MATERNITY HESI NEWEST 2026 ACTUAL EXAM TEST
BANK| RN HESI MATERNITY EXAM PREP WITH
COMPLETE REAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS) ALREADY
GRADED A+ (MOST RECENT!!) - 190 Questions
This rigorous examination assesses advanced knowledge of antepartum care and complications, including risk
assessment, diagnostic interpretation, and management of high-risk pregnancies. It adheres to the latest ACOG
guidelines and evidence-based practice standards. It contains 190 multiple-choice questions, each with four
distractors and a fully worked rationale that explains why the keyed answer is correct. Content is organized into
10 focused sections: Antepartum Care and Complications, Intrapartum Care and Complications, Postpartum Care
and Complications, Newborn Care and Complications, Pharmacological Therapies in Maternity, Health
Promotion and Maintenance, Reduction of Risk Potential, Physiological Adaptation, Psychosocial Integrity,
Management of Care. Targeted learning outcomes include: Analyze risk factors and pathophysiology of
antepartum complications.; Interpret diagnostic findings to guide management decisions.; Evaluate
evidence-based interventions for complex antepartum scenarios.; Synthesize maternal-fetal physiology to
anticipate complications.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so
that students can study with confidence and self-correct as they work through the bank. Use it as a high-yield
review immediately before the exam, or as a structured practice tool during the unit - the rationales double as
concise teaching notes. The recommended writing time is 3 hours, with a passing score of 90%. Aligned with This
exam meets the rigor expected of top-tier US nursing and midwifery programs, aligned with AACN and AC NM
Section 1: Antepartum Care and Complications (Questions 1-20)
1 A primigravid client at 28 weeks gestation presents with sudden onset of severe epigastric pain and vomiting.
Blood pressure is 160/110 mm Hg, and urinalysis shows 3+ proteinuria. Laboratory results reveal elevated liver
enzymes and thrombocytopenia (platelets 85,000/µL). Which of the following is the priority intervention?
A) Administer intravenous hydralazine for blood pressure control.
B) Prepare for immediate cesarean delivery after stabilization.
C) Administer magnesium sulfate for seizure prophylaxis.
D) Obtain a stat CT scan of the abdomen to rule out hepatic rupture.
Answer: C
Rationale: The presentation is consistent with HELLP syndrome with severe features. Magnesium sulfate is
indicated for seizure prophylaxis in severe preeclampsia/HELLP. While blood pressure control and delivery are
important, seizure prophylaxis is the immediate priority given the risk of eclampsia. CT is not indicated unless
there is suspicion of hepatic hematoma.
2 A client with a previous history of preterm birth at 32 weeks gestation is now at 16 weeks gestation.
Transvaginal cervical length measurement is 22 mm. Which of the following management strategies is most
appropriate according to current ACOG guidelines?
A) Initiate intramuscular 17-alpha-hydroxyprogesterone caproate (Makena) weekly.
B) Place a cervical cerclage immediately.
C) Administer betamethasone for fetal lung maturity.
D) Schedule serial cervical length assessments every 2 weeks and reassess.
Answer: A
,Rationale: For women with a prior spontaneous preterm birth and a short cervix (<25 mm) before 24 weeks, ACOG
recommends weekly 17-OHPC. Cerclage is not indicated for a cervix >20 mm in singleton gestations.
Betamethasone is not given at 16 weeks. Serial monitoring alone is insufficient given the prior preterm birth and
short cervix.
3 A client at 34 weeks gestation with type 1 diabetes mellitus reports episodes of hypoglycemia and
hyperglycemia. Her HbA1c is 7.2%. Which of the following is the most significant risk to the fetus associated
with poor glycemic control in the third trimester?
A) Increased risk of neural tube defects.
B) Fetal macrosomia and neonatal hypoglycemia.
C) Congenital heart defects.
D) Spontaneous abortion.
