Title DIAGNOSTIC EXAM - NP3 (KEY) ✅

TOP RANK REVIEW ACADEMY, INC. Page 1 | REFRESHER PHASE DIAGNOSTIC EXAMINATION NURSING PRACTICE III FEB 2026 Philippine Nurse Licensure Examination Review Situation 1 – A retired dietitian, who is your mother’s friend, told you that she is experiencing symptoms related to gastroesophageal reflux disease (GERD). 1. Which of the following symptoms do you expect the retired dietitian to report as MOST bothersome? A. Nausea. B. Loss of appetite. C. Heartburn. D. Vomiting. 2. The client asks what the nurse can recommend until she can visit the doctor. The nurse would offer which of the following suggestions? A. Eat foods that are easily swallowed. B. Avoid lying down after eating. C. Avoid drinking while eating. D. Increase her fluid intake to 2 liters a day. 3. The client inquired about esophagoscopy. Which statement of the nurse describes the procedure CORRECTLY? A. It is a surgical procedure of the esophagus by using fiberoptic tube. B. It is a diagnostic procedure by instilling normal saline with a dye into the esophagus before taking x-ray. C. It involves passing a nasogastric tube down the esophagus to remove any obstruction of any form. D. It is a diagnostic procedure that involves inserting a flexible fiberoptic tube through the mouth down the esophagus. 4. Which is considered the most essential preparation for clients undergoing esophagoscopy? A. A warm shower before the procedure. B. Injection of pre medication about 30 minutes before the procedure. C. Food and fluids are avoided after midnight until after the procedure. D. Light breakfast before the examination. 5. After esophagoscopy, what positive indication would signal that the client is ready to take in food? A. Gag reflex has returned. B. The client signals that she is hungry. C. The client complains of thirst. D. The client is massaging her stomach. Situation 2 – The highly subjective nature of pain makes assessment and management a constant challenge to health care workers including nurses. 6. During assessment of a confused client, which of the following can be considered as “proxy indicator” of pain? A. Hunger. B. Anger. C. Thirst. D. Restlessness. 7. Many factors influence the client’s response to pain. Which statement is NOT TRUE among older adults? A. Pain perception is diminished among older adults. B. Older adults are fearful addiction. C. Small doses of analgesic agents maybe sufficient to relieve pain among older adults. D. Older adults require a higher dosage of pain medication. 8. In rare occasions, administration of placebo among clients who are chronically in pain is resorted to. The following principles should guide the nurse EXCEPT: A. A placebo effect is not an indication that the client does not experience the pain. B. A placebo should be used to test the client’s truthfulness about pain. C. A client should never be given a placebo as a substitute for an analgesic. D. Placebo should never be used as a first line of therapy. 9. The chronic pain of arthritis illustrates the usefulness of determining between time and intensity. Arthritic clients usually report that pain worsens during what time of the day? A. Morning. B. Night. C. Afternoon. D. Midday. 10. Essential in pain assessment are the aggravating and alleviating factors as a basis of health education. As a nurse in charge of the client with gastritis, you will consider the following factors to alleviate pain and discomfort EXCEPT: A. Reducing stress. B. Small frequent feeding of bland diet. C. Administering NSAID (Non Steroidal Anti- Inflammatory Drugs). D. Promoting rest. Situation: Nurse Uncle Drew is assigned in the telemetry area. He handles patients suffering from cardiovascular conditions. The following questions apply. 11. One of Nurse Uncle Drew’s patients, patient Stephen Curry,suffers from pericardial effusion. Nurse Uncle drew knows that the normal amount of fluid in the pericardial sac is approximately: A. 10 mL B. 20 mL C. 30 mL D. 40mL 12. One of the classic clinical manifestations of pericardial effusion is pulsus paradoxus. Which of the following describes this phenomenon? A. Diastolic blood pressure that is markedly lower during inhalation B. Abnormal difference of at least 10mmhg in systolic pressure between the point of exhalation and inhalation C. Abnormal difference of at least 10mmhg in diastolic pressure between the point of * NLE * NCLEX * HAAD * PROMETRICS * DHA * MIDWIFERY * LET * RAD TECH * CRIMINOLOGY * DENTISTRY * PHARMACY * MED TECH
