RN HESI MATERNITY EXAM
2026/2027 Edition
Comprehensive Obstetric & Neonatal Nursing Competency Assessment
for RN Licensure Readiness
Elsevier Evolve / AWHONN Standards Alignment
EXACT OFFICIAL COUNT: 100 QUESTIONS
Complete Exam-Style Questions with Detailed Rationales | 100% Verified | Graded A+
Total Testing Time: 150 Minutes | Passing Score: 850 HESI or 75-80% | Format: Computer-Based,
Proctored
,Introduction
This RN HESI Maternity Exam format for 2026/2027 reflects the standardized competency assessment
used to evaluate proficiency in comprehensive obstetric and newborn care principles for pre-licensure RN
students. The official examination consists of exactly 100 multiple-choice questions (MCQ) covering
critical domains: antepartum care and fetal development, intrapartum care and labor management,
postpartum care and maternal recovery, newborn assessment and care, high-risk pregnancy and OB
pharmacology, women's health and gynecological care, and NGN case study application. The exam
measures knowledge essential for safe, effective, and family-centered practice in maternal-child health
settings, aligned with current AWHONN standards, NCSBN NCLEX-RN test plan, Elsevier HESI test
blueprints, and institutional nursing program learning outcomes.
Exam Structure
• Exact official question count: 100 multiple-choice questions (MCQ) per commonly cited RN HESI
Maternity specifications and verified Elsevier Evolve documentation.
• All questions must be presented in MCQ format with four options (A, B, C, D), single-best-answer unless
otherwise specified as SATA or NGN case study format.
• Questions must be presented in bold.
• Item types: Standard MCQ, Select-All-That-Apply (SATA), NGN bow-tie items, trend recognition, matrix
multiple-choice, prioritization scenarios, and clinical judgment application questions.
• Focus on evidence-based obstetric nursing interventions, AWHONN standards application, and
professional judgment aligned with NCSBN NCLEX-RN test plan and maternal-child nursing
competencies.
• Total testing time: 150 minutes (computer-based, proctored format via Elsevier Evolve testing platform
or institutional learning management system).
• Passing score: Typically 850 HESI score or 75-80% required for program progression per nursing
program policy (75-80/100 correct).
• Assessment delivery: Fixed-format objective assessment with clinical case vignettes, fetal heart rate strip
interpretation, labor/postpartum prioritization, and newborn care application items.
Answer Format
All correct answers must be presented in bold #FF007D Dopamine Powder, each question must appear in
bold, and all rationales explaining obstetric nursing interventions, fetal monitoring interpretation, labor
management protocols, and scenario-based professional reasoning must be written in italic font with light
lavender background #F5EDF9.
Examination Overview (2026/2027)
Domain Questions Key Topics Weight
Antepartum Care & 20 Prenatal Assessment, 20%
Fetal Development Fetal Growth, Danger
Signs, Ectopic
Pregnancy, Prenatal
Testing, Discomforts of
Pregnancy
Intrapartum Care & 25 Stages of Labor, FHR 25%
Labor Management Monitoring (VEAL
CHOP), Pain
Management, Oxytocin
Administration,
Placental
Abruption/Previa
Postpartum Care & 20 Uterine Involution, 20%
Maternal Recovery Lochia Assessment,
Postpartum Hemorrhage
, (BTL), Breastfeeding
Support, Endometritis,
Mental Health
Newborn Assessment & 15 APGAR Scoring, 15%
Care Thermoregulation,
Newborn Reflexes,
Jaundice/Phototherapy,
Safe Sleep, Newborn
Screening
High-Risk Pregnancy & 15 Preeclampsia/Eclampsia, 15%
OB Pharmacology Magnesium Sulfate,
Gestational Diabetes,
RhoGAM, Preterm
Labor, Tocolytics,
Betamethasone
Women's Health & 5 Contraception, STI 5%
Gynecological Care Screening, Menopause,
Cervical/Breast Cancer
Screening, Reproductive
Health
TOTAL 100 Comprehensive 100%
Maternity
Competency
Examination Questions
Domain: Antepartum Care & Fetal Development
1. A client at 8 weeks gestation presents to the emergency department with sharp,
unilateral lower abdominal pain and vaginal spotting. Which condition should the nurse
suspect first?
