RN HESI Maternity Exam ACTUAL EXAM
2026/2027 | Elsevier Evolve AWHONN
Standards Alignment | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: ANTEPARTUM NURSING & PRENATAL CARE (18 Questions)
Q1: A pregnant patient at 10 weeks gestation reports nausea and vomiting that occurs mostly in the
morning. Which nursing instruction is most appropriate?
A. Take prenatal vitamins on an empty stomach to enhance absorption
B. Eat dry crackers before getting out of bed and eat small, frequent meals throughout the day
[CORRECT]
C. Avoid all fluids until the nausea resolves completely
D. Take over-the-counter bismuth subsalicylate for symptom relief
Correct Answer: B
Rationale: Morning sickness in early pregnancy is caused by elevated human chorionic gonadotropin
(hCG) and estrogen levels. Eating dry crackers before rising helps absorb gastric acid, and small frequent
meals prevent an empty stomach which worsens nausea. Prenatal vitamins should be taken with food to
minimize GI upset. Fluid restriction is dangerous in pregnancy and can lead to dehydration. Bismuth
subsalicylate is contraindicated in pregnancy due to salicylate content and potential teratogenic effects.
Q2: A pregnant patient at 28 weeks gestation has a 1-hour glucose challenge test result of 155 mg/dL.
Which action should the nurse take next?
A. Reassure the patient that this is a normal result and no further testing is needed
B. Schedule a 3-hour oral glucose tolerance test (OGTT) for definitive diagnosis [CORRECT]
C. Immediately start the patient on insulin therapy for gestational diabetes
D. Recommend the patient begin a strict ketogenic diet
Correct Answer: B
Rationale: A 1-hour glucose challenge test result of 155 mg/dL exceeds the screening threshold
(typically 130-140 mg/dL depending on the institution), indicating the need for a diagnostic 3-hour
,OGTT. The 3-hour test uses fasting glucose and 1-hour, 2-hour, and 3-hour post-glucose measurements
with specific diagnostic criteria. Insulin should not be started until gestational diabetes is confirmed. A
ketogenic diet is contraindicated in pregnancy as it may cause ketosis and inadequate fetal nutrition.
Q3: A pregnant patient at 32 weeks gestation reports a sudden gush of clear fluid from the vagina. The
nurse tests the fluid with Nitrazine paper, which turns blue, and observes ferning on microscopic
examination. Which complication should the nurse suspect?
A. Urinary incontinence
B. Preterm premature rupture of membranes (PPROM) [CORRECT]
C. Normal vaginal discharge in the third trimester
D. Cervical mucus plug expulsion
Correct Answer: B
Rationale: A sudden gush of clear fluid with positive Nitrazine (blue indicates alkaline pH; amniotic fluid
is alkaline while vaginal secretions are acidic) and ferning pattern on microscopy confirms rupture of
membranes. At 32 weeks, this is classified as preterm PROM (before 37 weeks), which increases risk of
chorioamnionitis, cord prolapse, and preterm birth. The nurse should assess fetal heart rate, check for
signs of infection, and notify the provider immediately. Urinary incontinence would not show ferning or
positive Nitrazine.
Q4: A pregnant patient at 20 weeks gestation has a blood pressure of 152/96 mmHg on two occasions 4
hours apart, proteinuria of 1+, and reports a severe headache. Which condition does the nurse suspect?
A. Gestational hypertension
B. Preeclampsia [CORRECT]
C. Chronic hypertension
D. Eclampsia
Correct Answer: B
Rationale: Preeclampsia is diagnosed after 20 weeks gestation with new-onset hypertension (systolic
≥140 or diastolic ≥90 on two occasions at least 4 hours apart) and either proteinuria or maternal organ
dysfunction (thrombocytopenia, renal insufficiency, elevated liver enzymes, pulmonary edema, or
cerebral/visual disturbances). The severe headache suggests possible cerebral involvement. Gestational
hypertension lacks proteinuria or organ dysfunction. Chronic hypertension predates pregnancy.
Eclampsia requires seizure activity.
,Q5: A pregnant patient at 18 weeks gestation is Rh-negative and the father is Rh-positive. Which
intervention is most important?
