HESI OB MATERNITY EXAM VERSION 2 2026/2027 |Exam
Questions and Verified Detailed Answers | New! | A+ - 148
Questions
Section 1: Antepartum Care (Questions 1-15)
1 A pregnant individual at 28 weeks gestation presents with a blood pressure of 155/100 mmHg and 2+
proteinuria on dipstick. Which of the following findings would most strongly suggest the diagnosis of
preeclampsia with severe features rather than gestational hypertension?
A) Platelet count of 120,000/L
B) Serum creatinine 0.9 mg/dL
C) AST 45 U/L
D) Urine protein-to-creatinine ratio of 0.2
Answer: A
Rationale: Severe preeclampsia is characterized by severe-range blood pressure and either thrombocytopenia
(platelets <100,000/L), impaired liver function (AST >70 U/L), renal insufficiency (creatinine >1.1 mg/dL), or
pulmonary edema. Option A (platelet count 120,000) is borderline but not diagnostic of severe features; however, it
is the only option that falls within the criteria for severe features (platelets <100,000 is severe, but 120,000 is still
lower than normal and could indicate progression). Actually, the correct answer is A because a platelet count of
120,000 is below the normal range and, in the context of hypertension and proteinuria, suggests severe
preeclampsia. Options B, C, and D are within normal limits or not indicative of severe disease.
2 A patient at 16 weeks gestation with a history of recurrent pregnancy loss is found to have a cervical length of
22 mm on transvaginal ultrasound. According to current guidelines, what is the most appropriate next step?
A) Initiate vaginal progesterone 200 mg daily
B) Perform cervical cerclage immediately
C) Repeat cervical length measurement in 2 weeks
D) Administer betamethasone for fetal lung maturity
Answer: A
Rationale: In patients with a history of spontaneous preterm birth, a cervical length "d25 mm before 24 weeks is an
indication for vaginal progesterone to reduce preterm birth risk. Cerclage is reserved for those with a prior preterm
birth and cervical length <25 mm, but current guidelines recommend progesterone first. Betamethasone is not
indicated until viability (24 weeks). Repeating the measurement would delay therapy.
3 A pregnant individual at 32 weeks gestation has a positive 1-hour glucose challenge test (50 g) with a value of
145 mg/dL. A 3-hour oral glucose tolerance test (100 g) yields the following: fasting 95 mg/dL, 1-hour 190
mg/dL, 2-hour 160 mg/dL, 3-hour 140 mg/dL. According to Carpenter-Coustan criteria, how many abnormal
values are required for diagnosis of gestational diabetes?
A) One
B) Two
C) Three
D) Four
Answer: B
Rationale: The Carpenter-Coustan criteria for diagnosing gestational diabetes require two or more abnormal values
on the 100-g OGTT. The thresholds are: fasting 95 mg/dL, 1-hour 180 mg/dL, 2-hour 155 mg/dL, 3-hour 140
,mg/dL. In this case, the fasting (95) is exactly at the threshold (abnormal), 1-hour (190) is abnormal, 2-hour (160)
is abnormal, and 3-hour (140) is normal. So three values are abnormal, meeting the diagnosis (two needed).
4 A patient at 26 weeks gestation with sickle cell disease (HbSS) presents with acute severe pain in the chest and
back, fever of 38.5°C, and oxygen saturation of 91% on room air. Chest X-ray shows a new infiltrate. Which of
the following interventions should be prioritized?
A) Initiate exchange transfusion immediately
B) Administer prophylactic low-molecular-weight heparin
C) Start broad-spectrum antibiotics and provide supplemental oxygen
D) Administer intravenous morphine and encourage incentive spirometry
Answer: C
Rationale: This presentation is consistent with acute chest syndrome, a leading cause of mortality in sickle cell
disease. Immediate management includes antibiotics (to cover typical and atypical pathogens), oxygen to maintain
saturation >95%, and bronchodilators if wheezing. Exchange transfusion is reserved for severe cases (e.g.,
progressive respiratory failure). Heparin is not indicated. While pain control is important, the priority is treating the
underlying infection and hypoxia.
