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RECALLS EXAMINATION 5 NURSING PRACTICE III CARE OF CLIENTS WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART A) 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 III” on the box provided Situation: A newly graduated nurse is preparing to apply for licensure in the Philippines. They are studying Republic Act 9173 to understand the qualifications, responsibilities, and ethical standards required for professional practice in the country. 1. What additional qualifications must a nurse possess to occupy the position of chief nurse or director of nursing service as per RA 9173? A. A master's degree major in nursing and at least five (5) years of experience in a supervisory or managerial position in nursing B. A master's degree in any field and at least three (3) years of experience in nursing service administration C. A bachelor's degree in nursing and at least ten (10) years of experience in a managerial position D. A bachelor's degree in nursing and at least five (5) years of experience in general nursing 2. According to RA 9173, what is the term of office for each member of the Board of Nursing? A. 2 years B. 3 years C. 4 years D. 5 years 3. According to RA 9173, how many members are there in the Board of Nursing? A. 3 members B. 5 members C. 7 members D. 9 members 4. Under RA 9173, which of the following is NOT a ground for the revocation or suspension of a nurse's certificate of registration/professional license? A. Unprofessional and unethical conduct B. Gross incompetence or serious ignorance C. Refusal to participate in continuing education D. Malpractice or negligence in the practice of nursing 5. When does RA 9173, the Philippine Nursing Act of 2002, take effect? A. Thirty (30) days after signing by the President B. Fifteen (15) days after approval by Congress C. Fifteen (15) days after publication in the D. Official Gazette or in any two (2) newspapers of general circulation in the Philippines Immediately after being signed by the President Situation: You are Nurse Sung Deok-sun, providing education to Choi Taek, a 16-year-old with Type 1 Diabetes Mellitus. Your focus includes understanding the etiology of diabetes, assessing self-care skills, managing complications, and appropriate emergency interventions. 6. Choi Taek, newly admitted, asks about the cause of his Type 1 diabetes. What process should you describe to him? A. The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase. B. Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it. C. The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin. D. Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down. 7. Choi Taek has reported a positive urine ketone test. What is the most appropriate nurse's response based on this finding? A. The patient should withhold his next scheduled dose of insulin. B. The patient should promptly eat some protein and carbohydrates. C. The patient's insulin levels are inadequate. D. The patient would benefit from a dose of metformin (Glucophage). 8. Which criterion supports the diagnosis of diabetes and warrants checking blood glucose levels? A. Fasting plasma glucose greater than or equal to 126 mg/dL B. Random plasma glucose greater than 150 mg/dL C. Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions D. Random plasma glucose greater than 126 mg/dL 9. Choi Taek reports abdominal pain, appears weak, and is displaying Kussmaul respirations at 30 breaths/minute. What prescriptions should you implement in his care? (Select all that apply.) 1. Dextrose 50% by intravenous (IV) push 2. Regular insulin by IV infusion 3. Obtain a STAT capillary blood glucose measurement 4. Start an IV line and begin an infusion of 0.9% sodium chloride 5. Draw blood for the prescribed serum potassium level A. 1, 3, 4 B. 1, 2, 3, 4 C. 2, 3, 4, 5 D. All of the above 10. The nurse is reviewing medication orders for Choi Taek. Which prescription should the nurse clarify with the healthcare provider (HCP)? A. 12 units of subcutaneous detemir insulin daily at 2000 B. 8 units of regular insulin by IV infusion for serum glucose greater than 300 mg/dL C. 16 units of subcutaneous lispro insulin daily at 1000 before breakfast D. 18 units of NPH insulin PO daily at 0700 for blood glucose greater than 80 mg/dL Situation: You are Nurse Sung Deok-sun, providing education to Kim Jung Hwan, a 55-year-old recently diagnosed with Type 2 Diabetes Mellitus. Your focus includes understanding the etiology of diabetes, assessing self-care skills, managing complications, and appropriate emergency interventions. 1 | Page
