HESI Maternal Nursing Study Guide
with Practice Questions and Answers
2025
A nurse is caring for a newborn who has just been delivered via cesarean section and is
exhibiting nasal flaring, grunting, and intercostal retractions. What is the most likely cause of
these symptoms?
a. Meconium aspiration
b. Transient tachypnea of the newborn (TTN)
c. Respiratory distress syndrome (RDS)
d. Neonatal sepsis
Correct answer: b. Transient tachypnea of the newborn (TTN)
Rationale:
TTN is common in infants born by cesarean delivery due to delayed absorption of lung fluid,
causing mild respiratory distress shortly after birth. Symptoms include grunting, retractions, and
nasal flaring that resolve within 48–72 hours. RDS is more common in preterm infants, and
meconium aspiration usually presents with coarse crackles and hypoxia.
A neonate is diagnosed with patent ductus arteriosus (PDA). Which medication does the nurse
anticipate to help close the ductus arteriosus?
a. Indomethacin
b. Prostaglandin E1
c. Dopamine
d. Furosemide
Correct answer: a. Indomethacin
Rationale:
Indomethacin, a prostaglandin synthesis inhibitor, promotes closure of the ductus arteriosus in
premature infants. Prostaglandin E1 keeps the ductus open in conditions like transposition of the
great arteries. Dopamine supports blood pressure, and furosemide treats fluid overload.
A nurse is caring for a newborn who is small for gestational age (SGA). Which finding requires
immediate intervention?
a. Temperature of 36°C (96.8°F)
b. Blood glucose of 32 mg/dL
,c. Mild acrocyanosis
d. Poor suck reflex
Correct answer: b. Blood glucose of 32 mg/dL
Rationale:
SGA infants are prone to hypoglycemia due to decreased glycogen stores. A glucose level below
40 mg/dL requires urgent feeding or IV glucose. Low temperature and weak suck require support
but are not immediately life-threatening.
A neonate born at 42 weeks has dry, cracked skin and meconium-stained fluid. The nurse should
anticipate which complication?
a. Hypoglycemia
b. Hyperbilirubinemia
c. Polycythemia
d. All of the above
Correct answer: d. All of the above
Rationale:
Post-term infants are at risk for hypoglycemia (due to depleted glycogen), polycythemia (from
chronic hypoxia), and hyperbilirubinemia (due to RBC breakdown). Dry, cracked skin and
meconium-stained fluid are characteristic findings.
A newborn develops respiratory distress shortly after birth. The nurse notes a scaphoid abdomen
and bowel sounds in the chest. Which condition is suspected?
a. Diaphragmatic hernia
b. Gastroschisis
c. Tracheoesophageal fistula
d. Necrotizing enterocolitis
Correct answer: a. Diaphragmatic hernia
Rationale:
Diaphragmatic hernia allows abdominal organs to enter the thoracic cavity, causing respiratory
distress and a scaphoid abdomen. Bowel sounds in the chest are a key diagnostic clue. Immediate
respiratory support and surgical repair are required.
A nurse is administering erythromycin eye ointment to a newborn. The purpose of this
medication is to prevent which condition?
a. Herpes simplex infection
b. Gonococcal ophthalmia neonatorum
c. Group B strep sepsis
,d. Cytomegalovirus conjunctivitis
Correct answer: b. Gonococcal ophthalmia neonatorum
Rationale:
Erythromycin ophthalmic ointment prevents ophthalmia neonatorum caused by Neisseria
gonorrhoeae, which can lead to blindness. It is given within 1 hour of birth as mandated
prophylaxis.
A preterm infant on mechanical ventilation suddenly shows a drop in oxygen saturation,
hypotension, and asymmetrical chest expansion. What should the nurse suspect?
a. Pneumothorax
b. Pneumonia
c. Atelectasis
d. Bronchopulmonary dysplasia
Correct answer: a. Pneumothorax
Rationale:
A sudden drop in oxygen saturation and asymmetric chest movement indicate pneumothorax, a
known complication of mechanical ventilation in preterm infants. Immediate decompression or
chest tube insertion is often required.
