Title DIAGNOSTIC EXAM - NP4 (KEY) ✅

TOP RANK REVIEW ACADEMY, INC. Page 1 | REFRESHER PHASE DIAGNOSTIC EXAMINATION NURSING PRACTICE IV FEB 2026 Philippine Nurse Licensure Examination Review Situation 1– As a nurse assigned in the emergency department you should be prepared for any situation. Thus, you should be able to anticipate what your patient’s needs are. 1. Four victims of an automobile crash are brought by ambulance to the emergency department. As a triage nurse which of the following four victims should you give highest PRIORITY for treatment? A. Multiple closed fracture of the upper and lower extremities. B. Severe bleeding of facial and head lacerations. C. A sucking chest wound. D. An open femur fracture with profuse bleeding. 2. When caring for Julio, 30 years old, with head and neck trauma after a motorcycle accident, your PRIORITY action should be to: A. Administer supplemental oxygen. B. Immobilize the cervical spine. C. Suction the mouth and oropharynx. D. Obtain venous access. 3. Cedie, a 24-year-old, is brought to the emergency department with multiple lacerations and tissue avulsion of the right hand after catching the hand in a produce conveyor belt. When asked about tetanus immunization, he says, “I’ve never had any vaccinations.” You will anticipate administration of tetanus: A. Immunoglobulin and tetanus-diphtheria toxoid. B. Immunoglobulin. C. Tetanus-diphtheria toxoid. D. Immunoglobulin, tetanus-diphtheria toxoid and pertussis vaccine. 4. Lavinia is admitted to the emergency department after a near-drowning accident in a local lake. She received rescue breathing at the site and now has spontaneous respirations. You will observe the patient for several hours to monitor for symptoms of: A. Pulmonary edema. B. Hypernatremia. C. Head injury. D. Hypothermia. 5. Harry, unconscious is admitted to the emergency department 45 minutes after ingesting approximately 30 diazepam (Valium) tablets. The physician prescribes gastric lavage. As a nurse, your FIRST action when implementing the order is to: A. Insert a large-bore nasogastric tube. B. Prepare a 60-ml syringe with saline. C. Assist physician to intubate the patient. D. Position the patient on his side. Situation 2 – You are assigned in the Emergency Department. You know that critical decision making and prompt interventions are very important to address the problems and concerns of patients. 6. Becky, a 36 year old hair dresser with hypovolemic shock, has a urinary output of 15 ml/hr. As her nurse, you understand that the compensatory physiologic mechanism that leads to altered urinary output is: A. Activation of the sympathethic nervous system (SNS), causing vasodilation of renal arteries. B. Movement of interstitial fluid to the intravascular space, increasing renal blood flow. C. Stimulation of cardiac-adrenergic receptors, leading to increased cardiac output. D. Release of aldosterone and antidiuretic hormone (ADH), which cause sodium and water retention. 7. Rafael with massive trauma and possible spinal cord injury is admitted to the Emergency Department. You suspect that he may be experiencing neurogenic shock in addition to hypovolemic shock, based on your assessment finding of: A. Shortness of breath. B. BP of 82/40 mmHg. C. Cool, clammy skin. D. Heart rate of 48 beats/min. 8. All of these collaborative interventions are ordered by the physician for Vincent who was stung by a bee and develops severe respiratory distress and faintness. Which one will you administer FIRST? A. Normal saline infusion. B. Diphenhydramine (Benadryl). C. Epinephrine (Adrenalin). D. Dexamethasone (Decadron). 