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RECALLS EXAMINATION 4 NURSING PRACTICE V CARE OF CLIENTS WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART C) 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 V” on the box provided Situation 1- You’re assigned as a staff nurse in the Stroke Unit of the Medical Ward. One of your responsibilities is to provide health teachings to the stroke patients and to the other members of the family. The following questions refer to these statements. 1. You are teaching a patient about taking prophylactic warfarin sodium (Coumadin). Which of these statement indicate that the patient understands how to take the drug. SELECT all that apply: 1) “The drug’s action peak in two hours” 2) “Maximum dosage is not achieved until 3 to 4 days after starting the medication” 3) “Effects of the drug continue for 4 to 5 days after discontinuing the medication 4) “Protamine Sulfate is the antidote for Warfarin” 5) “I should have my blood levels tested periodically” A. 2, 4, 5 B. 2, 3, 5 C. 1, 4, 5 D. 1, 3, 4 2. Maintaining oral hygiene for a stroke patient is important in his care. You are teaching a family member how to give oral care to the stroke patient. Which of the following nursing measure is NOT APPROPRIATE when giving oral care to such patient? A. Cleaning the patient’s mouth and teeth with a soft-bristled toothbrush B. Keeping portable suctioning equipment at the bedside C. Opening the patient’s mouth with a padded tongue depressor D. Placing the patient on his back with a small pillow under the head 3. Your patient has paraplegia. In giving instruction to the watcher when changing the patient’s position in bed, which of the following is NOT APPROPRIATE? A. Lifting the patient when moving him up in bed B. Rolling the patient unto the side C. Using a trapeze to help the patient lift off the bed D. Sliding the patient to move up in bed 4. A patient is experiencing mood swings after stroke. Often times she has episodes of crying that are distressed to the family members. What is the BEST TECHNIQUE that you will advise the family members when the patient is having crying spells? A. Ignore the patient during this time B. Sit quietly with the patient until the crying episode is over C. Tell the patient that the behavior is unacceptable D. Attempt to divert the patient’s attention 5. To prevent joint deformities of the arm and hands of a hemiplegic patients what are the APPROPRIATE position will you include in your health teachings of the family member? SELECT all that apply. 1) Placing a pillow in the axilla so the arm is way from the body 2) Inserting a pillow under the slightly flexed arm so the hand is higher than the elbow 3) Immobilizing the extremity with a sling 4) Placing a hand cone so the finger are barely flexed 5) Keeping the arm at the sides using a pillow A. 2, 3, 4 B. 1, 3, 5 C. 1, 2, 4 D. 2, 4, 5 Situation 2- You are a community health nurse assisting a family in the care of their daughter suffering from the past traumatic stress disorder. 6. While caring for this client, the family notices that loud noises cause a serious anxiety response. Which of the following explanations by you would help the family understand the client’s response? A. After a trauma, the client cannot respond to stimuli in an appropriate manner B. Clients often experience extreme fear about normal environmental stimuli C. Environmental triggers can cause the client to react emotionally D. The response indicates that another emotion problem needs investigation 7. Which of the following instructions should you include about relationships for this client with post-traumatic stress disorder? A. Assess the client’s discomfort when talking about feelings to family member. B. Explain that avoiding emotional attachment protects against anxiety. C. Warn the client that she will have a tendency to be overdependent in relationships D. Encourage the client to resume former roles as soon as possible 8. Which of the following nursing intervention would best help this client and her family handle interpersonal conflict at home? Have the family: A. Discuss how to change dysfunctional family patterns B. Teach the client to identify defensive behavior. C. Agree not to tell the client what to do about problem D. Arrange for the client to participate in social activities. 9. Which of the following nursing actions would be more appropriate when speaking with this client about the trauma she experienced? A. Listen attentively B. Request the client write what is being said C. Ask question to convey an interest in the details D. Obtain validation of what the client says from another party 10. Which of the following nursing actions would you include in the plan of care for this client who keeps saying that the trauma she experienced was just a case of bad luck? A. Assist the client in defining the experience as a trauma B. Encourage the client to verbalize the experience 1 | Page
