PNLE Reviewer: 5 Nursing Questions with Rationales 261025

 

ST. LOUIS REVIEW CENTER

PNLE Nursing Review

5 Practice Questions with Answers and Rationales

Family Planning • Ostomy Care • Research Ethics • Renal Calculi • Geriatric Nursing

Preparing for the Philippine Nurses Licensure Examination (PNLE)? Practice these five nursing questions and review the reasoning behind each answer. Understanding the rationale helps you apply nursing principles to clinical situations instead of relying on memorization alone.

This reviewer covers reproductive health, enterostomal therapy, research ethics, urinary stone management, and age-related sensory changes. Read each question carefully, identify the key clinical clue, and connect it with the safest nursing action.

Study tip: For every question, ask yourself: What is the main problem? Which nursing principle applies? What action protects the patient's safety, autonomy, and dignity?

Table of Contents

1. Family Planning: Suspected Genital Infection
2. Colostomy Irrigation
3. Research Ethics and Self-Determination
4. Renal Calculi: Promoting Stone Passage
5. Geriatric Nursing: Hearing Loss and Behavior
6. Quick Review and PNLE Tips
7. Frequently Asked Questions

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Question 1: Family Planning and Suspected Genital Infection

Situation: Proper counseling of couples on the importance of family planning helps them choose appropriate methods, plan birth spacing, and decide on family size.

Rosita, 24 years old, is sexually active. She complains of a burning sensation on urination, itchiness, and greenish vaginal discharge. Which contraceptive method is contraindicated for Rosita?

1. Condom
2. Intrauterine device (IUD)
3. Oral contraceptive pills (OCP)
4. Depot medroxyprogesterone acetate (DMPA)

Correct Answer: B. Intrauterine device (IUD)

The intended answer is an IUD because symptoms suggest a possible genital tract infection. A current purulent cervicitis or known untreated gonorrhea or chlamydia infection is a reason not to initiate IUD placement until appropriately evaluated and managed.

Nursing Rationale

Burning during urination, itching, and greenish vaginal discharge may indicate an infection, including a sexually transmitted infection. These symptoms are not enough to identify the exact organism, so assessment and appropriate testing are needed.

Inserting an IUD in a patient with current purulent cervicitis or a known untreated gonorrhea or chlamydia infection is generally contraindicated because insertion may increase the risk of ascending infection. The nurse should refer Rosita for clinical evaluation and treatment before arranging IUD placement.

Condoms remain important because they help reduce transmission of many sexually transmitted infections. OCPs and DMPA are hormonal contraceptives and do not provide STI protection.

Priority Nursing Interventions

• Assess the symptoms and relevant sexual and reproductive health history respectfully and confidentially.
• Refer for examination and appropriate testing for vaginal or sexually transmitted infections.
• Provide education about treatment, partner evaluation when indicated, and avoiding sexual activity until advised by the treating clinician.
• Discuss condoms and other contraceptive options based on the patient's needs and clinical eligibility.

Clinical Pearls

• Greenish discharge may suggest infection but is not diagnostic by itself.
• Condoms provide dual protection: pregnancy prevention and reduced STI transmission risk.
• Do not assume that all vaginal infections automatically prohibit every contraceptive method.

PNLE memory aid: Suspected infection plus planned IUD insertion = assess and treat the infection before initiating an IUD when an applicable contraindication is present.

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Question 2: Colostomy Irrigation

Situation: You are participating in an ostomy care class.

When preparing to teach Fermin how to irrigate his colostomy, you should plan to perform the procedure:

1. When Fermin would have a normal bowel movement
2. At least two hours before visiting hours
3. After breakfast
4. After Fermin accepts the alteration in body image

Answer indicated by the supplied quiz: C. After breakfast

Clinical clarification: Colostomy irrigation is usually scheduled consistently, often at the same time each day. Some teaching protocols use the gastrocolic reflex after a meal to help stimulate bowel activity. The best timing depends on the patient's colostomy type, bowel pattern, tolerance, and the care plan.

Nursing Rationale

Colostomy irrigation introduces a prescribed amount of lukewarm water into the colostomy to stimulate evacuation of stool. It may help selected patients with a descending or sigmoid colostomy establish a more predictable bowel routine. It is not appropriate for every ostomy patient and should be taught by a qualified clinician according to the patient's needs.

After a meal, the gastrocolic reflex can increase colonic activity. However, the phrase “after breakfast” should not be treated as a universal rule. Consistency, patient comfort, privacy, and individualized instruction are essential.

