alcohol in the cord healing process.
A.Wash the cord frequently with mild soap and water. Options A, B, and D are incorrect because they promote moisture and increase
the potential for infection.
B.Cover the cord with a sterile dressing.
C.Allow the cord to air-dry as much as possible.
D.Apply baby lotion after the baby's daily bath
A mother expresses fear about changing the infant's C.Place petroleum ointment around the glans with each diaper change and
diaper after circumcision. What information should the cleansing.
nurse include in the teaching plan?
Rationale:
A.Cleanse the penis with prepackaged diaper wipes With each diaper change, the glans penis should be washed with warm water to
every 3 to 4 hours. remove any urine or feces, and petroleum ointment should be applied to prevent
the diaper from sticking to the healing surface. Prepackaged wipes often contain
B.Wash off the yellow exudate on the glans once every other products that may irritate the site. The yellow exudate, which covers the
day to prevent infection. glans penis as the area heals and epithelializes, is not an infective process and
should not be removed. If bleeding occurs at home, the client should be
C.Place petroleum ointment around the glans with each instructed to apply gentle pressure to the site of the bleeding with sterile gauze
diaper change and cleansing. squares and call the health care provider.
D.Apply pressure by squeezing the penis with the fingers
for 5 minutes if bleeding occurs.
A 26-year-old gravida 2, para 1, client is admitted to the C.Tachycardia and a feeling of nervousness
hospital at 28 weeks of gestation in preterm labor. She is
given three doses of terbutaline sulfate (Brethine), 0.25 Rationale: Terbutaline sulfate (Brethine), a beta-sympathomimetic drug,
mg subcutaneously, to stop her labor contractions. What stimulates beta-adrenergic receptors in the uterine muscle to stop contractions.
are the primary side effects of terbutaline sulfate? The beta-adrenergic agonist properties of the drug may cause tachycardia,
increased cardiac output, restlessness, headache, and a feeling of nervousness.
A.Drowsiness and paroxysmal bradycardia Option A is not a side effect. Options B and D are side effects of magnesium
sulfate.
B.Depressed reflexes and increased respirations
C.Tachycardia and a feeling of nervousness
D.A flushed warm feeling and dry mouth
A mother who is breastfeeding her baby receives C.Ensure that the baby is positioned correctly for latching on.
instructions from the nurse. Which instruction is most
effective in preventing nipple soreness? Rationale: The most common cause of nipple soreness is incorrect positioning of
the infant on the breast for latching on. The baby's body is in alignment with the
A.Wear a cotton bra with nonbinding support. ears, shoulders, and hips in a straight line, with the nose, cheeks, and chin
touching the breast. Option A helps prevent chafing, and nonbinding support aids
B.Increase nursing time gradually over several days. in prevention of discomfort from the stretching of the Cooper ligament. Option B
is important but is not necessary for all women. Option D helps soften an
C.Ensure that the baby is positioned correctly for latching engorged breast and encourages correct infant latching on but is not the best
on. answer.
D.Manually express a small amount of milk before
nursing.
, A new mother asks the nurse, "How do I know that my B."Your milk is sufficient if the baby is voiding pale, straw-colored urine six to ten
daughter is getting enough breast milk?" Which times a day."
explanation is appropriate?
Rationale: The urine will be dilute (straw-colored) and frequent (>6 to 10
A."Weigh the baby daily, and if she is gaining weight, she times/day), if the infant is adequately hydrated. Although a weight gain of 30
is getting enough to eat." g/day is indicative of adequate nutrition, most home scales do not measure this
accurately, and the suggestion will likely make the mother anxious. Option C
B."Your milk is sufficient if the baby is voiding pale, causes nipple confusion and diminishes the mother's milk production. Option D
straw-colored urine six to ten times a day." does not address the client's question.
C."Offer the baby extra bottled milk after her feeding and
see if she still seems hungry."
D."If you're concerned, you might consider bottle feeding
so that you can monitor intake."
