NLE Practice Questions Volume 1: 25 High-Yield Sample Items with Rationales (November 2026)

📝 NLE NOVEMBER 2026 PRACTICE TEST — VOLUME 1. Five months out from the next Nurse Licensure Examination (November 7–8, 2026), the single highest-yield study habit is daily board-style item drilling with rationale review. This first volume gives you 25 sample items — five from each of the five official PRC Board of Nursing tests — modeled on the difficulty, phrasing, and case-based reasoning style of actual NLE items. Every item includes the correct answer and a complete rationale that explains both the right choice and the most common distractor traps. Drill these timed (45 seconds per item), then read the rationales slowly — the reasoning is where the learning happens.

Pair this practice test with our NLE November 2026: Complete 20-Week Prep Roadmap for the full study plan, recommended Filipino reviewers, and the after-exam RN career pipeline.

Test I — Foundation of Nursing Practice

Question 1 — The Nursing Process

A nurse caring for a post-operative client documents the following: “Client reports incisional pain of 7/10 on the numeric rating scale, grimacing observed during repositioning, abdomen non-distended.” This entry best reflects which phase of the nursing process?

• A. Planning
• B. Assessment
• C. Implementation
• D. Evaluation

Correct Answer: B

Rationale: The entry contains subjective data (client reports pain 7/10) and objective data (grimacing, non-distended abdomen) — the hallmarks of the assessment phase. Planning involves setting measurable goals; implementation is the actual intervention (e.g., administering analgesic); evaluation compares outcomes against the goal. Remember the ADPIE mnemonic: Assessment, Diagnosis, Planning, Implementation, Evaluation.

Question 2 — Medication Administration Rights

A nurse is about to administer cefuroxime 750 mg IV to a client with pneumonia. Before connecting the IV line, the nurse asks the client to state their name and birth date and checks the medication label against the medication administration record (MAR). Which of the “rights” of medication administration is the nurse primarily verifying?

• A. Right route
• B. Right time
• C. Right patient
• D. Right documentation

Correct Answer: C

Rationale: Verifying patient identity using two identifiers (name and birth date) is the universal standard for confirming the right patient. The other rights — right drug, right dose, right route, right time, and right documentation — are verified through label and MAR checks, but the act of asking the client to state identifiers specifically addresses identity. Patient identification errors are among the most common and most preventable medication errors worldwide.

Question 3 — Standard Precautions

A nurse will provide oral care to a client with no known infectious disease. Which personal protective equipment (PPE) is most appropriate?

• A. Gloves only
• B. Gloves and gown
• C. Gloves, gown, mask, and goggles
• D. No PPE is required

Correct Answer: A

Rationale: Under Standard Precautions, gloves are required whenever there is potential contact with mucous membranes, non-intact skin, or body fluids — including saliva. A gown, mask, and goggles are added when splashes or sprays are anticipated (suctioning, irrigation, dental procedures). Routine oral care without suctioning warrants gloves alone. Standard Precautions apply to all clients regardless of known infectious status — this is the foundation of infection control under the CDC and Philippine DOH protocols.

Question 4 — Vital Signs Interpretation

An adult client’s vital signs are: temperature 37.8°C, pulse 112 beats per minute, respiratory rate 24 breaths per minute, blood pressure 138/86 mmHg, and SpO₂ 94% on room air. Which finding warrants the most immediate further assessment?

• A. Temperature
• B. Respiratory rate
• C. Blood pressure
• D. SpO₂

Correct Answer: B

Rationale: Apply the ABC principle (Airway, Breathing, Circulation) for prioritization. Tachypnea (RR >20) is the earliest physiologic compensation for impending respiratory or circulatory compromise and warrants immediate further assessment for signs of hypoxia, sepsis, pain, anxiety, or metabolic acidosis. While the SpO₂ of 94% is borderline, the elevated respiratory rate indicates the client is already working hard to maintain it — a more sensitive early warning sign. The mild fever and tachycardia could be related findings (e.g., early sepsis).

