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RECALLS EXAMINATION 3 NURSING PRACTICE IV CARE OF CLIENTS WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART B) 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 IV” on the box provided SITUATION: You are a nurse tasked to care for patients with different pituitary disorders. You are to take care of Karoo and Koza, both diagnosed with SIADH, and Paula, who is diagnosed with diabetes insipidus. You utilize your knowledge on this concept to help care for your patients safely. 1. One of the clients in your unit, Karoo, is diagnosed to have a pituitary tumor. Karoo developed Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which of the following interventions should you implement as Karoo’s primary nurse? A. Assess for dehydration and monitor blood glucose levels. B. Assess for nausea and vomiting and weigh daily. C. Monitor potassium levels and encourage fluid intake. D. Administer vasopressin IV and conduct a fluid deprivation test. 2. You are reviewing the chart of Karoo who has SIADH. Which of the following clinical manifestations you noted in Karoo’s chart should be reported to his primary care physician? A. Serum sodium of 112 mEq/L and a headache. B. Serum potassium of 5.0 mEq/L and a heightened awareness. C. Serum calcium of 10 mg/dL and tented tissue turgor. D. Serum magnesium of 1.2 mg/dL and large urinary output. 3. Another patient in your unit, Koza, was diagnosed with SIADH secondary to cancer of the lung. He tells you that he wants to discontinue his fluid restriction and that he does not care if he dies. Which of the following actions by the nurse is an example of the ethical principle of autonomy? A. Discuss the information the client told the nurse with the health-care provider and significant other. B. Explain it is possible the client could have a seizure if he drank fluid beyond the restrictions. C. Notify the health-care provider of the client’s wishes and give the client fluids as desired. D. Allow the client an extra drink of water and explain the nurse could get into trouble if the client tells the health-care provider. 4. Paula, another patient assigned to you in the unit, is recently diagnosed with diabetes insipidus. Which of the following interventions should you implement as Paula’s primary nurse? 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 5. Following Paula’s diagnosis of diabetes insipidus, she stayed in the hospital for a few days. She is now about to be discharged and you are conducting your health teaching regarding her condition. Which of the following statements made by Paula 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.” SITUATION: You are a nurse caring for patients with inflammatory bowel disease. 6. Pierre is a patient admitted to the hospital with a diagnosis of ulcerative colitis. You are currently reviewing his history and physical assessment chart. Based on Pierre’s diagnosis, which of the following information should you expect to see in Pierre’s medical records? A. Abdominal pain and bloody diarrhea B. Weight gain and elevated blood glucose C. Abdominal distension and hypoactive bowel sounds D. Heartburn and regurgitation 7. Pierre had a recent exacerbation of ulcerative colitis. He is put on mesalamine (Asacol), which is to be administered rectally via an enema. Pierre finds this procedure distasteful and he asks you, “Why can't the medication just be given orally?”. You answer Pierre correctly by saying which of the following? A. “It can be given orally; I’ll contact the doctor and see if the change can be made.” B. “Rectal administration delivers the medication directly to the affected area.” C. “Oral administration will not be as effective for the disease condition.” D. “It can be given orally, I’ll make the change and we’ll tell the doctor in the morning.” 8. You overhear a licensed practical nurse (LPN) talking to one of your patients, Mousse, who is being prepared for a total colectomy with creation of an ileoanal reservoir for her ulcerative colitis. To decrease Mousse’s anxiety, you should intervene to clarify the information given by the LPN when you hear the LPN saying: A. “This surgery will prevent you from developing colon cancer.” B. “After this surgery you will no longer have ulcerative colitis.” C. “When you return from surgery you will not be able to eat solid food for several days.” D. “You will have an ileostomy when you return from this surgery.” 9. Wyper, a 20 year old male client, is admitted to your unit because of the exacerbation of their ulcerative colitis. You go into Wyper’s room to complete an initial assessment, and he yells, “Get outta here! I am tired of you nurses and doctors looking at my body all the time!” Which of the following is your best action? A. Leave the room and ask a male colleague to complete the assessment. B. Verbally acknowledge the client’s frustration and anger. 1 | Page
