NLE Antepartum, Intrapartum & Postpartum Care Reviewer 2026

Answer: C. Presumptive signs

Step 1 — Understand the three categories: Pregnancy signs are classified as presumptive (subjective, felt by the woman), probable (objective, observed by the examiner), or positive/diagnostic (conclusively confirm pregnancy). Step 2 — Identify what the client is describing: Amenorrhoea (missed period) and nausea/vomiting (morning sickness) are both symptoms felt by the woman herself — they are subjective. Step 3 — Match to the correct category: Because they are subjective and experienced by the client, they fall under PRESUMPTIVE signs. Step 4 — Why the other options are wrong: Positive/diagnostic signs require direct fetal evidence (e.g., hearing fetal heart tones, ultrasound visualization). Probable signs are observed by the examiner (e.g., Hegar's sign, positive pregnancy test). 'Diagnostic' is simply another term for positive signs. Step 5 — Key takeaway: Presumptive signs are the LEAST reliable because they can have causes other than pregnancy (e.g., stress causing amenorrhoea, gastroenteritis causing nausea).

Answer: C. Chadwick's sign

Step 1 — Recall the probable signs and what each refers to: Each probable sign is named after the clinician who described it, so a memory aid is crucial. Step 2 — Chadwick's sign: This is the bluish-violet or purple discoloration of the cervix, vagina, and vulva caused by increased vascularity and venous congestion in early pregnancy. The 'C' in Chadwick's can remind you of 'Color change.' Step 3 — Eliminate wrong options: Hegar's sign is the softening of the lower uterine segment (isthmus) — it is felt by the examiner during bimanual palpation, not seen. Goodell's sign is the softening of the cervix itself — again, palpated, not visualized as a color change. Ballottement is the rebounding of the fetus when the lower uterine segment is tapped. Step 4 — Classify correctly: Chadwick's sign is a PROBABLE sign — it is objective (examiner can see it) but does not exclusively confirm pregnancy. Step 5 — Memory tip for the NLE: Chadwick = Color (blue/violet); Goodell = softening of the cervix (Good cervix is soft); Hegar = lower uterine segment (H for isthmus = Hegar).

Answer: B. Visualization of the fetus on ultrasound

Step 1 — Know the three and ONLY three positive signs: (1) Fetal heart tones heard by the examiner, (2) Fetal movement felt by the examiner (NOT the mother), and (3) Visualization of the fetus on ultrasound. These are the only signs that CONCLUSIVELY confirm pregnancy. Step 2 — Why a positive pregnancy test is NOT a positive sign: A urine or blood hCG test is classified as a PROBABLE sign. This is because rare conditions (e.g., hydatidiform mole, choriocarcinoma) can elevate hCG without a viable fetus. This is one of the most common NLE trick questions! Step 3 — Why ballottement is NOT a positive sign: Ballottement is a probable sign — it is an objective finding by the examiner, but it does not directly confirm fetal viability. Step 4 — Why Braxton Hicks is NOT a positive sign: Braxton Hicks contractions are irregular, painless practice contractions classified as a probable sign. Step 5 — NLE key point: Always remember — positive pregnancy test = PROBABLE, not positive. Only direct fetal evidence = positive sign.

Answer: A. December 17, 2025

Step 1 — Recall Naegele's rule formula: EDD = LMP date − 3 months + 7 days + 1 year (adjust year as needed). Step 2 — Apply to LMP = March 10, 2025: Subtract 3 months from March → March is month 3, so 3 − 3 = 0, which means December of the PREVIOUS year. But since we then add 1 year: December 2025. Step 3 — Add 7 days to the day: 10 + 7 = 17. Step 4 — EDD = December 17, 2025. Note: Because March − 3 months = December, we stay in 2025 (we add 1 year only when the result goes to the following calendar year). Step 5 — Why other options are wrong: December 10 forgets to add the 7 days. January 17, 2026 incorrectly adds the year unnecessarily. November 17 subtracts 4 months instead of 3. Memory tip: 'Minus 3, Plus 7, Plus 1 year' — always do steps in this order.

