Title RECALLS 7 (NP4) - STUDENT COPY ✅

RECALLS EXAMINATION 7 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: You are caring for patient Igaram, a patient with Addison’s disease. You utilize your knowledge on this concept to help care for the patient. 1. Igaram was just recently diagnosed with Addison’s disease. He still lacks knowledge about his disease so he decided to ask you some questions. Igaram asked you, “How does the disease happen?” You answer him correctly by stating that this disease results from: A. Insufficient secretion of growth hormone (GH). B. Dysfunction of the hypothalamic pituitary. C. Idiopathic atrophy of the adrenal gland. D. Oversecretion of the adrenal medulla. 2. Igaram is admitted to your unit. After your assessment on him, you formulated the nursing diagnosis Deficient fluid volume related to inadequate fluid intake and to fluid loss secondary to inadequate adrenal hormone secretion. As Igaram’s oral intake increases, which of the following fluids would be the most appropriate for him? A. Milk and diet soda. B. Water and eggnog. C. Bouillon and juice. D. Coffee and milkshakes. 3. You are instructing Igaram how to adjust the dose of the glucocorticoids he is taking. As his nurse, you should explain to him that he may need an increased dosage of glucocorticoids in which of the following scenarios? A. Completing the spring semester of school. B. Gaining 4 pounds. C. Becoming engaged. D. Undergoing a root canal. 4. Igaram is diagnosed with Addison’s disease. As a knowledgeable nurse, you know that this condition may lead to Addisonian crisis if not adequately managed. Which of the following manifestations would be expected in Igaram if he develops this condition? A. Fluid retention. B. Pain. C. Peripheral edema. D. Hunger. 5. If Igaram develops Addisonian crisis, which of the following would be your priority as Igaram’s primary nurse? A. Controlling hypertension. B. Preventing irreversible shock. C. Preventing infection. D. Relieving anxiety. SITUATION: You are a nurse tasked to care for patients with different pituitary disorders. You are to take care of Karoo and Koza, both diagnosed with SIADH, and Paula, who is diagnosed with diabetes insipidus. You utilize your knowledge on this concept to help care for your patients safely. 6. One of the clients in your unit, Karoo, is diagnosed to have a pituitary tumor. Karoo developed Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which of the following interventions should you implement as Karoo’s primary nurse? A. Assess for dehydration and monitor blood glucose levels. B. Assess for nausea and vomiting and weigh daily. C. Monitor potassium levels and encourage fluid intake. D. Administer vasopressin IV and conduct a fluid deprivation test. 7. You are reviewing the chart of Karoo who has SIADH. Which of the following clinical manifestations you noted in Karoo’s chart should be reported to his primary care physician? A. Serum sodium of 112 mEq/L and a headache. B. Serum potassium of 5.0 mEq/L and a heightened awareness. C. Serum calcium of 10 mg/dL and tented tissue turgor. D. Serum magnesium of 1.2 mg/dL and large urinary output. 8. Another patient in your unit, Koza, was diagnosed with SIADH secondary to cancer of the lung. He tells you that he wants to discontinue his fluid restriction and that he does not care if he dies. Which of the following actions by the nurse is an example of the ethical principle of autonomy? A. Discuss the information the client told the nurse with the health-care provider and significant other. B. Explain it is possible the client could have a seizure if he drank fluid beyond the restrictions. C. Notify the health-care provider of the client’s wishes and give the client fluids as desired. D. Allow the client an extra drink of water and explain the nurse could get into trouble if the client tells the health-care provider. 9. Paula, another patient assigned to you in the unit, is recently diagnosed with diabetes insipidus. Which of the following interventions should you implement as Paula’s primary nurse? A. Administer sliding-scale insulin as ordered. B. Restrict caffeinated beverages. C. Check urine ketones if blood glucose is >250. D. Assess tissue turgor every four (4) hours 10. Following Paula’s diagnosis of diabetes insipidus, she stayed in the hospital for a few days. She is now about to be discharged and you are conducting your health teaching regarding her condition. Which of the following statements made by Paula warrants further intervention? A. “I will keep a list of my medications in my wallet and wear a Medic Alert bracelet.” B. “I should take my medication in the morning and leave it refrigerated at home.” C. “I should weigh myself every morning and record any weight gain.” D. “If I develop a tightness in my chest, I will call my health-care provider.” SITUATION: You are a nurse caring for patients with inflammatory bowel disease. 11. Pierre is a patient admitted to the hospital with a diagnosis of ulcerative colitis. You are currently reviewing his history and physical assessment chart. Based on Pierre’s diagnosis, which 1 | Page