Answer: B
Rationale: Poor glycemic control in the third trimester leads to fetal hyperinsulinism, causing macrosomia and
neonatal hypoglycemia. Neural tube defects and congenital heart defects are associated with first-trimester
hyperglycemia. Spontaneous abortion is not typically linked to third-trimester control.
4 A client at 20 weeks gestation with a body mass index of 38 kg/m² is screened for gestational diabetes using a
50-gram glucose challenge test. The 1-hour glucose level is 185 mg/dL. Which of the following is the next best
step?
A) Diagnose gestational diabetes and initiate dietary counseling.
B) Perform a 3-hour oral glucose tolerance test after a 3-day carbohydrate load.
C) Repeat the 50-gram glucose challenge test in 4 weeks.
D) Prescribe metformin for glycemic control.
Answer: B
Rationale: A positive screen ("e180 mg/dL at 1 hour) requires a diagnostic 3-hour OGTT. Diagnosis should not be
made on a single screening test. Metformin is not first-line without a diagnosis. Repeating the screen is not
appropriate; the diagnostic test is indicated.
5 A client at 30 weeks gestation presents with painless vaginal bleeding. Ultrasound reveals a placenta previa
completely covering the internal os. The client is stable with normal vital signs and no contractions. Which of
the following is the most appropriate management?
A) Perform a digital cervical examination to assess dilation.
B) Administer oxytocin to induce labor.
C) Admit for expectant management with bed rest and avoid vaginal exams.
D) Schedule an immediate cesarean delivery.
Answer: C
Rationale: In stable clients with placenta previa, expectant management to 36-37 weeks is recommended to improve
fetal maturity. Digital exams are contraindicated due to risk of hemorrhage. Immediate delivery is not indicated
without active bleeding or fetal distress. Oxytocin would worsen bleeding.
6 A client at 26 weeks gestation with a history of cervical insufficiency undergoes a McDonald cerclage. Two
weeks later, she presents with rupture of membranes. Amniotic fluid leakage is confirmed. Which of the
following is the priority action?
A) Remove the cerclage to reduce infection risk.
B) Administer antibiotics and corticosteroids.
C) Perform an amniocentesis to rule out infection.
,D) Tighten the cerclage to prevent further leakage.
Answer: A
Rationale: In the setting of preterm premature rupture of membranes (PPROM) with a cerclage in place, removal is
recommended to reduce the risk of chorioamnionitis and maternal sepsis. Antibiotics and corticosteroids may be
considered after removal, but removal is the priority. Tightening the cerclage is contraindicated.
7 A client at 22 weeks gestation with chronic hypertension is started on labetalol. Her blood pressure is 145/95
mm Hg. Which of the following parameters is most important to monitor during therapy?
A) Fetal heart rate variability on nonstress test.
B) Maternal heart rate and blood pressure.
C) Serum electrolytes and renal function.
D) Liver function tests.
Answer: B
Rationale: Labetalol can cause maternal bradycardia and hypotension. Monitoring maternal heart rate and blood
pressure is essential to avoid over-treatment and ensure uteroplacental perfusion. Fetal monitoring is important but
not the most immediate. Electrolytes and liver function are not primarily affected by labetalol.
8 A client at 32 weeks gestation is admitted with suspected placental abruption after a motor vehicle collision. She
reports sudden onset of abdominal pain and vaginal bleeding. The uterus is firm and tender. Fetal heart rate is
170 bpm with minimal variability. Which of the following is the most appropriate immediate action?
A) Administer terbutaline for tocolysis.
B) Obtain a Kleihauer-Betke test.
C) Prepare for emergency cesarean delivery.
D) Perform a biophysical profile.
Answer: C
Rationale: The presentation suggests severe abruption with fetal distress. Immediate delivery is indicated to save the
fetus and prevent maternal coagulopathy. Tocolysis is contraindicated. Kleihauer-Betke test is for Rh status, not a
priority. BPP would delay delivery.
9 A client at 18 weeks gestation with a twin pregnancy (dichorionic diamniotic) is found to have a cervical length
of 18 mm on routine ultrasound. She has no prior preterm birth. Which of the following is the most appropriate
management?
