JNCLEX-RM (Jordan) cheat sheet

Naegele's rule: first day of last menstrual period minus 3 months plus 7 days plus 1 year; gives estimated date of delivery (EDD) for a 28-day cycle.

Parity notation GTPAL: Gravida (all pregnancies), Term births, Preterm births, Abortions (spontaneous or induced before 20 weeks), Living children.

Estimated gestational age by fundal height: at 20 weeks the fundus is at the umbilicus; after 20 weeks fundal height in cm approximates weeks ± 2.

Normal fetal heart rate baseline is 110-160 beats per minute; auscultation is reliable from about 20 weeks with a Pinard or Doppler.

Recommended antenatal visit schedule for uncomplicated pregnancy: every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, then weekly until delivery.

Daily elemental iron 60 mg plus folic acid 400 mcg (5 mg if prior neural tube defect) is standard antenatal supplementation; folate is most protective before conception and in the first trimester.

Blood pressure thresholds in pregnancy: normal below 140/90 mmHg; 140/90 or higher on two occasions 4 hours apart defines hypertension; 160/110 or higher is severe and needs urgent action.

Danger signs requiring immediate referral: vaginal bleeding, severe headache or visual disturbance, epigastric pain, reduced fetal movements, leaking fluid, fever, and severe abdominal pain.

RhD-negative unsensitised women receive anti-D immunoglobulin prophylaxis at 28 weeks and within 72 hours of delivery of an RhD-positive baby, plus after any sensitising event.

First stage: latent phase to 5 cm dilatation with irregular contractions; active phase from 5 cm to full dilatation, with cervical change of about 1 cm per hour as a reference in nulliparas.

Second stage: full dilatation to birth; nulliparas typically up to 3 hours with epidural and multiparas up to 2 hours, provided progress and maternal-fetal status are normal.

Third stage: birth to expulsion of placenta; active management (uterotonic, controlled cord traction, uterine tone check) reduces postpartum haemorrhage compared with expectant management.

Uterine contraction assessment: frequency (contractions per 10 minutes), duration in seconds, and intensity; normal established labour is about 3-5 contractions per 10 minutes lasting 45-60 seconds.

Partograph review triggers: action line crossing, cervical dilatation slower than 1 cm/hour in active phase, or descent arrest; escalate for obstetric review.

Cardiotocography interpretation: baseline 110-160 bpm, variability 5-25 bpm, accelerations of 15 bpm for 15 seconds, no decelerations; late or prolonged decelerations require intrauterine resuscitation.

Intrauterine resuscitation measures: maternal left lateral position, intravenous fluid, oxygen where indicated by local protocol, stop oxytocin, and vaginal examination to exclude cord prolapse.

Prolonged second stage or non-reassuring fetal status is an indication for operative birth; vacuum or forceps require full dilatation, engaged head, ruptured membranes, and empty bladder.

Delayed cord clamping for at least 1 minute after birth improves neonatal iron stores and is recommended for term and preterm infants not needing immediate resuscitation.

Postpartum haemorrhage definitions: primary is 500 mL or more after vaginal birth or 1000 mL or more after caesarean within 24 hours; secondary is excessive bleeding from 24 hours to 6 weeks.

Uterine atony causes about 70% of primary postpartum haemorrhage; first-line uterotonics are oxytocin, then ergometrine (avoid in hypertension), then carboprost (avoid in asthma).

Bimanual uterine compression and aortic compression are mechanical measures while uterotonics and blood products are arranged.

Newborn Apgar score at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration; each 0-2, total 0-10; scores of 7 or above are generally reassuring.

Newborn thermoregulation: dry immediately, skin-to-skin contact, hat, and warm environment; target axillary temperature 36.5-37.5 degrees Celsius to prevent hypothermia.

Delayed newborn bathing for at least 24 hours preserves vernix and reduces hypothermia and hypoglycaemia risk.

Exclusive breastfeeding is recommended for the first 6 months; effective latch shows wide mouth, chin to breast, and audible swallowing with no nipple pain.

Postpartum assessment includes uterine involution (fundus descends about 1 cm per day, palpable abdominally for about 2 weeks), lochia pattern, perineal wound, and bladder emptying.

Newborn vitamin K 1 mg intramuscularly at birth prevents vitamin K deficiency bleeding; hepatitis B vaccine is given within 24 hours per national schedule.

Shoulder dystocia sequence: call for help, McRoberts position with suprapubic pressure, then internal manoeuvres (Rubin II, Woods screw, reverse Woods); never apply fundal pressure or traction on the head.

Cord prolapse: elevate the presenting part manually or with a filled bladder, position knee-chest or Trendelenburg, avoid handling the cord, and prepare immediate caesarean birth.

