Title RECALLS 8 (NP3) - STUDENT COPY ✅

RECALLS EXAMINATION 8 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: The emergency department receives two clients with diabetes-related complications. The first client, a 45-year-old with type 1 diabetes mellitus, presents with rapid breathing, fruity breath odor, and confusion. The client’s blood glucose level is 600 mg/dL (33.3 mmol/L), and blood tests reveal significant ketones and a pH of 7.1. A diagnosis of diabetic ketoacidosis (DKA) is made. The second client, a 68-year-old with type 2 diabetes mellitus, arrives in an unresponsive state. The family reports excessive thirst and urination over the past week. The client’s blood glucose level is 900 mg/dL (50 mmol/L), with elevated serum osmolality and no significant ketones present. A diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is made. 1. A client arrives at the emergency department unresponsive and is diagnosed with hyperosmolar hyperglycemic syndrome. The nurse should immediately prepare to carry out which primary health care provider's anticipated prescription? A. Endotracheal Intubation B. 100 units of NPH insulin C. IV of PNSS D. IV of NaHCO3 2. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings support this diagnosis? Select all that apply. A. Increase in pH B. Comatose state C. Deep, rapid breathing D. Decreased urine output E. Elevated blood glucose level 3. The nurse educates a client with diabetes mellitus on distinguishing between hypoglycemia and ketoacidosis. The client shows understanding by stating that glucose should be taken if which symptoms appear? Select all that apply. A. Shakiness B. Palpitations C. Light-headedness D. Polyuria E. Blurred vision F. Fruity breath odor 4. The nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus about measures to take if feeling sick to prevent diabetic ketoacidosis (DKA). The nurse recognizes accurate understanding of measures to prevent DKA when the client makes which statement? A. 1. “I will stop taking my insulin if I’m too sick to eat.” B. 2. “I will decrease my insulin dose during times of illness.” C. 3. “I will adjust my insulin dose according to the level of glucose in my urine.” D. 4. “I will notify my primary health care provider (PHCP) if my blood glucose level is higher than 250 mg/dL (13.9 mmol/L).” 5. The nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. The nurse places priority on which client problem? A. Lack of knowledge B. Inadequate fluid volume C. Compromised family coping D. Inadequate consumption of nutrients Situation: Mrs. Juanita Garcia, a 62-year-old woman, has been living with Type 2 diabetes for 10 years. She is currently prescribed Metformin 500 mg twice daily, and Glipizide 5 mg once daily before breakfast. She also takes Lisinopril for hypertension. Mrs. Garcia lives alone and has struggled with managing her medications and diet. She has had several episodes of hyperglycemia in the past month and expresses concerns about remembering to take her medication correctly.Of the categories of oral antidiabetic agents, which exert their primary action by directly stimulating the pancreas to secrete insulin? A. Thiazolidinediones B. Alpha Glucosidase inhibitors C. Biguanides D. Sulfonylureas 6. The home care nurse visits a client recently diagnosed with diabetes mellitus who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse would tell the client to take which action? A. Freeze the insulin. B. Refrigerate the insulin. C. Store the insulin in a dark, dry place. D. Keep the insulin at room temperature. 7. Glimepiride is prescribed for a client with diabetes mellitus. The nurse instructs the client that which food items are most acceptable to consume while taking this medication? Select all that apply. A. Alcohol B. Red meats C. Whole-grain cereals D. Low-calorie desserts E. Carbonated beverages A. B,C,E B. A,C,E C. C,D,E D. B,D,E 8. The primary health care provider (PHCP) prescribes semaglutide for a client with type 1 diabetes mellitus who takes insulin. The nurse would plan to take which most appropriate intervention? A. Withhold the medication and call the PHCP, questioning the prescription for the client. B. Teach the client about the signs and symptoms of hypoglycemia and hyperglycemia. C. Monitor the client for gastrointestinal side effects after administering the medication. D. Withdraw the insulin from the prefilled pen into an insulin syringe to prepare for administration. 9. The nurse is teaching a client with diabetes mellitus how to mix regular insulin and NPH insulin in the same syringe. Which 1 | Page