A) Administer 17-alpha-hydroxyprogesterone caproate weekly.
B) Place a cervical cerclage.
C) Initiate vaginal progesterone supplementation.
D) Recommend bed rest and pelvic rest.
Answer: C
Rationale: For asymptomatic twin gestations with a short cervix (<25 mm) before 24 weeks, ACOG recommends
vaginal progesterone to reduce preterm birth risk. 17-OHPC is not effective in twins. Cerclage is not recommended
for twin pregnancies. Bed rest has not been shown to be effective.
10 A client at 28 weeks gestation with pregestational diabetes (type 2) is on insulin therapy. She presents with
nausea, vomiting, and abdominal pain. Blood glucose is 340 mg/dL, serum pH is 7.2, and urine ketones are
large. Which of the following is the priority intervention?
A) Administer an intravenous bolus of insulin.
B) Start intravenous fluids with normal saline.
C) Obtain a stat fetal biophysical profile.
, D) Administer sodium bicarbonate for acidosis.
Answer: B
Rationale: Diabetic ketoacidosis (DKA) management begins with aggressive fluid resuscitation to correct
dehydration and improve tissue perfusion. Insulin is started after fluids. Bicarbonate is not recommended for pH
>6.9. Fetal assessment is important but not the first priority.
11 A 32-week pregnant client presents with a blood pressure of 160/110 mm Hg, proteinuria (3+ on dipstick), and
a platelet count of 90,000/mm³. The nurse notes that the client has right upper quadrant pain and blurred
vision. Which intervention should the nurse prioritize?
A) Administer labetalol 20 mg IV and prepare for emergent cesarean section
B) Administer magnesium sulfate 4 g IV bolus followed by 2 g/hour infusion
C) Administer betamethasone 12 mg IM and start oral nifedipine
D) Insert a Foley catheter and administer furosemide 20 mg IV
Answer: B
Rationale: The client is exhibiting signs of severe preeclampsia with HELLP syndrome (thrombocytopenia).
Magnesium sulfate is the priority to prevent seizures. While antihypertensives and delivery are indicated, seizure
prophylaxis takes precedence. Betamethasone is for fetal lung maturity but not immediate. Furosemide is not
indicated as it may worsen hypovolemia.
12 A client at 28 weeks gestation is diagnosed with gestational diabetes mellitus (GDM) after a 1-hour glucose
challenge test of 190 mg/dL and a 3-hour OGTT with two elevated values. Which of the following
pharmacologic interventions is considered first-line if medical nutrition therapy fails to achieve glycemic
targets?
A) Insulin lispro (Humalog) administered before meals
B) Metformin 500 mg twice daily
C) Glyburide 2.5 mg daily
D) Insulin glargine (Lantus) once daily at bedtime
Answer: A
Rationale: Insulin is the first-line pharmacologic therapy for GDM in pregnancy because it does not cross the
placenta. Metformin and glyburide are oral agents that cross the placenta and are considered second-line. Insulin
lispro is a rapid-acting insulin suitable for mealtime coverage, whereas glargine is a long-acting basal insulin; both
may be used, but rapid-acting insulin is typically initiated first for postprandial control.
13 A client at 34 weeks gestation presents with painless vaginal bleeding. Ultrasound reveals a placenta previa
completely covering the internal os. The client is stable with minimal bleeding. Which of the following
interventions is most appropriate at this time?
A) Perform a sterile vaginal examination to assess cervical dilation
B) Prepare the client for an immediate cesarean section
C) Administer betamethasone and monitor fetal status
D) Apply fetal scalp electrode for continuous monitoring
Answer: C
Rationale: In a stable client with placenta previa and preterm gestation, conservative management is indicated to
prolong pregnancy and administer corticosteroids for fetal lung maturity. Vaginal exams are contraindicated as they
may provoke hemorrhage. Immediate cesarean is not indicated unless there is hemorrhage or non-reassuring fetal
status. Fetal scalp electrode is invasive and avoided with previa.