Uterine rupture signs: sudden severe abdominal pain, loss of contraction pattern, fetal bradycardia, vaginal bleeding, and maternal shock; manage with laparotomy.

Eclampsia: magnesium sulfate loading 4 g intravenous over 20 minutes plus 10 g intramuscularly, then 1 g/hour infusion; monitor respiratory rate, reflexes, urine output, and for toxicity.

Magnesium toxicity: loss of deep tendon reflexes, respiratory depression, oliguria; antidote is calcium gluconate 1 g intravenous slowly.

Antepartum haemorrhage from placenta praevia: painless bright red bleeding, soft uterus; avoid vaginal examination and prepare caesarean birth.

Placental abruption: painful bleeding with a tense uterus, often concealed; risk of fetal distress, disseminated intravascular coagulation, and maternal shock.

Amniotic fluid embolism presents with sudden hypoxia, hypotension, and coagulopathy during labour or immediately postpartum; management is supportive and resuscitative.

Preterm labour before 34 weeks: antenatal corticosteroids (dexamethasone 6 mg intramuscularly 12-hourly, four doses) plus magnesium sulfate for neuroprotection where protocol indicates.

Oxytocin for induction or augmentation: start at low dose (for example 1-2 mU/min), titrate to contraction pattern, and stop for tachysystole (more than 5 contractions in 10 minutes) or fetal heart rate abnormality.

Oxytocin has antidiuretic effect; high-dose infusion with large volumes of hypotonic fluid can cause water intoxication and hyponatraemia.

Ergometrine causes sustained uterine contraction and is contraindicated in hypertension, pre-eclampsia, and cardiac disease; it may cause nausea and vomiting.

Carboprost (prostaglandin F2 alpha) is contraindicated in asthma; dinoprostone and misoprostol are prostaglandins requiring fetal and uterine monitoring.

Magnesium sulfate is renally excreted; reduce or withhold the dose when urine output is below 30 mL/hour and monitor serum levels in renal impairment.

Tocolysis with nifedipine or beta-agonists requires monitoring for maternal hypotension and tachycardia; beta-agonists may cause pulmonary oedema.

The five rights of medication administration: right patient, right drug, right dose, right route, right time; add right documentation and reason in maternity practice.

High-alert maternity medications requiring independent double-check include oxytocin, magnesium sulfate, concentrated potassium, and insulin.

Drugs contraindicated or used with caution in breastfeeding include codeine (CYP2D6 ultrarapid metabolisers) and radioactive iodine; check compatibility with a reliable lactation source.

Informed consent requires capacity, adequate information about risks and alternatives, and voluntariness; consent may be withdrawn at any time, including during labour.

Confidentiality is a professional duty; disclosure without consent is limited to legal requirements, serious public health risk, or court order.

Mandatory reporting duties in Jordan include suspected child abuse or neglect and specified communicable diseases; follow Ministry of Health notification rules.

Scope of practice for midwives is defined by the Jordanian Nursing and Midwifery Council and Ministry of Health regulations; practising outside that scope requires referral or supervision.

Documentation must be contemporaneous, factual, signed, dated, and timed; it is a legal record and may be used in disciplinary or court proceedings.

Ethical principles applied to midwifery: autonomy (woman-centred choice), beneficence, non-maleficence, justice, and veracity.

Advocacy duty: a midwife escalates unsafe care through the chain of command even when this conflicts with a colleague or institutional pressure.

Registration and licensure renewal in Jordan require evidence of continuing professional development and current practice hours as set by the regulatory council.

Conscientious objection must not obstruct emergency care; the woman must be referred promptly and without discrimination.

WHO five moments for hand hygiene: before touching a patient, before clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings.

Alcohol-based hand rub is preferred for routine hand hygiene when hands are not visibly soiled; soap and water are required for visible soiling and for Clostridioides difficile.

Aseptic technique is required for vaginal examination, catheterisation, intravenous cannulation, and cord care; sterile gloves and single-use equipment are standard.

Standard precautions apply to all women regardless of diagnosis: gloves for body fluids, eye protection for splash risk, safe sharps disposal, and correct waste segregation.

Group B streptococcus intrapartum antibiotic prophylaxis (penicillin or ampicillin) is indicated for colonisation, previous infant with GBS disease, or GBS bacteriuria in pregnancy.

Surgical site infection prevention for caesarean birth: antibiotic prophylaxis within 60 minutes before incision, chlorhexidine skin preparation, and normothermia.

Sharps injury management: wash the wound, report immediately, assess source status, and start post-exposure prophylaxis within the local window, ideally within hours.

Quality indicators in maternity care include caesarean rate, postpartum haemorrhage rate, perineal tear grade III-IV rate, and neonatal mortality; audit cycles drive improvement.

Incident reporting should be non-punitive and timely; near misses are reported as well as adverse events to allow system learning.