11. Kim Jung Hwan, newly diagnosed with Type 2 diabetes, asks about the primary treatment approach. What should you emphasize? A. “A pancreas transplant will cure my diabetes.” B. “I will take my oral antidiabetic agents only when my blood sugar is high.” C. “I will follow the weight loss plan provided by the dietitian.” D. “I will call the diabetes educator whenever I have questions about my insulin.” 12. Kim Jung Hwan, who has been managing his Type 2 diabetes with oral medications and lifestyle changes, presents to the emergency department with a blood glucose level of 623 mg/dL and confusion following a recent gastrointestinal virus. What is the priority nursing action? A. Administer antihypertensive medications. B. Administer sodium bicarbonate intravenously. C. Reverse acidosis by administering insulin. D. Perform fluid and electrolyte replacement. 13. Kim Jung Hwan is at risk for Hyperglycemic Hyperosmolar Syndrome (HHS). In which population is HHS most commonly observed? A. Obese patients with no known history of diabetes. B. Patients with Type 1 diabetes and poor dietary control. C. Adolescents with Type 2 diabetes and sporadic use of antihyperglycemics. D. Middle-aged or older individuals with Type 2 diabetes or no known history of diabetes. 14. Kim Jung Hwan asks how long he can store a vial of insulin at room temperature before it goes bad. What is the best response? A. “If you use the vial within 1 month, it can be kept at room temperature.” B. “If you use the vial within 21 days, it may be kept at room temperature.” C. “If you use the vial within 2 weeks, it may be kept at room temperature.” D. “If you use the vial within 1 week, it may be kept at room temperature.” 15. Kim Jung Hwan, who has been diagnosed with Type 2 diabetes-related peripheral neuropathy, is receiving health education. Which of the following recommendations should the registered nurse (RN) provide? Select all that apply. 1. “Every day, check your feet, especially in the spaces between your toes, and report any changes in skin right away.” 2. “Avoid wearing socks to reduce the amount of perspiration and irritation on your skin.” 3. “Before stepping into the tub, use a thermometer to check the water's temperature.” 4. “Prevent nail breakage by keeping toenails clipped close to the skin.” 5. “Wear well-fitting, closed-toe shoes at all times, even when indoors.” A. 1, 3, 5 B. 2, 4, 5 C. 1, 3 D. All of the above Situation: Nurse Seo Woo-jin is managing the care of Cha Eun-jae, a 34-year-old female patient who was admitted with severe headache and altered mental status. After thorough diagnostic testing, Cha Eun-jae has been diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Nurse Seo Woo-jin needs to monitor her condition closely, manage her symptoms, and educate her about the treatment plan. 16. Cha Eun-jae is diagnosed with SIADH. Which of the following clinical manifestations should Nurse Seo Woo-jin expect to find during the assessment? Select all that apply. 1. Elevated serum osmolality 2. Elevated urine specific gravity 3. Decreased serum osmolality 4. Decreased urine output 5. Decreased serum sodium A. 2, 3, 5 B. 1, 4, 5 C. 2, 3, 4, 5 D. All of the above 17. Cha Eun-jae’s serum sodium level is critically low at 120 mEq/L. Nurse Seo Woo-jin understands that which of the following treatments is appropriate for severe hyponatremia in SIADH? A. Rapid infusion of hypotonic saline B. Slow infusion of isotonic saline C. Rapid infusion of hypertonic saline D. Administration of diuretics 18. Cha Eun-jae is prescribed demeclocycline for her SIADH. Nurse Seo Woo-jin knows that the purpose of this medication is to: A. Increase ADH secretion B. Decrease renal response to ADH C. Replace deficient ADH D. Promote water retention 19. During the follow-up visit, Nurse Seo Woo-jin reviews Cha Eun-jae’s sodium levels. Which range of serum sodium is considered critical and requires immediate intervention? A. 130-135 mEq/L B. 125-130 mEq/L C. 115-120 mEq/L D. 140-145 mEq/L 20. What is a priority nursing diagnosis for Cha Eun-jae who has been diagnosed with SIADH? A. Risk for peripheral neurovascular dysfunction B. Excess fluid volume C. Hypothermia D. Ineffective airway clearance Situation: Nurse Anneliese is assigned to Erika, a 35-year-old teacher diagnosed with diabetes insipidus (DI) after a car accident caused head trauma. Erika has been experiencing excessive thirst and urination. Nurse Anneliese needs to manage Erika's symptoms and provide education on her condition and treatment plan. 21. Erika complains of severe thirst. What is the underlying cause of this symptom in diabetes insipidus? A. Elevated blood glucose levels B. Increased renal reabsorption of water