1
2025-2026 HESI PN OBSTETRICS/MATERNITY PRACTICE EXAM,
PEDIATRICS HESI PN REVIEW, HESI PEDS, PN HESI PEDS, PEDS &
MATERNITY HESI, HESI MATERNITY/PEDIATRIC REMEDIATION 180
QUESTIONS AND CORRECT ANSWER. LATEST REVIEW…
HEATHSTUDYPRO
1) Postpartum — uterine atony and heavy bleeding
A 28-year-old woman, 1 hour postpartum after a spontaneous vaginal delivery,
reports feeling lightheaded. You observe saturated perineal pads and a soft (boggy),
enlarged uterus that sits above the umbilicus. Her blood pressure is 90/58 mm Hg
and pulse 120/min. Which nursing action should you perform first?
A. Administer IV oxytocin (Pitocin).
B. Firmly massage the fundus.
C. Notify the healthcare provider immediately.
D. Begin two large-bore IVs and start IV fluids.
Correct answer: B. Firmly massage the fundus.
Rationale: The most common cause of early postpartum hemorrhage is uterine
atony (a boggy, poorly contracted uterus). Immediate fundal massage stimulates
uterine contraction and can stop bleeding quickly — it’s the first, fastest nursing
action. After massage, assess for retained placenta or lacerations and administer
uterotonics (oxytocin) if the uterus remains boggy. Notifying the provider and
establishing IV access are important, but massage is the immediate priority to
reduce ongoing blood loss. Oxytocin is often given promptly, but only after or
,2
simultaneously with attempts to get the uterus firmly contracted — massage is the
immediate bedside action.
Why others are less correct:
A (oxytocin) is appropriate but not the very first immediate action at the
bedside — massage is done instantly while preparing medications.
C (notify provider) is required but after initiating immediate hemorrhage
control measures.
D (IV fluids) should begin quickly for hypotension but the immediate direct
action to control bleeding is uterine massage.
2) Newborn — signs of respiratory distress
A 6-hour-old newborn born at 39 weeks via SVD is being assessed. Vital signs: RR
40/min, HR 150, pink trunk with slightly bluish hands/feet (acrocyanosis). You
note nasal flaring and audible grunting with each breath. Which finding should be
reported immediately to the provider?
A. Respiratory rate 40 breaths per minute.
B. Heart murmur in the first 24 hours.
C. Nasal flaring and grunting.
D. Acrocyanosis of hands and feet.
Correct answer: C. Nasal flaring and grunting.
Rationale: Nasal flaring and grunting are classic signs of newborn respiratory
distress and increased work of breathing — they indicate possible respiratory
compromise (e.g., transient tachypnea of the newborn, RDS, pneumonia) and
require immediate evaluation and possible respiratory support. A term newborn’s
,3
RR can normally range 30–60, so 40 is acceptable. Heart murmurs may be
transient but persistent murmur or signs of poor perfusion warrant evaluation —
not as immediately alarming as active respiratory distress. Acrocyanosis
(peripheral cyanosis) is common in the first 24–48 hours.
Why others are less correct:
A is within expected neonatal RR range.
B: a murmur should be assessed, but nasal flaring/grunting require faster
action.
D is a common transitional finding and less urgent than signs of increased
work of breathing.
3) Pediatrics — sickle cell vaso-occlusive (pain) crisis
A 10-year-old with sickle cell disease presents to the ED with severe diffuse bone
pain rated 9/10 after a long car trip. Vitals show mild tachycardia but O₂ saturation
is 96% on room air. Which nursing intervention is the priority?
A. Provide immediate oxygen therapy by mask.
B. Start IV fluids and administer prescribed analgesics (opioids as ordered).
C. Apply cold compresses to painful joints.
D. Encourage ambulation and range-of-motion exercises.
Correct answer: B. Start IV fluids and administer prescribed analgesics
(opioids as ordered).
Rationale: Vaso-occlusive crisis causes severe pain from microvascular occlusion.
Priority interventions are aggressive pain control (often opioid analgesics per
protocol) and IV hydration to reduce blood viscosity and improve perfusion.
, 4
Oxygen is indicated if hypoxia is present (O₂ sat <94% or respiratory distress); in
this patient O₂ sat is 96% so oxygen is not the immediate priority. Cold compresses
can worsen vasoconstriction and pain in sickle cell crisis — heat is preferred.
Ambulation is not indicated during acute severe pain.
Why others are less correct:
A: Give oxygen only if hypoxic.
C: Cold may increase vasoconstriction and worsen sickling.
D: Ambulation during severe crisis is painful and contraindicated until pain
controlled.
4) OB — magnesium sulfate infusion for severe preeclampsia
A woman in active labor with severe preeclampsia is receiving magnesium sulfate
infusion for seizure prophylaxis. Which of the following assessment findings
requires immediate intervention?
A. Deep tendon reflexes 2+ (normal).
B. Urine output 30 mL/hr.
C. Respiratory rate 10 breaths/min.
D. FHR 140 bpm.
Correct answer: C. Respiratory rate 10 breaths/min.
