Tiêu đề RECALLS 8 (NP4) - STUDENT COPY ✅

RECALLS EXAMINATION 8 NURSING PRACTICE IV CARE OF CLIENTS WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART B) 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 IV” on the box provided Situation: Taking Care of Patients with Trauma and Burns injury. 1. One of your patient’s clothes has caught on fire. Which of the following will the nurse instruct the patient to do? A. Instruct the patient to duck, cover, and hold B. Instruct the patient to stand still C. Instruct the patient to stop, drop, and roll D. Instruct the patient to start running to extinguish the flames 2. A client is rushed to the emergency room showing a pale white, leathery, and painless burned area on his skin. The nurse classifies this burn as: A. First Degree burn B. Second Degree burn C. Third Degree Burn D. Deep Partial-Thickness Burn 3. Burns that is characterized by blisters, mottled red base, and is painful is A. First Degree burn B. Second Degree burn C. Third Degree burn D. Full Thickness burn 4. During the first 48 hours of burns, dehydration occurs due to A. Increased fluid loss by evaporation from the areas of burns B. Actual fluid destruction by the burning process C. Shifting of plasma into the interstitial compartment D. Fluid loss through blister formation Situation: Linda, a 55-year-old female patient has deep partial thickness burns on the posterior head and neck, front of the left arm, front and back of the right arm, posterior trunk, front and back of the left leg, and back of right leg. The patient weighs 91 kg. 5. The nurse estimates for the total body surface area burned. Using the rule of nines, how much of Linda’s body has suffered from burns? A. 54% B. 36% C. 63% D. 18% 6. Using the Parkland Burn Formula, calculate the total amount of Lactated Ringers that will be given over the next 24 hours? A. 22,932 mL B. 26,208 mL C. 16,380 ML D. 12,238 mL 7. How much fluid will be given to Linda during the first 8 hours postburn? A. 11,466 ml B. 13,104 ml C. 8,190 ml D. 6,119 ml 8. The purpose of inserting an NGT Tube to patients with burns that exceeds 20% to 25% TBSA is A. For feeding or gavage B. For gastric decompression C. For aesthetic purposes D. For the rapid return of peristalsis 9. What gauge/size of the needle will be used when administering IV solutions for trauma patients? A. G18 B. G22 C. G24 D. G26 10. A patient in the emergent/resuscitative phase of a burn injury has had blood work and arterial blood gases drawn. Upon analysis of the patient’s laboratory studies, the nurse will expect the results to indicate what? A. Hyperkalemia, hyponatremia, elevated hematocrit, and metabolic acidosis B. Hypokalemia, hypernatremia, decreased hematocrit, and metabolic acidosis C. Hyperkalemia, hypernatremia, decreased hematocrit, and metabolic alkalosis D. Hypokalemia, hyponatremia, elevated hematocrit, and metabolic alkalosis 11. A client has an order for an arterial blood gas analysis. Which of the following tests should be performed first before drawing the ABG specimen? A. Weber Test B. Romberg’s test C. Allen’s test D. Rinne Test 12. The Allen’s Test checks the patency of the A. Ulnar artery B. Radial artery C. Carotid artery D. Brachial artery 13. The normal oxygen saturation is A. 80% to 85% B. 85% to 90% C. 90% to 95% D. 95% to 100% 14. All of the following results in high-pressure alarms in a ventilator, except A. The ventilator tube is obstructed because of water B. Client coughs, gags, or bites on the oral endotracheal tube C. Client is anxious or fights the ventilator D. Disconnection or leak in the ventilator 15. Where would Nurse Reyes place the call light for a male patient with a right-sided brain attack and left homonymous hemianopsia? A. On the client’s right side B. On the client’s left side C. Directly in front of the client D. Where the client likes 16. The nurse to patient ratio recommended by the Department of Health is 1 | Page
A. 1:5 B. 1:20 C. 1:12 D. 1:50 17. A client is taking an antacid for treatment of peptic ulcer disease. Which of the following, if stated by the client, indicates understanding on how to correctly take an antacid? A. “I should take my antacid together with my other medications.” B. “I need to decrease my intake of fluids so that I don’t dilute the effects of my antacid.” C. “I will wait 30 min before I can take my other medications.” D. “It is best for me to take my antacid 1 to 3 hours after meals.” 18. The nurse evaluates the client’s stoma during the initial postoperative period. Which of the following observations should be reported immediately to the physician? A. The stoma is slightly edematous B. The stoma is dark red to purple C. The stoma oozes a small amount of blood D. The stoma does not expel stool. 