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RECALLS EXAMINATION 11 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 1. A patient is admitted to the hospital with a history of liver dysfunction associated with hepatitis. With which metabolic problem does the nurse anticipate that this patient may have a problem? A. Emulsifying fats B. Digesting carbohydrates C. Manufacturing red blood cells D. Reabsorbing water in the intestines 2. A patient is anorexic due to stomatitis (inflammation of the mouth and lips) related to chemotherapy. Which should the nurse be MOST concerned about when planning care for this patient? A. Aspiration B. Dehydration C. Malnutrition D. Constipation 3. An older patient tends to bruise easily and the primary health-care provider recommends that the patient eat foods high in vitamin K. In addition to teaching the patient about food sources of Vit K, the nurse should include nutrients that must be ingested for Vit K to be absorbed. Which foods that increase the absorption of Vit K should be included in the teaching plan? A. Carbohydrates B. Starches C. Proteins D. Fats 4. A primary health care provider orders a clear liquid diet for a patient. Which foods should the nurse teach the patient to AVOID when following this diet A. Strawberry gelatin B. Decaffeinated tea C. Strong coffee D. Ice cream 5. A nurse is caring for a client who has a body mass index (BMI) of 26.5. Which category should the nurse understand this client would be placed in? A. Overweight B. Healthy weight C. Obese D. Underweight 6. The nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis who is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and bowel sounds are diminished. Which is the most appropriate nursing intervention? A. Administer the prescribed pain medication. B. Notify the primary health care provider (PHCP). C. Call and ask the operating room team to perform surgery as soon as possible. D. Reposition the client and apply a heating pad on the warm setting to the client’s abdomen 7. A client has undergone esophagogastroduodenoscopy. The nurse should place highest priority on which item as part of the client’s care plan? A. Monitoring the temperature B. Monitoring complaints of heartburn C. Giving warm gargles for a sore throat D. Assessing for the return of the gag reflex 8. The nurse has taught the client about an upcoming endoscopic retrograde cholangiopancreatography (ERCP) procedure. The nurse determines that the client needs further information if the client makes which statement? A. “I know I must sign the consent form.” B. “I hope the throat spray keeps me from gagging.” C. “I’m glad I don’t have to lie still for this procedure.” D. “I’m glad some intravenous medication will be given to relax me.” 9. The nurse is monitoring a client with a diagnosis of peptic ulcer. Which assessment finding would most likely indicate perforation of the ulcer? A. Bradycardia B. Numbness in the legs C. Nausea and vomiting D. A rigid, board-like abdomen 10. The nurse is caring for a client following a gastrojejunostomy (Billroth II procedure). Which postoperative prescription should the nurse question and verify? A. Leg exercises B. Early ambulation C. Irrigating the nasogastric tube D. Coughing and deep-breathing exercises 11. The nurse is providing discharge teaching for a client with newly diagnosed Crohn’s disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for further instruction? A. “I should increase the fiber in my diet.” B. I will need to avoid caffeinated beverages.” C. “I’m going to learn some stress reduction techniques.” D. “I can have exacerbations and remissions with Crohn’s disease.” 12. The nurse is doing an admission assessment on a client with a history of duodenal ulcer. To determine whether the problem is currently active, the nurse should assess the client for which manifestation of duodenal ulcer? A. Weight loss B. Nausea and vomiting C. Pain relieved by food intake D. Pain radiating down the right arm 13. The nurse provides instructions to a client about measures to treat inflammatory bowel syndrome (IBS). Which statement by the client indicates a need for further teaching? A. “I need to limit my intake of dietary fiber.” B. “I need to drink plenty, at least 8 to 10 cups daily.” C. “I need to eat regular meals and chew my food well.” D. “I will take the prescribed medications because they will regulate my bowel patterns.” 14. A client with Crohn’s disease is scheduled to receive an infusion of infliximab. What intervention by the nurse will determine the effectiveness of treatment? 1 | Page
