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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 *
2 | Page Prepared by: GARCIA, RHYAN P. ROMAN, HANNAH GISELLA B. Hyperglycemia from insufficient insulin leading to lipolysis. C. Overhydration diluting blood glucose levels. D. Excessive glucagon secretion during fasting. 12. Danica asks Nurse Sarah why she needs both rapid-acting and long-acting insulin. Which explanation is best? A. "Long-acting insulin prevents ketones, and rapid- acting lowers fasting glucose." B. "Rapid-acting insulin covers meals, while long-acting mimics basal secretion." C. "You can switch to one insulin type once your pancreas recovers." D. "Both types prevent the liver from making glucose during sleep." Situation: Anna Carter, a 30-year-old Hispanic female at 26 weeks gestation with a BMI of 32 (obesity) and a family history of type 2 diabetes (mother). Newly diagnosed with gestational diabetes, Anna expresses anxiety about her baby’s health. Her husband asks Nurse Maria, "Will this harm the baby? What do we do next?" 13. Nurse Maria reviews Anna’s care plan. Which intervention should be prioritized initially? A. Prescribe insulin therapy. B. Schedule a follow-up oral glucose tolerance test. C. Provide dietary education and blood glucose monitoring. D. Refer to an endocrinologist for pancreatic evaluation. 14. Anna’s husband asks about risks to the baby. Which statement by Nurse Maria is most accurate? A. "The baby may develop type 1 diabetes at birth." B. "There’s a risk of preterm labor due to low blood sugar." C. "Uncontrolled glucose increases the risk of a macrosomia." D. "No risks exist if Anna avoids carbohydrates." 15. Anna asks why she developed gestational diabetes. Nurse Maria explains it is primarily due to: A. Destruction of pancreatic beta cells. B. Placental hormones causing insulin resistance. C. Excessive maternal cortisol production. D. Genetic mutations affecting glucose transporters. 16. At a postpartum visit, Anna says, "My glucose is normal now, so I don’t need diabetes checks." How should Nurse Maria respond? A. "You’re correct; gestational diabetes resolves completely." B. "Schedule annual screenings for type 1 diabetes." C. "Get screened for type 2 diabetes every 3 years." D. "No further testing is needed unless symptoms recur." 17. Nurse Maria develops Anna’s dietary plan. Which component aligns with ADA guidelines? A. Restrict carbohydrates to 100g daily to avoid hyperglycemia. B. Prioritize 175g carbohydrates, 71g protein, and 28g fiber daily. C. Eliminate saturated fats entirely to reduce insulin resistance. D. Recommend intermittent fasting to stabilize glucose levels. Situation: Mr. Samuel Carter, a 58-year-old male with Stage 4 CKD secondary to uncontrolled hypertension and type 2 diabetes. He presents with edema in both legs, fatigue, and shortness of breath. His serum creatinine is 3.8 mg/dL, and he has gained 4 kg in the past week. His wife asks, "Why is he so swollen? What can we do to help him?" 18. Nurse James reviews Mr. Carter’s condition (edema, weight gain, SOB). Which action should the nurse prioritize first? A. Administer IV furosemide (Lasix). B. Obtain a daily weight. C. Restrict dietary sodium intake. D. Prepare for hemodialysis. 19. Mr. Carter’s lab results show hemoglobin 9.2 g/dL. Nurse James explains this anemia is primarily caused by: A. Iron deficiency from poor dietary intake. B. Decreased erythropoietin production by the kidneys. C. Blood loss from gastrointestinal ulcers. D. Bone marrow suppression due to uremia. 20. Nurse James educates Mrs. Carter about managing her husband’s fluid retention. Which statement by her indicates understanding? A. "We’ll limit his fluids to 500 mL daily." B. "I’ll track his daily weight at the same time each morning." C. "He should drink when thirsty to prevent dehydration." D. "Measuring urine output isn’t necessary now." 21. Mr. Carter’s shortness of breath worsens, and crackles are heard in his lungs. Nurse James suspects which complication? A. Hyperkalemia-induced arrhythmia. B. Pulmonary edema from fluid overload. C. Metabolic acidosis causing Kussmaul respirations. D. Pneumonia due to immunosuppression. 