NCLEX Deck

Maternity

NCLEX Clinical Study Booklet · 12 cards

Contents

Preeclampsia / Eclampsia.

Complication
What is Preeclampsia / Eclampsia?
  • New-onset hypertension + proteinuria after 20 weeks.
  • Eclampsia = preeclampsia + seizures.
What are the Causes / Risk Factors?
  • First pregnancy
  • Chronic HTN, diabetes
  • Multiple gestation
  • Extremes of maternal age
  • Obesity
What are the Symptoms?
  • BP ≥140/90, proteinuria
  • Severe: headache, visual changes, epigastric/RUQ pain
  • Edema (face, hands)
  • Hyperreflexia, clonus
  • Eclampsia: seizures
  • HELLP syndrome
How is it Diagnosed?
  • BP monitoring
  • Urine protein
  • LFTs, platelets, CBC (HELLP)
What is the Treatment?
  • Magnesium sulfate (seizure prophylaxis) — antidote calcium gluconate
  • Antihypertensives (labetalol, hydralazine)
  • Monitor DTRs, RR, urine output, mag levels
  • Delivery is the cure; seizure precautions
NCLEX TipMagnesium sulfate prevents seizures in preeclampsia. Watch for mag toxicity (↓DTRs, RR<12, ↓urine) — antidote is calcium gluconate.
© NCLEX Deck1 / 12

Gestational Diabetes.

Prenatal
What is Gestational Diabetes?
  • Glucose intolerance first recognized in pregnancy.
  • Risk to mother and baby (macrosomia).
What are the Causes / Risk Factors?
  • Placental hormones cause insulin resistance
  • Obesity, family history
  • Previous GDM / large baby
  • Advanced maternal age
What are the Symptoms?
  • Often asymptomatic
  • Detected on screening
  • Excessive weight gain
  • Large fundal height (macrosomia)
How is it Diagnosed?
  • Glucose challenge test (24–28 weeks)
  • 3-hour OGTT (confirm)
What is the Treatment?
  • Diet & exercise first
  • Insulin if needed
  • Blood glucose monitoring
  • Monitor fetal growth; watch neonatal hypoglycemia
NCLEX TipAfter birth, monitor the newborn for hypoglycemia — the baby's insulin stays high after the maternal glucose supply stops.
© NCLEX Deck2 / 12

Placenta Previa.

Emergency
What is Placenta Previa?
  • Placenta implants over or near the cervical os.
  • Causes PAINLESS bright red bleeding.
What are the Causes / Risk Factors?
  • Previous C-section / uterine surgery
  • Multiparity
  • Advanced maternal age
  • Multiple gestation
What are the Symptoms?
  • PAINLESS, bright red vaginal bleeding (3rd trimester)
  • Soft, non-tender uterus
  • Normal fetal heart tones (usually)
How is it Diagnosed?
  • Ultrasound (confirms placement)
  • NO vaginal exams (can trigger hemorrhage)
What is the Treatment?
  • Bed rest, monitor bleeding
  • NO vaginal exams
  • C-section delivery
  • Monitor for hemorrhage; prepare blood
NCLEX TipPlacenta previa = PAINLESS bright red bleeding. NEVER perform a vaginal exam — it can cause severe hemorrhage.
© NCLEX Deck3 / 12

Abruptio Placentae.

Emergency
What is Abruptio Placentae?
  • Premature separation of the placenta from the uterine wall.
  • Causes PAINFUL dark red bleeding. Emergency.
What are the Causes / Risk Factors?
  • Hypertension / preeclampsia
  • Trauma
  • Cocaine use
  • Smoking
  • Previous abruption
What are the Symptoms?
  • PAINFUL, dark red bleeding (may be concealed)
  • Rigid, board-like, tender uterus
  • Fetal distress
  • Signs of shock
  • Contractions
How is it Diagnosed?
  • Clinical
  • Ultrasound
  • Monitor fetal & maternal status
What is the Treatment?
  • Emergency C-section (often)
  • IV fluids/blood; treat shock
  • Continuous fetal monitoring
  • Monitor for DIC
NCLEX TipAbruptio placentae = PAINFUL bleeding + rigid, board-like uterus. It's an emergency — prepare for delivery and watch for DIC.
© NCLEX Deck4 / 12

Postpartum Hemorrhage.

