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RECALLS EXAMINATION 5 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 1. Nurse Dagul is assessing a client with drooping of their left eyelid. He documents this finding as A. mydriasis. B. ptosis. C. presbyopia. D. hyphema. 2. He is now caring for a client following a stroke. The client can understand instructions but is unable to express himself verbally. He anticipates that this stroke has impacted which lobe of the client's brain? A. Frontal lobe B. Parietal lobe C. Temporal lobe D. Occipital lobe 3. He then receives a client with myocardial infarction (MI), who is receiving tissue plasminogen activator (tPA), he should plan to prioritize which of the following? A. Observe for neurological changes B. Monitor for any signs of renal failure C. Observe for signs of bleeding D. Check the client’s food diary 4. Dags is now planning to perform a dressing change for a client with a stage three pressure injury. He should initially perform which action? A. Gather all the necessary equipment B. Use non-sterile gloves to remove the old dressing C. Documenting the characteristics of the wound D. Administer prescribed oral pain medication 5. He cares for assigned clients. He should initially follow-up on the client who: A. has chronic back, neck, and shoulder pain and is crying. B. is being treated for pneumonia and reports a persistent cough with thick, yellow mucus. C. had a colostomy placed three hours ago and has an edematous stoma with scant bloody drainage. D. is being treated for diabetes insipidus, and the family member reports the client has developed confusion. 6. Nurse Sarah is assessing a client receiving peritoneal dialysis. Which laboratory result should immediately be reported to the doctor? A. WBC 19,000 mm3 B. Hemoglobin 9 g/dL C. Calcium 8.6 mg/dL D. Serum pH 7.33 7. Nurse Sarah is assessing a client with systemic lupus erythematosus (SLE). Which laboratory data is essential for her to monitor to determine if the client is experiencing a complication? A. urine analysis B. hemoglobin A1C (HbA1C) C. thyroid-stimulating hormone (TSH) D. ammonia 8. She has received the following prescriptions for newly admitted clients. Which prescription should she administer first? A. Aspirin to a client experiencing an acute myocardial infarction B. Lisinopril to a client with essential hypertension C. Risperidone to a client with schizophrenia D. Levodopa-carbidopa to a client with Parkinson’s disease 9. The occupational health nurse is conducting an in-service on reducing back injuries. Which of the following statements, if made by a participant, would indicate a correct understanding of the conference? A. "I should keep my legs straight while lifting." B. "Heavy objects should be held away from my body." C. "I shouldn't twist while lifting an object." D. "I should keep a narrow base of support." 10. The nurse is assessing a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following laboratory tests require careful monitoring? A. Potassium B. Sodium C. Glucose D. Magnesium 11. John is caring for a client with heart failure. Which medication should he clarify with the doctor? A. lisinopril B. Prednisone C. Hydralazine D. carvedilol 12. John is providing asthma education to a teen that has just been diagnosed with asthma. Which of the following statements by the client would indicate a need for further teaching? Select all that apply. A. “When I am having an asthma attack, I should call 911 first.” B. “When I am having an asthma attack, my airway is constricting, and it can become dangerous.” C. “I should try to identify what causes me to have an asthma attack and avoid those activities.” D. “I’ve really been wanting to get a dog and my asthma will not stop me.” E. "I should inhale quickly when using my albuterol inhaler." F. "I will take theophylline prior to exercising." 13. John is teaching a client with hypercalcemia appropriate dietary measures. Which food selections by the client would require follow-up by him? Select all that apply. A. Broccoli B. 2% milk C. whole wheat pasta D. Bananas E. seafood 14. John plans to care for a client experiencing a hyperglycemic-hyperosmolar state (HHS). He should anticipate which prescriptions from the doctor? 1 | Page
