Title DIAGNOSTIC EXAMINATION - NP3 - KEY ✅

REFRESHER PHASE DIAGNOSTIC EXAMINATION NURSING PRACTICE 3 (NP3) NOVEMBER 2024 Philippine Nurse Licensure Examination Review Situation - As a staff nurse in a government hospital, you have been exposed to varied cases of clients with endocrine problems. Your nursing responsibility starts from admission to discharge which is a domain of your competencies. 1. Which of the following questions should you ask during an admission interview for a client with a diagnosis of pheochromocytoma? A. Do you always feel like you are suffocating, you want to rest and sleep B. Do you suddenly feel warm and flushed when you get out of bed C. Do you notice an increase in your heart beat? D. Do you have an increase in urination lately? 2. When the sympathetic nervous system is stimulated in the case of pheochromocytoma, you expect which of the following signs? i. Hypertension ii. Headache iii. Hyperhidrosis iv. Hypermetabolism A. 3 and 4 B. 1 only C. 1, 2, 3, and 4 D. 2 and 3 3. Which of the following drugs can induce hypertensive crisis in Pheochromocytoma? A. Tricyclic antidepressant B. Corticosteroid C. Respiratory stimulant D. Radioiodine therapy 4. In the presence of pheochromocytoma, the diagnostic test which is expected to be elevated is ___________. A. Serum thyroid hormone levels B. Albumin globulin test C. Urine cyclic adenosine mono phosphate D. 24 hours urine collection for vanillylmandelic acid (VMA) 5. Palpation, as a modality for physical examination is AVOIDED when diagnosed with pheochromocytoma because this action_______________. A. Will cause sudden release of norepinephrine and severe hypotension B. Will cause a sudden release of cathecolamines and severe hypertension C. Will displace the location of the tumor D. Will cause sudden release of epinephrine and severe palpitation Situation – Janine is the Nurse on duty in the medical ward and many of her patients are suffering from problems of oxygenation. 6. The following are relevant data to be documented when taking the health history of a client with anemia EXCEPT: A. Alcohol intake B. Fatigue and weakness C. Dietary intake D. Episodes of bleeding 7. 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 terms should Ime use to accurately describe MOST the client’s condition in the chart? A. Peripheral cyanosis B. Pallor of the fingertips C. Peripheral neuropathy D. Clubbing of the fingers 8. 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 9. Mr. Gabby is with left sided heart failure. Janine’s documentation of her assessment findings will include the following, EXCEPT______________. A. Dependent edema B. Pulmonary crackles C. Difficulty of breathing D. Cough 10. A client is on a diuretic therapy. Expected entry in patient’s chart should include the following information, EXCEPT: A. Serum electrolytes monitored B. Intake and output recorded C. Lasix administered at 8 o’clock in the evening D. Weight is taken before drug is given Situation – 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: 11. 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 12. 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. 13. 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 – 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 TOP RANK REVIEW ACADEMY, INC. Page 1 | 6
cancer. He was advised by the doctor for admission. 14. 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 15. 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. D. Chilled electrolyte solution is allowed. SITUATION: You are caring for patients in the Respiratory Ward of Demacia General Hospital. The following questions apply: Situation - Mr. Kerro, a 62 year-old male, complains of shortness of breath, dyspnea on exertion, palpitation, and expectorating frothy, blood-tinged sputum. He was brought to the emergency room of Hospital C. During the interview, he also complained of easy fatigability and weakness. 16. Given the following assessment cues, Nurse Joncel creates a nursing care plan with the priority nursing diagnosis of: A. Anxiety related to actual threat to biological integrity secondary to heart failure B. Ineffective breathing patterns related to decreased respiratory depth secondary to pain C. Activity intolerance related to compromised oxygen transport system secondary to heart failure D. Activity intolerance related to compromised oxygen transport system secondary to heart muscle dysfunction 17. The doctor ordered oxygen administration for the patient. The nurse knows that the rationale behind this intervention is that: A. Oxygen helps to decrease the work of breathing B. Oxygen is contraindicated in heart failure so the order is questionable C. Oxygen is given to reduce anxiety D. Oxygen is administered through mechanical ventilation only 18. Nurse Joncel prepares to perform the following interventions for the immediate management of Mr. Kerro excluding: A. Establish an IV line and administer PNSS immediately B. Monitor heart rate and dysrhythmia by using a cardiac monitor C. Continuously assess level of consciousness D. Provide reassurance and support to the patient 19. The nurse knows that the management of a patient with heart failure requires interprofessional collaboration. Mr. Kerro asks Nurse Joncel from whom can he ask for assistance and counsel regarding home care services. Nurse Joncel responds that the professional who can help him with his concern and who assists the continuing care nurse with planning the patient's discharge is the: A. Physical therapist B. Social worker C. Psychologist D. Head nurse Situation - Nurse Ayanah was invited to be a member of the ethics committee of Hospital D, a training hospital. A prerequisite to her formal induction into the committee was for her to complete a research. 