A. Monitoring the leukocyte count for 2 days after the infusion B. Checking the frequency and consistency of bowel movements C. Checking serum liver enzyme levels before and after the infusion D. Carrying out a Hematest on gastric fluids after the infusion is completed 15. A client has begun medication therapy with pancrelipase. The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed? A. Weight loss B. Relief of heartburn C. Reduction of steatorrhea D. Absence of abdominal pain 16. An older client recently has been taking cimetidine. The nurse monitors the client for which most frequent central nervous system side effect of this medication? A. Tremors B. Dizziness C. Confusion D. Hallucinations 17. A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including clarithromycin, esomeprazole, and amoxicillin. Which statement by the client indicates the best understanding of the medication regimen? A. “My ulcer will heal because these medications will kill the bacteria.” B. “These medications are only taken when I have pain from my ulcer.” C. “The medications will kill the bacteria and stop the acid production.” D. “These medications will coat the ulcer and decrease the acid production in my stomach.” 18. The nurse has given instructions to a client who has just been prescribed cholestyramine. Which statement by the client indicates a need for further instruction? A. “I will continue taking vitamin supplements.” B. “This medication will help lower my cholesterol.” C. “This medication should only be taken with water.” D. “A high-fiber diet is important while taking this medication.” 19. The patient returned from a 6-week mission trip to Somalia with complaints of nausea, malaise, fatigue, and achy muscles. Which type of hepatitis is this patient most likely to have contracted? A. Hepatitis B (HBV) B. Hepatitis C (HCV) C. Hepatitis D (HDV) D. Hepatitis E (HEV) 20. The patient has been newly diagnosed with Wilson's disease. D-penicillamine, a chelating agent, has been prescribed. What assessment finding should the nurse expect? A. Pruritus B. Acute kidney injury C. Corneal Fleischer rings D. Elevated serum iron levels 21. A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barretts esophagus with minor cell changes. Which of the following principles should be integrated into the patients subsequent care? A. The patient will require an upper endoscopy every 6 months to detect malignant changes. B. Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage. C. Small amounts of blood are likely to be present in the stools and are not cause for concern. D. Antacids may be discontinued when symptoms of heartburn subside. 22. The nurses comprehensive assessment of a patient includes inspection for signs of oral cancer. What assessment finding is most characteristic of oral cancer in its early stages? A. Dull pain radiating to the ears and teeth B. Presence of a painless sore with raised edges C. Areas of tenderness that make chewing difficult D. Diffuse inflammation of the buccal mucosa 23. A patient comes to the clinic complaining of pain in the epigastric region. What assessment question during the health interview would most help the nurse determine if the patient has a peptic ulcer? A. Does your pain resolve when you have something to eat? B. Do over-the-counter pain medications help your pain? C. Does your pain get worse if you get up and do some exercise? D. Do you find that your pain is worse when you need to have a bowel movement? 24. A patient with a diagnosis of peptic ulcer disease has just been prescribed omeprazole (Prilosec). How should the nurse best describe this medications therapeutic action? A. This medication will reduce the amount of acid secreted in your stomach. B. This medication will make the lining of your stomach more resistant to damage. C. This medication will specifically address the pain that accompanies peptic ulcer disease. D. This medication will help your stomach lining to repair itself. 25. A nurse is assessing a patient who has peptic ulcer disease. The patient requests more information about the typical causes of Helicobacter pylori infection. What would it be appropriate for the nurse to instruct the patient? A. Most affected patients acquired the infection during international travel. B. Infection typically occurs due to ingestion of contaminated food and water. C. Many people possess genetic factors causing a predisposition to H. pylori infection. D. The H. pylori microorganism is endemic in warm, moist climates. 26. A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurses most plausible conclusion based on this assessment finding? A. The patient should withhold his next scheduled dose of insulin. B. The patient should promptly eat some protein and carbohydrates. C. The patients insulin levels are inadequate. D. The patient would benefit from a dose of metformin (Glucophage). 