action, if performed by the client, indicates the need for further teaching? A. Withdraws the NPH insulin first B. Withdraws the regular insulin first C. Injects air into NPH insulin vial first D. Injects an amount of air equal to the desired dose of insulin into each vial Situation. Mr. Thomas Rivera, a 28-year-old man, has recently been diagnosed with Crohn's disease after experiencing chronic abdominal pain, diarrhea, and weight loss for several months. He has been started on Mesalamine and is learning to manage his condition. Mr. Rivera is anxious about his diagnosis and concerned about how it will affect his quality of life and ability to work. 10. The nurse is providing discharge teaching for a client with newly diagnosed Crohn’s disease about dietary measures to implement during exacerbation episodes. Which statement made by the client indicates a need for further instruction? A. “I need to increase the fiber in my diet.” B. “I will need to avoid caffeinated beverages.” C. “I’m going to learn some stress-reduction techniques.” D. “I can have exacerbations and remissions with Crohn’s disease. 11. A client with severe Crohn’s disease has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which most frequent complication of this type of surgery? A. Folate deficiency B. Malabsorption of fat C. Intestinal obstruction D. Fluid and electrolyte imbalance 12. What is the primary goal of Mesalamine in the treatment of Crohn’s disease? A. To cure the disease. B. To reduce inflammation in the gastrointestinal tract. C. To increase nutrient absorption. D. To prevent surgery. 13. The nurse is reviewing the record of a female client with Crohn's disease. Which stool characteristics should the nurse expect to note documented in the client's record A. Diarrhea B. Chronic constipation C. Constipation alternating with diarrhea D. Stools constantly oozing form the rectum 14. The client is diagnosed with Crohn's disease, also known as regional enteritis. Which statement by the client would support this diagnosis? A. "My pain goes away when I have a bowel movement" B. "I have bright red blood in my stool all the time" C. "I have episodes of diarrhea and constipation" D. "My abdomen is hard and rigid and I have a fever". Situation: Ulcerative Colitis 15. Nurse is caring for a patient with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the Dr? A. Hypotension B. Bloody diarrhea C. Rebound tenderness D. Hemoglobin of 12 mg/ dl 16. A client with acute colcerative colitis requests a snack. Which of the following foods is the most appropriate to give the client? A. Carrots and ranch dip B. Whole grain cereal and milk C. A cup of popcorn and a cola D. Applesauce and a graham cracker 17. Which of the following factors is believed to cause ulcerative colitis? A. Acidic diet B. Altered immunity C. Chronic constipation D. Emotional stress 18. During the first few days of recovery from ostomy surgery for ulcerative colitis, which of the following aspects should be the first priority of client care? A. Body image B. Ostomy care C. Sexual concerns D. Skin care 19. A client with ulcerative colitis has an order to begin salicylate medication to reduce inflammation. The nurse instructs the client to take the medication: A. 30 minutes before meals B. On an empty stomach C. After meals D. On arising Situation: Prioritizing safety in nursing involves proactive measures to prevent accidents and injuries. By addressing potential hazards, educating patients, and maintaining a safe environment, nurses can significantly reduce the risk of harm and ensure high-quality patient care. 20. The nurse is preparing to initiate an intravenous (IV) line containing potassium chloride using an IV infusion pump. While preparing to plug the pump cord into the wall, the nurse finds that no outlet is available in the wall socket. What should the nurse do? A. Initiate the IV line without the use of a pump. B. Contact the electrical maintenance department for assistance. C. Plug in the pump cord into the available plug above the room sink. D. Use an extension cord from the nurses’ lounge for the pump plug. 21. The nurse obtains a prescription from a primary health care provider to restrain a client and instructs an assistive personnel (AP) to apply the safety device. Which observation of unsafe application of the safety device would indicate that further instruction is required for the AP? A. Placing a safety knot in the safety device straps B. Safely securing the safety device straps to the side rails C. Applying safety device straps that do not tighten when force is applied against them D. Securing so that two fingers can slide easily between the safety device and the client’s skin 22. The nurse is giving a report to an assistive personnel (AP) who will be caring for a client with hand restraints (safety devices) applied. How frequently should the nurse instruct the AP to remove the restraints to allow for muscle