HESI Maternity OB Nursing Exam Study Guide 2026 –
Complete Obstetrics & Maternal Health Review Pack,
Verified Practice Questions & Answers, Labor and Delivery,
Postpartum & Newborn Care Notes for HESI Success
Question 1: A primigravida at 32 weeks gestation reports experiencing occasional mild uterine
contractions that resolve with rest and hydration. The nurse recognizes these as Braxton Hicks
contractions. Which characteristic is MOST indicative of Braxton Hicks rather than true labor?
A. Contractions occur at regular 5-minute intervals
B. Contractions intensify with ambulation
C. Contractions are felt primarily in the lower back and radiate anteriorly
D. Contractions decrease in frequency and intensity with position change
CORRECT ANSWER: D. Contractions decrease in frequency and intensity with position change
Rationale: Braxton Hicks contractions are irregular, non-progressive, and typically diminish with
interventions such as rest, hydration, or position change. In contrast, true labor contractions
become regular, increase in intensity and frequency, and are not relieved by positional changes
or hydration. Options A, B, and C describe characteristics of true labor: regularity, progression
with activity, and back-to-front radiation (often associated with occiput posterior position).
Question 2: During a prenatal visit at 28 weeks gestation, a client's blood pressure is recorded
as 142/92 mm Hg, with +1 proteinuria on dipstick. The client reports no headache, visual
changes, or epigastric pain. Which action should the nurse prioritize?
A. Administer labetalol 20 mg orally immediately
B. Instruct the client to return to the clinic in 1 week for recheck
C. Notify the healthcare provider for possible diagnosis of gestational hypertension
D. Prepare the client for immediate hospital admission for magnesium sulfate infusion
CORRECT ANSWER: C. Notify the healthcare provider for possible diagnosis of gestational
hypertension
Rationale: According to ACOG criteria, gestational hypertension is defined as systolic BP ≥140
mm Hg or diastolic BP ≥90 mm Hg on two occasions at least 4 hours apart after 20 weeks
gestation in a previously normotensive woman, without proteinuria or other signs of
preeclampsia. While this single reading with +1 proteinuria warrants evaluation, it does not yet
confirm preeclampsia. The nurse should notify the provider for further assessment and possible
repeat testing. Immediate antihypertensive administration (A) is not indicated without severe-
range BP. Waiting one week (B) delays necessary evaluation. Admission for magnesium (D) is
reserved for severe preeclampsia or eclampsia.
, Question 3: A client in active labor at 6 cm dilation requests pain relief. The nurse notes the
fetal heart rate baseline is 140 bpm with moderate variability and no decelerations. Which non-
pharmacologic intervention is MOST appropriate to offer first?
A. Epidural anesthesia consultation
B. Intravenous morphine sulfate
C. Position change to lateral recumbent with peanut ball
D. Nitrous oxide self-administration
CORRECT ANSWER: C. Position change to lateral recumbent with peanut ball
Rationale: Non-pharmacologic interventions should be offered first for pain management in
labor when maternal and fetal status are reassuring. Position changes, especially lateral
positioning with a peanut ball, can enhance comfort, promote fetal descent, and optimize
uteroplacental perfusion without medication side effects. Epidural (A), IV opioids (B), and
nitrous oxide (D) are pharmacologic options that may be considered if non-pharmacologic
methods are insufficient, but they carry potential risks such as maternal hypotension, fetal
heart rate changes, or respiratory depression.
Question 4: A newborn is assessed at 1 minute of life with the following findings: heart rate 90
bpm, slow irregular respirations, some flexion of extremities, grimace to stimulation, and body
pink with blue extremities. What is the infant's Apgar score?
A. 4
B. 5
C. 6
D. 7
CORRECT ANSWER: B. 5
Rationale: The Apgar score assesses five criteria (Appearance, Pulse, Grimace, Activity,
Respiration), each scored 0-2. For this infant: Appearance (body pink, extremities blue) = 1;
Pulse (HR 90 bpm) = 1 (HR <100 = 1 point); Grimace (grimace to stimulation) = 1; Activity (some
flexion) = 1; Respiration (slow, irregular) = 1. Total = 5. A score of 4-6 indicates moderate
difficulty requiring some resuscitative measures (e.g., stimulation, oxygen). Scores of 7-10 are
reassuring; 0-3 indicate severe distress requiring immediate intervention.
Question 5: Which finding in a postpartum client at 24 hours after vaginal delivery requires
IMMEDIATE nursing intervention?