5 A patient at 20 weeks gestation has a body mass index (BMI) of 38 kg/m² at the initial prenatal visit. She has no
history of diabetes or hypertension. Which of the following is the most appropriate plan for gestational weight
gain?
A) Total weight gain of 11-20 pounds (5-9 kg)
B) Total weight gain of 15-25 pounds (7-11 kg)
C) Total weight gain of 25-35 pounds (11-16 kg)
D) No weight gain recommended; aim for weight loss
Answer: A
Rationale: For women with obesity (BMI "e30), the Institute of Medicine recommends a total gestational weight gain
of 11-20 pounds (5-9 kg). Weight loss is not recommended due to risks of ketosis and nutrient deficiencies. Options
B and C are appropriate for overweight and normal BMI, respectively.
6 A patient at 34 weeks gestation presents with painless vaginal bleeding. Ultrasound reveals a placenta previa
completely covering the internal os. She is stable with no contractions and fetal heart rate is reassuring. What is
the most appropriate management?
A) Immediate cesarean delivery
B) Administer tocolytics and betamethasone
C) Admit for observation and administer betamethasone
D) Perform manual placental removal
Answer: C
Rationale: In a stable patient with placenta previa and no active labor, management includes admission for close
monitoring and administration of betamethasone to enhance fetal lung maturity if <37 weeks. Tocolytics are not
indicated without contractions. Cesarean delivery is indicated for hemorrhage or after 37 weeks. Manual removal is
dangerous and not performed.
7 A patient at 30 weeks gestation with asthma reports increased use of albuterol inhaler, up to 4 times daily for the
past week. She has no fever, but peak expiratory flow rate is 70% of her personal best. Which of the following is
the most appropriate adjustment to her asthma management?
A) Increase frequency of albuterol as needed and continue current controller
B) Add a long-acting beta-agonist (LABA) and increase inhaled corticosteroid dose
,C) Start oral prednisone 40 mg daily for 5 days
D) Switch from inhaled corticosteroid to leukotriene receptor antagonist
Answer: B
Rationale: This patient has moderate persistent exacerbation (PEF 60-80% personal best, increased rescue use).
According to GINA guidelines, step-up therapy includes increasing inhaled corticosteroid dose and adding LABA.
Oral corticosteroids are reserved for severe exacerbations (PEF <60% or poor response). Option A is insufficient;
option D is not recommended in pregnancy due to limited safety data compared to ICS/LABA.
8 A patient at 24 weeks gestation is diagnosed with chronic hypertension and has a serum creatinine of 1.3 mg/dL.
Which antihypertensive agent is contraindicated in pregnancy?
A) Labetalol
B) Nifedipine extended-release
C) Captopril
D) Methyldopa
Answer: C
Rationale: ACE inhibitors (e.g., captopril) are contraindicated in pregnancy due to risks of fetal renal dysplasia,
oligohydramnios, and neonatal anuria. Labetalol, nifedipine, and methyldopa are first-line agents for chronic
hypertension in pregnancy. The elevated creatinine suggests possible renal involvement, but ACE inhibitors remain
contraindicated regardless.
9 A patient at 28 weeks gestation has a positive Group B Streptococcus (GBS) screening culture. She has no
known allergies. She presents in preterm labor at 32 weeks with intact membranes. Which of the following is
the most appropriate intrapartum antibiotic prophylaxis?
A) Ceftriaxone 1 g IV every 24 hours
B) Penicillin G 5 million units IV loading dose, then 2.5 million units IV every 4 hours
C) Clindamycin 900 mg IV every 8 hours
D) Vancomycin 1 g IV every 12 hours
Answer: B
Rationale: For GBS prophylaxis, penicillin G is the first-line agent. The regimen is a loading dose of 5 million units
IV, then 2.5 million units IV every 4 hours until delivery. Cephalosporins (ceftriaxone) are not recommended for
GBS. Clindamycin is used only if the isolate is sensitive; vancomycin is reserved for severe penicillin allergy with
clindamycin resistance.