activity? A. Every 2 hours B. Every 3 hours C. Every 4 hours D. Every 6 hours 23. The nurse is reviewing a plan of care for a client with an internal radiation implant. Which intervention, if noted in the plan, indicates the need for revision of the plan? A. Wearing gloves when emptying the client’s bedpan B. Keeping all linens in the room until the implant is removed C. Wearing a lead apron when providing direct care to the client D. Placing the client in a semiprivate room at the end of the hallway 24. The best overall rule for avoiding accidents with equipment in the hospital is for the nurse to: A. Always lock wheels on movable equipment B. Never operate equipment without prior instruction C. Always unplug equipment when moving the client D. Never use equipment without a person to assist you Situation: Effective perioperative care is essential for optimizing patient outcomes and minimizing risks. By thoroughly preparing Mrs. Jones, providing clear instructions, and ensuring all safety protocols are followed, you help ensure a smooth surgical experience and contribute to her overall well-being and recovery. 25. The nurse is instructing a client on coughing and deep-breathing techniques to prevent complications after surgery. Which statement should the nurse make to the client regarding these techniques? A. “Using an incentive spirometer will help prevent pneumonia.” B. “Closely monitoring your oxygen saturation will detect hypoxemia.” 2 | Page
C. “Receiving intravenous fluids will prevent or treat fluid imbalance.” D. “Early ambulation and the use of blood thinners will prevent pulmonary embolism.” 26. When preparing a nursing care plan for a client scheduled for surgery, which activity should be included for the day of the procedure? A. Avoid performing oral hygiene and using mouthwash. B. Confirm that the client has fasted for the past 24 hours. C. Ensure the client void before going into surgery. D. Report any slight increases in blood pressure or pulse immediately. 27. During preoperative teaching about using an incentive spirometer, which instruction should the nurse include for the client? A. Inhale as rapidly as possible. B. Maintain a loose seal between the lips and the mouthpiece. C. After taking the deepest breath, hold it for 15 seconds and then exhale. D. The best results are obtained when sitting up or with the head of the bed elevated 45 to 90 degrees. 28. A client has had preadmission testing and blood drawn for various laboratory studies. Which laboratory result should the nurse report to the surgeon’s office, as it could potentially cause the surgery to be postponed? A. Hemoglobin, 8.0 g/dL (80 mmol/L) B. Sodium, 145 mEq/L (145 mmol/L) C. Serum creatinine, 0.8 mg/dL (70.6 mcmol/L) D. Platelets, 210,000 cells/mm3 (210 × 109/L) 29. The nurse is reviewing a surgeon’s prescription sheet that states the client must be nothing by mouth (NPO) after midnight. Which medication should the nurse clarify with the surgeon to determine if it should be given to the client and not withheld? A. Prednisone B. Ferrous sulfate C. Cyclobenzaprine D. Conjugated estrogen Situation: Mrs. Thompson, a 55-year-old patient, has recently undergone a colostomy due to colon cancer. She is being discharged from the hospital and will need to manage her ostomy and stoma care at home. The nurse is providing instructions and support to ensure she can perform these tasks effectively. 30. The nurse is evaluating a client with bladder cancer who has undergone a cystectomy and has a ureterostomy. Which statement made by the client suggests they need additional instruction on urinary stoma care? A. “I replace my pouch once a week.” B. “I change the appliance in the morning.” C. “I empty the urinary collection bag when it is two-thirds full.” D. “I make sure to direct the water away from my stoma while showering.” 31. The nurse is caring for a client with ulcerative colitis who has had a transverse colostomy. Which observation should prompt the nurse to immediately notify the surgeon? A. Stoma is beefy red and shiny. B. Stoma has a purple discoloration. C. Skin excoriation is noted around the stoma. D. Semiformed stool is noted in the ostomy pouch. 32. The staff nurse is observing a new graduate nurse performing care for an indwelling urinary catheter on an uncircumcised client. Which action by the new graduate nurse suggests that additional teaching is needed? A. Cleans the catheter from proximal to distal with soap and water. B. Keeps the urinary collection bag positioned below the level of the bladder. C. Removes a loose catheter anchor and attaches a new anchor on the lower leg. D. Uses the nondominant hand to retract the foreskin, cleanse the urethral meatus with soap and water, and then returns the foreskin to its normal position. 