A. 0.9% saline infusion B. Glargine insulin C. Sodium polystyrene D. Sodium bicarbonate 15. John is teaching a client who has hypertension about the newly prescribed medication, furosemide. Which of the following should he include in the teaching? A. Limit intake of bananas, cantaloupe, and potatoes. B. Avoid taking the medication with grapefruit juice. C. Take this medication in the early part of the day. D. A nagging cough can occur as a side effect of the medication. 16. Carlos cares for assigned clients. Which of the following clients should he identify is at the highest risk for falling? A. 88-year-old admitted with a chest tube secondary to pneumothorax and has a history of dementia B. 44-year-old admitted with heart failure, has a peripheral IV, and receiving IV furosemide C. 33-year-old admitted with cholecystitis, has a peripheral IV, and is receiving IV hydromorphone D. 28-year-old admitted with bacteremia is receiving intravenous fluids via central line and is diaphoretic 17. Carlos is preparing a staff in-service regarding sensorineural hearing loss. It would be appropriate for him to identify which factors cause this type of hearing loss? Select all that apply. A. Presbycusis B. Ototoxic substance C. Foreign body D. Exposure to loud noise E. Edema 18. Carlos is preparing to insert an indwelling urinary catheter. Which action may be delegated to the nursing aide? A. Set up the sterile field B. Palpate the bladder for distention C. Explain the procedure to the client D. Place the urinary catheter kit at the bedside 19. The unit charge nurse, Carlos, knows which of the following are internal disasters? Select all that apply. A. A loss of electrical power to the facility B. The sudden cessation of internal communication C. toxic chemical spill in the lobby of the facility D. A serious life-threatening medication error E. Train crash in neighboring town 20. Which is an intrinsic risk factor that increases the risk of patients developing pressure ulcers? A. Shearing B. Friction C. Impaired tissue perfusion D. Pressure 21. Yulo is caring for a client with suspected retinal detachment. Which of the following manifestations would not be consistent with a diagnosis of retinal detachment? A. Seeing “floaters” in the field of vision B. A sense of having a curtain drawn over the eyes C. Flashes of light D. Intense pain in the affected eye 22. Yulo is teaching a client about newly prescribed tamsulosin. Which of the following statements should the nurse include? A. “This medication may turn your urine reddish/orange.” B. “You will urinate more often with this medication.” C. “Change positions slowly while you take this medication.” D. “Avoid calcium-containing foods while on this medication.” 23. Yulo is teaching a client about newly prescribed tamsulosin. Which of the following statements should he include? A. “This medication may turn your urine reddish/orange.” B. “You will urinate more often with this medication.” C. “Change positions slowly while you take this medication.” D. “Avoid calcium-containing foods while on this medication.” 24. Yulo is caring for a client in labor who is positive for the human immunodeficiency virus (HIV). He should obtain a prescription for which medication? A. valacyclovir B. zidovudine C. amphotericin b D. metronidazole 25. Angelika, the nurse manager, has received a complaint from a client's family member. She should take which initial action? A. Tell the night charge nurse to ensure the night shift nurse performs the assigned duties appropriately B. Speak with the night shift nurse regarding the complaint and discuss the care provided C. Assess the complaint and clarify the details with the family member and client D. Take note of the complaint and place it in the applicable employee's file 26. Angelika is positioning a client following a liver biopsy. Which position is best suited for this client? A. On the left side with a pillow under the ribs. B. Supine with a pillow under the client's knees. C. Face down with a pillow under the hips. D. On the right side with a pillow under the biopsy site. 27. Nurse Angelika is conducting a teaching session with the parents of a child newly diagnosed with asthma. The priority topic for her to cover is: A. how to use a peak flow meter. B. signs and symptoms of an asthma attack. C. the need to stay current with immunizations. D. community resources available for asthma management. 28. Which of the following statements should she use to best describe a very low-calorie diet? A. “This is a long-term treatment measure that assists obese people who can’t lose weight.” B. “A very low-calorie diet contains very little protein.” C. “This diet can be used only when there is close medical supervision.” D. “This diet consists of solid food that is pureed to facilitate digestion and absorption.” 