Title RECALLS 8 - NP4 - SC ✅

RECALLS 8 EXAMINATION NURSING PRACTICE IV CARE OF CLIENTS WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART B) NOVEMBER 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: Renal disease affects millions worldwide and often leads to serious health complications. It commonly results from diabetes, hypertension, infections, or autoimmune disorders. Nurses must understand its causes, recognize early signs, and provide proper care to manage the disease and prevent complications. 1. In caring for patient with renal calculi, which is the priority nursing intervention? A. Record vital sign B. Strain the urine C. Limit fluids D. Administer analgesics as prescribed 2. In a patient with renal failure, the diet should be: A. Low protein, low sodium, high potassium B. Low protein, high potassium C. High carbohydrate, low protein D. Low protein, low sodium, low potassium 3. Which of the following cannot be corrected by dialysis? A. Hypernatremia B. Decreased hemoglobin C. Hyperkalemia D. Elevated Creatinine 4. A patient was admitted to the hospital with a diagnosis of acute glomerulonephritis. History reveals a 5-pound weight gain in one week and peritoneal edema. For the most accurate information on the status of the patient’s edema, nursing intervention should include? A. Measuring the patient’s intake and output B. Obtaining the patient’s daily weight C. Doing a visual inspection on the patient D. Monitoring the patient’s electrolyte values 5. The nurse is caring for a patient suspected of having renal dysfunction. When reviewing laboratory results, the nurse interprets the presence of which substances in the urine as most suggestive of pathology? A. Potassium and sodium B. Bicarbonate and urea C. Glucose and protein D. Creatinine and chloride 6. A patient with acute kidney injury is being assessed to determine where physiologically the cause is. If the cause is found to be prerenal, which condition mostly caused it? A. Glomerulonephritis B. Heart failure C. Ureterolithiasis D. Aminoglycoside toxicity 7. The client receiving dialysis is complaining of being dizzy and light-headed. Which action should the nurse implement first? A. Place the client in the Trendelenburg position. B. Turn off the dialysis machine immediately. C. Bolus the client with 500 mL of normal saline. D. Notify the health-care provider as soon as possible. 8. What is the normal characteristic of peritoneal dialysis effluent? A. Bloody fluid with clots B. Milky and odorless C. Cloudy and pale yellow D. Clear and pale yellow 9. The nurse is caring for a patient receiving hemodialysis three times weekly. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this patient? A. Using a stethoscope for auscultating the fistula is contraindicated B. The patient feels tired immediately after the dialysis treatment C. Taking a BP on the affected arm can damage the fistula D. The patient should not feel pain during initiation of dialysis. 10. A patient was admitted with a diagnosis of post-infectious glomerular disease. The nurse recognizes that this form of kidney disease may have been precipitated by what event? A. Hypersensitivity to immunization B. Menarche C. Sore throat D. Tuberculosis Situation: Endocrine disorders result from hormone imbalances that affect various body functions. Nurses play a key role in early detection, monitoring, and managing these disorders to prevent complications and support patient health. 11. A patient with hyperthyroidism is receiving radioactive iodine therapy. Which of the following should the nurse include in the discharge? A. “You should avoid close contact with pregnant women for a few days.” B. “You may return to work immediately after your treatment.” C. “You should increase your iodine intake in your diet.” D. “You need to take thyroid hormone replacement immediately for life.” 12. The patient underwent total thyroidectomy. You are caring for the patient eight hours postoperative. Which of the following assessment findings indicate that the patient is developing a complication? A. Moderate amount of dry sanguineous drainage on the dressing B. Oral temperature of 99.2°F (37.3°C) C. RR of 23 and apical pulse of 97 D. Patient reports sore throat when speaking 13. The nurse identifies the client problem “risk for imbalanced body temperature” for the client diagnosed with hypothyroidism. Which intervention should be included in the plan of care? A. Discourage the use of an electric blanket. B. Assess the client’s temperature every two hours. C. Keep the room temperature cool. D. Space activities to promote rest. 1 | Page
