Maternal and Newborn Nursing
What this domain tests
Maternal and Newborn Nursing covers antepartum, intrapartum, postpartum, and newborn transition. Expect GTPAL interpretation, fetal heart-rate patterns, labor stages, postpartum hemorrhage, breastfeeding, and medication safety with oxytocin and magnesium sulfate.
Core rules
- GTPAL: G = gravida (all pregnancies), T = term, P = preterm, A = abortions, L = living children. A current pregnancy counts in G but not L.
- Labor stages: first stage from onset to 10 cm; second stage to birth; third to placental delivery; fourth is the first 1-2 hours postpartum, when hemorrhage risk is highest.
- Category III fetal heart tracing: absent variability with recurrent late decelerations or bradycardia; requires immediate action.
- Postpartum hemorrhage: fundal massage, empty bladder, oxytocin per order, assess lochia and vital signs; a boggy fundus is the common early sign.
- Magnesium sulfate for preeclampsia: monitor respirations at least 12/min, deep tendon reflexes, and urine output at least 30 mL/hr; calcium gluconate is the antidote.
Worked example
Thirty minutes after a vaginal birth, the client's pad is saturated, the fundus is boggy and above the umbilicus, and pulse is 110. First action? Massage the fundus and assess the bladder, then give oxytocin as ordered. Reasoning: uterine atony is the most common cause of early postpartum hemorrhage; a full bladder displaces the uterus and worsens atony.
Traps
- Documenting a "small" lochia amount when the pad is saturated; quantify blood loss.
- Confusing variable decelerations (cord compression) with late decelerations (uteroplacental insufficiency).
- Forgetting to check the bladder before giving more oxytocin.