HESI RN OB Obstetrics Exam Prep Document | 2026/2027
Edition | 150 Verified Questions
HESI RN OB Obstetrics 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam prep document contains 150 verified questions and answers covering all
major topics in obstetrics for the HESI RN OB exam. Each question is accompanied by detailed
rationales and distractors explanations to reinforce learning. Updated for the 2026/2027 academic year,
this resource ensures students are well-prepared for the obstetrics portion of the HESI RN exam. Ideal
for nursing students seeking to master maternal-newborn nursing concepts.
Key Features:
Antepartum Care and Complications
Intrapartum Care and Labor Management
Postpartum Care and Complications
Newborn Assessment and Care
High-Risk Pregnancy Conditions
Pharmacology and Pain Management in Obstetrics
Updates for 2026:
- Incorporated 2026 ACOG guidelines for gestational diabetes management
- Updated newborn resuscitation protocols per latest NRP guidelines
- Revised postpartum hemorrhage management reflecting new evidence
- Added questions on COVID-19 considerations in pregnancy
- Enhanced rationales with current evidence-based practice references
Abstract:
This exam preparation document is meticulously designed for nursing students preparing for the HESI RN
Obstetrics (OB) examination. It comprises 150 verified questions that comprehensively cover antepartum,
intrapartum, postpartum, and newborn care. Each question is crafted to reflect the latest clinical guidelines and
evidence-based practices, ensuring alignment with the 2026/2027 academic standards. Detailed rationales
accompany each answer, elucidating correct choices and explaining common distractors to deepen understanding.
The content areas are weighted to mirror the actual HESI exam blueprint, with emphasis on high-risk pregnancies,
labor management, and neonatal assessment. This resource serves as an essential tool for achieving a high score
and demonstrating clinical competence in obstetrical nursing.
Keywords:
HESI RN OB, Obstetrics exam prep, Maternal-newborn nursing, Antepartum care, Intrapartum care, Postpartum
complications, Newborn assessment, NCLEX-style questions
Answer Format:
Each question is followed by the correct answer and a detailed rationale explaining why it is correct. Incorrect
options are also analyzed with distractor explanations to clarify common misconceptions. This format reinforces
critical thinking and application of nursing knowledge.
Compliance Checklist:
All questions align with 2026/2027 HESI RN OB test blueprint
Rationales cite current evidence-based practice and guidelines
Content covers all major obstetrics nursing domains
Page 1
, Questions are verified for accuracy by subject matter experts
Format simulates actual exam conditions for effective practice
Content Area Overview:
Content Area Questions Key Topics Weight
Antepartum Care 1-30 Prenatal assessments, gestational age 20%
determination, common discomforts,
prenatal nutrition, danger signs
Intrapartum Care 31-60 Stages of labor, fetal monitoring, pain 20%
management, labor complications,
induction/augmentation
Postpartum Care 61-90 Postpartum assessment, hemorrhage, 20%
infection, breastfeeding, mood disorders
Newborn Care 91-120 Newborn assessment, thermoregulation, 20%
hypoglycemia, jaundice, congenital
anomalies
High-Risk Pregnancy 121-140 Gestational diabetes, preeclampsia, preterm 13%
labor, multiple gestation, substance abuse
Pharmacology & Pain 141-150 Oxytocics, tocolytics, analgesics, 7%
Management anesthetics, magnesium sulfate
Page 2
,Q1. A nulliparous patient at 28 weeks gestation presents with a blood pressure of 155/100 mmHg and 3+
proteinuria on dipstick. She has no headache or visual changes. Laboratory results show elevated liver
enzymes (AST 120 U/L, ALT 150 U/L) and a platelet count of 90,000/L. Which of the following is the most
appropriate immediate management?