14. The client is admitted to the intensive care department and diagnosed with myxedema coma. Which assessment data warrant immediate intervention by the nurse? A. Serum blood glucose level of 74 mg/dL. B. Pulse oximeter reading of 90%. C. Telemetry reading showing sinus bradycardia. D. The client is lethargic and sleeps all the time. 15. Propylthiouracil (PTU) is prescribed for a client diagnosed with hyperthyroidism. The client asks the nurse, “Why do I have to take this medication if I am going to get the atomic cocktail? ” The nurse explains that the medication is being prescribed because it decreases the: A. vascularity of the thyroid gland. B. production of thyroid hormones. C. need for thyroid iodine supplements. D. amount of already formed thyroid hormones. 16. A 21-year-old patient with hyperthyroidism complains of her “ugly” appearance and ask, “Will I always look so terrible?” What is the nurse best response? A. Makeup can help your protruding eyes seem less noticeable. B. “Your appearance doesn’t matter. It’s what’s inside that counts.” C. “With treatment, the fluid buildup behind your eyes will decrease.” D. “If you cut back the fluids, the swelling behind your eyes will go down.” 17. The patient with hyperparathyroidism should have extremities handled gently because: A. Decreased calcium bone deposits can lead to pathologic fractures. B. Edema causes stretched tissues to tear easily. C. hypertension can lead to stroke with residual paralysis D. Polyuria leads to dry skin and mucous membranes that can break down 18. Which medication should be available to provide emergency treatment if a client develops tetany after a subtotal thyroidectomy? A. sodium phosphate B. calcium gluconate C. echothiophate iodide D. sodium bicarbonate 19. A client with hyperthyroidism is to take saturated solution of potassium iodide (SSKI). What should the nurse do when administering this drug? A. Pour the solution over ice chips, popsicle, or ice cream. B. Mix the solution with an antacid after the patient’s last meal. C. Dilute the solution with carbonated drink and have the client drink it with a straw. D. Disguise the solution in a pureed fruit or vegetable and let the patient enjoy their meal. 20. A nurse is caring for a patient diagnosed with hypoparathyroidism. Laboratory tests reveal hypocalcemia. Which statement best describes the role of calcitonin in this patient’s condition? A. Calcitonin increases serum calcium levels by stimulating osteoclast activity. B. Calcitonin decreases serum calcium levels by inhibiting bone resorption. C. C. Calcitonin has no effect on calcium regulation in hypoparathyroidism. D. D. Calcitonin increases parathyroid hormone secretion to maintain calcium balance. Situation: A 56-year-old patient has been diagnose to have type 2 Diabetes Mellitus and has been admitted due to headache and blurring of vision. She had been on insulin therapy for almost 10 years now. 21. Which of the following diagnostic test do you expect to be ordered by the diabetologist as an indicator that the patient is compliant to her prescribed diet? A. Oral glucose tolerance test B. Glycosated hemoglobin level C. Fasting blood glucose level D. Finger glucose findings for one day 22. Before supper, an adult client who has type 2 diabetes and requires insulin tells the nurse about having tremors and being weak and anxious. What should the nurse do next? A. Tell the client to lie down for 30 minutes. B. Have the client drink a glass of milk or orange juice. C. Administer IM glucagon D. Administer the next dose of insulin. 23. Which nursing intervention should be done first when managing a pediatric client admitted to the emergency department with severe diabetic ketoacidosis (DKA)? A. Begin an insulin drip to lower the client’s blood glucose level. B. Correct any fluid deficit using an isotonic saline solution. C. Draw a blood glucose level and serum electrolyte panel. D. Secure the client’s airway to ensure adequate ventilation. 