Introduction
Success in the Philippine Nurse Licensure Examination (PNLE) requires more than memorizing answers. Future nurses must understand the nursing process, prioritize patient safety, and apply clinical judgment in real-life situations.
In this PNLE Practice Questions with Rationales series, each question is discussed in detail to help you understand:
- Assessment
- Nursing Diagnosis
- Planning
- Nursing Interventions
- Evaluation
- Clinical Reasoning
- PNLE Test-Taking Strategies
These discussions are also helpful for NCLEX preparation and classroom examinations.
Table of Contents
- Cardiopulmonary Arrest: What Should the Nurse Do First?
- HIV ELISA Testing in Newborns
- Key Takeaways
- Study Tips
Question 1
Situation
You are on duty in the medical ward. The mother of your patient, who is also a nurse, rushed to the nurses’ station and reported that Fiolo had gone into cardiopulmonary arrest.
What should the nurse do FIRST?
A. Start basic life support measures
B. Call for the Code
C. Bring the crash cart
D. Go to see Fiolo and assess for airway patency and breathing problems
Correct Answer
D. Go to see Fiolo and assess for airway patency and breathing problems
Detailed Nursing Rationale
One of the most important principles in nursing is never rely solely on another person’s report. Even if the patient’s mother is a nurse, the staff nurse must independently assess the patient’s actual condition.
The first step of the nursing process is Assessment.
The nurse should immediately verify whether the patient is:
- Responsive or unresponsive
- Breathing normally
- Has an open airway
- Has a palpable pulse
Once cardiopulmonary arrest is confirmed, the nurse can activate the emergency response system and begin Basic Life Support (BLS).
This question tests your understanding of the Assessment before Intervention principle.
Nursing Process
Assessment
- Check responsiveness.
- Assess airway.
- Determine breathing.
- Assess circulation.
Nursing Diagnosis
- Ineffective Airway Clearance
- Decreased Cardiac Output
- Ineffective Breathing Pattern
Planning
Restore oxygenation and circulation immediately.
Nursing Intervention
- Rapidly assess the patient.
- Activate the code team once arrest is confirmed.
- Begin CPR according to current BLS guidelines.
- Request the crash cart and defibrillator.
- Continue high-quality chest compressions until advanced support arrives.
Evaluation
The desired outcome is restoration of spontaneous circulation (ROSC) and stabilization of airway, breathing, and circulation.
Priority Nursing Intervention
Always verify the patient’s condition first, then activate emergency protocols without delay.
Safety Considerations
- Never assume the patient is in arrest based solely on another person’s statement.
- Follow institutional emergency protocols.
- Document assessment findings and interventions accurately.
- Maintain effective team communication during resuscitation.
Clinical Pearls
- Assessment is always the first step in the nursing process.
- ABC (Airway, Breathing, Circulation) remains the cornerstone of emergency nursing care.
- Early recognition of deterioration improves survival.
Common Mistakes
❌ Calling the Code before confirming the patient’s condition.
❌ Bringing the crash cart without assessing the patient.
❌ Assuming another healthcare worker’s report replaces your own assessment.
PNLE Tips
Whenever the question asks “What should the nurse do FIRST?”, look for the option involving assessment, unless the stem clearly indicates that assessment has already been completed.
Quick Review
✔ Nursing Process starts with Assessment.
✔ ABC always guides emergency priorities.
✔ Verify the patient’s condition before initiating further interventions.
Question 2
Situation
A newborn infant born to a mother with Human Immunodeficiency Virus (HIV) undergoes an ELISA test. The result is positive.
How should the nurse interpret the result?
A. Positive for HIV infection
B. Indicates the presence of maternal infection
C. Indicates absence of maternal infection
D. Negative for HIV infection
Correct Answer
B. Indicates the presence of maternal infection
Detailed Nursing Rationale
A positive ELISA in a newborn does not confirm that the infant is infected with HIV.
Maternal IgG antibodies readily cross the placenta during pregnancy. Therefore, an ELISA performed shortly after birth often detects maternal antibodies, not necessarily infection in the infant.