C. Call the health-care practitioner and ask for a sedative order. D. Tell the client that gathering data about his current condition will promote effective timely treatment of his health concerns. 10. You are caring for Conis, a patient admitted in your unit who is diagnosed with Crohn’s disease. She has undergone a barium enema that demonstrated the presence of strictures in her ileum. Based on this finding, you should monitor the client closely for signs of: A. peritonitis. B. obstruction. C. malabsorption. D. fluid imbalance. SITUATION: You are caring for patients in your unit with alterations in their fluid and electrolytes. As a knowledgeable nurse, you apply the concepts of fluid and electrolytes in your nursing practice. 11. As an experienced nurse, you know that client incidence of hypermagnesemia is rare in comparison with hypomagnesemia. A student nurse approached you and asked how hypermagnesemia develops. You answer her correctly by saying that hypermagnesemia generally occurs secondary to: A. Cardiac contractility. B. Hypokalemia. C. Liver failure. D. Renal insufficiency. 12. You are assigned to care for Ace, a patient diagnosed to have hypokalemia. As a knowledgeable nurse, you know that the electrolyte that must be corrected in this scenario is: A. Calcium. B. Magnesium. C. Manganese. D. Zinc. 13. You are caring for a group of patients in the ward. While reviewing each of the patient’s charts, you determine which of the following patients is most likely at risk for fluid volume deficit? A. A client with an ileostomy B. A client with heart failure C. A client on long-term corticosteroid therapy D. A client receiving frequent wound irrigations 14. You are refreshing your knowledge on sodium imbalances. As a knowledgeable nurse, you know that which of the following patients in the ward is most likely to develop a sodium level at 130 mEq/L (130 mmol/L)? A. The client who is taking diuretics B. The client with hyperaldosteronism C. The client with Cushing’s syndrome D. The client who is taking corticosteroids 15. You are reviewing one of your patient’s progress notes. You read that the physician has documented “insensible fluid loss of approximately 800mL daily”. As a knowledgeable nurse, you make a notation that insensible fluid loss occurs through which of the following types of excretion? A. Urinary output B. Wound drainage C. Integumentary output D. The gastrointestinal tract SITUATION: You are a new nurse assigned to take care of patients with various eye disorders. You use your knowledge to help these patients with their condition. 16. One of the patients in your unit, Pagaya, is diagnosed with glaucoma. Which of the following symptoms should you expect the client to report during your initial assessment with him? A. Loss of peripheral vision. B. Floating spots in the vision. C. A yellow haze around everything. D. A curtain coming across vision. 17. Pagaya has now been prescribed a miotic cholinergic medication for his glaucoma. Which of the following data indicates that the medication has been effective on Pagaya? A. No redness or irritation of the eyes B. A decrease in intraocular pressure C. The pupil reacts briskly to light D. The client denies any type of floaters 18. You are caring for Gan Fall, a postoperative patient, after his retinal detachment surgery. Gas tamponade was used to flatten the patient’s retina during the procedure. Which of the following interventions should you implement first? A. Teach the signs of increased intraocular pressure. B. Position the client as prescribed by the surgeon. C. Assess the eye for signs/symptoms of complications. D. Explain the importance of follow-up visits. 19. You are caring for Conis, a patient with severe myopia. She is scheduled for a laser assisted in situ keratomileusis (LASIK) surgery. Which of the following instructions should you discuss with Conis prior to her discharge from the surgery? A. Wear bilateral eye patches for three (3) days. B. Wear corrective lenses until the follow-up visit. C. Do not read any material for at least one (1) week. D. Teach the client how to instill corticosteroid ophthalmic drops. 