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NLE TEST PLAN

PROFESSIONAL REGULATION COMMISSION-

BOARD OF NURSING

NURSING PRACTICE I
Test Description:

Theories, concepts, principles and processes basic to the practice of

nursing with emphasis on health promotion and health maintenance. It includes
basic nursing skills in the care of clients across age groups in any setting.

Moreover, it encompasses the varied roles, functions and responsibilities

of the professional nurse in varied health care settings.

TEST SCOPE

I. Safe and Quality Care, Health Education, Communication, and

Collaboration and Teamwork

A. The nursing process

B. Basic nursing skills

1. Admission and discharge

2. Vital signs
3. Physical examination and health assessment
4. Administration of medications
5. Asepsis and infection control
6. First aid measures
7. Wound care
8. Peri-operative care
9. Post-mortem care

C. Measures to meet physiological needs

1. Oxygenation
2. Nutrition
3. Activity, rest and sleep
4. Fluid and electrolyte balance
5. Urinary elimination
6. Bowel elimination
7. Safety, comfort and hygiene
8. Mobility and immobility

D. Health Education

1. Teaching and learning principles in the care of clients

2. Health education in all levels
3. Discharge planning

E. Communication

1. Dynamics of communication
2. Nurse-client relationship
3. Professional-professional relationship
4. Therapeutic use of self
5. Use of information technology

F. Collaboration and Teamwork

1. Networking
2. Inter-agency partnership
3. Teamwork strategies
4. Nursing and partnership with other professions and agencies

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II. Ethico-Moral Responsibility and Legal Responsibility

A. Bioethical principles

1. Beneficence
2. Non-malefescence
3. Justice
4. Autonomy
5. Stewardship
6. Truth telling
7. Confidentiality
8. Privacy
9. Informed consent

B. Patients Bill of Rights

C. Code of Ethics in Nursing

D. Legal Responsibility

1. Legal aspects in the practice of nursing

2. The Philippine Nursing Act of 2002 (R.A. 9173)
3. Related laws affecting the practice of nursing

III. Personal and Professional Growth and Development

A. Historical perspectives in nursing

B. Nursing as a profession

C. Theoretical foundation of nursing applied in health care situations

D. Continuing professional education

E. Professional organizations in nursing

F. The nurse in health care

1. Eleven Key Areas of Responsibilities

2. Fields of nursing
3. Roles and functions

IV. Management of Environment and Resources and Environment

A. Theories and principles of management

B. Nursing administration and management

C. Theories, principles and styles of leadership

D. Concepts and principles of organization

E. Patient care classification

F. Nursing care systems

G. Delegation and accountability

H. Records Management

1. Anecdotal report
2. Incident report
3. Memorandum
4. Hospital manual
5. Documentation
6. Endorsement and end-of-shift report
7. Referral

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V. Quality Improvement and Research

A. Standards of nursing practice

B. Nursing audit

C. Accreditation/certification in nursing practice

D. Quality assurance

E. Research

1. Problem identification
2. Ethics and science of research
3. The scientific approach
4. Research process
5. Research designs and methodology
a. Qualitative
b. Quantitative

6. Utilization and dissemination of research findings

NURSING PRACTICE II
Test Description :

Theories, concepts, principles and processes in the care of individuals,

families, groups and communities to promote health and prevent illness, and
alleviate pain and discomfort, utilizing the nursing process as framework. This
includes care of high risk and at-risk mothers, children and families during the
various stages of life cycle.

TEST SCOPE

Part I: CHN

I. Safe & Quality Care, Health Education, and Communication,

Collaboration and Teamwork

A. Principles and Standards of CHN

B. Levels of Care

C. Types of Clientele

D. Health Care Delivery System

E. PHC as a Strategy

F. Family-based Nursing Services (Family Health Nursing Process)

G. Population Group-based Nursing Services

H. Community-based Nursing Services/Community Health Nursing Process

I. Community Organizing

COMMUNITY ORGANIZING
from the lecture of Prof. Gerardo P. Andamo of The Royal Pentagon Review Specialists, Inc.