9. You are caring for Arturo, 70kg., who was admitted to the Emergency Department in a shock state. You evaluate that fluid resuscitation for Arturo is effective based on which of the following? A. Urine output is 40ml over the last hour. B. Hemoglobin is within normal limits. C. CVP has decreased. D. Mean arterial pressure (MAP) is 65 mmHg. 10. What is the best intervention for Arturo who has a nursing diagnosis of fear related to perceived threat of death? A. Leave Arturo alone with family members whenever possible. B. Place Arturo’s call bell where it can be easily reached. C. Ask the physician to prescribe a sedative drug to Arturo. D. Arrange for the hospital pastoral care staff to visit Arturo. Situation 3 – Kyle, male, 14 years old, unconscious, was admitted because of intracranial hemorrhage due to an arteriovenous malformation, suspected to be a congenital anomaly. Patient was intubated and attached to a mechanical ventilator. Patient is closely monitored for increased intracranial pressure. 11. Nursing order states that periodic suctioning should be limited to 10-15 seconds or less. Nurses understand that suctioning the patient for more than 15 seconds may cause hypercapnia which in turn: A. Constricts cerebral vessels and thus, decrease cerebral blood volume. B. Reduce PaCO2 and promote vasoconstriction. C. Vasodilates cerebral vessels and thus, increases cerebral blood volume. D. Stimulate stretch receptors within small blood vessels of the brain resulting to vasoconstriction. 12. Nursing diagnosis identified by the nurse is “Risk for Aspiration”. Which of the following is the most relevant nursing intervention to prevent aspiration? A. Report promptly signs of aspiration. B. Assess gag reflex appropriate to level of consciousness. C. Place on side lying position. D. Provide oral hygiene. 13. Mannitol therapy was initiated on the patient. The nurse recognizes which of the following as the specific action of Mannitol? * NLE * NCLEX * HAAD * PROMETRICS * DHA * MIDWIFERY * LET * RAD TECH * CRIMINOLOGY * DENTISTRY * PHARMACY * MED TECH
TOP RANK REVIEW ACADEMY, INC. Page 2 | A. Draws fluid out of the brain cells by increasing osmolality of the blood. B. Decreases the osmotic draw in the blood, pulling extracellular water. C. Binds the vascular receptors to vasoconstrict cranial blood vessels. D. Cause reduction in the rate of cerebrospinal fluid production. 14. The physician confirmed that Kyle is in a state of Respiratory Acidosis. Which of the following data will the nurse expect? A. Increased PaCO2, high serum pH. B. Increased PaCO2, low serum pH. C. Decreased PaCO2, high serum pH. D. Decreased PaCO2, low serum pH. 15. The vital signs sheet showed that the temperature of the patient was increasing with 39.8°C as the latest report. The nurse analyzed this finding as an impending sign of: A. Brain death. B. Increased intracranial pressure. C. Neurogenic shock. D. Brain injury. Situation 4 – To ensure safe and quality nursing care delivery especially in the special nursing units such as the Intensive Care Unit and the Emergency Department, it is important that human resources are effectively managed. 16. The unit manager of the ICU ensured that the unit is adequately staffed every shift by adopting a self-scheduling scheme. Which of the following reflects the action of the unit manager? A. Controlling. B. Planning. C. Organizing. D. Directing. 17. The unit manager received report of the incidences of needle stick injury in her unit from the hospital’s clinic for employees. For continuous quality improvement, which of the following is the MOST appropriate action of the unit manager? A. Reorganize the medication area to ensure proper needle disposal. B. Call the nurses involved and reiterate to them the policy. C. Communicate through posters proper needle disposal. D. Meet the staff and look for better practices. 18. A child with Bronchial Asthma is being admitted in the Emergency Department by Ella. Which of the following actions of Ella is correct? A. Ella told the nursing assistant to observe the child’s breathing while she prepares her assessment tools. B. Ella asked the nursing assistant to reposition the child while she consults the physician. C. The nursing assistant was told to get a kidney basin and some wipes because the child vomited. D. The nursing assistant restrained the child as directed by Ella while she interviewed the parents. 