C. Deficient antidiuretic hormone (ADH) production D. High serum calcium levels 22. Nurse Anneliese notices that Erika's serum sodium levels are elevated. What does this indicate in the context of diabetes insipidus? A. Effective management of fluid balance B. Dehydration due to excessive urine output C. Overhydration from excessive fluid intake D. Normal renal function 23. Erika's urine output is being monitored. Which of the following would indicate effective management of her DI? A. Urine output decreases to 1.5 liters per day B. Urine specific gravity increases to 1.030 C. Serum sodium levels decrease to 125 mEq/L D. Erika reports severe headaches 24. During a follow-up visit, Erika mentions frequent headaches. What potential complication should Nurse Anneliese consider? A. Hyperglycemia B. Hyponatremia C. Hypercalcemia D. Hypokalemia 25. Nurse Anneliese is educating Erika about the signs of water intoxication. Which symptom should she highlight? A. Increased thirst B. Dry mucous membranes C. Sudden weight loss D. Reduced urine output Situation: Nurse Yoon Seo Jung is assessing a male patient, Kang Dong Joo, who has recently been diagnosed with Addison’s disease. The focus is on understanding clinical manifestations, appropriate interventions, and management strategies. 26. Kang Dong Joo, newly diagnosed with Addison’s disease, exhibits several symptoms. Which of the following clinical signs should Nurse Yoon Seo Jung expect? Select all that apply. 1. Increased body or facial hair 2 | Page
2. Purple or red striae on the abdomen 3. Skin color that is tanned in appearance 4. Orthostatic hypotension 5. Anorexia and weight loss A. 3, 4, 5 B. 1, 3, 5 C. 3, 4 D. 1, 4 27. Kang Dong Joo is experiencing signs of an Addisonian crisis. Which of the following should Nurse Yoon Seo Jung prioritize in the management of this crisis? A. Administer high-dose hydrocortisone intravenously as prescribed. B. Encourage increased oral fluid intake without medical supervision. C. Increase the dose of oral glucocorticoids immediately. D. Monitor blood glucose levels and provide immediate glucose supplementation. 28. Kang Dong Joo’s Addison’s disease requires ongoing management. Which dietary recommendation is most appropriate for him? A. High protein and carbohydrate diet. B. Low-sodium and high-potassium diet. C. Low-protein and high-fat diet. D. High-fiber and low-carbohydrate diet. 29. Kang Dong Joo’s laboratory results show hyperkalemia and hyponatremia. What is the significance of these findings in the context of Addison’s disease? A. They indicate an acute exacerbation of heart failure. B. They are consistent with the electrolyte imbalances seen in Addison’s disease. C. They suggest a complication from diabetes mellitus. D. They are a sign of renal failure. 30. Which lifestyle adjustment should Nurse Yoon Seo Jung emphasize for Kang Dong Joo to help manage his Addison’s disease effectively? A. “Increase your physical exercise to boost overall health.” B. “Avoid situations that may lead to physical or emotional stress.” C. “Engage in regular high-intensity workouts to improve endurance.” D. “Limit your fluid intake to prevent fluid overload.” Situation: Nurse Lee Mi-hyun is working at a busy regional hospital in the Philippines. She is assigned to manage the care of Kim Doo-shik, a local businessman who has recently been diagnosed with Cushing's syndrome. Kim Doo-shik has been struggling with the symptoms of his condition while trying to maintain his demanding job. Nurse Lee Mi-hyun needs to coordinate his care, address his concerns about the disease, and help him manage his treatment plan effectively while considering his lifestyle and the local healthcare resources available. 31. Kim Doo-shik, newly diagnosed with Cushing’s syndrome, is presenting with specific physical signs. Which of the following manifestations should Nurse Lee Mi-hyun expect? Select all that apply. 1. Moon facies 2. Thin, fragile skin 3. Hyperpigmentation of the skin 4. Truncal obesity 5. Hirsutism A. 1, 4 B. 1, 2, 4 C. 1, 2, 4, 5 D. All of the above 32. Kim Doo-shik has been prescribed mitotane for his Cushing’s syndrome. What should Nurse Lee Mi-hyun instruct him about this medication? A. Mitotane is used to stimulate adrenal hormone production. B. Mitotane can cause hyperglycemia and should be monitored closely. C. Mitotane is used to suppress ACTH production from the pituitary gland. D. Mitotane is a form of chemotherapy used to reduce cortisol levels by targeting adrenal glands. 