HESI PEDIATRIC AND MATERNITY NURSING | HESI / ELSEVIER | ACADEMIC YEAR
2026/2027 | COMPREHENSIVE SPECIALTY EXAMINATION | VERIFIED QUESTIONS
AND CORRECT ANSWER RATIONALES
1. What occurs during the latent phase of labor? - ANSWERS-early phase, lasts from the
beginning of labor until approx. 3cm-5cm of cervical dilation. Cervical effacement
and subtle fetal position change occurs. Women is usually sociable and excited.
Contractions mild.
2. What occurs during the active phase of labor? - ANSWERS-Cervix dilates more
rapidly. From 4-7cm cervical dilation. Contractions more severe, mother has
increased discomfort and anxiety.
3. What occurs during the transition phase of labor? - ANSWERS-From 8cm-10cm
cervical dilation. Contractions are severe and about 1 1/2 minutes apart and 60-90
second duration. Behavioral changes occur with extreme irritability
4. What defines the beginning and end of the 2nd stage of labor? - ANSWERS-Begins
with complete (10cm) dilation and full (100%) effacement of the cervix and ends with
the birth of the baby.
5. What occurs in the 4th stage of labor? - ANSWERS-Begins with the birth of the baby
and ends with the expulsion of the placenta.
6. What are the 4 signs that suggest placental separation? - ANSWERS-The uterus has a
spherical shape, the uterus rises upwards in the abdomen as the placenta descends
in to the vagina, the cord descends further from the vagina, a gush of blood appears
as blood trapped behind the placenta is released.
7. What describes the decent of the fetal presenting part in relation to the level of the
ischial spine? - ANSWERS-Station
8. How long should it take for the placenta to be delivered? - ANSWERS-No more than
30 minutes
9. In the Schultz mechanism, how is the placenta expelled? - ANSWERS-With the shiny,
fetal side first "shiny Shultz"
10. In the Duncan mechanism of placental expulsion, what side is presenting? -
ANSWERS-Rough, maternal side "dirty Duncan"
11. When does the 4th stage of labor begin and end? - ANSWERS-Stage of physical
recovery, It lasts from the delivery of the placenta through the first 1-4 hours after
birth.
12. Cloudy, yellow, or foul-smelling amniotic fluid suggests - ANSWERS-infection
,13. Green amniotic fluid may indicate what? - ANSWERS-meconium
14. If the 2nd stage of labor lasts longer than 2 hours is that considered safe? - ANSWERS-
Yes, as long as the mother or fetus shows no signs of compromise
15. Immediate nursing care of a newborn - ANSWERS-supporting cardiopulmonary and
thermoregulatory function and placing identifying bands on mother and infant.
16. If fundus is soft and boggy upon assessment, what should the nurse do? - ANSWERS-
Massage until firm
17. If the fundus is above the umbilicus or is displaced to one side (usually the right), what
should the nurse suspect? - ANSWERS-full bladder
18. What makes contractions hypertonic? - ANSWERS-if the contractions are too long
(greater than or equal to 90-120 seconds), too frequent (closer than every 2 minutes),
or have an inadequate relaxation period (less than 30 seconds of complete relaxation)
they will not allow optimal uteroplacental exchange.
19. Does a tocotransducer with a pressure sensor reliably measure internal contraction
intensity and uterine resting tone? - ANSWERS-No, it is useful for observing frequency
and duration of contractions.
20. What defines an acceleration? - ANSWERS-temporary increase in FHR that peaks at
least 15 BPM above the baseline and lasts at least 15 seconds.
21. What are prolonged accelerations? - ANSWERS-Accelerations lasting longer than 2
minutes but less than 10 minutes.
22. If the fetal heart rate acceleration lasts for greater than 10 minutes or longer, what
does that typically mean? - ANSWERS-change in baseline
23. Describes fluctuations in the baseline FHR that can cause the printed line to have an
irregular wave-like appearance rather than a smooth, flat one. - ANSWERS-Variability
24. If a nurse notes early decelerations, what interventions are necessary? - ANSWERS-
Early decelerations are not associated with fetal compromise and require no
intervention
25. What causes early decelerations? - ANSWERS-fetal head compression
26. Early decelerations in relation to the contraction - ANSWERS-They mirror the
contraction, gradually falling from the baseline and gradually returning to baseline by
the end of the contraction
27. Late decelerations are caused by? - ANSWERS-uteroplacental insufficiency
, 28. Characteristics of late decelerations - ANSWERS-Look similar to early decelerations
but begin after the contraction begins.