A nurse is assessing a newborn with hypoxic-ischemic encephalopathy. Which finding is
expected?
a. Hyperactive Moro reflex
b. Decreased muscle tone and poor feeding
c. Excessive crying and irritability
d. Rapid weight gain
Correct answer: b. Decreased muscle tone and poor feeding
Rationale:
Hypoxic-ischemic encephalopathy (HIE) leads to neurological depression, hypotonia, and poor
feeding due to cerebral hypoxia. Hyperactivity and irritability may occur in less severe cases but
are not the primary signs.
A newborn delivered by a diabetic mother has tremors and irritability. The nurse obtains a heel
stick glucose of 25 mg/dL. Which action is most appropriate?
a. Continue monitoring the infant
b. Begin an IV infusion of D10W
c. Offer the baby sterile water
, d. Notify social services
Correct answer: b. Begin an IV infusion of D10W
Rationale:
A glucose level below 30 mg/dL in a symptomatic infant requires immediate IV glucose to
prevent seizures and neurological damage. Oral feeds may be insufficient in severe
hypoglycemia.
A nurse notes a swelling that crosses the suture lines of a newborn’s scalp after vacuum-assisted
delivery. What is the correct term for this finding?
a. Cephalohematoma
b. Caput succedaneum
c. Subdural hematoma
d. Fontanel bulging
Correct answer: b. Caput succedaneum
Rationale:
Caput succedaneum is edema of the scalp that crosses suture lines and resolves in 24–48 hours.
Cephalohematoma is confined to one bone and takes weeks to resolve.
A nurse prepares to administer vitamin K to a newborn. The mother asks, “Why does my baby
need that shot?” The nurse’s best response is:
a. “It helps your baby fight infection.”
b. “It helps your baby’s blood clot properly.”
c. “It protects your baby’s liver.”
d. “It boosts your baby’s immune system.”
Correct answer: b. “It helps your baby’s blood clot properly.”
Rationale:
Newborns have sterile intestines and lack vitamin K-producing flora, putting them at risk for
bleeding. Vitamin K promotes synthesis of clotting factors II, VII, IX, and X.
A newborn exhibits persistent vomiting with a bile-stained (green) appearance. What condition
should the nurse suspect?
a. Pyloric stenosis
b. Hirschsprung’s disease
c. Intestinal obstruction
d. Gastroesophageal reflux
Correct answer: c. Intestinal obstruction
with Practice Questions and Answers
2025
A nurse is caring for a newborn who has just been delivered via cesarean section and is
exhibiting nasal flaring, grunting, and intercostal retractions. What is the most likely cause of
these symptoms?
a. Meconium aspiration
b. Transient tachypnea of the newborn (TTN)
c. Respiratory distress syndrome (RDS)
d. Neonatal sepsis
Correct answer: b. Transient tachypnea of the newborn (TTN)
Rationale:
TTN is common in infants born by cesarean delivery due to delayed absorption of lung fluid,
causing mild respiratory distress shortly after birth. Symptoms include grunting, retractions, and
nasal flaring that resolve within 48–72 hours. RDS is more common in preterm infants, and
meconium aspiration usually presents with coarse crackles and hypoxia.
A neonate is diagnosed with patent ductus arteriosus (PDA). Which medication does the nurse
anticipate to help close the ductus arteriosus?
a. Indomethacin
b. Prostaglandin E1
c. Dopamine
d. Furosemide
Correct answer: a. Indomethacin
Rationale:
Indomethacin, a prostaglandin synthesis inhibitor, promotes closure of the ductus arteriosus in
premature infants. Prostaglandin E1 keeps the ductus open in conditions like transposition of the
great arteries. Dopamine supports blood pressure, and furosemide treats fluid overload.
A nurse is caring for a newborn who is small for gestational age (SGA). Which finding requires
immediate intervention?
a. Temperature of 36°C (96.8°F)
b. Blood glucose of 32 mg/dL
,c. Mild acrocyanosis
d. Poor suck reflex
Correct answer: b. Blood glucose of 32 mg/dL
Rationale:
SGA infants are prone to hypoglycemia due to decreased glycogen stores. A glucose level below
40 mg/dL requires urgent feeding or IV glucose. Low temperature and weak suck require support
but are not immediately life-threatening.
A neonate born at 42 weeks has dry, cracked skin and meconium-stained fluid. The nurse should
anticipate which complication?
a. Hypoglycemia
b. Hyperbilirubinemia
c. Polycythemia
d. All of the above
Correct answer: d. All of the above
Rationale:
Post-term infants are at risk for hypoglycemia (due to depleted glycogen), polycythemia (from
chronic hypoxia), and hyperbilirubinemia (due to RBC breakdown). Dry, cracked skin and
meconium-stained fluid are characteristic findings.