A. Placenta previa
B. Ectopic pregnancy
C. Abruptio placentae
D. Gestational trophoblastic disease
Correct Answer: B
Rationale: Sharp, unilateral abdominal pain combined with vaginal spotting in the first trimester (8
weeks) is the classic presentation of a ruptured or leaking ectopic pregnancy. Placenta previa and
abruptio placentae typically present in the second or third trimester. Gestational trophoblastic disease
presents with a uterus larger than dates and "snowstorm" ultrasound findings, but acute unilateral
pain strongly points to an ectopic pregnancy, which is a life-threatening emergency.
Domain: High-Risk Pregnancy & OB Pharmacology
2. A client with severe preeclampsia is receiving a continuous IV infusion of magnesium
sulfate. Which assessment finding indicates magnesium toxicity?
A. Urine output of 40 mL/hr
B. Deep tendon reflexes of 2+
C. Respiratory rate of 10 breaths/min
D. Blood pressure of 140/90 mmHg
Correct Answer: C
Rationale: Magnesium sulfate toxicity manifests as central nervous system and respiratory
depression. A respiratory rate of less than 12 breaths/min (C) indicates toxicity and requires
immediate intervention: stop the infusion, notify the provider, and administer the antidote, calcium
, gluconate. Urine output of 40 mL/hr (A) is adequate (>30 mL/hr). Reflexes of 2+ (B) are normal. BP
of 140/90 (D) is elevated but expected in preeclampsia; magnesium is given for seizure prophylaxis,
not primarily for BP control.
Domain: Intrapartum Care & Labor Management
3. The nurse is monitoring the fetal heart rate (FHR) of a client in active labor and notes a
pattern of gradual decreases in FHR that begin after the peak of the contraction and return
to baseline after the contraction ends. What is the nurse's priority action?
A. Document the finding as a normal early deceleration
B. Reposition the client to the left lateral position and administer oxygen
C. Prepare for an immediate cesarean delivery
D. Administer oxytocin to augment labor
Correct Answer: B
Rationale: The FHR pattern describes late decelerations, which indicate uteroplacental insufficiency
and fetal hypoxia. The nurse must initiate intrauterine resuscitation immediately: reposition to the
lateral position to improve placental perfusion, administer oxygen, increase IV fluids, and notify the
provider. Early decelerations (A) are head compression and benign. Immediate cesarean (C) may be
required if resuscitation fails, but is not the first action. Oxytocin (D) is contraindicated as it worsens
uteroplacental insufficiency.
4. A client in labor is receiving oxytocin (Pitocin) for augmentation. The nurse notes
uterine tachysystole (more than 5 contractions in 10 minutes). What is the nurse's first
action?
A. Increase the IV fluid rate
B. Turn off the oxytocin infusion
C. Administer terbutaline subcutaneously
D. Prepare for an emergency cesarean section
Correct Answer: B
Rationale: Tachysystole increases the risk of fetal hypoxia and uterine rupture. The very first action is
to turn off the oxytocin infusion to stop the stimulus causing the excessive contractions. Increasing IV
fluids (A) is a subsequent step. Terbutaline (C) may be ordered if stopping the oxytocin does not
resolve the tachysystole. Preparing for a cesarean (D) is done if fetal distress persists despite
interventions.
Domain: Postpartum Care & Maternal Recovery
5. A postpartum client, 2 hours after a vaginal delivery, has a boggy uterus that is displaced
to the right. What is the nurse's first action?
A. Administer methylergonovine IM
B. Assist the client to empty her bladder, then massage the fundus
C. Document the finding and reassess in 30 minutes
D. Prepare the client for a D&C
Correct Answer: B
Rationale: A boggy, deviated uterus indicates uterine atony, often caused by a distended bladder
displacing the uterus and preventing it from contracting effectively. The priority is to assist the client
to void (or catheterize), then massage the fundus until firm. Uterotonics like methylergonovine (A) are
administered if massage and voiding do not resolve the atony. Documentation alone (C) delays life-
saving intervention for postpartum hemorrhage.
