OB questions concentrate on a handful of high-stakes scenarios. Learn to recognize each one's signature, and the maternity section gets much smaller.
| Pattern | Cause | Move |
|---|---|---|
| Variable decelerations | Cord compression | Reposition the mother; consider amnioinfusion per orders |
| Early decelerations | Head compression | Benign — mirrors contractions; keep monitoring |
| Accelerations | OK — reassuring | Document; a sign of fetal well-being |
| Late decelerations | Placental insufficiency | Reposition left side, stop oxytocin, give oxygen, increase IV fluids, notify provider |
Normal fetal heart rate: 110–160 bpm. Late decelerations are the emergency pattern — they start after the contraction peaks and recover after it ends, and the response sequence above is one of the most-tested action chains in OB.
The signature: hypertension after 20 weeks with proteinuria or end-organ signs (headache, visual changes, epigastric pain, swelling). Severe features move the client to magnesium sulfate for seizure prophylaxis — which creates the second testable layer: magnesium toxicity. Watch respirations (below 12), deep tendon reflexes (absent = danger), and urine output (below 30 mL/hr). The antidote stays at the bedside: calcium gluconate. First response to toxicity signs: stop the infusion.
| Placenta previa | Abruptio placentae | |
|---|---|---|
| Pain | Painless bleeding | Painful — rigid, board-like abdomen |
| Blood | Bright red | Dark red (may be concealed) |
| The rule | Never perform a vaginal exam on a client with undiagnosed late-pregnancy bleeding — in previa it can tear the placenta and cause catastrophic hemorrhage | |
The cord slips ahead of the presenting part and gets compressed. Actions, in order: call for help, glove up and lift the presenting part off the cord (and keep your hand there), position the mother knee-chest or Trendelenburg, give oxygen, prepare for emergency cesarean. Don't try to push the cord back in.
The most common cause is a boggy (uncontracted) uterus — so the first move is fundal massage until it firms, after checking the bladder (a full bladder displaces the uterus and prevents contraction — empty it). Medications follow: oxytocin first-line; methylergonovine (avoid in hypertension); carboprost (avoid in asthma). Lochia progression to recite: rubra (red, days 1–3) → serosa (pink-brown, ~days 4–10) → alba (white, up to ~6 weeks).
Practice. A client at 36 weeks reports painless, bright-red vaginal bleeding. Which action is contraindicated?
A. Assessing fetal heart tones
B. Performing a vaginal examination to check dilation
C. Starting an IV line
D. Monitoring the amount of bleeding
Answer: B — painless bright-red bleeding is the previa signature; a vaginal exam can disrupt the placenta and cause massive hemorrhage. The other actions are all appropriate parts of assessment and preparation.
Module 4 of the Core Bundle covers the full arc — pregnancy signs, GTPAL, labor stages, every complication above, postpartum assessment, and newborn care — with 30 questions and a six-item preeclampsia case study.
Next Gen NCLEX questions are where exams are won and lost. Our free field guide walks through every NGN item type — case study, bow-tie, trend, cloze, matrix — with fully worked examples and the scoring explained in plain English.