NLE NP2 Med-Surg: Priority Frameworks (ABC, Maslow)

NLE NP2 Med-Surg is where the test stops being kind. The 100-item paper drops you into adult care scenarios with three reasonable options and asks which one comes first. If you don't have a working priority framework, you'll burn ten extra seconds per item — and that's twenty-five minutes lost across the paper. This guide builds the priority engine the PRC Board of Nursing actually rewards.

We'll cover the three frameworks that solve nearly every NP II scenario: ABC, Maslow, and safety-first. Then the medical-surgical content blocks where they get applied — cardiac, respiratory, renal, GI, endocrine, neuro, and the perioperative cluster.

What NLE NP2 Med-Surg Covers

Cardiovascular — heart failure, MI, arrhythmias, hypertension. Around 18–20 items.
Respiratory — COPD, asthma, pneumonia, TB, ARDS. Around 15–18 items.
Endocrine — diabetes, thyroid, adrenal, pituitary. Around 12–15 items.
Renal and GU — AKI, CKD, dialysis, BPH, nephrotic. Around 10–12 items.
GI and hepatic — peptic ulcer, IBD, cirrhosis, pancreatitis. Around 10–12 items.
Neuro and musculoskeletal — stroke, ICP, spinal cord, fractures. Around 12–15 items.
Perioperative — pre-op, intra-op, post-op care. Around 8–10 items.
Oncology and immunology — chemo, radiation, HIV, autoimmune. Around 5–8 items.

That's roughly 100 items — sometimes 110 with overlap into pharmacology — and the board frames most of them as priority scenarios.

The Three Priority Frameworks

Memorise these three. Apply them in this order. Most NP II priority items resolve in under fifteen seconds when you do.

Framework 1: ABC (Airway, Breathing, Circulation)

Always run ABC first. If any option addresses an airway compromise, that wins. If two options address airway, the more invasive one wins (suction beats reposition if there's audible gurgling). Breathing comes second — oxygen, repositioning, breath sound assessment. Circulation third — bleeding, pulses, BP, perfusion.

The rule: if the patient is stable, ABC doesn't apply. Move to Maslow. If the patient is unstable, ABC overrides everything — including pain management, anxiety, and education.

Framework 2: Maslow's Hierarchy

For stable patients, Maslow ranks the options. Physiological needs first (airway, oxygen, food, fluid, elimination, comfort, rest). Then safety (fall risk, infection control, medication safety). Then psychosocial (anxiety, family, education, dignity).

The trap: reviewers see an emotional fact pattern and pick the empathetic option. Wrong. If a post-op patient is anxious AND hasn't voided in eight hours, you address the bladder before the anxiety. Physiological always beats psychosocial.

Framework 3: Safety-First

When ABC and Maslow tie, safety breaks the tie. Fall prevention, medication right-checks, isolation precautions, suicide precautions. The board uses safety-first to test whether you can spot a delegation error or an unsafe practice — even when the action looks therapeutic on paper.

Cardiovascular: The Heaviest Block

Around 18–20 items. The recurring patterns:

Acute MI

MONA — Morphine, Oxygen, Nitroglycerin, Aspirin. Aspirin is given first (chewed, not swallowed) for the antiplatelet effect.
STEMI vs NSTEMI — STEMI gets cath lab within 90 minutes (door-to-balloon).
Troponin rises 3–4 hours after onset, peaks at 24, stays elevated for 7–14 days.

Heart Failure

Left-sided — pulmonary congestion (crackles, dyspnea, orthopnea, frothy pink sputum).
Right-sided — systemic congestion (JVD, peripheral edema, hepatomegaly, ascites).
Priority position — high Fowler's for pulmonary edema. Legs dependent if not contraindicated.
Diuretic teaching — daily weights, low sodium, monitor potassium with loop diuretics.

Arrhythmias

V-fib and pulseless V-tach — defibrillate immediately. CPR while waiting.
Stable V-tach — amiodarone. Synchronised cardioversion if symptomatic.
Asystole — CPR and epinephrine. Don't defibrillate asystole; there's no rhythm to convert.
SVT — vagal manoeuvres first (if stable), then adenosine.

Respiratory: The Asthma and COPD Patterns

Asthma

Acute attack — high Fowler's, oxygen, short-acting beta agonist (albuterol nebuliser), then corticosteroid. The order matters because each step buys time for the next. Status asthmaticus — silent chest is worse than wheezing; the airways are too narrow to make sound.

COPD

Chronic CO2 retention drives the hypoxic respiratory drive. Oxygen target is SpO2 88–92%, not 95%. Over-oxygenating a COPD patient can cause CO2 narcosis. Pursed-lip breathing prolongs expiration; tripod position maximises accessory muscle use.