Answer: B. Position the woman on her left side

Step 1 — Identify the problem: This woman is experiencing supine hypotensive syndrome (also called vena cava syndrome). When a heavily pregnant woman lies flat on her back, the enlarged uterus compresses the inferior vena cava (IVC), reducing blood return to the heart, leading to decreased cardiac output, hypotension, and dizziness. Step 2 — Prioritize using Maslow's hierarchy and ABCs: This is a circulatory problem affecting perfusion — it needs immediate correction. The FASTEST and most effective intervention is repositioning. Step 3 — Why LEFT lateral position: Turning to the left side displaces the uterus off the IVC, immediately restoring venous return and resolving the hypotension. This is the priority nursing action. Step 4 — Why other options are lower priority: Oxygen may be a secondary measure if symptoms persist, but repositioning is first. Elevating the head of the bed to 90° does not relieve IVC compression effectively. Checking BP is assessment — important, but repositioning first relieves the cause. Step 5 — NLE application: In any question where a pregnant woman is symptomatic while supine, the answer is almost always 'left lateral position.'

Answer: B. 20 weeks

Step 1 — Recall the key fundal height landmarks: Symphysis pubis = ~12 weeks; Umbilicus = ~20 weeks; Midway between umbilicus and xiphoid = ~28 weeks; Near the xiphoid = ~36 weeks. Step 2 — Apply McDonald's rule: After 20 weeks, the fundal height in centimeters roughly equals the gestational age in weeks (±2 cm). At the umbilicus, the fundal height is approximately 20 cm, which corresponds to 20 weeks. Step 3 — This is also the time of quickening: At ~20 weeks (primigravida), the mother first feels fetal movement, and the fundus reaches the umbilicus — these two events coincide, making 20 weeks a highly memorable milestone. Step 4 — Why the other options are wrong: At 12 weeks the fundus is just at the symphysis. At 28 weeks the fundus is midway between the umbilicus and xiphoid. At 36 weeks (lightening may have occurred) the fundus is near the xiphoid. Step 5 — Key NLE mnemonic: '12 = symphysis, 20 = umbilicus, 36 = xiphoid' — commit these three landmarks to memory.

Answer: B. Embryonic stage (weeks 3–8)

Step 1 — Understand why this period is critical: During the embryonic stage (weeks 3–8), all major organ systems are being formed through a process called organogenesis. This is when the heart, brain, limbs, eyes, and other vital structures develop from undifferentiated cells. Step 2 — Teratogen effect: A teratogen is any agent (drug, alcohol, radiation, infection like rubella) that disrupts normal embryonic development. Because organ systems are actively forming during weeks 3–8, even brief exposure can cause major structural defects. Step 3 — Why not weeks 1–2: During the pre-embryonic stage, the fertilized egg is still implanting. If a teratogen affects this period, it usually causes complete loss (miscarriage) rather than malformation — 'all or nothing' effect. Step 4 — Why not the fetal stage (weeks 9+): After organogenesis is complete, the fetal stage involves growth and maturation of already-formed structures. Teratogens during this period are less likely to cause major structural defects but can still affect growth and function. Step 5 — Clinical application: This is why nurses counsel pregnant women to AVOID alcohol, unprescribed drugs, and X-ray exposure especially in the FIRST TRIMESTER (particularly weeks 3–8).

Answer: B. A normal emotional response called ambivalence

Step 1 — Identify the psychological concept: Ambivalence is the simultaneous experience of conflicting feelings — wanting and not wanting the pregnancy at the same time. Step 2 — Is this normal? YES. Ambivalence in the first trimester is a NORMAL psychological response, even in planned and wanted pregnancies. This is a well-established developmental milestone of early pregnancy described by Reva Rubin's maternal tasks framework. Step 3 — Why it occurs: The reality of pregnancy brings lifestyle changes, financial concerns, relationship shifts, and physical discomfort. Even excited mothers can have moments of doubt. Step 4 — Nursing response: The therapeutic nursing action is to NORMALIZE the feeling ('Many mothers feel this way, especially in the first trimester') and provide emotional support, not alarm the client or suggest pathology. Step 5 — What to watch for: Ambivalence is different from persistent low mood, inability to function, or thoughts of self-harm — those require further assessment and referral. Ambivalence alone, especially in the first trimester, is expected and normal.

