Title PRE-INTENSIVE - NP5 - SC ✅

PRE- INTENSIVE EXAMINATION NURSING PRACTICE V CARE OF THE CLIENT WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART C) 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 V” on the box provided 1. The client diagnosed with borderline personalitydisorder is admitted to the unit after havingattempted to cut her wrists with a pair of scissors.The client has several scars on both arms from self-mutilationand suicide gestures. A staff member states to the nurse, “It’s just attention that she wants,she’s not going to kill herself.” The nurse should respond to the staff member by saying: A. “She’s here now and we have to do our best.” B. “She needs to be here until she can control her behavior.” C. “I’m ashamed of you; you know better than tosay that.” D. “Any attempt at self-harm is serious, andsafety is a priority.” 2. The nurse assesses a client to be at risk for self-mutilation and implements a safety contract with the client. Which of the following client behaviors indicate that the contract is working? A. The client withdraws to his room when feeling overwhelmed. B. The client notifies staff when anxiety is increasing. C. The client suppresses his feelings when angry. D. The client displaces his feelings onto the physician. 3. The client with histrionic personality disorder is melodramatic and responds to others and situations in an exaggerated manner. The nurse should recommend which of the following activities for this client? A. Party planning. B. Music group. C. Cooking class. D. Role-playing. 4. When assessing a hospitalized client diagnosed with Major Depression and BorderlinePersonality Disorder, the nurse should ask the client about which of the following first? A. Access to pills and weapons. B. Suicidal plans. C. Suicidal thoughts. D. Seriousness of the client’s intent to die. 5. A 4-month-old child is brought to the clinic for the next set of immunizations. Which of the following would contraindicate receiving immunizations at this time? A. Delayed development. B. Weight loss. C. Anorexia. D. Active infection. 6. The client is given the hepatitis B immune globulin serum, which will provide passive immunity. What is an advantage of passive immunity? A. It has effects that last a long time. B. It is highly effective in treatment of disease. C. It offers immediate protection. D. It encourages the body to produce antibodies. 7. What common adverse effects will the nurse tell the client may be experienced after being given hepatitis B immune globulin? A. Tachycardia and chest tightness. B. Heartburn and diarrhea. C. Dyspnea and upper respiratory infection. D. Pain and tenderness at the injection site. 8. College freshman are participating in a study abroad program. When teaching them about hepatitisB, the nurse should instruct the students on: A. Water sanitation. B. Single dormitory rooms. C. Vaccination for hepatitis D. D. Safe sexual practices. 9. Which of the following is normal for a client during the icteric phase of viral hepatitis? A. Tarry stools. B. Yellowed sclera. C. Shortness of breath. D. Light, frothy urine. 10. The nurse is planning a home visit for a client with hepatitis. In order to prevent transmission the nurse should focus teaching on: A. Proper food handling. B. Insulin syringe disposal. C. Alpha-interferon. D. Use of condoms. 11. The nurse develops a teaching plan for the client about how to prevent the transmission of hepatitis A. Which of the following discharge instructions is appropriate for the client? A. Spray the house to eliminate infected insects. B. Tell family members to try to stay away from the client. C. Tell family members to wash their hands frequently. D. Disinfect all clothing and eating utensils. 12. The nurse is preparing a community education program about preventing hepatitis B infection. Which of the following would be appropriate to incorporate into the teaching plan? A. Hepatitis B is relatively uncommon among college students. B. Frequent ingestion of alcohol can predispose an individual to development of hepatitis B. C. Good personal hygiene habits are most effective at preventing the spread of hepatitis B. D. The use of a condom is advised for sexual intercourse. 13. What is most important for the nurse to teach a client newly diagnosed with genital herpes? A. Use condoms at all times during sexual intercourse. B. A urologist should be seen only when lesionsoccur. C. Oral sex is permissible without a barrier. D. Determine if your partner has received a vaccine against herpes. 14. A nurse is planning care for a 25-year-old female client who has just been diagnosed with human immunodeficiency virus (HIV) infection. The client asks the nurse, “How could this have happened?” The nurse responds to the question based on the most frequent mode of HIV transmission, which is: 1 | Page
A. Hugging an HIV-positive sexual partner without using barrier precautions. B. Inhaling cocaine. C. Sharing food utensils with an HIV-positive person without proper cleaning of the utensils. D. Having sexual intercourse with an HIV-positive person without using a condom. 15. In educating a client about human immunodeficiency virus (HIV), the nurse should take into account the fact that the most effective method known to control the spread of HIV infection is: A. Premarital serologic screening. B. Prophylactic treatment of exposed people. C. Laboratory screening of pregnant women. D. Ongoing sex education about preventive behaviors. 16. The typical chancre of syphilis appears as: A. A grouping of small, tender pimples. B. An elevated wart. C. A painless, moist ulcer. D. An itching, crusted area. 17. The nurse is interviewing a client with newly diagnosed syphilis. In order to prevent the spread of the disease, the nurse should focus the interview by: A. Motivating the client to undergo treatment. B. Obtaining a list of the client’s sexual contacts. C. Increasing the client’s knowledge of the disease. D. Reassuring the client that records are confidential. 18. When educating a female client with gonorrhea, the nurse should emphasize that for women gonorrhea: A. Is often marked by symptoms of dysuria or vaginal bleeding. B. Does not lead to serious complications. C. Can be treated but not cured. D. May not cause symptoms until serious complications occur. 19. The parents of an 18-year-old preparing to enter college ask if their daughter should have the meningococcal (MCV4) vaccine. The nurse should tell the parents: A. “It is only necessary to have the vaccine if your daughter will be living in a dormitory.” B. “Yes, we recommend the vaccine, but it needs to be given as a series of three injections.” C. “Let’s review your records. The vaccine may have already been given a few years ago.” D. “We highly recommend this vaccine, but we will need to do a pregnancy screening first.” 20. During the acute stage of meningitis, a 3-year-old child is restless and irritable. Which of the following would be most appropriate to institute? A. Limiting conversation with the child. B. Keeping extraneous noise to a minimum. C. Allowing the child to play in the bathtub. D. Performing treatments quickly. Situation: Joshua, 35-year old farmer, unmarried, had been confined in the National Center for mental health for three years with a diagnosis of schizophrenia. 21. The most common defense mechanism used by a paranoid client is: A. Displacement B. Suppression C. Rationalization D. Projection 22. Joshua says to you: “The voices are telling me bad things again!” Your best response is: A. “Whose voices are those?” B. “I doubt what the voices are telling you.” C. “I do not hear the voice you say you hear.” D. “What are the voices telling you?” 23. A relevant nursing diagnosis for clients with auditory hallucination is: A. Sensory perceptual alteration B. Altered though process C. Impaired social interaction D. Impaired verbal communication 24. During meal time, Joshua refused to eat telling that the food was poisoned. The nurse should: A. Ignore his remark B. Offer him food in its container C. Show him how irrational his thinking is D. Respect his refusal to eat 25. When communicating with Joshua, the nurse considers the following, except: A. Be warm and enthusiastic B. Refrain from touching Joshua C. Do not argue regarding his hallucinations and delusions D. Use simple, clear language Situation: Bruno seeks psychiatric counseling for his ritualistic behavior of counting his money as many as 10 times before leaving home. 26. What is the most appropriate initial nursing diagnosis? A. Impaired social interaction B. Ineffective individual coping C. Impaired adjustment D. Anxiety: Moderate 27. Obsessive compulsive disorder is best described by: A. Uncontrollable impulse to perform act or ritual repeatedly B. Persistent thought C. Recurring, unwanted and disturbing thoughts alternating with behavior D. Pathological persistence of unwilled thought, feeling, or impulse 28. The defense mechanism used by persons with obsessive compulsive disorder is undoing and it is best described in which of the following statements? A. Unacceptable feelings or behaviors are kept out of awareness by developing the opposite behavior or emotion B. Consciously unacceptable instinctual drives are diverted into personally and socially acceptable channels C. Something unacceptable already done is symbolically acted out in reverse D. Transfer of emotions associated with a particular person, object, or situation to another less threatening person, object or situation 29. To be more effective, the nurse who cares for persons with obsessive compulsive disorder must possess which of the following qualities? A. Compassion B. Consistency C. Patience D. Friendliness 30. Persons with OCD usually manifest A. Fear B. Apathy C. Suspiciousness D. Anxiety Situation: The patient who is depressed will undergo electroconvulsive therapy. 31. Studies on biological depression support electroconvulsive therapy as a mode of treatment. The rationale is: A. ECT produces massive brain damage which employs the specific area containing memories related to the events surrounding the development of psychotic condition B. The treatment serves as a symbolic punishment for the client who feels guilty and worthless C. ECT relieves depression psychologically by increasing the norepinephrine level D. ECT is seen as a life-threatening experience and depressed patients mobilize bodily defenses to deal with this attack 32. The preparation for a patient for ECT ideally is most similar to the preparation for a patient for: A. Electroencephalogram B. X-ray C. General anesthesia D. Electrocardiogram 2 | Page
33. Which of the following is a possible side effect which you will discuss with the patient? * A. Hemorrhage within the brain B. Encephalitis C. Robot-like body stiffness D. Confusion, disorientation, and short term memory loss 34. Informed consent is necessary for the treatment for involuntary clients. If this cannot be obtained, permission may be taken from the: A. Social worker B. Doctor C. Next of kin or guardian D. Chief nurse 35. After ECT, What should the nurse do before giving the client food, fluid, or medication? A. Assess the gag reflex B. Assess the sensorium C. Ask for the passage of flatus D. Check O2 saturation with a pulse oximeter Situation:Mrs. Janna Mendoza, 52 years old, teacher, is affected with myasthenia gravis. 36. Looking at Mrs. Mendoza, your assessment would include the following except: * A. Nystagmus B. Difficulty of hearing C. Weakness of levator palpebrae D. Weakness of the ocular muscle 37. In an effort to combat complications which might occur, relatives should be taught: * A. Checking cardiac rate B. Taking blood pressure reading C. Technique of oxygen inhalation D. Administration of oxygen inhalation 38. The drug of choice for her condition is: * A. Prostigmine B. Morphine C. Codeine D. Prednisone 39. As her nurse, you have to be cautious about administration of medication, if she is undermedicated this can cause: A. Emotional crisis B. Cholinergic crisis C. Menopausal crisis D. Myasthenic crisis 40. If you are not extra careful and by chance you give overmedication, this would lead to: * A. Emotional crisis B. Cholinergic crisis C. Menopausal crisis D. Biological treatment for mental disorders Situation: Teri, 25 years of age, unmarried, believes that the toilet for female patients is contaminated with AIDS virus and refuses to use it unless she flushes it three times and wipes the seat same number of times with antiseptic solution. 41. The fear of using “contaminated toilet seat” can be attributed to Teri’s inability to: * A. Adjust to a strange environment B. Express her anxiety C. Develop the sense of trust in other persons D. Control unacceptable impulses or feelings 42. Assessment data upon admission helps the nurse identify which appropriate nursing diagnosis? A. Ineffective denial B. Impaired adjustment C. Ineffective individual coping D. Impaired social interaction 43. An effective nursing intervention to help Teri is: * A. Convincing her to use the toilet after the nurse has used it first B. Explaining to her that AIDS cannot be transmitted through the toilet seat C. Allowing her to flush and clean the toilet seat until she can manage her anxiety D. Explaining to her how AIDS is transmitted 44. The goal of treatment for Teri must be directed towards helping her to: * A. Walk freely about her past experience B. Develop trusting relationship with others C. Gain insight that her behavior is due to feeling of anxiety D. Accept the environment unconditionally 45. Psychotherapy, which is prescribed for Teri, is described as: A. Establishing an environment adapted to an individual patient needs B. Sustained interaction between the therapist and client to help her develop more functional behavior C. Using dramatic techniques to portray interpersonal conflicts D. Biological treatment for mental disorders Situation: Tom, a 38-year old married man, an industrial engineer, was admitted with the diagnosis of paranoid disorder. He has become suspicious and mistrustful two months before admission. Upon admission, he kept saying: “My wife has been planning to kill me.” 46. A paranoid individual who cannot accept the guilt demonstrates which of the following defense mechanisms? A. Denial B. Projection C. Rationalization D. Displacement 47. One morning, Tom was seen tilting his head as if he was listening to someone. An appropriate nursing intervention would be: A. Tell him to socialize with other patients to divert his attention B. Involve him in group activities C. Address him by his name to ask if he is hearing voices again D. Request for an order of antipsychotic medicine 48. He says “These voices are telling me that my wife is going to kill me.” A therapeutic response by the nurse is: A. “I do not hear the voices you say you hear.” B. “Are you really sure you heard those voices?” C. “I don’t think you heard those voices.” D. “Whose voices are those?” 49. The nurse confirms that Tom is manifesting auditory hallucination. The appropriate nursing diagnosis is: A. Sensory perceptual alteration B. Self-esteem disturbance C. Ineffective individual coping D. Impaired verbal communication 50. What is the most appropriate nursing intervention for a client with suspicious behavior? A. Talk to the client constantly to reinforce reality B. Involve him in competitive activities C. Use non-judgmental and consistent approach D. Project cheerfulness in interacting with the patient 51.Which of these questions should a nurse ask a patient who is suspected of having acromegaly? A. “Do you urinate often?” B. “Are you buying larger size shoes?” C. “Is your mouth frequently dry?” D. “Have you had increase hair loss?” 52.Which of the following assessment findings, if identified in a patient who has a short-leg east, would require immediate follow-up by a nurse? A. Bounding pedal pulses B. Rapid capillary refill C. Nail beds blanch with pressure D. Tingling of the toes 53. A nurse is assessing a patient with a fractured femur. The development of a fat embolus in this patient would be indicated by A. calf tenderness B. shortness of breath C. abdominal distention D. urinary retention 54. Which of the following nursing diagnoses would be most appropriate for a patient who has a diagnosis of deep venous thrombosis in the leg? A. Impaired gas exchange B. Altered tissue perfusion 3 | Page