Title RECALLS 6 (NP4) - STUDENT COPY ✅

RECALLS EXAMINATION 6 NURSING PRACTICE IV CARE OF CLIENTS WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART B) NOVEMBER 2024 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: Maria has recently graduated from college with a Bachelor of Science in Nursing from a recognized institution. She plans to take the nurse licensure examination so she can practice as a nurse after passing the exam. 1. Which of the following requirements is not needed for Maria to qualify for the said examination? A. A holder of a Bachelor’s Degree in Nursing from a college or university that complies with the standards of nursing education duly recognized by the proper government agency B. Must be of good moral character C. A citizen of the Philippines D. A member of the accredited professional organization 2. To pass the examination, Maria must obtain a general average of ______ with a rating of not below ____ in any subject. A. 75%, 60% B. 70%, 65% C. 75%, 70% D. 70%, 60% 3. If Maria fails one subject but obtains the required general average, what should she do? A. Take the entire examination again B. Take the examination on the subject where she scored below the required passing rate C. Appeal to the board for rechecking of her examination papers D. Enroll in a one-year refresher course 4. Upon passing the licensure examination, what is Maria's priority action? A. Take an oath of profession before the Board of Nursing B. Apply for registration with the Professional Regulation Commission C. Apply for membership to the Philippine Nurses D. Association Prepare credentials for job hunting 5. How often must Maria renew her professional identification card? A. Every five years B. Every three years C. Annually D. Biannually SITUATION: A 67-year-old patient was rushed to the emergency room, presenting with an altered level of consciousness. When the triage nurse asked the daughter about her mother's weight, the daughter's estimate seemed significantly lower than the weight obtained during the physical assessment. Additionally, the daughter reported that her mother had produced little to no urine since the previous day. The medical team quickly recognized the urgency of the situation and began a thorough evaluation to determine the underlying cause and provide immediate care. 6. Based on the patient’s manifestation and history, what could be the underlying condition of the patient? A. DI B. DM C. SIADH D. HYPERTHYROIDSM 7. What disturbance should you be aware of related to this diagnosis? A. Excess water loss B. Dilutional hyponatremia C. Serum sodium level of 148 mg/dL D. Decreased urine osmolality 8. What will be the priority nursing diagnosis for the patient? A. Risk for peripheral neurovascular dysfunction B. Excess fluid volume C. Insufficient fluid volume D. Ineffective airway clearance 9. If that is the priority nursing diagnosis, what could be the ideal nursing intervention now? A. Fluid restriction B. Transfusion of fluids C. Transfusion of fresh frozen plasma (FFP) D. Electrolyte restriction 10. The patient’s plan of care includes assessment of specific gravity every 4 hours. The results of this test will allow you to assess what aspect of the patients health? A. Nutritional status B. Potassium balance C. sodium balance D. Fluid volume status 11. Which of the following medical history if obtained, is strongly related to the patient’s development of the disease? A. Breast carcinoma B. Adrenal carcinoma C. Lung carcinoma D. Liver carcinoma SITUATION: Patrick is a nurse working in a busy dialysis unit, where he provides specialized care for patients undergoing dialysis treatments. 12. Nurse Patrick is on duty in the dialysis unit when a patient receiving hemodialysis suddenly reports shortness of breath and chest pain. The patient exhibits tachycardia, pallor, and anxiety. Recognizing these symptoms, Nurse Patrick suspects an air embolism. What priority nursing actions should he initiate to address the emergency situation? A. Stop dialysis, and turn the client on the right side with head lower than feet. B. Continue dialysis at a slower rate after checking the lines for air. C. Notify the primary health care provider (PHCP) and Rapid Response Team. D. Stop dialysis, and turn the client on the left side with head lower than feet. 13. Prior to initiating hemodialysis to a patient, Patrick must assess the patency of a client’s arm with arteriovenous fistula. The following finding does not indicate patent fistula, except? A. Vibration upon palpating the access site. 1 | Page
