← Maternity & OB – NCLEX-RN Flashcards

NCLEX-RN Nursing Exam Study Guide

Key concepts, definitions, and exam tips organized by topic.

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Maternity & OB – NCLEX-RN Study Guide


Overview

This study guide covers essential maternity and obstetric nursing concepts tested on the NCLEX-RN, including prenatal complications, labor and delivery management, postpartum care, and newborn assessment. Mastery of these topics requires understanding both the physiologic processes and priority nursing interventions for common obstetric emergencies. Special emphasis is placed on recognizing life-threatening conditions and responding with appropriate, evidence-based actions.


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Prenatal Care & Complications


Types of Abortion/Early Pregnancy Loss


| Type | Cervical Os | Bleeding | Outcome |

|------|------------|---------|---------|

| Threatened | Closed | Painless | May continue |

| Inevitable | Open | Heavy | Will not continue |

| Complete | Closed | Heavy (then stops) | All products expelled |

| Incomplete | Open | Heavy | Partial expulsion |

| Missed | Closed | None/minimal | Fetal demise retained |


  • • Threatened abortion: painless vaginal bleeding + closed cervical os → management = bed rest and pelvic rest
  • • Pregnancy may still continue with a threatened abortion

    • Key Terms

  • • Threatened abortion: Possible pregnancy loss with intact cervix
  • • Pelvic rest: No intercourse, douching, or tampon use

    • ---


    Hypertensive Disorders of Pregnancy


    #### Preeclampsia

    The classic triad (after 20 weeks gestation):

    1. Hypertension: BP ≥ 140/90 mmHg (on two occasions, 4 hours apart)

    2. Proteinuria: ≥ 300 mg/24-hour urine collection

    3. Edema: Particularly facial and hand edema


    #### Eclampsia

  • • Definition: Grand mal seizure in a preeclamptic patient with no prior seizure history
  • • First-line treatment: IV Magnesium Sulfate — stops current seizure and prevents future ones
  • • Represents an obstetric emergency

    • #### Magnesium Sulfate Monitoring — Critical Safety Points

    Monitor for signs of toxicity:

  • • Loss of deep tendon reflexes (DTRs) — first sign
  • • Respiratory rate < 12 breaths/min
  • • Urine output < 30 mL/hour
  • • Serum Mg level > 7–8 mEq/L

    • Antidote: Calcium Gluconate 1 g IV — must be kept at the bedside at ALL times


    > Watch Out For: Students often confuse the antidote. Calcium gluconate reverses magnesium toxicity — NOT calcium carbonate or calcium chloride. Also, remember to check DTRs before each dose of magnesium.


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    Placental Complications


    | Feature | Placenta Previa | Abruptio Placentae |

    |---------|----------------|-------------------|

    | Pain | Painless | Painful |

    | Bleeding color | Bright red | Dark red |

    | Abdomen | Soft | Rigid/board-like |

    | Cause | Low-lying placenta | Premature placental separation |


    Priority Intervention for Placenta Previa:

  • • NEVER perform a vaginal or rectal exam (may cause massive hemorrhage)
  • • Position patient on her side
  • • Initiate IV access
  • • Monitor fetal heart tones (FHTs)
  • • Prepare for possible emergency delivery

    • Key Terms

  • • Placenta previa: Placenta implanted over or near the cervical os
  • • Abruptio placentae: Premature separation of a normally implanted placenta
  • • Board-like abdomen: Classic rigid abdomen finding in abruption

    • > Watch Out For: On the NCLEX, "painless bright red bleeding" always points to placenta previa. A vaginal exam is absolutely contraindicated — this is a priority safety question.


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    Gestational Diabetes Mellitus (GDM)


    Screening Timeline:

  • • 24–28 weeks gestation
  • • Test: 1-hour 50 g Oral Glucose Challenge Test (GCT)
  • • Positive result: ≥ 140 mg/dL → requires 3-hour Glucose Tolerance Test (GTT) for diagnosis

    • Key Terms

  • • GCT (Glucose Challenge Test): Initial screening test — no fasting required
  • • GTT (Glucose Tolerance Test): Diagnostic test — fasting required

    • ---


    Fetal Well-Being Testing


    | Test | Normal (Reactive) | Abnormal (Non-Reactive) |

    |------|------------------|------------------------|

    | NST | ≥ 2 accelerations of ≥15 bpm lasting ≥15 sec in 20 min | Fewer than 2 accelerations |

    | BPP | Score 8–10 | Score ≤ 6 — concern |


    Non-reactive NST next step: Proceed to Biophysical Profile (BPP) or Contraction Stress Test (CST)


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    Rh Incompatibility & RhoGAM


    When to administer RhoGAM (Rh Immune Globulin):

  • • 28 weeks gestation (antepartum)
  • • Within 72 hours after delivery of an Rh-positive infant
  • • Also given after miscarriage, amniocentesis, or any event causing potential fetal-maternal hemorrhage

    • Why: Prevents maternal antibody formation → protects future pregnancies from Hemolytic Disease of the Fetus and Newborn (HDFN)


    Key Terms

  • • Rh-negative mother: At risk for sensitization
  • • RhoGAM: Passive immunity — destroys fetal Rh+ cells before maternal antibodies form

    • > Watch Out For: RhoGAM is given to the mother, NOT the baby. It is only needed when the mother is Rh-negative. The 72-hour window post-delivery is frequently tested.