Because of this passive transfer, antibody-based tests are unreliable during the first months of life.
Instead, virologic tests (such as HIV nucleic acid testing) are used to diagnose HIV infection in infants according to current pediatric HIV guidelines.
Nursing Process
Assessment
- Maternal HIV history
- Infant’s exposure risk
- Feeding method
- Signs of infection
- Laboratory results
Nursing Diagnosis
Risk for Infection related to perinatal HIV exposure.
Planning
Prevent transmission and ensure early diagnosis and treatment if infection is confirmed.
Nursing Intervention
- Explain the meaning of the ELISA result to the family.
- Reinforce follow-up testing as scheduled.
- Administer prescribed antiretroviral prophylaxis if indicated.
- Educate caregivers regarding infant follow-up.
Evaluation
Parents understand that a positive ELISA shortly after birth reflects maternal antibodies and that additional testing is required for diagnosis.
Priority Nursing Intervention
Provide accurate education and reduce parental anxiety through evidence-based explanation.
Safety Considerations
- Avoid giving false reassurance.
- Avoid telling parents the infant definitely has HIV based only on ELISA.
- Encourage adherence to follow-up appointments and prescribed therapy.
Clinical Pearls
- Maternal IgG crosses the placenta.
- ELISA detects antibodies—not the virus itself.
- Virologic testing is required to diagnose HIV infection in infants.
Common Mistakes
❌ Interpreting a positive ELISA as definite HIV infection.
❌ Forgetting passive maternal antibody transfer.
❌ Neglecting follow-up diagnostic testing.
PNLE Tips
When newborn HIV questions involve ELISA, immediately remember:
Positive ELISA = maternal antibodies may be present.
It does not automatically mean the infant is infected.
Quick Review
✔ ELISA detects antibodies.
✔ Maternal antibodies cross the placenta.
✔ Positive ELISA ≠ confirmed infant HIV infection.
✔ Follow-up virologic testing is essential.
Study Tips
- Always answer “FIRST” questions using the nursing process (Assessment before Intervention when appropriate).
- Master the ABC framework for emergency situations.
- Review maternal and newborn concepts, especially passive immunity and antibody transfer.
- Understand the difference between screening tests and confirmatory diagnostic tests.
- Focus on understanding concepts rather than memorizing answer keys.
Question 3
Situation
Ginny works as a registered nurse in a skin clinic where she cares for patients with both communicable and non-communicable skin disorders.
A patient consults the clinic because of psoriasis. Ginny understands that psoriasis is:
A. An infection of the dermis and subcutaneous tissue
B. A contagious inflammatory skin disorder
C. An infection requiring strict isolation
D. A chronic inflammatory skin disorder
Correct Answer
D. A chronic inflammatory skin disorder
Detailed Nursing Rationale
Psoriasis is a chronic, immune-mediated inflammatory skin disease characterized by excessive proliferation of skin cells (keratinocytes). Instead of the normal skin cell turnover of about 28 days, psoriasis causes rapid turnover within approximately 3 to 5 days, resulting in thick, scaly plaques.
One of the most common misconceptions tested in the PNLE is that psoriasis is contagious. It is NOT an infectious disease. Therefore, standard precautions are sufficient, and strict isolation is unnecessary unless another communicable disease is present.
Psoriasis commonly affects:
- Elbows
- Knees
- Scalp
- Lower back
- Nails
Patients typically experience:
- Thick erythematous plaques
- Silvery-white scales
- Pruritus
- Dry, cracked skin
- Nail pitting
- Periods of remission and exacerbation
Stress, infections, certain medications, skin trauma (Koebner phenomenon), smoking, obesity, and alcohol use may trigger flare-ups.
Nursing Process
Assessment
Assess for:
- Location and extent of skin lesions
- Presence of itching or pain
- Signs of secondary infection
- Emotional response and body image concerns
- Joint pain suggestive of psoriatic arthritis
- Triggers that worsen symptoms
Nursing Diagnosis
Possible nursing diagnoses include:
- Impaired Skin Integrity
- Disturbed Body Image
- Chronic Pain
- Risk for Infection (if skin breakdown occurs)
- Ineffective Coping
Planning
Goals include:
- Reduce skin inflammation.