of the following information should you expect to see in Pierre’s medical records? A. Abdominal pain and bloody diarrhea B. Weight gain and elevated blood glucose C. Abdominal distension and hypoactive bowel sounds D. Heartburn and regurgitation 12. Pierre had a recent exacerbation of ulcerative colitis. He is put on mesalamine (Asacol), which is to be administered rectally via an enema. Pierre finds this procedure distasteful and he asks you, “Why can't the medication just be given orally?”. You answer Pierre correctly by saying which of the following? A. “It can be given orally; I’ll contact the doctor and see if the change can be made.” B. “Rectal administration delivers the medication directly to the affected area.” C. “Oral administration will not be as effective for the disease condition.” D. “It can be given orally, I’ll make the change and we’ll tell the doctor in the morning.” 13. You overhear a licensed practical nurse (LPN) talking to one of your patients, Mousse, who is being prepared for a total colectomy with creation of an ileoanal reservoir for her ulcerative colitis. To decrease Mousse’s anxiety, you should intervene to clarify the information given by the LPN when you hear the LPN saying: A. “This surgery will prevent you from developing colon cancer.” B. “After this surgery you will no longer have ulcerative colitis.” C. “When you return from surgery you will not be able to eat solid food for several days.” D. “You will have an ileostomy when you return from this surgery.” 14. Wyper, a 20 year old male client, is admitted to your unit because of the exacerbation of their ulcerative colitis. You go into Wyper’s room to complete an initial assessment, and he yells, “Get outta here! I am tired of you nurses and doctors looking at my body all the time!” Which of the following is your best action? A. Leave the room and ask a male colleague to complete the assessment. B. Verbally acknowledge the client’s frustration and anger. C. Call the health-care practitioner and ask for a sedative order. D. Tell the client that gathering data about his current condition will promote effective timely treatment of his health concerns. 15. You are caring for Conis, a patient admitted in your unit who is diagnosed with Crohn’s disease. She has undergone a barium enema that demonstrated the presence of strictures in her ileum. Based on this finding, you should monitor the client closely for signs of: A. peritonitis. B. obstruction. C. malabsorption. D. fluid imbalance. SITUATION: You are a new nurse assigned to take care of patients with various eye disorders. You use your knowledge to help these patients with their condition. 16. One of the patients in your unit, Pagaya, is diagnosed with glaucoma. Which of the following symptoms should you expect the client to report during your initial assessment with him? A. Loss of peripheral vision. B. Floating spots in the vision. C. A yellow haze around everything. D. A curtain coming across vision. 17. Pagaya has now been prescribed a miotic cholinergic medication for his glaucoma. Which of the following data indicates that the medication has been effective on Pagaya? A. No redness or irritation of the eyes B. A decrease in intraocular pressure C. The pupil reacts briskly to light D. The client denies any type of floaters 18. You are caring for Gan Fall, a postoperative patient, after his retinal detachment surgery. Gas tamponade was used to flatten the patient’s retina during the procedure. Which of the following interventions should you implement first? A. Teach the signs of increased intraocular pressure. B. Position the client as prescribed by the surgeon. C. Assess the eye for signs/symptoms of complications. D. Explain the importance of follow-up visits. 19. You are caring for Conis, a patient with severe myopia. She is scheduled for a laser assisted in situ keratomileusis (LASIK) surgery. Which of the following instructions should you discuss with Conis prior to her discharge from the surgery? A. Wear bilateral eye patches for three (3) days. B. Wear corrective lenses until the follow-up visit. C. Do not read any material for at least one (1) week. D. Teach the client how to instill corticosteroid ophthalmic drops. 20. Eneru, a 65 year old male client is complaining of blurred vision, but denies having any type of pain. He reports to you, “I feel like I need to clean my glasses all the time”. Which of the following eye disorders should you suspect that Eneru has? A. Corneal dystrophy B. Conjunctivitis C. Diabetic retinopathy D. Cataracts SITUATION: You are a nurse studying the different types of shock and its appropriate nursing interventions. You come across the following patients in your unit. You applied the concepts you’ve learned to your nursing practice. 21. Foxy is a client admitted to the emergency department. Assessment findings include diaphoresis, pale clammy skin, and a blood pressure reading of 90/70. Which of the following interventions should you implement first? A. Start an IV with an 18-gauge catheter. B. Administer dopamine intravenous infusion. C. Obtain arterial blood gases (ABGs). D. Insert an indwelling urinary catheter. 