The client comes to the hospital assuming she is in labor. A.Pain in the lower back that radiates to abdomen
Which assessment findings by the nurse would indicate C.Progressive cervical dilation and effacement
that the client is in true labor? (Select all that apply.) E.Regular and rhythmic painful contractions
A.Pain in the lower back that radiates to abdomen Rationale: These are all signs of true labor. Options B and D are signs of false
labor.
B.Contractions decreased in frequency with ambulation
C.Progressive cervical dilation and effacement
D.Discomfort localized in the abdomen
E.Regular and rhythmic painful contractions
Which statement made by the client indicates that the A."Breastfeeding my infant consistently every 3 to 4 hours stops ovulation and
mother understands the limitations of breastfeeding her my period."
newborn?
Rationale: Continuous breastfeeding on a 3- to 4-hour schedule during the day
A."Breastfeeding my infant consistently every 3 to 4 will cause a release of prolactin, which will suppress ovulation and menses, but
hours stops ovulation and my period." is not completely effective as a birth control method. Option B is incorrect
because alcohol can immediately enter the breast milk. Nicotine is transferred to
B."Breastfeeding my baby immediately after drinking the infant in breast milk. Taking a warm shower will stimulate the production of
alcohol is safer than waiting for the alcohol to clear my milk, which will be more painful after breastfeedings.
breast milk."
C."I can start smoking cigarettes while breastfeeding
because it will not affect my breast milk."
D."When I take a warm shower after I breastfeed, it
relieves the pain from being engorged between
breastfeedings.
A new mother who has just had her first baby says to the C."That is normal. The head will return to a round shape within 7 to 10 days."
nurse, "I saw the baby in the recovery room. She sure
has a funny-looking head." Which response by the nurse Rationale: Option C reassures the mother that this is normal in the newborn and
is best? provides correct information regarding the return to a normal shape. Although
option A is correct, it implies that the client should not worry. Any implied or
A."This is not an unusually shaped head, especially for a spoken "don't worry" is usually the wrong answer. Option B is condescending
first baby." and dismissing; the mother is seeking reassurance and information. Option D is
a negative statement and implies that molding is the mother's fault.
B."It may look odd, but newborn babies are often born
with heads like that."
C."That is normal. The head will return to a round shape
within 7 to 10 days."
D."Your pelvis was too small, so the head had to adjust
to the birth canal."
Twenty minutes after a continuous epidural anesthetic is C.Place the client in a lateral position.
administered, a laboring client's blood pressure drops
from 120/80 to 90/60 mm Hg. Which action should the Rationale: The nurse should immediately turn the client to a lateral position or
nurse take immediately? place a pillow or wedge under one hip to deflect the uterus. Other immediate
interventions include increasing the rate of the main line IV infusion and
A.Notify the health care provider or anesthesiologist. administering oxygen by facemask. If the blood pressure remains low after these
interventions or decreases further, the anesthesiologist or health care provider
B.Continue to assess the blood pressure every 5 should be notified immediately. To continue to monitor blood pressure without
minutes. taking further action could constitute malpractice. Option D may also be
warranted, but such action is based on hospital protocol.
C.Place the client in a lateral position.
D.Turn off the continuous epidural.
red Hesi and other sources)
2026-2027 Updated
** Expert-Verified Explanation
** Questions with Verified Answer
** New Edition
** 100% Guaranteed Pass
** 100% Correct Answers
,An expectant father tells the nurse he fears that his wife D) Reassure him that normal maternal-fetal bonding is occurring.
is "losing her mind." He states that she is constantly
rubbing her abdomen and talking to the baby and that Rationale:
she actually reprimands the baby when it moves too These behaviors are positive signs of maternal-fetal bonding and do not reflect
much. Which recommendation should the nurse make to ambivalence. No intervention is needed. Quickening, the first perception of fetal
this expectant father? movement, occurs at 17 to 20 weeks of gestation and begins a new phase of
prenatal bonding during the second trimester. Options A and C are not necessary
A.Suggest that his wife seek professional counseling to because the behaviors displayed are normal.
deal with her symptoms.
