Title RECALLS 4 (NP3) - STUDENT COPY ✅

1 | Page Prepared by: GARCIA, RHYAN P. ROMAN, HANNAH GISELLA RECALLS EXAMINATION 4 NURSING PRACTICE III Care of Clients with Physiologic and Psychosocial Alterations (Part A) MAY 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 I” on the box provided Scenario: Mr. Reynolds, a 68-year-old patient, is admitted to the stroke unit with sudden onset of left- sided weakness and difficulty speaking. Upon assessment, the nurse notes that he has left-sided hemiparesis but retains some movement in his arm and leg. 1. Mr. Reynolds presents with sudden left-sided weakness and difficulty speaking. A CT scan confirms an ischemic stroke. Based on his symptoms, which area of the brain is most likely affected? A. Right frontal lobe B. Left frontal lobe C. Brainstem D. Pons 2. Mr. Reynolds now knows which area of his brain has been affected. He asks why his stroke is causing weakness on the left side of his body. The nurse knows the reason for this is: A. Lower motor neurons in the spinal cord are damaged. B. Upper motor neurons decussate in the medulla. C. The cerebellum coordinates movement ipsilaterally (on the same side). D. Spinal reflexes are disrupted unilaterally. 3. Upon assessment, the nurse notes that Mr. Reynolds has mild weakness in his left arm and leg but retains some movement. Which term best describes this finding? A. Hemiplegia B. Hemiparesis C. Paraplegia D. Ataxia 4. A different patient with a left hemisphere stroke asks the nurse why their right side is weak. Which response by the nurse is most accurate? A. “Your brain’s right side controls both sides of the body.” B. “Nerve pathways cross in the brain, so left-brain damage affects the right side.” C. “The spinal cord on your left side is compressed.” D. “Brainstem inflammation is causing bilateral weakness.” 5. Mr. Reynolds is scheduled for a swallowing assessment due to his stroke. Which of the following interventions should the nurse implement to prevent aspiration? A. Encourage the patient to drink thin liquids to stay hydrated. B. Position the patient in a semi-Fowler's position during meals. C. Instruct the patient to tilt their head back while swallowing. D. Provide small, frequent meals with thickened liquids. 6. During a family meeting, Mr. Reynolds' daughter expresses concern about her father's emotional well-being, noting that he seems depressed and unmotivated. What is the nurse's best response? A. "It's common for stroke patients to feel this way; it will pass with time." B. "Let's consider starting an antidepressant to improve his mood." C. "We can arrange for a psychiatric evaluation to assess his mental health." D. "Encouraging him to participate in social and recreational activities can help improve his mood." 7. Which principle of neuroplasticity is most critical for enhancing motor recovery in stroke patients like Mr. Reynolds? A. Early initiation of therapy with repetitive, task-specific training B. Complete immobilization of the affected limb to prevent secondary injury C. Exclusive reliance on compensatory techniques for functional independence D. Administration of neuroprotective medications to reverse neuronal damage Situation: Danica Bagang, a 16-year-old female newly diagnosed with type 1 diabetes. Danica missed her evening insulin dose after a school event and now reports confusion, sweating, and palpitations. Her blood glucose level is 48 mg/dL. Her mother asks, "Why is this happening? She hasn’t eaten since lunch!" 8. Nurse Sarah assesses Emily’s symptoms (confusion, sweating, BSL = 48 mg/dL). Which action should the nurse take first? A. Administer intravenous dextrose. B. Provide 15g of fast-acting carbohydrates (e.g., juice). C. Administer glucagon intramuscularly. D. Recheck blood glucose in 15 minutes. 9. Nurse Sarah educates Danica’s mother about preventing hypoglycemia. Which statement by the mother indicates a need for further teaching? A. "She should always carry glucose tablets when exercising." B. "If she skips a meal, she should skip her insulin dose too." C. "Checking her blood sugar before driving is important." D. "Eating a snack with protein before bed can help prevent nighttime lows." 10. Danica’s mother asks why her daughter’s blood sugar dropped despite not eating. Nurse Sarah explains this is due to: A. Excess glucagon breaking down stored glycogen. B. Unopposed basal insulin activity without dietary glucose. C. Overproduction of cortisol increasing glucose uptake. D. Delayed gluconeogenesis after 12 hours of fasting. 11. Danica’s laboratory results show ketones in her urine. Nurse Sarah recognizes this is most likely caused by: A. Hypoglycemia triggering fat breakdown for energy. * NLE * NCLEX * CGFNS * HAAD * PROMETRICS * DHA * MIDWIFERY * LET * RAD TECH * CRIMINOLOGY * DENTISTRY * PHARMACY *