22. Porche is a patient diagnosed with neurogenic shock. As a knowledgeable nurse, you expect to note which of the following signs and symptoms in this client? A. Cool, moist skin. B. Bradycardia. C. Wheezing. D. Decreased bowel sounds 23. One of the patients in your unit, Hamburg, was diagnosed with septicemia. The following are the orders given by Hamburg’s primary physician. Which of these orders will have the highest priority? A. Provide a clear liquid diet. B. Initiate IV antibiotic therapy. C. Obtain a STAT chest x-ray. D. Perform hourly glucometer checks. 24. You wrote the nursing diagnosis of “alteration in comfort related to chills in fever” in one of your patients who has sepsis. Which of the following interventions would you include in this patient’s plan of care? A. Ambulate the client in the hallway every shift. B. Monitor urinalysis, creatinine level, and BUN level. C. Apply sequential compression devices to the lower extremities. D. Administer an antipyretic medication every four (4) hours PRN. 25. A patient named Chiqicheetah presents themselves in the emergency department complaining of abdominal pain, is pale and clammy, and has a pulse of 110 and a blood pressure reading of 92/60. Chiqicheetah has vertebral fractures, and she reported she has been self-medicating with Ibuprofen, a type of nonsteroidal anti-inflammatory drug (NSAID). Which of the following type of shocks should you expect in patient Chiqicheetah? A. Cardiogenic shock. B. Hypovolemic shock. C. Neurogenic shock. D. Septic shock. SITUATION: You are caring for patients in your unit with alterations in their fluid and electrolytes. As a knowledgeable nurse, you apply the concepts of fluid and electrolytes in your nursing practice. 2 | Page
26. As an experienced nurse, you know that client incidence of hypermagnesemia is rare in comparison with hypomagnesemia. A student nurse approached you and asked how hypermagnesemia develops. You answer her correctly by saying that hypermagnesemia generally occurs secondary to: A. Cardiac contractility. B. Hypokalemia. C. Liver failure. D. Renal insufficiency. 27. You are assigned to care for Ace, a patient diagnosed to have hypokalemia. As a knowledgeable nurse, you know that the electrolyte that must be corrected in this scenario is: A. Calcium. B. Magnesium. C. Manganese. D. Zinc. 28. You are caring for a group of patients in the ward. While reviewing each of the patient’s charts, you determine which of the following patients is most likely at risk for fluid volume deficit? A. A client with an ileostomy B. A client with heart failure C. A client on long-term corticosteroid therapy D. A client receiving frequent wound irrigations 29. You are refreshing your knowledge on sodium imbalances. As a knowledgeable nurse, you know that which of the following patients in the ward is most likely to develop a sodium level at 130 mEq/L (130 mmol/L)? A. The client who is taking diuretics B. The client with hyperaldosteronism C. The client with Cushing’s syndrome D. The client who is taking corticosteroids 30. You are reviewing one of your patient’s progress notes. You read that the physician has documented “insensible fluid loss of approximately 800mL daily”. As a knowledgeable nurse, you make a notation that insensible fluid loss occurs through which of the following types of excretion? A. Urinary output B. Wound drainage C. Integumentary output D. The gastrointestinal tract SITUATION: You are a nurse assigned to care for and educate patients in the cancer unit of the hospital you are working on. You apply the concepts you’ve learned regarding cancer to ensure a safe nursing practice. 31. You are reviewing your notes on cancer. After much reading, you know that cancer prevalence is defined as? A. The likelihood cancer will occur in a lifetime. B. The number of persons with cancer at a given point in time. C. The number of new cancers in a year. D. All cancer cases more than 5 years old. 32. Gol is your patient diagnosed to have testicular cancer. He expressed his concerns regarding fertility since him and his partner desires to eventually have a family. As Gol’s primary nurse, you discuss the option of sperm banking. You inform Gol and his partner that sperm banking needs to be performed when? A. Before treatment is started. B. Once the client is tolerating the treatment. C. Upon completion of treatment. D. When tumor markers drop to normal levels. 33. You are working with Bellamy, a client with known risks for lung cancer. He asks you why he is scheduled for a computed tomography (CT) scan as part of his initial workup. You answer Bellamy correctly when you respond by saying: A. “CT is far superior to magnetic resonance imaging for evaluating lymph node metastasis.” B. “CT is noninvasive and readily available.” C. “CT is useful for distinguishing small differences in tissue density and detecting nodal involvement.” D. “CT can distinguish malignant adenopathy from nonmalignant adenopathy.” 34. You are caring for Cricket, a patient with pain related to bone cancer. You conducted an assessment on Cricket in relation to this. You know that which of the following is the most important component of a thorough pain assessment specific for patient Cricket? A. Intensity. B. Cause. C. Aggravating factors. D. Location. 