29. What causes variable decelerations? - ANSWERS-umbilical cord compression
30. How long should the uterus relax between contractions? - ANSWERS-at least 30
seconds.
31. Nonreassuring patterns - ANSWERS-*Absent variability*:
--Recurrent late decelerations
--Recurrent variable decelerations
--Bradycardia
*Sinusoidal pattern*:
--A visually undulating pattern (rare)
32. What is the main cause of fetal tachycardia? - ANSWERS-maternal fever
33. Nursing interventions for nonreassuring FHR patterns - ANSWERS-Reposition
woman, avoid the supine position. Increase rate of fluid with nonadditive solution,
administer O2 via facemask at 8-10 L/min. Notify physician or midwife. Stop oxytocin
or other stimulants. Identify cause.
34. Risks after amniotomy - ANSWERS-Prolapsed cord, infection, abruptio placentae
35. What should be assessed prior to an amniotomy? - ANSWERS-FHR for a minimum of
20-30 minutes for baseline evaluation.
36. How often should the maternal temperature be assessed after amniotomy? What
temperature should be reported? - ANSWERS-Q2H after membranes rupture. Report
elevations greater than 100.4. Fetal tachycardia often precedes fever.
37. What is the bishop score used for? - ANSWERS-Used to estimate how easily a
women's labor can be induced. A woman who has given birth before usually has a
successful induction when her score is 5 or higher, a woman who is having her first
child is most successfully induced if her score is 7 or higher.
38. Factors of the Bishop Score - ANSWERS-Dilation of cervix, Effacement of cervix,
Consistency of cervix, Position of cervix, Station
39. Medical methods for induction or augmentation of labor - ANSWERS-use of
prostaglandins, IV oxytocin or both.
40. How are prostaglandins given to facilitate cervical ripening? - ANSWERS-intravaginal
or intracervical gel, or a timed release vaginal insert.
41. Major adverse reaction to prostaglandin for induction - ANSWERS-Tachysystole that
can reduce placental blood flow and fetal O2 exchange
2026/2027 | COMPREHENSIVE SPECIALTY EXAMINATION | VERIFIED QUESTIONS
AND CORRECT ANSWER RATIONALES
1. What occurs during the latent phase of labor? - ANSWERS-early phase, lasts from the
beginning of labor until approx. 3cm-5cm of cervical dilation. Cervical effacement
and subtle fetal position change occurs. Women is usually sociable and excited.
Contractions mild.
2. What occurs during the active phase of labor? - ANSWERS-Cervix dilates more
rapidly. From 4-7cm cervical dilation. Contractions more severe, mother has
increased discomfort and anxiety.
3. What occurs during the transition phase of labor? - ANSWERS-From 8cm-10cm
cervical dilation. Contractions are severe and about 1 1/2 minutes apart and 60-90
second duration. Behavioral changes occur with extreme irritability
4. What defines the beginning and end of the 2nd stage of labor? - ANSWERS-Begins
with complete (10cm) dilation and full (100%) effacement of the cervix and ends with
the birth of the baby.
5. What occurs in the 4th stage of labor? - ANSWERS-Begins with the birth of the baby
and ends with the expulsion of the placenta.
6. What are the 4 signs that suggest placental separation? - ANSWERS-The uterus has a
spherical shape, the uterus rises upwards in the abdomen as the placenta descends
in to the vagina, the cord descends further from the vagina, a gush of blood appears
as blood trapped behind the placenta is released.
7. What describes the decent of the fetal presenting part in relation to the level of the
ischial spine? - ANSWERS-Station
8. How long should it take for the placenta to be delivered? - ANSWERS-No more than
30 minutes
9. In the Schultz mechanism, how is the placenta expelled? - ANSWERS-With the shiny,
fetal side first "shiny Shultz"
10. In the Duncan mechanism of placental expulsion, what side is presenting? -
ANSWERS-Rough, maternal side "dirty Duncan"
11. When does the 4th stage of labor begin and end? - ANSWERS-Stage of physical
recovery, It lasts from the delivery of the placenta through the first 1-4 hours after
birth.
