Maternal and Child Nursing Reviewer for NLE Philippines 2026

Maternal and Child Nursing covers two of the most life-affirming areas of clinical practice: the care of women through pregnancy, labor, and the postpartum period, and the care of children from the newborn stage through adolescence.

For the NLE, this subject rewards examinees who understand the normal sequence of events clearly because most questions test whether you can identify what is normal, recognize what is abnormal, and know the correct nursing response to each. This reviewer covers the highest-yield topics across the maternal and child nursing spectrum.

Antepartum Care: The Pregnant Patient

Naegele's Rule: Estimating Delivery Date

Naegele's rule calculates the estimated date of delivery (EDD) and appears consistently in NLE maternal nursing questions.

Formula: Take the first day of the last menstrual period (LMP). Subtract 3 months. Add 7 days. Add 1 year.

Example: If the LMP is September 10, 2025. Subtract 3 months = June 10. Add 7 days = June 17. Add 1 year = June 17, 2026.

Prenatal Visit Schedule

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Danger Signs of Pregnancy

The NLE tests whether examinees can distinguish normal pregnancy discomforts from danger signs requiring immediate medical attention.

Danger signs that require immediate reporting:

Sudden gush or continuous leaking of fluid from the vagina (premature rupture of membranes)

Vaginal bleeding at any stage of pregnancy

Severe persistent headache with visual disturbances and edema (signs of pre-eclampsia)

Epigastric pain (upper abdominal pain, a sign of HELLP syndrome or severe pre-eclampsia)

Decreased or absent fetal movement after 28 weeks

Painful uterine contractions before 37 weeks (preterm labor)

Fever with chills

Preeclampsia and Eclampsia

Pre-eclampsia is defined as hypertension (BP 140/90 or higher on two occasions at least 4 hours apart) occurring after 20 weeks of gestation, accompanied by proteinuria or end-organ damage.

Severe features include BP of 160/110 or higher, severe headache, visual disturbances, epigastric pain, thrombocytopenia, and impaired liver function.

Eclampsia is the onset of seizures in a woman with pre-eclampsia without another cause.

Nursing priority: Magnesium sulfate is the drug of choice for seizure prevention and treatment in eclampsia. Monitor for magnesium toxicity: loss of deep tendon reflexes (first sign), respiratory depression, and cardiac arrest. Antidote for magnesium toxicity: calcium gluconate (keep at bedside).

Intrapartum Care: Labor and Delivery

The Four Ps of Labor

The four factors that determine the course of labor are the Powers, Passage, Passenger, and Psyche.

Powers are the uterine contractions and maternal pushing effort.

Passage is the bony pelvis and soft tissues.

Passenger refers to the fetus, including its size, position, and presentation.

Psyche refers to the mother's psychological state and readiness.

Stages of Labor

Fetal Heart Rate Monitoring

Normal fetal heart rate is 110 to 160 beats per minute.

Early decelerations: Uniform, mirror image of contractions. Caused by fetal head compression during contractions. Benign finding. No intervention needed.

Variable decelerations: Abrupt decrease in FHR. Caused by umbilical cord compression. Intervention: change maternal position (left lateral or knee-chest), administer oxygen, increase IV fluid.

Late decelerations: Begin after the peak of a contraction and return to baseline after the contraction ends. Caused by uteroplacental insufficiency. Ominous sign. Immediate intervention: turn patient to left lateral position, stop oxytocin if infusing, administer oxygen, notify physician, prepare for emergency delivery if unresolved.

Postpartum Care

Normal Postpartum Assessment (BUBBLE-LE)

The BUBBLE-LE acronym covers all postpartum assessment areas:

B reasts: Check for engorgement, nipple condition, and breastfeeding latch.

U terus: Should be firm, midline, at the umbilicus on day 1, descending 1 cm per day. A boggy uterus indicates atony and risk of hemorrhage.