COMMUNITY ORGANIZING a continuous and sustained (i.e. never-ending) process of

awareness-raising, organizing, and mobilizing.
Awareness
Basic Concepts and Principles primary motivation
Based on concrete analysis of actual situation to action
Basic trust on the people
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By, for, with, and among the people

Anyone is capable of change
Self-willed changes have more meaning than imposed ones

Context of Community Organizing (CO): Current situation

towards the poor, deprived, oppressed (i.e. not all)
but struggling segments of the society

Goal of Community Organizing (CO): Community Development the creation of a society that
provides equal access to all benefits and opportunities the society can offer to the people

Application of CO in Health: PRIMARY HEALTH CARE

PRIMARY HEALTH CARE

- Essential care (i.e. not alternative)
- Based on scientifically sound and socially acceptable methods and
technology
- Made universally available to individuals, families, and communities
- At a cost they can afford at any given stage of their development
- Through their full participation
- Towards self- reliance and self-determination

Major Pillars of Primary Health Care

a. Multi-sectoral approach (inter- and intra-sectoral linkages)
b. Peoples participation
Partnership or shared leadership; minimum level of peoples
participation
c. Appropriate technology underwent experimentation and with high empirical
COMMUNITY ORGANIZING IN HEALTH
basis;
Two types of community:
e.g. herbal medicine and accupressure
a.d. Support
Organizedmechanism
communitymade
withavailable
peoples organization
b. Virgin community without peoples organization

Phases of CO:
1. SOCIAL INVESTIGATION
Preliminary Investigation
- done before entry to community
- secondary data sources are utilized
- baseline information from secondary data sources (e.g. Records Review)
Deepening Social Investigation
- continuous appraisal of community situation through primary data sources
2. ENTRY low-key or low-profile approach
Upon entry, start the following:
a. Deepening Social Investigation
b. Social Preparation
c. Community Integration
3. SOCIAL PREPARATION tampering the grounds for setting up health programs
Target: community leaders
- Establish rapport, develop trust, clarify intentions and expectations
- Starts upon entry, ends with launching
Methods: courtesy call and attendance to meetings
4. COMMUNITY INTEGRATION imbibing the community way of life
Target: community
- Deepen rapport, develop mutual trust, draw objectives
Methods: house-to-house, going to places where people are, direct participation
in the production process (best method)
5. SMALL GROUP FORMATION
- cluster of 8-15 households
- manageable units
- data processing of community diagnosis is being done
6. ELECTION OF CHWs

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7. LAUNCHING social preparation ends

8. COMMUNITY DIAGNOSIS
Outcome: Problems and needs of the people
9. TRAINING AND SERVICES
Advanced community health workers have the leadership traits
10. CORE GROUP FORMATION
- Group of advanced CHWs
11. PHASE OUT so that people can practice self-reliance
- Provide opportunity for the health workers to stand on their own
Indicator of Phase-out: Advanced CHWs are able to assume staff level functions

COMMUNITY ORGANIZING PROCESS

PRE-ENTRY
1. Site selection
2. Preliminary Social Investigation
ENTRY
1. Social preparation
2. Community integration
3. Deepening social investigation
ORGANIZATION FORMATION PHASE
1. Small group formation
2. Election of CHW (women; middle-aged; married)
3. Organizational meetings - to clarify matters
TRAINING PHASE
1. Training needs assessment COMMUNITY DIAGNOSIS
2. Curriculum development based on problems identified
3. Actual training
4. Training evaluation
SERVICES PHASE
1. Community clinics
2. Other services
LEADERSHIP FORMATION PHASE
1. Core group formation
2. Advanced training
CONSOLIDATION PHASE
1. Evaluation session
2. Staff development
SUSTENANCE AND MAINTENANCE PHASE
1. Endorsement to sectoral organizing
2. Formation of regional coordinating bodies
PHASE OUT

J. Public Health Programs

II. Research and Quality Improvement

A. Research in the Community

B. National Health Situation

C. Vital Statistics

D. Epidemiology

E. Demography

III. Management of Resources & Environment and Records

Management

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A. Field Health Services and Information System

B. Target-setting

C. Environmental Sanitation

IV. Ethico-Moral-Legal Responsibility

A. Socio-cultural values, beliefs, and practices of individuals,

families, groups and communities.

B. Code of Ethics for Government Workers

C. WHO, DOH, LGU policies on health

D. Local Government Code

E. Issues

V. Personal and Professional Development

A. Self-assessment of CHN competencies, importance, methods

and tools

B. Strategies and methods of updating ones self, enhancing

competence in community health nursing and related areas.

