Title RECALLS 11- NP3 - SC ✅

2 | Page 10. When the nurse checked the water sealed drainage, she observed that the water level does not fluctuate simultaneously with the client’s breathing. The nurse interprets this observation as: A. An abnormal occurrence suggestion problem with the system’s patency B. Normal but may require water to be added to the suction control chamber C. Emergent requiring immediate reporting to the physician D. Expected with the client’s current condition Situation: A woman who underwent hysterectomy 2 days ago is under your care. 11. Which nursing observations would MOST likely predispose the client to develop venous thrombosis in the lower extremity? A. Drinking coffee at least 3 to 5 cups in a day B. Refusing to get out of bed C. Taking soft diet only D. Requesting for analgesics frequently 12. The patient was prescribed to have antiembolism stockings. The nurse assess the patient knows its purpose when she states 1. It promotes venous return 2. It strengthen muscle tone 3. It prevents pooling of blood in the extremities A. 1 & 2 B. 1 & 3 C. 2 & 3 D. 1, 2 & 3 13. The nurse assesses the client for Homan’s sign. Which of the following is the CORRECT instruction of the nurse? A. Have the client push each foot hard against the mattress B. Tell the client to sit on bed and point to her toes C. Ask the client to contract her tight musclesma D. Instruct the client to extent her legs and flex each foot toward the head 14. Which client’s response suggest a positive Homan’s sign? A. Inability of the client to bend her knees B. Sudden numbness while extending the foot C. Tingling sensation throughout the affected leg D. Sharp, immediate calf pain in the legs 15. Based on the findings, the client has been diagnosed with thrombophlebitis. Which of the following nursing action must be AVOIDED? A. Elevating the client’s leg B. Massaging the affected leg C. Applying ice compress to the affected leg D. Ambulating at least twice each shift Situation: After a head injury, Samantha, 36 years old begun to manifest signs and symptoms of Diabetes Insipidus. 16. The nurse in charge understands that Diabetes Insipidus (DI) is caused by an ADH deficiency resulting to which problem in metabolism?. A. Protein B. Water C. Carbohydrates D. Fat 17. The nurse caring for Samantha would expect to find which characteristic assessment findings? 1. Excessive thirst 2. Polyuria 3. Hyperglycemia 4. Glycosuria A. 1 and 3 B. 2 and 3 C. 1 and 2 D. 3 and 4 18. Which nursing action is critical in monitoring Samantha’s condition? A. Measuring intake and output B. Assessing vital signs C. Monitoring sleeping pattern D. Analyzing blood glucose 19. The physician orders “weigh daily”. When instructing the nursing aide to weigh the client, what essential instruction is MOST important to obtain an accurate data? A. Weight the client on the same scale time of the day wearing the similar amount of clothing B. Ask the client to state her weight before the disorder manifested C. Instruct the client to weigh before breakfast daily D. Have the client remove her footwear 20. The client was prescribed with intranasal Lypressin (Diapid) 2 spray 4x a day and as needed. Which is the CORRECT way to administer the spray? A. Siting in an upright position, insert the spray into the nostril then inhale while compressing the container B. Shaking the spray vigorously before inhaling in both nostrils C. Tilting the head to the side, and inhale the spray 2 times D. Inhaling with each spray 2 times Situation: A 45 year old female was admitted because of acute pancreatitis. Nurse Michelle was assigned to take care of the client. 21. While nurse Michelle was making her rounds before endorsement to the next shift, her client asks her which would be a comfortable position to assume. The nurse would recommend the following positions EXCEPT: A. Flexing the left leg B. Leaning forward C. Lying in supine position D. Sitting up 22. There has been an increasing rate of acute pancreatitis in the Philippines. She is aware that the most common cause of acute pancreatitis is? A. Alcohol Use B. Trauma C. Infections D. Gallstones 23. Nurse Michelle is aware that the treatment of acute pancreatitis consist of pain relief and “putting the pancreas to rest”. This is BEST accomplished by which of the following? A. Serving clear liquid diet B. Following a frequent but small feeding C. Feeding by nasogastric tube D. Parenteral nutrition administration as prescribed 24. The client has a standing order of Meperidine HCL (Demerol) 100mg intramuscularly (IM) every 4 hours. At 8am, nurse Michelle administered Demerol as prescribed. At 10am, the client asked for the next dose. The nurse verified the intensity of pain and the client said, it is not so painful. I just don’t want to feel any sort of pain”. What would be the MOST appropriate action of the nurse? A. Apply warm compress over the painful area B. Inject the prescribed dose and the other half at 12 noon C. Change patient’s position and implement diversional activity D. Administer the full dose of Demerol now. 25. When the client said, “it is not so painful”. What is the client trying to describe? A. Unrelieved pain B. Location of pain C. Pain tolerance