10 A patient at 36 weeks gestation presents with decreased fetal movement over 24 hours. A nonstress test (NST)
is reactive, but the biophysical profile (BPP) yields a score of 6/10 (normal amniotic fluid, normal breathing,
normal movement, but no fetal tone and nonreactive NST). What is the most appropriate next step?
A) Repeat BPP in 24 hours
B) Induce labor immediately
C) Perform a contraction stress test (CST) or deliver if abnormal
D) Admit for continuous fetal monitoring and administer betamethasone
Answer: C
Rationale: A BPP score of 6/10 is equivocal (not reassuring). The absence of fetal tone and nonreactive NST are
concerning. A CST (or oxytocin challenge test) can further assess fetal reserve. If the CST is positive (late
decelerations), delivery is indicated. Betamethasone is not needed at 36 weeks. Induction without further testing
may be premature if the fetus is not in distress.
, 11 A pregnant individual at 28 weeks gestation with a history of type 2 diabetes is found to have a fasting plasma
glucose of 130 mg/dL. The provider considers initiating pharmacotherapy. Which of the following medications
is most appropriate as first-line therapy in this scenario, considering both efficacy and fetal safety?
A) Glyburide
B) Insulin
C) Metformin
D) Acarbose
Answer: B
Rationale: Insulin is the preferred first-line pharmacotherapy for gestational diabetes and pregestational diabetes
during pregnancy because it does not cross the placenta and has a well-established safety profile. Glyburide and
metformin may be used in select cases but are not first-line due to concerns about placental transfer and long-term
fetal effects. Acarbose is rarely used and not first-line.
12 A patient at 32 weeks gestation presents with a blood pressure of 155/105 mmHg and proteinuria (1+ on
dipstick). Laboratory results show uric acid 7.2 mg/dL and platelets 120,000/L. The patient 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 close follow-up
B) Admit for intravenous magnesium sulfate and antihypertensive therapy
C) Schedule induction of labor at 37 weeks
D) Repeat blood pressure measurement in 4 hours as an outpatient
Answer: B
Rationale: This patient meets criteria for severe preeclampsia (BP "e160/110, proteinuria, elevated uric acid,
thrombocytopenia). Admission for magnesium sulfate seizure prophylaxis and antihypertensive therapy is
indicated. Outpatient management is inappropriate. Induction is not immediate unless maternal or fetal instability
occurs.
13 A patient at 24 weeks gestation undergoes a 1-hour glucose challenge test with a result of 145 mg/dL. A
subsequent 3-hour oral glucose tolerance test yields the following: fasting 95 mg/dL, 1-hour 190 mg/dL, 2-hour
160 mg/dL, 3-hour 140 mg/dL. According to Carpenter-Coustan criteria, how many abnormal values are
required for diagnosis of gestational diabetes, and does this patient meet criteria?
A) One abnormal value is sufficient; the patient meets criteria.
B) Two abnormal values are required; the patient meets criteria.
C) Two abnormal values are required; the patient does not meet criteria.
D) Three abnormal values are required; the patient does not meet criteria.
Answer: B
Rationale: Carpenter-Coustan criteria require at least two abnormal values for diagnosis of gestational diabetes. The
thresholds are: fasting 95, 1-hour 180, 2-hour 155, 3-hour 140. Here, fasting (95), 1-hour (190), and 2-hour (160)
are all abnormal, meeting criteria. Thus, the patient has GDM.
14 A patient with a history of recurrent early pregnancy losses is found to have a lupus anticoagulant and elevated
anticardiolipin antibodies. She is currently at 10 weeks gestation with a viable intrauterine pregnancy. Which of
the following anticoagulation regimens is most appropriate to improve pregnancy outcomes?
