EXAM TEST BANK| OB HESI FINAL EXAM REVIEW
WITH COMPLETE REAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
ALREADY GRADED A+ (MOST RECENT!!) - 200 Questions
This exam assesses advanced knowledge of antepartum care, including prenatal risk assessment, screening tests,
management of high-risk conditions, and evidence-based interventions. Questions reflect current ACOG
guidelines and require synthesis of complex maternal-fetal physiology. It contains 200 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, Intrapartum Care, Postpartum Care, Newborn Care,
Complications of Pregnancy, Maternal-Newborn Pharmacology, High-Risk Conditions, Family Planning and
Contraception, Women's Health Issues, Psychosocial and Cultural Considerations. Targeted learning outcomes
include: Evaluate maternal and fetal risk factors using biophysical and biochemical markers; Interpret prenatal
screening and diagnostic test results to guide management; Apply evidence-based interventions for common
antepartum complications; Differentiate between normal physiologic changes and pathological conditions in
pregnancy. 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
examination meets the standards of the American Association of Colleges of Nursing (AACN) and the National
Section 1: Antepartum Care (Questions 1-20)
1 A nulliparous woman at 28 weeks gestation presents with a blood pressure of 155/95 mmHg and 2+ proteinuria
on dipstick. Her serum creatinine is 0.9 mg/dL, and uric acid is 6.8 mg/dL. She has no headache or visual
changes. Which of the following is the most appropriate next step in management?
A) Administer labetalol 200 mg orally and discharge with home BP monitoring
B) Admit for 24-hour urine protein collection and magnesium sulfate seizure prophylaxis
C) Immediate delivery by cesarean section due to severe preeclampsia
D) Start oral nifedipine and schedule outpatient antenatal testing twice weekly
Answer: B
Rationale: The patient meets criteria for preeclampsia without severe features (BP "e140/90, proteinuria). However,
the elevated uric acid and creatinine suggest worsening renal function, warranting inpatient evaluation. Admission
for 24-hour urine protein quantification and magnesium sulfate is indicated to assess severity and prevent
eclampsia. Option A is insufficient as outpatient management is not safe with evidence of end-organ dysfunction.
Option C is premature without fetal lung maturity assessment. Option D fails to address the need for seizure
prophylaxis.
2 A pregnant woman at 16 weeks gestation undergoes chorionic villus sampling (CVS) for advanced maternal
age. The karyotype reveals 45,X. Which of the following additional findings is most likely to be present on
ultrasound examination?
A) Echogenic intracardiac focus and echogenic bowel
B) Increased nuchal translucency and cystic hygroma
C) Choroid plexus cyst and sandal gap deformity
,D) Single umbilical artery and two-vessel cord
Answer: B
Rationale: 45,X (Turner syndrome) is frequently associated with increased nuchal translucency and cystic hygroma
in the first trimester due to lymphatic obstruction. These are hallmark ultrasound findings. Echogenic intracardiac
focus and echogenic bowel are more typical of trisomy 21. Choroid plexus cysts are seen in trisomy 18. Single
umbilical artery can be associated with various aneuploidies but is not specific to Turner syndrome.
3 A woman at 34 weeks gestation with a history of class III obesity (BMI 42 kg/m²) presents with complaints of
epigastric pain, nausea, and vomiting. Vital signs: BP 148/92 mmHg, HR 92 bpm, RR 18, O2 saturation 97%.
Laboratory results show hemoglobin 11.2 g/dL, platelets 98,000/L, AST 120 U/L, ALT 110 U/L, and lactate
dehydrogenase 800 U/L. Which of the following is the most likely diagnosis?
A) Acute fatty liver of pregnancy
B) HELLP syndrome
C) Acute cholecystitis
D) Severe preeclampsia with hepatic involvement
Answer: B
Rationale: The triad of hemolysis (elevated LDH, low hemoglobin), elevated liver enzymes (AST, ALT), and low
platelets (98,000) is diagnostic of HELLP syndrome. Epigastric pain and nausea are classic presenting symptoms.
