Title DIAGNOSTIC EXAMINATION - NP3 - STUDENT COPY ✅

REFRESHER PHASE DIAGNOSTIC EXAMINATION NURSING PRACTICE 3 (NP3) NOVEMBER 2025 Philippine Nurse Licensure Examination Review Situation: Kris a 48 year old Bank manager is receiving an antihypertensive drug intravenously for control of severe hypertension. The client’s blood pressure is unstable and is 160/94 mm Hg before the infusion. Fifteen minutes after the infusion is started, the blood pressure rises to 180/100 mm Hg. 1. The response to the drug is described as a (n): A. allergic response B. synergistic response C. paradoxical response D. hypersusceptibility response 2. Kris is further being treated for hypertension reports having a persistent hacking cough. The nurse explains that this may be a side effect associated with: A. ACE inhibitors B. thiazide diuretics C. calcium channel blockers D. Angiotensin receptor blockers 3. What should the nurse assess to determine if Kris is experiencing the therapeutic effect of valsartan (Diovan), an Angiotensin II receptor blocking agent? A. lipid profile B. apical pulse C. urinary output D. blood pressure 4. To assess the effectiveness of a vasodilator administered to a client, what should the nurse assess? A. pulse rate B. breath sounds C. cardiac output D. blood pressure 5. Nifepidine (Procardia XL) 90 mg is prescribed for another client with Hypertension. The nurse should instruct the client to notify the Physician if the client experiences: A. blurred vision B. dizziness on rising C. excessive urination D. difficulty breathing 6. Nurse Benjie observes an anxious client hyperventilating after learning that his wife met an accident and intervenes to prevent: A. cardiac arrest B. carbonic acid deficit C. reduction in serum pH D. excess oxygen saturation 7. Nurse Benjie admitted another client with an arterial blood gas report indicates the client’s pH is 7.25, Pco2 is 35 mm Hg, and HCO3 is 20 mEq/L. Which disturbance does the nurse identify based on these results? A. metabolic acidosis B. metabolic alkalosis C. respiratory acidosis D. respiratory alkalosis 8. A client arterial blood gas report indicates the pH is 7.52, Pco2 is 32 mm Hg, and HCO3 is 24 mEq/L. What imbalance does Nurse Benjie identify as a possible cause of these results? A. airway obstruction B. inadequate nutrition C. prolonged gastric suction D. excessive mechanical ventilation 9. Nurse Benjie understands that in the absence of pathology, a client’s respiratory center is stimulated by: A. oxygen B. lactic acid C. calcium ions D. carbon dioxide 10. The client stated that the Physician said the tidal volume is slightly diminished and asks the nurse what this means. What explanation should the nurse give the client? Tidal volume is the amount of air: A. exhaled forcibly after a normal expiration B. exhaled after there is a normal inspiration C. inspired forcibly above a normal inspiration D. trapped in the alveoli that cannot be exhaled 11. A pregnant patient at 32 weeks’ gestation came to the health center for consult. It was found out that the fetal position is ROA. Where does the nurse expect to hear the fetal heart tone? A. Umbilical area B. Left upper abdomen C. Suprapubic area D. Right lower abdomen 12. The nurse enters the room and observes that the Marco is restless, breathing difficulty, develops rashes and has flushed appearance. She suspects an anaphylactic reaction. Which nursing action takes priority? A. Administer epinephrine (EpiPen) as ordered. B. Provide oxygen support via face mask. C. Maintain open airway. D. Call the physician. 13. Marco has known past exposure to allergens and triggers to anaphylactic reactions. Which drug is most appropriate to be given to him? A. Diphenhydramine B. Cetirizine C. Epinephrine D. Loratadine 14. A nurse is talking to a woman who consulted to the clinic. What does the nurse ask the client when assessing for dyspareunia? A. Have you talked to your partner about this? B. Have these spasms started when you became sexually active? C. Do you experience pain before your menstruation? D. When did you start having excessive vaginal discharge? 15. Play is an essential part of development in a child. Which of the following aspects is developed in an infant during play? A. Cognitive B. Emotional C. Social D. Physical 16. Which deciduous tooth erupts first during approximately 6 th month of a child’s life? A. Lower lateral incisor B. Upper lateral incisor C. Upper central incisor D. Lower central incisor 17. Why are people reluctant in talking about sex with the health care providers? A. They are too embarrassed. B. It is assumed to not talk about sex to strangers. C. The health care providers may discover information that must not be disclosed. D. It may cause negative impact to the lifestyle of the person. TOP RANK REVIEW ACADEMY, INC. Page 1 | 6
