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REFRESHER PHASE DIAGNOSTIC EXAMINATION NURSING PRACTICE 4 (NP4) NOVEMBER 2024 Philippine Nurse Licensure Examination Review Situation - The nurse provides health education to a group of adolescents about pelvic inflammatory disease (PID). 1. The nurse explains that prevention of PID in adolescents is important due to which of the following reasons. PID ________: A. can have devastating effects on the reproductive tract of affected adolescents B. is easily prevented by compliance to any form of contraception C. can cause life-threating defects in infants born to affected adolescents. D. Is easily prevented by proper personal hygiene 2. The nurse explains to the group of adolescents that the most common cause of PID is _______: A. Tuberculosis bacilli B. Gonorrhea C. Staphylococcus D. Streptococcus 3. The nurse further explains that PID presents the following signs and symptoms, which the adolescent should be aware of: A. A hard painless, red and defined lesion on the genital area. B. Small vesicles on the genital area with itching. C. Lower abdominal pain and urinary tract infection. D. Cervical discharge with redness and edema. 4. Which of the following statements is true when teaching adolescents about gonorrhea? A. Gonorrhea may be contracted through contact with a contaminated toilet seat. B. The infectious agent for gonorrhea is Neisseria gonorrheae. C. Gonorrhea is most often treated by multidose of administration of penicillin. D. Treatment of sexual partners is an essential part of treatment. 5. The nurse further explains to the adolescents that gonorrhea is highly infectious and it ____: A. Is limited to the external genitalia B. Can lead to sterility C. Is easily treated D. Occurs rarely among adolescents Situation - A 45 year-old female, married with two children, is admitted in the medical department with a diagnosis of osteoarthritis. The nurse assists in the care of this client. 6. Which of the following signs and symptoms should the nurse correlate with a diagnosis of osteoarthritis? A. Erythema and edema over the affected joints B. Joints stiffness that decrease with activity C. Anorexia and weight loss D. Fever and malaise 7. Which of the following factors would MOST likely increase the joints symptoms of osteoarthritis? A. Emotional stress B. Obesity C. History of smoking D. Alcohol abuse Situation – Archie Alviz has been wearing eyeglasses since he was 5 years old. When he turned 18, he wanted to dispose of the eyeglasses and started wearing long-wearing contact lenses. Before his 24th birthday, he was rushed into the emergency department because of severe eye pain. After assessment, he was diagnosed to have corneal ulcer. 8. The nurse attending to Archie is aware that the part of the eye which affects the ability to focus is the: A. Epithelium of the eyeball B. Cornea C. Retina D. Sclera — NO ANSWER 9. Dr. EJ Flaminiano, discusses in simple terms the pathophysiology of Archie's case. He mentions that the cornea is prone to infection and that the body's immune defenses cannot fight off microorganisms because the cornea is: A. Made up of three layers B. A vascular tissue C. An avascular tissue D. Filled with aqueous humor — NO ANSWER 10. He emphasized that the predisposing factor for Archie's condition is: A. Bacterial infection B. Prolonged use of contact lenses C. Fungal infection D. Low socioeconomic status — NO ANSWER 11. Dr. EJ Flaminiano further discussed that corneal ulcers are considered medical emergencies. He mentions that in cases of corneal ulcers, the priority intervention is to: A. Remove the contact lens B. Refer to opthalmologist immediately C. Administer eyedrops D. Apply pressure dressing to both eyes — NO ANSWER SITUATION : Venice, is an autistic child who loves to bang her head. One day, while head banging, she unintentionally hits the wall and briefly loses consciousness. 12. Venice is brought into the emergency department of Malan-dee Medical Center after suffering a head injury. The first action by the nurse is to determine the Venice’s: A. Level of consciousness B. Pulse and blood pressure C. Respiratory rate and depth D. Ability to move extremities 13. The nurse anticipates to detect the occurrence of what common complication of head injury? A. Intracranial haemorrhage B. Diabetes insipidus C. Diabetes mellitus D. Basilar skull fracture 14. The nurse is aware that she should monitor Venice’s? A. Pulse rate B. Temperature C. Urine output D. Oxygen saturation 15. Venice is ordered to receive desmopressin (DDAVP) for management her condition. The nurse should check which of the following measurements to determine the effectiveness of this medication? A. Daily weight TOP RANK REVIEW ACADEMY, INC. Page 1 | 6