TOP RANK REVIEW ACADEMY, INC. Page 2 | exhalation and inhalation D. False high readings of blood pressure upon inhalation than exhalation 13. Which of the following tests can be the diagnostic test for cardiac tamponade? A. Doppler Ultrasound B. BNP test C. Pericardiocentesis D. Echocardiogram 14. Which of the following signs indicates that pericardiocentesis has been unsuccessful? A. Increasing central venous pressure B. Increasing blood pressure C. Feeling of immediate relief D. Audible heart sounds 15. One alternative treatment for patient Stephen Curry is pericardiotomy. Nurse Uncle Drew would explain to the patient that this procedure is: A. A procedure wherein a stoma is created in the anterior part of the heart to be connected to the peritoneum for drainage of pericardial fluid B. A portion of the pericardium is excised to permit drainage of pericardial fluid into the lymphatic system C. A portion of the heart is directed to the ureters for drainage of the excessive pericardial fluid D. A stoma is created in the pericardium to be connected to a Jackson pratt for drainage of excessive fluid 16. Nurse Westbrook is monitoring a 53 year old client who is undergoing treadmill stress test. Which client finding will require the most immediate action? A. Blood pressure of 152/98 mmhg B. Heart rate of 134 beats/minute C. Oxygen saturation of 91% D. Chest pain level of 2 on a scale of 10 17. Nurse Westbrook is making a home visit to patient James Harden, a hypertensive client, who has been taking enalapril (Vasotec). Which finding indicates that you need to contact the health care provider about the change in drug therapy? A. Client reports frequent urination B. Client’s blood pressure is 136/86 mmhg C. Client coughs often during visit D. Client says “I get dizzy sometimes” 18. Charge nurse Michael Jordan is assigning patients in the telemetry. Which client is best to assign to Nurse Antenkoumpo who has come for the day from the general medical surgical unit? A. Client requiring discharge teaching about coronary artery stenting B. Client receiving IV furosemide to treat acute left ventricular failure C. Client who just transferred in from the radiology department after a coronary angioplasty D. Client just admitted with unstable angina who has orders of heparin infusion and aspirin 19. At 1000H, a hospitalized client receives a new order for transesophageal echocardiography (TEE) as soon as possible. Which action will you take first? A. Put the client on nothing by mouth status B. Teach the client about the procedure C. Insert an IV catheter in the client’s forearm D. Attach the client to a cardiac monitor 20. A resident in a long term care facility who has venous stasis ulcers is treated with an Unna boot. Which nursing activity included in the care is best to delegate to the NA? A. Teaching family members the signs of infection B. Monitoring capillary perfusion once every 8 hours C. Evaluating foot sensation and movement each shift D. Assisting the client in cleaning around the Unna boot Situation: Nurse Hannah is helping a patients at the orthopedic ward with ambulation. 21. While Nurse Hannah is helping a patient walk without any walker or crutches, the patient suddenly has syncope and falls. How will the nurse protect the patient from any injuries during the fall? A. Flexing both legs at the knees and catching by the waist B. Flexing the patient’s hip and knees, and carrying her back to her bed C. Extending one of the patient’s leg and letting her gently slide against that leg down to the floor D. Widening the base of support of the patient by putting his feet apart, catching the patient’s back 22. A patient who had above-the-knee amputation of the left leg is being prescribed with crutches. He claims to have no problems with ambulation on the right leg. Which among the following crutch gaits is BEST for the patient? A. Four-point alternate gait B. Three-point gait C. Two-point gait D. Swing-through gait 23. Nurse Hannah is teaching a patient with crutches how to go up the stairs. Which among the following is a wrong instruction? A. Patient should assume the tripod position initially at the bottom of the stairs B. The crutches and the affected leg go up the step together. C. When moving the affected leg up, the body weight should be on the crutches. D. The unaffected leg goes up the step before the affected leg. 24. Nurse Hannah flexes the arm of a patient with right-sided hemiparesis. Which among the following will ALLOW flexion of the arm? A. Contraction of the triceps brachii B. Relaxation of the biceps brachii C. Contraction of the biceps brachii D. A & B only 25. Nurse Hannah is assisted by another staff nurse in lifting a patient. Which among the following actions will only cause injury to Nurse Hannah? A. Keeping the feet wide apart and knees extended B. Positioning herself close to the patient C. Using the muscles of the arms and legs, not the back, in lifting D. Keeping her back, neck, and pelvis aligned Situation: Nurse Klay Thompson is handling patients in the medical surgical unit. The following questions apply to hematological conditions. 26. A 32 year old patient with sickle cell anemia is admitted to the hospital during a sickle cell crisis. Which action prescribed by the health care provider
