HESI Maternity OB Exam
Latest 2 Versions With 110 Questions And Answers
Including Comprehensive Rationales | Next Generation NCLEX (NGN) Style Integration
Aligned with 2026-2027 HESI Specialty Exam Standards and NCSBN NCLEX-RN Test Plan
for Maternal-Newborn Nursing
Total Questions 110 (EXACTLY) Versions 2
Question Style 70% Scenario / 15% Recall / 15% NGN Format 4-option MC (A-D)
Cognitive Levels 25% Recall / 55% Application / 20% Analysis Pass Level A+ Guaranteed
VERSION 1
Section 1: Antepartum (Prenatal Care, Complications, & Assessment) - Q1-15
Q1: A client at 8 weeks gestation presents to the emergency department reporting sharp right-sided abdominal
pain, light vaginal spotting, and a history of pelvic inflammatory disease treated 2 years ago. On assessment, the
nurse notes a palpable right adnexal mass and the client's blood pressure is 88/52 mm Hg with a heart rate of 112
bpm. Which action should the nurse prioritize?
A. Obtain a quantitative serum beta-hCG level and schedule transvaginal ultrasound
B. Administer IV fluid resuscitation and monitor vital signs every 15 minutes
C. Prepare the client for immediate surgical intervention **[CORRECT]** **[CORRECT]**
D. Obtain a complete blood count and type and crossmatch for blood products
Correct Answer: C
Rationale: This client presents with classic manifestations of a ruptured ectopic pregnancy: amenorrhea, unilateral abdominal
pain, vaginal bleeding, an adnexal mass, and signs of hemoperitoneum (hypotension and tachycardia indicating hemorrhagic
shock). A ruptured ectopic pregnancy is a life-threatening emergency requiring immediate surgical intervention to control
intra-abdominal hemorrhage. Diagnostic testing (A) and blood product preparation (D) are important but do not replace the
need for definitive surgical management when rupture has already occurred. IV fluids (B) should be initiated simultaneously
but will not control the active intra-abdominal bleeding without surgical intervention.
Page 1
,HESI Maternity OB Exam | 110 Questions | 2026-2027 Edition | NGN Integrated
Q2: A pregnant client tells the nurse during her initial prenatal visit that her last menstrual period (LMP) began on
March 10. Using Naegele's rule, which estimated date of confinement (EDC) should the nurse document?
A. December 3
B. December 17 **[CORRECT]** **[CORRECT]**
C. January 3
D. January 17
Correct Answer: B
Rationale: Naegele's rule calculates the EDC by subtracting 3 months from the first day of the LMP, adding 7 days, and then
adding 1 year. From March 10: subtract 3 months to get December 10, then add 7 days to arrive at December 17. Option A
(December 3) incorrectly subtracts 7 days instead of adding them. Options C (January 3) and D (January 17) result from
adding 3 months rather than subtracting them, representing a common directional error when applying Naegele's formula.
Q3: During a prenatal visit, a nurse measures a client's fundal height at 28 cm. The client is at 30 weeks gestation
based on her confirmed last menstrual period and a first-trimester ultrasound. Which interpretation and follow-up
action is most appropriate?
A. The measurement suggests intrauterine growth restriction; schedule a follow-up ultrasound for
fetal growth assessment **[CORRECT]** **[CORRECT]**
B. The measurement is within normal limits; document and continue routine prenatal care
C. The measurement indicates polyhydramnios; refer for glucose screening
D. The measurement suggests the gestational age is incorrect; recalculate the EDC
Correct Answer: A
Rationale: McDonald's rule states that fundal height in centimeters should approximate gestational age in weeks between 18
and 32 weeks, with a normal variation of plus or minus 2 cm. A fundal height of 28 cm at 30 weeks is 2 cm below the
expected value, which is at the lower limit of normal; however, a measurement more than 2 cm below expected warrants
evaluation for possible intrauterine growth restriction (IUGR). Option B is incorrect because this measurement falls at the
borderline and requires further assessment rather than simple documentation. Polyhydramnios (C) is associated with fundal
height significantly above expected values. Recalculating the EDC (D) is unnecessary when the gestational age was confirmed
by first-trimester ultrasound, which is the most reliable method for dating.
Q4: A primigravida client asks the nurse during a prenatal visit at 16 weeks gestation when she will begin to feel
her baby move. At which gestational age should the nurse inform this client that quickening is typically first
perceived?
