Title RECALLS 4 - NP5 - SC ✅

RECALLS 4 EXAMINATION NURSING PRACTICE V CARE OF THE CLIENT WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART C) NOV 2025 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 V” on the box provided Situation: A 28-year-old male client with a history of bipolar disorder and recent suicide attempt is admitted to the psychiatric unit. He is currently exhibiting manic symptoms and is prescribed lithium. 1. Which of the following is the most important nursing intervention when assessing a client taking lithium? A. Monitor for signs of hyperkalemia. B. Assess for gastrointestinal distress. C. Monitor serum lithium levels regularly. D. Observe for extrapyramidal symptoms. 2. The client's lithium level is 1.8 mEq/L. What is the nurse's priority action? A. Administer the next dose of lithium as prescribed. B. Document the finding and continue to monitor the client. C. Notify the physician immediately. D. Encourage increased fluid intake. 3. The signs of lithium toxicity include which? A. Sedation, fever, and restlessness B. Psychomotor agitation, insomnia, and increased thirst C. Elevated WBC count, sweating, and confusion D. Severe vomiting, diarrhea, and weakness 4. Which of the following medications is contraindicated in a client taking an MAOI? A. Lithium B. Sertraline (Zoloft) C. Valproic acid (Depakote) D. Lamotrigine (Lamictal) 5. Which nursing diagnosis is appropriate for this client at this time? A. Risk for injury related to impulsivity B. Ineffective coping related to bipolar disorder C. Disturbed thought processes related to mania D. Imbalanced nutrition: less than body requirements Situation: A nurse is caring for several clients who are exhibiting different coping mechanisms in response to stressful life events. Identify the ego defense mechanism being used in each case. 6. A client who recently lost their job states, "I'm actually better off without that stressful job. I can now focus on my family and hobbies." A. Displacement B. Rationalization C. Projection D. Sublimation 7. A client who experienced a traumatic car accident has no memory of the event. A. Repression B. Dissociation C. Denial D. Regression 8. A client who is angry at their supervisor for a recent reprimand yells at their spouse when they get home. A. Displacement B. Projection C. Reaction Formation D. Compensation 9. A client with a history of substance abuse begins volunteering at a local homeless shelter. A. Undoing B. Sublimation C. Identification D. Compensation 10. A client who has always wanted to be a doctor but failed the medical school entrance exam repeatedly now excels as a medical researcher. A. Reaction Formation B. Compensation C. Intellectualization D. Substitution 11. A client presents with sharpened senses, increased motivation, and reports feeling restless with gastrointestinal "butterflies." They are able to solve problems and learning is effective. A. Panic B. Severe C. Moderate D. Mild 12. A client is unable to complete tasks, solve problems, or learn effectively. They report feeling awe and dread, and have a severe headache. Their behavior is geared toward anxiety relief, but is ineffective. A. Mild B. Moderate C. Severe D. Panic 13. A client's perceptual field is reduced to focus solely on themselves. They cannot process environmental stimuli and exhibit distorted perceptions. They are possibly suicidal and unable to communicate verbally. A. Severe B. Moderate C. Mild D. Panic 14. A client exhibits muscle tension, diaphoresis, and a pounding pulse. They can be redirected from the immediate task, but cannot connect thoughts or events independently. A. Panic B. Severe C. Moderate D. Mild 15. A client reports feeling restless and sleepless. They are irritable and hypersensitive to noise. A. Panic B. Severe C. Moderate D. Mild 1 | Page
Situation: A nurse is conducting therapeutic communication sessions with clients who are experiencing various emotional and mental health challenges. The nurse uses different communication techniques to support effective interaction and understanding. Identify the therapeutic communication technique being used in each situation. 16. A client is hesitant to talk about their feelings, stating only, "I don't know where to begin." The nurse responds, "Is there something you'd like to talk about? What would you like to begin with?" A. Consensual validation B. Encouraging comparison C. Broad openings D. Accepting 17. A client is describing a stressful event, but keeps shifting between different aspects without fully exploring any one point. The nurse says, "Of all the concerns you've mentioned, which is most troublesome?" A. Exploring B. Focusing C. Formulating a plan of action D. Giving information 18. A client expresses anger about a recent situation. The nurse asks, "What could you do to let your anger out harmlessly? Next time this comes up, what might you do to handle it?" A. Exploring B. Focusing C. Formulating a plan of action D. Giving information 19. A client shares a past experience of overcoming a similar challenge. The nurse responds, "Have you had similar experiences? Was it something like...?" A. Accepting B. Encouraging comparison C. Broad openings D. Encouraging expression 20. A client expresses a belief about a situation, and the nurse says, "Tell me whether my understanding of it agrees with yours. Are you using this word to convey that...?" A. Encouraging description of perceptions B. Encouraging expression C. Consensual validation D. Broad openings Situation: A nurse is interacting with several clients exhibiting various emotional states. The nurse needs to identify and avoid using non-therapeutic communication techniques. 