33. Nurse Lee Mi-hyun is reviewing Kim Doo-shik’s medication regimen. Which of the following instructions should she give him regarding corticosteroid therapy? A. Take the medication at bedtime to mimic the natural cortisol rhythm. B. Take the medication in the morning to align with the body's natural cortisol secretion. C. Take the medication with meals to reduce gastrointestinal irritation. D. Take the medication at noon to manage symptoms effectively. 34. During Kim Doo-shik’s follow-up visit, Nurse Lee Mi-hyun reviews his lab results. His serum sodium is elevated, and his potassium is low. What should Nurse Lee Mi-hyun infer about these findings? A. These electrolyte imbalances are typical of primary adrenal insufficiency. B. The electrolyte changes are consistent with Cushing’s syndrome, indicating mineralocorticoid excess. C. These findings suggest acute adrenal crisis. D. The lab results are indicative of a side effect of antidiabetic medication. 35. Nurse Lee Mi-hyun is preparing Kim Doo-shik for a dexamethasone suppression test. What should she explain to him about this test? A. The test involves intravenous administration of dexamethasone and subsequent imaging of the adrenal glands. B. The test involves oral administration of dexamethasone at 11 PM, with a plasma cortisol level checked at 8 AM. C. The test involves oral administration of dexamethasone, followed by hourly plasma cortisol levels for 3 hours. D. The test involves intravenous administration of dexamethasone, followed by plasma cortisol measurement 3 hours later. Situation: Nurse Jeong Gu-won is caring for Do Do-Hee, a 45-year-old female who has been admitted to the hospital with a diagnosis of Graves' disease. Do Do-Hee has been experiencing severe symptoms of hyperthyroidism, including agitation, tremors, and high fever. Upon examination, her symptoms suggest the possibility of thyroid storm. Nurse Jeong Gu-won needs to assess her condition, implement immediate interventions, and provide patient education about managing her hyperthyroidism effectively. 36. Which clinical manifestation is characteristic of Graves' disease and would Nurse Jeong Gu-won expect to observe in Do Do-Hee? 1. Exophthalmos 2. Irregular heart rhythm 3. Obesity 4. Insomnia and anxiety 5. Hand tremors 6. Increased perspiration A. 1, 2, 4, 6 B. 1, 3, 4, 5, 6 C. 1, 3, 4, 5 D. 1, 2, 4, 5, 6 37. When planning Do Do-Hee's diet to manage hyperthyroidism, what should Nurse Jeong Gu-won include in her meal plan? A. Small, frequent meals, high in protein and calories B. Large, bland meals C. Clear liquid diet D. High-fiber and low-fat diet 38. Which laboratory finding is most indicative of hyperthyroidism in Do Do-Hee? A. Elevated TSH levels B. Low T3 and T4 levels C. Elevated T3 and T4 levels D. Normal T3 and T4 levels 39. Which symptom should Nurse Jeong Gu-won be most vigilant for in managing Do Do-Hee’s thyroid storm? A. Elevated appetite and weight gain B. Severe agitation and delirium C. Decreased urinary frequency D. Increased dryness of the skin 3 | Page
40. What is the primary goal of treatment for thyroid storm? A. Decrease thyroid hormone levels B. Decrease thyroid gland size C. Increase thyroid hormone production D. Normalize thyroid function tests Situation: Nurse Pia is preparing to administer a unit of packed red blood cells (PRBCs) to Rancho, who has a diagnosis of severe anemia. Nurse Pia ensures that all necessary preparations are in place before starting the transfusion. 41. What is Nurse Pia's first action before starting the blood transfusion? A. Prime the IV tubing with normal saline. B. Check Rancho's identification band and confirm the blood type with another nurse. C. Administer pre-medications as prescribed. D. Assess Rancho's baseline vital signs. 42. After starting the transfusion, Nurse Pia observes that Rancho begins to show signs of a transfusion reaction, including chills, back pain, and fever. What is the most appropriate initial action for Nurse Pia? A. Stop the transfusion immediately and disconnect the blood bag. B. Administer acetaminophen and continue monitoring Rancho. C. Apply a warm compress to Rancho’s back and continue the transfusion slowly. D. Notify the blood bank to report the reaction. 43. Nurse Pia is preparing to administer a unit of fresh-frozen plasma (FFP) to Rancho. Which of the following is the correct procedure for administering FFP? A. Infuse the FFP over 1 to 2 hours. B. Use a blood warmer to heat the FFP before infusion. C. Administer the FFP with normal saline through a blood transfusion pump. D. Infuse the FFP immediately upon thawing and complete the infusion within 30 minutes. 