Title RECALLS 6 (NP3) - STUDENT COPY ✅

RECALLS EXAMINATION 5 NURSING PRACTICE III CARE OF CLIENTS WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART A) 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 III” on the box provided Situation: You'll be working in the Medical Step-down Unit, where you expect to deal with numerous patients who have acid-base imbalances. To be thoroughly prepared as a professional nurse, you plan to review key information on how to manage various types of acid-base imbalances. 1. As a nurse you were taught how to evaluate arterial blood gas (ABG) values. Which of the following steps would you do FIRST? A. Evaluate HCO3 B. Evaluate pH C. Determine acid base status D. Evaluate PaCO2 2. Which of the following conditions may cause metabolic acidosis due to a decrease in bicarbonate (HC03) level? 1. Loss of gastric fluids from vomiting or nasogastric suction 2. Loss of body fluids from drains below the umbilicus 3. Gastrointestinal fistulas 4. Aspirin ingestion A. 3 and 4 B. 1 and 2 C. 1 and 4 D. 2 and 3 3. Jian, 30 years old, was brought to the Emergency Department (ED) with nausea confusion, dehydration and oliguria. Her mother informs you that Jian has been depressed after losing her job as a bank executive. An empty bottle of aspirin was found in her bathroom sink. Her laboratory values revealed the if.: pH = 7.35, PaCO2=16 mmHg, PaO2=130 mmHg, and HCO3=15mEq/L. What is the CORRECT acid-base interpretation of her ABG? A. Partially compensated respiratory acidosis B. Uncompensated metabolic acidosis C. Partially compensated metabolic: acidosis D. Compensated metabolic acidosis. 4. The nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, Paco2 of 30 mm Hg, and HCO3 of 20 mEq/L (20 mmol/L). The nurse analyzes these results as indicating which condition? A. Metabolic acidosis, compensated B. Respiratory alkalosis, compensated C. Metabolic alkalosis, uncompensated D. Respiratory acidosis, uncompensated 5. Anne, a client with a 3-day history of nausea and vomiting and suspected gastroenteritis presents to the emergency department. Anne is hypoventilating and has a respiratory rate of 10 breaths per minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats per minute. Arterial blood gases are drawn, and the nurse reviews the results, expecting to note which finding? A. A decreased pH and an increased Paco2 B. An increased pH and a decreased Paco2 C. A decreased pH and a decreased HCO3 D. An increased pH and an increased HCO3 6. Nurse AVA is caring for a client having respiratory distress related to an anxiety attack. Recent arterial blood gas (ABG) values are pH = 7.53, Pao2 =72 mm Hg, Paco2 = 32 mm Hg, and HCO3 = 28 mEq/L (28 mmol/L). Which conclusion about the client would the nurse make? A. The client has acidotic blood. B. The client is probably overreacting. C. The client is fluid volume overloaded. D. The client is probably hyperventilating. Situation: Nurse Ces, an infectious control nurse, is caring for a client with Pulmonary Tuberculosis. 7. Which client has special risk factors that warrant testing for tuberculosis? A. 45-year-old Caucasian man who has been homeless for 2 years B. 15-year-old Caucasian woman with asthma C. 72-year-old woman who is a recent immigrant from Russia D. 50-year-old Iowa farmer 8. Nurse Ces knows that the priority action for a client admitted with a productive cough, weight loss, and a suspected diagnosis of tuberculosis is: A. Instruction on preventing disease transmission B. Planning for frequent rest period C. Recording accurate Intake and output D. Reviewing current dietary patterns 9. Nurse Ces concludes that an intradermal TB test result is positive in any person if the following is present: A. An induration of 15 mm or more B. An induration of 10 cm or more C. An induration of 5-9 mm D. A hivelike vesicle 10. A client with tuberculosis has a prescription for Myambutol (Ethambutol HCI). Nurse Ces should tell the client to notify the doctor immediately if he notices: A. Gastric distress B. Changes in hearing C. Red discoloration of body fluids D. Changes in color vision 11. The Mantoux test is used to determine whether a person has been exposed to tuberculosis. If the test is positive, Nurse Ces will find a: A. Fluid filled vesicle B. Sharply demarcated erythema C. Central area of induration D. Circular blanched area Situation: You are the nurse on duty caring for multiple patients with cardiac conditions. 12. A patient with a history of type 2 diabetes is admitted to the hospital with chest pain and is scheduled for a cardiac catheterization. Which medication should you withheld for 24 hours before the procedure and for 48 hours afterward? A. Glipizide B. Metformin C. Repaglinide D. Regular insulin 1 | Page