27. A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes? A. Fasting plasma glucose greater than or equal to 126 mg/dL B. Random plasma glucose greater than 150 mg/dL C. Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions D. Random plasma glucose greater than 126 mg/dL 28. A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the physician prescribe for this patient? A. A sulfonylurea B. A biguanide C. A thiazolidinedione D. An alpha glucosidase inhibitor 29. The nurse is teaching a client with hyperparathyroidism how to manage the condition at home. Which response by the client indicates the need for additional teaching? A. “I should consume less than 1 liter of fluid per day.” B. “I should use my treadmill or go for walks daily.” C. “I should follow a moderate-calcium, high-fiber diet.” D. “My alendronate helps keep calcium from coming out of my bones.” 30. The nurse is performing an assessment on a client with pheochromocytoma. Which assessment data would indicate a potential complication associated with this disorder? A. A urinary output of 50 mL/hr B. A coagulation time of 5 minutes C. A heart rate that is 90 beats per minute and irregular D. A blood urea nitrogen level of 20 mg/dL (7.1 mmol/L) 31. A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 2 | Page
A. Hoarseness B. Hypocalcemia C. Audible stridor D. Edema at the surgical site 32. During assessment of the patient with acromegaly, what should the nurse expect the patient to report? A. Infertility B. Dry, irritated skin C. Undesirable changes in appearance D. An increase in height of 2 to 3 inches a year 33. What findings are commonly found in a patient with a prolactinoma? A. Gynecomastia in men B. Profuse menstruation in women C. Excess follicle-stimulating hormone (FSH) and luteinizing hormone (LH) D. Signs of increased intracranial pressure, including headache, nausea, and vomiting 34. The patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What manifestation should the nurse expect to find? A. Decreased body weight B. Decreased urinary output C. Increased plasma osmolality D. Increased serum sodium levels 35. During care of the patient with SIADH, what should the nurse do? A. Monitor neurologic status at least every 2 hours. B. Teach the patient receiving treatment with diuretics to restrict sodium intake. C. Keep the head of the bed elevated to prevent antidiuretic hormone (ADH) release. D. Notify the HCP if the patient's blood pressure decreases more than 20 mm Hg from baseline 36. The nurse is caring for a patient diagnosed with hypothyroidism secondary to Hashimotos thyroiditis. When assessing this patient, what sign or symptom would the nurse expect? A. Fatigue B. Bulging eyes C. Palpitations D. Flushed skin 37. The nurse is caring for a patient with a diagnosis of Addisons disease. What sign or symptom is most closely associated with this health problem? A. Truncal obesity B. Hypertension C. Muscle weakness D. Moon face 38. The nurse is caring for a patient with Addisons disease who is scheduled for discharge. When teaching the patient about hormone replacement therapy, the nurse should address what topic? A. The possibility of precipitous weight gain B. The need for lifelong steroid replacement C. The need to match the daily steroid dose to immediate symptoms D. The importance of monitoring liver function 39. A patient is prescribed corticosteroid therapy. What would be priority information for the nurse to give the patient who is prescribed long-term corticosteroid therapy? A. The patients diet should be low protein with ample fat. B. The patient may experience short-term changes in cognition. C. The patient is at an increased risk for developing infection. D. The patient is at a decreased risk for development of thrombophlebitis and thromboembolism. 40. A nurse caring for a patient with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding? A. Glucose in the urine B. Albumin in the urine C. Highly dilute urine D. Leukocytes in the urine 41. The nurse is assessing the motor and sensory function of an unconscious client who sustained a head injury. The nurse should use which technique to test the client’s peripheral response to pain? A. Sternal rub B. Nailbed pressure C. Pressure on the orbital rim D. Squeezing of the sternocleidomastoid muscle 42. The nurse is caring for the client with increased intracranial pressure as a result of a head injury? The nurse would note which trend in vital signs if the intracranial pressure is rising? A. Increasing temperature, increasing pulse, increasing respirations, decreasing blood pressure B. Increasing temperature, decreasing pulse, decreasing respirations, increasing blood pressure C. Decreasing temperature, decreasing pulse, increasing respirations, decreasing blood pressure D. Decreasing temperature, increasing pulse, decreasing respirations, increasing blood pressure 43. The nurse has instructed the family of a client with stroke (brain attack) who has homonymous hemianopsia about measures to help the client overcome the deficit. Which statement suggests that the family understands the measures to use when caring for the client? A. “We need to discourage him from wearing eyeglasses.” B. “We need to place objects in his impaired field of vision.” C. “We need to approach him from the impaired field of vision.” D. “We need to remind him to turn his head to scan the lost visual field.” 