B. Presence of a radial pulse in the left wrist. C. Visualization of enlarged blood vessels at the fistula site. D. Capillary refill less than 3 seconds in the nailbeds of the fingers on the left hand. 14. Recognizing that a patient with fistula is at risk for arterial steal syndrome, Patrick always conducts a thorough assessment. He ensures he is vigilant for any indications that require immediate attention. Which of the following manifestations refer to this? A. Warmth, redness, and pain in the left hand B. Ecchymosis and audible bruit over the fistula C. Edema and reddish discoloration of the left arm D. Pallor, coolness, and pain in the left hand 15. Patrick is reviewing another client’s record and notes that the primary health care provider has documented that the client has chronic kidney disease. On review of the laboratory results, the Patrick most likely would expect to note which finding? A. serum CREA: 2.3mg/dL B. hgb level: 21g/dL C. RBC level: 5.3 million/mcL D. Positive WBC in the urine 16. A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment. On assessment, Patrick notes that the client’s temperature is 38.5° C. Which nursing action is most appropriate? A. Encourage fluid intake. B. Continue to monitor vital signs. C. Notify the primary health care provide. D. Monitor the site of the shunt for bleeding. 17. Patrick is explaining peritoneal dialysis to a client with diabetes mellitus. He highlights that maintaining the prescribed dwell time for the dialysis is crucial to avoid which complication? A. Peritonitis B. Hyperglycemia C. Hyperphosphatemia D. Disequilibrium syndrome 18. Another client newly diagnosed with chronic kidney disease recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, Patrick should assess the client during dialysis for which associated manifestations? A. Hypertension, tachycardia, and fever B. Hypotension, bradycardia, and hypothermia C. Restlessness, irritability, and generalized weakness D. Headache, deteriorating level of consciousness, and twitching 19. Patrick is looking after a patient undergoing hemodialysis three times a week who recently had surgery to create an arteriovenous fistula. What should the nurse prioritize when caring for this patient? A. Using a stethoscope for auscultating thrill for the fistula. B. The patient feels best immediately after the dialysis treatment. C. Taking a BP reading on the affected arm can damage the fistula. D. The patient should not feel pain during initiation of dialysis. 20. Patrick needs to educate a 45-year-old man with diabetic nephropathy and end-stage kidney disease (ESKD) who is beginning hemodialysis. What essential information should he provide about the hemodialysis process? A. Hemodialysis is a treatment option that is usually required three times a week. B. Hemodialysis is a program that will require you to commit to daily treatment. C. This will require you to have surgery and a catheter will need to be inserted into your abdomen. D. Hemodialysis is a treatment that is used for a few months until your kidney heals and starts to produce urine again. 21. Patrick has determined that a patient undergoing peritoneal dialysis is at risk for infection. What nursing intervention would most effectively mitigate this risk? A. Maintain aseptic technique when administering dialysate. B. Wash the skin surrounding the catheter site with soap and water prior to each exchange. C. Add antibiotics to the dialysate as ordered. D. Administer prophylactic antibiotics by mouth or IV as ordered. 22. When Patrick notices that the peritoneal fluid is draining slowly and the patient’s abdomen is becoming distended, what should the nurse do next? A. Advance the catheter 2 to 4 cm further into the peritoneal cavity. B. Reposition the patient to facilitate drainage. C. Aspirate from the catheter using a 60-mL syringe. D. Infuse 50 mL of additional dialysate. Situation: You are caring for Antonio, a 65-year-old man who was brought to the hospital after experiencing significant tremors and difficulty with balance. After a thorough assessment and tests, the diagnosis of Parkinson's disease was confirmed. 23.During your health history interview, Antonio reveals that he can no longer perform many activities he once could. What factor should you identify as having the most significant impact on Antonio's life? A. Neurologic deficits B. Loss of independence C. Age-related changes D. Tremors and decreased mobility 24. You are now aiming to determine the current status of his tremors. When would be the best time to conduct this assessment to gather the most accurate information? A. When Antonio is resting B. When Antonio is ambulating C. When Antonio is preparing his or her meal tray to eat D. When Antonio is participating in occupational therapy 25. To provide effective and safe care for Antonio, it is crucial to understand the underlying processes of his condition. Which of the following would you identify as the primary cause? A. Premature degradation of acetylcholine B. Decreased availability of dopamine C. Insufficient synthesis of epinephrine D. Delayed reuptake of serotonin Ans: B 26. Due to the manifestations he display, it is essential