13. One of your clients is having a sinus bradycardia, with a heart rate of 45 beats per minute and blood pressure of 82/60 mm Hg, reports dizziness. Which intervention would you anticipate will be prescribed? A. Administer digoxin. B. Defibrillate the client. C. Continue to monitor the client. D. Prepare for transcutaneous pacing. 14. You are watching the cardiac monitor and notices that a client’s rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but more than 140 beats per minute. The nurse determines that the client is experiencing which dysrhythmia? A. Sinus tachycardia B. Ventricular Fibrillation C. Ventricular tachycardia D. Premature ventricular contractions 15. You are assisting to defibrillate a client in ventricular fibrillation. Which intervention is your priority after placing the pads on the client’s chest and before discharging the device? A. Ensure that the client has been intubated. B. Set the defibrillator to “synchronize” mode. C. Administer an amiodarone bolus. D. Confirm the cardiac rhythm. 16. You noticed that your client with myocardial infarction suddenly becomes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. Which finding would you anticipate when auscultating the client’s breath sounds? A. Stridor B. Crackles C. Scattered rhonchi D. Diminished breath sound 17. You are assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable. How would you interpret the client’s neurovascular status? A. The neurovascular status is expected because of increased blood flow through the leg. B. The neurovascular status is moderately impaired, and the surgeon needs to be called. C. The neurovascular status is slightly deteriorating and needs to be monitored for another hour. D. The neurovascular status shows adequate arterial flow, but venous complications are arising. 18. A client has frequent bursts of ventricular tachycardia on the cardiac monitor. Which factor is your highest priority with regard to this dysrhythmia? A. It can develop into ventricular fibrillation at any time. B. It is almost impossible to convert to a normal rhythm. C. It is uncomfortable for the client, giving a sense of impending doom. D. It produces a high cardiac output with cerebral and myocardial ischemia 19. Your client with ventricular fibrillation is about to be defibrillated. Which energy level (in joules, J) would you set on the monophasic defibrillator machine for the first delivery? A. 50 J B. 120 J C. 200 J D. 360 J 20. You are caring for a client who had a resection of an abdominal aortic aneurysm yesterday. The client has an intravenous (IV) infusion at a rate of 150 mL/hr, unchanged for the last 10 hours. The client’s urine output for the last 3 hours has been 90, 50, and 28 mL (28 mL is most recent). The client’s blood urea nitrogen level is 35 mg/dL (12.6 mmol/L), and the serum creatinine level is 1.8 mg/dL (159 mcmol/L), measured this morning. Which nursing action is your priority? A. Check the serum albumin level. B. Check the urine specific gravity. C. Continue to monitor urine output. D. Call the primary health care provider. 21. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. You notice that there are no electrocardiographic complexes on the screen. Which is the priority nursing action? A. Call a code. B. Check the client’s status. C. Call the primary health care provider. D. Document the lack of complexes. 22. You are evaluating a client’s response to cardioversion. Which assessment would be the priority? A. Blood pressure B. Airway patency C. Oxygen flow rate D. Level of consciousness Situation: You are on shift, responsible for managing the care of several patients with various respiratory conditions. 