35. Noland is a cancer patient you are tasked to care for. He is receiving the medication vincristine (Oncovin). You plan your health teaching for Noland regarding this medication. Which of the following should you include in your instructions to Nolan? A. Use of loperamide (Imodium). B. Fluid restriction. C. Low fiber, bland diet. D. Bowel regimen. 36. Sarquiss is a 57 year old client receiving chemotherapy that has the potential to cause pulmonary toxicity. Which of the following symptoms would you note in Sarquiss that could indicate a toxic response to the chemotherapy? A. Decrease in appetite. B. Drowsiness. C. Spasms of the diaphragm. D. Cough and shortness of breath. 37. Hina is one of the patients you are tasked to care for her in the unit. She is beginning external beam radiation therapy to the right axilla after her lumpectomy for breast cancer. You plan to conduct a health teaching. Which of the following would you include in your education to Hina? A. Use a heating pad under the right arm. B. Immobilize the right arm. C. Place ice on the area after each treatment. D. Apply deodorant only under the left arm. 38. Tony Tony is a patient receiving radiation therapy for lung cancer. He complains that he is having difficulty sleeping. After hearing this statement from your patient, you should: A. Suggest the client stop watching television before bed. B. Assess the client’s usual sleep patterns, amount of sleep, and bedtime rituals. C. Tell the client sleeplessness is expected with radiation therapy. D. Suggest that the client stop drinking coffee until the therapy is completed. 39. You are caring for Nico, a patient with cancer who requires a bolus tube feeding. You prepare to administer the bolus tube feeding and as a skilled nurse, which of the following nursing interventions is most appropriate to decrease the risk of aspiration in this patient? A. Place the client on bed rest with the head of the bed elevated to 60 degrees for 2 hours. B. Place the client on the left side with the head of the bed at 45 degrees for 15 minutes. C. Assist the client out of bed to sit upright in a chair for 1 hour. D. Ask the client to rest in bed with the head of the bed elevated to 30 degrees for 20 minutes. 40. Portgas is a cancer patient receiving chemotherapy. He is experiencing a flare up of pruritus. You are planning to develop a care plan for Portgas. In order to develop the nursing care plan, you should ask him if he has been: A. Wearing clothes made from 100% cotton. B. Sleeping in a cool, humidified room. C. Increasing fluid intake to at least 3,000 mL/ day. D. Taking daily baths with a deodorant soap. SITUATION: You are a nurse caring for patients with cardiac complications. You use your knowledge on cardiovascular concepts to help these patients. 41. You are working on the unit with patient Brogy. At 7:30 AM, you received a verbal order from his primary HCP for a cardiac catheterization to be completed on him by 2:00 PM. Which of the following actions should you initiate first in Brogy? A. Initiate NPO (nothing per mouth) status for the client. B. Teach the client about the procedure. C. Start an intravenous (IV) infusion of 0.9% NaCl. D. Ask the client to sign a consent form. 42. You are working with Dorry, a male patient who experienced a myocardial infarction a few days ago. You noted that patient Dorry seems unusually fatigued. Upon your assessment, you find that patient Dorry is dyspneic with 3 | Page
activity, has a heart rate of 110 bpm, and has generalized edema. Which of the following actions would be most appropriate for this patient? A. Administer high-flow oxygen B. Encourage the client to rest more C. Continue to monitor the client’s heart rhythm D. Compare the client’s admission weight with the client’s current weight 43. You are caring for patient Whitebeard immediately following an insertion of a permanent pacemaker via his right subclavian vein. As a skilled nurse, you know that the action that can best prevent pacemaker lead dislodgement is: A. inspecting the incision site dressing for bleeding and the incision for approximation B. limiting the client’s right arm activity and preventing the client reaching above shoulder level C. assisting the client with getting out of bed and ambulating with a walker D. ordering a stat chest x-ray following return from the implant procedure 44. You are increasing activity for patient Bon with an admitting diagnosis of acute coronary syndrome. Which of the following symptoms experienced by patient Bon best supports the nursing diagnosis of activity intolerance? A. Pulse rate increased by 15 beats per minute during activity B. Blood pressure (BP) 130/86 mm Hg before activity; BP 108/66 mm Hg during activity C. Increased dyspnea and diaphoresis relieved when sitting in a chair D. A mean arterial pressure (MAP) of 80 following activity 45. Cobra is a patient who suffered an inferior septal wall myocardial infarction. Which of the following complications would you suspect in Cobra when you note on your assessment a jugular venous distention and ascites? A. Left-sided heart failure B. Pulmonic valve malfunction C. Right-sided heart failure D. Ruptured septum SITUATION: You are an emergency nurse tasked to work with patients with medical emergencies. You utilize your knowledge to help these patients. 