Part II: MCN

I. Safe & Quality Care, Health Education, and Communication,

Collaboration and Teamwork

A. Principles and Theories of Growth and Development

B. Nursing Care in the Different Stages of Growth and

Development including

a. Nutrition
b. Safety
c. Language development
4. Discipline
5. Play
6. Immunization
7. Anticipatory guidance
8. Values formation

C. Human Sexuality and Reproduction including Family

Planning

D. Nursing Care of Women during Normal Labor, Delivery and

Postpartum

E. Nursing Care of the Newborn

1. APGAR scoring
2. Newborn screening
3. Maintenance of body processes (oxygenation, temperature, etc.)

F. Nursing Care of Women with complications of pregnancy, labor, delivery and

postpartum period (High-risk conditions)

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G. Nursing Care of High-Risk Newborn

1. Prematurity
2. Congenital defects
3. Infections

H. Nursing Care of Women with disturbances in reproduction and gynecology

II. Research and Quality Improvement

A. Fertility Statistics

B. Infant Morbidity and Mortality

C. Maternal Mortality

D. Standards of Maternal and Child Nursing Practice

III. Management of Resources and Record Management

A. Home-Based Mothers Record

B. Under Five Clinic Record

IV. Ethico-Moral-Legal Responsibility

A. Socio-cultural values, beliefs, and practices of individuals, families related to

MCN

B. WHO, DOH, LGU policies on health

C. Family Code

D. Child and Youth Welfare Code

E. Issues related to MCN

V. Personal and Professional Development

A. Self-assessment of MCN competencies, importance, methods and

tools

B. Strategies and methods of updating ones self, enhancing

competence in MCN and related areas.

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NURSING PRACTICE III, IV, and V

Test Description :

Theories, concepts, principles and processes in the care of clients with

altered health patterns, utilizing the nursing process and integrating the key
areas of nursing competencies.

TEST SCOPE

I. Safe & Quality Care, Health Education, Communication, Collaboration

and Teamwork

Test III

A. Client in Pain

B. Perioperative Care

C. Alterations in Human Functioning

1. Disturbances in Oxygenation
2. Disturbances in Metabolic and Endocrine Functioning
3. Disturbances in Elimination

Test IV

A. Alterations in Human Functioning

1. Disturbances in Fluids and Electrolytes

Fluids in Human Body

I. Fluid Status of Human Body

A. Homeostasis: state of the body when maintaining a state of balance in the presence
of constantly changing conditions
B. Includes balance of fluid, electrolytes, and acid-base balance
C. Body water intake and output approximately equal (2500 mL/24 hr.)

Adult body: 40L water, 60% body weight

2/3 intracellular
1/3 extracellular (80% interstitial, 20% intravascular)
Infant: 70-80% water
Elderly: 40-50% water

II. Body Fluid Composition

A. Water: 60% of body weight
B. Electrolytes: substances that become charged particles in solution
1. Cations: positively charged (e.g. Na+, K+)
2. Anions: negatively charged (e.g. Cl-)
3. Both are measured in milliequivalents per liter (mEq/L)
C. Osmolality: concentration of a solution measured in milliosmoles per liter
D. Balance of hydrostatic pressure and osmotic pressure regulates movement of water
between intravascular and interstitial spaces

III. Body Fluid Distribution:

A. 2 body compartments:
1. Intracellular fluids (ICF): fluids within cells of body [major intracellular
electrolytes: Potassium (K+), Magnesium (Mg +2)]
2. Extracellular fluids (ECF): fluid outside cells; [major extracellular
electrolytes: Sodium (Na+), Chloride(Cl-)]; this is where transportation of
nutrients, oxygen, and waste products occurs

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B. Locations of ECF:
1. Interstitial: fluid between most cells

2. Inflammatory and Infectious Disturbances

3. Disturbances in Immunologic Functioning

4. Disturbances in Cellular Functioning
5. Client in Biologic Crisis

6. Emergency and Disaster Nursing

TERM USE:
Trauma
-Intentional or unintentional wounds / injuries on the human body from
particular mechanical mechanism that exceeds the bodys ability to protect itself
from injury.
Emergency Management
-Traditionally refers to care given to patient with urgent and critical needs.
Triage
-Process of assessing patients to determine management priorities.
First Aid
-An immediate or emergency treatment given to person who has been injured
before complete medical and surgical treatment can be secured.
BLS (BASIC LIFE SUPPORT)
-Level of medical care which is used for patient with illness or injury until medical
care can be given.
ACLS
-Set of clinical interventions for the urgent treatment of cardiac arrest and often
life threatening medical emergencies as well as the knowledge and skills to
deploy those interventions.
Defibrillation
-Restoration of normal rhythm to the heart in ventricular or atrial fibrillation.
Disaster
-Any catastrophic situation in which the normal patterns of life (or ecosystems)
have been disrupted and extraordinary emergency, interventions are required to
save and preserve human lives and/or the environment.
Mass Casualty Incident
-Situation in which the number of casualties exceeds the number of resources
Post-Traumatic Stress Syndrome
-Characteristic of symptoms after a psychological stressful event was out of
range of a normal human experience

