National Council Licensure Examination for Registered Nurses (NCLEX-RN) Health Promotion and Maintenance Syllabus

At what gestational age is fetal heart rate normally detectable by Doppler, and what is the normal range?

Detectable by ~10–12 weeks; normal FHR is 110–160 bpm.

What does GTPAL stand for in obstetric history?

Gravida, Term births, Preterm births, Abortions/miscarriages, Living children.

When is the maternal serum quad screen (AFP) typically performed?

Between 15 and 20 weeks gestation.

What is a reactive nonstress test (NST)?

2 or more FHR accelerations of at least 15 bpm above baseline lasting at least 15 seconds within a 20-minute period.

List the 5 components of the biophysical profile (BPP).

Fetal breathing, gross body movements, fetal tone, amniotic fluid volume, and reactive NST (each scored 0 or 2).

What are the four stages of labor?

First (onset to full dilation), Second (full dilation to birth), Third (birth to placental delivery), Fourth (1–2 hr postpartum recovery).

What dilation defines the transition phase of the first stage of labor?

8 to 10 cm cervical dilation.

What are the '5 Ps' affecting the labor process?

Passenger (fetus), Passageway (pelvis/birth canal), Powers (contractions), Position (maternal), and Psyche (psychological response).

Differentiate early, late, and variable FHR decelerations by cause.

Early = head compression (benign); Late = uteroplacental insufficiency (ominous); Variable = cord compression.

What is the priority nursing action for late decelerations?

Reposition mother (left side), stop oxytocin, give O2, increase IV fluids, and notify provider (intrauterine resuscitation).

What does the acronym REEDA assess in postpartum perineal/incision healing?

Redness, Edema, Ecchymosis, Discharge, Approximation.

Where should the fundus be located immediately after delivery and at 1 hour postpartum?

At or just below the umbilicus right after birth; rises to umbilicus level ~1 hr postpartum, then descends ~1 cm/day.

What is the most common cause of early postpartum hemorrhage, and the first nursing action?

Uterine atony; first action is to firmly massage the fundus.

Define the normal progression of postpartum lochia.

Lochia rubra (red, days 1–3), serosa (pink/brown, days 4–10), then alba (yellow/white, up to 6 weeks).

What are warning signs of postpartum deep vein thrombosis or pulmonary embolism?

Unilateral calf pain/swelling/warmth (DVT); sudden dyspnea, chest pain, and tachycardia (PE).

What are the 5 parameters of the APGAR score?

Heart rate, Respiratory effort, Muscle tone, Reflex irritability, and Color (each 0–2), scored at 1 and 5 minutes.

What is the normal newborn heart rate and respiratory rate?

Heart rate 110–160 bpm; respiratory rate 30–60 breaths/min.

Differentiate physiologic from pathologic newborn jaundice by timing.

Physiologic appears after 24 hr (peaks days 3–5); pathologic appears within the first 24 hr of life.

Which vitamin injection is routinely given to newborns and why?

Vitamin K (phytonadione) to prevent hemorrhagic disease, since newborn gut flora cannot yet synthesize it.

List four normal newborn reflexes.

Moro (startle), rooting, sucking, palmar/plantar grasp, Babinski, and tonic neck (any four).

What is the difference between active and passive immunity?

Active = body produces its own antibodies (infection or vaccine), long-lasting; passive = preformed antibodies given (maternal/immunoglobulin), temporary.

Which vaccine is given at birth in the routine US immunization schedule?

Hepatitis B (first dose).

When is the MMR vaccine first administered, and what type is it?

At 12–15 months; it is a live attenuated vaccine (contraindicated in pregnancy/immunocompromise).

What are the levels of disease prevention with an example of each?

Primary (prevent onset, e.g., immunization), Secondary (early detection, e.g., screening/Pap), Tertiary (limit disability, e.g., rehab).

What are the recommended screening intervals for cervical (Pap) and mammography in average-risk women?

Pap every 3 years starting at 21 (or with HPV co-test every 5 yr at 30+); mammography every 1–2 years starting at 40–50.

At what age should average-risk adults begin colorectal cancer screening?

Age 45 (colonoscopy every 10 years, or stool-based tests more frequently).

Using the CAGE questionnaire, what does each letter assess for alcohol misuse?

Cut down, Annoyed by criticism, Guilty about drinking, Eye-opener (morning drink).

What are the '5 A's' framework for smoking cessation counseling?

Ask, Advise, Assess, Assist, Arrange.

In what sequence should the four techniques of physical assessment be performed, and what is the exception?

Inspection, palpation, percussion, auscultation — except the abdomen, where auscultation precedes palpation/percussion.

What is the difference between subjective and objective data in health history?

Subjective = what the patient reports (symptoms, feelings); objective = measurable/observable findings (vital signs, exam, labs).

What does the OLDCARTS mnemonic capture in a symptom history?

Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Timing, Severity.

Give an example of an expected versus an unexpected finding when assessing skin turgor.

Expected: skin recoils immediately when pinched. Unexpected: tenting/slow recoil indicating dehydration.

What is an unexpected finding when auscultating the lungs that signals airway narrowing?

Wheezing (high-pitched musical sound), as opposed to clear vesicular breath sounds (expected).

Define complementary and alternative medicine (CAM) and give an example.

Non-mainstream practices used alongside (complementary) or instead of (alternative) conventional medicine, e.g., acupuncture, herbal supplements, meditation, yoga.

Why must nurses always ask patients about herbal/dietary supplement use?

Many herbs interact with medications (e.g., St. John's wort, ginkgo, garlic increase bleeding/alter drug levels) and patients often omit them from medication lists.