4 | Page SITUATION: Peptic Ulcer Disease prevalence in urban- based hospitals is 15-30%. The following questions are related to PUD. 41. Kiara presents to the hospital stating she his having gastric ulcer. Which of the following assessment data supports the diagnosis? A. The client is experiencing blood in his stool for the past month B. After eating a heavy fatty meal, the patient experiences upper abdominal pain. C. The patient reports wave-like burning sensation D. After ingesting food, the patient complains epigastric pain 30 to 60 minutes. 42. The nurses performs physical examination to the client. The nurse is knowledgeable when she implements which among the following first? A. Examine the abdominal area for tenderness using fingertips B. Listening to each of the quadrants using a stethoscope C. Use plexor and pleximeter in assessing the abdominal borders to identify organs D. Assess the tender area from progressing to nontender 43. Kiara was referred to a gastrointestinal doctor and was informed that she should undergo diagnostic test. What tests confirms the diagnosis? A. MRI B. CTSCAN C. FOBT D. EGD 44. Which physiological complications is expected for the nurse to consider in creating plan of care for patient diagnosed with PUD? A. Knowledge deficit in the causes of ulcers B. Inability to cope in bowel elimination C. Potential for alteration in gastric emptying D. Alteration in bowel elimination patterns. 45. Kiara was discharged and was given home instructions. Which among the following statements means that Kiara learned the expected outcome? A. She should not present any signs and symptoms of hemoptysis B. She should take antacids with each meal to prevent excessive gastric acid. C. She controls her pain by taking NSAIDs D. She maintains modifications in her lifestyle SITUATION: Anemia in the Philippines is prevalent and needs an intervention. There are different types of anemia and the following questions are about it. 46. The nurse is admitting Roy, a 26-year-old male. In gathering his past medical history, he stated that he undergone a gastric bypass surgery for his obesity 3 years ago. The following assessment findings includes height 5’7’’, weight 81kg, P112, R26, BP110/70, pale mucous membranes and dyspnea on exertion. Upon assessment, the nurse suspects that the client is having what type of anemia? A. Folic Acid Deficiency B. Vitamin B12 Deficiency C. Sickle cell anemia D. Iron deficiency Anemia 47. The client with a diagnosis of IDA is prescribe FeSO4 orally. The patient should be educated about: A. Taking laxative for diarrhea B. Exercise being limited until tolerance to the supplement is achieved C. Red meats and organ meats are the only foods that should be consumed to increase the level of iron in the body D. The stools may appear dark green-black which may mask blood 48. The anemia of the patient diagnosed with CHF became so severe that requires the HCP to order two units of PRBCs to transfuse. The unit has 250 mL of RBC plus 45mL of additive. The nurse set the IV pump at what rate to infuse each unit of PRBC? A. 74ml/hr B. 62-63ml/hr C. 147ml/hr D. 125ml/hr 49. You are the charge nurse assigned in the ward. Patients with different types of anemia was admitted. As a charge nurse, you assigned which among the patient to the most experienced nurse? A. client with IDA taking supplements B. client with Vitamin B12 deficiency requiring intramuscular administration C. client with Renal problem with deficiency of erythropoietin D. client with aplastic anemia which developed pancytopenia. 50. The client diagnosed with anemia was discharged. Which among the health education given by the nurse is correct? A. Take the prescribed iron until it is consumed B. Checking the vital signs specially pulse and BP at botika weekly C. Performing exercises at least three times a week D. Have a regular blood workup for CBC at HCP’s office. Situation: A woman who underwent hysterectomy 2 days ago is under your care. 51. Which nursing observations would MOST likely predispose the client to develop venous thrombosis in the lower extremity? A. Drinking coffee at least 3 to 5 cups in a day B. Refusing to get out of bed C. Taking soft diet only D. Requesting for analgesics frequently 52. The following are true regarding antiemboli stockings except: A. Too small stockings may cause skin breakdown. B. Apply stockings in the morning. C. The patient who has been ambulating should wait for 1 hour before applying the stockings. D. Antiemboli stockings can prevent edema of the legs and feet. 53. The nurse assesses the client for Homan’s sign. Which of the following is the CORRECT instruction of the nurse? A. Have the client push each foot hard against the mattress B. Tell the client to sit on bed and point to her toes C. Ask the client to contract her tight muscles D. Instruct the client to extent her legs and flex each foot toward the head 54. Which client’s response suggest a positive Homan’s sign? A. Inability of the client to bend her knees B. Sudden numbness while extending the foot C. Tingling sensation throughout the affected leg D. Sharp, immediate calf pain in the legs 55. Based on the findings, the client has been diagnosed with deep vein thrombophlebitis. Which of the following nursing action must be AVOIDED? A. Elevating the client’s leg B. Massaging the affected leg C. Applying warm compress to the affected leg D. Crossing the legs when seated Situation: After a head injury, Samantha, 36 years old begun to manifest signs and symptoms of Diabetes Insipidus. 56. The nurse in charge understands that Diabetes Insipidus (DI) is caused by an ADH deficiency resulting to which problem in metabolism?.