Naegele's rule: first day of last menstrual period minus 3 months plus 7 days plus 1 year; gives estimated date of delivery (EDD) for a 28-day cycle.

Parity notation GTPAL: Gravida (all pregnancies), Term births, Preterm births, Abortions (spontaneous or induced before 20 weeks), Living children.

Estimated gestational age by fundal height: at 20 weeks the fundus is at the umbilicus; after 20 weeks fundal height in cm approximates weeks ± 2.

Normal fetal heart rate baseline is 110-160 beats per minute; auscultation is reliable from about 20 weeks with a Pinard or Doppler.

Recommended antenatal visit schedule for uncomplicated pregnancy: every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, then weekly until delivery.

Daily elemental iron 60 mg plus folic acid 400 mcg (5 mg if prior neural tube defect) is standard antenatal supplementation; folate is most protective before conception and in the first trimester.

Blood pressure thresholds in pregnancy: normal below 140/90 mmHg; 140/90 or higher on two occasions 4 hours apart defines hypertension; 160/110 or higher is severe and needs urgent action.

Danger signs requiring immediate referral: vaginal bleeding, severe headache or visual disturbance, epigastric pain, reduced fetal movements, leaking fluid, fever, and severe abdominal pain.

RhD-negative unsensitised women receive anti-D immunoglobulin prophylaxis at 28 weeks and within 72 hours of delivery of an RhD-positive baby, plus after any sensitising event.

First stage: latent phase to 5 cm dilatation with irregular contractions; active phase from 5 cm to full dilatation, with cervical change of about 1 cm per hour as a reference in nulliparas.

Second stage: full dilatation to birth; nulliparas typically up to 3 hours with epidural and multiparas up to 2 hours, provided progress and maternal-fetal status are normal.

Third stage: birth to expulsion of placenta; active management (uterotonic, controlled cord traction, uterine tone check) reduces postpartum haemorrhage compared with expectant management.

Uterine contraction assessment: frequency (contractions per 10 minutes), duration in seconds, and intensity; normal established labour is about 3-5 contractions per 10 minutes lasting 45-60 seconds.

Partograph review triggers: action line crossing, cervical dilatation slower than 1 cm/hour in active phase, or descent arrest; escalate for obstetric review.

Cardiotocography interpretation: baseline 110-160 bpm, variability 5-25 bpm, accelerations of 15 bpm for 15 seconds, no decelerations; late or prolonged decelerations require intrauterine resuscitation.

Intrauterine resuscitation measures: maternal left lateral position, intravenous fluid, oxygen where indicated by local protocol, stop oxytocin, and vaginal examination to exclude cord prolapse.

Prolonged second stage or non-reassuring fetal status is an indication for operative birth; vacuum or forceps require full dilatation, engaged head, ruptured membranes, and empty bladder.

Delayed cord clamping for at least 1 minute after birth improves neonatal iron stores and is recommended for term and preterm infants not needing immediate resuscitation.

Postpartum haemorrhage definitions: primary is 500 mL or more after vaginal birth or 1000 mL or more after caesarean within 24 hours; secondary is excessive bleeding from 24 hours to 6 weeks.

Uterine atony causes about 70% of primary postpartum haemorrhage; first-line uterotonics are oxytocin, then ergometrine (avoid in hypertension), then carboprost (avoid in asthma).

Bimanual uterine compression and aortic compression are mechanical measures while uterotonics and blood products are arranged.

Newborn Apgar score at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration; each 0-2, total 0-10; scores of 7 or above are generally reassuring.

Newborn thermoregulation: dry immediately, skin-to-skin contact, hat, and warm environment; target axillary temperature 36.5-37.5 degrees Celsius to prevent hypothermia.

Delayed newborn bathing for at least 24 hours preserves vernix and reduces hypothermia and hypoglycaemia risk.

Exclusive breastfeeding is recommended for the first 6 months; effective latch shows wide mouth, chin to breast, and audible swallowing with no nipple pain.

Postpartum assessment includes uterine involution (fundus descends about 1 cm per day, palpable abdominally for about 2 weeks), lochia pattern, perineal wound, and bladder emptying.

Newborn vitamin K 1 mg intramuscularly at birth prevents vitamin K deficiency bleeding; hepatitis B vaccine is given within 24 hours per national schedule.

Shoulder dystocia sequence: call for help, McRoberts position with suprapubic pressure, then internal manoeuvres (Rubin II, Woods screw, reverse Woods); never apply fundal pressure or traction on the head.

Cord prolapse: elevate the presenting part manually or with a filled bladder, position knee-chest or Trendelenburg, avoid handling the cord, and prepare immediate caesarean birth.