22. Nurse James plans interventions for Mr. Carter’s electrolyte imbalances. Which order is most appropriate? A. Administer calcium carbonate with meals. B. Encourage bananas and oranges for potassium. C. Monitor for Trousseau’s sign related to hypophosphatemia. D. Restrict dietary phosphate and administer binders. Scenario: Mr. John Miller, a 62-year-old male undergoing hemodialysis (HD) three times weekly for end-stage kidney disease (ESKD). He weighs 70 kg and has a history of hypertension and takes lisinopril daily. He reports feeling dizzy during his last dialysis session and admits, "I took my blood pressure pill this morning before dialysis." His wife asks, "What can we do to prevent this from happening again?” 23. Nurse Emily reviews Mr. Miller’s medications. Which action should she prioritize first? A. Administer IV fluids to treat hypotension. B. Hold lisinopril on dialysis days. C. Increase the dose of lisinopril post-dialysis. D. Monitor potassium levels for hyperkalemia. 24. Nurse Emily educates Mr. Miller about dietary restrictions. Which statement by him indicates understanding? A. "I can eat bananas and oranges to boost my potassium." B. "I’ll limit my fluid intake to 500 mL daily." C. "I should aim for high-quality protein like eggs and chicken." D. "Sodium isn’t a concern since dialysis removes it." 25. Mr. Miller asks why his potassium levels are high despite dialysis. Nurse Emily explains this is due to: A. Excessive potassium intake from dietary sources. B. Inadequate removal of potassium during dialysis. C. Residual renal function excreting potassium. D. Potassium-binding medications being ineffective. 26. Mr. Miller’s interdialytic weight gain is 3.5 kg. Nurse Emily recognizes this as: A. Within the goal of <4% dry weight. B. Excessive, indicating poor fluid restriction. C. A sign of improved renal function. D. Unrelated to dietary sodium intake. 27. Nurse Emily collaborates with the renal dietitian to plan Mr. Miller’s diet. Which recommendation aligns with HD dietary guidelines? A. "Increase phosphorus intake to strengthen bones." B. "Limit protein to 0.8 g/kg to reduce uremic toxins." C. "Restrict potassium to 2000 mg/day and sodium to 2 g/day." D. "Avoid all fluids to prevent interdialytic weight gain." Situation: Nurse Rachel is assigned to care for Mr. John Davis, a 35‐year–old man who was admitted after falling from a ladder. He experienced a brief loss of consciousness and now presents with headache, dizziness, confusion, and impaired short–term memory.
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:
4 | Page Prepared by: GARCIA, RHYAN P. ROMAN, HANNAH GISELLA A. Dehydration from insufficient intravenous fluid administration. B. Hypokalemia due to excessive potassium loss in urine. C. Fluid overload from rapid rehydration. D. Hypoglycemia due to impaired glucose metabolism. 40. Nurse Sarah plans Mr. Carter’s care during the recovery phase of AKI. Which intervention is most appropriate? A. Restrict protein intake to reduce urea production. B. Monitor serum creatinine and BUN levels weekly. C. Administer potassium supplements to prevent hypokalemia. D. Encourage high sodium intake to replace urinary losses. Situation: Nurse Emily Johnson is caring for Mr. David Thompson, a 68-year-old patient with end-stage kidney disease (ESKD) who has been on hemodialysis (HD) for three years. During assessment, Nurse Johnson notes that Mr. Thompson’s arteriovenous fistula (AVF) in his left forearm has a diminished thrill and no audible bruit. Mr. Thompson reports dizziness and nausea midway through his dialysis session. 41. What is Nurse Johnson’s priority action when assessing the diminished thrill and absent bruit in Mr. Thompson’s AVF? A. Administer heparin to prevent clotting. B. Apply a warm compress to the AVF site. C. Notify the nephrologist and hold dialysis. D. Palpate for a pulse distal to the AVF. 42. Mr. Thompson develops hypotension during dialysis. Which intervention should Nurse Johnson prioritize? A. Stop ultrafiltration and lower the head of the bed. B. Administer IV normal saline bolus. C. Discontinue dialysis immediately. D. Increase the dialysate sodium concentration. 43. Which statement by Mr. Thompson indicates a need for further education about AVF care? A. “I avoid lifting heavy objects with my left arm.” B. “I check for a buzzing sensation daily.” C. “I apply gentle pressure to the site if it bleeds after dialysis.” D. “I use my right arm for blood pressure checks pre- dialysis. My left arm is only used for blood pressure checks post-dialysis. 