NLE NP IV Review: Endocrine, Metabolism, Neuro and Sensory Care

NLE NP IV Review: Endocrine, Metabolism, Neuro and Sensory Care

Nursing Practice IV is the first test on Day 2 of the NLE (8:00–10:00 a.m., 2 hours). The PRC program titles it Care of Clients with Problems in Nutrition, GI, Metabolism & Endocrine, Perception & Coordination. So it covers diabetes, thyroid, adrenal and pituitary disorders, GI and nutrition, and neurologic and sensory care. (GI is covered in the med-surg review.)

PRC doesn't publish an item breakdown by topic. Diabetes care is a big, detailed area, so give it real time. This post goes with the NLE guide.

Endocrine: start with diabetes

Diabetes Mellitus:

• Type 1 vs Type 2: pathophysiology, presentation, age of onset
• Diagnostic criteria: fasting glucose ≥126, HbA1c ≥6.5%, OGTT ≥200, random + symptoms
• Insulin types: rapid (lispro, aspart), short (regular), intermediate (NPH), long (glargine, detemir)
• Insulin onset/peak/duration tables — memorize
• Sliding scale vs basal-bolus regimens
• Oral hypoglycemics: metformin (no contrast use), sulfonylureas (hypoglycemia risk), DPP-4, SGLT-2, GLP-1 agonists
• Hypoglycemia: management (15-15 rule), unconscious patient (glucagon, D50)
• DKA: hyperglycemia + ketosis + acidosis + dehydration. Management: fluids, insulin drip, K+ monitoring
• HHS: similar but no ketosis, more severe hyperglycemia
• Sick day rules
• Microvascular vs macrovascular complications
• Foot care education

Thyroid:

• Hyperthyroidism (Graves): symptoms, thyroid storm management, antithyroid drugs (PTU, methimazole)
• Hypothyroidism (Hashimoto's): symptoms, levothyroxine (take in morning, empty stomach)
• Myxedema coma vs thyroid storm

Adrenal:

• Addison's disease: hyperpigmentation, hypotension, hyponatremia, hyperkalemia, glucocorticoid replacement
• Cushing's syndrome/disease: moon face, buffalo hump, central obesity, hyperglycemia
• Pheochromocytoma: episodic HTN, headache, palpitations
• Adrenal crisis management

Pituitary:

• Diabetes insipidus: polyuria, polydipsia, hypernatremia, desmopressin
• SIADH: fluid retention, hyponatremia, fluid restriction
• Acromegaly, gigantism

Neurological

Drill list:

Stroke:

• Ischemic vs hemorrhagic — distinction is critical for treatment
• Symptoms by location (left vs right hemisphere, anterior vs posterior circulation)
• FAST mnemonic
• TPA window: <3-4.5 hours from symptom onset, contraindications
• Nursing care post-stroke: positioning, swallowing assessment, communication, safety
• Rehabilitation: speech, OT, PT

Seizures:

• Generalized vs focal
• Tonic-clonic management: protect from injury, side-lying, no objects in mouth, time the seizure
• Status epilepticus: medical emergency, IV benzodiazepines first
• Common antiseizure drugs: phenytoin (gingival hyperplasia, narrow therapeutic range), valproate, carbamazepine, levetiracetam

Head injury:

• ICP monitoring: signs of increased ICP (Cushing's triad: bradycardia, hypertension, irregular respirations)
• Concussion vs contusion vs hematoma (subdural vs epidural)
• Cervical spine precautions

Spinal cord injury:

• Levels and corresponding loss of function
• Autonomic dysreflexia (lesions T6 and above): hypertensive crisis from noxious stimulus below lesion. Management: sit upright, identify and remove cause (often bladder distension)
• Spinal shock vs neurogenic shock

Neurodegenerative:

• Parkinson's: TRAP (tremor, rigidity, akinesia, postural instability), levodopa-carbidopa, on-off phenomenon
• Multiple Sclerosis: relapsing-remitting most common, exacerbations, immunomodulators
• Myasthenia Gravis: muscle weakness worsening with use, anticholinesterase drugs (pyridostigmine), myasthenic vs cholinergic crisis
• Guillain-Barré: ascending paralysis, supportive care, plasmapheresis
• Alzheimer's: progressive cognitive decline, safety, family support

Headaches:

• Migraine: triggers, prophylaxis, abortive treatments
• Cluster: men, severe unilateral
• Tension: bilateral, dull
• Red flag headaches: sudden severe ("worst of life") = SAH

Sensory — eye

Drill list:

• Cataract: gradual vision loss, surgical removal
• Glaucoma: open-angle (chronic, IOP rises slowly) vs angle-closure (acute, emergency)
• Glaucoma medications: prostaglandin analogues, beta-blockers, alpha-agonists
• Macular degeneration: dry vs wet, central vision loss
• Retinal detachment: floaters, flashes, curtain over vision, emergency
• Diabetic retinopathy
• Conjunctivitis: bacterial vs viral vs allergic

Sensory — ear

• Otitis media (pediatric and adult)
• Otitis externa
• Meniere's disease: triad of vertigo, tinnitus, hearing loss; low-salt diet, diuretics
• Hearing loss: conductive vs sensorineural
• Tinnitus
• Vertigo: BPPV, Epley maneuver

Integumentary and musculoskeletal

PRC's NP titles don't name skin or musculoskeletal care. Burns overlap with the emergency content of NP V, and orthopedic surgery with NP III, so review them here once and revisit them with those tests. Drill list:

Burns:

• Classification: superficial, partial-thickness, full-thickness
• Rule of nines for adults; modified for children (head proportionally larger)
• Parkland formula: 4 mL × kg × % TBSA over 24 hours; half in first 8h
• Inhalation injury suspicion (face/neck burns, soot in airways)
• Burn shock, escharotomy, infection prevention

Skin cancer:

• Basal cell vs squamous cell vs melanoma
• ABCDE for melanoma: Asymmetry, Border, Color, Diameter, Evolving

Wound care:

• Pressure injury staging (1-4, unstageable, deep tissue)
• Wound assessment
• Dressing selection by wound type
• Negative pressure wound therapy

Common skin conditions:

• Cellulitis
• Eczema
• Psoriasis
• Herpes zoster (shingles)

Musculoskeletal

• Fractures: types, healing stages, casts, traction
• Compartment syndrome: 6 P's (pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia), emergency
• Hip fracture, hip replacement post-op care (avoid hip flexion >90, abduction)
• Osteoarthritis vs Rheumatoid Arthritis (joint involvement, morning stiffness duration, lab findings)
• Osteoporosis: risk factors, prevention, treatment (bisphosphonates — take in morning with water, sit up 30 min)
• Gout: uric acid, allopurinol, colchicine

Advanced GI/Nutrition

• Total Parenteral Nutrition (TPN): central line required, glucose monitoring, refeeding syndrome
• Enteral feeding: tube types, residual checks, aspiration prevention
• Bariatric surgery patient care
• Eating-disorder medical management (overlaps with psychiatric content in NP V)

Metabolic

• Acid-base disorders: deeper analysis with compensation
• Mixed acid-base disorders
• Anion gap calculation
• Electrolyte cascade effects

A 4-week plan

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What to read next

The NLE guide anchors the full review. Other topic reviews: med-surg (NP III and GI), maternal care and development (NP II), psychiatric nursing (NP V).