21. A client expresses feeling hopeless and says, "I wish I were dead." The nurse responds, "Everybody gets down in the dumps; I've felt that way myself." A. Advising B. Agreeing C. Belittling feelings expressed D. Challenging 22. A client expresses a concern about a medication side effect. The nurse says, "Let's not discuss that." A. Probing B. Making stereotyped comments C. Reassuring D. Rejecting 23. A client says, "I should just quit my job." The nurse says, "I think you should look for a new job instead." A. Advising B. Agreeing C. Belittling feelings expressed D. Challenging 24. A client, experiencing hallucinations, states, "The hospital is trying to poison me." The nurse responds, "But how can you be sure that's true? This hospital has a fine reputation." A. Advising B. Agreeing C. Belittling feelings expressed D. Challenging 25. A client shares a belief that is inconsistent with reality. The nurse asks, "Why do you think that? Why do you feel that way?" A. Rejecting B. Reassuring C. Making stereotyped comments D. Requesting an explanation 26. A client with a history of suicide attempts becomes increasingly agitated and threatens self-harm. The nurse decides to restrain the client without obtaining a physician's order. Which intentional tort has the nurse potentially committed? A. Assault B. Battery C. False imprisonment D. Negligence 27. A client with schizophrenia experiences an acute psychotic episode and becomes verbally abusive towards staff. The nurse responds by threatening to restrain the client. What intentional tort has the nurse potentially committed? A. Battery B. False imprisonment C. Negligence D. Assault 28. A nurse forgets to administer a prescribed medication to a client. The client subsequently experiences a seizure, resulting in a head injury. Which element of negligence is most directly implicated? A. Duty B. Breach of duty C. Injury or damage D. Causation 29. A nurse administers the wrong medication to a client due to a medication error. The client experiences an adverse reaction but recovers fully. Which element of negligence is ABSENT in this scenario? A. Duty B. Breach of duty C. Injury or damage D. Causation 30. A nurse is caring for two clients: one wealthy and one impoverished. The nurse provides the same standard of care to both clients. Which ethical principle is the nurse upholding? A. Autonomy B. Beneficence C. Justice D. Fidelity Situation: A nurse is caring for a client diagnosed with Obsessive-Compulsive Disorder (OCD) who is experiencing significant distress and functional impairment. 31. The client spends hours each day arranging and rearranging items on their bedside table, believing it must be "just so." This behavior is best described as: A. An obsession B. A compulsion C. A delusion D. A hallucination 32. The client reports experiencing persistent, intrusive thoughts of contamination. These thoughts cause significant anxiety and interfere with their ability to eat meals. This behavior is best described as: A. A compulsion B. A delusion C. An obsession D. A hallucination 33. The nurse is implementing exposure and response prevention (ERP) therapy. Which nursing intervention is consistent with this approach? A. Allowing the client extra time to complete their rituals. B. Distracting the client whenever they begin a ritual. C. Gradually reducing the time the client spends performing rituals. D. Immediately stopping the client from performing any ritualistic behavior. 34. The client's family expresses frustration with the client's OCD symptoms and requests advice on how to best support 2 | Page

C. Distract her from her feelings by engaging her in an activity. D. Tell her to calm down and control her emotions. Situation: Ms. Santos, a 19-year-old female college student, is admitted to the hospital with severe anorexia nervosa. She weighs 80 lbs (36 kg) and exhibits significant electrolyte imbalances, bradycardia, and lanugo. She denies any problems with her weight or eating habits. 51. Which of the following is a defining characteristic of anorexia nervosa? A. Recurrent episodes of binge eating followed by compensatory behaviors. B. Intense fear of gaining weight or becoming fat, despite being underweight. C. Consumption of large amounts of food in a short period, followed by guilt. D. Frequent use of laxatives or diuretics to control weight. 