A. Administer labetalol 200 mg orally and schedule induction at 37 weeks
B. Initiate magnesium sulfate for seizure prophylaxis and plan for delivery within 24-48 hours after
corticosteroid administration
C. Start nifedipine 30 mg extended-release daily and monitor as an outpatient
D. Perform immediate cesarean delivery regardless of gestational age
Correct Answer: B. Initiate magnesium sulfate for seizure prophylaxis and plan for delivery within 24-48
hours after corticosteroid administration
Rationale: This patient has severe preeclampsia with HELLP syndrome features (elevated liver enzymes, low
platelets). The standard of care for severe preeclampsia at 28 weeks is to administer magnesium sulfate for seizure
prophylaxis and corticosteroids for fetal lung maturity, then deliver after 24-48 hours. Option A is insufficient
because oral labetalol alone does not prevent eclampsia and delaying delivery is unsafe. Option C is inappropriate
for severe disease with end-organ involvement. Option D ignores the benefit of corticosteroid therapy and may
increase neonatal morbidity.
Why Wrong:
A - Oral labetalol alone does not prevent seizures and delaying delivery in severe preeclampsia with HELLP
increases maternal risk.
C - Outpatient management is contraindicated in severe preeclampsia with evidence of end-organ damage.
D - Immediate delivery without corticosteroid benefit increases neonatal respiratory morbidity; delivery
should be delayed 24-48 hours if possible.
Reference: ACOG Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia. Obstetrics &
Gynecology. 2020;135(6):e237-e260.
Q2. A patient at 32 weeks gestation with a history of two prior cesarean deliveries presents with sudden onset
of severe abdominal pain and vaginal bleeding. The uterus is tender and hypertonic. Fetal heart rate shows a
prolonged deceleration to 80 bpm. Which of the following is the most likely diagnosis?
A. Placenta previa
B. Uterine rupture
C. Abruptio placentae
D. Vasa previa
Correct Answer: B. Uterine rupture
Rationale: In a patient with prior cesarean deliveries, sudden severe abdominal pain, vaginal bleeding, uterine
tenderness, and fetal distress are classic for uterine rupture. Placenta previa typically presents with painless
bleeding. Abruptio placentae is also possible but less likely given the history of uterine scar; however, the
hypertonus and fetal distress are more specific for rupture. Vasa previa presents with painless bleeding and fetal
distress after membrane rupture.
Why Wrong:
A - Placenta previa usually presents with painless, bright red bleeding and no uterine tenderness.
C - Abruptio placentae can cause similar symptoms but the history of prior cesarean makes rupture more
likely, and the description of hypertonus and fetal distress is classic for rupture.
D - Vasa previa typically presents with painless bleeding and fetal distress after spontaneous or artificial
rupture of membranes.
Reference: Cunningham FG, et al. Williams Obstetrics. 26th ed. McGraw-Hill; 2022. Chapter 23.
Page 3
, Q3. A patient at 39 weeks gestation is in active labor. The fetal heart rate tracing shows recurrent late
decelerations with minimal variability. The baseline fetal heart rate is 160 bpm. The nurse notes that the
patient is lying supine. Which of the following interventions should the nurse implement first?
A. Administer oxygen via non-rebreather mask at 10 L/min
B. Reposition the patient onto her left side
C. Increase the intravenous fluid rate
D. Notify the healthcare provider immediately
Correct Answer: B. Reposition the patient onto her left side
Rationale: The supine position can cause aortocaval compression, reducing uteroplacental blood flow and leading to late
decelerations. The first-line intervention is to reposition the patient to a lateral position (preferably left) to relieve
compression. While oxygen and IV fluids are also appropriate, repositioning is the immediate priority. Notifying the provider
is important but should follow initial corrective measures.
Why Wrong:
A - Administering oxygen is important but not the first step; repositioning addresses the underlying cause.
C - Increasing IV fluids may help but does not directly correct aortocaval compression.
D - The provider should be notified after initial interventions are attempted, as the tracing is non-reassuring but not
emergent.
Reference: ACOG. Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management
Principles. ACOG Practice Bulletin No. 106. 2009; reaffirmed 2021.