44. The nurse is teaching a client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. Which client activity suggests that teaching is most effective? A. Taking medications as scheduled B. Eating large, well-balanced meals C. Doing muscle-strengthening exercises D. Doing all chores early in the day while less fatigued 45. The client is admitted to the hospital with a diagnosis of Guillain-Barré syndrome. Which past medical history finding makes the client most at risk for this disease? A. Meningitis or encephalitis during the last 5 years B. Seizures or trauma to the brain within the last year C. Back injury or trauma to the spinal cord during the last 2 years D. Respiratory or gastrointestinal infection during the previous 46. A client with Guillain-Barré syndrome has ascending paralysis and is intubated and receiving mechanical ventilation. Which strategy should the nurse incorporate in the plan of care to help the client cope with this illness? A. Giving client full control over care decisions and restricting visitors B. Providing positive feedback and encouraging active range of motion C. Providing information, giving positive feedback, and encouraging relaxation D. Providing intravenously administered sedatives, reducing distractions, and limiting visitors 47. Carbidopa-levodopa is prescribed for a client with Parkinson’s disease. The nurse monitors the client for side and adverse effects of the medication. Which finding indicates that the client is experiencing an adverse effect? A. Pruritus B. Tachycardia C. Hypertension D. Impaired voluntary movement 48. A client with trigeminal neuralgia is being treated with carbamazepine, 400 mg orally daily. Which value indicates that the client is experiencing an 2089 adverse effect to the medication? A. Sodium level, 140 mEq/L (140 mmol/L) B. Uric acid level, 4.0 mg/dL (240 mcmol/L) C. White blood cell count, 3000 mm3 (3.0 × 10 9 /L) D. Blood urea nitrogen level, 10 mg/dL (3.6 mmol/L) 49. The nurse has given medication instructions to a client receiving phenytoin. Which statement indicates that the client has an adequate understanding of the instructions? A. “Alcohol is not contraindicated while taking this medication.” 3 | Page
B. “Good oral hygiene is needed, including brushing and flossing.” C. “The medication dose may be self-adjusted, depending on side effects.” D. “The morning dose of the medication should be taken before a serum medication level is drawn. 50. A patient has had an ischemic stroke and has been admitted to the medical unit. What action should the nurse perform to best prevent joint deformities? A. Place the patient in the prone position for 30 minutes/day. B. Assist the patient in acutely flexing the thigh to promote movement. C. Place a pillow in the axilla when there is limited external rotation. D. Place patients hand in pronation. 51. When caring for a patient who had a hemorrhagic stroke, close monitoring of vital signs and neurologic changes is imperative. What is the earliest sign of deterioration in a patient with a hemorrhagic stroke of which the nurse should be aware? A. Generalized pain B. Alteration in level of consciousness (LOC) C. Tonicclonic seizures D. Shortness of breath 52. The nurse is assessing a patient with a suspected stroke. What assessment finding is most suggestive of a stroke? A. Facial droop B. Dysrhythmias C. Periorbital edema D. Projectile vomiting 53. The nurse is preparing health education for a patient who is being discharged after hospitalization for a hemorrhagic stroke. What content should the nurse include in this education? A. Mild, intermittent seizures can be expected. B. Take ibuprofen for complaints of a serious headache. C. Take antihypertensive medication as ordered. D. Drowsiness is normal for the first week after discharge. 