Title RECALLS 4 - NP4 - SC ✅

RECALLS 4 EXAMINATION NURSING PRACTICE IV CARE OF THE CLIENT WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART B) 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 IV” on the box provided Situation: Karlwin Revillame, a 10-year-old boy, with a known history of severe hemophilia A presents to the emergency department with acute pain and swelling in his right knee. He reports a minor fall earlier that day. 1. What could be the underlying cause of the acute onset of pain and swelling in the right knee? A. Osteoarthritis B. Spontaneous hemarthrosis C. Ligament tear D. Septic arthritis 2. Which of the following is the priority nursing intervention? A. Apply a warm compress to the knee B. Administer factor VIII concentrate C. Perform range-of-motion exercises on the knee D. Prepare the patient for arthroplasty 3. What long-term complication is at risk for if his bleeding episodes are not managed effectively? A. Iron deficiency anemia B. Joint arthropathy C. Thrombocytopenia D. Aplastic anemia 4. The boy's mother asks about the risk of her future children inheriting hemophilia. What is the nurse's best response? A. "Only your sons are at risk of inheriting hemophilia." B. "There is a 50% chance that your daughters will be carriers." C. "Your daughters are at no risk of inheriting hemophilia." D. "Both your sons and daughters are at equal risk." 5. The treatment plan includes prophylactic factor VIII infusions. What is the primary goal of prophylaxis? A. To cure hemophilia B. To reduce the frequency and severity of bleeding episodes C. To increase platelet count D. To improve bone density Management of Patients with Hematologic Neoplasms 6. A 68-year-old male patient presents with fatigue, pallor, and easy bruising. A bone marrow biopsy reveals >20% blast cells. Which of the following is the most likely diagnosis? A. Chronic Lymphocytic Leukemia (CLL) B. Acute Myeloid Leukemia (AML) C. Multiple Myeloma D. Hodgkin's Lymphoma 7. A patient with AML undergoing induction chemotherapy develops a fever and absolute neutrophil count (ANC) of 0. Which intervention is priority? A. Administer granulocyte colony-stimulating factor (G-CSF). B. Begin broad-spectrum antibiotics. C. Monitor for signs of tumor lysis syndrome. D. Increase fluid intake. 8. Which of the following nursing diagnoses is priority for this patient during the induction phase of chemotherapy? A. Risk for infection related to neutropenia B. Imbalanced nutrition: less than body requirements related to anorexia and mucositis C. Activity intolerance related to fatigue and anemia D. Risk for bleeding related to thrombocytopenia 9. A patient with AML is experiencing severe mucositis. Which nursing intervention is most helpful? A. Administer antiemetics. B. Provide frequent mouth care with a soft-bristled toothbrush. C. Encourage increased fluid intake. D. Monitor for signs of infection. 10. Which infection prevention measure should be emphasized during patient and family education? A. Avoid crowds and people with known infections. B. Practice meticulous hand hygiene. C. Report any fever, cough, or diarrhea immediately. D. Avoid raw fruits, vegetables, and undercooked meats. 11. Which condition is suggested by fatigue, bone pain, and an elevated white blood cell count with a high percentage of lymphoblasts in a 4-year-old patient? A. Acute Myeloid Leukemia (AML) B. Chronic Lymphocytic Leukemia (CLL) C. Acute Lymphocytic Leukemia (ALL) D. Hodgkin's Lymphoma 12. A patient with ALL is receiving induction chemotherapy. Which medication is commonly included in the initial treatment regimen? A. Imatinib B. Azacitidine C. Dexamethasone D. Hydroxyurea 13. Which of the following is a common extramedullary site of leukemic cell infiltration in ALL? A. Liver B. Kidneys C. Lungs D. Central Nervous System (CNS) 14. A patient with ALL in remission is undergoing minimal residual disease (MRD) testing. What is the primary purpose of this testing? A. To determine the type of ALL subtype. B. To assess the effectiveness of induction chemotherapy. C. To predict the likelihood of relapse. D. To guide the choice of HSCT. 15. Which of the following treatments is used to improve outcomes in patients with high-risk Acute Lymphocytic Leukemia (ALL)? A. Maintenance chemotherapy only B. Consolidation chemotherapy C. Supportive care alone D. Observation 1 | Page
