Maternal-Newborn NCLEX Practice Questions

NCLEX tests reassuring vs non-reassuring FHR patterns. Early decelerations (head compression, mirror contractions — normal and reassuring). Late decelerations (uteroplacental insufficiency — non-reassuring: position to left lateral, increase O2, stop oxytocin, notify provider). Variable decelerations (cord compression — reposition, assess, may require amnioinfusion).

Early PPH occurs within 24 hours, most commonly from uterine atony (boggy, soft uterus). Immediate actions: fundal massage, oxytocin administration, and bladder emptying. NCLEX tests recognizing a uterus that remains boggy after massage, heavy lochia (saturating a pad in <1 hour), and hemodynamic changes as priority emergency findings.

Preeclampsia: hypertension (>140/90 after 20 weeks gestation) plus proteinuria or end-organ damage. Severe features: BP >160/110, headache, visual changes, epigastric pain, elevated liver enzymes, low platelets. Treatment: magnesium sulfate (seizure prophylaxis) — monitor deep tendon reflexes, respirations (hold if <12/min), and urine output (>30 mL/hr). Antidote: calcium gluconate. Eclampsia: seizures in a preeclamptic patient — medical emergency requiring immediate magnesium and preparation for delivery.

APGAR score <7 at 5 minutes requires continued resuscitation. Respiratory distress: nasal flaring, grunting, retractions, central cyanosis. Hypoglycemia (blood glucose <40 mg/dL in newborns): jitteriness, poor feeding, lethargy — feed immediately or administer IV dextrose. Meconium-stained amniotic fluid with a non-vigorous newborn may require suctioning. Jaundice within the first 24 hours is pathological and requires investigation. Temperature instability: cold stress increases oxygen consumption and metabolic demand.

Stage 1 (longest): latent phase (0-6 cm, contractions mild), active phase (6-10 cm, stronger contractions), transition (8-10 cm, most intense). Stage 2: full dilation to delivery — coach pushing, monitor FHR with each contraction. Stage 3: delivery of placenta (5-30 minutes). Stage 4: first 1-2 hours postpartum — monitor vital signs every 15 minutes, assess fundus (should be firm at or below umbilicus), lochia amount, and bladder distension. Assess bonding and initiate breastfeeding.

First trimester: blood type and Rh factor, antibody screen, CBC, rubella titer, STI screening, urinalysis. Rh-negative mothers receive RhoGAM at 28 weeks and within 72 hours postpartum if newborn is Rh-positive. Gestational diabetes screening: 24-28 weeks with glucose challenge test. Group B Strep screening: 36-37 weeks — positive results require intrapartum IV antibiotics. Quad screen (15-20 weeks) screens for neural tube defects and Down syndrome risk.