Tiêu đề RECALLS 7 - NP4 - SC ✅

RECALLS 7 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: You are caring for clients with thyroid and adrenal disorders. Monitoring for medication complications and hormonal imbalances is critical. 1. A client on propylthiouracil (PTU) reports fever and sore throat. What is the best next action? A. Check TSH level B. Discontinue PTU and get WBC count C. Continue PTU and ice throat D. Teach about agranulocytosis risk 2. A client with Addison’s disease reports nausea, abdominal pain, and profound weakness after missing two doses of hydrocortisone. Which action is priority? A. Provide a high-protein snack B. Obtain serum potassium level C. Prepare to administer IV hydrocortisone D. Monitor intake and output 3. Which teaching point is correct for a client with hyperthyroidism? A. Increase intake of high-iodine foods B. Avoid caffeine and high-stimulant drinks C. Increase caloric intake by 50% D. Restrict fluid intake to 1L/day 4. A client after thyroidectomy reports hoarseness and difficulty speaking. What is the nurse’s best response? A. Reassure the client this is expected and temporary B. Notify the provider immediately of airway obstruction C. Assess for neck swelling and stridor D. Offer lozenges for throat irritation 5. A client with Cushing’s syndrome has a blood glucose of 210 mg/dL and reports muscle weakness. What is the most appropriate nursing action? A. Encourage ambulation and low-protein diet B. Restrict fluid and sodium intake C. Monitor glucose and potassium levels D. Prepare to administer calcium supplements Situation: You are teaching diabetic patients about insulin therapy, glycemic patterns, and self-monitoring of blood glucose. 6. A nurse is teaching a diabetic about the dawn phenomenon. Which statement shows correct understanding? A. “I’ll eat a snack before bed to prevent it.” B. “I’ll measure my blood sugar at 3am.” C. “I’ll increase my insulin in the morning.” D. “I’ll work out before dinner.” 7. Which insulin regimen most closely mimics normal pancreatic function? A. NPH insulin once daily at bedtime B. Short-acting insulin only with meals C. Long-acting insulin once daily with rapid-acting at meals D. Intermediate-acting insulin twice daily only 8. A diabetic client with retinopathy is learning about exercise. Which statement indicates correct understanding? A. “I will avoid heavy weightlifting.” B. “I can exercise vigorously without restriction.” C. “Exercise will reverse my vision loss.” D. “I only need to exercise when my blood sugar is above 250 mg/dL.” 9. A client on an insulin pump has blood glucose of 60 mg/dL and feels shaky. What is the best first action? A. Give 15 g of simple carbohydrate B. Turn off the insulin pump C. Notify the provider immediately D. Administer glucagon IM 10. The nurse is teaching foot care to a client with diabetes. Which statement indicates a need for further teaching? A. “I’ll inspect my feet every day.” B. “I’ll go barefoot at home to strengthen my feet.” C. “I’ll trim toenails straight across.” D. “I’ll wear well-fitting shoes.” Situation: You are caring for patients with acute abdominal emergencies and gastrointestinal disorders. Prompt recognition of complications is essential. 11. Which assessment finding is most concerning in a client with acute pancreatitis? A. Epigastric pain B. Grey-Turner’s sign C. Nausea and vomiting D. Fever 12. Which of the following best indicates resolution of bowel obstruction? A. Distended abdomen B. Absent bowel sounds C. Passage of flatus D. Increased pain 13. A client post-cholecystectomy reports right upper quadrant pain radiating to the shoulder and nausea. What is the nurse’s best initial action? A. Administer ordered opioid analgesic B. Assess for abdominal rigidity and rebound tenderness C. Apply a heating pad to the abdomen D. Encourage deep breathing and coughing 14. A patient with cirrhosis has ascites and dyspnea. Which position best promotes comfort? A. Supine with pillows under the knees B. High Fowler’s with feet dependent C. Prone with head elevated D. Side-lying with knees flexed 15. Which dietary teaching is appropriate for a client with a new ileostomy? A. “Eat high-fiber foods to regulate output.” B. “Limit fluid intake to reduce stool output.” C. “Chew food thoroughly and avoid high-fiber foods initially.” D. “Increase raw fruits and vegetables for bowel health.” 16. A 55-year-old man with a history of alcoholism presents with hematemesis and melena. He is pale, diaphoretic, and 1 | Page
hypotensive (BP 80/50 mmHg, HR 122/min). What is the nurse’s priority intervention? A. Insert a large-bore IV line and prepare for fluid resuscitation B. Prepare the patient for colonoscopy C. Position the patient flat and keep NPO D. Administer an antiemetic 17. A patient with cirrhosis and esophageal varices suddenly begins vomiting bright red blood. The nurse notes confusion and a distended abdomen with ascites. Which intervention is most important? A. Insert a nasogastric tube for gastric lavage B. Place the patient in a high Fowler’s position and give oxygen C. Administer oral vitamin K to reduce bleeding D. Encourage fluids to maintain hydration 18. A 43-year-old woman with peptic ulcer disease complains of sudden, severe abdominal pain radiating to the shoulder, with a rigid abdomen. Her blood pressure is 90/60 mmHg, and pulse is 118/min. What is the nurse’s best immediate action? A. Administer an antacid and reassess pain B. Insert a nasogastric tube and prepare for surgery C. Give oral sucralfate to coat the stomach lining D. Encourage fluids to prevent dehydration 19. A client with hepatic encephalopathy is increasingly drowsy and has asterixis (flapping tremor). The family asks why the client is receiving lactulose. What is the nurse’s best explanation? A. “It helps stop bleeding from the liver.” B. “It reduces fluid buildup in your abdomen.” C. “It decreases ammonia levels that affect brain function.” D. “It stimulates your liver to regenerate.” 