C. Work with the client to accept positive and negative feelings Situation 3 – One of the competencies expected of you as a beginning professional nurse is to have a positive attitude toward research. 11. You plan to study the effectiveness of films in teaching active exercises to post stroke patients. Which of the following research designs will give you the most confidence to answer the research problem? A. time- series design B. non-equivalent control group design C. one-group pre-test, post-test design D. post-test only, control group design 12. Which of the following sampling techniques is the most appropriate to answer a research question on the effectiveness of active exercise on the mobility of post stroke patients? A. convenience sampling B. purposive sampling C. quota sampling D. random sampling 13. You want to develop a tool for measuring the level of consciousness of stroke patients. This is what type of research? A. Historical study B. Case study C. Comparative study D. Methodological study 14. You want to examine the difference in the eating behaviors between two groups of high school students. Which of the following research designs would you use to answer the research question? A. Case study B. Correlation study C. Comparative design D. Survey study 15. In a study on the relationship between personality make-up and obesity, a Pearson r=.8 would mean: A. a high, negative correlation B. a moderate, positive correlation C. a high, positive correlation D. a low, positive correlation 16. Which of the following is the precipitating factor for Ella’s feeling of wanting to die? A. The death of Lory B. Her age C. Her authoritative mother D. Her fear of death 17. Ella’s feeling of joining Lory in heaven is manifestation of: A. Suicidal intent B. Suicidal threat C. Paranoia D. Suicidal ideation 18. Ella state “I will hang myself”. This is a manifestation of: A. Denial B. Suicidal threat C. Suicidal intent D. Paranoia 19. Which of the following is the best predictor of adolescents attempting suicide? A. Depressed mood B. Joyful mood C. Feeling of euphoria D. feeling of hopelessness 20. Ella state “I wish I were dead. I cannot stand anymore not having Lory around.” Your most appropriate nursing action would be: A. Do nothing because Ella will not do it B. Refer Ella to your supervisor C. Stay with Ella D. Explore Ella’s feeling situation 5- You are a staff nurse in the Out-Patient Department. Mrs. D brought her 9-year old daughter Bianca for consultation. Bianca is complaining of sore throat, muscle tenderness, weakness of the arms and a general feeling of not being well. The attending physician’s impression is Infectious Polyneuritis. 21. Initially, what assessment data would be the BEST IMPORTANT for you to make? A. Exposure to an infectious disease B. Difficulty in swallowing C. Difficulty in urinating D. Diet intake for the last 24 hours 22. Bianca was admitted to the Pediatric ward. What would be your PRIORITY nursing action when caring for her? A. Providing a diversional activity for Bianca B. Evaluating Bianca’s bilateral muscle strength C. Making a game of range-of motion exercise D. Assessing Bianca’s ability to follow simple commands 23. The pediatric ward nurse ask Bianca to cough every now and then. She also assesses Bianca’s speech for decreased volume and clarity, the underlying rationale for these assessments is to determine the ________. A. regression to an earlier developmental phase B. involvement of facial and cranial nerves C. increased intracranial pressure D. inflammation of the larynx and epiglottis 24. Assessment findings revealed that Bianca has weak gag and cough reflexes. During this acute phase of Bianca’s illness, which of the following problems should receive the HIGHEST PRIORITY? A. Impaired swallowing related to neuromuscular impairment. B. Risk for infection due to an altered immune system C. Ineffective breathing pattern to neuromuscular impairment D. Total urinary incontinence related to fluid losses 25. Bianca was placed on a medical ventilator. Which of the following nursing actions should the ward nurse give emphasis to? A. Turning Bianca slowly and gently from side to side to prevent respiratory complication B. Engaging Bianca in vigorous passive range-of-motion C. Maintaining Bianca in a supine position to prevent unnecessary nerve stimulation D. Transferring Bianca to a bedside chair three times a day to prevent posture hypotension Situation 6- Jennylyn Abad, 40-years old woman, has a history of Rheumatoid Arthritis for the last ten years. The following questions refer to this situation. 26. which of the following is common sign/symptom of rheumatoid arthritis? A. Presence of crepitus over joints B. Symptoms aggravated by humidity C. Deformity and displacement of proximal joints D. Presence of Heberden’s nodes 27. which of the following would NOT be a common laboratory findings in rheumatoid arthritis? A. Low hemoglobin B. Positive RA factor C. Positive Lupus Erythematosus (LE) prep D. Increase white blood count 28. Jennylyn has been taking steroids for the last five years to control her arthritis. Which of the following is a common side effects of steroid therapy? A. Hyponatremia B. Hyperkalemia C. Increase blood glucose D. Protein anabolism 29. Which of the following diet is best suited to decrease the side effects of Jennylyn’s steroid therapy? A. Normal carbohydrate, high protein, high potassium B. Low carbohydrate, high protein, high potassium C. Low carbohydrate, high protein, low potassium D. High carbohydrate, low protein, low potassium 30. Jennylyn was on Ibuprofen which has been stopped when the steroid therapy was started. Which was the main reason for stopping the Ibuprofen once the steroid therapy was started? A. The two drugs taken together increase the risk of GI bleeding B. The Ibuprofen would interfere with the action of the steroid C. The Ibuprofen was not needed with the steroid 2 | Page