Q4. A patient with type 1 diabetes mellitus is planning to conceive. She currently uses an insulin pump with
continuous glucose monitoring. Her hemoglobin A1c is 8.5%. Which of the following is the most appropriate
recommendation regarding glycemic control prior to pregnancy?
A. She can proceed with conception as long as she maintains her current regimen
B. She should achieve a hemoglobin A1c < 6.5% before attempting pregnancy
C. She should switch to multiple daily injections to improve control
D. She should aim for a hemoglobin A1c < 7.0% and add metformin
Correct Answer: B. She should achieve a hemoglobin A1c < 6.5% before attempting pregnancy
Rationale: Preconception care for women with diabetes emphasizes strict glycemic control to reduce the risk of
congenital anomalies. A target A1c < 6.5% (or as low as safely possible) is recommended before pregnancy. An
A1c of 8.5% is associated with increased risk of neural tube defects and other malformations. Option A is unsafe.
Option C is not necessarily better than pump therapy. Metformin is not first-line in type 1 diabetes and does not
replace insulin.
Why Wrong:
A - An A1c of 8.5% is associated with a high risk of congenital anomalies, so conception should be delayed.
C - Multiple daily injections are not inherently superior to insulin pump therapy; the mode of delivery is less
important than achieving glycemic targets.
D - Metformin is not indicated for type 1 diabetes and does not replace the need for tight glycemic control
with insulin.
Reference: American Diabetes Association. Management of Diabetes in Pregnancy: Standards of Medical Care in
Diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S282-S294.
Q5. A patient at 41 weeks gestation is undergoing induction of labor with oxytocin. She has an epidural for
pain management. The fetal heart rate tracing shows a sinusoidal pattern with a frequency of 3 cycles per
minute and amplitude of 10 bpm. Which of the following is the most appropriate next step?
A. Continue oxytocin and monitor closely
B. Discontinue oxytocin and prepare for immediate cesarean delivery
C. Administer terbutaline to reduce uterine activity
D. Increase the rate of intravenous fluids
Page 4
Edition | 150 Verified Questions
HESI RN OB Obstetrics 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam prep document contains 150 verified questions and answers covering all
major topics in obstetrics for the HESI RN OB exam. Each question is accompanied by detailed
rationales and distractors explanations to reinforce learning. Updated for the 2026/2027 academic year,
this resource ensures students are well-prepared for the obstetrics portion of the HESI RN exam. Ideal
for nursing students seeking to master maternal-newborn nursing concepts.
Key Features:
Antepartum Care and Complications
Intrapartum Care and Labor Management
Postpartum Care and Complications
Newborn Assessment and Care
High-Risk Pregnancy Conditions
Pharmacology and Pain Management in Obstetrics
Updates for 2026:
- Incorporated 2026 ACOG guidelines for gestational diabetes management
- Updated newborn resuscitation protocols per latest NRP guidelines
- Revised postpartum hemorrhage management reflecting new evidence
- Added questions on COVID-19 considerations in pregnancy
- Enhanced rationales with current evidence-based practice references
Abstract:
This exam preparation document is meticulously designed for nursing students preparing for the HESI RN
Obstetrics (OB) examination. It comprises 150 verified questions that comprehensively cover antepartum,
intrapartum, postpartum, and newborn care. Each question is crafted to reflect the latest clinical guidelines and
evidence-based practices, ensuring alignment with the 2026/2027 academic standards. Detailed rationales
accompany each answer, elucidating correct choices and explaining common distractors to deepen understanding.
The content areas are weighted to mirror the actual HESI exam blueprint, with emphasis on high-risk pregnancies,
labor management, and neonatal assessment. This resource serves as an essential tool for achieving a high score
and demonstrating clinical competence in obstetrical nursing.
Keywords:
HESI RN OB, Obstetrics exam prep, Maternal-newborn nursing, Antepartum care, Intrapartum care, Postpartum
complications, Newborn assessment, NCLEX-style questions
Answer Format:
Each question is followed by the correct answer and a detailed rationale explaining why it is correct. Incorrect
options are also analyzed with distractor explanations to clarify common misconceptions. This format reinforces
critical thinking and application of nursing knowledge.
