NCLEX Maternity and Pediatrics: High-Yield Review

Maternity and pediatric nursing are two of the most content-dense NCLEX categories. They require both clinical knowledge and developmental context that other specialties don't. Here's the high-yield review.

Labor and Delivery: The Four Stages

Stage	Definition	Nursing priority
Stage 1: Latent	0–6 cm dilation, irregular contractions	Monitor fetal heart rate, maternal vital signs, encourage ambulation
Stage 1: Active	6–10 cm, regular contractions q3–5 min	Pain management, IV access, continuous fetal monitoring
Stage 2: Pushing	10 cm to delivery	Coach pushing, monitor for crowning, prepare for delivery
Stage 3: Placenta	Delivery to placenta expulsion	Assess for signs of placenta delivery, fundal massage, oxytocin
Stage 4: Recovery	First 1–4 hours postpartum	Assess uterine firmness, lochia, BP — highest PPH risk period

Fetal Heart Rate Monitoring

Normal FHR: 110–160 bpm

Early decelerations: Gradual deceleration that mirrors contractions — caused by head compression. Benign, no intervention needed.

Variable decelerations: Abrupt, V-shaped, any timing — caused by cord compression. Position change (left lateral or knee-chest), oxygen, IV fluid bolus.

Late decelerations: Gradual deceleration that begins after contraction peak — caused by uteroplacental insufficiency. PRIORITY: position change, oxygen, stop oxytocin, notify provider. May require emergency delivery.

OB Emergencies: Immediate Recognition and Action

Eclampsia

Seizures in pregnancy (with or after 20 weeks). Priority: protect airway, administer magnesium sulfate. Magnesium toxicity signs: respiratory depression (less than 12 breaths/min), loss of deep tendon reflexes (first sign), decreased urine output. Antidote: calcium gluconate.

Placenta Previa vs. Abruption

	Placenta Previa	Placenta Abruption
Bleeding character	Painless, bright red	Painful, dark red or concealed
Uterus	Soft, non-tender	Board-like, tender
Nursing action	No vaginal exam, bedrest, C-section	Emergency delivery, blood products

Postpartum Hemorrhage (PPH)

Most common cause: uterine atony (boggy uterus). Priority interventions: fundal massage, oxytocin, bladder emptying. If atony persists: misoprostol, methylergonovine (not in hypertension). Blood loss >500 mL vaginal or >1000 mL C-section = PPH.

Pediatric Developmental Milestones (Must Know)

Age	Gross motor	Fine motor / Language / Social
2 months	Holds head up briefly	Social smile, coos
4 months	Rolls front to back	Laughs, reaches for objects
6 months	Sits with support	Babbles, transfers objects hand to hand
9 months	Pulls to stand	Object permanence, says mama/dada nonspecifically
12 months	Stands alone, first steps	1–2 words with meaning, pincer grasp
18 months	Walks up stairs with help	10–20 word vocabulary, uses spoon
24 months	Kicks a ball	2-word phrases, 50% understood by strangers
3 years	Rides tricycle	Speaks in sentences, 75% understood

Pediatric Medication Safety

All pediatric medications are weight-based. Always calculate mg/kg before administration. Do not give aspirin to children with viral illness (Reye syndrome risk). Age-specific vital sign norms differ from adults — a heart rate of 130 is normal in a 1-year-old, abnormal in an 8-year-old.

NCLEX maternity priority rule: Any sudden, painless bright red vaginal bleeding in the third trimester is placenta previa until proven otherwise — do NOT perform a vaginal exam. Any painful dark bleeding with uterine rigidity is placenta abruption — prepare for emergency delivery. These distinctions appear on nearly every NCLEX maternity set.

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