23. A 12-year-old child with asthma is being treated for a severe asthma attack in the emergency room. What symptom should you specifically watch for, as it would signal a worsening of the child's condition? A. Warm, dry skin B. Decreased wheezing C. Pulse rate of 90 beats per minute D. Respirations of 18 breaths per minute 24. An 8-year-old child undergoing home treatment for right lower lobe pneumonia calls the clinic with their parent, who reports that the child is experiencing discomfort on the right side and that ibuprofen is not providing relief. What guidance should you offer to the parent? A. Increase the dose of ibuprofen. B. Increase the frequency of ibuprofen. C. Encourage the child to lie on the left side. D. Encourage the child to lie on the right side. 25. A new parent is worried about sudden infant death syndrome (SIDS) and asks the nurse for guidance on the safest sleep position for their newborn. What position should you recommend for placing the infant? A. Side or prone B. Back or prone C. Stomach with the face turned D. Back rather than on the stomach 26. You are discussing the immunization schedule with the parent of a child with cystic fibrosis. What information should you, as the nurse, provide to the parent regarding the child's vaccinations? A. “The immunization schedule will need to be altered.” B. “The child should not receive any hepatitis vaccines.” C. “The child will receive all of the immunizations except for the polio series.” D. “The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination.” 27. You are an emergency department nurse evaluating a child diagnosed with epiglottitis. What signs should you watch for to determine if the child may be experiencing an airway obstruction? A. The child exhibits nasal flaring and bradycardia. B. The child is leaning forward, with the chin thrust out. C. The child has a low-grade fever and complains of a sore throat. D. The child is leaning backward, supporting self with the hands and arms. 28. A child with croup is being treated with a cool mist vaporizer in their hospital room. The child is visibly distressed, crying persistently, and attempting to leave the area. What should you do to address the child's discomfort and ensure their safety? A. Tell the parent that the child must stay in the tent. B. Place a toy in the tent to make the child feel more comfortable. C. Call the pediatrician and obtain a prescription for a mild sedative. D. Let the parent hold the child and direct the cool mist over the child’s face. 29. You reviews the tuberculin skin test (TST) results for a 3-year-old child and notes an induration area measuring 10 mm. How should you interpret these results? A. Positive B. Negative C. Inconclusive D. Definitive and requiring a repeat test 2 | Page
30. The parent of a hospitalized 2-year-old child with viral laryngotracheobronchitis (croup) asks you why antibiotics were not prescribed by the doctor. How should you respond? A. “The child may be allergic to antibiotics.” B. “The child is too young to receive antibiotics.” C. “Antibiotics are not indicated unless a bacterial infection is present.” D. “The child still has the maternal antibodies from birth and does not need antibiotics.” 31. You are an emergency department nurse evaluating a patient who has experienced a blunt trauma to the chest. Which sign would suggest that the patient may have a pneumothorax? A. A low respiratory rate B. Diminished breath sounds C. The presence of a barrel chest D. A sucking sound at the site of injury Situation: The nurse is preparing for an upcoming shift and decides to review her knowledge on various medications. She focuses on understanding the indications, side effects, and proper administration techniques for commonly used drugs in her unit. 32. A patient is prescribed guaifenesin. How would the nurse know the patient understands the correct way to take this medication if the patient describes which specific action? A. Take an extra dose if fever develops B. Take the medication with meals only C. Increase water intake when taking the medication D. Decrease the amount of daily fluid intake 32. The nurse is getting ready to administer intravenous naloxone to a patient with an opioid overdose. What supportive medical equipment should the nurse ensure is available at the patient’s bedside? A. Nasogastric tube B. Paracentesis tray C. Resuscitation equipment D. Central line insertion tray 33. Zafirlukast is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? A. Platelet count B. Neutrophil count C. Liver function tests D. Complete blood count 34. A patient is about to start a 6-month course of isoniazid therapy. What should the nurse plan to teach the patient to do during their treatment? A. Use alcohol in small amounts only. B. Report yellow eyes or skin immediately. C. Increase intake of Swiss or aged cheeses. D. Avoid vitamin supplements during therapy. 