Compliance Checklist:
All questions align with 2026/2027 HESI RN OB test blueprint
Rationales cite current evidence-based practice and guidelines
Content covers all major obstetrics nursing domains
Page 1
, Questions are verified for accuracy by subject matter experts
Format simulates actual exam conditions for effective practice
Content Area Overview:
Content Area Questions Key Topics Weight
Antepartum Care 1-30 Prenatal assessments, gestational age 20%
determination, common discomforts,
prenatal nutrition, danger signs
Intrapartum Care 31-60 Stages of labor, fetal monitoring, pain 20%
management, labor complications,
induction/augmentation
Postpartum Care 61-90 Postpartum assessment, hemorrhage, 20%
infection, breastfeeding, mood disorders
Newborn Care 91-120 Newborn assessment, thermoregulation, 20%
hypoglycemia, jaundice, congenital
anomalies
High-Risk Pregnancy 121-140 Gestational diabetes, preeclampsia, preterm 13%
labor, multiple gestation, substance abuse
Pharmacology & Pain 141-150 Oxytocics, tocolytics, analgesics, 7%
Management anesthetics, magnesium sulfate
Page 2
,Q1. A nulliparous patient at 28 weeks gestation presents with a blood pressure of 155/100 mmHg and 3+
proteinuria on dipstick. She has no headache or visual changes. Laboratory results show elevated liver
enzymes (AST 120 U/L, ALT 150 U/L) and a platelet count of 90,000/L. Which of the following is the most
appropriate immediate management?
A. Administer labetalol 200 mg orally and schedule induction at 37 weeks
B. Initiate magnesium sulfate for seizure prophylaxis and plan for delivery within 24-48 hours after
corticosteroid administration
C. Start nifedipine 30 mg extended-release daily and monitor as an outpatient
D. Perform immediate cesarean delivery regardless of gestational age
Correct Answer: B. Initiate magnesium sulfate for seizure prophylaxis and plan for delivery within 24-48
hours after corticosteroid administration
Rationale: This patient has severe preeclampsia with HELLP syndrome features (elevated liver enzymes, low
platelets). The standard of care for severe preeclampsia at 28 weeks is to administer magnesium sulfate for seizure
prophylaxis and corticosteroids for fetal lung maturity, then deliver after 24-48 hours. Option A is insufficient
because oral labetalol alone does not prevent eclampsia and delaying delivery is unsafe. Option C is inappropriate
for severe disease with end-organ involvement. Option D ignores the benefit of corticosteroid therapy and may
increase neonatal morbidity.
Why Wrong:
A - Oral labetalol alone does not prevent seizures and delaying delivery in severe preeclampsia with HELLP
increases maternal risk.
C - Outpatient management is contraindicated in severe preeclampsia with evidence of end-organ damage.
D - Immediate delivery without corticosteroid benefit increases neonatal respiratory morbidity; delivery
should be delayed 24-48 hours if possible.
Reference: ACOG Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia. Obstetrics &
Gynecology. 2020;135(6):e237-e260.
Q2. A patient at 32 weeks gestation with a history of two prior cesarean deliveries presents with sudden onset
of severe abdominal pain and vaginal bleeding. The uterus is tender and hypertonic. Fetal heart rate shows a
prolonged deceleration to 80 bpm. Which of the following is the most likely diagnosis?
A. Placenta previa
B. Uterine rupture
C. Abruptio placentae
D. Vasa previa
Correct Answer: B. Uterine rupture
Rationale: In a patient with prior cesarean deliveries, sudden severe abdominal pain, vaginal bleeding, uterine
tenderness, and fetal distress are classic for uterine rupture. Placenta previa typically presents with painless
bleeding. Abruptio placentae is also possible but less likely given the history of uterine scar; however, the
hypertonus and fetal distress are more specific for rupture. Vasa previa presents with painless bleeding and fetal
distress after membrane rupture.