BANK| RN HESI MATERNITY EXAM PREP WITH
COMPLETE REAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS) ALREADY
GRADED A+ (MOST RECENT!!) - 190 Questions
This rigorous examination assesses advanced knowledge of antepartum care and complications, including risk
assessment, diagnostic interpretation, and management of high-risk pregnancies. It adheres to the latest ACOG
guidelines and evidence-based practice standards. It contains 190 multiple-choice questions, each with four
distractors and a fully worked rationale that explains why the keyed answer is correct. Content is organized into
10 focused sections: Antepartum Care and Complications, Intrapartum Care and Complications, Postpartum Care
and Complications, Newborn Care and Complications, Pharmacological Therapies in Maternity, Health
Promotion and Maintenance, Reduction of Risk Potential, Physiological Adaptation, Psychosocial Integrity,
Management of Care. Targeted learning outcomes include: Analyze risk factors and pathophysiology of
antepartum complications.; Interpret diagnostic findings to guide management decisions.; Evaluate
evidence-based interventions for complex antepartum scenarios.; Synthesize maternal-fetal physiology to
anticipate complications.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so
that students can study with confidence and self-correct as they work through the bank. Use it as a high-yield
review immediately before the exam, or as a structured practice tool during the unit - the rationales double as
concise teaching notes. The recommended writing time is 3 hours, with a passing score of 90%. Aligned with This
exam meets the rigor expected of top-tier US nursing and midwifery programs, aligned with AACN and AC NM
Section 1: Antepartum Care and Complications (Questions 1-20)
1 A primigravid client at 28 weeks gestation presents with sudden onset of severe epigastric pain and vomiting.
Blood pressure is 160/110 mm Hg, and urinalysis shows 3+ proteinuria. Laboratory results reveal elevated liver
enzymes and thrombocytopenia (platelets 85,000/µL). Which of the following is the priority intervention?
A) Administer intravenous hydralazine for blood pressure control.
B) Prepare for immediate cesarean delivery after stabilization.
C) Administer magnesium sulfate for seizure prophylaxis.
D) Obtain a stat CT scan of the abdomen to rule out hepatic rupture.
Answer: C
Rationale: The presentation is consistent with HELLP syndrome with severe features. Magnesium sulfate is
indicated for seizure prophylaxis in severe preeclampsia/HELLP. While blood pressure control and delivery are
important, seizure prophylaxis is the immediate priority given the risk of eclampsia. CT is not indicated unless
there is suspicion of hepatic hematoma.
2 A client with a previous history of preterm birth at 32 weeks gestation is now at 16 weeks gestation.
Transvaginal cervical length measurement is 22 mm. Which of the following management strategies is most
appropriate according to current ACOG guidelines?
A) Initiate intramuscular 17-alpha-hydroxyprogesterone caproate (Makena) weekly.
B) Place a cervical cerclage immediately.
C) Administer betamethasone for fetal lung maturity.
D) Schedule serial cervical length assessments every 2 weeks and reassess.
Answer: A
,Rationale: For women with a prior spontaneous preterm birth and a short cervix (<25 mm) before 24 weeks, ACOG
recommends weekly 17-OHPC. Cerclage is not indicated for a cervix >20 mm in singleton gestations.
Betamethasone is not given at 16 weeks. Serial monitoring alone is insufficient given the prior preterm birth and
short cervix.
3 A client at 34 weeks gestation with type 1 diabetes mellitus reports episodes of hypoglycemia and
hyperglycemia. Her HbA1c is 7.2%. Which of the following is the most significant risk to the fetus associated
with poor glycemic control in the third trimester?
A) Increased risk of neural tube defects.
B) Fetal macrosomia and neonatal hypoglycemia.
C) Congenital heart defects.
D) Spontaneous abortion.
Answer: B
Rationale: Poor glycemic control in the third trimester leads to fetal hyperinsulinism, causing macrosomia and
neonatal hypoglycemia. Neural tube defects and congenital heart defects are associated with first-trimester
hyperglycemia. Spontaneous abortion is not typically linked to third-trimester control.