A. 22 to 24 weeks
B. 14 to 16 weeks
C. 24 to 26 weeks
D. 18 to 20 weeks **[CORRECT]** **[CORRECT]**
Correct Answer: D
Rationale: Quickening, the maternal perception of fetal movement, typically occurs between 18 and 20 weeks (Option D) in a
primigravida and between 16 and 18 weeks in a multigravida, because a multigravida recognizes the sensation from prior
pregnancy experience. Option B (14-16 weeks) is too early for a primigravida and more closely corresponds to multigravida
Page 2
,HESI Maternity OB Exam | 110 Questions | 2026-2027 Edition | NGN Integrated
timing. Options A (22-24 weeks) and C (24-26 weeks) represent gestational ages beyond the expected window for quickening;
failure to perceive movement by these gestational ages would warrant evaluation for potential fetal or maternal complications
such as oligohydramnios or fetal demise.
Q5: At which gestational age can fetal heart tones first be detected using a Doppler ultrasound stethoscope, and at
which age using a fetoscope?
A. Doppler at 8 to 10 weeks; fetoscope at 18 to 20 weeks
B. Doppler at 16 to 18 weeks; fetoscope at 20 to 22 weeks
C. Doppler at 12 to 14 weeks; fetoscope at 16 to 18 weeks
D. Doppler at 10 to 12 weeks; fetoscope at 18 to 20 weeks **[CORRECT]** **[CORRECT]**
Correct Answer: D
Rationale: Fetal heart tones are first detectable by Doppler ultrasound stethoscope between 10 and 12 weeks gestation (Option
D) due to the device's electronic amplification capability, whereas a fetoscope (acoustic stethoscope) detects tones between 18
and 20 weeks because it relies on sound transmission without amplification. Option A incorrectly states Doppler detection at
8-10 weeks; though fetal cardiac activity may be visible on transvaginal ultrasound at 6-7 weeks, it is not audible via Doppler
at that stage. Options B and C confuse the detection timelines for both devices, reflecting a common HESI exam error of
mixing Doppler and fetoscope detection milestones.
Q6: During a prenatal assessment, the nurse performs Leopold's maneuvers on a client at 36 weeks gestation.
During the second maneuver, the nurse palpates a smooth, hard, broad surface in the right upper quadrant of the
maternal abdomen and small, irregular knobs in the left lower quadrant. The third maneuver confirms a hard,
round, movable mass in the lower abdomen over the pelvis. Which fetal position should the nurse document?
A. Left occiput anterior (LOA)
B. Right sacrum anterior (RSA)
C. Right occiput anterior (ROA) **[CORRECT]** **[CORRECT]**
D. Left mentum anterior (LMA)
Correct Answer: C
Rationale: Leopold's second maneuver identifies the fetal back (smooth, hard surface) and small parts (irregular knobs
representing extremities). A smooth surface in the right upper quadrant places the fetal back on the maternal right, with small
parts on the maternal left. The third maneuver confirms a cephalic presentation (hard, round movable mass). With the occiput
on the maternal right and the fetus in anterior position, this indicates right occiput anterior (ROA) (Option C). LOA (A) would
require the back on the maternal left side. RSA (B) represents a sacrum presentation, inconsistent with the hard, round
cephalic mass palpated. LMA (D) represents a chin (mentum) presentation, which would palpate differently than a round
cephalic mass.
Q7: Which assessment finding represents Goodell's sign, and how does it differ from Chadwick's sign and Hegar's
sign?
A. Goodell's sign is softening of the cervix; Chadwick's sign is bluish-purple vaginal mucosa;
Hegar's sign is softening of the lower uterine segment **[CORRECT]** **[CORRECT]**
B. Goodell's sign is bluish-purple vaginal mucosa; Chadwick's sign is softening of the cervix; Hegar's sign is
uterine enlargement
Page 3
, HESI Maternity OB Exam | 110 Questions | 2026-2027 Edition | NGN Integrated
C. Goodell's sign is softening of the lower uterine segment; Chadwick's sign is bluish-purple vaginal mucosa;
Hegar's sign is cervical softening
D. Goodell's sign is palpable uterine enlargement; Chadwick's sign is cervical softening; Hegar's sign is
vaginal discoloration
Correct Answer: A
Rationale: Goodell's sign is cervical softening occurring at 6 to 8 weeks gestation due to increased vascularity and estrogen
effects. Chadwick's sign is the bluish-purple discoloration of the vaginal mucosa, cervix, and vulva caused by increased pelvic
blood flow from estrogen stimulation. Hegar's sign is softening of the lower uterine segment at 6 to 8 weeks, making the upper
and lower segments feel dissociated on bimanual examination. Options B, C, and D incorrectly swap the definitions of these
three classic pregnancy signs, a common error on the HESI exam that requires careful differentiation of pelvic assessment
findings.