Emergency
What is Postpartum Hemorrhage?
  • Blood loss >500 mL (vaginal) or >1000 mL (C-section) after birth.
  • Leading cause: uterine atony.
What are the Causes / Risk Factors?
  • Uterine atony (boggy uterus — #1)
  • Retained placenta
  • Lacerations
  • Coagulopathy (DIC)
What are the Symptoms?
  • Boggy, soft uterus (atony)
  • Excessive bright red bleeding
  • Tachycardia, hypotension (shock)
  • Pallor, dizziness
How is it Diagnosed?
  • Fundal assessment
  • Estimate blood loss
  • Vitals, H&H
What is the Treatment?
  • FUNDAL MASSAGE first
  • Oxytocin, methylergonovine, misoprostol
  • IV fluids/blood; ensure bladder empty
  • Monitor vitals & output
NCLEX TipA boggy uterus = uterine atony (the #1 cause of PPH). Massage the fundus first, then give uterotonics like oxytocin.
© NCLEX Deck5 / 12

Ectopic Pregnancy.

Emergency
What is Ectopic Pregnancy?
  • Implantation outside the uterus (usually the fallopian tube).
  • Can rupture → life-threatening hemorrhage.
What are the Causes / Risk Factors?
  • Previous PID / STIs
  • Tubal scarring / surgery
  • IUD
  • Previous ectopic
What are the Symptoms?
  • Unilateral lower abdominal / pelvic pain
  • Amenorrhea then spotting
  • Positive hCG
  • Referred shoulder pain (rupture)
  • Signs of shock (rupture)
How is it Diagnosed?
  • Serial hCG (abnormal rise)
  • Transvaginal ultrasound
What is the Treatment?
  • Methotrexate (early, unruptured)
  • Surgery (salpingectomy) if ruptured
  • Treat shock; monitor bleeding
  • Emotional support
NCLEX TipUnilateral pelvic pain + positive hCG + shoulder pain = suspect a ruptured ectopic pregnancy (a surgical emergency).
© NCLEX Deck6 / 12

Preterm Labor.

Labor
What is Preterm Labor?
  • Labor before 37 weeks gestation.
  • Risk of prematurity complications.
What are the Causes / Risk Factors?
  • Infection (UTI, chorioamnionitis)
  • Multiple gestation
  • Previous preterm birth
  • Dehydration, cervical insufficiency
What are the Symptoms?
  • Regular contractions before 37 weeks
  • Cervical dilation / effacement
  • Low back pain, pelvic pressure
  • Increased vaginal discharge
How is it Diagnosed?
  • Contraction & cervical monitoring
  • Fetal fibronectin
  • Ultrasound (cervical length)
What is the Treatment?
  • Tocolytics (magnesium, nifedipine, terbutaline)
  • Corticosteroids (betamethasone) for fetal lung maturity
  • Hydration, bed rest
  • Treat infection; monitor fetus
NCLEX TipBetamethasone is given to accelerate fetal lung maturity in preterm labor. Tocolytics delay birth to buy time for the steroids.
© NCLEX Deck7 / 12

Stages of Labor.

Labor
Stage 1 (Dilation)
  • Onset of labor to full dilation (10 cm)
  • Latent (0–6 cm), active (6–10 cm)
  • Longest stage; monitor contractions & fetal HR
Stage 2 (Delivery)
  • Full dilation to birth of the baby
  • Urge to push
  • Monitor fetal HR with each contraction
Stages 3 & 4
  • Stage 3: delivery of the placenta
  • Stage 4: first 1–2 hours postpartum (recovery)
  • Assess fundus, lochia, vitals, bladder
NCLEX TipIn the fourth stage (first 1–2 hours postpartum), assess the fundus and lochia frequently — the highest risk of hemorrhage.
© NCLEX Deck8 / 12

Fetal Heart Rate Monitoring.