to identify appropriate nursing diagnosis to ensure comprehensive care. One significant nursing diagnosis to consider is: A. Acute pain B. Impaired urinary elimination C. Unilateral neglect D. Risk for injury 27. The physician has prescribed both carbidopa and levodopa to Antonio. During a discussion, Antonio expresses curiosity about the need to take these two medications together. What should be your response? A. “To have fewer side effects.” B. “Dopamine requires the presence of both of these medications” C. “Carbidopa makes more levodopa available to the brain” D. “Carbidopa crosses the blood-brain barriers to treat Parkinson’s” 28. Three days after admission, you notice that his temperature has spiked to 39 degrees Celsius. A chest X-ray was ordered by the physician and it reveals lung infiltrates. Which of the following could explain these findings? A. Mask-like facies and shuffling gait. B. Difficulty swallowing and immobility. C. Pill rolling of fingers and flat affect. D. Lack of arm swing and bradykinesia 29. Antonio's condition is advancing quickly, and he has expressed a desire to receive care at home. Which interventions should you prioritize in the care plan? A. Aggressively continuing to fight the disease process B. Moving the patient to a long-term care facility when it becomes necessary C. Including the children in planning their fathers care D. Supporting the patients and family’s values and choices 2 | Page
SITUATION: Ms. Yolly, a 38-year-old woman, was brought to the hospital due to severe joint pain and stiffness, particularly in her knees. Upon admission, Nurse Keola conducts a thorough assessment and notes that Ms. Yolly lives a sedentary lifestyle, has a body mass index of 34, and has a history of primary hypertension. Ms. Yolly is diagnosed with with osteoarthritis. 30. What assessment finding would Nurse Keola identify as a risk factor contributing to the development of arthritis based on the available information? A. sedentary lifestyle. B. body mass index is 34. C. primary hypertension. D. 38 years old. 31. Which type of joint is primarily affected in Ms. Yolly's case? A. Diarthrosis B. Ampiarthrosis C. Synarthrosis D. Kneearthrosis 32. Ms. Yolly asks if her osteoarthritis is the same condition as her cousin's rheumatoid arthritis. How should Nurse Keola respond? A. OA is a considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints. B. OA and RA are very similar. OA affects the smaller joints such as the fingers, and RA affects the larger, weight-bearing joints like the knees. C. OA originates with an infection. RA is a result of your body cells attacking one another. D. OA is associated with impaired immune function; RA is a consequence of physical damage. 33. Ms. Yolly is eager to understand more about her condition. Which of the following statements about osteoarthritis should Keola add to her health teaching? A. Osteoarthritis is rarely debilitating B. Osteoarthritis is a rare form of arthritis C. Osteoarthritis is the most common form of arthritis D. Osteoarthritis afflicts people over 60 34. When creating a nursing care plan for Ms. Yolly, who is experiencing difficulty ambulating due to chronic pain, Keola may consider the following interventions to best promote her mobility: A. Motivate Ms. Yolly to walk in the afternoon rather than the morning. B. Encourage Ms. Yolly to push through the pain in order to gain further mobility. C. Administer an analgesic as ordered to facilitate Ms. Yolly’s mobility. D. Have another person with osteoarthritis visit Ms. Yolly 35. The physician observed that Ms. Yolly has developed Heberden’s nodes. Based on your understanding, which of the following statements is accurate about this deformity? A. It appears only in women B. It appears on the distal interphalangeal joint C. It appears on the proximal interphalangeal joint D. It appears on the dorsolateral aspect of the interphalangeal joint. SITUATION: Magdalene leads an active sexual life and has been experiencing painful urination for quite some time. However, the pain recently became intolerable, prompting her to seek medical attention. She has now been diagnosed with cystitis and is prescribed with antibiotics. 36. Magdalene asks the nurse, "How did I get this urinary tract infection?" The nurse should explain that cystitis is typically caused by: A. Congenital strictures in the urethra. B. An infection elsewhere in the body. C. Urinary stasis in the urinary bladder. D. An ascending infection from the urethra. 