Answer: B. Come to the hospital/clinic immediately for evaluation

Step 1 — Identify the danger sign: A sudden gush or leaking of clear fluid from the vagina during pregnancy is a prenatal DANGER sign that must be evaluated immediately. It suggests possible premature rupture of membranes (PROM) or preterm premature rupture of membranes (PPROM) at 32 weeks. Step 2 — Why this is urgent: At 32 weeks, this baby is preterm. Once membranes rupture, the amniotic sac — which protects the fetus from infection — is broken. Risks include umbilical cord prolapse (emergency), chorioamnionitis (intrauterine infection), and preterm birth. Every hour counts. Step 3 — Nursing priority under RA 9173: The nurse, functioning within the scope of nursing practice, must provide first-level care and refer appropriately. Instructing the client to seek immediate care is the correct action. Step 4 — Why the other options are wrong: Waiting at home, monitoring for 24 hours, or simply increasing fluids all delay necessary medical evaluation and increase risk of maternal and fetal complications. Step 5 — NLE principle: ANY prenatal danger sign (vaginal bleeding, fluid leaking, severe headache, visual changes, absent fetal movement, convulsions) = REPORT IMMEDIATELY. There is no 'wait and see' approach.

Answer: B. Two arteries and one vein

Step 1 — Memorize the normal structure: The normal umbilical cord contains 2 arteries and 1 vein — this is remembered as 'AVA' (Artery-Vein-Artery) or simply '2 arteries, 1 vein.' Step 2 — Understand the function: The two umbilical arteries carry deoxygenated blood (waste products) FROM the fetus TO the placenta. The one umbilical vein carries oxygenated blood (nutrients and oxygen) FROM the placenta TO the fetus. This is opposite to systemic circulation — a common source of confusion! Step 3 — What happens with a single umbilical artery (SUA): A cord with only 1 artery and 1 vein (called a single umbilical artery) is associated with an increased risk of congenital anomalies, especially renal and cardiac defects. The nurse must report this finding for further newborn assessment. Step 4 — Why the other options are wrong: A cord with one artery and one vein, or two arteries and two veins, is abnormal and not the standard. Step 5 — NLE memory tip: 'The cord has 3 vessels: AVA — 2 arteries + 1 vein. A single artery needs closer attention.'

Answer: B. 4 visits

Step 1: Recall that the DOH (Department of Health) of the Philippines sets the minimum standard for antenatal care. Step 2: The DOH recommends at least 4 ANC visits for a normal, low-risk pregnancy. Step 3: Note that the WHO 2016 model recommends 8 contacts for better outcomes, but the Philippine DOH minimum is 4. Step 4: Options A (2 visits) and C (6 visits) are not the DOH minimum standard. Option D (8 visits) is the WHO 2016 recommendation, not the Philippine DOH minimum. Step 5: For NLE purposes, always distinguish between the DOH Philippine standard (4 visits) and the WHO recommendation (8 contacts).

Answer: B. At least 4 weeks after Td1

Step 1: The Philippine DOH Td immunization schedule requires a minimum interval between doses for adequate immune response. Step 2: Td2 must be given at least 4 weeks (≥4 weeks) after Td1 to ensure proper antibody development. Step 3: Additionally, Td2 should be given at least 2 weeks before the expected delivery date so maternal antibodies can cross the placenta and protect the newborn. Step 4: Option A (2 weeks) is the minimum interval before delivery, not the interval between doses. Options C and D are too long and do not match the schedule. Step 5: A newborn protected by maternal Td immunization is called a Child Protected at Birth (CPAB) — a key Philippine term for the NLE.