HESI MATERNAL PEDIATRIC PRACTICE EXAM 2026/2027 |
100% Correct Answers with Complete Solutions | NCLEX-RN
Aligned | Maternal-Child Nursing | Pass Guaranteed - A+
Graded
Domain 1: Antepartum Nursing (20 Questions)
Q1: A 28-year-old primigravida at 32 weeks gestation presents to the prenatal clinic. Her
blood pressure is 148/92 mmHg, she has 2+ proteinuria on dipstick, and reports a
severe headache and visual disturbances. Which nursing intervention is the priority?
A. Administer oral methyldopa and schedule follow-up in 1 week
B. Instruct the client to rest in left lateral position and increase fluid intake
C. Notify the healthcare provider immediately and prepare for possible magnesium
sulfate therapy
D. Reassure the client that these are normal third-trimester symptoms and provide
dietary counseling
Correct Answer: C
Rationale: This client presents with classic signs of severe preeclampsia: hypertension
(≥140/90 mmHg), proteinuria, headache, and visual disturbances (hyperreflexia may
also be present). These symptoms indicate potential progression to eclampsia
(seizures), which is life-threatening. The priority nursing action is to immediately notify
the healthcare provider and prepare for magnesium sulfate administration, which is the
anticonvulsant of choice for seizure prophylaxis in severe preeclampsia. Option A is
,incorrect because oral antihypertensives alone are insufficient for severe preeclampsia
and do not address the seizure risk. Option B describes appropriate self-care for mild
gestational hypertension but is inadequate for severe preeclampsia with neurological
symptoms. Option D is dangerous and incorrect—these are not normal symptoms and
require immediate intervention to prevent maternal and fetal complications including
stroke, organ damage, placental abruption, and fetal demise.
Q2: A pregnant client at 24 weeks gestation is diagnosed with gestational diabetes
mellitus (GDM) following a 3-hour oral glucose tolerance test. Which nursing instruction
is most appropriate regarding dietary management?
A. Eliminate all carbohydrates to prevent hyperglycemia
B. Consume consistent amounts of complex carbohydrates distributed throughout the
day
C. Skip breakfast to minimize postprandial glucose spikes
D. Increase simple sugars to meet increased caloric needs of pregnancy
Correct Answer: B
Rationale: The cornerstone of GDM management is medical nutrition therapy
emphasizing consistent intake of complex carbohydrates (whole grains, legumes,
vegetables) distributed across three meals and snacks to maintain stable blood glucose
levels. Complex carbohydrates have lower glycemic index, causing slower glucose
absorption. Option A is incorrect—carbohydrates are essential for fetal brain
development and maternal energy; elimination causes ketosis which is harmful to the
fetus. Option C is incorrect—skipping meals, especially breakfast, can cause rebound
hyperglycemia and ketosis. Option D is incorrect—simple sugars cause rapid glucose
,spikes and poor glycemic control, increasing risks of macrosomia, birth trauma, and
neonatal hypoglycemia.
Q3: During a prenatal visit, a 35-year-old gravida 3, para 2 client at 18 weeks gestation
reports experiencing vaginal bleeding after intercourse. The bleeding is bright red,
minimal, and painless. Ultrasound reveals a placenta covering the internal cervical os.
Which nursing instruction is essential?
A. "You may continue sexual activity but avoid strenuous exercise"
B. "Complete bed rest is required for the remainder of your pregnancy"
C. "Avoid vaginal intercourse, douching, or any vaginal insertion until the placenta
migrates"
D. "Schedule immediate delivery by cesarean section this week"
Correct Answer: C
Rationale: This client has placenta previa (placenta covering or adjacent to the internal
cervical os), which presents classically with painless, bright red bleeding, often after
intercourse or other cervical irritation. The priority nursing intervention is to instruct the
client to avoid anything that could traumatize the cervix or cause bleeding—specifically
no vaginal intercourse, no douching, no tampons, and no vaginal examinations (unless
in operating room prepared for emergency delivery). Option A is dangerous—sexual
activity can trigger catastrophic hemorrhage. Option B is excessive—while pelvic rest is
essential, complete bed rest is not routinely recommended and increases risk of
thromboembolism; activity restrictions are individualized based on bleeding episodes.
Option D is incorrect—delivery is indicated only if there is life-threatening hemorrhage or
, at fetal maturity; many cases of previa resolve as the lower uterine segment develops
and the placenta "migrates" upward.
Q4: A client at 28 weeks gestation with type 1 diabetes mellitus is being monitored for
fetal well-being. Which assessment finding would require immediate nursing
intervention?
A. Fetal heart rate baseline of 140 beats per minute with moderate variability
B. Maternal blood glucose of 110 mg/dL 2 hours postprandial
C. Fundal height measurement of 26 cm
D. Absence of fetal movement for 12 hours and reactive non-stress test
Correct Answer: D
Rationale: Decreased fetal movement is an early indicator of potential fetal compromise
and requires immediate further evaluation, even if a recent NST was reactive. Maternal
diabetes increases risk of placental insufficiency and fetal demise. The nurse must
immediately notify the provider for biophysical profile or contraction stress test. Option
A is normal—baseline 110-160 bpm with moderate variability indicates fetal well-being.
Option B is acceptable—the target for GDM is <120 mg/dL 2-hour postprandial per ADA
guidelines; 110 mg/dL is well-controlled. Option C is within normal variation (fundal
height typically correlates with weeks ±2 cm); 26 cm at 28 weeks does not indicate
immediate concern.
Q5: A pregnant client at 10 weeks gestation asks the nurse about medications she
should avoid due to teratogenic risk. Which medication classification should the nurse
identify as having the highest risk for fetal malformation?