Acute fatty liver of pregnancy typically presents with hypoglycemia, coagulopathy, and encephalopathy, which are
absent here. Acute cholecystitis would not cause thrombocytopenia or elevated LDH. Severe preeclampsia may
have elevated liver enzymes but not necessarily the hemolysis and thrombocytopenia characteristic of HELLP.
4 A pregnant woman at 24 weeks gestation with type 1 diabetes mellitus has a glycosylated hemoglobin (HbA1c)
of 8.5%. Which of the following fetal complications is she at highest risk for?
A) Intrauterine growth restriction due to placental insufficiency
B) Congenital cardiac anomalies due to hyperglycemia during organogenesis
C) Polyhydramnios due to fetal polyuria from maternal hyperglycemia
D) Preterm premature rupture of membranes due to infection
Answer: B
Rationale: Poor glycemic control in the first trimester (reflected by elevated HbA1c) is strongly associated with
congenital anomalies, particularly cardiac and neural tube defects, due to teratogenic effects of hyperglycemia
during organogenesis. Intrauterine growth restriction is more typical of vascular disease, not diabetes.
Polyhydramnios can occur later in pregnancy due to fetal hyperglycemia and polyuria, but the highest risk for
anomalies is early. PPROM is not directly linked to diabetes.
5 A woman at 30 weeks gestation with a history of prior preterm birth at 32 weeks presents with regular
contractions every 8 minutes, cervical length of 22 mm on transvaginal ultrasound, and negative fetal
fibronectin test. Which of the following management strategies is most appropriate?
A) Administer betamethasone and start oral nifedipine for tocolysis
B) Administer terbutaline subcutaneously and magnesium sulfate for neuroprotection
C) Start vaginal progesterone suppositories and schedule weekly cervical length checks
D) Admit for intravenous magnesium sulfate and intramuscular betamethasone
Answer: C
Rationale: The patient has a short cervix (22 mm) and prior preterm birth, but negative fetal fibronectin suggests
low risk of imminent preterm delivery. Vaginal progesterone is recommended for women with prior spontaneous
preterm birth and short cervix (25 mm) to reduce recurrence. Betamethasone and tocolysis are indicated only if
preterm labor is diagnosed (cervical change + contractions). Terbutaline is not first-line. Admission with
,magnesium is not warranted without active labor.
6 A primigravida at 36 weeks gestation undergoes a biophysical profile (BPP) due to decreased fetal movement.
The BPP score is 6/10, with points lost for fetal breathing movements and amniotic fluid volume (AFI 4 cm).
Which of the following is the most appropriate next step?
A) Repeat the BPP in 24 hours
B) Perform a contraction stress test (CST)
C) Admit for induction of labor
D) Schedule a non-stress test (NST) twice weekly
Answer: B
Rationale: A BPP score of 6/10 is equivocal, especially with oligohydramnios (AFI <5 cm). A contraction stress test
(CST) is indicated to evaluate fetal heart rate response to contractions and assess placental reserve. A negative CST
is reassuring; a positive CST suggests uteroplacental insufficiency and may prompt delivery. Repeating BPP is not
recommended as the abnormal findings require further evaluation. Induction is not yet indicated without evidence
of fetal compromise. Twice-weekly NST is insufficient for this situation.
7 A woman at 20 weeks gestation is found to have a uterine artery pulsatility index (PI) above the 95th percentile
on Doppler ultrasound. She has no prior history of hypertension. Which of the following is she at highest risk
for developing later in pregnancy?
A) Gestational diabetes mellitus
B) Placenta previa
C) Preeclampsia
D) Preterm labor
Answer: C
Rationale: Elevated uterine artery PI at 20 weeks indicates increased resistance to blood flow in the uterine arteries,
suggesting impaired trophoblast invasion and inadequate spiral artery remodeling. This is strongly associated with
the subsequent development of preeclampsia and intrauterine growth restriction. Gestational diabetes is related to
insulin resistance, not vascular resistance. Placenta previa is diagnosed by placental location. Preterm labor has
multifactorial causes, not specifically linked to uterine artery Doppler.
8 A pregnant woman at 14 weeks gestation with a history of systemic lupus erythematosus (SLE) presents with a
positive anti-Ro/SSA antibody. Which of the following fetal complications is she at highest risk for?
