Medical-Surgical Nursing Reviewer for NLE Philippines 2026

Medical-Surgical Nursing is the largest and most content-heavy subject in the PNLE. It covers nursing care of adult patients across all major body systems and accounts for the bulk of Part 2B of the exam.

The sheer volume of content in MedSurg intimidates a lot of examinees. The key to reviewing it effectively is not trying to memorize every disease condition in existence but mastering the nursing process approach for the most commonly tested conditions across each body system. This reviewer covers the highest-yield topics organized by body system.

The Nursing Process: Your Framework for Every MedSurg Question

Before diving into specific conditions, internalize this principle: almost every MedSurg NLE question tests one step of the nursing process. When you read a question, identify which step it is asking about.

Cardiovascular Nursing

Heart Failure

Heart failure occurs when the heart cannot pump enough blood to meet the body's needs. Know the difference between left-sided and right-sided heart failure.

Left-sided heart failure causes pulmonary congestion. Key signs: dyspnea, orthopnea, paroxysmal nocturnal dyspnea, crackles in the lungs, pink frothy sputum in severe cases.

Right-sided heart failure causes systemic congestion. Key signs: peripheral edema (ankles and legs), jugular vein distension, hepatomegaly, ascites.

Priority nursing diagnosis: Decreased cardiac output related to altered myocardial contractility.

Key nursing interventions: Semi-Fowler's or high Fowler's position to ease breathing. Daily weight monitoring (report weight gain of more than 1 kg in a day or 2 kg in a week). Fluid restriction. Sodium restriction. Administer diuretics and monitor electrolytes.

Myocardial Infarction (MI)

MI occurs when a coronary artery is blocked, causing ischemia and necrosis of heart muscle.

Classic signs: Crushing, squeezing chest pain radiating to the left arm, jaw, or back. Not relieved by rest or nitroglycerin. Associated with diaphoresis, nausea, and pallor.

Atypical presentation in women and diabetics: Fatigue, shortness of breath, indigestion, or no chest pain. Know this because the NLE tests it.

Priority action: Administer oxygen, nitroglycerin (if SBP above 90 mmHg), and morphine. Aspirin 325 mg chewed immediately. Place patient on cardiac monitor.

Enzyme markers: Troponin I and T are the most specific markers for myocardial damage. They rise within 3 to 6 hours and remain elevated for 7 to 14 days.

Respiratory Nursing

Tuberculosis (TB)

TB is a priority health concern in the Philippines and appears in both MedSurg and CHN sections of the NLE.

Transmission: Airborne via droplet nuclei. Isolation: negative pressure room, N95 respirator for healthcare workers.

Classic signs: Productive cough lasting more than 2 weeks, hemoptysis, night sweats, weight loss, low-grade afternoon fever.

DOTS (Directly Observed Treatment Short-course):

• Intensive phase: 2 months of HRZE (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol)
• Continuation phase: 4 months of HR (Isoniazid, Rifampicin)

Key side effects to teach: Rifampicin causes orange-red discoloration of urine, sweat, and tears (normal, not harmful). Isoniazid causes peripheral neuropathy (give Vitamin B6 as prophylaxis). Ethambutol causes optic neuritis (monitor vision).

Chronic Obstructive Pulmonary Disease (COPD)

COPD is a progressive lung disease including emphysema and chronic bronchitis.

Emphysema: Destruction of alveolar walls. Pink Puffer appearance: barrel chest, pursed lip breathing, use of accessory muscles.

Chronic Bronchitis: Excessive mucus production. Blue Bloater appearance: cyanosis, productive cough, peripheral edema from cor pulmonale.

Critical nursing point: Do not administer high-flow oxygen to COPD patients. They rely on hypoxic drive to breathe. Use low-flow oxygen at 1 to 2 L/min via nasal cannula.

Neurological Nursing

Stroke (Cerebrovascular Accident)

Ischemic stroke: Caused by blood clot blocking cerebral artery. Treatment: tPA (tissue plasminogen activator) within 3 to 4.5 hours of symptom onset if no contraindications.

Hemorrhagic stroke: Caused by rupture of a cerebral blood vessel. tPA is contraindicated.

Signs of stroke (FAST): Face drooping, Arm weakness, Speech difficulty, Time to call emergency services.

Nursing priority: Airway maintenance. Position head of bed at 30 degrees to reduce intracranial pressure. Monitor for increased ICP: Cushing's triad (hypertension with widened pulse pressure, bradycardia, irregular respirations).

Increased Intracranial Pressure (ICP)

Early signs: Headache, vomiting (often projectile), altered level of consciousness, pupillary changes.

Cushing's Triad (late and ominous sign): Hypertension (widened pulse pressure), bradycardia, and irregular respirations. This is a medical emergency.

Nursing interventions: Elevate head of bed 30 to 45 degrees. Keep head in neutral alignment. Avoid anything that increases ICP: Valsalva maneuver, coughing, straining, hip flexion.

Gastrointestinal Nursing

Peptic Ulcer Disease

Duodenal ulcer: Pain relieved by food. Most common type.

Gastric ulcer: Pain worsened by food.

H. pylori is the most common cause of peptic ulcers. Treatment includes triple therapy: two antibiotics plus a proton pump inhibitor.

Complication to watch for: Perforation presents as sudden severe abdominal pain, rigid board-like abdomen, and signs of shock. This is a surgical emergency.

Liver Cirrhosis

Key complications:

Portal hypertension leads to esophageal varices (risk of massive hemorrhage), ascites (fluid accumulation in abdomen), and splenomegaly.

Hepatic encephalopathy results from accumulation of ammonia. Signs: asterixis (flapping tremor), confusion, altered consciousness.

Nursing priority for varices: Avoid anything that increases portal pressure. No straining, no heavy lifting. Soft foods. Monitor for signs of bleeding.

For hepatic encephalopathy: Restrict dietary protein. Administer lactulose to reduce ammonia absorption. Monitor neurological status.

Renal Nursing

Acute Kidney Injury (AKI)

AKI is a sudden decrease in kidney function. Three types based on cause.

Prerenal: Caused by decreased blood flow to kidneys (dehydration, shock, heart failure). Treated by restoring fluid volume.

Intrarenal: Caused by damage within the kidney itself (nephrotoxic drugs, contrast dye, glomerulonephritis).

Postrenal: Caused by obstruction to urine flow (kidney stones, enlarged prostate, tumor).

Oliguric phase: Urine output less than 400 mL per day. Monitor for hyperkalemia (peaked T waves on ECG), fluid overload, metabolic acidosis.

Nursing priority: Strict intake and output monitoring. Daily weight. Restrict potassium, sodium, and fluid.

Normal Lab Values Quick Reference

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Practice What You Just Learned

Medical-Surgical Nursing has too much content to master through reading alone. You need to practice applying the nursing process to scenario questions across every body system.

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