37. Magdalene wants to stop her medication because she feels it is aggravating her condition, as her urine has turned brown. The nurse reassured her that there is nothing to worry about since this is a normal side effect what medication? A. Fosfomycin B. Nitrofurantoin C. Methenamine D. Phenazopyridine 38. Magdalene persistently complains of painful urination. What might the nurse expect to be prescribed to alleviate her pain? A. Morphine B. Nitrofurantoin C. Tramadol D. Phenazopyridine 39. The nurse recommends a diet to help Magdalene. Which of the following foods would not contribute in improving her condition? A. cranberry walnut bread B. tomato juice C. plum puree D. banana cake 40. The nurse explains to Magdalene the importance of drinking plenty of fluids to combat cystitis. The nurse should advise her to drink: A. Twice as much fluid as usual. B. At least 1 quart (950 mL) more than usual. C. A lot of water, juice, and other fluids throughout the day. D. At least 3,000 mL of fluids daily. SITUATION: Nursing care in the oncology unit is a specialized field dedicated to support patients undergoing cancer treatment. This unit focuses on providing comprehensive care that addresses the physical, emotional, and psychological needs of cancer patients and their families. 41. Melissa is undergoing chemotherapy. She is approaching the nadir period. What should a nurse consider when caring for Melissa? A. Monitor the neutrophil count and be vigilant for signs and symptoms of infection. B. Anticipate nausea and vomiting, and administer antiemetics as prescribed. C. Watch for breakthrough pain and report the frequency of bolus doses of opioids. D. Monitor for anorexia and initiate daily weights as needed. 42. A new staff nurse learns about which laboratory result is particularly crucial to monitor in a patient undergoing chemotherapy. Which specific result should be reported? A. White blood cell count (WBC): 3000/mm3 (3 × 109/L) B. Serum potassium (K ): 3.4 mEq/L (3.4 mmol/L) C. Prealbumin (PAB): 14 mg/dL (140 mg/L) D. Blood urea nitrogen (BUN): 9 mg/dL (3.21 mmol/L) 43. Which task would be appropriate to assign to a nursing assistant when caring for a patient with oral cancer? A. Assisting the patient to perform oral hygiene B. Explaining when brushing and flossing are contraindicated C. Giving antacids and sucralfate suspension as prescribed D. Recommending saliva substitutes 44. Patient Jonel is being closely monitored for tumor lysis syndrome following chemotherapy. Which laboratory result requires special attention? A. Platelet count B. Electrolyte levels C. Red blood cell count D. White blood cell count 46. One month after being diagnosed with a brain tumor, Mariz has started showing signs of cachexia. What should the nurse prioritize in the subsequent assessment? A. Assessment of peripheral nervous function B. Assessment of cranial nerve function C. Assessment of nutritional status D. Assessment of respiratory status 47. Patient Jobel agreed to undergo chemotherapy, believing it is the only way to fight her cancer. However, she is aware that it can have negative effects, such as neutropenia. Which of the following should the nurse caring for Jobel implement? A. Restrict all visitors. B. Restrict fluid intake. C. Teach the client and family about the need for hand hygiene. D. Insert an indwelling urinary catheter to prevent skin breakdown. 3 | Page
48. A patient diagnosed with stage 4 colon cancer has been experiencing excruciating pain for several hours. To accurately assess the patient's pain, the nurse should use: A. The client’s pain rating B. Nonverbal cues from the client C. The nurse’s impression of the client’s pain D. Pain relief after appropriate nursing intervention 49. A client receiving radiation therapy for bladder cancer tells the nurse that it feels like she is voiding through her vagina. The nurse interprets that the client may be experiencing which condition? A. Rupture of the bladder B. The development of a vesicovaginal fistula C. Extreme stress caused by the diagnosis of cancer D. Altered perineal sensation as a side effect of radiation therapy SITUATION: Sickle cell anemia is a hereditary blood disorder that also affects populations in the Philippines. While exact statistics on the prevalence of sickle cell anemia are limited, it is recognized as a significant health concern due to its impact on affected individuals and their families. 50. Kassy, who has sickle cell disease, is admitted with a vaso-occlusive crisis and is experiencing severe abdominal and flank pain. Which analgesic medication should the nurse administer first according to the pain treatment protocol? A. Ibuprofen B. Morphine sulfate C. Hydromorphone D. Paracetamol 51. Given the crisis described above, which nursing diagnosis should the nurse prioritize when preparing the patient’s plan of care? A. Risk for disuse syndrome related to ineffective peripheral circulation B. Functional urinary incontinence related to urethral occlusion C. Ineffective tissue perfusion related to thrombosis D. Ineffective thermoregulation related to hypothalamic dysfunction 52. When teaching a patient with sickle cell anemia about strategies to prevent such crisis, what measures should the nurse recommend? A. Using prophylactic antibiotics and performing meticulous hygiene B. Maximizing physical activity and taking OTC iron supplements C. Limiting psychosocial stress and eating a high-protein diet D. Avoiding cold temperatures and ensuring sufficient hydration 53. Peter is admitted with splenic sequestration, presenting with a blood pressure of 80/40 mm Hg and a heart rate of 130 beats/min. What action should the nurse take first? A. Complete a physical assessment. B. Draw blood for type and cross-match. C. Infuse normal saline at 250 mL/hr. D. Ask the patient about vaccination history. 