HESI MATERNITY (MATERNAL–NEWBORN) EXAM
ACTUAL EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES GRADED A+ LATEST
Question 1:
A woman at 36 weeks gestation presents with painless vaginal bleeding. What is
the priority nursing action?
A. Assess maternal vital signs and fetal heart rate
B. Encourage ambulation
C. Perform a vaginal exam immediately
D. Administer oxytocin
Answer: A. Assess maternal vital signs and fetal heart rate
Rationale: Painless third-trimester bleeding may indicate placenta previa. Vaginal
exams can worsen bleeding; assessment of maternal-fetal status is first priority.
Question 2:
A postpartum client reports heavy lochia with large clots 2 hours after delivery.
What is the priority intervention?
A. Assess fundal firmness and massage if boggy
B. Encourage ambulation
C. Document findings only
D. Administer oral iron
Answer: A. Assess fundal firmness and massage if boggy
Rationale: Postpartum hemorrhage is most commonly caused by uterine atony;
fundal massage can help the uterus contract.
,Question 3:
A woman at 28 weeks gestation has a blood pressure of 150/100 mmHg, 2+
proteinuria, and reports headaches. Which complication is suspected?
A. Preeclampsia
B. Gestational diabetes
C. Hyperemesis gravidarum
D. Placenta previa
Answer: A. Preeclampsia
Rationale: Hypertension, proteinuria, and headache indicate preeclampsia;
requires close monitoring and potential hospitalization.
Question 4:
A woman in labor is at 7 cm dilation with regular contractions. She reports nausea
and trembling. Which intervention is appropriate?
A. Provide emotional support and monitor maternal-fetal status
B. Encourage immediate ambulation
C. Administer oxytocin
D. Prepare for cesarean delivery
Answer: A. Provide emotional support and monitor maternal-fetal status
Rationale: Nausea and trembling are common during active labor; continuous
monitoring ensures safety.
Question 5:
A newborn has a respiratory rate of 65/min with nasal flaring and intercostal
retractions. What is the priority nursing action?
A. Administer supplemental oxygen and monitor closely
B. Encourage breastfeeding
C. Monitor only
D. Give antibiotics
Answer: A. Administer supplemental oxygen and monitor closely
Rationale: Signs indicate respiratory distress; immediate oxygen support is
necessary.
,Question 6:
A postpartum client with preeclampsia is receiving magnesium sulfate. Which sign
indicates magnesium toxicity?
A. Absent deep tendon reflexes
B. Increased urine output
C. Heart rate 80 bpm
D. Blood pressure 120/70 mmHg
Answer: A. Absent deep tendon reflexes
Rationale: Loss of reflexes is an early sign of magnesium toxicity; nursing
intervention should include stopping infusion and notifying provider.
Question 7:
A pregnant woman at 32 weeks gestation reports sudden, sharp right upper
quadrant pain, nausea, and vomiting. What is the priority action?
A. Assess for HELLP syndrome
B. Encourage ambulation
C. Provide iron supplements
D. Schedule routine prenatal visit
Answer: A. Assess for HELLP syndrome
Rationale: Hemolysis, elevated liver enzymes, and low platelets can cause these
symptoms; immediate assessment is critical.
Question 8:
A newborn has a positive Babinski reflex. How should the nurse interpret this
finding?
A. Normal in infants up to 12 months
B. Sign of neurological impairment
C. Requires immediate intervention
D. Indicates hypotonia
, Answer: A. Normal in infants up to 12 months
Rationale: The Babinski reflex is a normal neurological finding in infants.
Question 9:
A woman at 38 weeks gestation presents with contractions every 3–4 minutes and
intact membranes. What is the priority nursing action?
A. Assess cervical dilation and fetal heart rate
B. Encourage oral fluids
C. Start oxytocin immediately
D. Administer analgesics only
Answer: A. Assess cervical dilation and fetal heart rate
Rationale: Evaluating labor progression and fetal status is the first priority.
Question 10:
A newborn is jittery, has a high-pitched cry, and poor feeding. Maternal history
reveals poorly controlled gestational diabetes. What is the priority nursing action?
A. Check blood glucose and provide early feedings or IV dextrose
B. Encourage swaddling only
C. Monitor for 24 hours
D. Administer antibiotics
Answer: A. Check blood glucose and provide early feedings or IV dextrose
Rationale: Symptoms indicate neonatal hypoglycemia; early treatment prevents
complications.
Question 11:
A postpartum client is experiencing perineal pain after a vaginal delivery. Which
intervention is appropriate?
A. Administer prescribed analgesics and apply cold packs
B. Encourage ambulation immediately
C. Restrict fluids
D. Apply heat only
ACTUAL EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES GRADED A+ LATEST
Question 1:
A woman at 36 weeks gestation presents with painless vaginal bleeding. What is
the priority nursing action?
A. Assess maternal vital signs and fetal heart rate
B. Encourage ambulation
C. Perform a vaginal exam immediately
D. Administer oxytocin
Answer: A. Assess maternal vital signs and fetal heart rate
Rationale: Painless third-trimester bleeding may indicate placenta previa. Vaginal
exams can worsen bleeding; assessment of maternal-fetal status is first priority.
Question 2:
A postpartum client reports heavy lochia with large clots 2 hours after delivery.
What is the priority intervention?
A. Assess fundal firmness and massage if boggy
B. Encourage ambulation
C. Document findings only
D. Administer oral iron
Answer: A. Assess fundal firmness and massage if boggy
Rationale: Postpartum hemorrhage is most commonly caused by uterine atony;
fundal massage can help the uterus contract.
,Question 3:
A woman at 28 weeks gestation has a blood pressure of 150/100 mmHg, 2+
proteinuria, and reports headaches. Which complication is suspected?
A. Preeclampsia
B. Gestational diabetes
C. Hyperemesis gravidarum
D. Placenta previa
Answer: A. Preeclampsia
Rationale: Hypertension, proteinuria, and headache indicate preeclampsia;
requires close monitoring and potential hospitalization.
Question 4:
A woman in labor is at 7 cm dilation with regular contractions. She reports nausea
and trembling. Which intervention is appropriate?
A. Provide emotional support and monitor maternal-fetal status
B. Encourage immediate ambulation
C. Administer oxytocin
D. Prepare for cesarean delivery
Answer: A. Provide emotional support and monitor maternal-fetal status
Rationale: Nausea and trembling are common during active labor; continuous
monitoring ensures safety.
Question 5:
A newborn has a respiratory rate of 65/min with nasal flaring and intercostal
retractions. What is the priority nursing action?
A. Administer supplemental oxygen and monitor closely
B. Encourage breastfeeding
C. Monitor only
D. Give antibiotics
Answer: A. Administer supplemental oxygen and monitor closely
Rationale: Signs indicate respiratory distress; immediate oxygen support is
necessary.
,Question 6:
A postpartum client with preeclampsia is receiving magnesium sulfate. Which sign
indicates magnesium toxicity?
A. Absent deep tendon reflexes
B. Increased urine output
C. Heart rate 80 bpm
D. Blood pressure 120/70 mmHg
Answer: A. Absent deep tendon reflexes
Rationale: Loss of reflexes is an early sign of magnesium toxicity; nursing
intervention should include stopping infusion and notifying provider.
Question 7:
A pregnant woman at 32 weeks gestation reports sudden, sharp right upper
quadrant pain, nausea, and vomiting. What is the priority action?
A. Assess for HELLP syndrome
B. Encourage ambulation
C. Provide iron supplements
D. Schedule routine prenatal visit
Answer: A. Assess for HELLP syndrome
Rationale: Hemolysis, elevated liver enzymes, and low platelets can cause these
symptoms; immediate assessment is critical.
Question 8:
A newborn has a positive Babinski reflex. How should the nurse interpret this
finding?
A. Normal in infants up to 12 months
B. Sign of neurological impairment
C. Requires immediate intervention
D. Indicates hypotonia
, Answer: A. Normal in infants up to 12 months
Rationale: The Babinski reflex is a normal neurological finding in infants.
Question 9:
A woman at 38 weeks gestation presents with contractions every 3–4 minutes and
intact membranes. What is the priority nursing action?
A. Assess cervical dilation and fetal heart rate
B. Encourage oral fluids
C. Start oxytocin immediately
D. Administer analgesics only
Answer: A. Assess cervical dilation and fetal heart rate
Rationale: Evaluating labor progression and fetal status is the first priority.
Question 10:
A newborn is jittery, has a high-pitched cry, and poor feeding. Maternal history
reveals poorly controlled gestational diabetes. What is the priority nursing action?
A. Check blood glucose and provide early feedings or IV dextrose
B. Encourage swaddling only
C. Monitor for 24 hours
D. Administer antibiotics
Answer: A. Check blood glucose and provide early feedings or IV dextrose
Rationale: Symptoms indicate neonatal hypoglycemia; early treatment prevents
complications.
Question 11:
A postpartum client is experiencing perineal pain after a vaginal delivery. Which
intervention is appropriate?
A. Administer prescribed analgesics and apply cold packs
B. Encourage ambulation immediately
C. Restrict fluids
D. Apply heat only