20. A post-gastrectomy client develops dizziness, tachycardia, and diaphoresis 20 minutes after eating. What is the nurse’s priority action? A. Encourage fluids during meals to improve digestion B. Place the patient in a recumbent position and monitor C. Give an immediate dose of insulin D. Offer a snack high in simple carbohydrates Situation: You are the charge nurse in a busy medical-surgical unit supervising a mixed team of registered nurses (RNs), licensed practical nurses (LPNs), and nursing assistants (NAs). Your priority is to ensure safe delegation, ethical practice, and proper patient education while handling time-sensitive tasks. 21. A nursing assistant reports a blood pressure of 90/60 mmHg on a post-op client who is pale and diaphoretic. What is the nurse’s first action? A. Reassess the blood pressure manually. B. Document the finding in the chart. C. Ask the NA to recheck it in 15 minutes. D. Notify the provider immediately without reassessing. 22. A nurse delegates feeding a stroke client with dysphagia to an NA. Which instruction is most important? A. “Feed them quickly to reduce fatigue.” B. “Keep them upright at 90 degrees during and after feeding.” C. “Offer thin liquids between each bite.” D. “Use a straw for easier fluid intake.” 23. An LPN asks which tasks they can perform. Which assignment is appropriate? A. Developing a new care plan for a client with sepsis. B. Administering oral antibiotics to a stable client. C. Performing the initial admission assessment. D. Teaching a client about insulin self-administration. 24. During rounds, you find a confused client attempting to pull out their IV line. What is the best immediate nursing action? A. Apply wrist restraints immediately. B. Reorient the client and offer a distraction. C. Document the incident only. D. Assign a staff member to sit with the client. 25. Which situation demonstrates advocacy? A. Supporting a client’s decision to refuse chemotherapy despite family pressure. B. Telling the client that the doctor’s orders cannot be changed. C. Encouraging a client to “just do what the doctor says.” D. Reminding a client that they have no right to refuse life-saving treatment. Situation: You are mentoring a new graduate nurse who struggles with ethical dilemmas, patient teaching, and infection control practices. Your role is to guide safe practice and reinforce core nursing principles. 26. A client says, “I don’t want CPR if I stop breathing.” Which action is most appropriate? A. Document the client’s statement as a DNR order. B. Inform the provider to discuss advance directives. C. Encourage the client to reconsider. D. Tell the family to decide what’s best. 27. Which infection control practice is correct when caring for a client with C. diff.? A. Use alcohol-based sanitizer after removing gloves. B. Wear a mask when within 3 feet of the client. C. Use soap and water handwashing after glove removal. D. Double-glove during all patient care. 28. A nurse educator teaches the principle of fidelity. Which statement shows understanding? A. “I will respect my client’s right to refuse treatment.” B. “I will keep promises and follow through with care I commit to.” C. “I will ensure that resources are distributed fairly.” D. “I will avoid harming my clients.” 29. Which teaching method is best for an older adult with mild hearing loss? A. Providing written instructions in large print. B. Speaking rapidly to finish instructions quickly. C. Turning away from the client while speaking. D. Increasing environmental noise for stimulation. 30. A client refuses a prescribed blood transfusion due to religious beliefs. Which is the nurse’s best response? A. “You must accept this treatment to save your life.” B. “Tell me more about your concerns and beliefs.” C. “I will explain why your family wants you to take it.” D. “You don’t have the right to refuse lifesaving care.” Situation: You are leading an ethics seminar for nurses, highlighting real clinical scenarios to help staff correctly identify ethical principles. 31. A nurse allows a competent client to sign an informed refusal form after explaining all potential consequences. Which principle is primarily upheld? A. Justice B. Autonomy C. Veracity D. Fidelity 32. A nurse documents all assessments truthfully and refrains from altering records, even under pressure. This best reflects: A. Veracity and fidelity B. Beneficence and justice C. Autonomy and non-maleficence D. Privacy and confidentiality 33. While caring for two patients, one wealthy and one homeless, the nurse provides equal attention and resources. Which principle applies? A. Justice B. Beneficence C. Autonomy D. Fidelity 34. After giving the wrong medication, the nurse immediately informs the client and provider, then completes an incident report. Which principle is shown? A. Non-maleficence B. Autonomy C. Veracity a. Privacy 35. A nurse follows through with a promise to return with pain medication within 10 minutes. This reflects: A. Justice B. Fidelity C. Privacy D. 