Title RECALLS 13 (NP3) - STUDENT COPY ✅

RECALLS EXAMINATION 13 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 1 - Dr. Cynthia, a Ph.D graduate in Nursing, has been appointed as a consultant in a tertiary hospital to help administration of coming up to strategies that will further enhance culture of team work and quality improvement (QI) among health personnel in the workplace. One day, Dr. Cynthia while conducting her rounds observed a charge nurse (CN) facilitating a team on reducing post-operative complications in her unit of assignment. The nurse was emphasizing the four (4) essential steps of the QI process. 1. The FIRST phase of this activity is __________. A. Review cause/s of the problems B. List of problems & prioritize C. Conduct root cause analysis D. Analyze the problems carefully 2. While undergoing the QI process, three (3) members of the team were having conflict in what management to do. Which of the following can be an EFFECTIVE strategy to resolve this conflict? A. Reprimand the three members of the team of their behavior B. Assign the three members of the team in the different shifts C. Assign an Administration to solve the conflict D. Have the three members confront with each other 3. Dr. Cynthia was initiating some innovative activities in the medical center for a continuous quality improvement (CQI) in patient care services. A policy has been adopted for nursing staff every shift to conduct hourly rounds for patients with PRIORITY health problems and attached policy was being complied with by the nurses however, she found out in the succeeding dates, it was no longer followed. What is the PRIORITY action of Dr. Cynthia in this situation? A. Assign one Nurse per shift to conduct the hourly rounds B. Conduct a general meeting with the staff and determine why such policy is NOT complied with C. Conduct a general meeting with the staff and explain the benefits of the hourly rounds D. Call to the office nurses who fail to comply the hourly rounds 4. The CQI team have observed that the incidence of FALL among older persons have increased by 50%. This data has reached Dr. Cynthia and she instructed the team to conduct which one of the following PRIORITY measures? A. Provide a cash incentive for units with 0 incidence of Fall. B. Intensify the in-service program for the unit with the highest incidence of Fall. C. Identification of the root cause of Fall. D. Decrease the benefits of those personnel who are involved in the Fall incidence. 5. A part of the CQI that Dr. Cynthia wanted to implement is the partnership safe and quality patient model, the collaboration process as a strategy is an example of _________. A. Feedback mechanism B. Through – put C. output D. Input Situation 2 - Abby is a BSN graduate and have to take the nurses licensure examination to be able to Practice her chosen profession. In order to qualify for the licensure examination, she has to comply with the basic requirements from the PRC-Board of Nursing. 6. Which one of the following is NOT considered an admission criterion for BSN graduates seeking admission to the Licensure examination? A. 20 years old upon registration B. Citizen of the Philippines C. Completed related learning experiences D. Good moral character 7. Taking an Oath of profession is a requirement for you to practice nursing in the Philippines. Which of the following is the legally designated officer to conduct the oathtaking? A. Professional Regulatory Board of Nursing B. President, Association of Nursing Service Administrators C. President, Phil. Nurses Association D. President, Association of Dens, Philippine College of Nursing 8. In RA 9173, which of the following is NOT among the provisions? A. Functions of the Board of Nursing B. Scholarship C. Nurse to patient ratio D. Salary and benefits 9. In health facilities, like tertiary hospitals, nurses are able to enhance their competence by rotating in different shifts. When a nurse is assigned to do wound dressings to all patients for the entire shift, this is an example of what type of nursing service delivery? A. Case management B. Team nursing C. Functional nursing D. Primary nursing 10. A framework that is adopted recently is the use SBAR for nurse-Health Care provider communication. SBAR is an acronym for Situation, Background, Information, Assessment while R is recommendation. Which of the following statements fall under the category of assessment? A. “Sally is 21 years old, single and college graduate.” B. “She had a relief of abdominal distention after an intake of antacid.” C. “Can you give pain medications for her abdominal pain.” D. She is having discomforts and crying because of abdominal distention” Situation 3 – Juaning, 58 year old is admitted for a suspected heart failure. He has shortness of breath, mild chest 1 | Page
