PNLE Nursing Practice Questions with Rationales
Renal Failure, Femur Fracture, Elderly Care, Newborn Respiratory Distress & Health Education
Preparing for the Philippine Nurse Licensure Examination (PNLE) requires more than memorizing answers. Nurses must understand the rationale behind each intervention and apply nursing concepts to different clinical situations.
This PNLE nursing practice test contains five multiple-choice questions with rationalized answers covering renal failure, orthopedic complications, elderly nursing care, newborn respiratory distress, and health education.
Do not memorize the answer alone. Understand the nursing principle behind it because similar concepts may appear in different forms during the board examination.
1. Renal Failure: Diet Therapy
Situation: Rudy was diagnosed to have chronic renal failure. Hemodialysis is ordered and an A-V shunt was surgically created.
Diet therapy for Rudy, who has renal failure, is low-protein, low-potassium, and low-sodium. The nutrition instruction should include:
☐ Encourage the client to include raw cucumbers, carrots, cabbage, and tomatoes.
☑ Recommend protein of high biologic value like eggs, poultry, and lean meat.
☐ Allow the client cheese, canned foods, and other processed foods.
☐ Bananas, cantaloupe, oranges, and other fresh fruits can be included in the diet.
✅ Correct Answer: Recommend protein of high biologic value like eggs, poultry, and lean meat.
Patients with renal disease require careful dietary management. When protein is included, high-biologic-value protein sources are preferred because they provide essential amino acids efficiently.
Examples include eggs, poultry, and lean meat. For patients undergoing hemodialysis, protein requirements are generally higher than for patients with advanced chronic kidney disease who are not receiving dialysis because protein and amino acids can be lost during treatment.
The other options are less appropriate. Foods such as bananas, cantaloupe, oranges, and tomatoes may contribute significant potassium, while canned and processed foods may contain substantial amounts of sodium and phosphorus.
2. Femur Fracture: Immediate Complication
Situation: Nurse Lucille is caring for Madame L, age 59, in the hospital with a tentative diagnosis of Stage IIIB Hodgkin disease.
A patient who has sustained a fracture of the femur is at risk for which of the following complications in the immediate post-fracture period?
☐ Electrolyte imbalance
☑ Fat embolus
☐ Fluid volume deficit
☐ Disuse syndrome
✅ Correct Answer: Fat embolus
A fracture of a large long bone such as the femur can damage the bone marrow and release fat droplets into the bloodstream. These droplets may enter the pulmonary circulation and cause fat embolism syndrome.
The nurse should closely monitor a patient with a long-bone fracture for signs of fat embolism, including:
- Sudden respiratory distress
- Hypoxemia
- Tachycardia
- Changes in mental status
- Fever
- Petechial rash
Disuse syndrome is generally associated with prolonged immobility rather than the immediate period following the fracture.
3. Nursing Care of a Confused Elderly Client
Situation: Nursing care for the elderly.
An elderly confused client gets out of bed at night to go to the bathroom and tries to go to another bed when she returns. The MOST appropriate action the nurse would take is to:
☑ Assign client to a single room
☐ Leave a light on all night
☐ Remind client to call the nurse when she wants to get up
☐ Put side rails on the bed
✅ Correct Answer: Assign client to a single room
A confused elderly client who becomes disoriented at night is at increased risk for falls, wandering, and injury. Assigning the client to a single room can provide a safer and less confusing environment.
The nurse should also maintain a consistent routine, provide appropriate lighting, frequently reorient the client, and remove environmental hazards.
Simply reminding a confused client to call the nurse may not be effective because the client may forget the instruction. Similarly, side rails are not automatically the safest intervention and may increase the risk of injury if the client attempts to climb over them.
4. Newborn Respiratory Difficulty
Situation: Baby girl Cheetah is born with an Apgar score of 5 and 7. The infant is experiencing respiratory difficulty.
For a newborn who had a respiratory compromise after an uneventful delivery and a “normal” newborn assessment, the nurse's initial response would be to:
☐ Obtain blood gas levels and position the infant prone.
☐ Increase the flow of oxygen and position the infant in the Trendelenburg position.
☐ Position the infant on her abdomen and lower the head of the bed.
☑ Position the infant with the head of the bed elevated.
✅ Correct Answer: Position the infant with the head of the bed elevated.
When a newborn develops respiratory difficulty, the immediate priority is to support the airway and breathing. Appropriate positioning can help promote airway patency and facilitate respiratory effort.
The nurse should assess the newborn's airway, breathing, respiratory rate, oxygen saturation, color, and other signs of respiratory compromise while providing appropriate respiratory support according to the clinical situation.
The Trendelenburg position is not appropriate for a newborn experiencing respiratory distress because it does not promote optimal respiratory mechanics. Diagnostic procedures such as blood gas analysis should not delay immediate assessment and management of the airway and breathing problem.
5. Health Education During a Home Visit
Situation: Being a health educator is an essential role of a nurse.
During a routine home visit, the nurse should educate the parents regarding:
☐ The infant's need for meat by 4 months of age
☑ Expected growth and development patterns
☐ Specific yearly milestones the child must meet
☐ Signs and symptoms of failure to thrive
✅ Correct Answer: Expected growth and development patterns
Health education during a home visit should help parents understand what to expect as their child grows and develops. Teaching parents about normal growth and developmental patterns helps them recognize whether their child's development is progressing appropriately.
Developmental milestones should not be treated as rigid deadlines that every child must meet at exactly the same age. Children develop at somewhat different rates, although there are expected developmental ranges that nurses use for assessment and education.
The nurse can also provide education regarding age-appropriate nutrition, safety, immunization, developmental expectations, and warning signs that require further assessment.
📋 PNLE Nursing Practice Questions Answer Key
| No. | Correct Answer | Key Concept |
|---|---|---|
| 1 | High-biologic-value protein | Renal Diet |
| 2 | Fat embolus | Femur Fracture |
| 3 | Assign client to a single room | Elderly Safety |
| 4 | Position infant with head elevated | Newborn Respiratory Care |
| 5 | Expected growth and development patterns | Health Education |
🎯 Key PNLE Review Takeaways
- Renal failure: Pay attention to protein, potassium, sodium, phosphorus, and fluid management.
- Femur fracture: A major early complication is fat embolism syndrome.
- Confused elderly client: Prioritize safety and minimize environmental confusion.
- Newborn respiratory distress: Prioritize airway and breathing and provide appropriate positioning and respiratory support.
- Community health nursing: Educate parents about normal growth and development and when professional assessment may be needed.
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TAKE THE FREE ONLINE NURSING REVIEWERDisclaimer: This article is intended for educational and review purposes only. Nursing students should consult current nursing textbooks, official examination references, clinical guidelines, and institutional protocols for comprehensive preparation and clinical decision-making.