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Situation: You are evaluating nursing practices during an ethics audit in a tertiary hospital. Your focus is to ensure nurses understand when multiple principles overlap. 36. A nurse explains risks and benefits of a clinical trial and gives the patient time to decide. This demonstrates which principles? A. Fidelity and privacy B. Veracity and autonomy C. Justice and beneficence D. Non-maleficence and fidelity 37. A nurse refuses to share a client’s HIV status with a friend who asks. Which ethical principle is prioritized? A. Justice B. Privacy and confidentiality C. Beneficence D. Autonomy 38. A nurse positions side rails and keeps the bed in the lowest position for a confused client. Which principle is demonstrated? A. Beneficence B. Autonomy C. Justice D. Fidelity 39. During discharge teaching, the nurse notices the client is drowsy and defers teaching to a later time. This respects which principle? A. Justice B. Fidelity C. Autonomy D. Non-maleficence 40. A nurse ensures each patient gets pain medication on time, regardless of how busy the shift is. Which ethical principle is at work? A. Justice B. Autonomy C. Privacy D. Veracity Situation: You are assigned to the psychiatric unit, caring for clients with schizophrenia, mood disorders, and suicidal risk. You must prioritize safety while using therapeutic communication techniques. 41. Which therapeutic communication technique is used when a nurse says, “Tell me more about what happened before you felt anxious”? A. Giving advice B. Exploring C. Belittling feelings D. Reassuring 42. A client states, “I want to end my life.” What is the nurse’s priority? A. Ask, “Why do you feel this way?” B. Confront the client about their choices C. Ask directly if there is a specific plan D. Offer to distract the client with an activity 43. Which symptom is most associated with command auditory hallucinations? A. The client repeatedly washes hands B. The client hears voices telling them to act C. The client expresses irrational fear of strangers D. The client avoids eye contact and becomes mute 44. A client says, “The TV is sending me secret messages.” Which is the nurse’s best response? A. “That’s impossible, the TV cannot do that.” B. “It seems like you feel concerned about the messages.” C. “We need to remove the TV from your room immediately.” D. “Why do you think the TV is sending messages?” 45. Which finding is considered a negative symptom of schizophrenia? A. Hearing voices B. Flat affect C. Grandiose delusions D. Disorganized speech Situation: You are caring for clients with bipolar disorder and major depression. Your role includes medication management, suicide precautions, and client teaching. 46. Which client statement indicates understanding of lithium therapy? A. “I will double my dose if I feel manic.” B. “I need to keep my salt and fluid intake consistent.” C. “I should stop taking lithium if I feel tremors.” D. “This drug will work instantly for my mood swings.” 47. What is the therapeutic serum lithium level? A. 0.1–0.4 mEq/L B. 0.5–1.5 mEq/L C. 2.0–3.0 mEq/L D. >3.5 mEq/L 48. Which behavior is characteristic of a manic episode? A. Withdrawn, decreased energy, low self-esteem B. Flight of ideas, decreased sleep, risky behavior C. Repetitive hand-washing and counting rituals D. Tearfulness and social isolation 49. What is the primary nursing goal for a severely depressed client? A. Encourage group participation B. Promote safety and assess suicide risk C. Discuss long-term employment goals D. Teach complex coping strategies 50. Which food should a client on MAOI avoid?\ A. Fresh bananas B. Aged cheddar cheese C. Baked chicken breast D. Rice and steamed vegetables Situation: You are assigned to clients with eating disorders and mood disorders. Your priority is to recognize complications, promote safety, and reinforce therapeutic interventions. 51. A client with bulimia nervosa most likely exhibits which physical finding? A. Low BMI and lanugo hair B. Dental erosion and parotid swelling C. Amenorrhea and osteoporosis D. Hyperpigmentation and alopecia 52. A nurse encourages a depressed client to join a morning group activity. This demonstrates which therapeutic strategy? A. Confrontation B. Behavioral activation C. Cognitive reframing D. Systematic desensitization 53. Which is an expected finding in PTSD? A. Amnesia for identity and relationships B. Recurrent intrusive memories and hypervigilance C. Social detachment only D. Delusions of persecution 54. Which statement by a client taking sertraline requires further teaching? A. “I may not feel better for several weeks.” B. “I should avoid abruptly stopping the medication.” C. “It’s okay to take St. John’s Wort for added effect.” D. “I might have some sexual side effects.” 55. A nurse is using motivational interviewing with a client who abuses substances. Which statement reflects this technique? A. “You must quit now or face the consequences.” B. “Tell me what you like and dislike about your substance use.” C. “If you don’t stop, you could die.” D. “You know using is wrong, don’t you?” Situation: You are managing clients with withdrawal syndromes, suicide risk, and severe anxiety episodes. Quick recognition and immediate safety measures are essential 56. The nurse cares for a client in methamphetamine withdrawal. Which symptom is expected? A. Euphoria and hyperactivity B. Severe depression and fatigue C. Seizures and vomiting D. Violent hallucinations 57. Which is a priority outcome for a suicidal client? A. Expressing reasons for living 3 | Page