44. Mr. Thompson’s temporary femoral catheter site is red and tender. Which action by Nurse Johnson is most appropriate? A. Culture the site and start broad-spectrum antibiotics. B. Cleanse the site with chlorhexidine and apply a sterile dressing. C. Remove the catheter and notify the provider. D. Elevate the leg and monitor for edema. 45. Why does Mr. Thompson experience muscle cramps during dialysis? A. Hypercalcemia from dialysate solutions. B. Rapid fluid shifts and electrolyte losses. C. Hypoxia due to anemia. D. Uremic neuropathy progression. Situation: Nurse Emily is caring for Mr. Johnson, a 68- year-old diabetic patient with a surgical wound colonized with methicillin-resistant Staphylococcus aureus (MRSA). The wound exhibits redness, warmth, and purulent drainage. Mr. Johnson’s daughter asks how the infection could spread to others. 46. Nurse Emily plans to interrupt the mode of transmission in the chain of infection. Which action is most effective? A. Administering antibiotics to Mr. Johnson B. Performing hand hygiene before and after wound care C. Applying a sterile dressing to the wound D. Educating the daughter about diabetic diet restrictions 47. Mr. Johnson’s wound culture shows MRSA. Which transmission-based precaution should Nurse Emily initiate? A. Airborne precautions B. Droplet precautions C. Contact precautions D. Standard precautions only 48. Mr. Johnson’s daughter asks why COVID-19 requires stricter masking than MRSA. Nurse Emily’s response should cite which key difference in transmission? A. COVID-19 requires direct blood contact. B. SARS-CoV-2 remains airborne for hours and travels >6 feet. C. MRSA is only transmitted through wounds. D. COVID-19 cannot survive on surfaces. 49. The microbiology report for Mr. Johnson’s wound notes “neutrophils present” and “S. aureus identified.” What does this most likely indicate? A. Colonization without infection B. Latent tuberculosis infection C. Active infection requiring treatment D. Normal flora imbalance 50. To prevent HAIs in Mr. Johnson’s case, Nurse Emily should prioritize: A. Limiting family visits B. Using antiseptic mouthwash C. Hand hygiene before and after patient contact D. Administering prophylactic antivirals SITUATION: A 75-year-old female is admitted to the medical ward for osteoarthritis. 51. The nurse knows that by nature, osteoarthritis can be described as __. A. A local inflammatory disease of the joints B. A systemic and widespread inflammation of the joints and bones C. Degenerative and non-inflammatory breakdown of the joints D. Idiopathic in etiology 52. The PRIMARY goal for acute management of Rheumatoid Arthritis is _____. A. Prevention of contractures and deformities B. Maintenance of optimum function C. Relief from pain D. Maintenance of the client’s body image 53. Heberden’s nodes eventually become a visible manifestation of the client. It is known to be located in the? A. Proximal Interphalangeal Joints B. Distal Interphalangeal Joints C. Large, weight bearing Joints D. None of the above E. All of the above SITUATION: Nurse Cedric is a seasoned medical- surgical nurse. He has extensive experience caring for managing various pain conditions and understands the importance of effective pain management and its impact on patient recovery and overall well-being. 54. Nurse Cedric is caring for a patient involved in a traffic collision who rates their pain as 8/10 on a numeric pain scale. As a knowledgeable nurse, Cedric applies the World Health Organization’s Three Step Ladder for Pain Management. He understands that the most appropriate intervention is ____________________. A. Administering a non-opioid analgesic, such as acetaminophen or ibuprofen. B. Administering a weak opioid, such as codeine, with or without adjuvants. C. Administering a strong opioid, such as morphine, with or without adjuvants. D. Delaying intervention until pain escalates further and re-evaluating later. 55. A patient with chronic back pain rates their pain as 4/10 on the numeric pain scale and requests medication. They have been prescribed ibuprofen 400 mg every 8 hours as needed and tramadol 50 mg every 6 hours as needed. What is the most appropriate nursing action? A. Administer ibuprofen and evaluate pain relief in 1 hour. B. Administer tramadol and evaluate pain relief in 30 minutes. C. Offer a heating pad and delay medication administration.