A. Fundus firm at the umbilicus, midline
Complete Obstetrics & Maternal Health Review Pack,
Verified Practice Questions & Answers, Labor and Delivery,
Postpartum & Newborn Care Notes for HESI Success
Question 1: A primigravida at 32 weeks gestation reports experiencing occasional mild uterine
contractions that resolve with rest and hydration. The nurse recognizes these as Braxton Hicks
contractions. Which characteristic is MOST indicative of Braxton Hicks rather than true labor?
A. Contractions occur at regular 5-minute intervals
B. Contractions intensify with ambulation
C. Contractions are felt primarily in the lower back and radiate anteriorly
D. Contractions decrease in frequency and intensity with position change
CORRECT ANSWER: D. Contractions decrease in frequency and intensity with position change
Rationale: Braxton Hicks contractions are irregular, non-progressive, and typically diminish with
interventions such as rest, hydration, or position change. In contrast, true labor contractions
become regular, increase in intensity and frequency, and are not relieved by positional changes
or hydration. Options A, B, and C describe characteristics of true labor: regularity, progression
with activity, and back-to-front radiation (often associated with occiput posterior position).
Question 2: During a prenatal visit at 28 weeks gestation, a client's blood pressure is recorded
as 142/92 mm Hg, with +1 proteinuria on dipstick. The client reports no headache, visual
changes, or epigastric pain. Which action should the nurse prioritize?
A. Administer labetalol 20 mg orally immediately
B. Instruct the client to return to the clinic in 1 week for recheck
C. Notify the healthcare provider for possible diagnosis of gestational hypertension
D. Prepare the client for immediate hospital admission for magnesium sulfate infusion
CORRECT ANSWER: C. Notify the healthcare provider for possible diagnosis of gestational
hypertension
Rationale: According to ACOG criteria, gestational hypertension is defined as systolic BP ≥140
mm Hg or diastolic BP ≥90 mm Hg on two occasions at least 4 hours apart after 20 weeks
gestation in a previously normotensive woman, without proteinuria or other signs of
preeclampsia. While this single reading with +1 proteinuria warrants evaluation, it does not yet
confirm preeclampsia. The nurse should notify the provider for further assessment and possible
repeat testing. Immediate antihypertensive administration (A) is not indicated without severe-
range BP. Waiting one week (B) delays necessary evaluation. Admission for magnesium (D) is
reserved for severe preeclampsia or eclampsia.
, Question 3: A client in active labor at 6 cm dilation requests pain relief. The nurse notes the
fetal heart rate baseline is 140 bpm with moderate variability and no decelerations. Which non-
pharmacologic intervention is MOST appropriate to offer first?
A. Epidural anesthesia consultation
B. Intravenous morphine sulfate
C. Position change to lateral recumbent with peanut ball
D. Nitrous oxide self-administration
CORRECT ANSWER: C. Position change to lateral recumbent with peanut ball
Rationale: Non-pharmacologic interventions should be offered first for pain management in
labor when maternal and fetal status are reassuring. Position changes, especially lateral
positioning with a peanut ball, can enhance comfort, promote fetal descent, and optimize
uteroplacental perfusion without medication side effects. Epidural (A), IV opioids (B), and
nitrous oxide (D) are pharmacologic options that may be considered if non-pharmacologic
methods are insufficient, but they carry potential risks such as maternal hypotension, fetal
heart rate changes, or respiratory depression.
Question 4: A newborn is assessed at 1 minute of life with the following findings: heart rate 90
bpm, slow irregular respirations, some flexion of extremities, grimace to stimulation, and body
pink with blue extremities. What is the infant's Apgar score?
A. 4
B. 5
C. 6
D. 7
CORRECT ANSWER: B. 5
Rationale: The Apgar score assesses five criteria (Appearance, Pulse, Grimace, Activity,
Respiration), each scored 0-2. For this infant: Appearance (body pink, extremities blue) = 1;
Pulse (HR 90 bpm) = 1 (HR <100 = 1 point); Grimace (grimace to stimulation) = 1; Activity (some
flexion) = 1; Respiration (slow, irregular) = 1. Total = 5. A score of 4-6 indicates moderate
difficulty requiring some resuscitative measures (e.g., stimulation, oxygen). Scores of 7-10 are
reassuring; 0-3 indicate severe distress requiring immediate intervention.
Question 5: Which finding in a postpartum client at 24 hours after vaginal delivery requires
IMMEDIATE nursing intervention?
A. Fundus firm at the umbilicus, midline