SCOPE AND PRACTICE OF EMERGENCY NURSING

The emergency nurse has had specialized education, training, and
experience.
The emergency nurse establishes priorities, monitors and continuously
assesses acutely ill and injured patients, supports and attends to families,
supervises allied health personnel, and teaches patients and families
within a time-limited, high pressured care environment.
Nursing interventions are accomplished interdependently, in consultation
with or under the direction of a licensed physician.
Appropriate nursing and medical interventions are anticipated based on
assessment data.
The emergency health care staff members work as a team in performing
the highly technical, hands-on skills required to care for patients in an
emergency situation.
Patients in the ED have a wide variety of actual or potential problems, and
their condition may change constantly.
Although a patient may have several diagnosis at a given time, the focus
is on the most-life threatening ones.

ISSUES IN EMERGENCY NURSING CARE

Emergency nursing is demanding because of the diversity of conditions
and situations which are unique in the ER.
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Issues include legal issue, occupational health and safety risk for ED staff,
and the challenge of providing holistic care in the context of fast-paced,
technology-driven environment in which serious illness and death are
confronted on a daily basis.
The emergency nurse must expand his or her knowledge base to
encompass recognizing and treating patients and anticipate nursing care
in the event of a mass casualty incident.
Legal issues include:
-Actual consent
-Implied consent
-Parental consent
Good Samaritan Law
-Gives legal protection to the rescuer who act in good faith and are not
guilty of gross negligence or willful misconduct.

Focus of Emergency Care

Preserve or Prolong life
Alleviate suffering
Do no further harm
Restore to Optimal Function

Golden Rules of Emergency Care

Dos
-Obtain Consent
-Think of the Worst
-Respect Victims Modesty and Privacy
Donts
-let the patient see his own injury
-Make any unrealistic promises

Guidelines in Giving Emergency Care

o A- Ask for help
o I- Intervene
o D- Do no further harm

Stages of Crisis
1. Anxiety and Denial
-encouraged to recognize and talk about their feelings.
-asking questions is encouraged
-honest answers given
-prolonged denial is not encouraged or supported.
2. Remorse and Guilt
-verbalize their feelings
3. Anger
-way of handling anxiety and fear
-allow the anger to be ventilated
4. Grief
-help family members work through their grief
-letting them know that it is normal and acceptable

Core Competencies in Emergency Nursing

Assessment
Priority Setting/Critical Thinking Skills
Knowledge of Emergency Care
Technical Skills
Communication

Assess and Intervene

Check for ABCs of life
A- Airway
B- Breathing
C- Circulation

Team Members
Rescuer
Emergency Medical Technician
Paramedics
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Emergency Medicine Physicians

Incident Commander
Support Staff
Inpatient Unit Staff

Emergency Action Principle

Test V

A. Disturbances in Perception and coordination

1. Neurologic disorders
NEUROLOGIC SYSTEM
*The neurological or nervous system is composed of two primary areas:
The Central Nervous System, which includes the brain and the spinal
cord, and the Peripheral Nervous System, which includes the entire
network of nerves extending from the Central Nervous System.

PHYSIOLOGY OF NEUROLOGICAL SYSTEM

Central Nervous System
The brain and the spinal cord within the vertebral column make up the central
nervous system (CNS).
A. The brain and the spinal cord are protected by the rigid bony structure of
the skull and by the vertebral column, respectively

-Spinal Cord serves as a connecting link between the brain and the
periphery.

B. Meninges: the protective membranes that cover the brain and are
continuous with those of the spinal cord.

PIA MATER: covers the surface of the brain and the spinal column
ARACHNOID: waterproof membrane that encases the entire CNS; the
subarachnoid space contains the cerebrospinal fluid.
DURA MATER: a tough membrane that provides protection to the brain
and spinal cord.

C. Cerebrospinal Fluid (CSF)

1. Serves to cushion and protect the brain and spinal cord; the brain
literally floats in CSF.
-Surrounds brain and spinal cord
-Offer protection by functioning as a shock absorber.
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2. CSF is clear, colorless, watery fluid; approximately 100- to 200-ml

Total volume, with a normal fluid pressure of 70 to 150 cm of water
(average: 125 cm of water pressure).
3. Formation and circulation of CSF: CSF is formed continuously by the
choroid plexus located in the ventricles of the brain. It is reabsorbed
by the arachnoid villi in the ventricles at the same rate it is formed.
-Allows fluid shifts from the cranial cavity to the spinal cavity.
-Carries nutrients to & waste product away from the nerve cells.
4. Components of CSF: CHON, WBC, Glucose.