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    Labor & Delivery


    Fetal Heart Rate (FHR) Decelerations


    | Type | Onset | Cause | Reassuring? | Priority Action |

    |------|-------|-------|-------------|----------------|

    | Early | With contraction, mirrors it | Fetal head compression | ✅ Yes (benign) | Continue monitoring |

    | Late | After contraction peak | Uteroplacental insufficiency | ❌ No (ominous) | LION interventions |

    | Variable | Abrupt, variable timing | Umbilical cord compression | ❌ No (concerning) | Change maternal position |


    LION Mnemonic for Late Decelerations:

  • • L — Lateral (left lateral) position
  • • I — Increase IV fluids
  • • O — Oxygen via face mask 8–10 L/min
  • • N — Notify provider; discontinue oxytocin

    • For Variable Decelerations:

  • • First action: Change maternal position (side to side, knee-chest)
  • • Goal: Relieve umbilical cord compression

    • > Watch Out For: Early decelerations are normal and expected — do not panic or intervene. Late decelerations are always abnormal and require immediate action. Variable decelerations are caused by cord compression, not head compression.


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    Umbilical Cord Prolapse — Obstetric Emergency


    Immediate Actions (in order):

    1. Manually push the presenting part OFF the cord with a gloved hand

    2. Maintain that position — do not remove hand

    3. Call for help / activate emergency response

    4. Administer oxygen

    5. Prepare for emergency cesarean delivery


    > Watch Out For: The nurse must physically hold the presenting part off the cord until the baby is delivered surgically. This is non-negotiable and must be the first action stated.


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    APGAR Score


    | Score | 0 | 1 | 2 |

    |-------|---|---|---|

    | Appearance | Blue/pale all over | Blue extremities, pink body | Completely pink |

    | Pulse | Absent | < 100 bpm | ≥ 100 bpm |

    | Grimace | No response | Grimace | Cry/cough/sneeze |

    | Activity | Limp | Some flexion | Active motion |

    | Respiration | Absent | Weak/irregular | Strong cry |


    Scoring Interpretation:

  • • 7–10: Good condition
  • • 4–6: Moderate depression — stimulation/oxygen needed
  • • 0–3: Severe depression — resuscitation required

    • Timing: Assessed at 1 minute and 5 minutes after birth


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    Stages of Labor


    | Stage | Definition | Duration (Nullipara) |

    |-------|-----------|---------------------|

    | 1st Stage (Latent) | 0–6 cm dilation | Variable |

    | 1st Stage (Active) | 6–10 cm dilation | 4–8 hours; ≥1.2 cm/hour |

    | 2nd Stage | Complete dilation → birth of baby | Up to 3 hours with epidural |

    | 3rd Stage | Birth of baby → delivery of placenta | Up to 30 minutes |

    | 4th Stage | Delivery of placenta → 1–2 hours postpartum | 1–2 hours |


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    Oxytocin (Pitocin) & Uterine Tachysystole


    Uterine Tachysystole (formerly hyperstimulation):

  • • Contractions lasting > 90 seconds
  • • Less than 30 seconds rest between contractions
  • • More than 5 contractions in 10 minutes

    • Nursing Actions:

    1. Discontinue oxytocin infusion immediately

    2. Reposition to lateral

    3. Increase IV fluids (bolus)

    4. Administer oxygen

    5. Notify provider

    6. Consider tocolytic (terbutaline) per order


    > Watch Out For: Stopping the oxytocin is ALWAYS the priority action when tachysystole is identified. Do not adjust the rate — stop it completely.


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    Postpartum Care & Complications


    Postpartum Hemorrhage (PPH)


    Most common cause of early PPH (within 24 hours): Uterine Atony (~80% of cases)


    The 4 T's of PPH Causes:

  • • Tone (Atony) — most common
  • • Trauma (lacerations, hematoma)
  • • Tissue (retained placenta)
  • • Thrombin (coagulopathy)

    • #### Uterine Displacement

  • • Boggy uterus displaced to the right → indicates a full bladder
  • • Priority intervention: Assist patient to void or catheterize
  • • Then reassess uterine tone and fundal massage if boggy

    • ---


    Medications for Uterine Atony


    | Medication | Route | Contraindication |

    |-----------|-------|-----------------|

    | Oxytocin (Pitocin) | IV/IM | None absolute |

    | Methylergonovine (Methergine) | IM/PO | HYPERTENSION |

    | Misoprostol (Cytotec) | PR/sublingual | None absolute |

    | Carboprost (Hemabate) | IM | Asthma |


    > Watch Out For: Methergine (methylergonovine) is absolutely contraindicated in hypertensive patients — it causes vasoconstriction and dangerously elevates BP. This is a high-yield NCLEX concept.


