Maternity & Newborn
Maternity and newborn content appears under Health Promotion and Maintenance and Physiological Adaptation. The NCLEX focuses on recognizing danger signs in pregnancy, labor, postpartum and the newborn period, and on what the nurse does first. This topic walks through each stage with the priorities most likely to be tested.
Key facts
- Signs of pre-eclampsia: high blood pressure after 20 weeks with signs such as proteinuria, headache or visual changes.
- Late decelerations suggest uteroplacental insufficiency. Reposition the client, give oxygen per protocol and notify the provider.
- Variable decelerations suggest cord compression. Change the client's position first.
- Postpartum hemorrhage: a boggy fundus calls for fundal massage.
- Newborn Apgar scores are taken at 1 and 5 minutes.
- Prevent heat loss in newborns: dry the baby, provide skin-to-skin contact and cover the head.
Prenatal care
Prenatal teaching covers nutrition, folic acid, danger signs and screening tests. Danger signs to report include vaginal bleeding, severe headache, visual changes, sudden swelling of the face or hands, fewer fetal movements and signs of preterm labor.
Gestational diabetes and hypertensive disorders are common NCLEX topics. Magnesium sulfate for pre-eclampsia requires monitoring of reflexes, respirations and urine output, with calcium gluconate available.
Labor and fetal monitoring
Early decelerations mirror contractions and are usually benign. Variable decelerations point to cord compression. Late decelerations, which start after the peak of a contraction, suggest poor placental perfusion.
For a worrying pattern, typical actions include changing the client's position, stopping oxytocin if it is running, increasing IV fluids and giving oxygen according to facility protocol, and notifying the provider. If the cord prolapses, relieve pressure on it and call for help immediately.
Postpartum
The fundus should be firm and midline. A boggy uterus is the leading cause of postpartum hemorrhage and is first managed with fundal massage. A fundus displaced to one side often means a full bladder.
Watch lochia amount and color, perineal healing, pain, and emotional wellbeing, including signs of postpartum depression that need follow-up.
Newborn care
Priorities after birth are airway, warmth and assessment. Apgar scores assess heart rate, respiratory effort, muscle tone, reflex irritability and color.
Newborn assessment includes glucose monitoring for at-risk infants, jaundice checks, feeding patterns and safe sleep teaching: baby on their back, on a firm flat surface, with no loose bedding.
Practice: 3 original questions
1. The nurse finds a boggy fundus one hour after birth. What should the nurse do first?
Answer and rationale
Correct: B. Fundal massage is the first action for uterine atony, the leading cause of postpartum hemorrhage. If the uterus stays boggy, the nurse escalates.
2. Variable decelerations appear on the fetal monitor. What is the first action?
Answer and rationale
Correct: B. Variable decelerations suggest cord compression, and a position change is the first step to relieve it.
3. A client receiving magnesium sulfate has absent deep tendon reflexes. What should the nurse do?
Answer and rationale
Correct: B. Absent reflexes are a sign of magnesium toxicity. Stop the infusion, assess respirations and notify the provider, with calcium gluconate available.
Related Nurseclex guides
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