HESI OB MATERNITY EXAM VERSION 2 2026/2027 | Exam
Questions & Verified Detailed Answers | New! | A+ Grade
Assured - Pass Guaranteed
Section 1: Antepartum Complications & High-Risk Pregnancies
(Questions 1-14)
Question 1
A 28-year-old primigravida at 36 weeks gestation presents to the antepartum clinic with
complaints of severe epigastric pain, nausea, vomiting, and a persistent headache. Her
blood pressure is 168/110 mmHg, and laboratory results reveal hemolysis, elevated liver
enzymes, and platelet count of 82,000/mm³. Which clinical presentation best
differentiates HELLP syndrome from severe preeclampsia?
A. Presence of proteinuria >2+ on dipstick
B. Hemolysis with fragmented red blood cells on peripheral smear
C. Blood pressure elevation >160/110 mmHg
D. Hyperreflexia with clonus
Answer: B. Hemolysis with fragmented red blood cells on peripheral smear [CORRECT]
,Rationale: HELLP syndrome is characterized by Hemolysis, Elevated Liver enzymes, and
Low Platelets (<100,000/mm³). While severe preeclampsia and HELLP syndrome share
hypertension and proteinuria, the presence of hemolysis with schistocytes (fragmented
RBCs) on peripheral smear is pathognomonic for HELLP and not required for the
diagnosis of severe preeclampsia. Option A (proteinuria) is common to both. Option C
(severe hypertension) is a criterion for severe preeclampsia but may be absent in
15-20% of HELLP cases. Option D (hyperreflexia) indicates CNS involvement in
preeclampsia but does not differentiate the two conditions. (AWHONN Perinatal
Guidelines, 2026; ACOG Practice Bulletin #222)
Correct Answer: B
Question 2
A 32-year-old G2P1 at 30 weeks gestation is diagnosed with HELLP syndrome. Her
platelet count is 78,000/mm³, AST is 210 U/L, and LDH is 680 U/L. She is
hemodynamically stable with a blood pressure of 154/96 mmHg. What is the priority
nursing intervention?
A. Administer magnesium sulfate for seizure prophylaxis at a loading dose of 4-6 g IV
over 20 minutes
B. Prepare the patient for immediate delivery regardless of gestational age
C. Administer betamethasone 12 mg IM to promote fetal lung maturity and delay
delivery for 48 hours
D. Initiate antihypertensive therapy with labetalol 20 mg IV to lower blood pressure
below 140/90 mmHg
,Answer: A. Administer magnesium sulfate for seizure prophylaxis at a loading dose of
4-6 g IV over 20 minutes [CORRECT]
Rationale: In HELLP syndrome, magnesium sulfate is indicated for seizure prophylaxis
due to the high risk of eclampsia, even in the absence of severe hypertension. The
standard loading dose is 4-6 g IV over 20 minutes, followed by a maintenance infusion
of 1-2 g/hr. Option B is incorrect because delivery at <34 weeks is not immediate if the
mother is stable; corticosteroids should be administered first. Option C is partially
correct but secondary to seizure prophylaxis. Option D is incorrect because
antihypertensives are not first-line unless BP exceeds 160/110 mmHg or there is
evidence of end-organ damage. (ACOG Practice Bulletin #222, 2026 Update; AWHONN
Critical Care Obstetrics Education)
Correct Answer: A
Question 3
A 35-year-old G1P0 at 28 weeks gestation with a history of gestational diabetes (GDM)
presents for her routine prenatal visit. Her fasting blood glucose has been consistently
102-108 mg/dL despite dietary modifications. Her insulin regimen currently includes
NPH 20 units at bedtime and regular insulin 6 units before breakfast. Which statement
by the nurse demonstrates correct understanding of gestational diabetes management
in the third trimester?
A. "Your insulin requirements typically decrease as pregnancy progresses into the third
trimester due to increased insulin sensitivity."
, B. "Insulin requirements typically double in the third trimester due to increasing
placental hormone production and insulin resistance."
C. "Oral hypoglycemic agents are preferred over insulin after 28 weeks gestation
because they cross the placenta less readily."
D. "Your target fasting blood glucose should be maintained below 120 mg/dL
throughout the remainder of your pregnancy."
Answer: B. "Insulin requirements typically double in the third trimester due to increasing
placental hormone production and insulin resistance." [CORRECT]
Rationale: Insulin requirements approximately double in the third trimester due to
progressive insulin resistance caused by human placental lactogen, progesterone,
cortisol, and prolactin. Option A is incorrect because insulin resistance increases, not
decreases. Option C is incorrect because insulin remains the gold standard for GDM
management in pregnancy; while glyburide and metformin may be used in select cases,
they are not preferred over insulin. Option D is incorrect because the target fasting
blood glucose for GDM is <95 mg/dL per ACOG and AWHONN guidelines. (AWHONN
Nursing Care of the Woman with Diabetes in Pregnancy, 2026; ACOG Practice Bulletin
#180)
Correct Answer: B
Question 4
A 29-year-old G2P1 at 32 weeks gestation with GDM is undergoing fetal surveillance.
Her non-stress test (NST) performed at the clinic is non-reactive after 40 minutes.