19. While Aurora, the charge nurse is receiving endorsement from the outgoing charge nurse, the daughter of the patient approached her and complained about the behavior of the nurse assigned to her father. Which of the following is the MOST appropriate response of Aurora? A. Politely tell the daughter to wait until she talks to the nurse concerned. B. Call immediately the nurse concerned. C. Discontinue the endorsement and request the outgoing charge nurse to address the complaint. D. Listen attentively to the complaints of the daughter. 20. While the unit manger was reviewing the patient’s chart, four nurses approached her. Which of the following reports will the unit manager attend to first? A. Nurse 1 says the Director of Nursing is in the patient’s room and wants to talk to her. B. Nurse 2 reports that her patient expired. C. Nurse 3 requests to be taught ECG reading of her patient. D. Nurse 4 reports she has just administered a wrong medication to her patient. Situation: After experiencing visual disturbances, sudden fatigue and paresthesia in his arms and leg, Annika, 35 years old teacher, he was rushed to the Emergency Department of Tarlac Doctor’s Hospital. He is diagnosed with Multiple Sclerosis. 21. In planning care and intervention for a client diagnosed with multiple sclerosis, which of the following aspects should the nurse prioritize to address in relation to the disease? A. Client’s coping B. Client’s salience and attitude towards his treatment C. Client’s actual and potential needs D. Client’s future plans and direction in life 22. One of the client’s concerns is his generalized weakness and fluctuating endurance to activities. Which of the following nursing interventions should be implemented by the nurse to address this problem? A. Conduct an activity planning and limit the clients activities B. Restrict activities and maintain client on bed rest C. Ensure that a family member is always present to assist the client D. Space the client’s activities throughout the day 23. The nurse can say that the client experience a heightening of the disease if which of the following is observed during physical assessment? A. Dissociation fugue B. Heightened levels of energy C. Diplopia and nystagmus D. Distended jugular veins 24. Ms. Annika complains of not being able to control her voiding. She said she experiences bed wetting and finds it hard to hold her urge to void. What nursing intervention should the nurse implement to address the problem? A. Initiate bladder training B. Limit fluid intake from 2000mL/day to 1000mL/day C. Insert an indwelling catheter D. Regularly check the client’s diapers and change it frequently 25. During discharge planning, the nurse would give an appropriate instruction to Annika if she instructs the client to: A. Engage client to vigorous and strenuous activities to prevent disuse syndrome B. Prepare equipment such as cane and walker as anticipation for the clients future needs C. Promote the client’s regular exercise and inactive lifestyle D. Keep the client active with minimally stressful activities to avoid fatigue Situation: Nurse Alexis is handling patients with immunologic problems. The following questions apply. 26. Nurse Alexis is working with student nurse Alyssa to care for an HIV positive patient with severe esophagitis caused by candida albicans. Which action by the student indicates that you need to intervene most quickly? A. putting on mask and gown before entering patient’s room B. giving the patient a glass of water after administering the ordered oral nystatin a. (Mycostatin) suspension C. suggesting that the patient should order chile con carne or chicken soup for next meal D. placing a “no visitor” sign on patient’ room 27. Nurse Alexis is evaluating an HIV patient who is receiving IV pentamidine (Pentam) as a treatment for Pneumocystis jiroveci (PCP) pneumonia. Which information is most important to communicate to the physician?