44. Rancho’s blood transfusion is nearly complete, and Nurse Pia notes that it has been infusing for over 4 hours. What is the best course of action for Nurse Pia? A. Continue the transfusion until the bag is empty. B. Reduce the infusion rate and continue the transfusion. C. Stop the transfusion and dispose of the remaining blood. D. Return the remaining blood to the blood bank. 45. To ensure the safe and effective administration of the blood product, Nurse Pia needs to use the correct gauge for the IV catheter. What is the appropriate range of gauge sizes for the IV catheter used in blood transfusion? A. 16-gauge to 18-gauge B. 18-gauge to 20-gauge C. 20-gauge to 22-gauge D. 22-gauge to 24-gauge Situation: Nurse Claudine is managing Rico’s care in the hospital for congestive heart failure (CHF). Rico’s symptoms are being monitored and adjusted as needed. Nurse Claudine needs to ensure that all aspects of his care, including medication management, lifestyle changes, and disease monitoring, are optimized. 46. Nurse Claudine is reviewing Rico's treatment plan for congestive heart failure. Which medication class is considered a cornerstone of CHF management due to its ability to reduce afterload and improve cardiac output? A. Angiotensin-converting enzyme (ACE) inhibitors B. Diuretics C. Beta-blockers D. Calcium channel blockers 47. Rico presents with orthopnea and dyspnea. Upon lung auscultation, Nurse Claudine hears fine crackles that do not clear with coughing. What is the most likely cause of these lung sounds? A. Bronchitis B. Atelectasis C. Pulmonary edema D. Lung cancer 48. Nurse Claudine is explaining the procedure of a stress test to Rico. Which of the following best describes how a stress test is performed? A. The patient is given medication to increase heart rate while lying down. B. The patient exercises on a treadmill or stationary bike while their heart rate, blood pressure, and ECG are monitored. C. The patient undergoes an echocardiogram while at rest. D. The patient receives an injection of a radioactive substance, and images of the heart are taken. 49. Nurse Claudine is educating Rico on how to manage his CHF at home. Which statement by Rico indicates he has understood the importance of monitoring his condition? Select all that apply. 1. "I will take my medications as prescribed and not skip doses." 2. "I’ll check my weight every day at the same time and report any significant changes." 3. "I’ll avoid all physical activity to prevent fatigue." 4. "I will limit my fluid intake and avoid high-sodium foods." 5. "I’ll see my healthcare provider only when I feel very sick." A. 1, 2, 4 B. 1, 2, 5 C. 2, 3, 4 D. 3, 4, 5 50. Rico reports experiencing fatigue and shortness of breath during moderate exertion, such as walking up a flight of stairs. He has no symptoms at rest. Based on the New York Heart Association (NYHA) Classification, how would you classify Rico's heart failure? A. NYHA Class I B. NYHA Class II C. NYHA Class III D. NYHA Class IV 51. Nurse Sandiego, a senior nurse, is teaching his students about caring for a client immediately following transsphenoidal hypophysectomy. It would be essential for him to obtain a prescription for which medication? A. Ondansetron B. Methimazole C. Omeprazole D. Methylphenidate 52. The senior nurse conducts a lecture for nursing students. It would be appropriate for him to state which of the following procedures requires a sterile technique? Select all that apply. A. Changing the dressing for a central line B. Inserting an indwelling urinary catheter C. Removing a peripheral vascular access device D. Suctioning an endotracheal tube with in-line suction E. Inserting a nasogastric tube (NGT) 53. He is now teaching the class on acid-base imbalances. It would be correct for the class to identify which of the following would cause respiratory acidosis? Select all that apply. A. Aspirin overdose B. Pneumothorax C. Opioid overdose D. Anxiety E. Renal disease 54. He then comes back to the hospital and cares for assigned clients. He should initially intervene when the client reports: A. nausea during an infusion of amphotericin B. palpitations after receiving rapid-acting insulin. C. drowsiness after receiving fentanyl. D. itching in the perineal area while receiving intravenous dexamethasone. 55. He is now then teaching a group of students a potential cause of metabolic alkalosis. It would indicate a correct understanding if a student stated which condition could cause this acid-base imbalance? A. Hyperventilation B. Urinary retention C. Opioid toxicity D. Excessive vomiting 56. Which of the following interventions is helpful in reducing the effects of GERD? A. Lie down after eating. B. Wear a girdle. C. Elevate the head of the bed on 4-6 inch blocks. D. Increase fluid intake just before bedtime. 4 | Page