B. Temperature C. Apical heart rate D. Pupillary response 16. The nurse knows that which of the following conditions may alter the effectiveness of DDAVP (Noctiva)? A. Increased oral secretions B. Arterial obstruction C. Nasal congestion D. Obesity SITUATION: A 30-year old client named Gardo Versosa is admitted to Philippine Lung Center due to sudden onset of chest pain and dyspnea. He has no history of respiratory disease but had complete femur fracture 3 days ago. The following questions apply. 17. He is diagnosed with pulmonary embolism. The nurse immediately implements which expected prescription for this client? A. Semi-Fowler’s position, oxygen, and morphine sulfate (IV) B. Supine position, oxygen, and meperidine hydrochloride (Demerol) [IM] C. High Fowler’s position, oxygen, and meperidine hydrochloride (Demerol) [IV] D. High Fowler’s position, oxygen, and two tablets of acetaminophen with codeine (Tylenol #3) 18. The doctor ordered ABG analysis for Gardo Versosa. The nurse is now sending the ABG specimen to the laboratory for analysis. Which of the following pieces of information should the nurse write on the laboratory requisition? 1.Ventilator settings 2 A list of client allergies 3 The client’s temperature 4 The date and time the specimen was drawn 5 Any supplemental oxygen the client is receiving 6 Extremity from which the specimen was obtained A. 1, 3, 5, 6 B. 1, 2, 4, 5 C. 1, 2, 3, 4 D. 1, 3, 4, 5 19. Arterial blood gas (ABG) results indicate: pH 7.29, PCO2 49 mm Hg, PO2 58 mm Hg, HCO3 18 mEq/L. Gardo Versosa is at risk for respiratory failure. He is receiving oxygen via nasal cannula at 6 L per minute. The nurse anticipates that the physician will prescribe which of the following for respiratory support? A. Intubation and mechanical ventilation B. Adding a partial rebreather mask to the current prescription C. Keeping the oxygen at 6 L per minute via nasal cannula D. Lowering the oxygen to 4 L per minute via nasal cannula 20. The nurse is now inserting an oropharyngeal airway to Gardo Versosa. The nurse plans to use which correct insertion procedure? A. Flex the client’s neck B. Leave any dentures in place C. Suction the client’s mouth once per shift D. Insert the airway with the tip pointed upward 21. Gardo Versosa is now intubated and receiving mechanical ventilation. The physician has added 7 cm of positive end expiratory pressure (PEEP) to the ventilator settings of the client. The nurse assesses for which of the following expected but adverse effects of PEEP? A. Decreased peak pressure on the ventilator B. Increased temperature from 98OF to 100OF rectally C. Decreased heart rate from 78 to 64 beats per minute D. Systolic blood pressure decrease from 122 to 98 mm Hg SITUATION: Dyosa Lande is a 50-year old obese patient. She admits that her self-esteem has been progressively becoming low as her body size increases. She also claimed that her performance in her work has already been impaired. She electively subjects herself to bariatric surgery. 22. Rapid emptying of gastric contents into the small intestine may occur postoperatively due to gastric resection. Dyosa Lande is at risk for developing dumping syndrome. The nurse monitors her for: A. Dizziness B. Bradycardia C. Constipation D. Extreme thirst 23. The nurse places Dyosa Lande in which best position to prevent occurrence of dumping syndrome? A. Prone B. Supine C. Trendelenburg D. Fowler’s 24. The nurse performed an abdominal assessment on Dyosa Lande 36 hours postop. The nurse documents that her bowel sounds are normal. Which of the following descriptions best describes this assessment finding? A. Waves of loud gurgles auscultated in all four quadrants B. Soft gurgling or clicking sounds auscultated in all four quadrants C. Low-pitched swishing sounds auscultated in one or two quadrants D. Very high-pitched loud rushes auscultated, especially in one or two quadrants 25. Dyosa Lande is now ready to resume diet since she now has normal bowel sounds. To minimize complications from eating, the nurse teaches her to do which of the following? 