Rationale: Magnesium sulfate toxicity first depresses the central nervous system
and the earliest life-threatening sign is respiratory depression — a respiratory rate
<12 (and especially <10) is concerning and requires stopping the infusion and
giving calcium gluconate per protocol. Deep tendon reflexes depression (absent
DTRs) is another sign of toxicity; 2+ is normal. Urine output of 30 mL/hr is at the
2025-2026 HESI PN OBSTETRICS/MATERNITY PRACTICE EXAM,
PEDIATRICS HESI PN REVIEW, HESI PEDS, PN HESI PEDS, PEDS &
MATERNITY HESI, HESI MATERNITY/PEDIATRIC REMEDIATION 180
QUESTIONS AND CORRECT ANSWER. LATEST REVIEW…
HEATHSTUDYPRO
1) Postpartum — uterine atony and heavy bleeding
A 28-year-old woman, 1 hour postpartum after a spontaneous vaginal delivery,
reports feeling lightheaded. You observe saturated perineal pads and a soft (boggy),
enlarged uterus that sits above the umbilicus. Her blood pressure is 90/58 mm Hg
and pulse 120/min. Which nursing action should you perform first?
A. Administer IV oxytocin (Pitocin).
B. Firmly massage the fundus.
C. Notify the healthcare provider immediately.
D. Begin two large-bore IVs and start IV fluids.
Correct answer: B. Firmly massage the fundus.
Rationale: The most common cause of early postpartum hemorrhage is uterine
atony (a boggy, poorly contracted uterus). Immediate fundal massage stimulates
uterine contraction and can stop bleeding quickly — it’s the first, fastest nursing
action. After massage, assess for retained placenta or lacerations and administer
uterotonics (oxytocin) if the uterus remains boggy. Notifying the provider and
establishing IV access are important, but massage is the immediate priority to
reduce ongoing blood loss. Oxytocin is often given promptly, but only after or
,2
simultaneously with attempts to get the uterus firmly contracted — massage is the
immediate bedside action.
Why others are less correct:
A (oxytocin) is appropriate but not the very first immediate action at the
bedside — massage is done instantly while preparing medications.
C (notify provider) is required but after initiating immediate hemorrhage
control measures.
D (IV fluids) should begin quickly for hypotension but the immediate direct
action to control bleeding is uterine massage.
2) Newborn — signs of respiratory distress
A 6-hour-old newborn born at 39 weeks via SVD is being assessed. Vital signs: RR
40/min, HR 150, pink trunk with slightly bluish hands/feet (acrocyanosis). You
note nasal flaring and audible grunting with each breath. Which finding should be
reported immediately to the provider?
A. Respiratory rate 40 breaths per minute.
B. Heart murmur in the first 24 hours.
C. Nasal flaring and grunting.
D. Acrocyanosis of hands and feet.
Correct answer: C. Nasal flaring and grunting.
Rationale: Nasal flaring and grunting are classic signs of newborn respiratory
distress and increased work of breathing — they indicate possible respiratory
compromise (e.g., transient tachypnea of the newborn, RDS, pneumonia) and
require immediate evaluation and possible respiratory support. A term newborn’s
,3
RR can normally range 30–60, so 40 is acceptable. Heart murmurs may be
transient but persistent murmur or signs of poor perfusion warrant evaluation —
not as immediately alarming as active respiratory distress. Acrocyanosis
(peripheral cyanosis) is common in the first 24–48 hours.
Why others are less correct:
A is within expected neonatal RR range.
B: a murmur should be assessed, but nasal flaring/grunting require faster
action.
D is a common transitional finding and less urgent than signs of increased
work of breathing.
3) Pediatrics — sickle cell vaso-occlusive (pain) crisis
A 10-year-old with sickle cell disease presents to the ED with severe diffuse bone
pain rated 9/10 after a long car trip. Vitals show mild tachycardia but O₂ saturation
is 96% on room air. Which nursing intervention is the priority?
A. Provide immediate oxygen therapy by mask.
B. Start IV fluids and administer prescribed analgesics (opioids as ordered).
C. Apply cold compresses to painful joints.
D. Encourage ambulation and range-of-motion exercises.
Correct answer: B. Start IV fluids and administer prescribed analgesics
(opioids as ordered).
Rationale: Vaso-occlusive crisis causes severe pain from microvascular occlusion.
Priority interventions are aggressive pain control (often opioid analgesics per
protocol) and IV hydration to reduce blood viscosity and improve perfusion.
, 4
Oxygen is indicated if hypoxia is present (O₂ sat <94% or respiratory distress); in
this patient O₂ sat is 96% so oxygen is not the immediate priority. Cold compresses
can worsen vasoconstriction and pain in sickle cell crisis — heat is preferred.
Ambulation is not indicated during acute severe pain.
Why others are less correct:
A: Give oxygen only if hypoxic.
C: Cold may increase vasoconstriction and worsen sickling.
D: Ambulation during severe crisis is painful and contraindicated until pain
controlled.
4) OB — magnesium sulfate infusion for severe preeclampsia
A woman in active labor with severe preeclampsia is receiving magnesium sulfate
infusion for seizure prophylaxis. Which of the following assessment findings
requires immediate intervention?
A. Deep tendon reflexes 2+ (normal).
B. Urine output 30 mL/hr.
C. Respiratory rate 10 breaths/min.
D. FHR 140 bpm.
Correct answer: C. Respiratory rate 10 breaths/min.
Rationale: Magnesium sulfate toxicity first depresses the central nervous system
and the earliest life-threatening sign is respiratory depression — a respiratory rate
<12 (and especially <10) is concerning and requires stopping the infusion and
giving calcium gluconate per protocol. Deep tendon reflexes depression (absent
DTRs) is another sign of toxicity; 2+ is normal. Urine output of 30 mL/hr is at the