3 | Page Prepared by: GARCIA, RHYAN P. ROMAN, HANNAH GISELLA A CT scan revealed a small contusion in his right temporal lobe with no evidence of hemorrhage. Nurse Rachel is closely monitoring his neurologic status, including pupillary responses and level of consciousness, to detect any early signs of increased intracranial pressure. 28. Based on Mr. Davis’s presentation and CT findings, what should be Nurse Rachel’s primary nursing priority during the initial monitoring period? A. Monitor for subtle changes in neurologic status. B. Focus solely on administering prescribed pain medications to alleviate his headache. C. Immediately request a repeat CT scan every 2 hours to detect any progression of the contusion. D. Restrict all cognitive activities and enforce complete physical rest for 72 hours. 29. Which of the following best distinguishes a concussion from a cerebral contusion in the context of diagnostic findings? A. A concussion always results in loss of consciousness, whereas a contusion does not. B. A concussion is characterized by functional impairment with normal imaging, whereas a contusion is associated with structural changes on CT. C. Both conditions show similar CT findings, but the severity of symptoms differentiates them. D. A concussion involves permanent brain damage, while a contusion is always temporary. 30. The student nurse caring for Mr. Thompson knows that signs of a mid-basilar fracture include? SATA: i. Otorrhea ii. Raccoon’s eyes iii. Battle’s sign iv. Mastoid ecchymosis v. Rhinorrhea A. i, v B. i, v, iv C. i, iii, iv D. i, iv, v 31. Student Nurse Rejz notices clear fluid draining from Mr. Thompson’s ear and suspects a cerebrospinal fluid (CSF) leak. She performs a halo sign test by placing a drop of the fluid on a gauze pad. Which finding would confirm the presence of CSF? A. The blood coagulates. B. The fluid separates into a double ring. C. The fluid dries quickly and leaves a crusty residue. D. The fluid turns blue when mixed with a chemical reagent. Situation: Mr. James Wilson, a 28-year-old male admitted to the emergency department after a motorcycle accident. He has a linear fracture of the temporal bone and experienced a brief loss of consciousness at the scene. He is currently alert and oriented but complains of a severe headache. A CT scan reveals an epidural hematoma on the right temporal lobe, caused by a tear in the middle meningeal artery. His wife asks, "What should we watch for? Is he out of danger?" 32. Nurse Emily is monitoring Mr. Wilson for signs of an epidural hematoma. Which finding would indicate the onset of neurological deterioration? A. Lucid moments and improving orientation. B. Right pupil dilation and decreased LOC. C. Mild headache relieved by over-the-counter painkillers. D. Left pupil constriction and increased drowsiness. 33. Nurse Emily educates Mr. Wilson’s wife about the "lucid period" associated with epidural hematoma. Which statement by her indicates understanding? A. "He’s awake now, so the bleeding must have stopped completely." B. "He might seem okay for a few hours, but we need to watch for any changes in his behavior or alertness." C. "The lucid period means the hematoma is resolving on its own, and he won’t need surgery." D. "He’s alert now, so we can take him home and monitor him there." Situation: Nurse Emily is caring for Mr. Robert Thompson, a 72–year–old man with a history of chronic alcohol abuse and atrial fibrillation managed on warfarin, who was admitted after a low–velocity fall. Two weeks after his fall, Mr. Thompson began experiencing subtle symptoms—including a gradually worsening headache and mild confusion—and a CT scan confirmed a chronic subdural hematoma. Nurse Emily explains to his family that, unlike acute hematomas, chronic subdural hematomas develop slowly and may be missed if not carefully monitored. She also reinforces the importance of timely evaluation if his symptoms worsen. 34. Chronic alcohol abuse predisposes individuals to subdural hematoma. Which mechanism is most responsible for this increased risk? A. Chronic alcohol use leads to brain atrophy and impaired coagulation due to liver dysfunction. B. Alcohol causes vasoconstriction, reducing the capacity to buffer trauma. C. Alcohol increases platelet production, which paradoxically leads to bleeding. D. Alcohol enhances the structural integrity of cerebral vessels, making them rigid. 35. Elderly individuals are more vulnerable to subdural hematoma following minor head trauma primarily because of which age-related change? A. A reduction in brain mass that causes bridging veins to stretch and become more susceptible to tearing. B. Increased cerebrospinal fluid production that raises intracranial pressure. C. Enhanced vascular elasticity leading to overdistension of cerebral vessels. D. An increase in brain tissue density that predisposes vessels to rupture. Situation: Mr. John Carter, a 55-year-old male admitted to the hospital with acute kidney injury (AKI) following severe dehydration due to gastroenteritis. His baseline serum creatinine was 0.9 mg/dL, but it has risen to 2.1 mg/dL. He is currently in the oliguric phase, producing only 300 mL of urine in the past 24 hours. His wife asks, "What does this mean? Will his kidneys recover?" 36. Nurse Sarah is caring for Mr. Carter during the oliguric phase of AKI. Which intervention should she prioritize first? A. Administer IV fluids to restore renal perfusion. B. Monitor serum potassium levels for hyperkalemia. C. Prepare the patient for hemodialysis. D. Restrict fluid intake to prevent fluid overload. 37. Nurse Sarah educates Mr. Carter’s wife about the phases of AKI. Which statement by her indicates a need for further teaching? A. "During the oliguric phase, his urine output will be very low, and his lab values will worsen." B. "Once he starts producing more urine, his kidneys are fully recovered." C. "The recovery phase can take months, and his lab values will gradually improve." D. "Even after recovery, his kidney function might not return to 100%." 38. Mr. Carter’s serum potassium level is 6.2 mEq/L. Nurse Sarah understands that this is primarily due to: A. Excessive potassium intake from IV fluids. B. Impaired renal excretion of potassium during the oliguric phase. C. Intracellular potassium shifting into the bloodstream. D. Overactive aldosterone secretion. 39. Mr. Carter progresses to the diuresis phase, producing 2.5 L of urine in 24 hours. Nurse Sarah recognizes the greatest risk during this phase is: