HESI RN OBMATERNITY V1 2026 FOUR FULL SET
EXAMS NGN STYLE CASE SCENARIOS
1. A client at 10 weeks' gestation reports urinary frequency without dysuria or fever. What is the best nursing
response?
■ This is commonly related to pregnancy-related urinary tract changes.
● Restrict fluids after noon.
● Take an over-the-counter diuretic.
● Remain on bed rest until symptoms resolve.
Rationale: Urinary frequency is common early in pregnancy because of hormonal and pelvic changes. Dysuria, fever, or flank pain would
require evaluation for infection.
2. At 20 weeks' gestation, which fundal-height measurement is most consistent with expected growth?
● 14 cm
■ 20 cm
● 27 cm
● 32 cm
Rationale: After about 20 weeks, fundal height in centimeters generally approximates gestational age within a small expected range.
3. Which prenatal finding should the nurse report promptly?
● Mild ankle edema after standing
● Fetal heart rate of 145/min
■ Blood pressure of 168/108 mm Hg
● Urinary frequency in the first trimester
Rationale: Severe hypertension during pregnancy can indicate a hypertensive emergency and requires prompt evaluation.
4. Which teaching is appropriate for a client taking iron during pregnancy?
■ Take iron with orange juice if tolerated.
● Take iron with an antacid.
● Stop iron when stools become dark.
● Take iron only when fatigue occurs.
Rationale: Vitamin C can enhance iron absorption. Dark stools are an expected effect and do not mean the medication should be stopped.
5. A pregnant client asks why folic acid is emphasized before conception and early in pregnancy. What is the
best response?
■ It reduces the risk of neural-tube defects.
● It prevents all congenital heart defects.
● It guarantees a term birth.
● It prevents gestational diabetes.
Rationale: Adequate folate before conception and in early pregnancy reduces the risk of fetal neural-tube defects.
HESI RN OB/Maternity V1 2026 • Original study practice • Page 1
,6. Which finding is most consistent with Braxton Hicks contractions?
● They become progressively stronger and closer together.
■ They are relieved by activity or hydration.
● They cause progressive cervical dilation.
● They always rupture the membranes.
Rationale: Braxton Hicks contractions are usually irregular and may lessen with hydration, rest, or activity changes; true labor causes
progressive cervical change.
7. A client at 28 weeks asks when fetal movement should generally be assessed as a routine concern. Which
response is best?
■ Movement patterns become useful for monitoring fetal well-being.
● Fetal movement should stop after 28 weeks.
● Movement is not affected by fetal sleep cycles.
● Only ultrasound can assess movement.
Rationale: Once a client knows the fetus's usual movement pattern, a noticeable decrease can be clinically important and should be
reported.
8. Which symptom during pregnancy is most concerning for severe preeclampsia?
● Mild morning nausea
● Occasional round-ligament discomfort
■ Persistent severe headache with visual changes
● Increased appetite
Rationale: Severe headache and visual disturbances can indicate significant hypertension and cerebral involvement.
9. A client at 30 weeks reports painless, bright-red vaginal bleeding. Which condition should the nurse suspect?
■ Placenta previa
● Placental abruption
● Uterine rupture
● Preterm labor
Rationale: Placenta previa classically presents with painless bright-red bleeding in the second half of pregnancy.
10. A client at 34 weeks has painful vaginal bleeding and a rigid, tender uterus. Which condition is most likely?
● Placenta previa
■ Placental abruption
● Cervical insufficiency
● Hyperemesis gravidarum
Rationale: Painful bleeding with uterine tenderness or rigidity is characteristic of placental abruption.
HESI RN OB/Maternity V1 2026 • Original study practice • Page 2
,11. Which action is appropriate when placenta previa is suspected?
● Perform a routine digital vaginal examination.
■ Monitor fetal and maternal status and avoid unnecessary vaginal examination.
● Encourage vigorous ambulation.
● Apply fundal pressure.
Rationale: Digital vaginal examination can provoke severe hemorrhage when placenta previa is present; maternal and fetal assessment is
prioritized.
12. A pregnant client with persistent vomiting has dry mucous membranes and ketones in the urine. Which
problem is most likely?
■ Hyperemesis gravidarum
● Normal morning sickness
● Gestational hypertension
● Polyhydramnios
Rationale: Persistent vomiting with dehydration, weight loss, and ketonuria suggests hyperemesis gravidarum.
13. Which finding is expected during normal pregnancy?
■ Mild physiologic anemia
● Severe persistent hypertension
● Persistent proteinuria
● Cyanosis
Rationale: Plasma volume increases more than red-cell mass, producing a mild dilutional anemia in many pregnancies.
14. A client asks why the heart rate may increase during pregnancy. What is the best explanation?
■ Cardiac output and circulatory demands increase.
● The fetus directly controls the maternal pulse.
● Pregnancy always causes cardiac disease.
● Blood volume decreases substantially.
Rationale: Maternal blood volume and cardiac output rise during pregnancy to support uteroplacental circulation.
15. Which instruction is most appropriate for a client with constipation during pregnancy?
■ Increase fiber, fluids, and activity as tolerated.
● Use stimulant laxatives daily without consultation.
● Restrict fluids.
● Remain inactive after meals.
Rationale: Fiber, adequate fluids, and activity are first-line nonpharmacologic measures for pregnancy-related constipation.
16. Which statement about exercise in an uncomplicated pregnancy is correct?
■ Moderate activity is generally encouraged when no contraindication exists.
● All exercise should stop after the first trimester.
● Only bed rest is safe.
● Exercise causes inevitable preterm labor.
Rationale: For most uncomplicated pregnancies, appropriately modified moderate exercise is beneficial and safe.
17. A pregnant client reports dizziness when lying flat on her back. What should the nurse recommend?
■ Use a side-lying position, especially the left side.
● Remain supine for all sleep.
● Increase caffeine intake.
● Place the head lower than the feet.
Rationale: The enlarged uterus can compress major vessels when supine; side-lying positioning improves venous return.
18. Which immunization is generally recommended during pregnancy to protect the newborn from pertussis?
■ Tdap
● Live varicella vaccine
● Live measles vaccine
● Live intranasal influenza vaccine
HESI RN OB/Maternity V1 2026 • Original study practice • Page 3
, Rationale: Tdap is recommended during each pregnancy, commonly during the late second or third trimester, to provide passive antibody
protection to the newborn.
19. Which food choice best supports increased iron needs during pregnancy?
■ Lean meat with a vitamin-C-rich side
● Candy and soda
● White bread alone
● Coffee with each meal
Rationale: Lean meat supplies heme iron, and vitamin C can improve absorption of nonheme iron as well.
20. A client at 36 weeks reports a sudden gush of clear fluid. What is the priority initial assessment?
■ Assess fetal heart rate.
● Encourage walking.
● Perform a digital vaginal examination immediately.
● Give a laxative.
Rationale: After suspected rupture of membranes, fetal heart rate assessment is a priority because cord compression or prolapse can
occur.
21. Which finding most strongly suggests rupture of membranes rather than urinary incontinence?
■ Continuous leakage of clear fluid from the vagina
● Leakage only after coughing
● No fluid leakage
● Dark concentrated urine
Rationale: A sudden gush or ongoing leakage of clear fluid may indicate ruptured membranes and requires evaluation.
22. A client with gestational diabetes is taught about fetal surveillance. Which complication is especially
associated with poor glycemic control?
■ Macrosomia
● Microcephaly as the only expected outcome
● Maternal hypothermia
● Placenta always remaining previa
Rationale: Poorly controlled gestational diabetes increases the risk of excessive fetal growth and related birth complications.
23. Which assessment is most important for a client with suspected preeclampsia?
■ Blood pressure, neurologic symptoms, urine protein assessment, and fetal status
● Hair texture only
● Visual acuity once a year
● Daily hearing test
Rationale: Preeclampsia assessment focuses on blood pressure, end-organ symptoms, laboratory findings, and fetal well-being.
24. A client asks about decreased fetal movement. Which instruction is safest?
■ Follow the recommended fetal-movement assessment method and report a significant decrease promptly.
● Wait until the next routine prenatal visit regardless of severity.
● Drink alcohol to stimulate movement.
● Ignore movement changes after 20 weeks.
Rationale: A significant change from the fetus's usual movement pattern can signal compromise and warrants timely evaluation.
25. Which finding in a pregnant client requires the most immediate follow-up?
● A mild increase in urinary frequency
■ A new severe epigastric or right-upper-quadrant pain
● Mild breast tenderness
● Occasional heartburn after meals
Rationale: Severe epigastric or right-upper-quadrant pain can reflect hepatic involvement in severe hypertensive disease and requires
urgent evaluation.
26. A laboring client has contractions every 3 minutes lasting 60 seconds with progressive cervical dilation. This
pattern most strongly indicates:
■ True labor
HESI RN OB/Maternity V1 2026 • Original study practice • Page 4
EXAMS NGN STYLE CASE SCENARIOS
1. A client at 10 weeks' gestation reports urinary frequency without dysuria or fever. What is the best nursing
response?
■ This is commonly related to pregnancy-related urinary tract changes.
● Restrict fluids after noon.
● Take an over-the-counter diuretic.
● Remain on bed rest until symptoms resolve.
Rationale: Urinary frequency is common early in pregnancy because of hormonal and pelvic changes. Dysuria, fever, or flank pain would
require evaluation for infection.
2. At 20 weeks' gestation, which fundal-height measurement is most consistent with expected growth?
● 14 cm
■ 20 cm
● 27 cm
● 32 cm
Rationale: After about 20 weeks, fundal height in centimeters generally approximates gestational age within a small expected range.
3. Which prenatal finding should the nurse report promptly?
● Mild ankle edema after standing
● Fetal heart rate of 145/min
■ Blood pressure of 168/108 mm Hg
● Urinary frequency in the first trimester
Rationale: Severe hypertension during pregnancy can indicate a hypertensive emergency and requires prompt evaluation.
4. Which teaching is appropriate for a client taking iron during pregnancy?
■ Take iron with orange juice if tolerated.
● Take iron with an antacid.
● Stop iron when stools become dark.
● Take iron only when fatigue occurs.
Rationale: Vitamin C can enhance iron absorption. Dark stools are an expected effect and do not mean the medication should be stopped.
5. A pregnant client asks why folic acid is emphasized before conception and early in pregnancy. What is the
best response?
■ It reduces the risk of neural-tube defects.
● It prevents all congenital heart defects.
● It guarantees a term birth.
● It prevents gestational diabetes.
Rationale: Adequate folate before conception and in early pregnancy reduces the risk of fetal neural-tube defects.
HESI RN OB/Maternity V1 2026 • Original study practice • Page 1
,6. Which finding is most consistent with Braxton Hicks contractions?
● They become progressively stronger and closer together.
■ They are relieved by activity or hydration.
● They cause progressive cervical dilation.
● They always rupture the membranes.
Rationale: Braxton Hicks contractions are usually irregular and may lessen with hydration, rest, or activity changes; true labor causes
progressive cervical change.
7. A client at 28 weeks asks when fetal movement should generally be assessed as a routine concern. Which
response is best?
■ Movement patterns become useful for monitoring fetal well-being.
● Fetal movement should stop after 28 weeks.
● Movement is not affected by fetal sleep cycles.
● Only ultrasound can assess movement.
Rationale: Once a client knows the fetus's usual movement pattern, a noticeable decrease can be clinically important and should be
reported.
8. Which symptom during pregnancy is most concerning for severe preeclampsia?
● Mild morning nausea
● Occasional round-ligament discomfort
■ Persistent severe headache with visual changes
● Increased appetite
Rationale: Severe headache and visual disturbances can indicate significant hypertension and cerebral involvement.
9. A client at 30 weeks reports painless, bright-red vaginal bleeding. Which condition should the nurse suspect?
■ Placenta previa
● Placental abruption
● Uterine rupture
● Preterm labor
Rationale: Placenta previa classically presents with painless bright-red bleeding in the second half of pregnancy.
10. A client at 34 weeks has painful vaginal bleeding and a rigid, tender uterus. Which condition is most likely?
● Placenta previa
■ Placental abruption
● Cervical insufficiency
● Hyperemesis gravidarum
Rationale: Painful bleeding with uterine tenderness or rigidity is characteristic of placental abruption.
HESI RN OB/Maternity V1 2026 • Original study practice • Page 2
,11. Which action is appropriate when placenta previa is suspected?
● Perform a routine digital vaginal examination.
■ Monitor fetal and maternal status and avoid unnecessary vaginal examination.
● Encourage vigorous ambulation.
● Apply fundal pressure.
Rationale: Digital vaginal examination can provoke severe hemorrhage when placenta previa is present; maternal and fetal assessment is
prioritized.
12. A pregnant client with persistent vomiting has dry mucous membranes and ketones in the urine. Which
problem is most likely?
■ Hyperemesis gravidarum
● Normal morning sickness
● Gestational hypertension
● Polyhydramnios
Rationale: Persistent vomiting with dehydration, weight loss, and ketonuria suggests hyperemesis gravidarum.
13. Which finding is expected during normal pregnancy?
■ Mild physiologic anemia
● Severe persistent hypertension
● Persistent proteinuria
● Cyanosis
Rationale: Plasma volume increases more than red-cell mass, producing a mild dilutional anemia in many pregnancies.
14. A client asks why the heart rate may increase during pregnancy. What is the best explanation?
■ Cardiac output and circulatory demands increase.
● The fetus directly controls the maternal pulse.
● Pregnancy always causes cardiac disease.
● Blood volume decreases substantially.
Rationale: Maternal blood volume and cardiac output rise during pregnancy to support uteroplacental circulation.
15. Which instruction is most appropriate for a client with constipation during pregnancy?
■ Increase fiber, fluids, and activity as tolerated.
● Use stimulant laxatives daily without consultation.
● Restrict fluids.
● Remain inactive after meals.
Rationale: Fiber, adequate fluids, and activity are first-line nonpharmacologic measures for pregnancy-related constipation.
16. Which statement about exercise in an uncomplicated pregnancy is correct?
■ Moderate activity is generally encouraged when no contraindication exists.
● All exercise should stop after the first trimester.
● Only bed rest is safe.
● Exercise causes inevitable preterm labor.
Rationale: For most uncomplicated pregnancies, appropriately modified moderate exercise is beneficial and safe.
17. A pregnant client reports dizziness when lying flat on her back. What should the nurse recommend?
■ Use a side-lying position, especially the left side.
● Remain supine for all sleep.
● Increase caffeine intake.
● Place the head lower than the feet.
Rationale: The enlarged uterus can compress major vessels when supine; side-lying positioning improves venous return.
18. Which immunization is generally recommended during pregnancy to protect the newborn from pertussis?
■ Tdap
● Live varicella vaccine
● Live measles vaccine
● Live intranasal influenza vaccine
HESI RN OB/Maternity V1 2026 • Original study practice • Page 3
, Rationale: Tdap is recommended during each pregnancy, commonly during the late second or third trimester, to provide passive antibody
protection to the newborn.
19. Which food choice best supports increased iron needs during pregnancy?
■ Lean meat with a vitamin-C-rich side
● Candy and soda
● White bread alone
● Coffee with each meal
Rationale: Lean meat supplies heme iron, and vitamin C can improve absorption of nonheme iron as well.
20. A client at 36 weeks reports a sudden gush of clear fluid. What is the priority initial assessment?
■ Assess fetal heart rate.
● Encourage walking.
● Perform a digital vaginal examination immediately.
● Give a laxative.
Rationale: After suspected rupture of membranes, fetal heart rate assessment is a priority because cord compression or prolapse can
occur.
21. Which finding most strongly suggests rupture of membranes rather than urinary incontinence?
■ Continuous leakage of clear fluid from the vagina
● Leakage only after coughing
● No fluid leakage
● Dark concentrated urine
Rationale: A sudden gush or ongoing leakage of clear fluid may indicate ruptured membranes and requires evaluation.
22. A client with gestational diabetes is taught about fetal surveillance. Which complication is especially
associated with poor glycemic control?
■ Macrosomia
● Microcephaly as the only expected outcome
● Maternal hypothermia
● Placenta always remaining previa
Rationale: Poorly controlled gestational diabetes increases the risk of excessive fetal growth and related birth complications.
23. Which assessment is most important for a client with suspected preeclampsia?
■ Blood pressure, neurologic symptoms, urine protein assessment, and fetal status
● Hair texture only
● Visual acuity once a year
● Daily hearing test
Rationale: Preeclampsia assessment focuses on blood pressure, end-organ symptoms, laboratory findings, and fetal well-being.
24. A client asks about decreased fetal movement. Which instruction is safest?
■ Follow the recommended fetal-movement assessment method and report a significant decrease promptly.
● Wait until the next routine prenatal visit regardless of severity.
● Drink alcohol to stimulate movement.
● Ignore movement changes after 20 weeks.
Rationale: A significant change from the fetus's usual movement pattern can signal compromise and warrants timely evaluation.
25. Which finding in a pregnant client requires the most immediate follow-up?
● A mild increase in urinary frequency
■ A new severe epigastric or right-upper-quadrant pain
● Mild breast tenderness
● Occasional heartburn after meals
Rationale: Severe epigastric or right-upper-quadrant pain can reflect hepatic involvement in severe hypertensive disease and requires
urgent evaluation.
26. A laboring client has contractions every 3 minutes lasting 60 seconds with progressive cervical dilation. This
pattern most strongly indicates:
■ True labor
HESI RN OB/Maternity V1 2026 • Original study practice • Page 4