A. Administer Rho(D) immune globulin (RhoGAM) immediately
B. Administer RhoGAM at 28 weeks gestation and within 72 hours after delivery [CORRECT]
C. No intervention is needed until after the first pregnancy
D. Schedule an amniocentesis to determine fetal Rh status
Correct Answer: B
Rationale: RhoGAM is administered to Rh-negative pregnant patients at approximately 28 weeks
gestation to prevent sensitization during pregnancy, and again within 72 hours after delivery if the infant
is Rh-positive. It may also be given after any sensitizing event (amniocentesis, chorionic villus sampling,
trauma, bleeding). RhoGAM is not given at 18 weeks unless there is a sensitizing event. Waiting until
after delivery is too late to prevent initial sensitization. Amniocentesis for Rh status is unnecessary and
carries risk.
Q6: A pregnant patient at 24 weeks gestation reports decreased fetal movement. Which action should
the nurse take first?
A. Reassure the patient that decreased movement is normal at this gestational age
B. Instruct the patient to perform fetal kick counts and have her lie on her left side while monitoring
[CORRECT]
C. Immediately schedule an emergency cesarean birth
D. Tell the patient to drink a large glass of ice water and call back in 2 hours
Correct Answer: B
Rationale: Decreased fetal movement requires assessment but does not always indicate an emergency.
The nurse should first instruct the patient to perform kick counts (10 movements in 2 hours is typically
reassuring) while lying in the left lateral recumbent position, which improves uteroplacental perfusion. If
movement remains decreased, further evaluation with non-stress test or biophysical profile is indicated.
Reassurance without assessment is unsafe. Immediate cesarean is excessive without fetal assessment.
Ice water may stimulate fetal movement but is not the primary intervention.
Q7: A pregnant patient at 16 weeks gestation is scheduled for amniocentesis. Which nursing instruction
is most important?
A. The patient should have a full bladder during the procedure
B. The patient should empty her bladder before the procedure to reduce uterine compression
[CORRECT]
, C. The patient will receive general anesthesia for the procedure
D. The patient should avoid all prenatal vitamins for 1 week before the procedure
Correct Answer: B
Rationale: For amniocentesis in the second trimester, the patient should empty her bladder to reduce
the size of the uterus and minimize risk of bladder puncture during needle insertion. A full bladder is
required for early pregnancy procedures (such as chorionic villus sampling or early amniocentesis) to
elevate the uterus. Amniocentesis uses local anesthesia only. Prenatal vitamins should not be
discontinued; folic acid is particularly important for neural tube development.
Q8: A pregnant patient at 8 weeks gestation reports severe vomiting, weight loss of 3 kg (6.6 lbs), and
ketonuria. Which condition does the nurse suspect?
A. Normal morning sickness
B. Hyperemesis gravidarum [CORRECT]
C. Gestational diabetes
D. Pyloric stenosis
Correct Answer: B
Rationale: Hyperemesis gravidarum is characterized by severe, persistent nausea and vomiting leading
to weight loss (>5% of pre-pregnancy weight), dehydration, electrolyte imbalances, and ketonuria. It
typically begins before 16 weeks gestation and requires medical intervention including IV fluids,
electrolyte replacement, and antiemetics. Normal morning sickness does not cause significant weight
loss or ketonuria. Gestational diabetes typically presents later in pregnancy. Pyloric stenosis is a
newborn condition, not a pregnancy complication.
Q9: A pregnant patient at 35 weeks gestation is diagnosed with placenta previa after an episode of
painless vaginal bleeding. Which nursing intervention is most appropriate?
A. Prepare the patient for immediate vaginal delivery
B. Maintain the patient on bed rest with pelvic rest and monitor for further bleeding [CORRECT]
C. Perform a vaginal examination to assess cervical dilation
D. Administer oxytocin to induce labor
Correct Answer: B
Rationale: Placenta previa (placenta covering or adjacent to the cervical os) presents with painless,
bright red vaginal bleeding and is managed expectantly if the fetus is immature and bleeding is
controlled. Bed rest with pelvic rest (no vaginal exams, intercourse, or tampons) prevents further
placental disruption. Vaginal examination is contraindicated as it can cause catastrophic hemorrhage.