B.Explain that his wife is exhibiting ambivalence about
the pregnancy.
C. Ask him to report similar abnormal behaviors at the
next prenatal visit.
D.Reassure him that normal maternal-fetal bonding is
occurring.
The nurse is preparing a laboring client for an C. Fetal heart rate (FHR)
amniotomy. Immediately after the procedure is
completed, it is most important for the nurse to obtain Rationale:
which information? The FHR should be assessed before and after the procedure to detect changes
that may indicate the presence of cord compression or prolapse. An amniotomy
A.Maternal blood pressure (artificial rupture of membranes [AROM]) is used to stimulate labor when the
condition of the cervix is favorable. The fluid should be assessed for color, odor,
B.Maternal temperature and consistency. Option A should be assessed every 15 to 20 minutes during
labor but is not specific for AROM. Option B is monitored hourly after the
C.Fetal heart rate (FHR) membranes are ruptured to detect the development of amnionitis. Option D
should be determined for all clients in labor.
D.White blood cell count (WBC)
A nurse receives a shift change report for a newborn who B. Skin color that is slightly jaundiced
is 12 hours post-vaginal delivery. In developing a plan of
care, the nurse should give the highest priority to which Rationale: Jaundice, a yellow skin coloration, is caused by elevated levels of
finding? bilirubin, which should be further evaluated in a newborn <24 hours old.
Acrocyanosis (blue color of the hands and feet) is a common finding in
A.Cyanosis of the hands and feet newborns; it occurs because the capillary system is immature. Milia are small
white papules present on the nose and chin that are caused by sebaceous gland
B.Skin color that is slightly jaundiced blockage and disappear in a few weeks. Small red patches on the cheeks and
trunk are called erythema toxicum neonatorum, a common finding in newborns.
C.Tiny white papules on the nose or chin
D.Red patches on the cheeks and trunk
A breastfeeding postpartum client is diagnosed with A.Breastfeed the infant, ensuring that both breasts are completely emptied.
mastitis, and antibiotic therapy is prescribed. Which
instruction should the nurse provide to this client? Rationale:Mastitis, caused by plugged milk ducts, is related to breast
engorgement, and breastfeeding during mastitis facilitates the complete
A.Breastfeed the infant, ensuring that both breasts are emptying of engorged breasts, eliminating the pressure on the inflamed breast
completely emptied. tissue. Option B is less painful but does not facilitate complete emptying of the
breast tissue. Option C will not relieve the engorgement on the affected side.
B.Feed expressed breast milk to avoid the pain of the Option D will not decrease antibiotic effects on the infant.
infant latching onto the infected breast.
C.Breastfeed on the unaffected breast only until the
mastitis subsides.
D.Dilute expressed breast milk with sterile water to
reduce the antibiotic effect on the infant.
A 38-week primigravida who works as a secretary and C.Move about every hour.
sits at a computer 8 hours each day tells the nurse that
her feet have begun to swell. Which instruction will aid in Rationale:
the prevention of pooling of blood in the lower Pooling of blood in the lower extremities results from the enlarged uterus exerting
extremities? pressure on the pelvic veins. Moving about every hour will relieve pressure on
the pelvic veins and increase venous return. Option A would increase venous
A.Wear support stockings. return from varicose veins in the lower extremities but would be of little help with
swelling. Option B might be helpful with generalized edema but is not specific for
B.Reduce salt in the diet. edematous lower extremities. Option D does not address venous return, and
there is no indication in the question that constrictive clothing is a problem.
C.Move about every hour.
D.Avoid constrictive clothing.