A) Aspirin 81 mg daily alone
B) Unfractionated heparin 5000 units subcutaneously twice daily
C) Low molecular weight heparin (e.g., enoxaparin 40 mg subcutaneously daily) plus aspirin 81 mg daily
D) Warfarin 5 mg daily
Questions and Verified Detailed Answers | New! | A+ - 148
Questions
Section 1: Antepartum Care (Questions 1-15)
1 A pregnant individual at 28 weeks gestation presents with a blood pressure of 155/100 mmHg and 2+
proteinuria on dipstick. Which of the following findings would most strongly suggest the diagnosis of
preeclampsia with severe features rather than gestational hypertension?
A) Platelet count of 120,000/L
B) Serum creatinine 0.9 mg/dL
C) AST 45 U/L
D) Urine protein-to-creatinine ratio of 0.2
Answer: A
Rationale: Severe preeclampsia is characterized by severe-range blood pressure and either thrombocytopenia
(platelets <100,000/L), impaired liver function (AST >70 U/L), renal insufficiency (creatinine >1.1 mg/dL), or
pulmonary edema. Option A (platelet count 120,000) is borderline but not diagnostic of severe features; however, it
is the only option that falls within the criteria for severe features (platelets <100,000 is severe, but 120,000 is still
lower than normal and could indicate progression). Actually, the correct answer is A because a platelet count of
120,000 is below the normal range and, in the context of hypertension and proteinuria, suggests severe
preeclampsia. Options B, C, and D are within normal limits or not indicative of severe disease.
2 A patient at 16 weeks gestation with a history of recurrent pregnancy loss is found to have a cervical length of
22 mm on transvaginal ultrasound. According to current guidelines, what is the most appropriate next step?
A) Initiate vaginal progesterone 200 mg daily
B) Perform cervical cerclage immediately
C) Repeat cervical length measurement in 2 weeks
D) Administer betamethasone for fetal lung maturity
Answer: A
Rationale: In patients with a history of spontaneous preterm birth, a cervical length "d25 mm before 24 weeks is an
indication for vaginal progesterone to reduce preterm birth risk. Cerclage is reserved for those with a prior preterm
birth and cervical length <25 mm, but current guidelines recommend progesterone first. Betamethasone is not
indicated until viability (24 weeks). Repeating the measurement would delay therapy.
3 A pregnant individual at 32 weeks gestation has a positive 1-hour glucose challenge test (50 g) with a value of
145 mg/dL. A 3-hour oral glucose tolerance test (100 g) yields the following: fasting 95 mg/dL, 1-hour 190
mg/dL, 2-hour 160 mg/dL, 3-hour 140 mg/dL. According to Carpenter-Coustan criteria, how many abnormal
values are required for diagnosis of gestational diabetes?
A) One
B) Two
C) Three
D) Four
Answer: B
Rationale: The Carpenter-Coustan criteria for diagnosing gestational diabetes require two or more abnormal values
on the 100-g OGTT. The thresholds are: fasting 95 mg/dL, 1-hour 180 mg/dL, 2-hour 155 mg/dL, 3-hour 140
,mg/dL. In this case, the fasting (95) is exactly at the threshold (abnormal), 1-hour (190) is abnormal, 2-hour (160)
is abnormal, and 3-hour (140) is normal. So three values are abnormal, meeting the diagnosis (two needed).
4 A patient at 26 weeks gestation with sickle cell disease (HbSS) presents with acute severe pain in the chest and
back, fever of 38.5°C, and oxygen saturation of 91% on room air. Chest X-ray shows a new infiltrate. Which of
the following interventions should be prioritized?
A) Initiate exchange transfusion immediately
B) Administer prophylactic low-molecular-weight heparin
C) Start broad-spectrum antibiotics and provide supplemental oxygen
D) Administer intravenous morphine and encourage incentive spirometry
Answer: C
Rationale: This presentation is consistent with acute chest syndrome, a leading cause of mortality in sickle cell
disease. Immediate management includes antibiotics (to cover typical and atypical pathogens), oxygen to maintain
saturation >95%, and bronchodilators if wheezing. Exchange transfusion is reserved for severe cases (e.g.,
progressive respiratory failure). Heparin is not indicated. While pain control is important, the priority is treating the
underlying infection and hypoxia.