pain, tachypea and presence of crackles on the bases of both lungs. Your head nurse (HN) instructed you to prepare nitroglycerin to be administered by Intravenous route. You validated from your head nurse why such medication is going to be given to patient Juaning. 11. The HN as part of her teaching function provided you this APPROPRIATE response. This is to _______. A. “reduce after load” B. “increase preload” C. “increase after load” D. “reduce preload” 12. When doing a health teaching to a patient, the FIRST step is to determine ____________. A. readiness to learn B. learning needs C. adaptation to learning styles D. capacity to learn You are assigned to do a health education class on Thursday morning with several patients for possible discharge. 13. You have a diabetic patient for discharge. He is taking a medication Carvedilol. Which one of the following instructions must be EMPHASIZED during your discharge teaching? A. Observe skin care because the drug can decrease tissue perfusion B. Monitor blood sugar level because the drug can cause hyperglycemia C. Monitor pulse rate, sugar levels because the drug may mask hypoglycemia D. Check pulse rate every 6 hours because the drug can cause palpitation 14. You are teaching a group of patients who are undergoing hemodialysis regarding their dietary plan. You should explain to them that intake of protein is necessary because it __________. A. reduces demand for liver functioning B. increases nitrogenous waste products C. maintains osmotic pressure D. induces frequent urination 15. There is a doctor’s order for your patient with heart failure to be discharged after two days. The diet order is for him to limit his sodium intake to only 2 g. Identify which of the following breakfast selection should be included in your plan. A. Orange juice, bacon, fried egg, and steamed rice. B. Orange juice, fried salted fish, and steamed rice. C. Orange juice, toast bread, poached egg and jam. D. Orange juice, pouched egg, brown rice and ham. Situation 4 - Ms. Maribel is the Nurse director in a Level 3 private hospital in Metro Manila. In the past months she has been encountering staffing problems so she is worried that she cannot comply with the expectations of her stakeholders as a Premiere health institution in the country that can deliver Safe and Quality care. 16. In the Strategic plan process, which of the following questions is addressed to be able to arrive at a specific vision-mission in a nursing business plan? 1. What business are we in now? 2. What business do we want to be? 3. What do our customers expect of us now? 4. What will be the expectations of our customers in the future? 5. Who are our customers? A. 2, 3 & 4 B. 1,2,3,4 & 5 C. 1 & 2 D. 1, 3 & 4 17. The hallmark of Nursing shortage is BEST described as ___________. A. Predetermined standards of group of patients with the available nursing staff B. Situation related to recruitment and retention of nursing personnel C. Use of nursing models to forecast availability of nursing personnel D. Discrepancy between the supply and demand of nursing graduates 18. In the light of the brainstorming session of the team leaders, the issue of managing performance of personnel was raised into the discussion. Which of the following is the sequence in the performance appraisal? 1. Assess the institutional and personal goals 2. Assess progress of the staff 3. Evaluate progress 4. Establish objectives and time frame A. 4, 1, 2, & 3 B. 1, 3, 4 & 2 C. 2, 3, 1 & 4 D. 1, 4, 2 & 3 19. Prioritization and delegation of personnel can also be of help to the professional nurses in staffing problem. Cases have been raised by the team members such as; if you have a plan of care for a diabetic patient which of the following interventions can be delegated to the experienced nursing attendant? A. Discuss with the patient and family on insulin therapy B. Perform wound care for a diabetic foot C. Administer metformin for his diabetes D. Teach the patient to perform daily foot care 20. Likewise a clinical situation in the ward is when a patient is attached to a Naso-gastric tube (NGT), which of the following nursing measure can be delegated to a nursing attendant? A. Removing the nasogastric tube as ordered B. Performing oral care every 4 hours and PRN C. Securing the safety of the nasogastric tube with a tape D. Disconnect the suction to accompany patient to the toilet Situation – Eddie Wao, 71 years old, a former car dealer has been chronically-ill due to Emphysema. He was in and out of the hospital for the past 2 years. He decided to have a living will so he asked his eldest daughter to contact their lawyer. 