TOP RANK REVIEW ACADEMY, INC. Page 3 | A. the patient is reporting pain at the site of infusion B. the patient is not taking in an adequate amount of oral fluids C. blood pressure is 104/76mmHg after pentamidine administration D. blood glucose level is 55 mg/dl after medication administration 28. After interviewing an HIV positive patient who is considering starting highly active antiretroviral therapy (HAART), which patient information concerns you the most? A. the patient has been HIV positive for 8 years and has never taken any drug therapy for a. the HIV infection B. the patient tells you “I have never been faithful about taking medications” C. the patient is sexually active with multiple partners and says “I always use a condom” D. the patient has many question and concerns regarding the effectiveness and safety of the medications 29. A patient with chronic hepatitis C has been receiving interferon alfa-2a (Roferon-A) injections for the last month. Which information gathered during a home visit is more important to communicate to the physician? A. The patient has persistent nausea and vomiting B. The patient injects the medication into the thigh by the intramuscular route C. The patient’s temperature is 37.6 deg Celsius orally D. The patient reports chronic fatigue, muscle aches, and anorexia 30. An HIV positive patient who has been started on HAART is seen in the clinic for follow up. Which test will be most helpful in determining the response to the therapy? A. CD4 level B. Complete blood count C. Total lymphocyte percent D. Viral load Situation: Nurse Reine is an emergency nurse in Philippine General Hospital. An infant girl was rushed to the emergency department and is complaining of multiple burns in different parts of the body. The following questions apply. 31. The patient suffers superficial burns on the chest, posterior left leg, and anterior right thigh; deep partial burns on the whole head, posterior trunk, right and left forearm; and full thickness burns of the abdomen, and anterior left leg. How much is the TBSA of the patient that would be included in the parkland formula? A. 76.5% B. 54% C. 89.5% D. 70% 32. The patient weighs 30lbs. How much fluid would be given in the first 24 hours? A. 3,819mL B. 1,910mL C. 4,171mL D. 2,085mL 33. What would be the drops/minute in the first 8 hours given that the drop factor is 15 drops/ml? A. 119 drops/min B. 60 drops/min C. 130 drops/min D. 65 drops/min 34. What would be the priority of the patient’s condition in the emergent phase? A. fluid resuscitation B. risk for infection C. patent airway D. optimal functioning 35. Which of the following conditions would be the priority assessment in the given patient, at the acute phase? A. compartment syndrome B. risk for infection C. shock D. contractures Situation: Basic concepts on neuroanatomy and neurophysiology are important before one is able to intervene with abnormal occurrences. 36. Which among the following cranial nerves arise from the cerebral hemisphere? A. Optic nerve B. Trigeminal nerve C. Vagus nerve D. Trochlear nerve 37. Which among the following is not an occurrence with agonist stimulation of the muscarinic and cholinergic receptors? A. Bronchodilation B. Increased peristalsis C. Bradycardia D. Miosis 38. Performing Romberg’s test is what part of the neurologic examination? A. Sensory B. Cranial nerves C. Motor D. Reflexes 39. The umbilicus corresponds to which of the following dermatomal level? A. T4 B. T10 C. L4 D. S5 40. The gag reflex is tested in the assessment of which of the following cranial nerves? A. CN VII B. CN IX and X C. CN V D. CN XII SITUATION 4: Floro, a practicing registered nurse for 2 years in a private hospital has resigned because she realized that her salary cannot sustain the growing needs of her family anymore. She has recently been accepted as a staff nurse in a local government hospital. She was assigned to the Emergency Department (ED). 41. Nurse Floro received an unconscious client after being involved in a car crash. The client’s name is unknown and no identification card was found. An emergency exploratory laparotomy is required. Regarding informed consent for surgery, which of the following is his best action? A. Transport the victim to the operating room for surgery B. Request the police to find the client’s family C. Ask the physician to sign the consent D. Obtain a consent order for the surgery 42. A 16-year-old client was brought to emergency room for treatment of leg fracture. Assessment revealed that the client is married. Nurse Floro knows that who among the following can sign the consent for admission? A. Client’s mother B. Client’s husband C. Client herself D. Client’s significant others 43. Suppose the 16-year old client becomes unconscious due to blood loss, nurse Floro should obtain the consent for admission from? A. Client’s mother B. Client’s husband C. Client herself D. Client’s significant others 44. Nurse Floro has been granted a 30-minute break after managing his patients well. While on hisway to the canteen, he heard two nursing aides discussing his client’s condition. Which of the following should primarily be done by him? A. Approach them and have a more detailed discussion regarding the patient B. Report them to the nursing supervisor C. Ignore them since it would be improper to join in