Q8: According to standard prenatal care guidelines, how frequently should a pregnant client with an
uncomplicated pregnancy be seen during the third trimester between 28 and 36 weeks gestation?
A. Every week
B. Every 2 weeks **[CORRECT]** **[CORRECT]**
C. Every 3 weeks
D. Every 4 weeks
Correct Answer: B
Rationale: The standard prenatal visit schedule for uncomplicated pregnancies is every 4 weeks during the first and second
trimesters (through 28 weeks), every 2 weeks from 28 to 36 weeks gestation, and every week from 36 weeks until delivery.
More frequent visits in the third trimester allow monitoring for emerging complications such as preeclampsia, gestational
hypertension, and fetal growth abnormalities. Every week (A) is correct only after 36 weeks. Every 3 weeks (C) is not part of
the standard schedule at any gestational age. Every 4 weeks (D) applies only to the first 28 weeks of pregnancy.
Q9: A client with a pre-pregnancy BMI of 27 asks the nurse about the recommended total weight gain during her
pregnancy. Which weight gain range should the nurse recommend based on current Institute of Medicine
guidelines?
A. 11 to 20 pounds
B. 15 to 25 pounds **[CORRECT]** **[CORRECT]**
C. 25 to 35 pounds
D. 28 to 40 pounds
Correct Answer: B
Rationale: A pre-pregnancy BMI of 27 falls in the overweight category (BMI 25.0 to 29.9), for which the IOM recommends
a total weight gain of 15 to 25 pounds during pregnancy. Option A (11-20 pounds) is the recommended range for obese clients
(BMI greater than or equal to 30). Option C (25-35 pounds) applies to normal-weight clients (BMI 18.5 to 24.9). Option D
(28-40 pounds) is the recommendation for underweight clients (BMI less than 18.5). Excessive weight gain in overweight
clients increases the risk of gestational diabetes, preeclampsia, macrosomia, and operative delivery.
Page 4
Latest 2 Versions With 110 Questions And Answers
Including Comprehensive Rationales | Next Generation NCLEX (NGN) Style Integration
Aligned with 2026-2027 HESI Specialty Exam Standards and NCSBN NCLEX-RN Test Plan
for Maternal-Newborn Nursing
Total Questions 110 (EXACTLY) Versions 2
Question Style 70% Scenario / 15% Recall / 15% NGN Format 4-option MC (A-D)
Cognitive Levels 25% Recall / 55% Application / 20% Analysis Pass Level A+ Guaranteed
VERSION 1
Section 1: Antepartum (Prenatal Care, Complications, & Assessment) - Q1-15
Q1: A client at 8 weeks gestation presents to the emergency department reporting sharp right-sided abdominal
pain, light vaginal spotting, and a history of pelvic inflammatory disease treated 2 years ago. On assessment, the
nurse notes a palpable right adnexal mass and the client's blood pressure is 88/52 mm Hg with a heart rate of 112
bpm. Which action should the nurse prioritize?
A. Obtain a quantitative serum beta-hCG level and schedule transvaginal ultrasound
B. Administer IV fluid resuscitation and monitor vital signs every 15 minutes
C. Prepare the client for immediate surgical intervention **[CORRECT]** **[CORRECT]**
D. Obtain a complete blood count and type and crossmatch for blood products
Correct Answer: C
Rationale: This client presents with classic manifestations of a ruptured ectopic pregnancy: amenorrhea, unilateral abdominal
pain, vaginal bleeding, an adnexal mass, and signs of hemoperitoneum (hypotension and tachycardia indicating hemorrhagic
shock). A ruptured ectopic pregnancy is a life-threatening emergency requiring immediate surgical intervention to control
intra-abdominal hemorrhage. Diagnostic testing (A) and blood product preparation (D) are important but do not replace the
need for definitive surgical management when rupture has already occurred. IV fluids (B) should be initiated simultaneously
but will not control the active intra-abdominal bleeding without surgical intervention.
Page 1
,HESI Maternity OB Exam | 110 Questions | 2026-2027 Edition | NGN Integrated
Q2: A pregnant client tells the nurse during her initial prenatal visit that her last menstrual period (LMP) began on
March 10. Using Naegele's rule, which estimated date of confinement (EDC) should the nurse document?