21. Which of the following conditions is APPROPRIATE to have a living will? When a patient is __________. A. on a stage of drowsiness and receiving sedatives B. incapacitated but conscious and in a terminal condition C. with family members who are around and can make decisions for him D. in a critical condition and receiving lifesaving drugs 22. Which of the following actions of the Nurse can be classified as intentional tort? A. Refusing a patient to sign a waiver so he can go home. B. Failure to instruct the nursing aid to put up the side rails of an older patient resulting to fall. C. Administering a blood transfusion to a wrong patient. D. Failure to report to the physicial the untoward reaction of a drug. 23. A Nurse is assigned in the ICU unit for almost 3 years and has attended several patients who have died under her shift. She was emotionally affected with this situation but remains to be silent every time she reports for duty. The BEST way for the Nurse to cope with this feeling is to ________. A. consult a psychologist regarding this feeling B. discuss this feeling with the other members of the staff C. neglect this behavior and go out with friends D. request the supervisor to transfer her to another unit 24. A patient is admitted in your unit because of rectal bleeding and need a blood transfusion. Being a Jehovah’s witness, he refused the order of the physician. The wife secretly talked with the Nurse and the physician to administer the blood transfusion after taking his sleeping pills. What is the BEST action of the health care professionals in this situation. A. Refer the case to the minister so he can convince the patient B. Proceed with giving of blood transfusion as this is highly needed C. Refuse the suggestion of the wife for the husband might be awake D. Talk with the wife that she is violating the husband’s request 25. A waitress in a nearby bar was admitted because she was suspected to be suffering from HIV. The waitress is single, but with a boyfriend working in the Middle East. During the shift report of the nurses, the outgoing morning shift was discussing 2 | Page
the case in a very loud voice and being heard by some patients in the ward. The Nurse, can be charged for_________. A. Breach of confidentiality B. Oral defamation C. Injustice D. Non-maleficence Situation 5 - Nurse Joy is assigned in the Female Medical ward, caring for patients with varying health conditions. She believes that documentation is an essential aspect of the nursing process and vital for the role as a Nurse especially on record keeping and reporting. 26. When Nurse Joy indicates basic care information, skills and referral services that the patients may need before being released from the health facility is an entry of what documentation in the chart? A. Multidisciplinary notes B. Physician orders C. Discharge Plan D. Nurses notes 27. In coming up with her formulated nursing diagnosis for her patient Ms. Dina, who is suffering from hemolytic anemia, you will expect Nurse Joy to write in the Nursing care plan which one of the following PRIORITIES? A. Ineffective airway clearance R/T poor gas exchange. B. Activity Intolerance R/T to fatigue. C. Poor tolerance to heat R/T increased metabolism. D. Imbalanced Nutrition: less body weight. 28. The physician on duty (POD) ordered a specific diet for patient Dina. Which of the following diet prescriptions will Nurse Joy transmit to dietary department? A. High protein, high caloric diet. B. High fiber, less fat, high protein diet. C. High fats, high protein diet. D. High carbohydrate, less fiber, low protein diet. 29. Marimar, 55 yr old is another patient of Nurse Joy who is having an asthmatic attack, with extreme dyspnea and presence of sternal retraction. The physician who was making his rounds examined the patient and ordered the drug of choice that will relieve patient’s problems. Which of the following will be likely be written by the physician, carried out and recorded by the Nurse in the Medication chart? A. Nor-epinephrine B. Epinephrine C. Prednisone D. Albuterol 30. Nurse Joy is preparing for her shift report with the members of her team in the ward, when she was approached by her junior nurse who raised this concern regarding a physician order. Which of the following orders should I question if this has been written by a doctor? A. twenty four hour ambulatory EKG for a hypertensive patient B. stress test monitoring for an obese adult C. a high dose of insulin for a diabetic adolescent D. blood transfusion for an anemic elderly Situation 6 - Nicolo, 32 years old, single, who is an electrical engineer is scheduled to undergo left leg amputation because of an abscess from a non-healing wound. He is a Juvenile Diabetic. 