Question 5 — R.A. 9173 and Scope of Practice

Under Republic Act No. 9173 (Philippine Nursing Act of 2002), which of the following acts is outside the scope of practice of a Registered Nurse?

• A. Providing direct nursing care to the sick, injured, or infirm
• B. Establishing a medical diagnosis and prescribing medications
• C. Teaching, supervising, and evaluating nursing personnel
• D. Collaborating with other healthcare professionals in patient care

Correct Answer: B

Rationale: R.A. 9173 explicitly defines nursing practice as the provision of nursing care, health teaching, collaboration with the healthcare team, and administration of medications and treatments as prescribed by an authorized physician. Diagnosing illness and prescribing medications are reserved for licensed physicians under R.A. 2382 (the Medical Act). Nurses make nursing diagnoses (e.g., “Impaired Gas Exchange”) — not medical diagnoses. This distinction is tested in every NLE batch.

Test II — Care of Mother, Child, Family, and Population Group

Question 6 — Leopold’s Maneuvers

During Leopold’s maneuvers on a client at 36 weeks gestation, the nurse palpates a smooth, hard, round mass at the fundus and an irregular, knobby mass just above the symphysis pubis. The fetal lie and presentation are best described as:

• A. Longitudinal lie, cephalic presentation
• B. Longitudinal lie, breech presentation
• C. Transverse lie, shoulder presentation
• D. Oblique lie, cephalic presentation

Correct Answer: B

Rationale: The smooth, hard, round mass at the fundus is the fetal head (high in the uterus). The irregular, knobby mass at the symphysis pubis is the fetal buttocks/feet (the presenting part). This indicates a longitudinal lie with breech presentation. A cephalic presentation would show the head at the symphysis pubis and the irregular buttocks at the fundus. Breech presentation at term often warrants external cephalic version or planned cesarean delivery.

Question 7 — Apgar Scoring

A newborn at one minute after birth has the following findings: heart rate 110 bpm, slow irregular respirations with weak cry, some flexion of extremities, grimace when suctioned, and pink body with blue extremities (acrocyanosis). The one-minute Apgar score is:

• A. 5
• B. 6
• C. 7
• D. 8

Correct Answer: B

Rationale: Score each parameter 0–2 (mnemonic APGAR: Appearance, Pulse, Grimace, Activity, Respiration). Heart rate >100 = 2; slow irregular respirations with weak cry = 1; some flexion = 1; grimace only = 1; acrocyanosis = 1. Total: 2 + 1 + 1 + 1 + 1 = 6. A score of 4–6 indicates moderate depression requiring stimulation and possible supplemental oxygen; 7–10 is normal; 0–3 indicates severe depression requiring resuscitation. The 5-minute Apgar is reassessed for prognosis.

Question 8 — Postpartum Hemorrhage

One hour after a normal vaginal delivery, a client’s pad is saturated within 15 minutes and the fundus is boggy and displaced to the right. The nurse’s first action should be to:

• A. Notify the obstetrician immediately
• B. Massage the fundus
• C. Initiate a second IV line
• D. Have the client void or insert a urinary catheter

Correct Answer: B

Rationale: The leading cause of early postpartum hemorrhage is uterine atony — signs include a boggy fundus and excessive bleeding. The first intervention is fundal massage to stimulate uterine contraction. A displaced (right or left) fundus indicates a full bladder, which prevents contraction; voiding/catheterization is the next step if massage alone doesn’t firm the fundus. Notifying the OB and starting IV access follow if bleeding persists. Do the immediate physical intervention first — act, then escalate.

Question 9 — DOH Expanded Program on Immunization

Under the DOH Expanded Program on Immunization (EPI), at what age is the first dose of measles-containing vaccine (MMR/MCV1) routinely given to Filipino infants?