2026/2027 | Elsevier Evolve AWHONN
Standards Alignment | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: ANTEPARTUM NURSING & PRENATAL CARE (18 Questions)
Q1: A pregnant patient at 10 weeks gestation reports nausea and vomiting that occurs mostly in the
morning. Which nursing instruction is most appropriate?
A. Take prenatal vitamins on an empty stomach to enhance absorption
B. Eat dry crackers before getting out of bed and eat small, frequent meals throughout the day
[CORRECT]
C. Avoid all fluids until the nausea resolves completely
D. Take over-the-counter bismuth subsalicylate for symptom relief
Correct Answer: B
Rationale: Morning sickness in early pregnancy is caused by elevated human chorionic gonadotropin
(hCG) and estrogen levels. Eating dry crackers before rising helps absorb gastric acid, and small frequent
meals prevent an empty stomach which worsens nausea. Prenatal vitamins should be taken with food to
minimize GI upset. Fluid restriction is dangerous in pregnancy and can lead to dehydration. Bismuth
subsalicylate is contraindicated in pregnancy due to salicylate content and potential teratogenic effects.
Q2: A pregnant patient at 28 weeks gestation has a 1-hour glucose challenge test result of 155 mg/dL.
Which action should the nurse take next?
A. Reassure the patient that this is a normal result and no further testing is needed
B. Schedule a 3-hour oral glucose tolerance test (OGTT) for definitive diagnosis [CORRECT]
C. Immediately start the patient on insulin therapy for gestational diabetes
D. Recommend the patient begin a strict ketogenic diet
Correct Answer: B
Rationale: A 1-hour glucose challenge test result of 155 mg/dL exceeds the screening threshold
(typically 130-140 mg/dL depending on the institution), indicating the need for a diagnostic 3-hour
,OGTT. The 3-hour test uses fasting glucose and 1-hour, 2-hour, and 3-hour post-glucose measurements
with specific diagnostic criteria. Insulin should not be started until gestational diabetes is confirmed. A
ketogenic diet is contraindicated in pregnancy as it may cause ketosis and inadequate fetal nutrition.
Q3: A pregnant patient at 32 weeks gestation reports a sudden gush of clear fluid from the vagina. The
nurse tests the fluid with Nitrazine paper, which turns blue, and observes ferning on microscopic
examination. Which complication should the nurse suspect?
A. Urinary incontinence
B. Preterm premature rupture of membranes (PPROM) [CORRECT]
C. Normal vaginal discharge in the third trimester
D. Cervical mucus plug expulsion
Correct Answer: B
Rationale: A sudden gush of clear fluid with positive Nitrazine (blue indicates alkaline pH; amniotic fluid
is alkaline while vaginal secretions are acidic) and ferning pattern on microscopy confirms rupture of
membranes. At 32 weeks, this is classified as preterm PROM (before 37 weeks), which increases risk of
chorioamnionitis, cord prolapse, and preterm birth. The nurse should assess fetal heart rate, check for
signs of infection, and notify the provider immediately. Urinary incontinence would not show ferning or
positive Nitrazine.
Q4: A pregnant patient at 20 weeks gestation has a blood pressure of 152/96 mmHg on two occasions 4
hours apart, proteinuria of 1+, and reports a severe headache. Which condition does the nurse suspect?
A. Gestational hypertension
B. Preeclampsia [CORRECT]
C. Chronic hypertension
D. Eclampsia
Correct Answer: B
Rationale: Preeclampsia is diagnosed after 20 weeks gestation with new-onset hypertension (systolic
≥140 or diastolic ≥90 on two occasions at least 4 hours apart) and either proteinuria or maternal organ
dysfunction (thrombocytopenia, renal insufficiency, elevated liver enzymes, pulmonary edema, or
cerebral/visual disturbances). The severe headache suggests possible cerebral involvement. Gestational
hypertension lacks proteinuria or organ dysfunction. Chronic hypertension predates pregnancy.
Eclampsia requires seizure activity.
,Q5: A pregnant patient at 18 weeks gestation is Rh-negative and the father is Rh-positive. Which
intervention is most important?