4 A client at 20 weeks gestation with a body mass index of 38 kg/m² is screened for gestational diabetes using a
50-gram glucose challenge test. The 1-hour glucose level is 185 mg/dL. Which of the following is the next best
step?
A) Diagnose gestational diabetes and initiate dietary counseling.
B) Perform a 3-hour oral glucose tolerance test after a 3-day carbohydrate load.
C) Repeat the 50-gram glucose challenge test in 4 weeks.
D) Prescribe metformin for glycemic control.
Answer: B
Rationale: A positive screen ("e180 mg/dL at 1 hour) requires a diagnostic 3-hour OGTT. Diagnosis should not be
made on a single screening test. Metformin is not first-line without a diagnosis. Repeating the screen is not
appropriate; the diagnostic test is indicated.
5 A client at 30 weeks gestation presents with painless vaginal bleeding. Ultrasound reveals a placenta previa
completely covering the internal os. The client is stable with normal vital signs and no contractions. Which of
the following is the most appropriate management?
A) Perform a digital cervical examination to assess dilation.
B) Administer oxytocin to induce labor.
C) Admit for expectant management with bed rest and avoid vaginal exams.
D) Schedule an immediate cesarean delivery.
Answer: C
Rationale: In stable clients with placenta previa, expectant management to 36-37 weeks is recommended to improve
fetal maturity. Digital exams are contraindicated due to risk of hemorrhage. Immediate delivery is not indicated
without active bleeding or fetal distress. Oxytocin would worsen bleeding.
6 A client at 26 weeks gestation with a history of cervical insufficiency undergoes a McDonald cerclage. Two
weeks later, she presents with rupture of membranes. Amniotic fluid leakage is confirmed. Which of the
following is the priority action?
A) Remove the cerclage to reduce infection risk.
B) Administer antibiotics and corticosteroids.
C) Perform an amniocentesis to rule out infection.
,D) Tighten the cerclage to prevent further leakage.
Answer: A
Rationale: In the setting of preterm premature rupture of membranes (PPROM) with a cerclage in place, removal is
recommended to reduce the risk of chorioamnionitis and maternal sepsis. Antibiotics and corticosteroids may be
considered after removal, but removal is the priority. Tightening the cerclage is contraindicated.
7 A client at 22 weeks gestation with chronic hypertension is started on labetalol. Her blood pressure is 145/95
mm Hg. Which of the following parameters is most important to monitor during therapy?
A) Fetal heart rate variability on nonstress test.
B) Maternal heart rate and blood pressure.
C) Serum electrolytes and renal function.
D) Liver function tests.
Answer: B
Rationale: Labetalol can cause maternal bradycardia and hypotension. Monitoring maternal heart rate and blood
pressure is essential to avoid over-treatment and ensure uteroplacental perfusion. Fetal monitoring is important but
not the most immediate. Electrolytes and liver function are not primarily affected by labetalol.
8 A client at 32 weeks gestation is admitted with suspected placental abruption after a motor vehicle collision. She
reports sudden onset of abdominal pain and vaginal bleeding. The uterus is firm and tender. Fetal heart rate is
170 bpm with minimal variability. Which of the following is the most appropriate immediate action?
A) Administer terbutaline for tocolysis.
B) Obtain a Kleihauer-Betke test.
C) Prepare for emergency cesarean delivery.
D) Perform a biophysical profile.
Answer: C
Rationale: The presentation suggests severe abruption with fetal distress. Immediate delivery is indicated to save the
fetus and prevent maternal coagulopathy. Tocolysis is contraindicated. Kleihauer-Betke test is for Rh status, not a
priority. BPP would delay delivery.
9 A client at 18 weeks gestation with a twin pregnancy (dichorionic diamniotic) is found to have a cervical length
of 18 mm on routine ultrasound. She has no prior preterm birth. Which of the following is the most appropriate
management?