Brain: The basic brain anatomy consists of the cerebrum, the

cerebellum, the brain stem, and the interior structures.
1. Cerebrum:
-The largest portion of the brain; separated into hemispheres. Each
hemisphere is divided into four lobes: frontal, parietal, occipital, and
temporal.
-outermost area (cerebral cortex) is gray matter.

-deeper area is composed of white matter

-Function of Cerebrum: integration, sensory, motor

-Composed of two hemisphere: The Right Cerebral Hemisphere and

Left Cerebral Hemisphere enclosed in the Corpus Callosum.

-Each hemisphere divided into four lobes; many of the functional

areas of the cerebrum have been located in these lobes:
a. Frontal Lobe: memory, language, personality and emotions are
primarily controlled here; highly vulnerable to traumatic brain injury.
-controls personality, behavior
-higher cortical thinking, intellectual functioning
-Precentral gyrus: controls motor function
-Brocas Area: specialized motor speech area- when damaged result
to garbled speech.
b. Temporal Lobe: controls auditory, verbal, visual, memory and
personality functions.
-hearing, taste, smell
-short term memory
-Wernickes Area: sensory speech area (understanding/formulation
of language).
c. Parietal Lobe: integrates sensory information and interprets spatial
relationships.
-for appreciation
-integrates sensory information
-discrimination of sensory impulses to pain, touch, pressure, heat,
cold, numbness.
-Postcentral gyrus: registered general sensation (ex. Touch,
pressure)
d. Occipital Lobe: central for visual perception and integration.
-for vision
e. some functions of the brain occur in more than one lobe.

2. Cerebellum:
-contains more neurons than the rest of the brain combined. It serves
to interpret motor and mental dexterity, as well as sense of balance.
-smallest part of the brain, lesser brain.
-coordinates muscle tone and movements and maintains position in
space (equilibrium)
-controls balance, equilibrium, posture and gait.

3. Brain Stem:
-conduit for all information transmission between upper and lower
nervous system. Consists of Pons Midbrain, and Medulla.
-located at lowest part of brain.
-extends from cerebral hemisphere to the foramen magnum at the
base of the skull.

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-contains nuclei of the cranial nerves and the long ascending and
descending tracts connecting the cerebrum and the spinal cord.
-contains vital center of respiratory vasomotor, and cardiac functions.
a. Pons: responsible for alertness; relays sensory information between
cerebellum and cerebrum.
-Pneumotaxic center controls the rate, rhythm and depth of
respiration.
b. Midbrain: interprets auditory and visual reflexes.
c. Medulla Oblongata: lower portion of the brain stem. Controls
autonomic functions.
1. Respiratory center for changes in rate and depth of breathing.
2. Controls heart rate.
3. Vomiting reflex center
4. Swallowing reflex center.
-controls respiration, heart rate, swallowing, vomiting, hiccup,
vasomotor center (dilation and constriction of bronchioles).

2. Sensory disorders

3. Musculoskeletal disorders

4. Degenerative disorders

B. Maladaptive Patterns of Behavior

1. Anxiety Response and anxiety related disorders

ANXIETY RESPONSE AND ANXIETY RELATED DISORDER

2. Psychophysiologic responses, somatoform and sleep disorders

3. Abuse and violence
4. Emotional responses and mood disorders
5. Schizophrenia and other psychotic and mood disorders
6. Social responses and personality disorders
7. Substance related disorders
8. Eating disorders
9. Sexual Disorders
10. Emotional disorders of infants, children and adolescents

II. Communication, Collaboration & Teamwork

A. Team Approach

B. Referral

C. Network/Linkage

D. Therapeutic communication

III. Ethico-Moral-Legal Responsibility

A. Confidentiality

B. Clients Rights

1. Informed consent
2. Refusal to take medications, treatment and admission procedures

C. Nursing accountability, liability

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D. Documentation/Charting

E. Culture sensitivity

III. Personal & Professional Development

A. Nurse-Client Relationship

B. Continuing Education

IV. Research and Quality Improvement

A. Evidence-based Practice

B. Standards of Safe Practice

V. Management of Resources, Environment and Record Management

A. Patient Safety

B. Standards of Documentation

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