HESI Maternity Review Exam Prep – Real Practice Questions, Answers &
Detailed Rationales (Updated 2026) | Prenatal & Postpartum
Care, Labor & Delivery Nursing, Fetal Monitoring & Obstetric Assessment,
High-Risk Pregnancy Complications, Maternal Pharmacology, Newborn
Care & Neonatal Disorders, Family-Centered Care, NCLEX-Style Clinical
Judgment & HESI Maternity Success
Question 1: A pregnant client at 32 weeks gestation reports experiencing frequent
heartburn. Which nursing recommendation is most appropriate to alleviate this
discomfort?
A. Lie down immediately after meals to promote digestion
B. Consume three large meals daily to reduce gastric emptying time
C. Avoid spicy foods and eat small, frequent meals throughout the day
D. Increase intake of citrus fruits to neutralize stomach acid
CORRECT ANSWER: C. Avoid spicy foods and eat small, frequent meals throughout
the day
Rationale: Heartburn during pregnancy is caused by progesterone-induced relaxation of
the lower esophageal sphincter and upward displacement of the stomach by the
enlarging uterus. Eating small, frequent meals reduces gastric distention, and avoiding
spicy, fatty, or acidic foods minimizes irritation. Lying down after meals worsens reflux,
and citrus fruits increase acidity, making options A, B, and D incorrect.
Question 2: During a prenatal assessment, a nurse notes that a client at 20 weeks
gestation has a fundal height measuring 24 cm. What is the most appropriate
nursing action?
A. Document the finding as normal for gestational age
B. Notify the healthcare provider immediately for possible fetal macrosomia
C. Schedule an ultrasound to evaluate for multiple gestation or polyhydramnios
D. Advise the client to reduce caloric intake to prevent excessive fetal growth
CORRECT ANSWER: C. Schedule an ultrasound to evaluate for multiple gestation or
polyhydramnios
Rationale: Fundal height in centimeters typically corresponds to gestational age in
weeks between 20–34 weeks, with a variance of ±2 cm considered normal. A
measurement of 24 cm at 20 weeks exceeds this range and may indicate multiple
gestation, polyhydramnios, or inaccurate dating. An ultrasound is warranted to
determine the cause. Documenting as normal (A) ignores the discrepancy, while
immediate notification (B) or dietary advice (D) is premature without further
assessment.
Question 3: A client in active labor at 39 weeks gestation has a fetal heart rate
pattern showing late decelerations. Which intervention should the nurse
implement first?
,A. Administer oxygen via nonrebreather mask at 10 L/min
B. Reposition the client to a lateral position
C. Increase the rate of intravenous fluids
D. Prepare for immediate cesarean delivery
CORRECT ANSWER: B. Reposition the client to a lateral position
Rationale: Late decelerations indicate uteroplacental insufficiency and fetal hypoxia.
The first nursing intervention is to improve placental perfusion by repositioning the
client to a lateral (usually left) position to relieve aortocaval compression. Oxygen
administration (A) and IV fluid bolus (C) are subsequent interventions if repositioning is
ineffective. Preparation for cesarean delivery (D) is reserved for persistent, non-
reassuring patterns unresponsive to conservative measures.
Question 4: Which finding in a postpartum client at 24 hours after delivery requires
immediate nursing intervention?
A. Lochia rubra with small clots
B. Fundus firm and located at the umbilicus
C. Temperature of 100.4°F (38°C)
D. Complaints of perineal pain rated 4/10
CORRECT ANSWER: C. Temperature of 100.4°F (38°C)
Rationale: A temperature of 100.4°F (38°C) or higher in the first 24 hours postpartum
may indicate infection, such as endometritis, and requires prompt assessment and
intervention. Lochia rubra with small clots (A), a firm fundus at the umbilicus (B), and
moderate perineal pain (D) are expected findings in the immediate postpartum period
and do not require urgent action.
Question 5: A newborn is assessed at 1 minute of life with the following: heart rate
90 bpm, weak cry, some flexion of extremities, grimace to stimulation, and blue
extremities with pink body. What is the newborn's Apgar score?
A. 4
B. 5
C. 6
D. 7
CORRECT ANSWER: B. 5
Rationale: The Apgar score assesses five criteria: heart rate (1 point for <100 bpm),
respiratory effort (1 point for weak cry), muscle tone (1 point for some flexion), reflex
irritability (1 point for grimace), and color (1 point for acrocyanosis). Total = 1+1+1+1+1 =
5. A score of 4 (A) undercounts, while 6 (C) or 7 (D) overestimates the findings
described.
Question 6: Which statement by a pregnant client indicates understanding of
teaching regarding prevention of neural tube defects?