TOP RANK REVIEW ACADEMY, INC. Page 3 | will you implement first? A. Give morphine sulfate 4 to 8mg IV every hours as needed B. Administer 100% oxygen using a nonrebreather mask C. Start a 14 gauge IV line and infuse normal saline at 200mL/hr D. Give Pneumococcal (Pneumovax) and Haemophilus influenzae (ActHIB) vaccines 27. As charge nurse, Nurse Steve Kerr is making the daily assignments on the medical-surgical unit. Which patient is best assigned to float Nurse Kristaps Porzingis who has come from the PACU? A. 30 year old patient with thalassemia major who has an order for SQ infusion of deferoxamine (Desferal) B. 43 year old patient with multiple myeloma who requires discharge teaching C. 52 year old chronic gastrointestinal bleeding who has returned to the unit after a colonoscopy D. 65 year old patient with pernicious anemia who has just been admitted to the unit 28. A 67 year old patient Vince Carter who is receiving chemotherapy for lung cancer is admitted to the hospital with thrombocytopenia. Which statement by the patient when you are obtaining the admission history is of most concern? A. I’ve noticed that I bruise more easily since the chemotherapy started B. My bowel movements are soft and dark brown C. I take one aspirin every morning because of my history of Angina D. My appetite has decreased since the chemotherapy has started 29. After a car accident, Ms. Thomas with a medical alert bracelet indicating hemophilia A is admitted to the emergency department. Which action prescribed by the health care provider will you implement first? A. Transport to the radiology department for cervical spine radiography B. Transfuse factor VIII concentrate C. Type and cross match for 4 units of PRBCs D. Infuse normal saline at 250ml/hr 30. As a home health nurse, you are obtaining an admission history for a patient who has deep vein thrombosis and is taking Warfarin (Coumadin) 2mg daily. Which statement by the patient is the best indicator that additional teaching about Warfarin may be needed? A. I have started to eat more healthy food like green salad and fruit B. The doctor said it is important to avoid becoming constipated C. Coumadin makes me feel a little nauseated unless I take it with food D. I will need to have some blood testing done once or twice a week 31. Manang Betchay, a high school undergraduate, has chronic pain due to osteoarthritis but has impaired speech. Which of the following is the most appropriate to determine her medication needs for pain? A. Observe typical pain behavior through facial expressions B. Medicate the client with analgesics as often as ordered C. Record frequency of patient’s complaint of pain and administer medication accordingly. D. Assess the client’s pain scale through writing in a magic slate 32. Mrs. Antonia, 65, diabetic, complained of elevated blood glucose since she strained her back a week ago despite following her diet and drug prescription. Your best explanation would be: A. Parasympathetic stimulation from the body’s normal response to pain B. Physiologic and psychologic stress can elevate blood glucose level C. Client is consuming more food as a coping mechanism D. It is usual occurrence among the elderly who has injuries 33. Individuals aged 50 years old and above are expected to receive pneumococcal and influenza vaccine yearly. Their increased susceptibility to develop pneumonia and influenza is caused by all of the following, except: A. Diminished ciliary & macrophage activity, drier mucus membranes B. Decreased cough reflex C. Increased risk of infection and bronchospasm with airway obstruction D. Decreased response to hypoxia and hypercapnia 34. Older male adults have an increased risk for developing urinary tract infection. All but one of the following statements provides correct explanation of this condition: A. Normal prostate enlargement in males with risk of BPH B. Increased post void residual and nocturnal urine production C. Normal occurrence of incontinence D. Reduced bladder elasticity and muscle tone 35. Which of the following statements is true regarding age-related sarcopenia? A. Physically inactive people can lose as much as 3% to 5% of their muscle mass each decade after age 30 B. Age-related sarcopenia starts at the age of 40s C. Only inactive aging individuals develop sarcopenia D. Sarcopenia typically happens faster around age 75 36. Patient Dwight Howard is admitted to the intensive care unit with disseminated intravascular coagulation associated with gram negative infection. Which assessment information has the most immediate implications for the patient’s care? A. There is no palpable radial or pedal pulse B. The patient reports chest pain C. The patient’s oxygen saturation is 87% D. There is mottling of the hands and feet 37. Nurse John Wall received a change of shift report about the following patients. Which one will you assess first? A. 26 year old with thalassemia who has a hemoglobin level of 8g/L and orders for a PRBC transfusion B. 44 year old who has admitted 3 days previously in a sickle cell crisis and has orders for a computerized tomographic scan C. 50 year old with stage IV non-hodgkin lymphoma who is crying and saying “I’m not ready to die” D. 69 year old with chemotherapy induced neutropenia who has an oral temperature of 100.1 degrees Fahrenheit