Labor
Normal
  • Baseline FHR 110–160 bpm
  • Moderate variability = reassuring
  • Accelerations = reassuring (good oxygenation)
Decelerations
  • EARLY (mirror contraction) = head compression — benign
  • LATE (after the peak) = uteroplacental insufficiency — BAD
  • VARIABLE (abrupt) = cord compression
VEAL CHOP
  • Variable→Cord, Early→Head, Accel→OK, Late→Placenta
  • Late/variable: reposition (left side), O₂, stop oxytocin, IV fluids, notify provider
NCLEX TipVEAL CHOP: Variable-Cord, Early-Head, Accel-OK, Late-Placenta. Late decels are ominous — reposition, O₂, stop oxytocin, notify.
© NCLEX Deck9 / 12

Hyperemesis Gravidarum.

Prenatal
What is Hyperemesis Gravidarum?
  • Severe, persistent vomiting in pregnancy.
  • Leads to dehydration, weight loss, electrolyte imbalance.
What are the Causes / Risk Factors?
  • High hCG levels
  • Multiple gestation, molar pregnancy
  • History of it
What are the Symptoms?
  • Severe, intractable vomiting
  • Weight loss (>5%)
  • Dehydration, ketosis
  • Electrolyte imbalance
  • Ketonuria
How is it Diagnosed?
  • Clinical
  • Electrolytes, ketones
  • Weight monitoring
What is the Treatment?
  • IV fluids & electrolyte replacement
  • Antiemetics
  • NPO then small bland meals
  • Monitor I&O, weight, electrolytes
NCLEX TipHyperemesis gravidarum needs IV fluids and electrolyte correction — it's more than normal morning sickness.
© NCLEX Deck10 / 12

Rh Incompatibility.

Prenatal
What is Rh Incompatibility?
  • Rh-negative mother carrying an Rh-positive fetus.
  • Maternal antibodies can attack fetal RBCs.
What are the Causes / Risk Factors?
  • Rh-negative mom + Rh-positive baby
  • Sensitization from a prior pregnancy / bleeding
What are the Symptoms?
  • Usually asymptomatic in the mother
  • Fetal: hemolysis, anemia, hydrops (if sensitized)
How is it Diagnosed?
  • Blood typing & Rh
  • Indirect Coombs (antibody screen)
What is the Treatment?
  • RhoGAM at 28 weeks and within 72h of birth
  • Also after miscarriage, amniocentesis, bleeding
  • Prevents sensitization
NCLEX TipGive RhoGAM to Rh-negative mothers at 28 weeks and within 72 hours of delivery to prevent Rh sensitization.
© NCLEX Deck11 / 12

Postpartum Depression.

Postpartum
What is Postpartum Depression?
  • Depression occurring after childbirth (beyond 'baby blues').
  • Can impair mother-infant bonding.
What are the Causes / Risk Factors?
  • Hormonal shifts
  • History of depression
  • Lack of support, stress
  • Difficult birth/pregnancy
What are the Symptoms?
  • Persistent sadness, hopelessness (>2 weeks)
  • Fatigue, sleep/appetite changes
  • Difficulty bonding with baby
  • Guilt, worthlessness
  • Thoughts of harming self or baby (emergency)
How is it Diagnosed?
  • Screening (Edinburgh scale)
  • Clinical assessment
What is the Treatment?
  • Antidepressants, therapy
  • Support systems
  • Assess safety (self & baby)
  • Distinguish from postpartum psychosis (emergency)
NCLEX TipBaby blues resolve in ~2 weeks; postpartum depression persists longer. Always assess for thoughts of harming self or the baby.
© NCLEX Deck12 / 12
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