,Twenty-four hours after admission to the newborn A.Cephalhematoma, which is caused by forceps trauma
nursery, a full-term male infant develops localized
swelling on the right side of his head. In a newborn, what Rationale: Cephalhematoma, a slight abnormal variation of the newborn, usually
is the most likely cause of this accumulation of blood arises within the first 24 hours after delivery. Trauma from delivery causes
between the periosteum and skull that does not cross the capillary bleeding between the periosteum and skull. Option C is a cranial
suture line? distortion lasting 5 to 7 days, caused by pressure on the cranium during vaginal
delivery, and is a common variation of the newborn. Options B and D both
A.Cephalhematoma, which is caused by forceps trauma involve intracranial bleeding and could not be detected by physical assessment
alone.
B.Subarachnoid hematoma, which requires immediate
drainage
C.Molding, which is caused by pressure during labor
D.Subdural hematoma, which can result in lifelong
damage
Prior to discharge, what instructions should the nurse C.Allow the cord to air-dry as much as possible.
give to parents regarding the newborn's umbilical cord
care at home? Rationale:Recent studies have indicated that air drying or plain water application
may be equal to or more effective than alcohol in the cord healing process.
A.Wash the cord frequently with mild soap and water. Options A, B, and D are incorrect because they promote moisture and increase
the potential for infection.
B.Cover the cord with a sterile dressing.
C.Allow the cord to air-dry as much as possible.
D.Apply baby lotion after the baby's daily bath
A mother expresses fear about changing the infant's C.Place petroleum ointment around the glans with each diaper change and
diaper after circumcision. What information should the cleansing.
nurse include in the teaching plan?
Rationale:
A.Cleanse the penis with prepackaged diaper wipes With each diaper change, the glans penis should be washed with warm water to
every 3 to 4 hours. remove any urine or feces, and petroleum ointment should be applied to prevent
the diaper from sticking to the healing surface. Prepackaged wipes often contain
B.Wash off the yellow exudate on the glans once every other products that may irritate the site. The yellow exudate, which covers the
day to prevent infection. glans penis as the area heals and epithelializes, is not an infective process and
should not be removed. If bleeding occurs at home, the client should be
C.Place petroleum ointment around the glans with each instructed to apply gentle pressure to the site of the bleeding with sterile gauze
diaper change and cleansing. squares and call the health care provider.
D.Apply pressure by squeezing the penis with the fingers
for 5 minutes if bleeding occurs.
A 26-year-old gravida 2, para 1, client is admitted to the C.Tachycardia and a feeling of nervousness
hospital at 28 weeks of gestation in preterm labor. She is
given three doses of terbutaline sulfate (Brethine), 0.25 Rationale: Terbutaline sulfate (Brethine), a beta-sympathomimetic drug,
mg subcutaneously, to stop her labor contractions. What stimulates beta-adrenergic receptors in the uterine muscle to stop contractions.
are the primary side effects of terbutaline sulfate? The beta-adrenergic agonist properties of the drug may cause tachycardia,
increased cardiac output, restlessness, headache, and a feeling of nervousness.
A.Drowsiness and paroxysmal bradycardia Option A is not a side effect. Options B and D are side effects of magnesium
sulfate.
B.Depressed reflexes and increased respirations
C.Tachycardia and a feeling of nervousness
D.A flushed warm feeling and dry mouth
A mother who is breastfeeding her baby receives C.Ensure that the baby is positioned correctly for latching on.
instructions from the nurse. Which instruction is most
effective in preventing nipple soreness? Rationale: The most common cause of nipple soreness is incorrect positioning of
the infant on the breast for latching on. The baby's body is in alignment with the
A.Wear a cotton bra with nonbinding support. ears, shoulders, and hips in a straight line, with the nose, cheeks, and chin
touching the breast. Option A helps prevent chafing, and nonbinding support aids
B.Increase nursing time gradually over several days. in prevention of discomfort from the stretching of the Cooper ligament. Option B
is important but is not necessary for all women. Option D helps soften an
C.Ensure that the baby is positioned correctly for latching engorged breast and encourages correct infant latching on but is not the best
on. answer.
D.Manually express a small amount of milk before
nursing.
, A new mother asks the nurse, "How do I know that my B."Your milk is sufficient if the baby is voiding pale, straw-colored urine six to ten
daughter is getting enough breast milk?" Which times a day."
explanation is appropriate?