A. December 3
B. December 17 **[CORRECT]** **[CORRECT]**
C. January 3
D. January 17
Correct Answer: B
Rationale: Naegele's rule calculates the EDC by subtracting 3 months from the first day of the LMP, adding 7 days, and then
adding 1 year. From March 10: subtract 3 months to get December 10, then add 7 days to arrive at December 17. Option A
(December 3) incorrectly subtracts 7 days instead of adding them. Options C (January 3) and D (January 17) result from
adding 3 months rather than subtracting them, representing a common directional error when applying Naegele's formula.
Q3: During a prenatal visit, a nurse measures a client's fundal height at 28 cm. The client is at 30 weeks gestation
based on her confirmed last menstrual period and a first-trimester ultrasound. Which interpretation and follow-up
action is most appropriate?
A. The measurement suggests intrauterine growth restriction; schedule a follow-up ultrasound for
fetal growth assessment **[CORRECT]** **[CORRECT]**
B. The measurement is within normal limits; document and continue routine prenatal care
C. The measurement indicates polyhydramnios; refer for glucose screening
D. The measurement suggests the gestational age is incorrect; recalculate the EDC
Correct Answer: A
Rationale: McDonald's rule states that fundal height in centimeters should approximate gestational age in weeks between 18
and 32 weeks, with a normal variation of plus or minus 2 cm. A fundal height of 28 cm at 30 weeks is 2 cm below the
expected value, which is at the lower limit of normal; however, a measurement more than 2 cm below expected warrants
evaluation for possible intrauterine growth restriction (IUGR). Option B is incorrect because this measurement falls at the
borderline and requires further assessment rather than simple documentation. Polyhydramnios (C) is associated with fundal
height significantly above expected values. Recalculating the EDC (D) is unnecessary when the gestational age was confirmed
by first-trimester ultrasound, which is the most reliable method for dating.
Q4: A primigravida client asks the nurse during a prenatal visit at 16 weeks gestation when she will begin to feel
her baby move. At which gestational age should the nurse inform this client that quickening is typically first
perceived?
A. 22 to 24 weeks
B. 14 to 16 weeks
C. 24 to 26 weeks
D. 18 to 20 weeks **[CORRECT]** **[CORRECT]**
Correct Answer: D
Rationale: Quickening, the maternal perception of fetal movement, typically occurs between 18 and 20 weeks (Option D) in a
primigravida and between 16 and 18 weeks in a multigravida, because a multigravida recognizes the sensation from prior
pregnancy experience. Option B (14-16 weeks) is too early for a primigravida and more closely corresponds to multigravida
Page 2
,HESI Maternity OB Exam | 110 Questions | 2026-2027 Edition | NGN Integrated
timing. Options A (22-24 weeks) and C (24-26 weeks) represent gestational ages beyond the expected window for quickening;
failure to perceive movement by these gestational ages would warrant evaluation for potential fetal or maternal complications
such as oligohydramnios or fetal demise.
Q5: At which gestational age can fetal heart tones first be detected using a Doppler ultrasound stethoscope, and at
which age using a fetoscope?
A. Doppler at 8 to 10 weeks; fetoscope at 18 to 20 weeks
B. Doppler at 16 to 18 weeks; fetoscope at 20 to 22 weeks
C. Doppler at 12 to 14 weeks; fetoscope at 16 to 18 weeks
D. Doppler at 10 to 12 weeks; fetoscope at 18 to 20 weeks **[CORRECT]** **[CORRECT]**
Correct Answer: D
Rationale: Fetal heart tones are first detectable by Doppler ultrasound stethoscope between 10 and 12 weeks gestation (Option
D) due to the device's electronic amplification capability, whereas a fetoscope (acoustic stethoscope) detects tones between 18
and 20 weeks because it relies on sound transmission without amplification. Option A incorrectly states Doppler detection at
8-10 weeks; though fetal cardiac activity may be visible on transvaginal ultrasound at 6-7 weeks, it is not audible via Doppler
at that stage. Options B and C confuse the detection timelines for both devices, reflecting a common HESI exam error of
mixing Doppler and fetoscope detection milestones.
Q6: During a prenatal assessment, the nurse performs Leopold's maneuvers on a client at 36 weeks gestation.
During the second maneuver, the nurse palpates a smooth, hard, broad surface in the right upper quadrant of the
maternal abdomen and small, irregular knobs in the left lower quadrant. The third maneuver confirms a hard,
round, movable mass in the lower abdomen over the pelvis. Which fetal position should the nurse document?
A. Left occiput anterior (LOA)
B. Right sacrum anterior (RSA)
C. Right occiput anterior (ROA) **[CORRECT]** **[CORRECT]**
D. Left mentum anterior (LMA)
Correct Answer: C
Rationale: Leopold's second maneuver identifies the fetal back (smooth, hard surface) and small parts (irregular knobs
representing extremities). A smooth surface in the right upper quadrant places the fetal back on the maternal right, with small
parts on the maternal left. The third maneuver confirms a cephalic presentation (hard, round movable mass). With the occiput
on the maternal right and the fetus in anterior position, this indicates right occiput anterior (ROA) (Option C). LOA (A) would
require the back on the maternal left side. RSA (B) represents a sacrum presentation, inconsistent with the hard, round
cephalic mass palpated. LMA (D) represents a chin (mentum) presentation, which would palpate differently than a round
cephalic mass.
Q7: Which assessment finding represents Goodell's sign, and how does it differ from Chadwick's sign and Hegar's
sign?
A. Goodell's sign is softening of the cervix; Chadwick's sign is bluish-purple vaginal mucosa;
Hegar's sign is softening of the lower uterine segment **[CORRECT]** **[CORRECT]**
B. Goodell's sign is bluish-purple vaginal mucosa; Chadwick's sign is softening of the cervix; Hegar's sign is
uterine enlargement
Page 3
, HESI Maternity OB Exam | 110 Questions | 2026-2027 Edition | NGN Integrated
C. Goodell's sign is softening of the lower uterine segment; Chadwick's sign is bluish-purple vaginal mucosa;
Hegar's sign is cervical softening
D. Goodell's sign is palpable uterine enlargement; Chadwick's sign is cervical softening; Hegar's sign is
vaginal discoloration
Correct Answer: A
Rationale: Goodell's sign is cervical softening occurring at 6 to 8 weeks gestation due to increased vascularity and estrogen
effects. Chadwick's sign is the bluish-purple discoloration of the vaginal mucosa, cervix, and vulva caused by increased pelvic
blood flow from estrogen stimulation. Hegar's sign is softening of the lower uterine segment at 6 to 8 weeks, making the upper
and lower segments feel dissociated on bimanual examination. Options B, C, and D incorrectly swap the definitions of these
three classic pregnancy signs, a common error on the HESI exam that requires careful differentiation of pelvic assessment
findings.
Q8: According to standard prenatal care guidelines, how frequently should a pregnant client with an
uncomplicated pregnancy be seen during the third trimester between 28 and 36 weeks gestation?
A. Every week
B. Every 2 weeks **[CORRECT]** **[CORRECT]**
C. Every 3 weeks
D. Every 4 weeks
Correct Answer: B
Rationale: The standard prenatal visit schedule for uncomplicated pregnancies is every 4 weeks during the first and second
trimesters (through 28 weeks), every 2 weeks from 28 to 36 weeks gestation, and every week from 36 weeks until delivery.
More frequent visits in the third trimester allow monitoring for emerging complications such as preeclampsia, gestational
hypertension, and fetal growth abnormalities. Every week (A) is correct only after 36 weeks. Every 3 weeks (C) is not part of
the standard schedule at any gestational age. Every 4 weeks (D) applies only to the first 28 weeks of pregnancy.
Q9: A client with a pre-pregnancy BMI of 27 asks the nurse about the recommended total weight gain during her
pregnancy. Which weight gain range should the nurse recommend based on current Institute of Medicine
guidelines?
A. 11 to 20 pounds
B. 15 to 25 pounds **[CORRECT]** **[CORRECT]**
C. 25 to 35 pounds
D. 28 to 40 pounds
Correct Answer: B
Rationale: A pre-pregnancy BMI of 27 falls in the overweight category (BMI 25.0 to 29.9), for which the IOM recommends
a total weight gain of 15 to 25 pounds during pregnancy. Option A (11-20 pounds) is the recommended range for obese clients
(BMI greater than or equal to 30). Option C (25-35 pounds) applies to normal-weight clients (BMI 18.5 to 24.9). Option D
(28-40 pounds) is the recommendation for underweight clients (BMI less than 18.5). Excessive weight gain in overweight
clients increases the risk of gestational diabetes, preeclampsia, macrosomia, and operative delivery.
Page 4