31. On admission the nurse started to gather his health history, but the client appears uneasy and uncomfortable to share information about his condition. What is the BEST approach of the nurse in this situation? A. Assure him that the information he is going to share will be treated confidentially. B. Tell him, you have encouraged similar problems in the past C. Continue getting his data in a professional manner D. Ask him if he wants to be interviewed at a later time 32. The parents of Nicolo came to visit him. They feel very anxious about their son’s condition. You were asked by the parents what they can do to help their son. Your BEST response is __________. A. “Don’t show him that you are anxious, it will just aggravate his condition.” B. “I am sure anything you will do for him will be appreciated.” C. “Allow him to do activities that interest him for the meantime.” D. “Don’t worry, he will be able to adapt to his condition in due time.” 33. After surgery, Nicolo was transferred to the Post Anesthesia unit (PACU). His vital signs were stable and he was responsive. After two hours, he was transferred to his room. The Ward Nurse received the patient. The BEST nursing approach to do REALITY orientation to Mr. Timmy is _______. A. “Good afternoon, Mr. Nicolo. Do you know where you are?” B. “Mr. Nicolo, you just had your surgery, and you are back to your room.” C. “Thanks God, you had a successful operation. Your parents are here.” D. “Good afternoon, Mr. Nicolo, did you have a good sleep during the operation.” 34. On the 3 rd day, after the operation, you observed that Mr. Nicolo was very quiet, and when approached, he said to the nurse. “I am really concerned with my future!” The nurse’s BEST response is __________. A. “You’re upset, what are you thinking about your future?” B. “We have our hospital chaplain, do you want to see him?” C. “Do you want to discuss your concerns to your parents?” D. “Tell me more about your concerns about your future.” 35. As the nurse of Mr. Nicolo, what is your PRIORITY goal for him? A. Plan for early rehabilitation. B. Arrange for his counselor to spend time with him. C. Create options for his future. D. Self-acceptance of his leg amputation. Situation 7 – Patient Dolores, a 60 year-old was brought to the Emergency Room due to severe pain caused by burns on her arms and legs after her house caught fire. She was crying and moaning. She was diagnosed by the doctor to have 3 rd degree burns. Nurse Tala started to conduct her health assessment and patient was subsequently admitted. 36. Nurse Tala formulated and documented in the chart her nursing diagnosis on Patient Dolores. A PRIORITY nursing diagnosis she wrote is, PAIN R/T _________. A. Exposed nerve endings B. Burn injury C. anxiety D. inflammation 37. Nurse Tala gives pain reliever to Patient Dolores before a procedure is done. Which of the following route should be avoided? A. Intramuscular injections B. Inhalations C. Topical medications D. Oral medications 38. Nurse Tala evaluates Patient Dolores a day after incurring the burn. Which of the following nursing interventions is APPROPRIATE at this time? A. Apply topical anesthesia on the site of burn B. Administer oxygen via nasal mask C. Evaluate the intensity of pain D. Administer pain reliever through injection 39. Nurse Tala provides bio-behavioral interventions to minimize pain and anxiety of Patient Dolores. Which one of the following is NOT appropriate to be done? A. Music therapy B. Guided imagery C. Distraction D. Stretching 40. A simple relaxation therapy was applied to Patient Dolores. The following steps of relaxation therapy done by Nurse Tala is _________. 1. evaluate and document Ms. Dolores’s response to therapy 2. create a quiet, non-disruptive environment with dim lights and comfortable temperature 3. demonstrate and practice the relaxation intervention 3 | Page
4. consider Dolores’s willingness to participate, past experiences and contraindications 5. individualize the content of the relaxation interventions A. 4, 1, 5, 3, 2 B. 2, 1, 4, 3, 5 C. 3, 2, 4, 1, 5 D. 4, 2, 5, 3, 1 Situation 8 – Mia Thermopolis, 4-week-old infant is admitted to the hospital with a history of vomiting. The mother explains that her daughter has an initial problem with the regurgitation which progressed to a projectile vomiting which becomes more forceful. 