18. You are a nurse caring for a lesbian patient. Which of the following statements by the patient demonstrates the need for further information? A. I have lesser risk factors to STI. B. I have lesser risk factors to breast cancer. C. I should have Pap smears. D. I have increased risk factors to cardiac diseases. Situation: Confusion and lethargy are experienced by a patient taking diuretics. 19. What is the most common electrolyte imbalance which causes hospitalization of patients? A. Hyponatremia B. Hypokalemia C. Hypercalcemia D. Hypomagnesemia 20. Which of the following must the nurse consider as priority in assessment of a client in the above situation? A. Urine output B. Thirst C. Mental status D. Pulse grade 21. Which of the following is true about hospitalized patients with hyponatremia? A. Decreased urine output leads to higher concentrations of serum sodium. B. Drinking excessive amounts of water dilutes the urine. C. The IV fluid regulator was adjusted by the client, increasing infusion rate. D. Large quantities of urine are excreted due to furosemide administration. 22. Considering the patient’s status, which of the following is the most appropriate nursing diagnosis? A. Fluid volume excess B. Fluid volume deficit C. Disturbed thought processes D. Ineffective tissue perfusion 23. You noticed a runner in a marathon looks pale, confused, fatigued, sweating and having tremors. Which of the following will you give the patient? A. A full meal B. Sandwich C. Candies D. Fruits 24. A patient is experiencing knife-like chest pain with increasing intensity upon inspiration. Which of the following is most likely its origin? A. Respiratory B. Cardiac C. Gastrointestinal D. Musculoskeletal 25. Which of the following conflict resolution strategies lead to a win-win situation? A. Compromise B. Accommodating C. Collaborating D. Competing 26. The nurse supervisor is creating a budget plan for salary of staff and equipment costs. Staff salary and equipment are considered what type of costs? A. Direct cost B. Indirect cost C. Direct and indirect cost D. Fixed cost 27. A nurse is showing a caring attitude for the patient in a surgical ward.The nurse also encourages her to take care of her body using her own efforts. Which of the following bioethical principles is demonstrated in this situation? A. Solidarity B. Stewardship C. Fidelity D. Totality 28. The patient opts to have her infected diabetic foot amputated so that the affected part will not spread to the other parts of the body. What bioethical principle is demonstrated? A. Solidarity B. Stewardship C. Fidelity D. Totality 29. The whole health care team is united in caring for a patient with cardiac disease. Interprofessional collaboration is present with the goal of improving patient outcomes. Which of the following bioethical principle is reflected? A. Solidarity B. Stewardship C. Fidelity D. Totality 30. The nurse in the labor room monitors a patient in her active phase for frequency of contractions. She measures this: A. From the beginning of one to the beginning of the next contraction. B. From the start of a contraction to the end of the same contraction. C. From the end of a contraction to the beginning of the next contraction. D. From the beginning of one contraction to the end of the next contraction. 31. The mother reports that no milk comes out of her breasts to feed her infant. Which of the following statements by the nurse is most helpful to the client? A. Apply hot compresses for 15 minutes each breast. B. Inspect the breasts and nipples for unusual changes in structure and if there is discharge. C. Apply cold compresses for 20 minutes per breast. D. Encourage mother to just continue breastfeeding. 32. Breast tumor is commonly found at what location of the breast? A. Lower inner quadrant B. Upper outer quadrant C. Lower outer quadrant D. Upper inner quadrant 33. Which of the following should be delegated to an experienced nursing assistant? A. Discuss about insulin therapy. B. Wound care on diabetic foot. C. Administration of metformin. D. Teaching on diabetic foot care. 34. A nurse is slowly and carefully administering furosemide via bolus to a patient with heart failure. She performs this action knowing that rapid administration may cause: A. Catheter site irritation B. Acute kidney injury C. Hearing loss D. Hypovolemic shock 35. The surgeon is about to close the fascia after herniotomy. Which of the following surgical equipment must the scrub nurse prepare? A. Monofilament, round B. Subcuticular, round C. Monofilament, cutting D. Subcuticular, cutting 36. What is the type of hypersensitivity reaction in which the patient is allergic to certain food or medications? A. Anaphylactic (Type I) B. Cytotoxic (Type II) C. Immune-complex (Type III) D. Delayed-Type (Type IV) 37. What are the risk factors of Peripheral Arterial Disease? i. Diabetes mellitus ii. Hypertension iii. Alcohol intake iv. Smoking A. i, ii, iii B. i, ii, iv C. i, ii, iii, iv D. ii, iiii, iv 38. A patient was sent to the ER due to rigid, board-like abdomen and fever. Which of the following is another sign of appendicitis in which pain is felt on the right abdomen as the left abdomen is palpated? A. Rovsing’s sign B. Mcburney’s point C. Rebound tenderness D. Psoas sign TOP RANK REVIEW ACADEMY, INC. Page 2 | 6

Situation 9 – Janine is the Nurse on duty in the medical ward and many of her patients are suffering from problems of oxygenation. 56. The following are relevant data to be documented when taking the health history of a client with anemia EXCEPT: A. Alcohol intake – an accurate history of alcohol intake, including the amount and duration, should be obtained (Brunner &Suddarth, p.879) B. Fatigue and weakness – weakness, fatigue & general malaise are common symptoms for patients with anemia (Brunner &Suddarth, p.879); this is assessed as part of Gordon’s functional health patterns (activity-exercise pattern) C. Dietary intake – a nutritional assessment is important, because it may indicate deficiencies in essential nutrients such as iron, vitamin B12, and folic acid (Brunner &Suddarth, p.879) D. Episodes of bleeding – anemia is a condition in which the haemoglobin concentration is lower than normal (presence of fewer than normal RBCs within the circulation), which results to diminished amount of oxygen delivered to body tissues (Brunner &Suddarth, p.877). Bleeding may only be related to anemia if the cause of anemia is excessive bleeding and/or bone marrow suppression (which is not specified in this situation). 