33. The nurse is getting ready to irrigate a client's sigmoid colostomy. Which intervention should the nurse plan to perform for this procedure? A. Instill 500 to 1000 mL of lukewarm tap water through the stoma. B. Advise the client to hold their breath if cramping occurs during the instillation of the solution. C. Hang the irrigation solution so that the bottom of the bag is 18 inches above the client's torso. D. Insert the irrigation tube with a small amount of force and a twisting motion into the stoma, and then unclamp the tubing to allow the solution to flow. 34. The nurse is inserting an indwelling urinary catheter and begins to inflate the balloon when the client complains of pain. What should the nurse do next? A. Continue inflating the balloon. B. Deflate the balloon, slightly withdraw the catheter, and attempt to reinflate the balloon. C. Deflate the balloon, completely withdraw the catheter, and end the procedure to notify the primary health care provider. D. Stop inflating the balloon, allow the saline solution to drain into the syringe, and advance the catheter further before reinflating the balloon. Situation: Mr. Johnson, a 68-year-old man with a history of chronic venous insufficiency and peripheral artery disease, is admitted to the hospital for evaluation and management of his leg ulcers. He has been experiencing worsening symptoms in both legs and is now presenting with new signs. 35. Which of the following client is at highest risk for developing a DVT? A. 25-year-old male, smoker with hypertension B. 67-year-old overweight female recovering from a hip replacement (1st day post-op) C. 22-year-old female with history of raynaud’s disease D. 72-year-old male with a history of arthritis and bypass surgery 36. A male client visits the ambulatory clinic reporting pain in the right leg when he tries to perform his walking exercises 3x a week. Upon examination, the right foot is dusky and purplish while it is dangling from the stretcher. The right dorsalis pedis is palpable but diminished, and he states his foot “tingles on occasion”. The nurse has him lie supine on the stretcher with the foot of the stretcher elevated for about 10 minutes, after which his foot shows pallor. The nurse concludes that the manifestations are consistent with? A. Varicose veins B. Thrombophlebitis C. Raynaud’s disease D. Arterial insufficiency 37. The home care nurse notes that a client with intermittent claudication of the left leg has developed tissue breakdown of the left foot. Nurse Sheena explains to the client that the plan of care should include which of the following activity levels at this time? A. Increased exercise to stimulate blood flow B. Bed rest to minimize tissue oxygen demand C. Active ROM exercises to maintain joint flexibility D. Walking in comfortable light slippers to minimize impact or fragile tissue 38. The nurse evaluates the teaching for a client with raynaud’s disease is effective when the client make which of the following statements? A. I will decrease my smoking to six cigarettes per day B. I will try to learn to relax, but I can’t promise anything C. I will wear gloves in cool weather and socks to bed at night D. I will try to eat a healthier diet. 39. A client is receiving a continuous intravenous infusion of heparin sodium for deep vein thrombosis. The client's activated partial thromboplastin time (aPTT) is 65 seconds. What action should the nurse anticipate? A. Discontinue the heparin infusion. B. Increase the rate of the heparin infusion. C. Decrease the rate of the heparin infusion. D. Leave the rate of the heparin infusion as is. 3 | Page
Situation: Mr. James Carter, a 65-year-old man, has been admitted to the emergency department with symptoms of palpitations, dizziness, and shortness of breath. He has a history of hypertension and coronary artery disease. An ECG reveals atrial fibrillation (AF) with a rapid ventricular response. 40. A patient experiencing a myocardial infarction is showing signs of cardiogenic shock. Which condition should the nurse expect and keep an eye on to identify cardiogenic shock? A. Pulsus paradoxus B. Ventricular dysrhythmias C. Increasing diastolic blood pressure D. Decreasing central venous pressure 41. A patient with atrial fibrillation who is on regular warfarin sodium therapy has a prothrombin time (PT) of 35 seconds. Based on these lab results, what prescription should the nurse expect? A. Administering a dose of heparin sodium B. Withholding the next dose of warfarin C. Increasing the next dose of warfarin D. Continuing with the next dose of warfarin 42. The nurse is observing the cardiac monitor and notices a sudden change in the client's rhythm. The rhythm shows no P waves, wide QRS complexes, and a regular ventricular rate exceeding 140 beats per minute. The nurse identifies the client as experiencing which dysrhythmia? A. Sinus tachycardia B. Ventricular fibrillation C. Ventricular tachycardia D. Premature ventricular contractions 43. A patient is wearing a continuous cardiac monitor that starts alarming, and no electrocardiographic complexes are visible on the screen. What should the nurse's priority action be? A. Call a code. B. Check the client’s status. C. Call the primary health care provider. D. Document the lack of complexes. 