Uterine rupture signs: sudden severe abdominal pain, loss of contraction pattern, fetal bradycardia, vaginal bleeding, and maternal shock; manage with laparotomy.

Eclampsia: magnesium sulfate loading 4 g intravenous over 20 minutes plus 10 g intramuscularly, then 1 g/hour infusion; monitor respiratory rate, reflexes, urine output, and for toxicity.

Magnesium toxicity: loss of deep tendon reflexes, respiratory depression, oliguria; antidote is calcium gluconate 1 g intravenous slowly.

Antepartum haemorrhage from placenta praevia: painless bright red bleeding, soft uterus; avoid vaginal examination and prepare caesarean birth.

Placental abruption: painful bleeding with a tense uterus, often concealed; risk of fetal distress, disseminated intravascular coagulation, and maternal shock.

Amniotic fluid embolism presents with sudden hypoxia, hypotension, and coagulopathy during labour or immediately postpartum; management is supportive and resuscitative.

Preterm labour before 34 weeks: antenatal corticosteroids (dexamethasone 6 mg intramuscularly 12-hourly, four doses) plus magnesium sulfate for neuroprotection where protocol indicates.

Oxytocin for induction or augmentation: start at low dose (for example 1-2 mU/min), titrate to contraction pattern, and stop for tachysystole (more than 5 contractions in 10 minutes) or fetal heart rate abnormality.

Oxytocin has antidiuretic effect; high-dose infusion with large volumes of hypotonic fluid can cause water intoxication and hyponatraemia.

Ergometrine causes sustained uterine contraction and is contraindicated in hypertension, pre-eclampsia, and cardiac disease; it may cause nausea and vomiting.

Carboprost (prostaglandin F2 alpha) is contraindicated in asthma; dinoprostone and misoprostol are prostaglandins requiring fetal and uterine monitoring.

Magnesium sulfate is renally excreted; reduce or withhold the dose when urine output is below 30 mL/hour and monitor serum levels in renal impairment.

Tocolysis with nifedipine or beta-agonists requires monitoring for maternal hypotension and tachycardia; beta-agonists may cause pulmonary oedema.

The five rights of medication administration: right patient, right drug, right dose, right route, right time; add right documentation and reason in maternity practice.

High-alert maternity medications requiring independent double-check include oxytocin, magnesium sulfate, concentrated potassium, and insulin.

Drugs contraindicated or used with caution in breastfeeding include codeine (CYP2D6 ultrarapid metabolisers) and radioactive iodine; check compatibility with a reliable lactation source.

Informed consent requires capacity, adequate information about risks and alternatives, and voluntariness; consent may be withdrawn at any time, including during labour.

Confidentiality is a professional duty; disclosure without consent is limited to legal requirements, serious public health risk, or court order.

Mandatory reporting duties in Jordan include suspected child abuse or neglect and specified communicable diseases; follow Ministry of Health notification rules.

Scope of practice for midwives is defined by the Jordanian Nursing and Midwifery Council and Ministry of Health regulations; practising outside that scope requires referral or supervision.

Documentation must be contemporaneous, factual, signed, dated, and timed; it is a legal record and may be used in disciplinary or court proceedings.

Ethical principles applied to midwifery: autonomy (woman-centred choice), beneficence, non-maleficence, justice, and veracity.

Advocacy duty: a midwife escalates unsafe care through the chain of command even when this conflicts with a colleague or institutional pressure.

Registration and licensure renewal in Jordan require evidence of continuing professional development and current practice hours as set by the regulatory council.

Conscientious objection must not obstruct emergency care; the woman must be referred promptly and without discrimination.

WHO five moments for hand hygiene: before touching a patient, before clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings.

Alcohol-based hand rub is preferred for routine hand hygiene when hands are not visibly soiled; soap and water are required for visible soiling and for Clostridioides difficile.

Aseptic technique is required for vaginal examination, catheterisation, intravenous cannulation, and cord care; sterile gloves and single-use equipment are standard.

Standard precautions apply to all women regardless of diagnosis: gloves for body fluids, eye protection for splash risk, safe sharps disposal, and correct waste segregation.

Group B streptococcus intrapartum antibiotic prophylaxis (penicillin or ampicillin) is indicated for colonisation, previous infant with GBS disease, or GBS bacteriuria in pregnancy.

Surgical site infection prevention for caesarean birth: antibiotic prophylaxis within 60 minutes before incision, chlorhexidine skin preparation, and normothermia.

Sharps injury management: wash the wound, report immediately, assess source status, and start post-exposure prophylaxis within the local window, ideally within hours.

Quality indicators in maternity care include caesarean rate, postpartum haemorrhage rate, perineal tear grade III-IV rate, and neonatal mortality; audit cycles drive improvement.

Incident reporting should be non-punitive and timely; near misses are reported as well as adverse events to allow system learning.