29. Angelika is now caring for a child with nocturnal enuresis that was not responsive to non-pharmacological modifications. She anticipates the doctor to provide which medication? A. urecholine B. desmopressin C. Prazosin D. finasteride 30. Angelika is caring for a client at risk of developing tumor lysis syndrome (TLS). Which of the following prescriptions would prevent TLS? Intravenous (IV) hydration Broad-spectrum antibiotics High dose corticosteroids Histamine-2 receptor antagonists 31. Nurse Chloe cares for assigned clients. She should immediately follow-up on the client who: A. is being treated for pneumonia and develops restlessness. B. is receiving intravenous fluids for influenza and dehydration and reports a headache. C. has a chest drainage system in place for a hemothorax and tidaling is present in the water seal chamber. D. is being treated for pleurisy and is experiencing inspiratory chest pressure. 32. Chloe educates a family with a child with phenylketonuria (PKU). It would be appropriate for her to recommend that the child avoid which foods? Select all that apply. A. pork tenderloin B. grapefruit slices C. cheese omelets D. steamed carrots E. ice cream 33. Chloe in the mental health unit is preparing to establish a new group therapy session. Which client would be most appropriate for group therapy? A client: A. in the acute phase of schizophrenia. B. with bipolar I disorder experiencing a mixed episode of depression and mania. 2 | Page
C. with post-traumatic stress disorder having difficulty sleeping because of night terrors. D. experiencing delirium tremens associated with alcohol withdrawal. 34. Chloe has provided discharge instructions to a client who was prescribed niacin. Which of the following statements, if made by the client, would indicate effective teaching? A. "This medication may increase my blood pressure." B. "I may experience flushing while taking this medication." C. "This medication may raise my total cholesterol." D. "I may feel fatigued and tired after taking this medication." 35. Chloe, RN, is caring for a patient who is receiving enteral feedings. What is the most effective method to verify initial tube placement is correct? A. Obtain chest and abdominal x-rays. B. Aspirate the contents to assess pH range. C. Mark tubing at the exit site and record the length of tubing that protrudes. D. Insert 20-30 mL of air into the tube while auscultating the epigastrium. 36. Hidilyn is observing a student nurse feed a client requiring aspiration precautions. She should intervene if the student: A. asks the client to remain sitting upright for at least 30 to 60 minutes after a meal. B. reminds the client to tilt their head backward when eating and drinking. C. avoids mixing foods of different textures in the same mouthful. D. places salt and pepper on the client's food at their request. 37. Hidilyn is caring for a client who is of the Islamic faith, who has expired. She should take which appropriate action? A. Prepare the client for cremation B. Position the client facing Mecca C. Keep the client's eyelids open D. Keep the client uncovered 38. Nurse Hidilyn is caring for a client who is postoperative and at risk for venous thromboembolism (VTE). Which of the following medications would prevent this complication? A. Enoxaparin B. Verapamil C. Tranexamic acid D. Aspirin 39. Hidilyn is caring for a client who is recovering from carotid endarterectomy. Which assessment would she recognize as a sign that the client experienced hypoglossal nerve injury? A. Tongue deviation B. Inspiratory stridor C. Tracheal deviation D. Severe headache 40. The RN cares for a client who sustained a stroke impacting the occipital lobe. Which of the following assessment findings would support this diagnosis? A. homonymous hemianopia B. impaired proprioception C. expressive aphasia D. impulsivity 41. Obiena is educating a client newly diagnosed with hypertension about sodium and its role in blood pressure. Which of the following statements about sodium are true? Select all that apply. A. Sodium cannot be completely eliminated from the diet. B. There is no sodium in fresh fruits and vegetables. C. Canned vegetables should be avoided. D. The body needs some sodium as it plays an important role in water balance. E. Reduce daily sodium intake to 2,000 mg 42. Obiena is caring for a client who is 75 years old with coronary artery disease and chronic obstructive pulmonary disease (COPD). Based on the client's age and medical problems, which immunization should he recommend for this client? A. hepatitis A vaccine B. hepatitis b vaccine C. pneumococcal vaccine D. live attenuated influenza vaccine 43. He is discharging a client following knee arthroplasty. Which of the following information should the nurse include in discharge teaching? A. “After this procedure, you will use a wheelchair to get around.” B. “You will need to resume your prescribed anticoagulants.” C. “Placing a pillow under your knee will help with the pain.” D. “You may ice the site for one hour at a time.” 44. RN Obiena is caring for a client immediately following scleral buckling surgery for a retinal detachment of the right eye. Which of the following actions would be appropriate for him to take? Select all that apply. A. place the client in a prone position. B. approach the client from the left side. C. instruct the client to perform deep breathing and coughing exercises. D. instruct client to avoid bending down. orientate the client to the environment. obtain a prescription for a stool softener. 