A) Congenital heart block
B) Neonatal lupus erythematosus rash
C) Intrauterine growth restriction
D) Preterm birth due to placental inflammation
Answer: A
Rationale: Anti-Ro/SSA antibodies cross the placenta and can bind to fetal cardiac tissue, causing inflammation and
fibrosis of the atrioventricular node, leading to congenital heart block. This typically occurs between 18-24 weeks.
Neonatal lupus rash is also possible but less severe. Intrauterine growth restriction and preterm birth are associated
with SLE activity and placental insufficiency but are not directly caused by anti-Ro antibodies alone.
9 A woman at 28 weeks gestation with a body mass index (BMI) of 18.5 kg/m² is found to have a fundal height
measurement of 24 cm. Which of the following is the most likely cause?
A) Incorrect dating due to irregular menses
B) Fetal growth restriction due to maternal malnutrition
C) Oligohydramnios due to placental insufficiency
, D) Constitutional small fetus with normal growth
Answer: B
Rationale: Fundal height less than expected for gestational age (24 cm at 28 weeks, which is 4 cm below the 50th
percentile) in a woman with low BMI suggests possible fetal growth restriction (FGR). Maternal undernutrition is a
risk factor for FGR. While incorrect dating or constitutional small fetus are possible, the most concerning and
likely cause given the maternal BMI is FGR. Oligohydramnios could be associated but is not the primary cause of
the small fundal height.
10 A pregnant woman at 32 weeks gestation with a history of chronic hypertension is started on labetalol 200 mg
twice daily. Her blood pressure is well-controlled at 130/80 mmHg. Which of the following is the primary
reason to avoid angiotensin-converting enzyme (ACE) inhibitors in pregnancy?
A) Increased risk of maternal hepatotoxicity
B) Fetal renal dysplasia and oligohydramnios
C) Maternal hyperkalemia and cardiac arrhythmias
D) Increased risk of preterm labor and placental abruption
Answer: B
Rationale: ACE inhibitors are teratogenic in the second and third trimesters, causing fetal renal tubular dysplasia,
leading to oligohydramnios, pulmonary hypoplasia, and neonatal anuria. They are contraindicated in pregnancy
except in rare circumstances. Hepatotoxicity is not a primary concern. Maternal hyperkalemia can occur but is not
the main fetal risk. Preterm labor and abruption are not directly caused by ACE inhibitors.
11 A primigravida at 28 weeks gestation presents with a blood pressure of 155/95 mmHg and 2+ proteinuria.
Which combination of findings is most indicative of severe preeclampsia rather than gestational hypertension?
A) Blood pressure 160/110 mmHg and proteinuria 5 g/24 hours
B) Elevated liver enzymes and thrombocytopenia
C) Headache, blurred vision, and right upper quadrant pain
D) All of the above are features of severe preeclampsia
Answer: D
Rationale: Severe preeclampsia is defined by blood pressure "e160/110 mmHg, proteinuria "e5 g/24 hours, or
multiorgan involvement including elevated liver enzymes, thrombocytopenia, and symptoms like headache, visual
disturbances, and epigastric pain. Gestational hypertension lacks these systemic features.
12 A patient at 16 weeks gestation has a positive screen for trisomy 21 with a nuchal translucency of 4.2 mm.
Which diagnostic test should be recommended to confirm the diagnosis?
A) Quadruple marker screen
B) Cell-free fetal DNA (cfDNA) testing
C) Chorionic villus sampling (CVS)
D) Percutaneous umbilical blood sampling (PUBS)
Answer: C
Rationale: CVS is the diagnostic test of choice for chromosomal abnormalities in the first trimester (10-13 weeks).
cfDNA is a screening test, not diagnostic. Quad screen is second-trimester screening. PUBS is used later for fetal
blood disorders.
13 Which of the following physiological changes in pregnancy increases the risk of venous thromboembolism, and
what is the primary prophylactic intervention for high-risk patients?
A) Increased venous capacitance; aspirin therapy
B) Hypercoagulable state due to elevated clotting factors; low-molecular-weight heparin