,A. "I will take iron supplements daily starting in the second trimester."
B. "I will increase my intake of folic acid–fortified cereals and leafy green vegetables."
C. "I will avoid all dairy products to reduce the risk of birth defects."
D. "I will limit my fluid intake to prevent swelling during pregnancy."
CORRECT ANSWER: B. "I will increase my intake of folic acid–fortified cereals and
leafy green vegetables."
Rationale: Folic acid supplementation (400–800 mcg/day) before conception and during
early pregnancy significantly reduces the risk of neural tube defects. Iron (A) prevents
anemia but not neural tube defects. Avoiding dairy (C) or limiting fluids (D) is unrelated
and potentially harmful. Option B demonstrates accurate understanding of preventive
nutrition.
Question 7: A client with preeclampsia is receiving magnesium sulfate. Which
assessment finding indicates magnesium toxicity?
A. Deep tendon reflexes +2
B. Urine output 40 mL/hr
C. Respiratory rate 10 breaths/min
D. Blood pressure 140/90 mm Hg
CORRECT ANSWER: C. Respiratory rate 10 breaths/min
Rationale: Magnesium sulfate depresses the central nervous system; toxicity
manifestations include respiratory depression (<12 breaths/min), absent deep tendon
reflexes, and oliguria. A respiratory rate of 10 breaths/min is a critical sign requiring
immediate intervention, including discontinuation of magnesium and administration of
calcium gluconate. Reflexes +2 (A), urine output 40 mL/hr (B), and BP 140/90 (D) are
within acceptable limits for a client with preeclampsia on magnesium therapy.
Question 8: Which intervention is most effective for preventing postpartum
hemorrhage in the immediate recovery period?
A. Encourage early ambulation within 2 hours of delivery
B. Massage the uterine fundus every 15 minutes
C. Administer oxytocin as prescribed after placental delivery
D. Apply ice packs to the perineum to reduce swelling
CORRECT ANSWER: C. Administer oxytocin as prescribed after placental delivery
Rationale: Oxytocin administration after delivery of the placenta promotes sustained
uterine contraction, which is the most effective pharmacologic intervention to prevent
postpartum hemorrhage due to uterine atony. Fundal massage (B) is used if the uterus
is boggy, not prophylactically every 15 minutes. Early ambulation (A) and perineal ice
packs (D) support recovery but do not directly prevent hemorrhage.
Question 9: A pregnant client at 10 weeks gestation reports nausea and vomiting.
Which dietary recommendation should the nurse prioritize?
, A. Drink large amounts of fluid with meals
B. Eat dry crackers or toast before getting out of bed
C. Consume high-fat foods to slow gastric emptying
D. Skip breakfast to allow the stomach to rest
CORRECT ANSWER: B. Eat dry crackers or toast before getting out of bed
Rationale: Eating dry, bland carbohydrates before rising helps absorb gastric acid and
stabilize blood sugar, reducing nausea in early pregnancy. Drinking fluids with meals (A)
can distend the stomach and worsen nausea. High-fat foods (C) delay gastric emptying
and may exacerbate symptoms. Skipping meals (D) can lead to hypoglycemia, triggering
nausea.
Question 10: Which finding in a newborn requires immediate notification of the
healthcare provider?
A. Mottled skin when exposed to cold
B. Respiratory rate of 50 breaths/min with brief apical pauses
C. Jaundice noted at 18 hours of life
D. Passage of meconium within 24 hours
CORRECT ANSWER: C. Jaundice noted at 18 hours of life
Rationale: Jaundice appearing within the first 24 hours of life is pathological and may
indicate hemolytic disease, infection, or other serious conditions requiring prompt
evaluation and treatment. Mottling (A) is a normal thermoregulatory response. A
respiratory rate of 50 with brief pauses (B) is within normal newborn parameters.
Meconium passage within 24 hours (D) is expected.
Question 11: A client in labor requests nonpharmacologic pain management.
Which technique is most appropriate during the latent phase?
A. Epidural anesthesia
B. Controlled breathing patterns
C. Pudendal nerve block
D. General anesthesia
CORRECT ANSWER: B. Controlled breathing patterns
Rationale: Controlled breathing is a nonpharmacologic, noninvasive technique
appropriate for pain management during the latent phase of labor. Epidural (A),
pudendal block (C), and general anesthesia (D) are pharmacologic interventions
typically reserved for active labor or delivery, not initial coping strategies.
Question 12: Which assessment finding indicates that a postpartum client is
experiencing afterpains?