45. Obiena inserts an indwelling urinary catheter for a female patient prior to surgery. Which of the following would require immediate intervention by him? A. The patient states she feels the need to urinate. B. Patient reports a pinching sensation as the catheter is advanced. C. The student nurse notes resistance when inflating the balloon. D. The student separates the labia majora and labia minora with non-dominant hand. 46. When performing a transcultural assessment, the nurse must: A. Determine which questions to ask the client based on the potential health effects of culture-based practices. B. Wait until the nurse-patient relationship is established before asking questions. C. Ask all questions for completeness of the assessment. D. Include all questions as part of an admitting assessment. 47. Nurse Simone supervises a student nurse preparing a client for a magnetic resonance imaging (MRI) test. Which of the following actions by the student nurse would require follow-up by her? The student: A. asks the client if they have claustrophobia. B. instructs the client to apply earplugs before the exam. C. moves the nitroglycerin patch from the torso to the back. D. tells the client that they will not have any exposure to radiation. 48. Simone is performing a physical assessment on an adult client. She should assess for tactile fremitus by: A. placing the thumbs on the client's spine at the level of the ninth ribs. B. asking the client to breathe slowly and deeply through an open mouth while auscultating lung sounds. C. asking the client to say “ninety-nine” while palpating the intercoastal spaces beginning at the lung apex. D. tapping the chest over the distal interphalangeal joint with the middle finger of the opposite hand. 49. Simone prepares a client for a positron emission tomography (PET) scan. Which laboratory data is necessary to obtain before this test? A. Urine specific gravity B. Liver function tests C. Blood glucose D. Creatinine kinase 50. She is evaluating a patient’s response to peripheral pain. Which technique should she use to perform this evaluation? A. Pressure on the patient’s mid-back B. Sternal rub C. Squeezing the sternocleidomastoid muscle D. Pressing on the patient’s nail bed 51. Nurse Elle is administering IV magnesium to a client with a magnesium level of 1.5 mEq/L. You check on them halfway through the infusion, and they report that their face feels flushed. What is your priority nursing intervention? A. Slow down the infusion rate. B. Notify the primary healthcare provider (PHCP). 3 | Page
C. Reassess the client when the infusion finishes. D. Stop the infusion. 52. Elle supervises a nursing student administering a purified protein derivative (PPD) skin test. Which action by the student requires follow-up by Elle? A. Inserts the needle, bevel up at a 15-degree angle B. Instructs the client that the test will be read in 48-72 hours C. Selects a site 3 to 4 finger widths below the antecubital space D. Administers the test using a 20-gauge needle, 2 inches long 53. Elle cares for a client who sustained full-thickness thermal burns to 30% of their total body surface area (TBSA). Which of the following initial laboratory values would be expected? A. Potassium 5.6 mEq/L B. Hematocrit 30% C. BUN 14 mg/dL D. Glucose 89 mg/dL 54. She has attended a staff education program about incident reporting. It will indicate effective understanding if she states that the primary purpose of incident reporting is to: A. implement corrective measures needed to prevent recurrence. B. collect data about errors and compare it to different time periods. C. communicate the error(s) to other departments within the facility. D. notify the individual involved of the deviation from the standard of care. 55. RN Elle is planning to care for a client with a newly diagnosed fractured pelvis. Which action would lessen the risk of fat embolism syndrome (FES)? A. Request a prescription for enoxaparin. B. Alternate with the application of ice and heat. C. Educate the client on pelvic immobilization. D. Encourage passive range of motion of the lower legs. 56. It will indicate effective understanding if the nurse classifies which immunization as live-attenuated? A. pneumococcal B. diphtheria, tetanus, and pertussis (DTaP) C. varicella D. hepatitis B 57. A client is