20. Before and during the conduct of her research, she is guided by the following ethical principles excluding: 1. Protect the privacy of the subjects 2. Get the informed consent of the subjects 3. Avoid injury or harm to the subjects 4. Treat the subjects fairly and justly A. 1 & 2 B. None of the options C. All but 3 D. All of the options 21. Ayanah believes that one of the most basic ethical principle that nurses must observe is the obligation to maintain a balance between benefits and harms. This principle is termed as: A. Justice B. Safety C. Beneficence D. Non-maleficence 22. Another important ethical principle that guides nurse researchers is the principle of justice. Nurse Ayanah knows that this principle connotes: A. Fairness and confidentiality B. Fairness and equality C. Fairness and equity D. Fairness and anonymity 23. Apart from the aforementioned ethical guidelines and principles, Nurse Ayanah is aware that which of the following codes of conduct has endured through the ages? A. Code of Ethics for Professionals B. Phairpine Constitution C. Honor Code D. Ten Commandments 24. Getting the informed consent of research participants show that the nurse honors the principle of autonomy. However, there are instances where participants become incapable of giving informed consent. These groups of participants exclude which of the following: A. Jestoni, a 19 year-old male who is paraplegic B. Karlyn, a 17 year-old college student C. Ayesha, a 34 year-old mother who is diagnosed with Schizophrenia with active positive symptoms D. All of the options Situation: The nurse in the outpatient clinic is interviewing patients with asthma, those enrolled in a research study to determine the genetic influence of Theophylline use among Filipinos. 25. Theophylline is being taken by an adult patient with asthma. The nurse knows that this medication is a/an: A. Inhaled corticosteroid B. Long-acting beta-agonist C. Leukotriene modifier D. Methylxanthine 26. Which of the following is potentiated by concurrent use of theophylline in an adult? A. Phenytoin B. Digoxin C. Simvastatin D. Lithium 27. A client has begun therapy with theophylline (Theo-24). A nurse plans to teach the client to limit the intake of which of the following while taking this medication? A. Coffee, cola, and chocolate B. Oysters, lobster, and shrimp C. Melons, oranges, and pineapple D. Cottage cheese, cream cheese, and dairy creamers 28. The nurse reviews the serum theophylline levels of the patient, noting the result of 18 mcg/mL. The nurse expects to see which of the following? A. Restlessness and nervousness B. Improved breathing effort C. Tremors D. Palpitations and tachycardia 29. To administer an intravenous form of theophylline preparation, the nurse anticipates to prepare which of the following? A. Carbon paper B. Volumetric set (Soluset) C. Ice cold bath D. Infusion pump Situation: Pneumonia is a respiratory condition that greatly affects both the adult, gerontologic and pediatric populations. The nurse should be confident in performing assessment and anticipating various causes of this disorder. TOP RANK REVIEW ACADEMY, INC. Page 2 | 6
30. In the community setting, an 80-year-old elderly female has been discharged after hip surgery for just 24-hours only. Soon after, she had to be rushed to the hospital again due to increasing breathlessness secondary to pneumonia. The nurse anticipates that the physician will document: A. Community-acquired pneumonia B. Hospital-acquired pneumonia C. Pneumonia in the immunocompromised host D. Aspiration pneumonia 31. Which of the following is the causative factor of pneumonia in the immunecompromised host (HIV)? A. Pneumocystitiscarinii B. Klebsiella spp. C. Pneumocystitisjiroveci D. Streptococcus spp. 32. What pathophysiologic mechanism is not involved in the disease process of pneumonia? A. Thinned alveolar membrane B. Increased production of exudates and secretions C. Pathologic shunting of blood D. Bronchospasm 33. Which is not an expected finding on the affected lung of patients with pneumonia? A. Decreased tactile fremitus B. Decreased lung expansion C. Positive egophony D. Dull upon percussion 34. The nurse gathers data about a pediatric patient with right lower lobe pneumonia. The mother asks the nurse on how to relieve the discomfort on the right side, noting that previously prescribed ibuprofen is not effective. The nurse responds by: A. “You can give the medication more often than ever.” B. “Keep your child on the right side.” C. “Take twice of the tablets that you give to your child.” D. “Elevate your child’s right side.” 35. Which of the following drugs would be mostly associated with the development of Cushing’s Syndrome? A. Antihypertensives B. Salicylates C. Antacids D. Glucocorticoids 36. Nurse Katarina cares for patient Xin suspected of having acute respiratory distress syndrome (ARDS). Which assessment statement data supports the suspected diagnosis? 