A newborn develops respiratory distress shortly after birth. The nurse notes a scaphoid abdomen
and bowel sounds in the chest. Which condition is suspected?
a. Diaphragmatic hernia
b. Gastroschisis
c. Tracheoesophageal fistula
d. Necrotizing enterocolitis
Correct answer: a. Diaphragmatic hernia
Rationale:
Diaphragmatic hernia allows abdominal organs to enter the thoracic cavity, causing respiratory
distress and a scaphoid abdomen. Bowel sounds in the chest are a key diagnostic clue. Immediate
respiratory support and surgical repair are required.
A nurse is administering erythromycin eye ointment to a newborn. The purpose of this
medication is to prevent which condition?
a. Herpes simplex infection
b. Gonococcal ophthalmia neonatorum
c. Group B strep sepsis
,d. Cytomegalovirus conjunctivitis
Correct answer: b. Gonococcal ophthalmia neonatorum
Rationale:
Erythromycin ophthalmic ointment prevents ophthalmia neonatorum caused by Neisseria
gonorrhoeae, which can lead to blindness. It is given within 1 hour of birth as mandated
prophylaxis.
A preterm infant on mechanical ventilation suddenly shows a drop in oxygen saturation,
hypotension, and asymmetrical chest expansion. What should the nurse suspect?
a. Pneumothorax
b. Pneumonia
c. Atelectasis
d. Bronchopulmonary dysplasia
Correct answer: a. Pneumothorax
Rationale:
A sudden drop in oxygen saturation and asymmetric chest movement indicate pneumothorax, a
known complication of mechanical ventilation in preterm infants. Immediate decompression or
chest tube insertion is often required.
A nurse is assessing a newborn with hypoxic-ischemic encephalopathy. Which finding is
expected?
a. Hyperactive Moro reflex
b. Decreased muscle tone and poor feeding
c. Excessive crying and irritability
d. Rapid weight gain
Correct answer: b. Decreased muscle tone and poor feeding
Rationale:
Hypoxic-ischemic encephalopathy (HIE) leads to neurological depression, hypotonia, and poor
feeding due to cerebral hypoxia. Hyperactivity and irritability may occur in less severe cases but
are not the primary signs.
A newborn delivered by a diabetic mother has tremors and irritability. The nurse obtains a heel
stick glucose of 25 mg/dL. Which action is most appropriate?
a. Continue monitoring the infant
b. Begin an IV infusion of D10W
c. Offer the baby sterile water
, d. Notify social services
Correct answer: b. Begin an IV infusion of D10W
Rationale:
A glucose level below 30 mg/dL in a symptomatic infant requires immediate IV glucose to
prevent seizures and neurological damage. Oral feeds may be insufficient in severe
hypoglycemia.
A nurse notes a swelling that crosses the suture lines of a newborn’s scalp after vacuum-assisted
delivery. What is the correct term for this finding?
a. Cephalohematoma
b. Caput succedaneum
c. Subdural hematoma
d. Fontanel bulging
Correct answer: b. Caput succedaneum
Rationale:
Caput succedaneum is edema of the scalp that crosses suture lines and resolves in 24–48 hours.
Cephalohematoma is confined to one bone and takes weeks to resolve.
A nurse prepares to administer vitamin K to a newborn. The mother asks, “Why does my baby
need that shot?” The nurse’s best response is:
a. “It helps your baby fight infection.”
b. “It helps your baby’s blood clot properly.”
c. “It protects your baby’s liver.”
d. “It boosts your baby’s immune system.”
Correct answer: b. “It helps your baby’s blood clot properly.”
Rationale:
Newborns have sterile intestines and lack vitamin K-producing flora, putting them at risk for
bleeding. Vitamin K promotes synthesis of clotting factors II, VII, IX, and X.
A newborn exhibits persistent vomiting with a bile-stained (green) appearance. What condition
should the nurse suspect?
a. Pyloric stenosis
b. Hirschsprung’s disease
c. Intestinal obstruction
d. Gastroesophageal reflux
Correct answer: c. Intestinal obstruction