TOP RANK REVIEW ACADEMY, INC. Page 4 | 38. Nurse John Wall obtain the following data about a patient admitted with multiple myeloma. Which information has the most immediate implications for the patient’s care? A. The patient reports chronic bone pain B. The blood uric acid level is very elevated C. The 24 hour urine test show Bence Jones protein D. The patient reports new onset leg numbness 39. Nurse John Wall is transferring a patient with newly diagnosed chronic myeloid leukemia to an LTC facility. Which information is most important to communicate to the LTC charge nurse before transferring the patient? A. Philadelphia chromosome is present in the patient’s blood smear B. Glucose level is elevated as a result of prednisone therapy C. There has been a 20lb weight loss over the year D. The patient’s chemotherapy has resulted in neutropenia 40. A patient who has been receiving cyclosporine (Sandimmune) following an organ transplantation is experiencing the following symptoms. Which one is of most concern? A. Bleeding of the gums while brushing the teeth B. Nontender lump in the right groin C. Occasional nauseas after taking the medication D. Numbness and tingling of the feet Situation: Nurse Hazel is assigned to the medical-surgical unit where most of her clients are elderly client, thus, it is essential for her to establish basic knowledge on the normal and abnormal physiological changes of the ageing population. 41. Changes in an older adult’s sensory perception is one of the normal changes occurring in ageing. Changes in vision is one of the most common occurrence. Which of the following statements about vision changes in ageing is not true? A. 30% of those over age 65 have some level of visual impairment B. It is normal for adults aged 65 and above to have a visual acuity of 20/200 C. Cataracts are the 5th most common chronic condition in adults over age 75 D. Macular degeneration is the most common cause of legal blindness in the elderly 42. For a client complaining of mild musculoskeletal pain, the nurse will anticipate that the treatment for this client’s level of discomfort will include which of the following? A. Diazepam B. Acetaminophen C. Meperidine hydrochloride D. Fentanyl – Narcotic 43. Elmma Rosario was to inject Vitamin B intramuscularly to another elderly patient. Before injecting, the nurse explained that the client may feel some discomfort. This is an example of: A. anticipatory response B. self-preservation C. reducing pain receptor D. distraction 44. Which of the following shows an incorrect statement about the peripheral sensation of an ageing individual? A. Two-point discrimination is decreased with age B. Vibratory sensation is decreased with age C. Ability to perceive painful stimuli is not preserved in aging D. There is a slowed reaction time in pain perception 45. Mr. Andrew, 69 years old, has a history of chronic back pain. He thinks that his family perceives him as a “weakling” because he often asks for pain medication. Which of the following is the most therapeutic response of the nurse? A. “It seems that you are worried. Which matters to you more? What people will say or getting relief from your pain?” B. “Taking pain medication as prescribed will help you become more active.” C. “Chronic back pain is very difficult to manage, use pain medication because that is what it is for.” D. “Don’t you think your family wants you to be comfortable, and the only way is to take your medicine?” SITUATION: A hypothesis in a research study is an intelligent guest which provides tentative answer to the problem. It’s vital to a quantitative study since it establishes basis for statistical testing, to determine whether findings are significant or insignificant. 46. Nurse-researcher Marj is currently reviewing related literature and studies which she can consider in her study. One of the published study hypotheses states that “The consumption of organo coffee may improve digestion among people with chronic constipation.” She correctly identifies the study hypothesis as: A. Statistical hypothesis B. Research hypothesis C. Null hypothesis D. H 0 47. If Marj’s research adviser will ask her to further classify the hypothesis she has read, she has a good understanding of what hypotheses are, if she responds: a. Alternative B. Directional C. Non-directional D. Complex 48. What interpretation can Marj draw from the value of the standard error of the mean (SEM): A. The larger the SEM value -- the less variable the sample -- the more accurate are the means as estimates of the population value B. The larger the SEM value -- the less variable the sample -- the less accurate are the means as estimates of the population value C. The smaller the SEM value -- the less variable the sample – the less accurate are the means as estimates of the population value D. The smaller the SEM value -- the less variable the sample -- the more accurate are the means as estimates of the population value 49. Suppose nurse-researcher Marj is already done analyzing and interpreting the hypothesis, if she incorrectly rejects a null hypothesis when it is true, resulting to a false positive conclusion, she has committed: A. Type I error