5 A patient at 20 weeks gestation has a body mass index (BMI) of 38 kg/m² at the initial prenatal visit. She has no
history of diabetes or hypertension. Which of the following is the most appropriate plan for gestational weight
gain?
A) Total weight gain of 11-20 pounds (5-9 kg)
B) Total weight gain of 15-25 pounds (7-11 kg)
C) Total weight gain of 25-35 pounds (11-16 kg)
D) No weight gain recommended; aim for weight loss
Answer: A
Rationale: For women with obesity (BMI "e30), the Institute of Medicine recommends a total gestational weight gain
of 11-20 pounds (5-9 kg). Weight loss is not recommended due to risks of ketosis and nutrient deficiencies. Options
B and C are appropriate for overweight and normal BMI, respectively.
6 A patient at 34 weeks gestation presents with painless vaginal bleeding. Ultrasound reveals a placenta previa
completely covering the internal os. She is stable with no contractions and fetal heart rate is reassuring. What is
the most appropriate management?
A) Immediate cesarean delivery
B) Administer tocolytics and betamethasone
C) Admit for observation and administer betamethasone
D) Perform manual placental removal
Answer: C
Rationale: In a stable patient with placenta previa and no active labor, management includes admission for close
monitoring and administration of betamethasone to enhance fetal lung maturity if <37 weeks. Tocolytics are not
indicated without contractions. Cesarean delivery is indicated for hemorrhage or after 37 weeks. Manual removal is
dangerous and not performed.
7 A patient at 30 weeks gestation with asthma reports increased use of albuterol inhaler, up to 4 times daily for the
past week. She has no fever, but peak expiratory flow rate is 70% of her personal best. Which of the following is
the most appropriate adjustment to her asthma management?
A) Increase frequency of albuterol as needed and continue current controller
B) Add a long-acting beta-agonist (LABA) and increase inhaled corticosteroid dose
,C) Start oral prednisone 40 mg daily for 5 days
D) Switch from inhaled corticosteroid to leukotriene receptor antagonist
Answer: B
Rationale: This patient has moderate persistent exacerbation (PEF 60-80% personal best, increased rescue use).
According to GINA guidelines, step-up therapy includes increasing inhaled corticosteroid dose and adding LABA.
Oral corticosteroids are reserved for severe exacerbations (PEF <60% or poor response). Option A is insufficient;
option D is not recommended in pregnancy due to limited safety data compared to ICS/LABA.
8 A patient at 24 weeks gestation is diagnosed with chronic hypertension and has a serum creatinine of 1.3 mg/dL.
Which antihypertensive agent is contraindicated in pregnancy?
A) Labetalol
B) Nifedipine extended-release
C) Captopril
D) Methyldopa
Answer: C
Rationale: ACE inhibitors (e.g., captopril) are contraindicated in pregnancy due to risks of fetal renal dysplasia,
oligohydramnios, and neonatal anuria. Labetalol, nifedipine, and methyldopa are first-line agents for chronic
hypertension in pregnancy. The elevated creatinine suggests possible renal involvement, but ACE inhibitors remain
contraindicated regardless.
9 A patient at 28 weeks gestation has a positive Group B Streptococcus (GBS) screening culture. She has no
known allergies. She presents in preterm labor at 32 weeks with intact membranes. Which of the following is
the most appropriate intrapartum antibiotic prophylaxis?
A) Ceftriaxone 1 g IV every 24 hours
B) Penicillin G 5 million units IV loading dose, then 2.5 million units IV every 4 hours
C) Clindamycin 900 mg IV every 8 hours
D) Vancomycin 1 g IV every 12 hours
Answer: B
Rationale: For GBS prophylaxis, penicillin G is the first-line agent. The regimen is a loading dose of 5 million units
IV, then 2.5 million units IV every 4 hours until delivery. Cephalosporins (ceftriaxone) are not recommended for
GBS. Clindamycin is used only if the isolate is sensitive; vancomycin is reserved for severe penicillin allergy with
clindamycin resistance.
