NLE NP1: Cardio, Respiratory, GI, Renal, Oncology Review

NLE NP1: Cardio, Respiratory, GI, Renal, Oncology Review

NP1 is the heaviest NLE subtest by content volume. The full title — Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious Disease, Inflammatory and Immunologic Response, Cellular Aberrations, Acute and Chronic — covers most of medical-surgical nursing in a single 100-item paper.

For BSN graduates with strong med-surg rotations, NP1 should be the highest-scoring subtest. For graduates whose med-surg exposure was thin, it's where the most ground needs to be made up.

This post is the topic-level plan that the NLE 2026 pillar guide hands off to.

What PRC actually asks

Approximate item distribution across the 100 NP1 items:

The cardiovascular block alone is a quarter of the subtest. Drill it first and deepest.

Cardiovascular

Drill list:

Dysrhythmias (heavily tested):

• 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: recognise on 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: MONA (morphine, oxygen, nitroglycerin, aspirin)
• 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

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

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 oedema)
• Potassium: hypo (cardiac dysrhythmias, peaked T waves on hyper), hyper (peaked T, wide QRS, treatment with calcium gluconate, insulin+glucose, kayexalate)
• 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 NP1 drilling plan

Realistic NP1 scores

Most BSN graduates score 70-80 on diagnostic NP1. The ceiling is high for prepared candidates.

Where Super Tutor fits

Super Tutor's NLE NP1 track covers the full medical-surgical scope with item drilling sequenced by system. Free tier opens cardiovascular and respiratory; the Focused plan (₱49/week, ₱249/month, ₱1,999/year) opens the rest plus mocks.

What to read next

The NLE 2026 pillar guide covers the five Nursing Practices. Other subtest plans: NP4 Mental Health, and the 60% floor trap guide.