20. Eneru, a 65 year old male client is complaining of blurred vision, but denies having any type of pain. He reports to you, “I feel like I need to clean my glasses all the time”. Which of the following eye disorders should you suspect that Eneru has? A. Corneal dystrophy B. Conjunctivitis C. Diabetic retinopathy D. Cataracts Situation – Ms. Gina is a staff nurse in a medical unit of x hospital. She collaborate with other members of the health team to provide safe and quality patient care. 21. Which of the following statements BEST explains the role of the nurse in collaborating with others to plan for the patient’s care? The nurse _____________. A. collaborates with colleagues and the patient’s family to provide combined expertise in planning care. B. works independently to plan and deliver care and does not depend on other staff for assistance. C. consults the physician for direction in establishing goals for clients. D. depends on the latest literature to complete an excellent plan of care. 22. Nurse Gina is aware that collaborative interventions are therapies that require the following: Which of the collaborative interventions is the MOST therapeutic? A. Nurse and patient intervention B. Multiple health care professionals C. Physician and nurse intervention D. Patient and physician intervention 23. To initiate an intervention in collaboration with the health team, Nurse Gina must be competent in which of the following areas? A. Leadership, autonomy, and skills B. Experience, advanced education, and skills C. Knowledge, function, and specific skills D. Leadership, finances, and skills 24. Nurse Gina is aware that there are nursing activities that may be delegated to other health care team members. Which principle should guide the nurse in delegating tasks? A. Delegation occurs only upon a physician’s order. B. The delegated personnel is accountable for the care. C. Delegation may reduce the patient’s cost of care. D. The nurse has the primary responsibility for the quality of patient care. 25. Nurse Gina is a potential team leader of the health team. Which of the following skills should she develop? A. Collaborative skills B. Management C. Supervisory skills D. Patient advocacy SITUATION: You are a nurse assigned to care for and educate patients in the cancer unit of the hospital you are working on. You apply the concepts you’ve learned regarding cancer to ensure a safe nursing practice. 26. You are reviewing your notes on cancer. After much reading, you know that cancer prevalence is defined as? A. The likelihood cancer will occur in a lifetime. 2 | Page
B. The number of persons with cancer at a given point in time. C. The number of new cancers in a year. D. All cancer cases more than 5 years old. 27. Gol is your patient diagnosed to have testicular cancer. He expressed his concerns regarding fertility since him and his partner desires to eventually have a family. As Gol’s primary nurse, you discuss the option of sperm banking. You inform Gol and his partner that sperm banking needs to be performed when? A. Before treatment is started. B. Once the client is tolerating the treatment. C. Upon completion of treatment. D. When tumor markers drop to normal levels. 28. You are working with Bellamy, a client with known risks for lung cancer. He asks you why he is scheduled for a computed tomography (CT) scan as part of his initial workup. You answer Bellamy correctly when you respond by saying: A. “CT is far superior to magnetic resonance imaging for evaluating lymph node metastasis.” B. “CT is noninvasive and readily available.” C. “CT is useful for distinguishing small differences in tissue density and detecting nodal involvement.” D. “CT can distinguish malignant adenopathy from nonmalignant adenopathy.” 29. You are caring for Cricket, a patient with pain related to bone cancer. You conducted an assessment on Cricket in relation to this. You know that which of the following is the most important component of a thorough pain assessment specific for patient Cricket? A. Intensity. B. Cause. C. Aggravating factors. D. Location. 30. Noland is a cancer patient you are tasked to care for. He is receiving the medication vincristine (Oncovin). You plan your health teaching for Noland regarding this medication. Which of the following should you include in your instructions to Nolan? A. Use of loperamide (Imodium). B. Fluid restriction. C. Low fiber, bland diet. D. Bowel regimen. 31. Sarquiss is a 57 year old client receiving chemotherapy that has the potential to cause pulmonary toxicity. Which of the following symptoms would you note in Sarquiss that could indicate a toxic response to the chemotherapy? A. Decrease in appetite. B. Drowsiness. C. Spasms of the diaphragm. D. Cough and shortness of breath. 32. Hina is one of the patients you are tasked to care for her in the unit. She is beginning external beam radiation therapy to the right axilla after her lumpectomy for breast cancer. You plan to conduct a health teaching. Which of the following would you include in your education to Hina? A. Use a heating pad under the right arm. B. Immobilize the right arm. C. Place ice on the area after each treatment. D. Apply deodorant only under the left arm. 33. Tony Tony is a patient receiving radiation therapy for lung cancer. He complains that he is having difficulty sleeping. After hearing this statement from your patient, you should: A. Suggest the client stop watching television before bed. B. Assess the client’s usual sleep patterns, amount of sleep, and bedtime rituals. C. Tell the client sleeplessness is expected with radiation therapy. D. Suggest that the client stop drinking coffee until the therapy is completed. 