Rationale: The urine will be dilute (straw-colored) and frequent (>6 to 10
A."Weigh the baby daily, and if she is gaining weight, she times/day), if the infant is adequately hydrated. Although a weight gain of 30
is getting enough to eat." g/day is indicative of adequate nutrition, most home scales do not measure this
accurately, and the suggestion will likely make the mother anxious. Option C
B."Your milk is sufficient if the baby is voiding pale, causes nipple confusion and diminishes the mother's milk production. Option D
straw-colored urine six to ten times a day." does not address the client's question.
C."Offer the baby extra bottled milk after her feeding and
see if she still seems hungry."
D."If you're concerned, you might consider bottle feeding
so that you can monitor intake."
The client comes to the hospital assuming she is in labor. A.Pain in the lower back that radiates to abdomen
Which assessment findings by the nurse would indicate C.Progressive cervical dilation and effacement
that the client is in true labor? (Select all that apply.) E.Regular and rhythmic painful contractions
A.Pain in the lower back that radiates to abdomen Rationale: These are all signs of true labor. Options B and D are signs of false
labor.
B.Contractions decreased in frequency with ambulation
C.Progressive cervical dilation and effacement
D.Discomfort localized in the abdomen
E.Regular and rhythmic painful contractions
Which statement made by the client indicates that the A."Breastfeeding my infant consistently every 3 to 4 hours stops ovulation and
mother understands the limitations of breastfeeding her my period."
newborn?
Rationale: Continuous breastfeeding on a 3- to 4-hour schedule during the day
A."Breastfeeding my infant consistently every 3 to 4 will cause a release of prolactin, which will suppress ovulation and menses, but
hours stops ovulation and my period." is not completely effective as a birth control method. Option B is incorrect
because alcohol can immediately enter the breast milk. Nicotine is transferred to
B."Breastfeeding my baby immediately after drinking the infant in breast milk. Taking a warm shower will stimulate the production of
alcohol is safer than waiting for the alcohol to clear my milk, which will be more painful after breastfeedings.
breast milk."
C."I can start smoking cigarettes while breastfeeding
because it will not affect my breast milk."
D."When I take a warm shower after I breastfeed, it
relieves the pain from being engorged between
breastfeedings.
A new mother who has just had her first baby says to the C."That is normal. The head will return to a round shape within 7 to 10 days."
nurse, "I saw the baby in the recovery room. She sure
has a funny-looking head." Which response by the nurse Rationale: Option C reassures the mother that this is normal in the newborn and
is best? provides correct information regarding the return to a normal shape. Although
option A is correct, it implies that the client should not worry. Any implied or
A."This is not an unusually shaped head, especially for a spoken "don't worry" is usually the wrong answer. Option B is condescending
first baby." and dismissing; the mother is seeking reassurance and information. Option D is
a negative statement and implies that molding is the mother's fault.
B."It may look odd, but newborn babies are often born
with heads like that."
C."That is normal. The head will return to a round shape
within 7 to 10 days."
D."Your pelvis was too small, so the head had to adjust
to the birth canal."
Twenty minutes after a continuous epidural anesthetic is C.Place the client in a lateral position.
administered, a laboring client's blood pressure drops
from 120/80 to 90/60 mm Hg. Which action should the Rationale: The nurse should immediately turn the client to a lateral position or
nurse take immediately? place a pillow or wedge under one hip to deflect the uterus. Other immediate
interventions include increasing the rate of the main line IV infusion and
A.Notify the health care provider or anesthesiologist. administering oxygen by facemask. If the blood pressure remains low after these
interventions or decreases further, the anesthesiologist or health care provider
B.Continue to assess the blood pressure every 5 should be notified immediately. To continue to monitor blood pressure without
minutes. taking further action could constitute malpractice. Option D may also be
warranted, but such action is based on hospital protocol.
C.Place the client in a lateral position.
D.Turn off the continuous epidural.
