NLE Med-Surg Review: Cardio, Respiratory, Fluids, Oncology (NP III) and GI (NP IV)

NLE Med-Surg Review: Cardio, Respiratory, Fluids, Oncology (NP III) and GI (NP IV)

Most of medical-surgical nursing on the NLE falls under Nursing Practice III: Care of Clients with Problems in Surgery, Oxygenation, Fluid & Electrolytes, Infectious, Inflammatory & Immunologic Response, and Cellular Aberrations. It's the third test on Day 1 (2:30–4:30 p.m.). GI problems belong to Nursing Practice IV (nutrition, GI, metabolism and endocrine, perception and coordination), the first test on Day 2. Both are covered here because you'll review them together.

PRC doesn't publish an item breakdown by topic, so cover every system below. This post goes with the NLE guide.

Surgery (perioperative care)

• Pre-op: informed consent (the surgeon obtains it; the nurse witnesses), NPO, pre-op teaching and checklist
• Intra-op: surgical asepsis, positioning, the time-out
• Post-op: airway first, vital signs, pain control, early ambulation, incentive spirometry, wound care
• Complications: hemorrhage, atelectasis, DVT/PE, wound dehiscence and evisceration (cover with sterile saline-moistened dressing, notify the surgeon)

Cardiovascular

Drill list:

Dysrhythmias (high-yield):

• Sinus rhythms: bradycardia, tachycardia, arrhythmia
• Atrial: PAC, atrial fib, atrial flutter, SVT
• Ventricular: PVC, V-tach (with/without pulse), V-fib, asystole
• Heart blocks: 1st degree, 2nd degree (Mobitz I and II), 3rd degree
• ECG basics: P, QRS, T waves, intervals, recognition of common rhythms

For each: recognize it on an ECG strip, name the rhythm, identify nursing intervention. V-fib + pulseless V-tach: defibrillate. PEA + asystole: CPR + epinephrine, no defibrillation.

Acute Coronary Syndrome:

• STEMI vs NSTEMI vs unstable angina
• Initial management: the classic "MONA" mnemonic (morphine, oxygen, nitroglycerin, aspirin); current practice gives oxygen only if the patient is hypoxic
• Cardiac biomarkers: troponin (most specific), CK-MB
• Reperfusion: fibrinolytics (window: <12 hours), PCI

Heart Failure:

• Left vs right-sided symptoms
• NYHA classification (I-IV)
• Medications: ACE inhibitors, ARBs, beta-blockers, diuretics, digoxin
• Digoxin toxicity signs: yellow-green halos, GI symptoms, dysrhythmias

Hypertension:

• Categories per JNC 8 / ACC-AHA
• Hypertensive emergency vs urgency
• Medications: ACE-I, ARB, CCB, diuretics, beta-blockers
• Patient education: salt restriction, exercise, weight, alcohol moderation

Vascular:

• DVT: prevention, signs (Homan's sign — historically tested but not specific), management
• Peripheral artery disease vs venous insufficiency (key differentiation)
• Aortic aneurysm: AAA presentation, surgical management
• Buerger's disease, Raynaud's

Respiratory

Drill list:

COPD:

• Emphysema vs chronic bronchitis (pink puffer vs blue bloater simplification)
• Pursed-lip breathing, low-flow oxygen (1-2L NC) — high O2 can suppress drive
• Bronchodilators, steroids, oxygen therapy

Asthma:

• Triggers, peak flow monitoring, action plans
• Acute attack: bronchodilators, oxygen, steroids
• Status asthmaticus: emergency management

Pneumonia:

• Community-acquired vs hospital-acquired vs aspiration
• Diagnostic: sputum culture, chest x-ray
• Nursing care: hydration, positioning, deep breathing, antibiotics

Tuberculosis:

• Active vs latent
• Diagnosis: PPD, IGRA, chest x-ray, sputum AFB
• Treatment: RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)
• Drug side effects: INH (peripheral neuropathy, hepatotoxicity), rifampin (orange body fluids)
• Airborne precautions, negative pressure room

ARDS:

• Causes, presentation
• PaO2/FiO2 ratio
• Mechanical ventilation, prone positioning

Pneumothorax / Hemothorax:

• Tension pneumothorax: tracheal deviation away from affected side, decreased breath sounds, immediate decompression
• Chest tube management: bubbling, fluctuation, drainage monitoring

Gastrointestinal (NP IV)

Drill list:

• Upper GI bleeding: causes (peptic ulcer most common), management, blood transfusion thresholds
• Inflammatory Bowel Disease: Crohn's vs ulcerative colitis (key differentiations: location, depth, bowel habit, surgery curative for UC not Crohn's)
• Hepatitis A, B, C, D, E (transmission, prevention, treatment)
• Cirrhosis: ascites, portal hypertension, hepatic encephalopathy
• Pancreatitis: acute (Cullen's sign, Grey-Turner sign), chronic
• Cholecystitis: Murphy's sign, lap chole post-op care
• Bowel obstruction: small vs large, management
• Intestinal stomas: ileostomy vs colostomy, ostomy care

Renal and Urinary

PRC's program titles don't name renal care, but it ties closely to fluids and electrolytes, so review it with NP III. Drill list:

• Acute Kidney Injury: prerenal, intrinsic, postrenal causes
• Chronic Kidney Disease: stages, management, dialysis indications (AEIOU: acidosis, electrolytes, ingestions, overload, uremia)
• Dialysis: hemodialysis vs peritoneal, access care, complications
• UTI: cystitis, pyelonephritis
• Renal calculi: types, presentation, management
• Glomerulonephritis vs nephrotic syndrome
• BPH and prostate care

Fluid and Electrolytes

Drill list:

• Sodium: hypo (causes, seizure risk if rapid drop), hyper (treat slowly to avoid cerebral edema)
• Potassium: hypo (muscle weakness, flattened T waves, U waves, dysrhythmias), hyper (peaked T waves, wide QRS; treated with calcium gluconate, insulin + glucose, sodium polystyrene sulfonate)
• Calcium: hypo (Trousseau's, Chvostek's signs), hyper
• Magnesium: hypo (seizures), hyper (decreased reflexes)
• Acid-base: ROME mnemonic (Respiratory Opposite, Metabolic Equal), ABG interpretation

Infectious Disease

• Sepsis: SIRS criteria, qSOFA, septic shock
• Common pathogens: MRSA, VRE, C. difficile (contact precautions, no alcohol-based hand rub for C.diff)
• Standard precautions vs transmission-based (contact, droplet, airborne)
• HAI prevention: bundles, hand hygiene
• Antibiotic stewardship basics

Inflammatory and Immunologic

• Rheumatoid Arthritis: morning stiffness, symmetric joints, DMARDs, methotrexate
• SLE: butterfly rash, multi-system involvement, photosensitivity
• HIV/AIDS: transmission, ART, opportunistic infections
• Allergic reactions: anaphylaxis (epinephrine first), graded reactions
• Latex allergy: cross-reactivity (banana, kiwi, avocado)

Cellular Aberrations (Oncology)

• Common cancers: breast, prostate, colorectal, lung, cervical
• Chemotherapy: side effects, neutropenia precautions, extravasation
• Radiation: skin care, fatigue, site-specific care
• Pain management in cancer: WHO ladder, breakthrough pain
• Oncologic emergencies: tumor lysis syndrome, SVC syndrome, spinal cord compression

A 4-week plan

Review with Super Tutor

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What to read next

The NLE guide covers all five Nursing Practice tests. See also the endocrine and neuro-sensory review (NP IV), the psychiatric nursing review (NP V) and the 60% floor rule explainer.