B ladder: Encourage voiding every 2 to 3 hours. Urinary retention is common postpartum. Full bladder displaces the uterus and prevents it from contracting properly.

B owels: Return of bowel sounds, first bowel movement expected within 2 to 3 days.

L ochia: Normal progression from rubra (red, days 1 to 3) to serosa (pink-brown, days 4 to 10) to alba (white-yellow, days 11 to 6 weeks). Heavy saturating bright red bleeding is abnormal.

E pisiotomy or perineum: Inspect for redness, edema, ecchymosis, discharge, and approximation (REEDA).

Lower extremities: Check for Homans' sign (calf pain on dorsiflexion), redness, warmth, and swelling indicating possible deep vein thrombosis.

E motional status: Screen for postpartum blues (days 1 to 5, self-limiting), postpartum depression (persists beyond 2 weeks), and postpartum psychosis (rare but requires immediate intervention).

Postpartum Hemorrhage (PPH)

PPH is blood loss of more than 500 mL after vaginal delivery or more than 1,000 mL after cesarean section. It is the leading cause of maternal mortality worldwide and one of the most tested postpartum complications in the NLE.

Most common cause: Uterine atony (failure of the uterus to contract after delivery).

Nursing interventions for PPH: Fundal massage to stimulate uterine contraction. Administer oxytocin as ordered. Monitor vital signs frequently. Establish large bore IV access. Prepare for blood transfusion if needed.

4 Ts of PPH causes: Tone (atony), Trauma (lacerations), Tissue (retained placenta), Thrombin (coagulation disorders).

Newborn Assessment

APGAR Scoring

The APGAR score is performed at 1 minute and 5 minutes after birth to assess newborn adaptation to extrauterine life.

Immediate Newborn Care

The first minutes after birth are critical. Know the sequence of immediate newborn care for the NLE:

1. Dry and stimulate: Immediately dry the newborn with a warm towel. Stimulate by rubbing the back or flicking the soles of the feet if the baby does not cry spontaneously.

2. Assess breathing: If breathing is present and heart rate is above 100 bpm, continue with routine care.

3. Cord clamping: Delayed cord clamping (30 to 60 seconds after birth) is now recommended. It allows transfer of blood from the placenta to the newborn, improving iron stores.

4. Skin-to-skin contact: Place the newborn on the mother's chest immediately after birth to promote bonding and breastfeeding initiation.

5. Eye prophylaxis: Erythromycin ophthalmic ointment is instilled in both eyes within 1 hour of birth to prevent ophthalmia neonatorum (gonococcal eye infection).

6. Vitamin K injection: Vitamin K (phytonadione) is given IM to prevent hemorrhagic disease of the newborn because newborns are born with very low Vitamin K levels.

7. BCG and Hepatitis B vaccines: Given within the first 24 hours of life per the Philippine EPI schedule.

Child Health: Growth and Development Milestones

Growth and development milestones appear regularly in the child health section of the NLE. Know the key milestones by age group.

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Common Childhood Illnesses

Dengue fever: Transmitted by Aedes aegypti mosquito. Classic presentation: sudden high fever, severe headache, retro-orbital pain, myalgia, arthralgia, and rash. Warning signs of severe dengue: abdominal pain, persistent vomiting, rapid breathing, bleeding, restlessness, and sudden decrease in temperature with profuse sweating. Nursing priority: monitor platelet count, watch for hemorrhagic signs.

Measles (Rubeola): Characterized by the 3 Cs: cough, coryza (runny nose), and conjunctivitis. Koplik's spots (white spots on buccal mucosa) appear 2 to 3 days before the rash. Rash begins on the face and spreads downward.

Practice What You Just Learned

Maternal and child nursing covers a wide range of content from Naegele's rule to APGAR scoring to childhood milestones. Practice is what ties all of it together.

Head to LisensyaPrep and start answering questions now. No account needed.

Practice Maternal and Child Nursing Questions at LisensyaPrep