24. A client with type 1 diabetes mellitus has diabetic ketoacidosis. Which finding has the greatest effect on fluid loss? A. hypotension B. decreased serum potassium level C. rapid, deep respirations D. warm, dry skin 25. A nurse enters the comfort room and finds a client with Diabetes Mellitus sitting on the floor, appearing confused and disoriented. Which action should the nurse take first? A. Obtain a capillary blood glucose reading B. Administer a prescribed insulin dose C. Administer intramuscular glucagon D. Inform the attending physician immediately 26. The nurse is performing discharge teaching for a client diagnosed with Cushing’s disease. Which statement by the client demonstrates an understanding of the instructions? A. “I will be sure to notify my health-care provider if I start to run a fever.” B. “Before I stop taking the prednisone, I will be taught how to taper it off.” C. “If I get weak and shaky, I need to eat some hard candy or drink some juice.” D. “It is fine if I continue to participate in weekend games of tackle football.” 27. The client diagnosed with Addison’s disease is admitted to the emergency department after a day at the lake. The client is lethargic, forgetful, and weak. Which intervention should the nurse implement? A. Start an IV with an 18-gauge needle and infuse NS rapidly. B. Have the client stay in the waiting room until a bed is available. C. Obtain a permit for the client to receive a blood transfusion. D. Collect urinalysis and blood samples for a CBC and calcium level. 28. The nurse is instructing a college student with Addison’s disease how to adjust the dose of glucocorticoids. The nurse should explain that the patient may need an increased dosage of glucocorticoids in which situation? A. completing course work. B. gaining 4 lb (1.8 kg) C. becoming engaged D. having wisdom teeth extracted 29. Which goal is the priority for a client in addisonian crisis? A. controlling hypertension B. preventing irreversible shock C. preventing infection D. relieving anxiety 30. Which of the following patient statements would indicate that no further teaching is needed for a client newly diagnosed with Addison’s disease who will be taking corticosteroids? A. "I know I need to watch for signs of high blood sugar while I’m on this medication." B. "I will adjust my steroid dose depending on how much I eat or how much exercise I do." C. "If my blood pressure suddenly gets very high, I will notify my health care provider right away." D. "If I’m under a lot of stress, I should lower my corticosteroid dose to avoid side effects." 2 | Page
31. When teaching a client about taking oral glucocorticoids, how should the nurse instruct the client to take the medication? A. with a full glass of water B. on an empty stomach C. at bedtime to increase absorption D. with meals or with an antacid 32. Which indicator is best for determining whether a client with Addison’s disease is receiving the correct amount of glucocorticoid replacement? A. skin turgor B. temperature C. thirst D. daily weight 33. A client diagnosed with Cushing’s syndrome is admitted to the hospital and scheduled for a dexamethasone suppression test. What should the nurse do during this test? A. Collect a 24-hour urine specimen to measure serum cortisol levels. B. Administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning. C. Draw blood samples before and after exercise to evaluate the effect of exercise on serum cortisol levels. D. Administer an injection of adrenocorticotropic hormone (ACTH) 30 minutes before drawing blood to measure serum cortisol levels. 34. Bone resorption is a possible complication of Cushing’s disease. To help the client prevent this complication, what should the nurse recommend to the client? A. Increase the amount of potassium in the diet. B. Maintain a regular program of weight-bearing exercise. C. Limit dietary vitamin D intake. D. Perform isometric exercises. 35. A client has an adrenal tumor and is scheduled for a bilateral adrenalectomy. During preoperative teaching, the nurse teaches the client how to do deep-breathing exercises after surgery. What should the nurse tell the client to do? A. “Sit in an upright position, and take a deep breath.” B. “Hold your abdomen firmly with a pillow, and take several deep breaths.” C. “Tighten your stomach muscles as you inhale, and breathe normally.” D. “Raise your shoulders to expand your chest.” 