Structure and Function of the Articular System 16. A patient complains of pain and limited movement in their right knee. Which joint structure is involved in cushioning the movement of tendons and bones in this joint? A. Ligament B. Tendon C. Bursa D. Bone 17. A patient experiences a tearing sensation in their ankle during a sports injury. Which structure is most likely injured? A. Bursa B. Tendon C. Synovium D. Ligament 18. Which type of joint allows for movement in two planes at right angles to each other, as seen in the thumb? A. Ball-and-socket joint B. Hinge joint C. Saddle joint D. Pivot joint 19. What type of joint allows for rotation, such as turning a doorknob? A. Gliding joint B. Hinge joint C. Pivot joint D. Saddle joint 20. What is the primary function of synovial fluid in a typical movable joint? A. To bind articulating bones together B. To connect muscle to bone C. To lubricate and absorb shock D. To provide anterior and posterior stability Situation: A 55-year-old patient newly diagnosed with Type 2 diabetes is being educated on self-administering insulin. The patient expresses anxiety about the process and asks many questions. 21. Which of the following is the priority initial instruction regarding insulin storage? A. Always keep insulin frozen to maintain potency. B. Store all insulin vials at room temperature to prevent injection site irritation. C. Refrigerate unopened insulin vials and keep the vial in use at room temperature. D. Insulin can be stored at any temperature; refrigeration is unnecessary. 22. The patient needs to mix regular and NPH insulin. What is the correct order for drawing up the insulin into the syringe? A. Draw up the NPH insulin first, then the regular insulin. B. Draw up the regular insulin first, then the NPH insulin. C. The order doesn't matter as long as both insulins are mixed thoroughly. D. It's best to use premixed insulin to avoid mixing errors. 23. The patient is concerned about injection site reactions. What is the best strategy to prevent lipodystrophy? A. Inject insulin into the same site every time. B. Randomly rotate injection sites throughout the body. C. Systematically rotate injection sites within a single anatomical area. D. Only use the abdomen for injections. 24. The patient asks about aspiration (pulling back on the plunger before injecting). What is the nurse's best response? A. Aspiration is always necessary to ensure the insulin is injected subcutaneously. B. Aspiration is no longer considered necessary for insulin injections. C. Aspiration is only necessary for patients with a history of injection site complications. D. Aspiration is recommended to prevent intramuscular injection. 25. The patient demonstrates the insulin injection technique. Which observation indicates a need for further teaching? A. The patient cleanses the injection site with alcohol and allows it to air dry. B. The patient pinches the skin before inserting the needle at a 90-degree angle. C. The patient injects the insulin quickly and removes the needle immediately. D. The patient rotates injection sites systematically within the abdomen. Situation: A 28-year-old patient with a history of type 1 diabetes presents to the emergency department with symptoms of diabetic ketoacidosis (DKA). The patient reports several days of nausea, vomiting, and increased thirst and urination. 26. Which of the following is not a primary clinical feature of DKA? A. Hyperglycemia B. Dehydration and electrolyte loss C. Hypoglycemia D. Acidosis 27. What is the underlying physiological process that leads to dehydration in DKA? A. Decreased gluconeogenesis B. Increased insulin production C. Osmotic diuresis D. Reduced lipolysis 28. Which of the following nursing interventions is priority in the initial management of this patient's DKA? A. Administering regular insulin intravenously. B. Initiating continuous cardiac monitoring. C. Providing meticulous skin care to prevent breakdown. D. Restricting fluids to prevent fluid overload. 29. The patient's initial blood glucose level is 450 mg/dL. What IV fluid is appropriate for initial rehydration? A. D5W (5% dextrose in water) B. 0.45% saline C. 0.9% saline (normal saline) D. Lactated Ringer's solution 30. During DKA treatment, which electrolyte requires particularly close monitoring due to its potential for both hypokalemia and hyperkalemia? A. Sodium B. Chloride C. Magnesium D. Potassium Situation: A 68-year-old patient with type 2 diabetes is admitted to the hospital with altered mental status, severe dehydration, and a blood glucose level of 800 mg/dL. 31. What condition is suggested by the patient’s signs and symptoms? A. Diabetic Ketoacidosis (DKA) B. Hyperglycemic Hyperosmolar Syndrome (HHS) C. Hypoglycemic coma D. Hyperosmolar hyperglycemic state 32. Which of the following electrolyte imbalances is most likely to be present in this patient? A. Hypokalemia B. Hyponatremia C. Hypocalcemia D. Hypernatremia 33. What is the primary physiological mechanism causing the altered mental status in this patient? A. Ketoacidosis B. Cerebral edema C. Cerebral dehydration D. Hypoxia 34. Which nursing assessment should be monitored frequently in a patient with HHS? A. Deep tendon reflexes B. Breath sounds for crackles C. Level of consciousness D. Presence of ketones in urine 35. Compared to DKA management, what is a key difference in the treatment of HHS? A. Insulin is not a primary treatment modality B. Fluid resuscitation is not as critical C. Electrolyte replacement is unnecessary 2 | Page
