Title RECALLS 7 (NP4) SC ✅

1 | Page RECALLS 7 EXAMINATION NURSING PRACTICE IV CARE OF CLIENTS WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART B) FEBRUARY 2026 Philippine Nurse Licensure Examination Review GENERAL INSTRUCTIONS: 1. This test questionnaire contains 100 test questions 2. Shade only one (1) box for each question on your answer sheets. Two or more boxes shaded will invalid your answer. 3. AVOID ERASURES. 4. Detach one (1) answer sheet from the bottom of your Examinee ID/Answer Sheet Set. 5. Write the subject title “NURSING PRACTICE IV” on the box provided Situation: A 35-year-old woman presents with unexplained weight loss despite increased appetite, palpitations, and heat intolerance. On assessment, she exhibits warm, moist skin, fine hand tremors, exophthalmos, and a heart rate of 112 beats per minute. She is started on methimazole therapy. 1. The client undergoing endocrine evaluation is observed to have anterior protrusion of both eyes with lid retraction. The nurse links this finding to which underlying physiologic mechanism? A. Persistent venous pooling secondary to increased cardiac workload B. Autoimmune-mediated tissue changes causing fluid accumulation behind the orbit C. Excessive sodium retention due to altered renal blood flow D. Localized infection causing orbital inflammation 2. During endocrine workup, the nurse reviews a client’s thyroid panel to validate a suspected diagnosis of hormone overproduction. Which pattern is most consistent with this disorder? A. Increased thyroid hormone release accompanied by reduced TSH levels B. Stable thyroid hormone levels with elevated TSH secretion C. Decreased thyroid hormones with partial pituitary suppression D. Uniform suppression of both thyroid and pituitary hormones 3. A patient with hyperthyroidism has just started with Methimazole. During discharge teaching, the nurse emphasizes monitoring for adverse effects. Which symptom should prompt immediate medical attention? A. Mild fatigue that worsens gradually over a week B. Persistent fever or sore throat C. Occasional headache relieved by rest D. Slight hair shedding after one week of therapy 4. Considering the patient’s history, which clinical manifestation most clearly indicates primary hyperparathyroidism as the underlying disorder? A. Restless energy and tremors interfering with fine motor tasks B. Frequent urination with mild dehydration and generalized fatigue C. Sudden weight loss despite increased appetite D. Warm, flushed skin with heat intolerance 5. Given the patient’s clinical presentation, which nursing diagnosis should the nurse prioritize to ensure patient safety and address the most immediate physiological risk? A. Imbalanced nutrition: less than body requirements B. Impaired gastrointestinal motility C. Risk for injury related to bone demineralization D. Activity intolerance related to muscle weakness 6. Which outcome BEST demonstrates that the interventions are successfully addressing the underlying physiological problem rather than only alleviating symptoms? A. The patient reports improved energy and reduced episodes of confusion B. Serum calcium levels return to within the normal reference range C. The patient notes decreased bone discomfort and increased phosphate levels D. Nausea resolves, and appetite improves Situation: A 42-year-old woman reports fatigue, dizziness, and darkened skin. On assessment, she has low blood pressure, sparse body hair, and muscle weakness. Labs show low cortisol, low aldosterone, and high potassium. She is prescribed prednisone. 7. Based on the patient’s history, physical exam, and lab findings, which of the following assessment findings is least indicative of Addison’s disease? A. Hyperpigmentation of the knuckles and palmar creases B. Salt cravings and postural hypotension C. Unexplained weight gain with fluid retention D. Generalized muscle weakness and fatigue 8. Which laboratory or diagnostic finding most definitively supports a diagnosis of primary adrenal insufficiency in this patient? A. Decreased plasma ACTH with elevated cortisol after ACTH stimulation B. Elevated plasma renin with low aldosterone C. Low morning cortisol with elevated ACTH D. Normal cortisol with abnormal CRH stimulation Situation: Mr. Santos, 58, was admitted after a head injury. He drinks water constantly and urinates large amounts of clear urine. Labs reveal high serum sodium and low urine specific gravity. The physician prescribes desmopressin. 9. Which clinical or laboratory finding most reliably distinguishes diabetes insipidus from SIADH in this patient? A. Low urine output despite high serum sodium B. Dilute urine with hypernatremia C. High urine osmolality with low serum sodium D. Decreased thirst with concentrated urine 10. Mr. Santos suddenly reports dizziness and extreme thirst, and his blood pressure drops to 85/60 mmHg. Which nursing action should be performed first? A. Administer oral fluids immediately to relieve thirst B. Notify the physician about the patient’s hypotension C. Reassess vital signs and evaluate for signs of fluid loss D. Adjust the desmopressin dose as a preventive measure Situation: Ms. Reyes, a 19-year-old female with type 1 diabetes, is brought to the ER with nausea, vomiting, and * NLE * NCLEX * CGFNS * HAAD * PROMETRICS * DHA * MIDWIFERY * LET * RAD TECH * CRIMINOLOGY * DENTISTRY * PHARMACY *