54. In patients with sickle cell anemia, blood transfusions are often needed to increase the number of normal red blood cells and improve oxygen delivery throughout the body. When performing this, which actions can the nurse delegate to the nursing assistant? A. Take the patient’s vital signs during the transfusion. B. Ensure that the blood is infused within no more than 4 hours. C. Ask the patient at frequent intervals about the presence of chills or dyspnea. D. Assist with double-checking the patient’s identification and blood bag number. 55. Before starting the infusion, another nurse is needed to recheck the information on the packed blood and ensure that everything is in place. Which of the following, if observed by a co-nurse, would require correction? A. Waiting 20 minutes after obtaining the PRBCs before starting the infusion B. Starting an IV line for the transfusion using a 20-gauge catheter C. Priming the transfusion set using 5% dextrose in lactated Ringer’s solution D. Telling the patient that the PRBCs may cause a serious transfusion reaction 56.Nurse Juliet in the pediatric ICU is caring for Tommy, a child who is dying of sickle cell anemia. Tommy's mother, Maria, is unable to eat or sleep and can only talk about her impending loss and the guilt she feels over Tommy's pain and suffering. What intervention should Nurse Juliet prioritize? A. Allowing the patient to express her feelings without judging her B. Helping the patient to understand the phases of the grieving process C. Reassuring the patient that the childs death is not her fault D. Arranging for genetic counseling to inform the patient of her chances of having another child with the disease SITUATION: Maintaining the balance of fluids and electrolytes is crucial for the proper functioning of the human body. Nurses play a vital role in monitoring and managing these balances to ensure optimal patient health. 57. Johnny is a fireman on duty when a fire broke out in Barangay Kimparaha. He was severely affected by the fire and attained a 3rd degree burn. Upon being brought to the emergency room, Johnny exhibits signs and symptoms of third spacing. Given this change in condition, what imbalance should you expect the patient to show? A. Metabolic alkalosis B. Hypermagnesemia C. Hypercalcemia D. Hypovolemia 58. You are doing your rounds in the ward when you noticed that the line of the patient is not flowing. Upon examination, you noticed an edema around the insertion site. When touched, it is cold. You understand that this IV complication could possibly be: A. Air emboli B. Phlebitis C. Infiltration D. Fluid overload 59. What steps should the nurse take when selecting a site on the hand or arm for IV catheter insertion? A. Shave the insertion site to be free of hair B. Consider potential effects on the patients mobility when selecting a site. C. Have the patient briefly hold his arm over his head before insertion. D. Leave the tourniquet on for at least 3 minutes. 60. Tita Baby is a patient undergoing hemodialysis to manage her chronic kidney disease. As you visit her during your shift, she reports experiencing muscle spasms, cramps, and a tingling sensation in her lips and fingers. What electrolyte imbalance should you first suspect? A. Hypophosphatemia B. Hypocalcemia C. Hypermagnesemia D. Hyperkalemia 61. Bea saw the love of her life cheating on her with her best friend. Her fight-or-flight response is activated, causing constriction of her renal arterioles. What could be your Bea’s response to this? A. Decrease in the release of aldosterone B. Increase of filtration in the Loop of Henle C. Decrease in the reabsorption of sodium D. Decrease in glomerular filtration 62.Mr. Lee is an elderly patient who has been experiencing intense diarrhea for the past three days. He is currently severely dehydrated. Which assessment finding supports this condition? A. Flattened neck veins when the patient is in the supine position B. Full and bounding pedal and post-tibial pulses C. Pitting edema located in the feet, ankles, and calves D. Shallow respirations with crackles on auscultation 63. A patient’s potassium level is 6.7 mEq/L (6.7 mmol/L). Which of the following do you expect the doctor to order? A. Administer sodium polystyrene sulfonate 15 g orally. 4 | Page