• A. At birth
• B. 6 weeks
• C. 9 months
• D. 12 months

Correct Answer: C

Rationale: Under the Philippine EPI schedule, MCV1 is given at 9 months and MCV2 at 12–15 months. Other EPI milestones: BCG and Hepatitis B at birth; OPV, DPT-HepB-Hib (pentavalent), and PCV at 6, 10, and 14 weeks; rotavirus and PCV per schedule. Vaccine schedules are tested in every NLE batch — memorize them cold.

Question 10 — Erikson’s Stages of Development

A nurse caring for a 4-year-old hospitalized for an appendectomy notes the child insists on choosing their own pajamas, refuses help with brushing teeth, and becomes upset when parents leave. According to Erikson, this child is in which stage of psychosocial development?

• A. Trust vs. Mistrust
• B. Autonomy vs. Shame and Doubt
• C. Initiative vs. Guilt
• D. Industry vs. Inferiority

Correct Answer: C

Rationale: At age 4 (3–6 years), the child is in Initiative vs. Guilt — characterized by goal-directed behavior, asserting power, and a strong sense of purpose. The child’s wish to choose their own clothes and reject help reflects the developing initiative. Trust vs. Mistrust is infancy (0–1 year); Autonomy vs. Shame is toddlerhood (1–3 years); Industry vs. Inferiority is school age (6–12 years).

Test III — Care of Clients with Physiologic Alterations, Part A

Question 11 — COPD and Oxygen Therapy

A client with severe chronic obstructive pulmonary disease (COPD) is admitted with worsening dyspnea. The target SpO₂ range during oxygen therapy for this client is:

• A. 88–92%
• B. 94–98%
• C. 95–100%
• D. 100%

Correct Answer: A

Rationale: In COPD, chronic CO₂ retention shifts respiratory drive from CO₂ levels to hypoxic drive (low O₂). Over-oxygenation removes the stimulus to breathe, suppresses respirations, and worsens CO₂ retention — potentially leading to respiratory acidosis and arrest. Target SpO₂ is 88–92% in COPD patients (vs. 94–98% in non-COPD adults). Use low-flow oxygen (1–2 L/min nasal cannula) and titrate carefully.

Question 12 — Acute Myocardial Infarction

A client presents to the ER with crushing substernal chest pain radiating to the left jaw, diaphoresis, and nausea. ECG shows ST elevation in leads II, III, and aVF. Which cardiac biomarker remains elevated for the longest period after an acute myocardial infarction (AMI)?

• A. Myoglobin
• B. CK-MB
• C. Troponin I
• D. LDH

Correct Answer: C

Rationale: Cardiac troponin I (and T) is the most sensitive and specific biomarker for AMI and remains elevated for 7–14 days. Myoglobin rises first (2–6 hours) but is non-specific; CK-MB peaks in 18–24 hours and normalizes within 2–3 days; LDH is non-specific and rarely used now. Troponin’s long detection window also makes it useful for late-presenting MIs. ST elevation in II, III, aVF indicates an inferior wall MI — usually involving the right coronary artery.

Question 13 — Diabetic Ketoacidosis

A client with type 1 diabetes presents with blood glucose 480 mg/dL, pH 7.20, bicarbonate 14 mEq/L, and positive serum ketones. The first nursing priority is:

• A. Administer IV regular insulin bolus
• B. Initiate IV normal saline at high rate
• C. Administer IV sodium bicarbonate
• D. Replace potassium intravenously

Correct Answer: B

Rationale: The first priority in DKA management is aggressive IV fluid resuscitation with isotonic normal saline (0.9% NaCl) at 15–20 mL/kg/hr in the first hour. Severe hyperglycemia causes profound osmotic diuresis and dehydration; insulin without fluid resuscitation can precipitate hemodynamic collapse. After fluid initiation, IV regular insulin infusion (0.1 unit/kg/hr) begins. Potassium must be measured before insulin — insulin shifts K⁺ into cells and can cause life-threatening hypokalemia. Bicarbonate is reserved for pH <6.9.

