1
HESI Exit Exam OB Pharmacology &
Safety Bank: Labor, Delivery &
Postpartum Review
Table of Contents
Subtopic 1: Intrapartum Monitoring and Safety Protocols...............................2
Subtopic 2: Labor Complications and Emergency Management....................10
Subtopic 3: Postpartum Hemorrhage and Recovery Safety...........................19
Subtopic 4: Hypertensive Disorders and Eclampsia Management in the
Perinatal Period..............................................................................................27
Subtopic 5: Maternal Infections and Neonatal Risk Prevention......................36
Subtopic 6: Pain Management and Epidural Safety in Labor..........................44
Subtopic 7: Postpartum Hemorrhage and Emergency Interventions.............53
Subtopic 8: Breastfeeding Safety and Neonatal-Maternal Bonding...............61
Subtopic 9: Maternal Infection Prevention and Early Postpartum
Complications................................................................................................70
Subtopic 10: Postpartum Mental Health and Maternal Safety........................78
, 2
Subtopic 1: Intrapartum Monitoring and Safety
Protocols
Question 1
A nurse observes recurrent late decelerations on the fetal heart rate monitor.
What is the priority nursing action?
A. Reposition the patient to the left lateral side
B. Administer oxygen via non-rebreather mask at 10 L/min
C. Prepare the client for amniotomy
D. Increase the oxytocin infusion
Correct Answer: B
Rationale: Late decelerations indicate uteroplacental insufficiency.
Administering oxygen improves fetal oxygenation. Repositioning and IV fluid
boluses follow if decelerations persist.
Question 2
Which fetal heart rate pattern requires immediate intervention?
A. Early decelerations
B. Sinusoidal pattern
C. Moderate variability with accelerations
D. Variable decelerations with shoulders
Correct Answer: B
Rationale: A sinusoidal pattern is ominous, often indicating fetal anemia or
hypoxia. It necessitates urgent evaluation and possible delivery.
Question 3
, 3
A patient receiving oxytocin for labor induction begins having contractions
every 90 seconds lasting 90 seconds. What should the nurse do first?
A. Increase IV fluids
B. Notify the healthcare provider
C. Stop the oxytocin infusion
D. Reposition the patient to supine
Correct Answer: C
Rationale: This is uterine tachysystole, which can impair fetal oxygenation.
Stopping oxytocin is the immediate action to reduce contraction frequency.
Question 4
During an assessment, the nurse notes fetal bradycardia. What maternal
factor may contribute to this?
A. Maternal fever
B. Supine hypotension syndrome
C. Maternal anxiety
D. Hyperthyroidism
Correct Answer: B
Rationale: Supine hypotension reduces uteroplacental perfusion, leading to
fetal bradycardia. Repositioning can resolve the issue.
Question 5
Which action best promotes maternal and fetal safety during epidural
placement?
A. Administering 500 mL of IV dextrose
B. Monitoring maternal blood pressure every 5 minutes initially
, 4
C. Keeping the mother flat post-insertion
D. Asking the mother to bear down during insertion
Correct Answer: B
Rationale: Epidural anesthesia can cause hypotension; frequent BP
monitoring ensures timely intervention to maintain perfusion to the fetus.
Question 6
Which is a contraindication to vaginal birth after cesarean (VBAC)?
A. History of gestational diabetes
B. One prior low-transverse cesarean section
C. Prior classical cesarean incision
D. Cephalic fetal presentation
Correct Answer: C
Rationale: A classical incision involves a vertical uterine cut with high rupture
risk, making VBAC contraindicated.
Question 7
A laboring patient has meconium-stained amniotic fluid. What is the nurse’s
priority?
A. Increase oxytocin
B. Prepare for possible neonatal resuscitation
C. Check maternal temperature
D. Reassure the patient
Correct Answer: B
HESI Exit Exam OB Pharmacology &
Safety Bank: Labor, Delivery &
Postpartum Review
Table of Contents
Subtopic 1: Intrapartum Monitoring and Safety Protocols...............................2
Subtopic 2: Labor Complications and Emergency Management....................10
Subtopic 3: Postpartum Hemorrhage and Recovery Safety...........................19
Subtopic 4: Hypertensive Disorders and Eclampsia Management in the
Perinatal Period..............................................................................................27
Subtopic 5: Maternal Infections and Neonatal Risk Prevention......................36
Subtopic 6: Pain Management and Epidural Safety in Labor..........................44
Subtopic 7: Postpartum Hemorrhage and Emergency Interventions.............53
Subtopic 8: Breastfeeding Safety and Neonatal-Maternal Bonding...............61
Subtopic 9: Maternal Infection Prevention and Early Postpartum
Complications................................................................................................70
Subtopic 10: Postpartum Mental Health and Maternal Safety........................78
, 2
Subtopic 1: Intrapartum Monitoring and Safety
Protocols
Question 1
A nurse observes recurrent late decelerations on the fetal heart rate monitor.
What is the priority nursing action?
A. Reposition the patient to the left lateral side
B. Administer oxygen via non-rebreather mask at 10 L/min
C. Prepare the client for amniotomy
D. Increase the oxytocin infusion
Correct Answer: B
Rationale: Late decelerations indicate uteroplacental insufficiency.
Administering oxygen improves fetal oxygenation. Repositioning and IV fluid
boluses follow if decelerations persist.
Question 2
Which fetal heart rate pattern requires immediate intervention?
A. Early decelerations
B. Sinusoidal pattern
C. Moderate variability with accelerations
D. Variable decelerations with shoulders
Correct Answer: B
Rationale: A sinusoidal pattern is ominous, often indicating fetal anemia or
hypoxia. It necessitates urgent evaluation and possible delivery.
Question 3
, 3
A patient receiving oxytocin for labor induction begins having contractions
every 90 seconds lasting 90 seconds. What should the nurse do first?
A. Increase IV fluids
B. Notify the healthcare provider
C. Stop the oxytocin infusion
D. Reposition the patient to supine
Correct Answer: C
Rationale: This is uterine tachysystole, which can impair fetal oxygenation.
Stopping oxytocin is the immediate action to reduce contraction frequency.
Question 4
During an assessment, the nurse notes fetal bradycardia. What maternal
factor may contribute to this?
A. Maternal fever
B. Supine hypotension syndrome
C. Maternal anxiety
D. Hyperthyroidism
Correct Answer: B
Rationale: Supine hypotension reduces uteroplacental perfusion, leading to
fetal bradycardia. Repositioning can resolve the issue.
Question 5
Which action best promotes maternal and fetal safety during epidural
placement?
A. Administering 500 mL of IV dextrose
B. Monitoring maternal blood pressure every 5 minutes initially
, 4
C. Keeping the mother flat post-insertion
D. Asking the mother to bear down during insertion
Correct Answer: B
Rationale: Epidural anesthesia can cause hypotension; frequent BP
monitoring ensures timely intervention to maintain perfusion to the fetus.
Question 6
Which is a contraindication to vaginal birth after cesarean (VBAC)?
A. History of gestational diabetes
B. One prior low-transverse cesarean section
C. Prior classical cesarean incision
D. Cephalic fetal presentation
Correct Answer: C
Rationale: A classical incision involves a vertical uterine cut with high rupture
risk, making VBAC contraindicated.
Question 7
A laboring patient has meconium-stained amniotic fluid. What is the nurse’s
priority?
A. Increase oxytocin
B. Prepare for possible neonatal resuscitation
C. Check maternal temperature
D. Reassure the patient
Correct Answer: B