34. You are caring for Nico, a patient with cancer who requires a bolus tube feeding. You prepare to administer the bolus tube feeding and as a skilled nurse, which of the following nursing interventions is most appropriate to decrease the risk of aspiration in this patient? A. Place the client on bed rest with the head of the bed elevated to 60 degrees for 2 hours. B. Place the client on the left side with the head of the bed at 45 degrees for 15 minutes. C. Assist the client out of bed to sit upright in a chair for 1 hour. D. Ask the client to rest in bed with the head of the bed elevated to 30 degrees for 20 minutes. 35. Portgas is a cancer patient receiving chemotherapy. He is experiencing a flare up of pruritus. You are planning to develop a care plan for Portgas. In order to develop the nursing care plan, you should ask him if he has been: A. Wearing clothes made from 100% cotton. B. Sleeping in a cool, humidified room. C. Increasing fluid intake to at least 3,000 mL/ day. D. Taking daily baths with a deodorant soap. Situation – An adult male is wheeled in the Emergency Department with complaints of nausea and vomiting, abdominal pain and lower back pain. The physician writes a medical diagnosis of abdominal aortic aneurysm (AAA) 36. The nurse assesses the patient with AAA. Which of the assessment findings is related to the aneurysm? 1. Pulsatile abdominal mass 2. Hyperactive bowel sounds 3. Systolic bruit over the area of the mass 4. Subjective sensation of “heart beating” in the abdomen A. 1, 3, 4 B. 1, 2, 3, 4 C. 2, 3, 4 D. 1, 2, 3 37. The nurse auscultates the abdominal area of the patient with AAA. Which of the following sounds can be DISTINCTLY heard over the area? A. Dullness B. Bruit C. Friction rubs D. Crackles 38. The nurse recalls specific anatomic sites for aneurysm. The most common sites are the aortic arch, thoracic aorta and abdominal aorta. Which of the following areas is an AAA most commonly located? A. Proximal to the renal arteries B. Distal to the iliac arteries C. Distal to the renal arteries D. Adjacent to the aortic arch 39. The patient complains of severe lower back pain. Which of the following is the PRIORITY action by the nurse? A. take the vital signs and document results B. administer pain medication as prescribed C. notify the physician D. observe for signs of abdominal distention. 40. The nurse is aware that rupture of the aneurysm is a life-threatening emergency. Which of the following groups of symptoms indicates a ruptured AAA? A. Intermittent lower back pain, decreased blood pressure, decreased RBC count, increased WBC count. B. Severe back pain, decreased blood pressure, decreased RBC count, increased WBC count. C. Lower back pain, increased blood pressure, decreased RBC count, increased WBC count. D. Severe lower back pain, decreased blood pressure, decreased RBC count, increased WBC count. SITUATION: You are a nurse caring for patients with cardiac complications. You use your knowledge on cardiovascular concepts to help these patients. 41. You are working on the unit with patient Brogy. At 7:30 AM, you received a verbal order from his primary HCP for a cardiac catheterization to be completed on him by 2:00 PM. Which of the following actions should you initiate first in Brogy? A. Initiate NPO (nothing per mouth) status for the client. B. Teach the client about the procedure. C. Start an intravenous (IV) infusion of 0.9% NaCl. D. Ask the client to sign a consent form. 42. You are working with Dorry, a male patient who experienced a myocardial infarction a few days ago. You noted that patient Dorry seems unusually fatigued. Upon your assessment, you find that patient Dorry is dyspneic with 3 | Page
activity, has a heart rate of 110 bpm, and has generalized edema. Which of the following actions would be most appropriate for this patient? A. Administer high-flow oxygen B. Encourage the client to rest more C. Continue to monitor the client’s heart rhythm D. Compare the client’s admission weight with the client’s current weight 43. You are caring for patient Whitebeard immediately following an insertion of a permanent pacemaker via his right subclavian vein. As a skilled nurse, you know that the action that can best prevent pacemaker lead dislodgement is: A. inspecting the incision site dressing for bleeding and the incision for approximation B. limiting the client’s right arm activity and preventing the client reaching above shoulder level C. assisting the client with getting out of bed and ambulating with a walker D. ordering a stat chest x-ray following return from the implant procedure 44. You are increasing activity for patient Bon with an admitting diagnosis of acute coronary syndrome. Which of the following symptoms