Question 14 — Hepatitis B Serology

A client’s hepatitis B panel shows: HBsAg negative, anti-HBs positive, anti-HBc total negative. The most accurate interpretation is that the client is:

• A. Acutely infected with hepatitis B
• B. Chronically infected with hepatitis B
• C. Immune from prior infection
• D. Immune from vaccination

Correct Answer: D

Rationale: Immunity from vaccination produces only anti-HBs (the protective antibody) without anti-HBc (which forms only after natural infection). The pattern: HBsAg(−), anti-HBs(+), anti-HBc(−) = vaccinated. Immunity from prior infection would show anti-HBs(+) AND anti-HBc(+). Acute infection: HBsAg(+), anti-HBc IgM(+). Chronic infection: HBsAg(+) for >6 months, anti-HBc IgG(+). Memorize this table — serology items appear in every batch.

Question 15 — TB-DOTS First-Line Therapy

Under the DOH National Tuberculosis Control Program (TB-DOTS), the standard intensive-phase regimen for a newly diagnosed adult with smear-positive pulmonary TB consists of which four first-line drugs?

• A. Isoniazid, rifampicin, pyrazinamide, ethambutol
• B. Streptomycin, isoniazid, rifampicin, ciprofloxacin
• C. Rifampicin, ethambutol, kanamycin, levofloxacin
• D. Isoniazid, ethambutol, pyrazinamide, ciprofloxacin

Correct Answer: A

Rationale: The standard regimen is HRZE: Hisoniazid, Rifampicin, Pyrazinamide, Ethambutol — for 2 months intensive phase, then HR for 4 months continuation phase. Common adverse effects to memorize: isoniazid — peripheral neuropathy (give pyridoxine/B6); rifampicin — orange body secretions, hepatotoxicity; pyrazinamide — hyperuricemia, hepatotoxicity; ethambutol — optic neuritis (test visual acuity). Streptomycin and ciprofloxacin are second-line.

Test IV — Care of Clients with Physiologic Alterations, Part B

Question 16 — Burn Fluid Resuscitation

A 70-kg adult sustains partial- and full-thickness burns covering 40% TBSA in a kitchen fire. Using the Parkland formula, calculate the total volume of lactated Ringer’s solution to be administered in the first 24 hours:

• A. 5,600 mL
• B. 8,400 mL
• C. 11,200 mL
• D. 16,800 mL

Correct Answer: C

Rationale: Parkland formula: 4 mL × kg × %TBSA = 4 × 70 × 40 = 11,200 mL in 24 hours. Half is given in the first 8 hours (5,600 mL), the other half over the next 16 hours (5,600 mL). Hours are counted from the time of burn, not arrival. Urine output target: 0.5 mL/kg/hr in adults. Memorize this formula — it is one of the most frequently tested calculations on the NLE.

Question 17 — Acute Ischemic Stroke and Thrombolysis

A client arrives in the ER with sudden-onset right-sided weakness, slurred speech, and facial drooping. Symptom onset was witnessed 90 minutes ago. CT scan rules out hemorrhage. The maximum time window for IV thrombolysis with tissue plasminogen activator (tPA) in eligible patients is:

• A. 1.5 hours from symptom onset
• B. 3 hours from symptom onset
• C. 4.5 hours from symptom onset
• D. 6 hours from symptom onset

Correct Answer: C

Rationale: The current AHA/ASA guideline window for IV tPA in eligible patients with acute ischemic stroke is up to 4.5 hours from symptom onset (extended from the original 3-hour window for select patients). Beyond 4.5 hours, mechanical thrombectomy may still be an option up to 24 hours in select large-vessel occlusions. Time is brain: every minute of delay loses ~1.9 million neurons. Remember FAST (Face, Arm, Speech, Time) for community education.