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    Postpartum Infections


    #### Endometritis

  • • Classic presentation: Fever (38.9°C), foul-smelling lochia, uterine tenderness, malaise — postpartum day 2–5
  • • Risk factors: Cesarean delivery, prolonged labor, PROM, multiple vaginal exams
  • • Treatment: IV broad-spectrum antibiotics

    • #### Mastitis

  • • Presentation: Hard, red, painful breast + fever (≥39°C) + flu-like symptoms — typically day 10 postpartum
  • • Organism: Usually Staphylococcus aureus
  • • Treatment: Oral antibiotics (dicloxacillin), continue breastfeeding, warm compresses, analgesics

    • > Watch Out For: Breastfeeding should continue or pumping should be encouraged with mastitis. Stopping breastfeeding can lead to abscess formation. This contradicts what many students assume.


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    Postpartum DVT


    Classic Signs:

  • • Homans' sign: Calf pain on dorsiflexion (historically used, limited sensitivity)
  • • Unilateral leg swelling, redness, warmth, tenderness

    • Diagnosis confirmed by: Doppler ultrasound


    Key Terms

  • • DVT: Deep vein thrombosis — clot in deep vein
  • • Virchow's Triad: Venous stasis, hypercoagulability, endothelial injury — all present postpartum

    • ---


    Postpartum Depression Screening


    Edinburgh Postnatal Depression Scale (EPDS):

  • • 10-item validated self-report screening tool
  • • Administered at 2–6 week postpartum visit
  • • Score of ≥10 warrants further psychiatric evaluation

    • Key Terms

  • • Baby blues: Mild mood changes, day 3–5, self-limiting (< 2 weeks)
  • • Postpartum depression: Persistent sadness, > 2 weeks, requires treatment
  • • Postpartum psychosis: Rare, severe, hallucinations — psychiatric emergency

    • ---


    Newborn Assessment & Care


    Normal Newborn Vital Signs


    | Parameter | Normal Range |

    |-----------|-------------|

    | Heart Rate | 120–160 bpm |

    | Respiratory Rate | 30–60 breaths/min |

    | Temperature | 36.5–37.5°C (97.7–99.5°F) |

    | Blood Glucose | ≥ 45 mg/dL after first hour |


    Signs of Respiratory Distress:

  • • Nasal flaring
  • • Grunting
  • • Retractions (subcostal, intercostal)
  • • Central cyanosis

    • ---


    Newborn Jaundice & Phototherapy


    Normal vs. Pathologic Jaundice:

  • • Physiologic jaundice: Appears after 24 hours, peaks day 3–5, resolves by day 7–10
  • • Pathologic jaundice: Appears within 24 hours — always requires investigation

    • Phototherapy (Bili Lights) — Nursing Care:

  • • Cover eyes with opaque patches (protect from retinal damage)
  • • Expose maximum skin surface
  • • Maintain adequate hydration (increased insensible losses)
  • • Monitor bilirubin levels every 4–12 hours
  • • Remove eye patches during feedings for parent bonding

    • > Watch Out For: Eye patches must be properly placed and removed only during feedings. A bilirubin of 15 mg/dL at 48 hours always requires phototherapy — this is above the threshold for that age.


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    Routine Newborn Medications


    | Medication | Route | Purpose |

    |-----------|-------|---------|

    | Vitamin K (Phytonadione) | IM | Prevent hemorrhagic disease of newborn (HDN) |

    | Erythromycin ointment | Ophthalmic | Prevent ophthalmia neonatorum (gonorrhea) |

    | Hepatitis B vaccine | IM | Active immunity against Hepatitis B |


    Why Vitamin K?

  • • Newborns have sterile intestines — cannot produce vitamin K-dependent clotting factors
  • • Vitamin K-dependent factors: II, VII, IX, X
  • • Prevents hemorrhagic disease of the newborn (HDN)

    • ---


    Hepatitis B Exposure at Birth


    If mother is HBsAg-positive, administer within 12 hours of birth:

    1. Hepatitis B Vaccine (active immunity) — one site

    2. Hepatitis B Immune Globulin (HBIG) (passive immunity) — different site


    > Watch Out For: BOTH the vaccine AND HBIG must be given within 12 hours — not one or the other. They must be administered at different injection sites.


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    Newborn Hypoglycemia


    Normal glucose: ≥ **45 mg

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