A. Sharp, localized pain at the episiotomy site
B. Intermittent, crampy lower abdominal pain during breastfeeding
Detailed Rationales (Updated 2026) | Prenatal & Postpartum
Care, Labor & Delivery Nursing, Fetal Monitoring & Obstetric Assessment,
High-Risk Pregnancy Complications, Maternal Pharmacology, Newborn
Care & Neonatal Disorders, Family-Centered Care, NCLEX-Style Clinical
Judgment & HESI Maternity Success
Question 1: A pregnant client at 32 weeks gestation reports experiencing frequent
heartburn. Which nursing recommendation is most appropriate to alleviate this
discomfort?
A. Lie down immediately after meals to promote digestion
B. Consume three large meals daily to reduce gastric emptying time
C. Avoid spicy foods and eat small, frequent meals throughout the day
D. Increase intake of citrus fruits to neutralize stomach acid
CORRECT ANSWER: C. Avoid spicy foods and eat small, frequent meals throughout
the day
Rationale: Heartburn during pregnancy is caused by progesterone-induced relaxation of
the lower esophageal sphincter and upward displacement of the stomach by the
enlarging uterus. Eating small, frequent meals reduces gastric distention, and avoiding
spicy, fatty, or acidic foods minimizes irritation. Lying down after meals worsens reflux,
and citrus fruits increase acidity, making options A, B, and D incorrect.
Question 2: During a prenatal assessment, a nurse notes that a client at 20 weeks
gestation has a fundal height measuring 24 cm. What is the most appropriate
nursing action?
A. Document the finding as normal for gestational age
B. Notify the healthcare provider immediately for possible fetal macrosomia
C. Schedule an ultrasound to evaluate for multiple gestation or polyhydramnios
D. Advise the client to reduce caloric intake to prevent excessive fetal growth
CORRECT ANSWER: C. Schedule an ultrasound to evaluate for multiple gestation or
polyhydramnios
Rationale: Fundal height in centimeters typically corresponds to gestational age in
weeks between 20–34 weeks, with a variance of ±2 cm considered normal. A
measurement of 24 cm at 20 weeks exceeds this range and may indicate multiple
gestation, polyhydramnios, or inaccurate dating. An ultrasound is warranted to
determine the cause. Documenting as normal (A) ignores the discrepancy, while
immediate notification (B) or dietary advice (D) is premature without further
assessment.
Question 3: A client in active labor at 39 weeks gestation has a fetal heart rate
pattern showing late decelerations. Which intervention should the nurse
implement first?
,A. Administer oxygen via nonrebreather mask at 10 L/min
B. Reposition the client to a lateral position
C. Increase the rate of intravenous fluids
D. Prepare for immediate cesarean delivery
CORRECT ANSWER: B. Reposition the client to a lateral position
Rationale: Late decelerations indicate uteroplacental insufficiency and fetal hypoxia.
The first nursing intervention is to improve placental perfusion by repositioning the
client to a lateral (usually left) position to relieve aortocaval compression. Oxygen
administration (A) and IV fluid bolus (C) are subsequent interventions if repositioning is
ineffective. Preparation for cesarean delivery (D) is reserved for persistent, non-
reassuring patterns unresponsive to conservative measures.
Question 4: Which finding in a postpartum client at 24 hours after delivery requires
immediate nursing intervention?
A. Lochia rubra with small clots
B. Fundus firm and located at the umbilicus
C. Temperature of 100.4°F (38°C)
D. Complaints of perineal pain rated 4/10
CORRECT ANSWER: C. Temperature of 100.4°F (38°C)
Rationale: A temperature of 100.4°F (38°C) or higher in the first 24 hours postpartum
may indicate infection, such as endometritis, and requires prompt assessment and
intervention. Lochia rubra with small clots (A), a firm fundus at the umbilicus (B), and
moderate perineal pain (D) are expected findings in the immediate postpartum period
and do not require urgent action.
Question 5: A newborn is assessed at 1 minute of life with the following: heart rate
90 bpm, weak cry, some flexion of extremities, grimace to stimulation, and blue
extremities with pink body. What is the newborn's Apgar score?
A. 4
B. 5
C. 6
D. 7
CORRECT ANSWER: B. 5
Rationale: The Apgar score assesses five criteria: heart rate (1 point for <100 bpm),
respiratory effort (1 point for weak cry), muscle tone (1 point for some flexion), reflex
irritability (1 point for grimace), and color (1 point for acrocyanosis). Total = 1+1+1+1+1 =
5. A score of 4 (A) undercounts, while 6 (C) or 7 (D) overestimates the findings
described.
Question 6: Which statement by a pregnant client indicates understanding of
teaching regarding prevention of neural tube defects?