Question 18 — Autonomic Dysreflexia

A client with a T4 spinal cord injury suddenly develops a pounding headache, BP 200/110, profuse sweating above the level of injury, and bradycardia. The nurse’s first action is to:

• A. Place the client in a supine position
• B. Sit the client upright and lower the legs
• C. Administer antihypertensive medication
• D. Call a rapid response code

Correct Answer: B

Rationale: This is autonomic dysreflexia — a life-threatening emergency in clients with SCI at or above T6, typically triggered by a noxious stimulus below the injury (most commonly bladder distention from a kinked catheter, fecal impaction, or pressure injury). The first action is to elevate the head of bed (sit upright) and lower the legs to use gravity to reduce blood pressure. Then assess and remove the trigger (check the catheter, palpate the bladder, check for impaction). Antihypertensives are given if BP doesn’t respond. Untreated, AD can cause stroke or seizure within minutes.

Question 19 — Neutropenic Precautions

A client receiving chemotherapy has an absolute neutrophil count (ANC) of 450/mm³. Which dietary choice should the nurse instruct the client to avoid?

• A. Well-cooked rice and chicken
• B. Hot soup
• C. Fresh raw salad with sliced tomatoes
• D. Peeled banana

Correct Answer: C

Rationale: An ANC <500/mm³ indicates severe neutropenia — the client is at high risk for infection from microbial flora on raw produce. Avoid raw fruits and vegetables, raw or undercooked meats and eggs, unpasteurized dairy, and fresh flowers. Allowed: thoroughly cooked foods, peeled fruits (the peel acts as a barrier), pasteurized dairy, and bottled water. A bland, low-microbial “neutropenic diet” is standard during periods of severe neutropenia.

Question 20 — Increased Intracranial Pressure

A client with a traumatic brain injury has signs of increased intracranial pressure (ICP). Which nursing intervention is most appropriate to help control the ICP?

• A. Place the client flat (supine) with the head turned to one side
• B. Cluster nursing care to minimize stimulation
• C. Elevate the head of the bed 30 degrees, keep the head and neck in midline position
• D. Encourage coughing and deep breathing every 2 hours

Correct Answer: C

Rationale: The single most effective non-pharmacologic intervention is elevating the head of bed to 30 degrees with the head and neck in midline (neutral) position to promote venous drainage from the brain. Avoid neck flexion or rotation, hip flexion >90 degrees, Valsalva-inducing activities (coughing, straining), and clustering of care (which causes spikes in ICP). Space interventions out to allow ICP to recover between activities — the opposite of option B.

Test V — Care of Clients with Psychosocial Alterations

Question 21 — Therapeutic Communication

A client with newly diagnosed metastatic cancer says, “I just want to give up. There’s no point in any of this anymore.” The most therapeutic nurse response is:

• A. “Don’t talk like that — there’s always hope.”
• B. “Why do you feel that way? You have a loving family.”
• C. “Tell me more about what you’re feeling right now.”
• D. “Many people in your situation feel discouraged at first, but they get through it.”

Correct Answer: C

Rationale: “Tell me more” is an open-ended exploratory statement that invites the client to elaborate and conveys empathy without judgment. Option A gives false reassurance and shuts down dialogue. Option B uses a “why” question that puts the client on the defensive and offers unsolicited reassurance about family. Option D minimizes the client’s unique experience by generalizing. The rule for NLE therapeutic communication items: choose the response that opens dialogue, focuses on the client’s feelings, and avoids advice, judgment, or false reassurance.

Question 22 — Schizophrenia Symptoms

Which of the following best illustrates a negative symptom of schizophrenia?

• A. Hearing voices commenting on the client’s actions
• B. Belief that the FBI is controlling the client’s thoughts
• C. Flat facial expression and lack of motivation
• D. Disorganized speech jumping from topic to topic

Correct Answer: C

Rationale: Negative symptoms represent a loss or absence of normal function: flat affect, alogia (poverty of speech), avolition (lack of motivation), anhedonia (inability to feel pleasure), and asociality. They are typically harder to treat than positive symptoms. Positive symptoms represent added behaviors: hallucinations (A), delusions (B), and disorganized speech/behavior (D). Atypical antipsychotics (risperidone, olanzapine, quetiapine, clozapine) treat both positive and negative symptoms; older typical antipsychotics primarily address positive symptoms.