Domain: Newborn Assessment & Care
2026/2027 Edition
Comprehensive Obstetric & Neonatal Nursing Competency Assessment
for RN Licensure Readiness
Elsevier Evolve / AWHONN Standards Alignment
EXACT OFFICIAL COUNT: 100 QUESTIONS
Complete Exam-Style Questions with Detailed Rationales | 100% Verified | Graded A+
Total Testing Time: 150 Minutes | Passing Score: 850 HESI or 75-80% | Format: Computer-Based,
Proctored
,Introduction
This RN HESI Maternity Exam format for 2026/2027 reflects the standardized competency assessment
used to evaluate proficiency in comprehensive obstetric and newborn care principles for pre-licensure RN
students. The official examination consists of exactly 100 multiple-choice questions (MCQ) covering
critical domains: antepartum care and fetal development, intrapartum care and labor management,
postpartum care and maternal recovery, newborn assessment and care, high-risk pregnancy and OB
pharmacology, women's health and gynecological care, and NGN case study application. The exam
measures knowledge essential for safe, effective, and family-centered practice in maternal-child health
settings, aligned with current AWHONN standards, NCSBN NCLEX-RN test plan, Elsevier HESI test
blueprints, and institutional nursing program learning outcomes.
Exam Structure
• Exact official question count: 100 multiple-choice questions (MCQ) per commonly cited RN HESI
Maternity specifications and verified Elsevier Evolve documentation.
• All questions must be presented in MCQ format with four options (A, B, C, D), single-best-answer unless
otherwise specified as SATA or NGN case study format.
• Questions must be presented in bold.
• Item types: Standard MCQ, Select-All-That-Apply (SATA), NGN bow-tie items, trend recognition, matrix
multiple-choice, prioritization scenarios, and clinical judgment application questions.
• Focus on evidence-based obstetric nursing interventions, AWHONN standards application, and
professional judgment aligned with NCSBN NCLEX-RN test plan and maternal-child nursing
competencies.
• Total testing time: 150 minutes (computer-based, proctored format via Elsevier Evolve testing platform
or institutional learning management system).
• Passing score: Typically 850 HESI score or 75-80% required for program progression per nursing
program policy (75-80/100 correct).
• Assessment delivery: Fixed-format objective assessment with clinical case vignettes, fetal heart rate strip
interpretation, labor/postpartum prioritization, and newborn care application items.
Answer Format
All correct answers must be presented in bold #FF007D Dopamine Powder, each question must appear in
bold, and all rationales explaining obstetric nursing interventions, fetal monitoring interpretation, labor
management protocols, and scenario-based professional reasoning must be written in italic font with light
lavender background #F5EDF9.
Examination Overview (2026/2027)
Domain Questions Key Topics Weight
Antepartum Care & 20 Prenatal Assessment, 20%
Fetal Development Fetal Growth, Danger
Signs, Ectopic
Pregnancy, Prenatal
Testing, Discomforts of
Pregnancy
Intrapartum Care & 25 Stages of Labor, FHR 25%
Labor Management Monitoring (VEAL
CHOP), Pain
Management, Oxytocin
Administration,
Placental
Abruption/Previa
Postpartum Care & 20 Uterine Involution, 20%
Maternal Recovery Lochia Assessment,
Postpartum Hemorrhage
, (BTL), Breastfeeding
Support, Endometritis,
Mental Health
Newborn Assessment & 15 APGAR Scoring, 15%
Care Thermoregulation,
Newborn Reflexes,
Jaundice/Phototherapy,
Safe Sleep, Newborn
Screening
High-Risk Pregnancy & 15 Preeclampsia/Eclampsia, 15%
OB Pharmacology Magnesium Sulfate,
Gestational Diabetes,
RhoGAM, Preterm
Labor, Tocolytics,
Betamethasone
Women's Health & 5 Contraception, STI 5%
Gynecological Care Screening, Menopause,
Cervical/Breast Cancer
Screening, Reproductive
Health
TOTAL 100 Comprehensive 100%
Maternity
Competency
Examination Questions
Domain: Antepartum Care & Fetal Development
1. A client at 8 weeks gestation presents to the emergency department with sharp,
unilateral lower abdominal pain and vaginal spotting. Which condition should the nurse
suspect first?