36. The client is admitted to the medical department with a diagnosis of rule-out (R/O) acute pancreatitis. Which laboratory values should the nurse monitor to confirm this diagnosis? A. Creatinine and blood urea nitrogen (BUN) B. Troponin and creatine kinase-MB (CK-MB) C. Serum amylase and lipase D. Serum bilirubin and calcium 37. Which client problem has priority for the client diagnosed with acute pancreatitis? A. Risk for fluid volume deficit B. Alteration in comfort C. Imbalanced nutrition: less than body requirements D. Knowledge deficit 38. The nurse is preparing to administer morning medications to clients. Which medication should the nurse question before administering? A. Pancreatic enzymes to the client who has finished breakfast B. The pain medication, morphine, to the client who has a respiratory rate of 20 C. The loop diuretic to the client who has a serum potassium level of 3.9 mEq/L D. The beta blocker to the client who has an apical pulse of 68 bpm 39. The nurse is administering a pancreatic enzyme to the client diagnosed with chronic pancreatitis. Which statement best explains the rationale for administering this medication? A. It is an exogenous source of protease, amylase, and lipase B. This enzyme increases the number of bowel movements C. This medication breaks down in the stomach to help with digestion D. Pancreatic enzymes help break down fat in the small intestine 40. The nurse is completing discharge teaching to the client diagnosed with acute pancreatitis. Which instruction should the nurse discuss with the client? A. Instruct the client to decrease alcohol intake B. Explain the need to avoid all stress C. Discuss the importance of stopping smoking D. Teach the correct way to take pancreatic enzymes 41. Which laboratory value should be monitored by the nurse for the client diagnosed with diabetes insipidus? A. Serum sodium B. Serum calcium C. Urine glucose D. Urine white blood cells 42. The nurse is discharging a client diagnosed with diabetes insipidus. Which statement made by the client warrants further intervention? A. “I will keep a list of my medications in my wallet and wear a Medic Alert bracelet.” B. “I should take my medication in the morning and leave it refrigerated at home.” C. “I should weigh myself every morning and record any weight gain.” D. “If I develop a tightness in my chest, I will call my health-care provider.” 43. The client is admitted to the medical unit with a diagnosis of rule-out diabetes insipidus (DI). Which instructions should the nurse teach regarding a fluid deprivation test? A. The client will be asked to drink 100 mL of fluid as rapidly as possible and then will not be allowed fluid for 24 hours. B. The client will be administered an injection of antidiuretic hormone (ADH), and urine output will be measured for 4 to 6 hours. C. The client will have nothing by mouth (NPO), and vital signs and weights will be done hourly until the end of the test. D. An IV will be started with normal saline, and the client will be asked to try to hold the urine in the bladder until a sonogram can be done. 44. The nurse is caring for a client diagnosed with diabetes insipidus (DI). Which intervention should be implemented? A. Administer sliding-scale insulin as ordered B. Restrict caffeinated beverages C. Check urine ketones if blood glucose is >250 D. Assess tissue turgor every four (4) hours 45.A client with central diabetes insipidus is prescribed desmopressin (DDAVP) nasal spray. Which statement by the client indicates the need for further teaching? A. “I will weigh myself daily and report sudden weight gain.” B. “If I notice swelling in my hands or feet, I should contact my health-care provider.” C. “I should blow my nose just before taking the nasal spray.” D. “If I miss a dose, I can double the next one to make up for it.” 46. Which recommendation should the nurse suggest to an elderly client who lives alone when discussing normal developmental changes of the olfactory organs? A. Suggest installing multiple smoke alarms in the home B. Recommend using a night-light in the hallway and bathroom C. Discuss keeping a high-humidity atmosphere in the bedroom D. Encourage the client to smell food prior to eating it 47. The elderly male client tells the nurse, “My wife says her cooking hasn’t changed, but it is bland and tasteless.” Which response by the nurse is most appropriate? A. “Would you like me to talk to your wife about her cooking?” B. “Taste buds change with age, which may be why the food seems bland.” C. “This happens because the medications sometimes cause a change in taste.” D. “Why don’t you barbecue food on a grill if you don’t like your wife’s cooking?” 3 | Page