Priority Nursing Interventions

• Confirm that irrigation is appropriate for the patient's type of colostomy and prescribed care plan.
• Explain the procedure and provide privacy.
• Use the correct equipment and lukewarm water as directed by the ostomy-care protocol.
• Never force the irrigation cone or instill fluid under pressure.
• Stop and seek clinical guidance if the patient develops severe pain, significant bleeding, or unusual resistance.

Clinical Pearls

• Teach irrigation only to patients for whom it is clinically appropriate.
• A predictable routine can support independence and confidence.
• Acceptance of body-image changes is important to holistic care, but it is not the sole criterion for selecting the procedure's timing.

PNLE memory aid: Ostomy irrigation requires correct patient selection, a consistent routine, privacy, gentle technique, and individualized teaching.

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Question 3: Research Ethics and the Right to Self-Determination

Situation: A nurse who has completed graduate studies wants to apply research knowledge to nursing service.

An 85-year-old client in a nursing home tells a nurse, “I signed the papers for that research study because the doctor was so insistent and I want him to continue taking care of me.” Which client right is being violated?

1. Right of self-determination
2. Right to privacy and confidentiality
3. Right to full disclosure
4. Right not to be harmed

Correct Answer: A. Right of self-determination

The client's decision appears influenced by pressure and fear that refusing participation could affect ongoing medical care. Research participation must be voluntary and free from coercion or undue influence.

Nursing Rationale

The right of self-determination means that a competent individual has the right to make an informed, voluntary decision about participating in research. The individual may accept or decline participation without punishment or loss of appropriate care.

A signed consent form does not automatically prove valid informed consent. The research team must ensure that the participant understands the study, its risks and benefits, available alternatives, and the right to withdraw.

Older adults must not be presumed incapable of making decisions because of age alone. The nurse should support understanding, assess for undue influence, and protect the client's autonomy.

Priority Nursing Interventions

• Clarify that research participation is voluntary.
• Explain that refusing or withdrawing from research should not compromise appropriate clinical care.
• Report possible coercion to the principal investigator or appropriate research ethics authority.
• Support the participant in asking questions and making an independent decision.

Clinical Pearls

• Autonomy and self-determination concern the patient's right to choose.
• Informed consent requires adequate information, understanding, and voluntariness.
• Confidentiality concerns protection of private information, while nonmaleficence concerns avoiding harm.

PNLE memory aid: Pressure to join a study = possible violation of voluntary consent and self-determination.

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Question 4: Renal Calculi and Promoting Stone Passage

Situation: Fe experiences sharp pain on the left side and occasional hematuria. Her physician recommends intravenous pyelography (IVP). The examination reveals a small renal calculus that may pass spontaneously.

To increase the chance of passing the stone, the nurse instructs her to increase fluid intake and do which of the following?

1. Eat a balanced diet
2. Ambulate more
3. Strain all urine
4. Remain on bed rest

Answer indicated by the supplied quiz: B. Ambulate more

Walking may be encouraged as tolerated, but it does not guarantee stone passage. Straining urine is also an important clinical instruction when stone analysis is desired, so the best nursing advice depends on the exact question being asked.

Nursing Rationale

Renal calculi can cause flank pain and hematuria as they move through the urinary tract. Small stones may pass without a procedure, depending on their size, location, and the patient's condition.

Fluid intake may be encouraged when clinically appropriate, but the nurse must consider kidney function, heart function, fluid restrictions, and the provider's plan. Ambulation as tolerated can support normal activity and comfort, although evidence does not establish it as a guaranteed way to expel a stone.

Straining urine is useful because a recovered stone can be sent for analysis to identify its composition and guide prevention. Patients should follow their clinician's instructions about pain control, follow-up imaging, and when to seek urgent care.

Priority Nursing Interventions

• Assess pain, urine output, hematuria, vital signs, and signs of infection or obstruction.
• Encourage fluids only as appropriate to the patient's clinical condition and prescribed plan.
• Provide a urine strainer if ordered or recommended so a passed stone can be collected for analysis.
• Encourage ambulation as tolerated and provide prescribed pain management.
• Escalate urgently for fever or chills, inability to urinate, uncontrolled pain, persistent vomiting, or other signs of deterioration.

Clinical Pearls

• Hematuria and flank pain are common findings in urinary stones, but other diagnoses are possible.
• Stone size and location strongly affect the likelihood of spontaneous passage.
• Collecting the stone can help determine prevention strategies.

PNLE memory aid: Suspected urinary stone = assess pain and obstruction, follow the individualized hydration plan, strain urine when instructed, and monitor for infection.