- Maintain skin integrity.
- Relieve itching.
- Prevent secondary infection.
- Improve quality of life.
- Promote adherence to long-term treatment.
Nursing Interventions
- Encourage regular application of prescribed emollients.
- Administer topical corticosteroids or other prescribed medications.
- Teach the patient to avoid scratching lesions.
- Encourage adequate hydration.
- Educate regarding trigger avoidance.
- Provide emotional support for body image concerns.
- Reinforce that psoriasis is chronic but manageable.
Evaluation
Expected outcomes include:
- Reduced inflammation
- Improved skin hydration
- Less itching
- No secondary infection
- Improved coping and treatment adherence
Priority Nursing Intervention
Educate the patient that psoriasis is a non-contagious chronic inflammatory disorder requiring long-term management rather than cure.
Safety Considerations
- Avoid harsh soaps that dry the skin.
- Monitor for signs of infection if lesions crack.
- Encourage adherence to prescribed medications.
- Advise patients not to discontinue corticosteroids abruptly without medical advice.
Clinical Pearls
- Psoriasis is immune-mediated, not infectious.
- It often follows a pattern of exacerbations and remissions.
- Stress management plays an important role in controlling flare-ups.
- Nail pitting is a classic manifestation.
- Some patients develop psoriatic arthritis.
Common Mistakes
❌ Thinking psoriasis is contagious.
❌ Placing patients under unnecessary isolation.
❌ Confusing psoriasis with cellulitis or fungal infections.
❌ Ignoring the psychological effects of chronic skin disease.
PNLE Tips
Whenever the choices include infection versus chronic inflammatory disorder, remember:
Psoriasis = Chronic inflammatory disease, NOT an infection.
Quick Review
✔ Autoimmune/immune-mediated disease
✔ Chronic inflammatory disorder
✔ Not contagious
✔ Silvery scales
✔ Extensor surfaces commonly affected
✔ Long-term management required
Question 4
Situation
An ICU nurse is caring for a 60-year-old patient with Parkinson’s disease who has experienced repeated hospitalizations due to electrolyte imbalance, falls, fecal incontinence, skin breakdown, and respiratory infection.
The nurse wants to gain a deeper understanding of patients’ experiences with fecal incontinence and strengthen a literature report.
Which research method is most appropriate?
A. Historical research
B. Qualitative research
C. Experimental research
D. Quantitative research
Correct Answer
B. Qualitative research
Detailed Nursing Rationale
Qualitative research seeks to understand human experiences, perceptions, emotions, beliefs, behaviors, and lived experiences rather than measuring numbers.
In this situation, the nurse wants to understand:
- How patients experience fecal incontinence
- The emotional impact
- Coping strategies
- Challenges in daily living
- Quality of life
These questions cannot be answered adequately through statistics alone.
Qualitative research commonly uses:
- Interviews
- Focus groups
- Observations
- Narrative analysis
- Phenomenological studies
By contrast:
- Quantitative research measures variables numerically.
- Experimental research determines cause-and-effect relationships.
- Historical research studies past events using historical records.
Nursing Process
Assessment
Assess:
- Frequency of fecal incontinence
- Skin condition
- Emotional well-being
- Caregiver concerns
- Impact on quality of life
Nursing Diagnosis
Possible diagnoses include:
- Bowel Incontinence
- Impaired Skin Integrity
- Risk for Infection
- Social Isolation
- Situational Low Self-Esteem
Planning
Goals include:
- Prevent skin breakdown.
- Improve dignity and comfort.
- Promote continence management.
- Enhance quality of life.
Nursing Interventions
- Perform regular skin assessments.
- Implement a bowel management program.
- Maintain meticulous perineal hygiene.
- Use moisture barrier creams as prescribed.
- Collaborate with dietitians and rehabilitation specialists.
- Encourage open communication about bowel concerns.
Evaluation
Desired outcomes:
- Healthy skin integrity
- Reduced episodes of incontinence
- Improved comfort
- Better psychosocial adaptation
Priority Nursing Intervention
Maintain skin integrity through prompt cleansing, moisture control, and prevention of pressure injury while addressing the patient’s emotional needs.
Safety Considerations
- Monitor for pressure injuries.
- Prevent falls during toileting.
- Observe for dehydration and electrolyte imbalance.
- Maintain patient dignity during bowel care.
Clinical Pearls
- Qualitative research answers “What is it like?”
- Quantitative research answers “How much?”
- Experimental research answers “Does this intervention work?”
- Historical research answers questions about past events.
Common Mistakes
❌ Choosing quantitative research simply because healthcare involves numbers.
❌ Confusing experimental with qualitative research.
❌ Forgetting that patient experiences are best explored qualitatively.
PNLE Tips
A quick memory aid:
- Qualitative = Quality of experiences
- Quantitative = Quantity or numbers
- Experimental = Cause and effect
- Historical = Past events
If the question asks about feelings, experiences, perceptions, coping, or lived experiences, the answer is almost always Qualitative Research.
Quick Review
✔ Focuses on human experiences
✔ Uses interviews and observations
✔ Explores perceptions and coping
✔ Generates descriptive findings rather than numerical data
Study Tips
For Nursing Research questions in the PNLE, memorize the primary purpose of each research design:
|
Research Method |
Primary Purpose |
|
Qualitative |
Explore experiences, feelings, and perceptions |
|
Quantitative |
Measure variables using numerical data |
|
Experimental |
Determine cause-and-effect relationships |
|
Historical |
Study past events and historical records |
A simple mnemonic is “Q-Q-E-H”:
- Qualitative → Quality of life
- Quantitative → Quantity or numbers
- Experimental → Effect of an intervention
- Historical → History or past events
Understanding the purpose of each design is more valuable than memorizing definitions because many PNLE questions use clinical scenarios instead of direct definitions.
Next: Part 3 will cover Question 5 (Wilms’ Tumor Stage II) and include the complete FAQ, Related Nursing Topics, SLRC promotion, Facebook Caption, YouTube Description, Pinterest Description, Instagram Caption, TikTok Caption, Email Description, JSON-LD Schema, and SEO-ready Blogger HTML to complete the article.
Question 5
Situation
A child is admitted to the hospital with a diagnosis of Wilms’ tumor (Nephroblastoma), Stage II.
Which statement best describes Stage II disease?
A. The tumor is less than 3 cm in size and requires no chemotherapy.
B. The tumor did not extend beyond the kidney and was completely resected.
C. The tumor extended beyond the kidney but was completely resected.
D. The tumor has spread into the abdominal cavity and cannot be resected.
Correct Answer
C. The tumor extended beyond the kidney but was completely resected.
Detailed Nursing Rationale
Wilms’ tumor (Nephroblastoma) is the most common malignant kidney tumor in children, usually affecting those younger than 5 years of age.
Understanding the staging is essential for the PNLE because treatment and prognosis depend largely on the stage.
Simplified Wilms’ Tumor Staging
Stage I
- Tumor is limited to the kidney.
- Completely removed.
Stage II ✅
- Tumor has spread beyond the kidney.
- Completely removed during surgery.
- No residual tumor remains.
Stage III
- Residual tumor remains within the abdomen after surgery.
- Regional lymph node involvement or tumor spillage may be present.
Stage IV
- Distant metastasis to organs such as the lungs, liver, brain, or bones.
Stage V
- Bilateral kidney involvement at diagnosis.
The key phrase for Stage II is:
Beyond the kidney but completely resected.