Which is the most appropriate next step in management?
Questions & Verified Detailed Answers | New! | A+ Grade
Assured - Pass Guaranteed
Section 1: Antepartum Complications & High-Risk Pregnancies
(Questions 1-14)
Question 1
A 28-year-old primigravida at 36 weeks gestation presents to the antepartum clinic with
complaints of severe epigastric pain, nausea, vomiting, and a persistent headache. Her
blood pressure is 168/110 mmHg, and laboratory results reveal hemolysis, elevated liver
enzymes, and platelet count of 82,000/mm³. Which clinical presentation best
differentiates HELLP syndrome from severe preeclampsia?
A. Presence of proteinuria >2+ on dipstick
B. Hemolysis with fragmented red blood cells on peripheral smear
C. Blood pressure elevation >160/110 mmHg
D. Hyperreflexia with clonus
Answer: B. Hemolysis with fragmented red blood cells on peripheral smear [CORRECT]
,Rationale: HELLP syndrome is characterized by Hemolysis, Elevated Liver enzymes, and
Low Platelets (<100,000/mm³). While severe preeclampsia and HELLP syndrome share
hypertension and proteinuria, the presence of hemolysis with schistocytes (fragmented
RBCs) on peripheral smear is pathognomonic for HELLP and not required for the
diagnosis of severe preeclampsia. Option A (proteinuria) is common to both. Option C
(severe hypertension) is a criterion for severe preeclampsia but may be absent in
15-20% of HELLP cases. Option D (hyperreflexia) indicates CNS involvement in
preeclampsia but does not differentiate the two conditions. (AWHONN Perinatal
Guidelines, 2026; ACOG Practice Bulletin #222)
Correct Answer: B
Question 2
A 32-year-old G2P1 at 30 weeks gestation is diagnosed with HELLP syndrome. Her
platelet count is 78,000/mm³, AST is 210 U/L, and LDH is 680 U/L. She is
hemodynamically stable with a blood pressure of 154/96 mmHg. What is the priority
nursing intervention?
A. Administer magnesium sulfate for seizure prophylaxis at a loading dose of 4-6 g IV
over 20 minutes
B. Prepare the patient for immediate delivery regardless of gestational age
C. Administer betamethasone 12 mg IM to promote fetal lung maturity and delay
delivery for 48 hours
D. Initiate antihypertensive therapy with labetalol 20 mg IV to lower blood pressure
below 140/90 mmHg
,Answer: A. Administer magnesium sulfate for seizure prophylaxis at a loading dose of
4-6 g IV over 20 minutes [CORRECT]
Rationale: In HELLP syndrome, magnesium sulfate is indicated for seizure prophylaxis
due to the high risk of eclampsia, even in the absence of severe hypertension. The
standard loading dose is 4-6 g IV over 20 minutes, followed by a maintenance infusion
of 1-2 g/hr. Option B is incorrect because delivery at <34 weeks is not immediate if the
mother is stable; corticosteroids should be administered first. Option C is partially
correct but secondary to seizure prophylaxis. Option D is incorrect because
antihypertensives are not first-line unless BP exceeds 160/110 mmHg or there is
evidence of end-organ damage. (ACOG Practice Bulletin #222, 2026 Update; AWHONN
Critical Care Obstetrics Education)
Correct Answer: A
Question 3
A 35-year-old G1P0 at 28 weeks gestation with a history of gestational diabetes (GDM)
presents for her routine prenatal visit. Her fasting blood glucose has been consistently
102-108 mg/dL despite dietary modifications. Her insulin regimen currently includes
NPH 20 units at bedtime and regular insulin 6 units before breakfast. Which statement
by the nurse demonstrates correct understanding of gestational diabetes management
in the third trimester?
A. "Your insulin requirements typically decrease as pregnancy progresses into the third
trimester due to increased insulin sensitivity."
, B. "Insulin requirements typically double in the third trimester due to increasing
placental hormone production and insulin resistance."
C. "Oral hypoglycemic agents are preferred over insulin after 28 weeks gestation
because they cross the placenta less readily."
D. "Your target fasting blood glucose should be maintained below 120 mg/dL
throughout the remainder of your pregnancy."
Answer: B. "Insulin requirements typically double in the third trimester due to increasing
placental hormone production and insulin resistance." [CORRECT]
Rationale: Insulin requirements approximately double in the third trimester due to
progressive insulin resistance caused by human placental lactogen, progesterone,
cortisol, and prolactin. Option A is incorrect because insulin resistance increases, not
decreases. Option C is incorrect because insulin remains the gold standard for GDM
management in pregnancy; while glyburide and metformin may be used in select cases,
they are not preferred over insulin. Option D is incorrect because the target fasting
blood glucose for GDM is <95 mg/dL per ACOG and AWHONN guidelines. (AWHONN
Nursing Care of the Woman with Diabetes in Pregnancy, 2026; ACOG Practice Bulletin
#180)
Correct Answer: B
Question 4
A 29-year-old G2P1 at 32 weeks gestation with GDM is undergoing fetal surveillance.
Her non-stress test (NST) performed at the clinic is non-reactive after 40 minutes.
Which is the most appropriate next step in management?