Why Wrong:
A - Placenta previa usually presents with painless, bright red bleeding and no uterine tenderness.
C - Abruptio placentae can cause similar symptoms but the history of prior cesarean makes rupture more
likely, and the description of hypertonus and fetal distress is classic for rupture.
D - Vasa previa typically presents with painless bleeding and fetal distress after spontaneous or artificial
rupture of membranes.
Reference: Cunningham FG, et al. Williams Obstetrics. 26th ed. McGraw-Hill; 2022. Chapter 23.
Page 3
, Q3. A patient at 39 weeks gestation is in active labor. The fetal heart rate tracing shows recurrent late
decelerations with minimal variability. The baseline fetal heart rate is 160 bpm. The nurse notes that the
patient is lying supine. Which of the following interventions should the nurse implement first?
A. Administer oxygen via non-rebreather mask at 10 L/min
B. Reposition the patient onto her left side
C. Increase the intravenous fluid rate
D. Notify the healthcare provider immediately
Correct Answer: B. Reposition the patient onto her left side
Rationale: The supine position can cause aortocaval compression, reducing uteroplacental blood flow and leading to late
decelerations. The first-line intervention is to reposition the patient to a lateral position (preferably left) to relieve
compression. While oxygen and IV fluids are also appropriate, repositioning is the immediate priority. Notifying the provider
is important but should follow initial corrective measures.
Why Wrong:
A - Administering oxygen is important but not the first step; repositioning addresses the underlying cause.
C - Increasing IV fluids may help but does not directly correct aortocaval compression.
D - The provider should be notified after initial interventions are attempted, as the tracing is non-reassuring but not
emergent.
Reference: ACOG. Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management
Principles. ACOG Practice Bulletin No. 106. 2009; reaffirmed 2021.
Q4. A patient with type 1 diabetes mellitus is planning to conceive. She currently uses an insulin pump with
continuous glucose monitoring. Her hemoglobin A1c is 8.5%. Which of the following is the most appropriate
recommendation regarding glycemic control prior to pregnancy?
A. She can proceed with conception as long as she maintains her current regimen
B. She should achieve a hemoglobin A1c < 6.5% before attempting pregnancy
C. She should switch to multiple daily injections to improve control
D. She should aim for a hemoglobin A1c < 7.0% and add metformin
Correct Answer: B. She should achieve a hemoglobin A1c < 6.5% before attempting pregnancy
Rationale: Preconception care for women with diabetes emphasizes strict glycemic control to reduce the risk of
congenital anomalies. A target A1c < 6.5% (or as low as safely possible) is recommended before pregnancy. An
A1c of 8.5% is associated with increased risk of neural tube defects and other malformations. Option A is unsafe.
Option C is not necessarily better than pump therapy. Metformin is not first-line in type 1 diabetes and does not
replace insulin.
Why Wrong:
A - An A1c of 8.5% is associated with a high risk of congenital anomalies, so conception should be delayed.
C - Multiple daily injections are not inherently superior to insulin pump therapy; the mode of delivery is less
important than achieving glycemic targets.
D - Metformin is not indicated for type 1 diabetes and does not replace the need for tight glycemic control
with insulin.
Reference: American Diabetes Association. Management of Diabetes in Pregnancy: Standards of Medical Care in
Diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S282-S294.
Q5. A patient at 41 weeks gestation is undergoing induction of labor with oxytocin. She has an epidural for
pain management. The fetal heart rate tracing shows a sinusoidal pattern with a frequency of 3 cycles per
minute and amplitude of 10 bpm. Which of the following is the most appropriate next step?
A. Continue oxytocin and monitor closely
B. Discontinue oxytocin and prepare for immediate cesarean delivery
C. Administer terbutaline to reduce uterine activity
D. Increase the rate of intravenous fluids
Page 4