100% Correct Answers with Complete Solutions | NCLEX-RN
Aligned | Maternal-Child Nursing | Pass Guaranteed - A+
Graded
Domain 1: Antepartum Nursing (20 Questions)
Q1: A 28-year-old primigravida at 32 weeks gestation presents to the prenatal clinic. Her
blood pressure is 148/92 mmHg, she has 2+ proteinuria on dipstick, and reports a
severe headache and visual disturbances. Which nursing intervention is the priority?
A. Administer oral methyldopa and schedule follow-up in 1 week
B. Instruct the client to rest in left lateral position and increase fluid intake
C. Notify the healthcare provider immediately and prepare for possible magnesium
sulfate therapy
D. Reassure the client that these are normal third-trimester symptoms and provide
dietary counseling
Correct Answer: C
Rationale: This client presents with classic signs of severe preeclampsia: hypertension
(≥140/90 mmHg), proteinuria, headache, and visual disturbances (hyperreflexia may
also be present). These symptoms indicate potential progression to eclampsia
(seizures), which is life-threatening. The priority nursing action is to immediately notify
the healthcare provider and prepare for magnesium sulfate administration, which is the
anticonvulsant of choice for seizure prophylaxis in severe preeclampsia. Option A is
,incorrect because oral antihypertensives alone are insufficient for severe preeclampsia
and do not address the seizure risk. Option B describes appropriate self-care for mild
gestational hypertension but is inadequate for severe preeclampsia with neurological
symptoms. Option D is dangerous and incorrect—these are not normal symptoms and
require immediate intervention to prevent maternal and fetal complications including
stroke, organ damage, placental abruption, and fetal demise.
Q2: A pregnant client at 24 weeks gestation is diagnosed with gestational diabetes
mellitus (GDM) following a 3-hour oral glucose tolerance test. Which nursing instruction
is most appropriate regarding dietary management?
A. Eliminate all carbohydrates to prevent hyperglycemia
B. Consume consistent amounts of complex carbohydrates distributed throughout the
day
C. Skip breakfast to minimize postprandial glucose spikes
D. Increase simple sugars to meet increased caloric needs of pregnancy
Correct Answer: B
Rationale: The cornerstone of GDM management is medical nutrition therapy
emphasizing consistent intake of complex carbohydrates (whole grains, legumes,
vegetables) distributed across three meals and snacks to maintain stable blood glucose
levels. Complex carbohydrates have lower glycemic index, causing slower glucose
absorption. Option A is incorrect—carbohydrates are essential for fetal brain
development and maternal energy; elimination causes ketosis which is harmful to the
fetus. Option C is incorrect—skipping meals, especially breakfast, can cause rebound
hyperglycemia and ketosis. Option D is incorrect—simple sugars cause rapid glucose
,spikes and poor glycemic control, increasing risks of macrosomia, birth trauma, and
neonatal hypoglycemia.
Q3: During a prenatal visit, a 35-year-old gravida 3, para 2 client at 18 weeks gestation
reports experiencing vaginal bleeding after intercourse. The bleeding is bright red,
minimal, and painless. Ultrasound reveals a placenta covering the internal cervical os.
Which nursing instruction is essential?
A. "You may continue sexual activity but avoid strenuous exercise"
B. "Complete bed rest is required for the remainder of your pregnancy"
C. "Avoid vaginal intercourse, douching, or any vaginal insertion until the placenta
migrates"
D. "Schedule immediate delivery by cesarean section this week"
Correct Answer: C
Rationale: This client has placenta previa (placenta covering or adjacent to the internal
cervical os), which presents classically with painless, bright red bleeding, often after
intercourse or other cervical irritation. The priority nursing intervention is to instruct the
client to avoid anything that could traumatize the cervix or cause bleeding—specifically
no vaginal intercourse, no douching, no tampons, and no vaginal examinations (unless
in operating room prepared for emergency delivery). Option A is dangerous—sexual
activity can trigger catastrophic hemorrhage. Option B is excessive—while pelvic rest is
essential, complete bed rest is not routinely recommended and increases risk of
thromboembolism; activity restrictions are individualized based on bleeding episodes.
Option D is incorrect—delivery is indicated only if there is life-threatening hemorrhage or
, at fetal maturity; many cases of previa resolve as the lower uterine segment develops
and the placenta "migrates" upward.
Q4: A client at 28 weeks gestation with type 1 diabetes mellitus is being monitored for
fetal well-being. Which assessment finding would require immediate nursing
intervention?
A. Fetal heart rate baseline of 140 beats per minute with moderate variability
B. Maternal blood glucose of 110 mg/dL 2 hours postprandial
C. Fundal height measurement of 26 cm
D. Absence of fetal movement for 12 hours and reactive non-stress test
Correct Answer: D
Rationale: Decreased fetal movement is an early indicator of potential fetal compromise
and requires immediate further evaluation, even if a recent NST was reactive. Maternal
diabetes increases risk of placental insufficiency and fetal demise. The nurse must
immediately notify the provider for biophysical profile or contraction stress test. Option
A is normal—baseline 110-160 bpm with moderate variability indicates fetal well-being.
Option B is acceptable—the target for GDM is <120 mg/dL 2-hour postprandial per ADA
guidelines; 110 mg/dL is well-controlled. Option C is within normal variation (fundal
height typically correlates with weeks ±2 cm); 26 cm at 28 weeks does not indicate
immediate concern.
Q5: A pregnant client at 10 weeks gestation asks the nurse about medications she
should avoid due to teratogenic risk. Which medication classification should the nurse
identify as having the highest risk for fetal malformation?