experienced by patient Bon best supports the nursing diagnosis of activity intolerance? A. Pulse rate increased by 15 beats per minute during activity B. Blood pressure (BP) 130/86 mm Hg before activity; BP 108/66 mm Hg during activity C. Increased dyspnea and diaphoresis relieved when sitting in a chair D. A mean arterial pressure (MAP) of 80 following activity 45. Cobra is a patient who suffered an inferior septal wall myocardial infarction. Which of the following complications would you suspect in Cobra when you note on your assessment a jugular venous distention and ascites? A. Left-sided heart failure B. Pulmonic valve malfunction C. Right-sided heart failure D. Ruptured septum Situation – A 35-year old female client presents herself in the outpatient Department with complaints of rashes particularly on the face, across the bridge of the nose and on the cheeks. The client is suspected of having systematic lupus erythematous (SLE). She is admitted to the female medical unit. 46. The nurse writes a care plan for the client. The Nurse is aware that this disorder is a/an ________. A. disease caused by over exposure to sunlight B. Local rash that occurs as a result of allergy. C. inflammatory disease of collagen contained in connective tissues. D. disease caused by the continuous release of histamine in the body. 47. The nurse includes in the care plan dietary instructions. Which of the food items should the nurse instruct the client to AVOID? A. steak B. broccoli C. legumes D. fish 48. The nurse is aware that fatigue is experienced by patients with SLE. Which of the following activities should be a component in the care plan for the client to manage fatigue? To ________. 1. sit whenever possible 2. take a hot shower in the morning 3. avoid long periods of rest 4. engage in moderate low impact exercise when not fatigued 5. maintain a balance diet A. 2, 3, 5 B. 1, 2, 3 C. 1, 2, 3, 4, 5 D. 1, 4, 5 49. The physician schedules the client for plasmapheresis. The client asks the nurse what is plasmapheresis. The nurse explains that it is a method that will __________. A. prevent foreign antibodies from damaging various body tissues B. decrease the damage to organs caused by attacking T-lymphocytes C. eliminate eosinophils and basophils from the blood D. remove antibody-antigen complexes from circulation 50. The nurse monitors the client undergoing plasmapheresis. Which of the following reactions should the nurse observe? A. shortness of breath B. numbness and tingling C. transfusion reactions D. high blood pressure Situation – The nurse assists in the care of clients with chronic obstructi pulmonary disease (COPD). 51. The nurse is aware that clients with COPD are at risk for ineffective respirations EXCEPT which of the following _________? A. Clients undergoing thoracic or abdominal surgery B. Clients with rib fractures and kyphosis C. Clients with neuromuscular disorders such as Guillain-Barre’ syndrome D. Clients with fluid volume deficit 52. Nursing interventions for clients with respiratory acidosis include the following EXCEPT to __________. A. monitor arterial blood gases (ABGs), pH, PCO2, and HCO3 B. administer oxygen and medication as ordered C. monitor hourly vital signs and respiratory status D. administer sedation as ordered by the physician to relax the client 53. The nurse understands that excess acid in the body acts as CNS depressant. Clients with acidosis may exhibit which of the following symptoms: 1. reduced level of consciousness 2. confusion 3. lethargy 4. coma A. all of the options B. 1, 3, & 4 C. 1, 2, 3 D. 1 & 3 54. The goal for treatment for respiratory acidosis is to improve ventilation. Which of the following measures is appropriate for clients with COPD experiencing respiratory acidosis? A. Bronchodilators B. Administer medications as ordered C. Ambulation D. Spirometers 55. The nurse understands that respiratory acidosis occurs when __________: A. the body retains too much carbon dioxide B. the client is unable to exhale carbon dioxide C. the client hyperventilates D. there is loss of acid or retention of base in the body Situation – Nurse Mark is assigned in the oncology unit of a tertiary hospital. He is aware of the increase in the number of colorectal cancer patients in his unit. He and a colleague plan to conduct a study of the incidence of colorectal cancer in the Philippines. 56. Nurse Mark formulates a possible title for the study. Which of the following is the MOST appropriate title? A. “Incidence of Colorectal Cancer in the Philippines” B. “Perceptions of the Filipinos on Colorectal Cancer” C. “Colorectal Cancer in the Philippines: It’s Risk Factors and Interventions” D. “A Comparative Study of Gastrointestinal Cancer Cases among Filipinos” 57. What research design is the MOST suitable to gather data for the study? A. Quasi Experimental B. Correlational Study 4 | Page