46. A patient’s wife is allowed to be present during resuscitation efforts for a patient in the ICU. Which of the following statements made by you would be the most correct and appropriate? A. “You can hold your loved one’s hand; sometimes a recovering person remembers that touch.” B. “Another staff member will be with you; I will show you where you can stand near your husband.” C. “Because the resuscitation team needs to work quickly, you need to stay out of their way and not \ interfere.” D. “If the resuscitation efforts fail, the health-care provider will ask you if you want to terminate resuscitation efforts.” 47. An apartment fire broke out near the hospital. The injured victims are sent to the emergency department of the hospital. Five families of the injured patients arrived in the ED subsequently to inquire about the health status of their family members. Which of the following is your best action? A. Take the families to the triage area so they can be with their loved ones B. Ask the families to wait in the waiting area until information is available C. Ensure that there is a designated area for family staffed by available social workers or clergy D. Direct families to a lounge where a receptionist will be keeping families informed 48. Patient Aokiji is a male client that presented themself in the emergency department after vomiting a “large” amount of bright red blood. Which of the following actions should you implement first? A. Start an intravenous line with an 18-gauge needle. B. Have the UAP take the client’s vital signs. C. Ask the client to provide a stool specimen for blood. D. Send the client to radiology for an abdominal CT scan. 49. You are working as a triage nurse in a large trauma center. The center has been notified of an explosion in a nearby major chemical manufacturing plant. Which of the following actions should you implement first when the injured patients arrive at the emergency department? A. Triage the clients and send them to the appropriate areas. B. Thoroughly wash the clients with soap and water and then rinse. C. Remove the clients’ clothing and have them shower. D. Assume the clients have been decontaminated at the plant. 50. You are attending a seminar on codes. After the session, you recall that which of the following interventions is the most important for you to implement when participating in a code? A. Elevate the arm after administering medication. B. Maintain sterile technique throughout the code. C. Treat the client’s signs/symptoms; do not treat the monitor. D. Provide accurate documentation of what happened during the code. Situation - Ms. Hange is the charge nurse of a medical unit. She is responsible for the management and supervision of the unit. 51. Ms. Hange observes that one of the female staff nurses is not performing her duties very well. Which of the following strategies will she implement to assist the staff nurse? A. Discuss with the staff nurse her performance and ways she can improve. B. Allow the staff nurse to select own assignment. C. Assign the staff nurse several clients with various illnesses. D. Ask the staff nurse to work as an assistant charge nurse. 52. Ms. Hange notes one of the male staff nurse is frequently absent and his absence has adversely affected the quality of care given to the clients unit. Which of the following would be the BEST approach? A. Talk with the staff nurse regarding the concern and remind him of the standards of the agency. B. Write the staff nurse a memorandum regarding his absence. C. Inform the staff nurse that his absence will be a ground for termination. D. Record the absence of the staff nurse in a log book. 53. Ms. Hange assigns a new staff nurse to administer the medications of a client. Which detail of the client’s drug therapy is the staff nurse legally responsible to document? The ________. A. Peak concentration time of the drug. B. Safe ranges of the drug. C. Client’s socio-economic status. D. Client’s reaction to the drug. 54. Ms. Hange decides what is best for a recovering client and acts on the decision without consulting the client. Ms. Hange is applying a moral principle which is ______________. A. Paternalism B. Beneficence C. Fidelity D. Autonomy Situation - The nurse cares for a female client who is terminally ill and is experiencing pain. The nurse prepares a care plan for the client. The overall goal for the client is ________. 55. The client will: A. Achieve control of pain and discomfort. B. Receive adequate cerebral oxygenation and perfusion. C. Be free from infection. D. Receive life sustaining food and liquids. 56. The nurse is aware of the document that expresses a client’s wish for life sustaining treatment in the event of terminal illness or permanent unconsciousness. This document is the ______; A. No-code order B. Durable power of attorney C. Living will D. Last will and testament 4 | Page