41. Upon admission, the FIRST nursing action you should perform is ________. A. Switch the child feedings to electrolyte solution B. Call the pediatric ward doctor for the admission C. Assess and weigh the infant D. Begin an IV fluid as ordered 42. Which of the following serum electrolyte imbalances occur in an infant with persistent vomiting? A. Potassium B. Sodium C. Chloride D. Calcium 43. What is the MOST APPROPRIATE nursing diagnosis for this patient? A. Altered Bowel Elimination B. Altered Nutrition C. Fluid volume deficit D. Alteration in Comfort 44. Due to excessive vomiting in Pyloric Stenosis, you should assess the child for which of the following imbalances? A. Respiratory Acidosis B. Metabolic Acidosis C. Metabolic Alkalosis D. Respiratory Alkalosis 45. Before scheduling the infant for surgery, the doctor ordered the administration of parenteral fluid and electrolytes. Which of the following incorporated solutions should be administered through IV? A. Potassium Chloride B. Magnesium Chloride C. Bicarbonate Chloride D. Calcium Chloride Situation 9 - Chacha, a 6 month old baby is admitted in the Pediatric unit for acute diarrhea and dehydration. 46. You are in charge of this patient. In your assessment you expect to find which of the following? A. Moderately lethargic B. Bulging fontanelle C. loosening of the skin D. High grade fever 47. Further clinical findings of the child that you have observed include which ONE of the following? A. Metabolic alkalosis B. Metabolic acidosis C. Respiratory acidosis D. respiratory alkalosis 48. The child was ordered Oresol (ORS). As a nurse, how would you prepare Oresol treatment for this child? A. Mix 2 sachet of ORS in 1 liter of water B. Mix 1 sachet of ORS in 2 liters of water C. Mix 2 sachet of ORS in 2 liters of water D. Mix 1 sachet of ORS in 1 liter of water 49. The BEST practice for the nursing staff to prevent spread of infection when patient has infectious diarrhea is _________. A. Autoclave linens B. Strict handwashing C. isolate the patient D. wear latex gloves 50. After the Oresol Treatment which of the following is an indication that Oresol is effective? A. Patient is well hydrated B. Refuse to play with other children C. Socialization with other children D. Temperature is 36.8°C Situation. Nurse Charm admits Mr. De Guzman, 31 year-old, who was brought to the Emergency room by his co-worker because of severe abdominal pain. He was observed to be very anxious; holding his abdomen with his right hand while bending towards his right side. The Emergency Room doctor made his initial assessment and referred the patient to the Surgical doctor on duty for further assessment. 51. To describe a sensation of severe pain felt for ruptured appendicitis, Nurse Charm applies deep pressure of her finger into the abdomen at a point away from the pain and then releases. This maneuver is termed as __________. A. Perforation B. McBurney’s Point C. Rovsing’s sign D. Rebound tenderness 52. Mr. De Guzman was diagnosed with ruptured appendicitis. When the appendix is suspected ruptured, a generalized abdominal pain is felt and becomes ____________. A. Merely a discomfort and steady rather that intermittent B. Intense and the patient guards the area by living room C. Rigid, stiff and board like feeling D. Tender and focused on the umbilical cord region 53. Immediate surgery was done on Mr. De Guzman. Which of the following measures for pain control is NOT advisable to be done by Nurse Charm while patient De Guzman is having post-op pain? A. Coughing exercises B. Deep breathing C. High-fowler’s position D. Semi-fowler’s position 54. After operation, a nasogastric tube (NGT) was inserted to Patient De Guzman. The rationale for this surgical measure is to _________. A. Prevent use of antibiotics B. Decrease hospitalization to two days C. Decrease pain after the operation D. Avoid the use of analgesics 55. Nurse Charm assesses the pain intensity of Mr. De Guzman. The pain assessment tool APPROPRIATE to be used for Mr. De Guzman is _____________. A. Faces Pain Rating scale B. Visual Rating Scale C. World Rating Scale D. Numeric Rating Scale 56-60. Situation. You are the nurse on night duty in the medical ward. You were assigned by Ms. Felipe, the Charge Nurse of the unit to monitor the status of a 9 year old boy with bronchial asthma. 56. Which of the following manifestations of the child would cause you to be alarmed? A. Excessive sweating B. Choking sensation C. Cough with phlegm D. Generalized chest tightness 57. You would like the child to be comfortable in bed. Which position should you put the child to ease his discomfort? A. Lying on his side B. Prone position C. High Fowler’s Position D. Supine position 58. The Pediatrician ordered theophylline by IV route. The effect(s) of this drug is __________. A. Decrease gastric acid secretion B. Causes coronary vasoconstriction C. Relaxes the smooth muscle of the bronchial tree D. Stimulation of the peripheral nervous system 59. What APPROPRIATE activity should you advise the child while in the hospital? A. Talk on the phone with his classmates B. Finish his assignments in school C. Watch cartoon movies on TV D. Play with his teddy bear 60. The patient is ready to go home. What health teachings can you give to him and to his mother? 4 | Page