,A. "I will take iron supplements daily starting in the second trimester."
B. "I will increase my intake of folic acid–fortified cereals and leafy green vegetables."
C. "I will avoid all dairy products to reduce the risk of birth defects."
D. "I will limit my fluid intake to prevent swelling during pregnancy."
CORRECT ANSWER: B. "I will increase my intake of folic acid–fortified cereals and
leafy green vegetables."
Rationale: Folic acid supplementation (400–800 mcg/day) before conception and during
early pregnancy significantly reduces the risk of neural tube defects. Iron (A) prevents
anemia but not neural tube defects. Avoiding dairy (C) or limiting fluids (D) is unrelated
and potentially harmful. Option B demonstrates accurate understanding of preventive
nutrition.
Question 7: A client with preeclampsia is receiving magnesium sulfate. Which
assessment finding indicates magnesium toxicity?
A. Deep tendon reflexes +2
B. Urine output 40 mL/hr
C. Respiratory rate 10 breaths/min
D. Blood pressure 140/90 mm Hg
CORRECT ANSWER: C. Respiratory rate 10 breaths/min
Rationale: Magnesium sulfate depresses the central nervous system; toxicity
manifestations include respiratory depression (<12 breaths/min), absent deep tendon
reflexes, and oliguria. A respiratory rate of 10 breaths/min is a critical sign requiring
immediate intervention, including discontinuation of magnesium and administration of
calcium gluconate. Reflexes +2 (A), urine output 40 mL/hr (B), and BP 140/90 (D) are
within acceptable limits for a client with preeclampsia on magnesium therapy.
Question 8: Which intervention is most effective for preventing postpartum
hemorrhage in the immediate recovery period?
A. Encourage early ambulation within 2 hours of delivery
B. Massage the uterine fundus every 15 minutes
C. Administer oxytocin as prescribed after placental delivery
D. Apply ice packs to the perineum to reduce swelling
CORRECT ANSWER: C. Administer oxytocin as prescribed after placental delivery
Rationale: Oxytocin administration after delivery of the placenta promotes sustained
uterine contraction, which is the most effective pharmacologic intervention to prevent
postpartum hemorrhage due to uterine atony. Fundal massage (B) is used if the uterus
is boggy, not prophylactically every 15 minutes. Early ambulation (A) and perineal ice
packs (D) support recovery but do not directly prevent hemorrhage.
Question 9: A pregnant client at 10 weeks gestation reports nausea and vomiting.
Which dietary recommendation should the nurse prioritize?
, A. Drink large amounts of fluid with meals
B. Eat dry crackers or toast before getting out of bed
C. Consume high-fat foods to slow gastric emptying
D. Skip breakfast to allow the stomach to rest
CORRECT ANSWER: B. Eat dry crackers or toast before getting out of bed
Rationale: Eating dry, bland carbohydrates before rising helps absorb gastric acid and
stabilize blood sugar, reducing nausea in early pregnancy. Drinking fluids with meals (A)
can distend the stomach and worsen nausea. High-fat foods (C) delay gastric emptying
and may exacerbate symptoms. Skipping meals (D) can lead to hypoglycemia, triggering
nausea.
Question 10: Which finding in a newborn requires immediate notification of the
healthcare provider?
A. Mottled skin when exposed to cold
B. Respiratory rate of 50 breaths/min with brief apical pauses
C. Jaundice noted at 18 hours of life
D. Passage of meconium within 24 hours
CORRECT ANSWER: C. Jaundice noted at 18 hours of life
Rationale: Jaundice appearing within the first 24 hours of life is pathological and may
indicate hemolytic disease, infection, or other serious conditions requiring prompt
evaluation and treatment. Mottling (A) is a normal thermoregulatory response. A
respiratory rate of 50 with brief pauses (B) is within normal newborn parameters.
Meconium passage within 24 hours (D) is expected.
Question 11: A client in labor requests nonpharmacologic pain management.
Which technique is most appropriate during the latent phase?
A. Epidural anesthesia
B. Controlled breathing patterns
C. Pudendal nerve block
D. General anesthesia
CORRECT ANSWER: B. Controlled breathing patterns
Rationale: Controlled breathing is a nonpharmacologic, noninvasive technique
appropriate for pain management during the latent phase of labor. Epidural (A),
pudendal block (C), and general anesthesia (D) are pharmacologic interventions
typically reserved for active labor or delivery, not initial coping strategies.
Question 12: Which assessment finding indicates that a postpartum client is
experiencing afterpains?
A. Sharp, localized pain at the episiotomy site
B. Intermittent, crampy lower abdominal pain during breastfeeding