1 Lying down after eating 2 Eating a diet high in protein 3 Eating a diet low in protein 4 Eating six small meals per day 5 Eating concentrated sweets between meals A. 1, 3, 5 B. 1, 2, 5 C. 1, 2, 4 D. 1, 3, 4 26. In preventing dumping syndrome, which additional instruction should be provided to Dyosa Lande? A. Ambulate following a meal B. Eat high carbohydrate foods C. Limit the fluids taken with meals D. Sit in a high Fowler’s positions during meals Situation: Jugs, a 40 year old teacher just returned to the ward from the PACU. He underwent subtotal thyroidectomy. 27. Jugs was transferred from the stretcher to the bed. The nurse would assist the client to assume which of the following positions? A. Semi-fowlers with head and neck supported with pillow B. High-fowlers with neck supported with rolled towel C. Dorsal recumbent with sandbags on both sides of the neck D. Recumbent with neck supported with pillow 28. The nurse is worrying about possible laryngeal nerve damage. The most appropriate way to assess this is to: A. Observe for any difficulty in swallowing B. Palpate for the laryngeal nerves on both sides of the neck C. Let the client cough three times D. Talk with the client and note change in voice 29. From the laboratory results, the nurse noted the serum calcium to be 5.0 mg/dL. Which of the following will the nurse do first? A. Refer to the physician. B. Take vital signs. C. Note the finding as normal. D. Assess signs of tetany. 30. Jugsstarted complaining of a tightening feeling in his wound dressing. Which of the following is the priority nursing action? A. Assess dressings for drainage. B. Check vital signs. C. Change position of the patient. D. Remove neck support. TOP RANK REVIEW ACADEMY, INC. Page 2 | 6
31. The watcher asked the nurse, “When can Jugs start to eat? The last time he ate was still last night.” The correct response is: A. “Jugs can start on clear liquids as soon as he is fully conscious.” B. “The doctor will evaluate the client when he is ready to eat.” C. “Jugs is still on IV fluids, and is doing fine.” D. “As soon as bowel sounds are present.” Situation: Knowledge about end-of-life principles of care and patients’ and families’ unique responses to illness are essential to support their unique values and goals. Nurses can have a significant and lasting effect on the way in which clients live until they die, the manner in which death occurs, and the enduring memories of that death for the families. 32. During one of your small group discussions, you were given a sample case of a client who is asking you to help her end her life. You, as the nurse, knows that: A. You should not participate in the wish of the client because it is a violation of the Code of Ethics. B. You should agree with the client’s wish to uphold autonomy. C. You should agree to lessen the suffering of your client. D. You should not agree because it is against your personal belief system. 33. It is a legal document through which the signer appoints and authorizes another individual to make medical decisions on his/her behalf when he/she is no longer able to speak for him/herself. A. Advanced Directive B. Medical Directive C. Living Will D. Durable Power of Attorney for Healthcare 34. While caring for a client who was admitted for Stage 4 Lung Cancer, he suddenly asked you “Am I dying?” How should the nurse best respond or best act? A. Maintain eye contact and remain silent. B. “Do you think you are dying?” C. “I don’t know. It will be best for you to ask your physician.” D. “This must be very difficult for you.” 35. One of the common signs of an approaching death in clients who are terminally ill is losing their interest in eating and drinking. What would be the best nursing intervention for this manifestation? A. Advice the client to take in small, frequent feedings. B. Tell the client to drink warm water at least 15 minutes before eating his meals. C. Enhance the presentation of the foods served to the client. D. Offer food and drinks but do not force the client. 