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

them. Which of the following is the most helpful suggestion the nurse can offer? A. Ignore the client's rituals to avoid reinforcing the behavior. B. Try to reason with the client to stop performing the rituals. C. Learn about OCD and provide consistent, supportive understanding. D. Punish the client for engaging in ritualistic behaviors. 35. The client is prescribed sertraline (Zoloft) for their OCD. The nurse should educate the client about which potential side effect? A. Increased appetite B. Weight gain C. Sexual dysfunction D. Sedation Situation: A 28-year-old female client, Ms. Santos, is admitted to the psychiatric unit exhibiting symptoms consistent with schizophrenia. She displays disorganized speech, flat affect, and social withdrawal. She has difficulty completing tasks and expresses a lack of motivation. She also reports auditory hallucinations, hearing voices that criticize her. 36. Which of the following is a positive symptom of schizophrenia exhibited by Ms. Santos? A. Apathy B. Avolition C. Auditory Hallucinations D. Flat Affect 37. Ms. Santos's disorganized speech is best described as: A. Circumstantiality B. Associative Looseness C. Perseveration D. Flight of Ideas 38. The nurse observes Ms. Santos exhibiting flat affect. This means: A. Ms. Santos is experiencing intense emotional outbursts. B. Ms. Santos is exhibiting inappropriate emotional responses. C. Ms. Santos shows a restricted range of emotional expression. D. Ms. Santos is actively trying to conceal her emotions. 39. Which nursing intervention is appropriate to address Ms. Santos's avolition? A. Engage her in long, complex tasks to challenge her lack of motivation. B. Provide a structured daily schedule with simple, achievable tasks. C. Allow her to rest as much as she needs to conserve energy. D. Ignore her lack of motivation, as it is a symptom of her illness. 40. Ms. Santos reports hearing voices that criticize her. The nurse's best initial response is: A. "Those voices aren't real; you need to ignore them." B. "Tell me more about the voices you are hearing." C. "Let's focus on more positive things to distract you from the voices." D. "I understand you're hearing voices, but we need to focus on your medication." Situation: A 25-year-old male client, Mr. Dela Cruz, is admitted to the psychiatric unit following a suicide attempt. He is diagnosed with Borderline Personality Disorder (BPD). He exhibits impulsivity, unstable relationships, and intense fear of abandonment. He has a history of self-harm and has difficulty regulating his emotions. 41. Which of the following behaviors is commonly associated with Borderline Personality Disorder? A. Grandiose sense of self-importance B. Persistent suspiciousness and distrust of others C. Unstable interpersonal relationships and impulsivity D. Detachment from social relationships and restricted emotional expression 42. Mr. Dela Cruz expresses intense anger towards the nursing staff after a request is denied. What is the nurse's best initial response? A. Immediately confront Mr. Dela Cruz about his inappropriate behavior. B. Validate his feelings while setting clear limits on his behavior. C. Ignore his outburst to avoid escalating the situation. D. Administer a PRN medication to calm him down without further interaction. 43. Mr. Dela Cruz frequently engages in self-harming behaviors. What is the priority nursing intervention? A. Punish self-harming behaviors to deter future incidents. B. Establish a safety plan with Mr. Dela Cruz to identify coping mechanisms. C. Isolate Mr. Dela Cruz to prevent him from harming himself. D. Constantly monitor Mr. Dela Cruz to prevent any self-harm attempts. 44. Which therapeutic approach is most effective in treating BPD? A. Aversion therapy B. Dialectical Behavior Therapy (DBT) C. Systematic desensitization D. Classical conditioning 45. Mr. Dela Cruz expresses a fear of abandonment. How should the nurse respond? A. Reassure him that he won't be abandoned. B. Acknowledge his fear and explore the origins of this fear. C. Distract him from focusing on his fear. D. Tell him that his fear is irrational. Situation: Ms. Reyes, a 30-year-old female client, is admitted to the psychiatric unit exhibiting symptoms consistent with a personality disorder. She presents with intense fear of abandonment, unstable relationships marked by idealization and devaluation, impulsivity, and self-harming behaviors. She has a history of multiple suicide attempts. 46. Which personality disorder best fits Ms. Reyes' presentation? A. Antisocial Personality Disorder B. Borderline Personality Disorder C. Histrionic Personality Disorder D. Narcissistic Personality Disorder 47. Ms. Reyes tells the nurse, "You're the best nurse ever! You understand me completely." Later that day, she accuses the same nurse of being incompetent and cold. This behavior is an example of: A. Idealization and devaluation B. Splitting C. Projection D. Reaction formation 48. What is the priority nursing intervention for Ms. Reyes' self-harming behaviors? A. Punish self-harming behaviors to deter future incidents. B. Establish a safety plan with Ms. Reyes to identify coping mechanisms. C. Isolate Ms. Reyes to prevent her from harming herself. D. Constantly monitor Ms. Reyes to prevent any self-harm attempts. 49. Which therapeutic approach is most effective in treating Ms. Reyes' BPD? A. Aversion Therapy B. Dialectical Behavior Therapy (DBT) C. Psychodynamic Therapy D. Supportive Therapy 50. When caring for Ms. Reyes during a period of intense emotional distress, which intervention should the nurse prioritize? A. Administer a PRN sedative immediately. B. Encourage her to express her feelings and validate her emotions. 3 | 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