52. Ms. Santos's low body weight and electrolyte imbalances necessitate which priority nursing intervention? A. Initiate a behavior modification program to address her eating disorder. B. Engage her in psychotherapy to address her distorted body image. C. Monitor vital signs and electrolyte levels closely, and provide nutritional support. D. Educate her on the health risks associated with her eating disorder. 53. Ms. Santos denies having a problem with her weight. What is the nurse's best approach? A. Confront Ms. Santos about her denial and the severity of her condition. B. Emphasize the health risks associated with her low weight and eating habits. C. Build rapport and establish trust before directly addressing her eating disorder. D. Immediately initiate a structured meal plan to increase her caloric intake. 54. Which medication might be considered the most to assist with weight gain in Ms. Santos? A. Fluoxetine (Prozac) B. Olanzapine (Zyprexa) C. Desipramine (Norpramin) D. Amitriptyline (Elavil) 55. What is a common long-term complication associated with anorexia nervosa? A. Osteoporosis B. Hypertension C. Type 2 Diabetes D. Hyperthyroidism Situation: Mr. Cruz, a 45-year-old male, presents to the clinic complaining of persistent, severe headaches, abdominal pain, and fatigue. He has undergone extensive medical testing, all of which have yielded negative results. He expresses significant distress and anxiety about his symptoms and worries he has a serious, undiagnosed illness. He has seen multiple specialists and continues to seek further medical evaluations. 56. Which somatic symptom disorder best describes Mr. Cruz's presentation? A. Hypochondriasis B. Illness anxiety disorder C. Somatic symptom disorder D. Pain disorder 57. Mr. Cruz insists that his symptoms are real and not "all in his head." How should the nurse respond? A. "I understand your symptoms are real to you, and we'll work together to manage them." B. "Many people experience similar symptoms without a medical explanation." C. "Your symptoms are likely related to stress; we need to address that." D. "Extensive testing has ruled out any medical cause; your symptoms are psychosomatic." 58. Which aspect of nursing care is important when managing clients with somatic symptom disorders? A. Consistently focusing on proving the absence of a physical cause for the symptoms. B. Providing reassurance that the symptoms will eventually disappear. C. Establishing a trusting relationship and providing consistent care. D. Prescribing medication to reduce anxiety and manage physical symptoms. 59. Mr. Cruz expresses frustration with the lack of medical explanations for his symptoms. What is the nurse's best response? A. "I know it's frustrating, but sometimes there isn't a clear medical reason for pain." B. "We'll continue to investigate possible medical causes, but let's also explore other factors." C. "Your symptoms are likely related to psychological factors; we need to address those." D. "It's important to accept that some pain is unexplained and learn to live with it." 60. Which type of medication might be helpful for Mr. Cruz to manage his anxiety and depression related to his symptoms? A. Antipsychotic B. Mood stabilizer C. Selective Serotonin Reuptake Inhibitor (SSRI) D. Benzodiazepine Situation: A 7-year-old boy, Miguel, is brought to the clinic by his parents because of persistent nighttime bedwetting (enuresis). He has no known medical conditions and has never been continent at night. His parents report increasing frustration and concern. 61. What is the most common type of enuresis? A. Secondary enuresis B. Primary enuresis C. Diurnal enuresis D. Nocturnal enuresis 62. Which of the following is a potential contributing factor to Miguel's enuresis? A. A family history of enuresis B. Constipation C. Oppositional Defiant Disorder D. A history of severe physical abuse 63. Which of the following interventions is most likely to be effective in treating Miguel's enuresis? A. Punishment for bedwetting incidents B. Fluid restriction before bedtime C. A bedwetting alarm system D. Immediate administration of diuretics 64. Which medication might be considered as an adjunct to behavioral therapy for Miguel's enuresis? A. Methylphenidate (Ritalin) B. Imipramine (Tofranil) C. Haloperidol (Haldol) D. Lithium 65. What is an important aspect of family education regarding Miguel's enuresis? A. The need for strict discipline to correct this behavior. B. That enuresis is a sign of emotional disturbance that requires immediate psychological intervention. C. The importance of patience, positive reinforcement, and avoiding blame. D. That enuresis will likely persist into adulthood, requiring long-term management. Situation: 8-year-old Ana is referred to a child psychiatrist for evaluation of possible ADHD. Her teacher reports significant difficulties with inattention, impulsivity, and hyperactivity in the classroom. Ana frequently interrupts, struggles to follow instructions, and has difficulty completing tasks. She is easily distracted and fidgets constantly. 66. Which of the following is a core symptom of ADHD? A. Persistent sadness and low mood B. Repetitive, stereotyped movements C. Inattention and hyperactivity 4 | Page