Nursing Process
Assessment
Assess for:
- Abdominal mass
- Hematuria
- Hypertension
- Abdominal pain
- Fever
- Weight loss
- Renal function
- Postoperative complications
Nursing Diagnosis
Possible nursing diagnoses include:
- Acute Pain
- Risk for Bleeding
- Anxiety (Child and Family)
- Risk for Infection
- Imbalanced Nutrition: Less Than Body Requirements
Planning
Goals include:
- Maintain adequate renal function.
- Prevent postoperative complications.
- Reduce pain.
- Support family coping.
- Prepare for chemotherapy if ordered.
Nursing Interventions
- Monitor vital signs frequently.
- Assess urine output.
- Monitor laboratory values.
- Administer prescribed analgesics.
- Educate parents regarding chemotherapy and follow-up care.
- Encourage age-appropriate play and emotional support.
- Maintain strict aseptic technique.
Evaluation
Expected outcomes:
- Stable vital signs
- Adequate urine output
- Controlled pain
- No postoperative infection
- Parents demonstrate understanding of the treatment plan
Priority Nursing Intervention
Never palpate a suspected Wilms’ tumor.
Palpation may rupture the tumor capsule, increasing the risk of tumor spread.
Safety Considerations
- Place a “Do Not Palpate Abdomen” sign if indicated.
- Monitor blood pressure regularly.
- Observe for postoperative bleeding.
- Watch for adverse effects of chemotherapy.
- Prevent infection through meticulous hand hygiene.
Clinical Pearls
- Wilms’ tumor is also called Nephroblastoma.
- Most common renal malignancy in children.
- Usually presents as a painless abdominal mass.
- Hypertension may occur because of increased renin production.
- Prognosis is generally excellent with early treatment.
Common Mistakes
❌ Confusing Stage I with Stage II.
❌ Forgetting that Stage II extends beyond the kidney.
❌ Palpating the abdominal mass.
❌ Assuming all pediatric abdominal masses are benign.
PNLE Tips
Remember this progression:
- Stage I → Inside kidney
- Stage II → Beyond kidney but removed
- Stage III → Residual abdominal disease
- Stage IV → Distant metastasis
- Stage V → Both kidneys
A useful memory phrase:
“2 = Too far for the kidney, but Totally removed.”
Quick Review
✔ Most common childhood kidney cancer
✔ Usually affects children younger than 5 years
✔ Do NOT palpate abdomen
✔ Stage II = Beyond kidney but completely resected
✔ Often treated with surgery plus chemotherapy
Overall Study Tips
When reviewing pediatric oncology:
- Learn disease staging instead of memorizing isolated facts.
- Focus on nursing priorities before and after surgery.
- Identify safety precautions that frequently appear in board examinations.
- Pay attention to “Do Not” interventions because they are common PNLE test points.
- Connect anatomy, pathophysiology, and nursing care for better long-term retention.
Frequently Asked Questions (FAQ)
1. Why is assessment often the first nursing action?
Assessment allows the nurse to gather objective data before implementing interventions. Many PNLE questions test your ability to prioritize assessment when the patient’s condition has not yet been verified.
2. Why doesn’t a positive ELISA confirm HIV infection in a newborn?
Maternal IgG antibodies cross the placenta and may remain in the infant for several months. A positive ELISA shortly after birth may reflect maternal antibodies rather than true infant infection.
3. Is psoriasis contagious?
No. Psoriasis is a chronic immune-mediated inflammatory skin disorder and cannot be transmitted from one person to another.
4. When should qualitative research be used?
Qualitative research is appropriate when exploring patients’ experiences, emotions, beliefs, coping mechanisms, and perceptions of illness or healthcare.
5. Why should a Wilms’ tumor not be palpated?
Palpating the abdomen may rupture the tumor capsule and increase the risk of tumor dissemination, which can worsen the child’s prognosis.
Related Nursing Topics
If you enjoyed this reviewer, continue studying:
- Medical-Surgical Nursing
- Fundamentals of Nursing
- Pediatric Nursing
- Maternal and Child Nursing
- Community Health Nursing
- Nursing Research
- Nursing Jurisprudence and Ethics
- Emergency Nursing
- Critical Care Nursing
- NCLEX-style Prioritization Questions
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