A. Placenta previa
B. Ectopic pregnancy
C. Abruptio placentae
D. Gestational trophoblastic disease
Correct Answer: B
Rationale: Sharp, unilateral abdominal pain combined with vaginal spotting in the first trimester (8
weeks) is the classic presentation of a ruptured or leaking ectopic pregnancy. Placenta previa and
abruptio placentae typically present in the second or third trimester. Gestational trophoblastic disease
presents with a uterus larger than dates and "snowstorm" ultrasound findings, but acute unilateral
pain strongly points to an ectopic pregnancy, which is a life-threatening emergency.
Domain: High-Risk Pregnancy & OB Pharmacology
2. A client with severe preeclampsia is receiving a continuous IV infusion of magnesium
sulfate. Which assessment finding indicates magnesium toxicity?
A. Urine output of 40 mL/hr
B. Deep tendon reflexes of 2+
C. Respiratory rate of 10 breaths/min
D. Blood pressure of 140/90 mmHg
Correct Answer: C
Rationale: Magnesium sulfate toxicity manifests as central nervous system and respiratory
depression. A respiratory rate of less than 12 breaths/min (C) indicates toxicity and requires
immediate intervention: stop the infusion, notify the provider, and administer the antidote, calcium
, gluconate. Urine output of 40 mL/hr (A) is adequate (>30 mL/hr). Reflexes of 2+ (B) are normal. BP
of 140/90 (D) is elevated but expected in preeclampsia; magnesium is given for seizure prophylaxis,
not primarily for BP control.
Domain: Intrapartum Care & Labor Management
3. The nurse is monitoring the fetal heart rate (FHR) of a client in active labor and notes a
pattern of gradual decreases in FHR that begin after the peak of the contraction and return
to baseline after the contraction ends. What is the nurse's priority action?
A. Document the finding as a normal early deceleration
B. Reposition the client to the left lateral position and administer oxygen
C. Prepare for an immediate cesarean delivery
D. Administer oxytocin to augment labor
Correct Answer: B
Rationale: The FHR pattern describes late decelerations, which indicate uteroplacental insufficiency
and fetal hypoxia. The nurse must initiate intrauterine resuscitation immediately: reposition to the
lateral position to improve placental perfusion, administer oxygen, increase IV fluids, and notify the
provider. Early decelerations (A) are head compression and benign. Immediate cesarean (C) may be
required if resuscitation fails, but is not the first action. Oxytocin (D) is contraindicated as it worsens
uteroplacental insufficiency.
4. A client in labor is receiving oxytocin (Pitocin) for augmentation. The nurse notes
uterine tachysystole (more than 5 contractions in 10 minutes). What is the nurse's first
action?
A. Increase the IV fluid rate
B. Turn off the oxytocin infusion
C. Administer terbutaline subcutaneously
D. Prepare for an emergency cesarean section
Correct Answer: B
Rationale: Tachysystole increases the risk of fetal hypoxia and uterine rupture. The very first action is
to turn off the oxytocin infusion to stop the stimulus causing the excessive contractions. Increasing IV
fluids (A) is a subsequent step. Terbutaline (C) may be ordered if stopping the oxytocin does not
resolve the tachysystole. Preparing for a cesarean (D) is done if fetal distress persists despite
interventions.
Domain: Postpartum Care & Maternal Recovery
5. A postpartum client, 2 hours after a vaginal delivery, has a boggy uterus that is displaced
to the right. What is the nurse's first action?
A. Administer methylergonovine IM
B. Assist the client to empty her bladder, then massage the fundus
C. Document the finding and reassess in 30 minutes
D. Prepare the client for a D&C
Correct Answer: B
Rationale: A boggy, deviated uterus indicates uterine atony, often caused by a distended bladder
displacing the uterus and preventing it from contracting effectively. The priority is to assist the client
to void (or catheterize), then massage the fundus until firm. Uterotonics like methylergonovine (A) are
administered if massage and voiding do not resolve the atony. Documentation alone (C) delays life-
saving intervention for postpartum hemorrhage.
Domain: Newborn Assessment & Care