12. Cloudy, yellow, or foul-smelling amniotic fluid suggests - ANSWERS-infection
,13. Green amniotic fluid may indicate what? - ANSWERS-meconium
14. If the 2nd stage of labor lasts longer than 2 hours is that considered safe? - ANSWERS-
Yes, as long as the mother or fetus shows no signs of compromise
15. Immediate nursing care of a newborn - ANSWERS-supporting cardiopulmonary and
thermoregulatory function and placing identifying bands on mother and infant.
16. If fundus is soft and boggy upon assessment, what should the nurse do? - ANSWERS-
Massage until firm
17. If the fundus is above the umbilicus or is displaced to one side (usually the right), what
should the nurse suspect? - ANSWERS-full bladder
18. What makes contractions hypertonic? - ANSWERS-if the contractions are too long
(greater than or equal to 90-120 seconds), too frequent (closer than every 2 minutes),
or have an inadequate relaxation period (less than 30 seconds of complete relaxation)
they will not allow optimal uteroplacental exchange.
19. Does a tocotransducer with a pressure sensor reliably measure internal contraction
intensity and uterine resting tone? - ANSWERS-No, it is useful for observing frequency
and duration of contractions.
20. What defines an acceleration? - ANSWERS-temporary increase in FHR that peaks at
least 15 BPM above the baseline and lasts at least 15 seconds.
21. What are prolonged accelerations? - ANSWERS-Accelerations lasting longer than 2
minutes but less than 10 minutes.
22. If the fetal heart rate acceleration lasts for greater than 10 minutes or longer, what
does that typically mean? - ANSWERS-change in baseline
23. Describes fluctuations in the baseline FHR that can cause the printed line to have an
irregular wave-like appearance rather than a smooth, flat one. - ANSWERS-Variability
24. If a nurse notes early decelerations, what interventions are necessary? - ANSWERS-
Early decelerations are not associated with fetal compromise and require no
intervention
25. What causes early decelerations? - ANSWERS-fetal head compression
26. Early decelerations in relation to the contraction - ANSWERS-They mirror the
contraction, gradually falling from the baseline and gradually returning to baseline by
the end of the contraction
27. Late decelerations are caused by? - ANSWERS-uteroplacental insufficiency
, 28. Characteristics of late decelerations - ANSWERS-Look similar to early decelerations
but begin after the contraction begins.
29. What causes variable decelerations? - ANSWERS-umbilical cord compression
30. How long should the uterus relax between contractions? - ANSWERS-at least 30
seconds.
31. Nonreassuring patterns - ANSWERS-*Absent variability*:
--Recurrent late decelerations
--Recurrent variable decelerations
--Bradycardia
*Sinusoidal pattern*:
--A visually undulating pattern (rare)
32. What is the main cause of fetal tachycardia? - ANSWERS-maternal fever
33. Nursing interventions for nonreassuring FHR patterns - ANSWERS-Reposition
woman, avoid the supine position. Increase rate of fluid with nonadditive solution,
administer O2 via facemask at 8-10 L/min. Notify physician or midwife. Stop oxytocin
or other stimulants. Identify cause.
34. Risks after amniotomy - ANSWERS-Prolapsed cord, infection, abruptio placentae
35. What should be assessed prior to an amniotomy? - ANSWERS-FHR for a minimum of
20-30 minutes for baseline evaluation.
36. How often should the maternal temperature be assessed after amniotomy? What
temperature should be reported? - ANSWERS-Q2H after membranes rupture. Report
elevations greater than 100.4. Fetal tachycardia often precedes fever.
37. What is the bishop score used for? - ANSWERS-Used to estimate how easily a
women's labor can be induced. A woman who has given birth before usually has a
successful induction when her score is 5 or higher, a woman who is having her first
child is most successfully induced if her score is 7 or higher.
38. Factors of the Bishop Score - ANSWERS-Dilation of cervix, Effacement of cervix,
Consistency of cervix, Position of cervix, Station
39. Medical methods for induction or augmentation of labor - ANSWERS-use of
prostaglandins, IV oxytocin or both.
40. How are prostaglandins given to facilitate cervical ripening? - ANSWERS-intravaginal
or intracervical gel, or a timed release vaginal insert.
41. Major adverse reaction to prostaglandin for induction - ANSWERS-Tachysystole that
can reduce placental blood flow and fetal O2 exchange