19. A client receiving routine preoperative fluids had a 1000-mL bag of 5% dextrose in 0.9% sodium chloride hung at 1500. The nurse making rounds at 1545 finds that the client is complaining of a pounding headache and is dyspneic, experiencing chills, and apprehensive, with an increased pulse rate. The intravenous (IV) bag has 400 mL remaining. The nurse would take which action first? A. Slow the IV infusion. B. Sit the client up in bed. C. Remove the IV catheter. D. Call the primary health care provider (PHCP). 20. Which of the following findings are to be seen in a patient with Addison’s disease? A. Hypokalemia B. Hypernatremia C. Hypoglycemia D. Hypertension 21. A prescription reads 1000 ml of normal saline 0.9% to infuse over 8 hours. The drop factor is 15 drops (gtt)/ 1 ml. The nurse gets the flow rate at how many drops per minute? A. 30 gtts/min B. 31 gtts/min C. 32 gtts/min D. 33 gtts/min 22. A prescription reads 1000 mL D5W to infuse at a rate of 125 mL/hr. The nurse determines that it will take how many hours for 1 L to infuse? A. 6 hours B. 7 hours C. 8 hours D. 9 hours 23. A prescription reads levothyroxine, 150 mcg orally daily. The medication label reads levothyroxine, 0.1 mg/tablet. The nurse administers how many tablet(s) to the client? A. 0.5 tablet B. 1 tablet C. 1.5 tablets D. 2 tablets 24. A prescription reads potassium chloride 30 mEq to be added to 1000 mL normal saline (NS) and to be administered over a 10-hour period. The label on the medication bottle reads 40 mEq/20 mL. The nurse prepares how many milliliters (mL) of potassium chloride to administer the correct dose of medication? A. 5 ml B. 10 ml C. 15 ml D. 20 ml 25. Gentamicin sulfate, 80 mg in 100 mL normal saline (NS), is to be administered over 30 minutes to a client with an infection. The drop factor is 10 drops (gtt)/1 mL. The nurse sets the flow rate at how many drops per minute? A. 30 gtts/min B. 31 gtts/min C. 32 gtts/min D. 33 gtts/min 26. Which of the following medications is an example of an Angiotensin-Converting Enzyme (ACE) Inhibitor? A. Telmisartan B. Amlodipine C. Enalapril D. Prazosin 27. The nurse is reviewing the client’s record with a diagnosis of cirrhosis and noted that there is a presence of asterixis. How would the nurse assess for its presence? A. Dorsiflex the client’s foot B. Measure the abdominal girth C. Ask the client to extend the arms D. Instruct the client to lean forward 28. In obtaining specimen for a sputum culture and sensitivity, which of the following instruction is the best. A. Upon waking up, cough deeply and expectorate into a sterile container B. Cough after pursed lip breathing C. Save sputum for two days in a covered container D. After a few breaths, spit into a clean container. 29. Which clinical manifestation in a client does the nurse assess as a typical reaction to long-term phenytoin (Dilatin) therapy? A. Weight gain B. Insomnia C. Excessive growth of gum tissue D. Deteriorating eyesight 30. The nurse determines that Baclofen is given for a client with Multiple Sclerosis to achieve what? A. Induces sleep B. Stimulate the client’s appetite C. Relives muscular spasticity D. Reduces the urine bacterial count 31. The client who is very anxious and is experiencing deep, rapid respiration is admitted in the emergency department. Which of the following acid-base imbalances may occur? A. Metabolic alkalosis B. Metabolic acidosis C. Respiratory alkalosis D. Respiratory acidosis 32. Which of the following diet is recommended for a client with Meniere’s disease? A. Low salt B. Low potassium C. Low fiber D. Low fat 33. Which of the following actions of a new RN when performing tracheostomy suctioning needs intervention by the charge nurse? A. Hyperoxygenating the patient before suctioning B. Applying suction while withdrawing the catheter C. Using non-sterile gloves D. Applying suction for 5 to 10 seconds at a time 34. The most characteristic sign and symptoms of Kawasaki Disease is A. Koplik’s spot B. Slapped face appearance C. Cervical lymph node enlargement and fever D. Linear burrows in the skin. 35. The nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretics. Which of the following is the most appropriate method to assess the urine output? A. Weighing the diapers B. Inserting a urinary catheter C. Comparing intake with output D. Measuring the amount of water added to formula 36. Which of the following foods is most appropriate to be given to a manic patient? A. Pasta B. Beef Stew C. Yogurt and banana D. Raisins, carrots, peanut butter cookies 37. A client with peptic ulcer disease has been taking omeprazole for 4 weeks. The nurse evaluates that the client is receiving the intended effect of the medication if the client reports the absence of which symptom? A. Diarrhea B. Heartburn 2 | Page