A) Administer 17-alpha-hydroxyprogesterone caproate weekly.
B) Place a cervical cerclage.
C) Initiate vaginal progesterone supplementation.
D) Recommend bed rest and pelvic rest.
Answer: C
Rationale: For asymptomatic twin gestations with a short cervix (<25 mm) before 24 weeks, ACOG recommends
vaginal progesterone to reduce preterm birth risk. 17-OHPC is not effective in twins. Cerclage is not recommended
for twin pregnancies. Bed rest has not been shown to be effective.
10 A client at 28 weeks gestation with pregestational diabetes (type 2) is on insulin therapy. She presents with
nausea, vomiting, and abdominal pain. Blood glucose is 340 mg/dL, serum pH is 7.2, and urine ketones are
large. Which of the following is the priority intervention?
A) Administer an intravenous bolus of insulin.
B) Start intravenous fluids with normal saline.
C) Obtain a stat fetal biophysical profile.
, D) Administer sodium bicarbonate for acidosis.
Answer: B
Rationale: Diabetic ketoacidosis (DKA) management begins with aggressive fluid resuscitation to correct
dehydration and improve tissue perfusion. Insulin is started after fluids. Bicarbonate is not recommended for pH
>6.9. Fetal assessment is important but not the first priority.
11 A 32-week pregnant client presents with a blood pressure of 160/110 mm Hg, proteinuria (3+ on dipstick), and
a platelet count of 90,000/mm³. The nurse notes that the client has right upper quadrant pain and blurred
vision. Which intervention should the nurse prioritize?
A) Administer labetalol 20 mg IV and prepare for emergent cesarean section
B) Administer magnesium sulfate 4 g IV bolus followed by 2 g/hour infusion
C) Administer betamethasone 12 mg IM and start oral nifedipine
D) Insert a Foley catheter and administer furosemide 20 mg IV
Answer: B
Rationale: The client is exhibiting signs of severe preeclampsia with HELLP syndrome (thrombocytopenia).
Magnesium sulfate is the priority to prevent seizures. While antihypertensives and delivery are indicated, seizure
prophylaxis takes precedence. Betamethasone is for fetal lung maturity but not immediate. Furosemide is not
indicated as it may worsen hypovolemia.
12 A client at 28 weeks gestation is diagnosed with gestational diabetes mellitus (GDM) after a 1-hour glucose
challenge test of 190 mg/dL and a 3-hour OGTT with two elevated values. Which of the following
pharmacologic interventions is considered first-line if medical nutrition therapy fails to achieve glycemic
targets?
A) Insulin lispro (Humalog) administered before meals
B) Metformin 500 mg twice daily
C) Glyburide 2.5 mg daily
D) Insulin glargine (Lantus) once daily at bedtime
Answer: A
Rationale: Insulin is the first-line pharmacologic therapy for GDM in pregnancy because it does not cross the
placenta. Metformin and glyburide are oral agents that cross the placenta and are considered second-line. Insulin
lispro is a rapid-acting insulin suitable for mealtime coverage, whereas glargine is a long-acting basal insulin; both
may be used, but rapid-acting insulin is typically initiated first for postprandial control.
13 A client at 34 weeks gestation presents with painless vaginal bleeding. Ultrasound reveals a placenta previa
completely covering the internal os. The client is stable with minimal bleeding. Which of the following
interventions is most appropriate at this time?
A) Perform a sterile vaginal examination to assess cervical dilation
B) Prepare the client for an immediate cesarean section
C) Administer betamethasone and monitor fetal status
D) Apply fetal scalp electrode for continuous monitoring
Answer: C
Rationale: In a stable client with placenta previa and preterm gestation, conservative management is indicated to
prolong pregnancy and administer corticosteroids for fetal lung maturity. Vaginal exams are contraindicated as they
may provoke hemorrhage. Immediate cesarean is not indicated unless there is hemorrhage or non-reassuring fetal
status. Fetal scalp electrode is invasive and avoided with previa.