Question 23 — Lithium Toxicity

A client with bipolar disorder taking lithium presents with coarse hand tremor, confusion, slurred speech, ataxia, and a serum lithium level of 2.4 mEq/L. The nurse should anticipate which immediate intervention?

• A. Increase oral fluid intake to 3 L/day
• B. Hold the next dose and obtain repeat level in 12 hours
• C. Initiate emergency hemodialysis
• D. Administer IV calcium gluconate

Correct Answer: C

Rationale: The therapeutic lithium range is 0.6–1.2 mEq/L. Toxicity stages: mild (1.5–2.0) — nausea, fine tremor, polyuria; moderate (2.0–2.5) — coarse tremor, confusion, ataxia, slurred speech; severe (>2.5) — seizures, coma, cardiovascular collapse, death. At 2.4 mEq/L with neurologic symptoms, the client is in moderate-to-severe toxicity — hemodialysis is the definitive treatment because lithium is small, water-soluble, and not protein-bound. Always monitor sodium intake, hydration, and concurrent NSAID/diuretic use, which all raise lithium levels.

Question 24 — Suicide Risk Assessment

A nurse interviewing a client with major depressive disorder learns the client has been giving away possessions and saying goodbye to friends. The most important next nursing assessment is to ask:

• A. “Have you been sleeping well lately?”
• B. “Are you having thoughts of hurting yourself? Do you have a plan?”
• C. “Have you been taking your antidepressant as prescribed?”
• D. “Do you have family or friends you can talk to?”

Correct Answer: B

Rationale: Giving away possessions and saying goodbye are classic warning signs of imminent suicide. The nurse must directly assess suicidal ideation, intent, and plan — specifically asking does not “plant the idea” (a long-debunked myth) and is in fact protective. If the client has a plan, especially a lethal and accessible method with a timeframe, hospitalization is warranted. Other risk factors: previous attempts, age (elderly males highest risk), substance use, recent loss, chronic illness, social isolation. After assessment, ensure safety, remove means, contract for safety if appropriate, and notify the psychiatric team.

Question 25 — Alcohol Withdrawal Management

A client admitted 48 hours ago for cellulitis becomes diaphoretic, tremulous, hypertensive (BP 178/100), tachycardic (HR 120), and reports seeing “bugs on the wall.” History reveals daily heavy alcohol intake. The medication of choice for this presentation is:

• A. Haloperidol IM
• B. Naloxone IV
• C. Lorazepam IV
• D. Methylphenidate orally

Correct Answer: C

Rationale: This is moderate-to-severe alcohol withdrawal with visual hallucinations — at risk of progressing to delirium tremens (DTs), which carries up to 15% mortality if untreated. Benzodiazepines (lorazepam, chlordiazepoxide, diazepam) are first-line: they cross-tolerate with alcohol at the GABA receptor and prevent seizures, autonomic hyperactivity, and DTs. Dosing is guided by the CIWA-Ar protocol. Also give thiamine (before glucose, to prevent Wernicke encephalopathy), folate, and multivitamin. Haloperidol may worsen seizure risk. Naloxone reverses opioids, not alcohol withdrawal.

How to Use This Practice Test

1. Time yourself. Set 19 minutes for all 25 items (45 seconds each) — about the pace you’ll need on the actual NLE.
2. Don’t peek at the rationale. Answer all 25 first, then check.
3. Score yourself. 22–25 correct = excellent; 18–21 = solid; 14–17 = needs more drills; below 14 = focus on identifying weak topics from the rationales.
4. Read every rationale, even for items you got right. Most NLE items reward conceptual understanding, not memorization — the rationale is where you learn the “why.”
5. Make flashcards from the items you missed and review them daily for the next two weeks.

This is Volume 1 of an ongoing series. Follow Exams Pinas for more practice sets covering each of the five NLE tests in greater depth between now and exam day. Pair these drills with the 20-week NLE prep roadmap for a complete preparation plan.

Good luck, future Registered Nurse. We’re rooting for you.