57. A client with congenital heart disease is suffering from thickening of the skin under his fingers due to chronic hemoglobin desaturation. Which of the following specific term should Ime use to accurately describe MOST the client’s condition in the chart? A. Peripheral cyanosis – Peripheral cyanosis, a bluish tinge, most often of the nails and skin of the nose, lips, earlobes, and extremities, suggests decreased flow rate of blood to a particular area (Brunner &Suddarth, p.662) B. Pallor of the finger tips – pallor is a decrease in the color of the skin, which is caused by lack of oxyhemoglobin (Brunner &Suddarth, p.662) C. Peripheral neuropathy – a disorder characterized by sensory loss, pain, muscle weakness, and wasting of muscles in the hands or legs and feet (Brunner &Suddarth, p.1548) D. Clubbing of the fingers – clubbing is manifested by a straightening of the normal angle (180 degrees or greater) and softening of the nail base(Brunner &Suddarth, p.1647). In clubbing, the distal phalanx of each finger is rounded and bulbous; among the many causes is chronic hypoxia (which is the cause for patients with anemia) (Brunner &Suddarth, p.474). 58. When the Nurse is assessing a client with Congestive Heart failure with pitting edema, the Nurse’s documentation will include which of the following: A. Degree of pitting edema B. Time of indention recovery C. Depth of edema D. All of the options 59. Mr. Gabby is with left sided heart failure. Janine’s documentation of her assessment findings will include the following, EXCEPT______________. A. Dependent edema – is the edema of the lower extremities, which worsens when the patient stands or dangles the legs, and decreases when the patient elevates the legs.This is a clinical manifestation of right-sided heart failure. In this condition, the right ventricle fails, leading to the congestion of the viscera. This occurs because the right side of the heart cannot eject blood and cannot accommodate all the blood that normally returns to it from the venous circulation. This leads to increased venous pressure, further leading to JVD (Brunner &Suddarth, p.795). B. Pulmonary crackles C. Difficulty of breathing D. Cough 60. A client is on a diuretic therapy. Expected entry in patient’s chart should include the following information, EXCEPT: A. Serum electrolytes monitored – nursing care for patients on diuretic therapy must include checking laboratory results for electrolyte depletion, especially potassium, magnesium and sodium; and for electrolyte elevation, especially potassium with potassium-sparing agents and calcium with thiazides (Brunner &Suddarth, p.807). B. Intake and output recorded – output must be measured carefully to establish a baseline against which to measure the effectiveness of the diuretic therapy; intake and output records must be rigorously maintained (Brunner &Suddarth, p.801). C. Lasix administered at 8 o’clock in the evening – patients receiving diuretic therapy may excrete a large volume of urine within minutes after a potent diuretic is administered (Brunner &Suddarth, p.806). Hence, diuretics must be administered early in the day to avoid nocturia(Brunner &Suddarth, p.807). D. Weight is taken before drug is given – patients with heart failure are weighed daily, at the same time of day, with the same type of clothing, and on the same scale to determine effectiveness of the diuretic therapy. Significant changes in weight must be watched out for (Brunner &Suddarth, p.801). Situation 1 – The TQM nurse reported to their director that there are a lot of medication errors committed by nurses and doctors in the hospital for the past 3 months. They made a decision to conduct a review of all the cases with these errors. A clinical enhancement on drug administration was strongly recommended by going back to the basics. The following questions apply: 61. Which of the following techniques in injection should the nurse use to minimize pain when administering imferon (Iron drugs). 1. Z_track technique 2. “Darting” needle quickly 3. Withdraw needle quickly 4. Inject medication quickly A. 2 and 3 B. 1, 2 and 4 C. 1 and 2 D. 1, 2, 3 and 4 62. In order to prevent error in insulin injection which of the following safety measure should you do? A. Leave the drug in the client refrigerator and ask it when needed. B. Double check with your head nurse calculations and consider high “alert” drugs. C. Compute the drug, proceed to the patient, and administer the drug. D. Request the dietary department to keep the drug until needed. 63. When giving injections to obese client, which of the following needle size should you use? A. 4 inch needle B. 2-3 inch needle C. 4 1⁄2 inch needle D. 1-1.5 inch needle Situation 2 – Jayson is a 72 year old who is a smoker and a social drinker. He consulted the OPD because of rectal bleeding. His tentative diagnosis is colorectal cancer. He was advised by the doctor for admission. 64. Which of the following would you likely expect as a specific complaint of the client during your initial health history taking? A. Projectile vomiting B. Bouts of hematemesis C. Change in bowel habits D. Passing out white watery stools 65. Colonoscopy has been ordered. Which of the following is not advisable for the client to do? A. Has to drink the electrolyte laxatives day before the procedure B. Can take PRN medications when taking electrolyte solution C. Can have liquid diet before the procedure. TOP RANK REVIEW ACADEMY, INC. Page 4 | 6