35. The nurse has provided a patient on ethambutol with information about the medication. How can the nurse confirm that the patient understands the instructions if the patient says they will promptly report which specific symptom? A. Impaired sense of hearing B. Gastrointestinal side effects C. Orange-red discoloration of body secretions D. Difficulty in discriminating the color red from green 36. A patient with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hr. Which lab result would signal to the nurse that the patient is receiving an effective therapeutic dose? A. Prothrombin time of 12.5 seconds B. Activated partial thromboplastin time of 28 seconds C. Activated partial thromboplastin time of 60 seconds D. Activated partial thromboplastin time longer than 120 seconds 37. The nurse provides discharge instructions to a patient with atrial fibrillation who is taking warfarin sodium. Which statement by the patient shows they require further education? A. “I will avoid alcohol consumption.” B. “I will take coated aspirin for my headaches.” C. “I will take my pills every day at the same time.” D. “I have already called my family to pick up a MedicAlert bracelet.” 38. The home health care nurse is visiting a patient with hypertension and high LDL cholesterol, whose serum cholesterol level is 420 mg/dL (11 mmol/L). The patient is prescribed warfarin, and the nurse provides education about the medication. Which statement by the patient indicates that further teaching is needed? A. “Constipation and bloating might be a problem.” B. “I’ll continue to watch my diet and reduce my fats.” C. “Walking a mile each day will help the whole process.” D. “I’ll continue my nicotinic acid from the health food store.” 39. For a patient receiving intravenous heparin therapy for atrial fibrillation, which medication should the nurse ensure is readily available on the nursing unit? A. Vitamin K B. Protamine sulfate C. Potassium chloride D. Aminocaproic acid 40. A patient on daily digoxin has a serum potassium level of 3 mEq/L (3 mmol/L) and reports anorexia. The cardiologist orders a serum digoxin level test. Which digoxin level would the nurse identify as being outside the therapeutic range? A. 0.5 ng/mL (0.63 nmol/L) B. 0.8 ng/mL (1.02 nmol/L) C. 0.9 ng/mL (1.14 nmol/L) D. 2.2 ng/mL (2.8 nmol/L) 41. Nurse Evelyn is assessing a patient newly diagnosed with COPD. The patient reports a chronic cough with sputum production. What assessment finding would she expect in this patient? A. Clear, thin sputum B. Pink, frothy sputum C. Yellow-green, thick sputum D. Rust-colored sputum 42. A patient with COPD is prescribed an inhaled corticosteroid. Nurse Evelyn instructs the patient on how to use the inhaler properly. Which statement by the patient indicates the need for further teaching? A. “I should rinse my mouth with water after using the inhaler.” B. “I will use the inhaler before using my bronchodilator.” C. “I will press down on the inhaler while I breathe in deeply.” D. “I should wait at least 1 minute between puffs if instructed to take more than one.” 43. A patient with COPD is receiving supplemental oxygen therapy. Which observation would indicate that the patient might be experiencing oxygen toxicity? A. Cyanosis of the lips and fingertips B. A decreased respiratory rate C. Complaints of dry cough and substernal discomfort D. Decreased oxygen saturation levels 44. A patient with COPD is experiencing increased shortness of breath and has a history of frequent exacerbations. Nurse Evelyn is reviewing the patient’s medications. Which class of medication would she expect to be prescribed to help manage this patient’s symptoms? A. Antihistamines B. Antibiotics C. Bronchodilators D. Antivirals 45. A patient with COPD is participating in pulmonary rehabilitation. Nurse Evelyn is educating the patient about lifestyle changes to improve their condition. Which lifestyle modification would she most likely recommend? A. Increase daily intake of caffeine B. Engage in regular physical activity C. Avoid all dietary fats D. Limit fluid intake to prevent congestion Situation: Annaliza, a senior nurse, is reviewing her knowledge regarding delegation and task management. 46. Annaliza, a nurse in a busy Philippine hospital is delegating tasks to a team of nurses and nursing assistants. Which task should she delegate to a nursing assistant? A. Administering intravenous medications B. Performing a comprehensive physical assessment C. Assisting a patient with daily activities and basic care D. Developing a care plan for a complex patient 47. The head nurse is reviewing the delegation process with a new nurse in a hospital in the Philippines. Which of the 3 | Page