D. Potassium monitoring is less important Situation: Justine Lloyd, a 12-year-old boy, presents to the clinic with cola-colored urine, periorbital edema, and hypertension three weeks after recovering from a streptococcal throat infection. 36. Based on the clinical presentation, what is the probable diagnosis? A. Acute interstitial nephritis B. Acute pyelonephritis C. Acute nephritic syndrome D. Chronic glomerulonephritis 37. Which of the following laboratory findings is most consistent with this diagnosis? A. Elevated serum creatinine and BUN, with normal urine protein B. Normal serum creatinine and BUN, with microscopic hematuria C. Elevated serum creatinine and BUN, with significant proteinuria and hematuria D. Normal serum creatinine and BUN, with significant glycosuria 38. The boy's mother asks about the long-term prognosis. What is the nurse's best response? A. "Most children with this condition make a full recovery." B. "This condition always progresses to end-stage renal disease." C. "There is a high risk of developing chronic kidney disease later in life." D. "The only treatment is dialysis." 39. Which of the following nursing interventions is priority in managing this patient's edema? A. Restricting fluid intake B. Monitoring intake and output (I&O) C. Encouraging high-sodium diet D. Administering diuretics without physician order 40. Which dietary adjustment is typically recommended in this type of treatment plan? A. High-protein diet B. High-sodium diet C. Protein restriction D. Unlimited fluid intake Situation: Mrs. Santiago, a 70-year-old patient with a history of heart failure is admitted to the hospital with oliguria, elevated BUN and creatinine, and a serum potassium level of 6.2 mEq/L. 41. Which condition best fits the patient's clinical presentation? A. Chronic kidney disease B. Acute kidney injury (AKI) C. Urinary tract infection D. Benign prostatic hyperplasia 42. What underlying cause is contributing to the development of AKI in this patient? A. Obstruction of the urinary tract B. Nephrotoxic medication C. Prerenal azotemia D. Acute tubular necrosis 43. Which of the following is a priority nursing intervention for this patient? A. Administering a loop diuretic B. Restricting fluids C. Monitoring for signs of hyperkalemia D. Encouraging increased physical activity 44. Which of the following medications would the nurse anticipate administering to address Mrs. Santiago's persistent hyperkalemia? A. Calcium gluconate B. Sodium bicarbonate C. Furosemide D. Mannitol 45. The patient progresses to the diuretic phase of AKI. What is the nurse's priority concern during this phase? A. Fluid overload B. Hyperkalemia C. Metabolic acidosis D. Hypovolemia Situation: A patient with end-stage renal disease (ESRD) is scheduled to begin hemodialysis (HD). The vascular access team is evaluating the patient's suitability for different types of vascular access. 46. What is the preferred method of permanent vascular access for hemodialysis? A. Central venous catheter B. Arteriovenous graft (AVG) C. Arteriovenous fistula (AVF) D. Peripherally inserted central catheter (PICC) 47. Why is a maturation period of at least 3 months required for an AVF before it can be used for dialysis? A. To allow the graft material to fully integrate with the vessels. B. To allow the venous segment to dilate sufficiently to accommodate needles. C. To allow the patient to adjust to the presence of the fistula. D. To allow the body to produce sufficient clotting factors. 48. Under what circumstances is an arteriovenous graft (AVG) typically created instead of an AVF? A. When the patient is allergic to the materials used in AVF creation. B. When the patient's native vessels are unsuitable for AVF creation. C. When the patient prefers a less invasive procedure. D. When the patient requires only temporary dialysis access. 49. What is a common complication associated with arteriovenous grafts? A. Spontaneous closure B. Thrombosis C. Aneurysm formation D. Hypertension 50. What physical examination findings should the nurse regularly assess in a patient with an AVF? A. Presence of a bruit and thrill B. Presence of a palpable pulse C. Presence of edema in the extremity D. Presence of skin discoloration Situation: A 25-year-old male presents to the clinic with complaints of penile pain and swelling. He reports difficulty retracting his foreskin and a persistent, painful erection unrelated to sexual activity. 51. The patient's inability to retract his foreskin is consistent with which condition? A. Paraphimosis B. Priapism C. Phimosis D. Balanitis 52. The persistent, painful erection the patient is experiencing is which type of priapism? A. Nonischemic priapism B. Stuttering priapism C. Ischemic priapism D. Psychogenic priapism 53. Which laboratory test is most helpful in differentiating between ischemic and non-ischemic priapism? A. Complete blood count B. Blood urea nitrogen and creatinine C. Blood gas analysis D. Penile blood gas analysis 54. Initial treatment for ischemic priapism typically involves which of the following? A. Manual reduction B. Circumcision C. Aspiration of the corpora cavernosa D. Application of ice packs 55. A patient with phimosis secondary to inflammation is likely to be treated with: A. Surgical circumcision B. Topical steroid cream C. Antibiotic therapy 3 | Page