1. Crackles 2. Metabolic Acidosis 3. Slow onset 4. Tachypnea 5. Confusion A. 1,2,3 B. 1,3,5 C. 1,2,5 D. 1,4,5 37. A client’s chest x ray suggests acute respiratory distress syndrome (ARDS). Which pathophysiological process does the nurse recognize is the underlying cause of this condition? A. Increased permeability of pulmonary capillaries. B. Decreased blood flow in the pulmonary vessels. C. Decrease compliance of the lungs. D. Increased retention of serum carbon dioxide 38. Nurse Katarina administers oxygen via nasal cannula and a nitroglycerin tablet per standing order to a client with a chest pain and diaphoresis and does not notify the health care provider. Thirty minutes later the client experiences a myocardial infarction. Which events places the nurse at risk for legal action form the client’s family? A. Nurse Katarina fails to react to the client’s condition and administer appropriate prescribed treatments. B. Nurse Katarina fails to notify her charge nurse of the client’s assessment data and prescribed treatment. C. Nurse Katarina fails to notify the client’s health care provider of the assessment data and treatments administered D. Nurse Katarina fails to assess the client’s status after the administering the prescribed medication. E. Both C and D 39. Nurse Katarina is teaching a client about the administration of nitroglycerin. What statement indicates understanding? A. I will always bring a few tablets with me whenever I go outside. B. I will put small case of nitroglycerin in my jacket C. I will have a year supply of nitroglycerin D. I will take nitroglycerin with water so I swallow it easily. 40. The patient is taking furosemide and digoxin. The nurse should teach the client to eat foods that are: A. High in potassium B. Low in potassium C. High in protein D. Low in protein SITUATION: Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by a novel coronavirus (Middle East respiratory syndrome coronavirus, or MERS‐CoV) that was first identified in Saudi Arabia in 2012. 41. The Middle East respiratory syndrome Corona Virus (MERS CoV) is zoonotic virus that is transferred from an animal reservoir to humans. What animal is the major reservoir of the said virus? A. Birds B. Pigs C. Camels D. Lamb 42. MERCoV’s origin is not fully understood but genome analysis reveals that it originates from: A. Bats B. Camels C. Porcupines D. Dogs 43. What is the complication of MERSCoV? A. Stroke B. Arthritis C. Myocardial Ischemia D. ARDS 44. What is the treatment modality for patients afflicted with MERSCoV? A. Post exposure prophylaxis using antivirals B. Vaccine C. Administration of Immunoglobulins D. Supportive therapy 45. MERSCoV do not easily spread to human-to-human contact but it is possible such as when: A. You ride on the same transit train. B. You have taken care of sick friend who MERSCoV. C. You ate well cooked camel meat. D. It is not possible at all. SITUATION: Nurse Caitlyn is working in a Diabetes Clinic in Winterfell and is teaching clients on home care management of Diabetes. 46. Nurse Caitlyn is teaching a child with Diabetes Milletus Type 1 and the child asked what he will do if he has game in the afternoon. What Nurse Caitlyn should instruct? A. Eat biscuit and juice B. Double lunch meal C. Administer insulin during lunch D. Administer half of the insulin. 47. Nurse Caitlyn is teaching about self-administration of insulin. What would indicate understanding about the administration of insulin? A. Change major site every month B. Change site frequently C. Change major site every 2-3 weeks D. Change site every week 48. Nurse Caitlyn is teaching a client about the administration of insulin. One of the clients asked if they would do if suddenly he feels dizzy, and diaphoretic. What would nurse Caitlyn instruct the client to do? A. Administer another shock of insulin. B. Drink Orange juice C. Check capillary blood sugar via glucometer D. Do nothing it will pass anyway. 49. Nurse Caitlyn knows that this type of insulin is the only TOP RANK REVIEW ACADEMY, INC. Page 3 | 6
type that can be administered intravenously. A. Humalog B. Humalog R C. Novolog D. Apidra 50. Nurse Caitlyn knows that best way to know if the patient is compliant with drug regimen for diabetes control is: A. Fasting Plasma Glucose B. Oral Glucose Challenge Test C. Urinalysis D. Glycosylated Hemoglobin 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. 51. The response to the drug is described as a (n): A. allergic response B. synergistic response C. paradoxical response D. hypersusceptibility response 52. 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 53. 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 54. 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 55. 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 Situation: Problems in Oxygenation involves patients with disturbances in lower and upper airways. Nurse Benjie a Pulmonary Nurse is attending to clients with respiratory diseases. 56. 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 57. 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 58. 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 59. 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 60. 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 61. 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 62. 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 an open airway. D. Call the physician. 63. 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 64. 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? 65. 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 66. 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 67. 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. 68. 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. 69. What is the most common electrolyte imbalance which causes hospitalization of patients? A. Hyponatremia TOP RANK REVIEW ACADEMY, INC. Page 4 | 6