44. A patient’s cardiac rhythm suddenly changes on the monitor, showing no P waves and fibrillatory waves before each QRS complex. How should the nurse interpret this rhythm? A. Atrial fibrillation B. Sinus tachycardia C. Ventricular fibrillation D. Ventricular tachycardia NO #45 Situation: A 55-year-old female patient is admitted to the hospital with symptoms of weight loss, frequent palpitations, and fatigue. She has a history of hyperthyroidism and is being evaluated for possible complications. During her admission, she also reports bone pain, muscle weakness, and increased thirst. Upon assessment, the nurse notes that the patient has a history of hyperparathyroidism, which is characterized by elevated calcium levels. The patient is currently taking alendronate to manage her condition. 46. The nurse is conducting an assessment on a client being admitted for a diagnostic workup for primary hyperparathyroidism. Which of the following complaints would be characteristic of this disorder? A) Polyuria B) Headache C) Bone pain D) Nervousness E) Weight gain A. A,C B. B,D C. B,C D. D,E 47. The nurse is instructing a client on how to manage hyperparathyroidism at home. Which statement by the client suggests that further education is needed? A. “I should limit my fluid intake to less than 1 liter per day.” B. “I should use my treadmill or go for walks every day.” C. “I should follow a diet that is moderate in calcium and high in fiber.” D. “My alendronate helps prevent calcium from being released from my bones.” 48. A client has just been admitted to the nursing unit after a thyroidectomy. Which assessment should be the priority for this client? A. Hoarseness B. Hypocalcemia C. Audible stridor D. Edema at the surgical site 49. The nurse is providing instructions to a client taking levothyroxine. The nurse should advise the client to take the medication in which manner? A. With food B. At lunchtime C. On an empty stomach D. At bedtime with a snack 50. The client with hyperparathyroidism is taking alendronate. Which of the following statements demonstrate the client’s understanding of how to properly take this medication? Select all that apply. A. “I should take this medication with food.” B. “I should take this medication at bedtime.” C. “I should remain upright for at least 30 minutes after taking this medication.” D. “I should take this medication first thing in the morning on an empty stomach.” E. “I can choose a time to take this medication that suits my schedule as long as I take it at the same time each day.” A. B,C B. A,C,E C. A,D,E D. C,D 51. You are caring for a patient admitted with a diagnosis of acute kidney injury. Upon reviewing your patient’s laboratory reports, you noted that the patient’s magnesium levels are high. You should prioritize assessment for which of the following health problems? A. Diminished deep tendon reflexes B. Tachycardia C. Twitches D. Seizures 52. Which of the following ECG Changes can be seen in a patient with Hypokalemia? A. Wide QRS complex B. Tall peaked T waves C. Flat P waves D. Prominent U wave 53. The nurse is caring for a client with heart failure. On assessment, the nurse notes that the client is dyspneic, and crackles are audible on auscultation. What additional manifestations would the nurse expect to note in this client if excess fluid volume is present? A. Weight loss and dry skin B. Flat neck and hand veins C. An increase in blood pressure and increased respirations D. Weakness and decreased central venous pressure (CVP) 54. The nurse is reading a physician’s progress notes in the client’s record and reads that the physician has documented “insensible fluid loss of approximately 500 mL daily.” The nurse plans to monitor the client, knowing that insensible fluid loss occurs through which type of excretion? A. Urinary output B. Wound drainage C. Integumentary output D. The gastrointestinal tract 55. A patient took 8 ounces of apple juice, 6 ounces of coffee, and 6 ounces of water. What is the calculated intake of the client? A. 400 ml B. 500 ml C. 600 ml D. 700 ml 56. What acid-base imbalance may occur if a patient undergoes gastric lavage or is experiencing prolonged vomiting? A. Respiratory acidosis B. Respiratory alkalosis 4 | Page