scheduled to undergo a computed tomography scan with iodine-based contrast dye. Which of the following medications may cause interaction and should be withheld for 24 hours before the procedure? A. Labetolol B. Metformin C. Levodopa D. Ondansetron 58. Emmett, RN, is caring for a client newly admitted to the mental health unit with bulimia nervosa. Which client statement requires immediate follow-up? A. “These sores in my mouth hurt." B. “When can I weigh myself?” C. “I hate my life and wish it was over.” D. “I feel really dizzy right now.” 59. RN Emmett is caring for a client who has been taken to the emergency department after a severe car accident. They require immediate life-saving surgery; however, they are unconscious and unable to consent to the operation. Which of the following is the best course of action? A. Ask a friend who was with the client to sign the consent form. B. Attempt calling a family member to obtain consent. C. Call the on-staff nursing supervisor and request a court order for the surgery. D. Immediately transport the client to the operating department without obtaining consent. 60. Emmett supervises a new graduate caring for a child immediately following surgery to correct an imperforate anus (anorectal malformation). Which action by the new graduate requires follow-up? The new graduate: A. positions the child side-lying prone position with the hips elevated. B. obtains a rectal temperature. C. auscultates bowel sounds in all four abdominal quadrants. D. secures the indwelling urinary catheter bag to the frame of the bed. 61. Nurse Vivian is caring for a client who is receiving prescribed metoclopramide for gastroparesis. Which of the following findings require immediate notification to the doctor? A. Muscle rigidity of the neck B. Hyperactive bowel sounds C. Frequent diarrhea D. Abdominal distention 62. Vivian is teaching a group of clients about varicose veins and home care management. Which of the following should Vivian include in the teaching session? A. When you are sitting, keep your legs lower than your heart B. Wear compression stockings during the day C. Participate in activities that have you stand for long periods D. Take a low-dose aspirin to prevent the development of new varicose veins 63. Vivian is assessing a client with Paget’s disease. Which of the following would be an expected finding? A. Bone deformities B. Berry aneurysm C. Heberden’s nodes D. Janeway lesions 64. She is caring for a client who is admitted to the emergency department with suspected rhabdomyolysis. Which of the following interventions would she anticipate implementing initially for this client? A. Administering intravenous fluids B. Placing the client on a low-potassium diet C. Administering corticosteroids D. Initiating prophylactic antibiotic therapy 65. Vivian is teaching a client with Parkinson's disease about dietary considerations. She understands that this client is at highest risk for: A. constipation and drooling. B. drooling and a loss of appetite. C. loose stools and choking. D. dysphagia and aspiration. 66. Student nurse Warner is preparing a client for a bronchoscopy procedure. Which pre-procedure intervention should he prioritize to ensure the client's safety? A. Administering benzodiazepines and opioids for sedation. B. Ensuring the client has been nothing by mouth (NPO) for 4-8 hours before the procedure. C. Monitoring for bleeding and infection following the procedure. D. Verifying that the bronchoscope is properly sterilized before use. 67. Warner teaches a group of students about phenytoin. Which of the following statements would indicate understanding? A. "Phenytoin is a selective serotonin reuptake inhibitor (SSRI) commonly used for epilepsy." B. "The therapeutic range of phenytoin is 10-20 mcg/mL, and levels above this range can lead to toxicity." C. "Phenytoin is contraindicated in clients with Parkinson's disease due to potential exacerbation of symptoms." D. "Phenytoin is primarily metabolized by the liver and has no significant drug interactions." 68. The ABCDEs of melanoma identification include which of the following? Select all that apply. A. Asymmetry: one half does not match the other half B. Birthmark: cafe au lait spot that does not fade C. Color: pigmentation is not uniform D. Diameter: greater than 6 mm E. Evolving: any change in size, shape, color, elevation, or any new symptom such as bleeding, itching, or crusting 69. Warner in a community-based setting is teaching clients strategies for preventing cardiovascular disease. Which of the following interventions should he include? Select all that apply. A. Encouraging regular physical exercise B. Promoting a diet high in saturated fats C. Advising smoking cessation 4 | Page