D. Manual reduction Stages in the Development of Pressure Injuries 56. What is the defining characteristic of a Stage 1 pressure injury? A. Partial-thickness skin loss B. Full-thickness skin loss C. Non-blanchable erythema of intact skin D. Exposed bone or muscle 57. Which stage involves partial-thickness skin loss with exposed dermis? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4 58. In which stage does adipose tissue become visible? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4 59. Which stage involves exposed fascia, muscle, tendon, or bone? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4 60. What term describes a pressure injury where the stage cannot be determined due to slough or eschar? A. Deep tissue injury B. Unstageable pressure injury C. Suspected deep tissue injury D. Partial-thickness skin loss Management of Patients with Dermatologic Disorders 61. A 6-year-old child presents with multiple, itchy, honey-yellow crusts on the face and hands, which started as small blisters. What is the most likely diagnosis? A. Cellulitis B. Bullous impetigo C. Nonbullous impetigo D. Ecthyma 62. Which of the following is the most appropriate initial treatment for this child? A. Oral corticosteroids B. Topical mupirocin ointment C. Systemic antibiotics D. Oral antiviral medication 63. Which of the following is a serious complication of streptococcal impetigo? A. Cellulitis B. Acute glomerulonephritis C. Permanent scarring D. Ecthyma 64. A nurse is providing education to a family about impetigo prevention. Which of the following strategies is essential to prevent its spread? A. Restricting fluid intake B. Avoiding contact with infected individuals C. Administering prophylactic antibiotics D. Encouraging high-protein diets 65. What is the typical prognosis for most children with impetigo? A. Complete recovery within 24 hours B. Full recovery without scarring C. High risk of chronic kidney disease D. Recurrence in 50% of cases 66. What condition is suggested by intense itching, particularly at night, and a rash with thin, wavy lines on their wrists and between their fingers? A. Cellulitis B. Bullous impetigo C. Scabies D. Ecthyma 67. What is a classic sign of scabies that may also indicate a secondary infection? A. Red, pruritic eruptions B. Tinnitus C. Hearing difficulties D. Isolation 68. What is the first-line treatment for scabies? A. Oral ivermectin B. Topical permethrin C. Topical lindane D. Oral clindamycin 69. Following treatment with permethrin cream, when should the family expect to see improvement in their symptoms? A. Within 24 hours B. Within 2-3 days C. Within 1-2 weeks D. Within 4-6 weeks 70. A nurse is educating a patient about scabies prevention. Which of the following is the most effective strategy? A. Avoiding contact with infected individuals B. Restricting fluid intake C. Administering prophylactic antibiotics D. Encouraging high-protein diets Hearing Loss 71. Which of the following age groups has the highest rate of adults experiencing disabling hearing loss? A. 45 to 54 years B. 55 to 64 years C. 65 to 74 years D. Over 75 years 72. What is the primary nursing intervention when communicating with this patient? A. Speak loudly and slowly. B. Speak directly into the patient's ear. C. Face the patient and speak clearly at a normal pace. D. Write down all important information. 73. Which type of hearing loss is characterized by a dysfunction in sound transmission due to an external or middle ear disorder? A. Sensorineural hearing loss B. Conductive hearing loss C. Mixed hearing loss D. Functional hearing loss 74. Which type of hearing loss is characterized by a dysfunction in sound transmission due to an internal ear disorder? A. Sensorineural hearing loss B. Conductive hearing loss C. Mixed hearing loss D. Functional hearing loss 75. What is the recommended action for individuals experiencing hearing loss? A. Wait for symptoms to improve B. Seek medical attention or wear a hearing aid C. Avoid communication with others D. Increase volume on all devices Conditions of the Middle Ear 76. A patient presents with acute ear pain, fever, and a bulging, opaque tympanic membrane. What is the most likely diagnosis? A. Otitis Externa B. Otitis Media with Effusion C. Acute Otitis Media D. Chronic Suppurative Otitis Media 77. What is the first-line treatment for Acute Otitis Media in children under two years old? A. Watchful Waiting B. High-dose Amoxicillin C. Topical Analgesics D. Myringotomy 78. Which of the following is not a risk factor for Acute Otitis Media? A. Younger Age B. Chronic Upper Respiratory Infections C. Breastfeeding D. Chronic Exposure to Secondhand Cigarette Smoke 79. What is a serious complication of Acute Otitis Media? A. Temporary Hearing Loss B. Tympanic Membrane Perforation 4 | Page