A. Administer Rho(D) immune globulin (RhoGAM) immediately
B. Administer RhoGAM at 28 weeks gestation and within 72 hours after delivery [CORRECT]
C. No intervention is needed until after the first pregnancy
D. Schedule an amniocentesis to determine fetal Rh status
Correct Answer: B
Rationale: RhoGAM is administered to Rh-negative pregnant patients at approximately 28 weeks
gestation to prevent sensitization during pregnancy, and again within 72 hours after delivery if the infant
is Rh-positive. It may also be given after any sensitizing event (amniocentesis, chorionic villus sampling,
trauma, bleeding). RhoGAM is not given at 18 weeks unless there is a sensitizing event. Waiting until
after delivery is too late to prevent initial sensitization. Amniocentesis for Rh status is unnecessary and
carries risk.
Q6: A pregnant patient at 24 weeks gestation reports decreased fetal movement. Which action should
the nurse take first?
A. Reassure the patient that decreased movement is normal at this gestational age
B. Instruct the patient to perform fetal kick counts and have her lie on her left side while monitoring
[CORRECT]
C. Immediately schedule an emergency cesarean birth
D. Tell the patient to drink a large glass of ice water and call back in 2 hours
Correct Answer: B
Rationale: Decreased fetal movement requires assessment but does not always indicate an emergency.
The nurse should first instruct the patient to perform kick counts (10 movements in 2 hours is typically
reassuring) while lying in the left lateral recumbent position, which improves uteroplacental perfusion. If
movement remains decreased, further evaluation with non-stress test or biophysical profile is indicated.
Reassurance without assessment is unsafe. Immediate cesarean is excessive without fetal assessment.
Ice water may stimulate fetal movement but is not the primary intervention.
Q7: A pregnant patient at 16 weeks gestation is scheduled for amniocentesis. Which nursing instruction
is most important?
A. The patient should have a full bladder during the procedure
B. The patient should empty her bladder before the procedure to reduce uterine compression
[CORRECT]
, C. The patient will receive general anesthesia for the procedure
D. The patient should avoid all prenatal vitamins for 1 week before the procedure
Correct Answer: B
Rationale: For amniocentesis in the second trimester, the patient should empty her bladder to reduce
the size of the uterus and minimize risk of bladder puncture during needle insertion. A full bladder is
required for early pregnancy procedures (such as chorionic villus sampling or early amniocentesis) to
elevate the uterus. Amniocentesis uses local anesthesia only. Prenatal vitamins should not be
discontinued; folic acid is particularly important for neural tube development.
Q8: A pregnant patient at 8 weeks gestation reports severe vomiting, weight loss of 3 kg (6.6 lbs), and
ketonuria. Which condition does the nurse suspect?
A. Normal morning sickness
B. Hyperemesis gravidarum [CORRECT]
C. Gestational diabetes
D. Pyloric stenosis
Correct Answer: B
Rationale: Hyperemesis gravidarum is characterized by severe, persistent nausea and vomiting leading
to weight loss (>5% of pre-pregnancy weight), dehydration, electrolyte imbalances, and ketonuria. It
typically begins before 16 weeks gestation and requires medical intervention including IV fluids,
electrolyte replacement, and antiemetics. Normal morning sickness does not cause significant weight
loss or ketonuria. Gestational diabetes typically presents later in pregnancy. Pyloric stenosis is a
newborn condition, not a pregnancy complication.
Q9: A pregnant patient at 35 weeks gestation is diagnosed with placenta previa after an episode of
painless vaginal bleeding. Which nursing intervention is most appropriate?
A. Prepare the patient for immediate vaginal delivery
B. Maintain the patient on bed rest with pelvic rest and monitor for further bleeding [CORRECT]
C. Perform a vaginal examination to assess cervical dilation
D. Administer oxytocin to induce labor
Correct Answer: B
Rationale: Placenta previa (placenta covering or adjacent to the cervical os) presents with painless,
bright red vaginal bleeding and is managed expectantly if the fetus is immature and bleeding is
controlled. Bed rest with pelvic rest (no vaginal exams, intercourse, or tampons) prevents further
placental disruption. Vaginal examination is contraindicated as it can cause catastrophic hemorrhage.