54. Which drug therapy is included for acute migraine and cluster headaches that appears to alter the pathophysiologic process for these headaches? A. Tricyclic antidepressants such as amitriptyline B. Nonsteroidal antiinflammatory drugs (NSAIDs) C. β-adrenergic blockers such as propranolol (Inderal) D. Specific serotonin receptor agonists such as sumatriptan (Imitrex) 55. Following a generalized tonic-clonic seizure, the patient is tired and sleepy. What care should the nurse provide? A. Suction the patient before allowing him to rest. B. Allow the patient to sleep as long as he feels sleepy. C. Stimulate the patient to increase his level of consciousness. D. Check the patient's level of consciousness every 15 minutes for an hour. 56. The registered nurse taking shift report learns that an assigned patient is blind. How should the nurse best communicate with this patient? A. Provide instructions in simple, clear terms. B. Introduce herself in a firm, loud voice at the doorway of the room. C. Lightly touch the patients arm and then introduce herself. D. State her name and role immediately after entering the patients room. 57. The nurse is providing health education to a patient newly diagnosed with glaucoma. The nurse teaches the patient that this disease has a familial tendency. The nurse should encourage the patients immediate family members to undergo clinical examinations how often? A. At least monthly B. At least once every 2 years C. At least once every 5 years D. At least once every 10 years 58. The nurse is administering eye drops to a patient with glaucoma. After instilling the patients first medication, how long should the nurse wait before instilling the patients second medication into the same eye? A. 30 seconds B. 1 minute C. 3 minutes D. 5 minutes 59. During the early postoperative period, a client who has undergone a cataract extraction complains of nausea and severe eye pain over the operative site. What should be the initial nursing action? A. Call the surgeon. B. Reassure the client that this is normal. C. Turn the client onto her or his operative side. D. Administer the prescribed pain medication and antiemetic 60. The nurse is developing a teaching plan for a client with glaucoma. Which instruction should the nurse include in the plan of care? A. Avoid overuse of the eyes. B. Decrease the amount of salt in the diet. C. Eye medications will need to be administered for life. D. Decrease fluid intake to control the intraocular pressure. 61. The nurse is performing an otoscopic examination on a client with mastoiditis. On examination of the tympanic membrane, which finding should the nurse expect to observe? A. A pink-colored tympanic membrane B. A pearly colored tympanic membrane C. A transparent and clear tympanic membrane D. A red, dull, thick, and immobile tympanic membrane 62. The nurse is caring for a client following craniotomy for removal of an acoustic neuroma. Assessment of which cranial nerve would identify a complication specifically associated with this surgery? A. Cranial nerve I, olfactory B. Cranial nerve IV, trochlear C. Cranial nerve III, oculomotor D. Cranial nerve VII, facial nerve 63. The nurse notes that the primary health care provider has documented a diagnosis of presbycusis on a client’s chart. Based on this information, what action should the nurse take? A. Speak loudly but mumble or slur the words. B. Speak loudly and clearly while facing the client. C. Speak at normal tone and pitch, slowly and clearly. D. Speak loudly and directly into the client’s affected ear 64. The nurse is caring for a hearing-impaired client. Which approach will facilitate communication? A. Speak loudly. B. Speak frequently. C. Speak at a normal volume. D. Speak directly into the impaired ear. 65. A client with Meniere’s disease is experiencing severe vertigo. Which instruction should the nurse give to the client to assist in controlling the 1965 vertigo? A. Increase sodium in the diet. B. Avoid sudden head movements. C. Lie still and watch the television. D. Increase fluid intake to 3000 mL a day. 66. A nurse is teaching a patient with osteomalacia about the role of diet. What would be the best choice for breakfast for a patient with osteomalacia? A. Cereal with milk, a scrambled egg, and grapefruit B. Poached eggs with sausage and toast C. Waffles with fresh strawberries and powdered sugar D. A bagel topped with butter and jam with a side dish of grapes 67. A patient presents at a clinic complaining of back pain that goes all the way down the back of the leg to the foot. The nurse should document the presence of what type of pain? A. Bursitis B. Radiculopathy C. Sciatica D. Tendonitis 68. A patient tells the nurse that he has pain and numbness to his thumb, first finger, and second finger of the right hand. The nurse discovers that the patient is employed as an auto mechanic, and that the pain is increased while working. This may indicate that the patient could possibly have what health problem? A. Carpel tunnel syndrome B. Tendonitis 4 | Page

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