NLE NP3: Endocrine, Neuro, Sensory, Integumentary Review

NLE NP3: Endocrine, Neuro, Sensory, Integumentary Review

NP3 covers what doesn't fit in NP1 — endocrine, neurological, sensory, integumentary, plus advanced GI/nutrition/metabolism content. The full title is Care of Clients with Problems in Nutrition and GI/Metabolism, Endocrine, Perception and Coordination, Acute and Chronic.

For BSN candidates with strong med-surg foundations, NP3 should score similarly to NP1. The block where most candidates lose ground is endocrine — specifically diabetes management, which carries 8-12 items per cycle.

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 NP3 items:

Endocrine — diabetes dominates

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 — memorise
• 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:

• Generalised 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 (paediatric 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 manoeuvre

Integumentary

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, Colour, 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 (overlap with NP4)

Metabolic

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

A 4-week NP3 drilling plan

Realistic NP3 scores

Where Super Tutor fits

Super Tutor's NLE NP3 track covers endocrine through musculoskeletal with item drilling. Free tier opens diabetes and stroke; the Focused plan (₱49/week, ₱249/month, ₱1,999/year) opens the rest plus mocks.

What to read next

The NLE 2026 pillar guide anchors the full review. Other subtest plans: NP1, NP2, NP4.