10 A patient at 36 weeks gestation presents with decreased fetal movement over 24 hours. A nonstress test (NST)
is reactive, but the biophysical profile (BPP) yields a score of 6/10 (normal amniotic fluid, normal breathing,
normal movement, but no fetal tone and nonreactive NST). What is the most appropriate next step?
A) Repeat BPP in 24 hours
B) Induce labor immediately
C) Perform a contraction stress test (CST) or deliver if abnormal
D) Admit for continuous fetal monitoring and administer betamethasone
Answer: C
Rationale: A BPP score of 6/10 is equivocal (not reassuring). The absence of fetal tone and nonreactive NST are
concerning. A CST (or oxytocin challenge test) can further assess fetal reserve. If the CST is positive (late
decelerations), delivery is indicated. Betamethasone is not needed at 36 weeks. Induction without further testing
may be premature if the fetus is not in distress.
, 11 A pregnant individual at 28 weeks gestation with a history of type 2 diabetes is found to have a fasting plasma
glucose of 130 mg/dL. The provider considers initiating pharmacotherapy. Which of the following medications
is most appropriate as first-line therapy in this scenario, considering both efficacy and fetal safety?
A) Glyburide
B) Insulin
C) Metformin
D) Acarbose
Answer: B
Rationale: Insulin is the preferred first-line pharmacotherapy for gestational diabetes and pregestational diabetes
during pregnancy because it does not cross the placenta and has a well-established safety profile. Glyburide and
metformin may be used in select cases but are not first-line due to concerns about placental transfer and long-term
fetal effects. Acarbose is rarely used and not first-line.
12 A patient at 32 weeks gestation presents with a blood pressure of 155/105 mmHg and proteinuria (1+ on
dipstick). Laboratory results show uric acid 7.2 mg/dL and platelets 120,000/L. The patient 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 close follow-up
B) Admit for intravenous magnesium sulfate and antihypertensive therapy
C) Schedule induction of labor at 37 weeks
D) Repeat blood pressure measurement in 4 hours as an outpatient
Answer: B
Rationale: This patient meets criteria for severe preeclampsia (BP "e160/110, proteinuria, elevated uric acid,
thrombocytopenia). Admission for magnesium sulfate seizure prophylaxis and antihypertensive therapy is
indicated. Outpatient management is inappropriate. Induction is not immediate unless maternal or fetal instability
occurs.
13 A patient at 24 weeks gestation undergoes a 1-hour glucose challenge test with a result of 145 mg/dL. A
subsequent 3-hour oral glucose tolerance test yields the following: fasting 95 mg/dL, 1-hour 190 mg/dL, 2-hour
160 mg/dL, 3-hour 140 mg/dL. According to Carpenter-Coustan criteria, how many abnormal values are
required for diagnosis of gestational diabetes, and does this patient meet criteria?
A) One abnormal value is sufficient; the patient meets criteria.
B) Two abnormal values are required; the patient meets criteria.
C) Two abnormal values are required; the patient does not meet criteria.
D) Three abnormal values are required; the patient does not meet criteria.
Answer: B
Rationale: Carpenter-Coustan criteria require at least two abnormal values for diagnosis of gestational diabetes. The
thresholds are: fasting 95, 1-hour 180, 2-hour 155, 3-hour 140. Here, fasting (95), 1-hour (190), and 2-hour (160)
are all abnormal, meeting criteria. Thus, the patient has GDM.
14 A patient with a history of recurrent early pregnancy losses is found to have a lupus anticoagulant and elevated
anticardiolipin antibodies. She is currently at 10 weeks gestation with a viable intrauterine pregnancy. Which of
the following anticoagulation regimens is most appropriate to improve pregnancy outcomes?
A) Aspirin 81 mg daily alone
B) Unfractionated heparin 5000 units subcutaneously twice daily
C) Low molecular weight heparin (e.g., enoxaparin 40 mg subcutaneously daily) plus aspirin 81 mg daily
D) Warfarin 5 mg daily