TB

Airborne precautions — N95, negative-pressure room. Treatment is RIPE — Rifampin, Isoniazid, Pyrazinamide, Ethambutol — for at least 6 months. Three consecutive negative sputum smears mark non-infectious status. Rifampin turns body fluids orange; warn the patient.

Endocrine: The Diabetes Cluster

Five to seven items per cycle on diabetes alone.

Hypoglycaemia vs Hyperglycaemia

Hypoglycaemia (under 70 mg/dL) — cold, clammy, confused, tachycardia, tremor. Treatment: 15g fast-acting carb, recheck in 15 minutes (the 15-15 rule). If unconscious — IV dextrose or IM glucagon.

Hyperglycaemia — warm, dry, polyuria, polydipsia, polyphagia, fruity breath if ketotic. DKA: insulin drip, fluids, potassium replacement (insulin drives K+ into cells, so monitor closely).

Insulin Mixing

Clear before cloudy — draw regular (clear) before NPH (cloudy). Never mix insulin glargine with anything. Memorise onset-peak-duration:

Rapid (lispro) — onset 15 min, peak 1 hr, duration 3–4 hr.
Short (regular) — onset 30 min, peak 2–3 hr, duration 6–8 hr.
Intermediate (NPH) — onset 2 hr, peak 6–8 hr, duration 12–18 hr.
Long (glargine) — onset 1 hr, no peak, duration 24 hr.

Renal: Dialysis and Fluid Balance

Hemodialysis vs peritoneal — hemo is faster, riskier, requires AV fistula or graft. Peritoneal is slower, gentler, lets the patient ambulate. Access care: never take BP or draw blood from the fistula arm; auscultate for bruit and palpate for thrill before each session. Dialysate temperature matters for peritoneal — body temperature, infused over 10 minutes.

Neurological: ICP and Stroke

Increased ICP

Cushing's triad — increasing systolic BP, widening pulse pressure, bradycardia, irregular respirations. Late sign. Earliest sign of ICP increase: change in level of consciousness. Position: HOB 30 degrees, neutral neck, avoid hip flexion. Avoid suctioning longer than 15 seconds; pre-oxygenate first.

Stroke

tPA window — 3 to 4.5 hours from symptom onset for ischaemic stroke. Get a CT first to rule out haemorrhagic. FAST screening — Face droop, Arm weakness, Speech difficulty, Time. Right brain stroke causes left-sided weakness; left brain stroke causes aphasia.

Perioperative: The Three Phases

Pre-op

Informed consent verified. NPO 6–8 hours. Skin prep, anti-embolism stockings. Pre-op checklist signed. Voiding before transport. Identify allergies, prosthetics, and the surgical site.

Intra-op

The circulating nurse counts sponges, sharps, and instruments at the start, before closure, and at the end. Time-out before incision — patient identity, surgical site, planned procedure.

Post-op

Priority assessment in PACU: airway first. Then breathing, circulation, level of consciousness, surgical site, drains, pain. Atelectasis is the most common post-op pulmonary complication; prevent with incentive spirometry, deep breathing, and early ambulation.

How to Drill NP II

Week 1 — Cardiovascular and respiratory. 50 case-style MCQs daily.
Week 2 — Endocrine and renal. Pair pharmacology with disease blocks.
Week 3 — GI, hepatic, neuro. Drill priority items mixed with content recall.
Week 4 — Perioperative, oncology, immunology. Full-paper mock at week's end.

For pacing strategy across the full two-day exam, see the NLE pacing guide. The priority vs best-action breakdown covers the question-type distinction that confuses most reviewers.

How Super Tutor's NLE Track Handles NP II

Our NLE Nursing track runs NP II as a system-tagged question bank — cardiac, respiratory, renal, GI, endocrine, neuro — so analytics show which body system is dragging your average down. Every priority item carries a rationale that walks through ABC, Maslow, and safety-first. Focused Yearly is ₱1,999/year.

For broader context, see the Complete NLE Guide 2026 and retake strategy. The NLE Preparation Guide on STM walks the full 12-week schedule. Eligibility and announcements: PRC Board of Nursing.

FAQ

Is ABC always the right priority framework?

For unstable patients, yes. For stable patients, Maslow takes over. The signal is in the stem — words like "acute", "sudden", "unresponsive", "struggling to breathe" trigger ABC.

How much pharmacology is on NP II?

Around 15–20% of items embed a medication. Know the major drug classes (beta blockers, ACE inhibitors, diuretics, anticoagulants, insulins) and their priority side effects.

Do I need to memorise lab values?Yes — at least the critical ones. Sodium, potassium, BUN, creatinine, glucose, troponin, BNP, INR, hemoglobin, hematocrit, platelets, WBC. Items frame fact patterns around abnormal values.

What's the most overlooked block?

Perioperative. Reviewers focus on diseases and skip pre/post-op care. The block delivers 8–10 reliable points and the framing rarely changes.

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