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Question 5: Geriatric Nursing, Hearing Loss, and Behavior

Situation: Salome, an 80-year-old widow, has become irritable and demanding and speaks louder than usual. She prefers to be alone, eats by herself, receives fewer visitors, and no longer answers telephone calls because her hearing has deteriorated. Her daughter brings her to a geriatric clinic for assessment and treatment.

The nurse counsels Salome's daughter that Salome's tendency to become very loud and aggressive is a/an:

1. Beginning indifference to the world around her
2. Attempt to maintain an authoritative role
3. Overcompensation for hearing loss
4. Behavior indicative of an unresolved repressed conflict

Answer indicated by the supplied quiz: C. Overcompensation for hearing loss

The intended explanation is that hearing difficulty may lead an older adult to speak louder or react with frustration when communication is difficult. However, aggression and social withdrawal should not automatically be attributed to hearing loss without further assessment.

Nursing Rationale

Hearing impairment can interfere with conversations, social participation, and a person's sense of independence. An older adult who repeatedly misunderstands others or cannot follow a conversation may become frustrated, withdraw socially, or raise their voice while trying to communicate.

In this situation, the pattern of reduced social contact and difficulty answering telephone calls makes hearing assessment important. Nevertheless, new or worsening irritability may also be associated with pain, medication effects, depression, delirium, cognitive changes, or other medical problems.

Priority Nursing Interventions

• Assess hearing ability and whether hearing aids or other assistive devices are available and working.
• Face the patient, reduce background noise, speak clearly, and use a normal-to-slightly-louder voice without shouting.
• Allow adequate time for responses and confirm understanding.
• Assess for sudden behavioral changes, pain, medication effects, mood symptoms, and cognitive changes.
• Encourage safe social engagement and involve family members with the patient's consent.

Clinical Pearls

• Do not assume that irritability is a normal or unavoidable part of aging.
• Hearing impairment may contribute to isolation, frustration, and communication difficulties.
• Sudden confusion or an abrupt change in behavior requires prompt clinical assessment.

PNLE memory aid: Older adult + hearing difficulty + communication frustration = assess hearing and communication barriers while ruling out other causes of behavioral change.

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Quick Review: Five Questions at a Glance

Topic	Intended Answer	Key Learning Point
Family planning	IUD	Evaluate and manage relevant genital tract infections before IUD initiation.
Colostomy care	After breakfast	Use an individualized, consistent irrigation routine.
Research ethics	Self-determination	Research participation must be voluntary.
Renal calculi	Ambulate more	Support activity as tolerated and monitor for obstruction or infection.
Geriatric nursing	Overcompensation for hearing loss	Address hearing and communication barriers while assessing other causes.

Study Tips for PNLE Examinees

1. Identify the central clue. For example, greenish discharge suggests possible infection, while pressure to join research suggests a consent problem.
2. Prioritize safety. Recognize warning signs that require urgent assessment instead of relying on a memorized answer.
3. Distinguish the intended answer from clinical practice. Some older review questions use simplified rules. Understand the principle and follow current standards.
4. Review rationales. Knowing why an answer is appropriate helps you apply the concept to differently worded questions.
5. Practice consistently. Review a few questions daily and revisit topics you answered incorrectly.

Frequently Asked Questions

1. Why is an IUD inappropriate with certain genital infections?

Current purulent cervicitis or a known untreated gonorrhea or chlamydia infection is a contraindication to initiating an IUD. Symptoms should be evaluated because discharge and dysuria alone do not establish the diagnosis.

2. Should every colostomy patient irrigate after breakfast?

No. Irrigation is appropriate only for selected patients, and the timing should be individualized. A consistent routine and the patient's tolerance are important.

3. What is the difference between self-determination and informed consent?

Self-determination is the person's right to make voluntary decisions. Informed consent is the process of providing and understanding relevant information before agreeing to participate or undergo a procedure.

4. Does walking guarantee that a kidney stone will pass?

No. Passage depends on factors such as stone size and location. Follow the care plan, monitor for complications, and seek prompt care for warning signs.

5. Is irritability always caused by hearing loss in older adults?

No. Hearing loss may contribute to communication difficulties, but new irritability or aggression can have several causes and deserves assessment.

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Educational disclaimer: This article is for nursing education and examination review. It does not replace current clinical guidelines, institutional protocols, or assessment by a qualified healthcare professional. Some source questions may reflect simplified or older teaching conventions; clinical decisions should follow current evidence and the patient's individual condition.