36. Clients who are dying may sometimes give reports of dead family or friends who seem to be calling them to come and join them. What is the nurse’s best action? A. Encourage the patient that may he may leave to join them. B. Stay close and be present for the client. C. Ask the client to discuss what other things do these people tell him to do. D. Remain silent and listen intently to what else the client has to say. Situation: Nurse Sisley is a nurse in Diliman Doctors Hospital caring for clients with problems in the biliary tree. 37. A patient with complaints of indigestion and RUQ pain was diagnosed with cholecystitis and underwent an emergency laparoscopic cholecystectomy. Which of these should Nurse Sisley not include in her post-operative care? A. Instruct the client about splinting during coughing. B. Encourage early ambulation. C. Maintain the client flat on bed. D. Assess the patient’s O2 saturation level frequently. 38. Which of these is the best indicator that peristalsis has resumed after the surgery? A. Active bowel sounds B. Passage of flatus C. Drainage from NG suction D. Tympany upon percussion 39. A T-tube was inserted to maintain patency of the common bile duct. How should Nurse Sisley position the client for better drainage? A. Side-lying position B. Prone position C. Semi-Fowler’s D. Low Fowler’s 40. Rico Y. An is brought to the emergency department because of severe and constant abdominal pain. Nurse Sisley should conduct comprehensive nursing interview: A. Right upon entrance to the emergency department B. After the vital signs have been taken C. After pain is controlled D. During physical examination 41. Rico Y. An was diagnosed to have acute pancreatitis from excessive alcohol intake. Which of these is a characteristic of the abdominal pain in acute pancreatitis? A. Sharp, intermittent pain B. Intense, boring pain C. Relieved when in supine position D. Worsens when a fetal position is assumed SITUATION: Patients with varying diseases always receive medications for them to recuperate. As part of the dependent functions of a nurse, knowledge in pharmacology is one of the most essential competencies that she should possess, to be aware when to verify a doctor’s medication order, and to know the side effects, adverse effects, therapeutic level and nursing consideration for each drug. 42. A nurse in the neuro ward is reviewing the results of a client Rey’s phenytoin (Dilantin) level that was drawn that morning. The nurse determines he had a therapeutic drug level if the result was: A. 3 mcg/mL B. 8 mcg/mL C. 15 mcg/mL D. 24 mcg/mL 43. Client Cyrus Mc Leo has begun medication therapy with Betaxolol (Kerlone). The nurse determines he is experiencing the intended effect of therapy if which of the following is noted? A. Edema present at 3+ B. Weight loss of 5 pounds C. Pulse rate increased from 58 to 74 beats/ min D. Blood pressure decreased from 142/94 mm Hg to 128/82 mm Hg 44. The nurse has taught another client named Fedilyn with asthma, who is taking a xanthine bronchodilator about beverages to avoid. The nurse determines that the client understands the information if the client chooses which of the following beverages from the dietary menu? A. Cola B. Coffee C. Chocolate milk D. Cranberry juice 45. Client Roma is ordered to start on Glipizide once daily. The nurse observes for which of the following intended effect of this medication? A. Weight loss B. Resolution of infection C. Decreased blood glucose D. Decreased blood pressure 46. Client Jahziel, a toddler is hospitalized for acetaminophen (Tylenol) overdose. The nurse prepares to administer which specific antidote for this medication overdose? A. Vitamin K B. Protamine sulphate C. Acetylcysteine (Mucomyst) D. Naloxone hydrochloride (Narcan) SITUATION: A nurse working in the hema ward of Bloody hospital for 3 years is assigned to care for TOP RANK REVIEW ACADEMY, INC. Page 3 | 6