D. The two drugs together would cause severe liver damage Situation 7- You are a staff nurse in the Musculo-skeletal Unit of the hospital. You are taking care of the patients with varied musculo-skeletal conditions. 31. which of the following inflammatory conditions commonly occurs in the shoulder? 1) Bursitis 2) Carpal Tunnel Syndrome 3) Tendonitis 4) Dupuytrens A. 1 and 2 B. 2 and 3 C. 3 and 4 D. 1 and 3 32. Which of the following is NOT considered a conservative treatment for inflammatory conditions of the shoulder? A. Non-steroid Anti-inflammatory Drugs B. Intermittent ice and heat application to the joint C. Laser photo-therapy D. Resting of the extremity 33. Impaired movement of the rotator cuff of the shoulder is generally termed as Impingement Syndrome. Edema, which is an early manifestation of this syndrome, is due to ________. A. acute trauma of the shoulder B. muscle spasm C. hemorrhage of the structures involved D. atrophy due to disuse 34. For a persistent shoulder pain and weakness, this usual treatment modality performed is _______. A. Pulse-magnetic field B. Laser photo-therapy C. Radio-frequency ablation D. Arthroscopic Synovectomy 35. One of the most common foot problems is Callus. This condition precedes the formation of a Callus _____. A. External pressure on the foot B. Faulty foot mechanics C. Flexion deformity of the interphalangeal joint D. Penetrating nail plate in the surrounding skin of the foot Situation 8- You are a staff nurse working in a hospital and encounter situations with ethico-moral implications. 36. Which of the following nursing actions will you do if the patient is unconscious and unable to make decisions? This fact should be: A. reported to the nurse supervisor B. reported to the attending physician C. documented in the patient’s chart D. reported to the police 37. A patient came in from prison for emergency treatment. Which of the following precautionary measures will you institute to ensure the safety of the hospital staff and the other patients? A. Provide the same assessment and care to the client B. Use restraints C. Lock the ER door against entry if security is in question D. Never release the hand or ankle restraint 38. In using restraints to patients, which of the following guidelines will you follow? A. Apply restraints because the patient needs it B. Apply restraints according to the hospital policy C. Restraint is the most effective nursing intervention to minimize aggressive behavior D. Maintain respect for the client when applying restraints 39. You have observed that a group of students are implementing their research project on the effect of hot and cold application to febrile patients without informing the participants properly. What ethical principle was violated by the students? A. Nonmaleficence B. Autonomy C. Justice D. Respect for person 40. A researcher should pay particular attention in protecting the rights of certain vulnerable groups. Which of the following is NOT considered vulnerable? A. Prisoners B. Children C. Mentally-challenged persons D. Postpartum mother with normal delivery Situation 9- You are a staff nurse in the Neurologic Unit of the Pediatric Department. Several problems have been reported in relation to ventriculo-peritoneal shunt for hydrocephalus patients. The initial investigation on the care of patient with this shunt revealed that majority of the staff nurses have little experience on caring for such patients. It was decided to look into their level of knowledge and skills to serve as baseline data for improving the nursing care of hydrocephalic patients on ventriculo-peritoneal shunt. The following questions refer to this situation. 41. a four-year old hydrocephalic preschooler is scheduled to have a ventriculo-peritoneal shunt at the right side of the head. Which of the following positions should the child be placed immediately after surgery? A. Supine, with the head of the bed flat B. On the left side with the head of the flat C. Prone, with the head of the bed elevated D. On the right side, with the foot of the bed elevated 42. What nursing action should the nurse do when providing post-operative nursing care to a child after insertion of a ventriculo-peritoneal shunt? A. Monitoring for the increased temperature B. Check the urine for glucose and protein C. Administer narcotics for pain control D. Test cerebrospinal fluid leakage for protein 43. An infant who has hydrocephalus is irritable, lethargic, and difficult to feed before the ventriculo-peritoneal shunt is placed. To maintain the infant’s nutritional status, which of the following nursing action is the MOST APPROPRIATE? A. Feeding the infant just before doing any procedures B. Giving the infant small, frequent feedings C. Scheduling the feeding every six hours D. Feeding the infant in a horizontal position 44. The parent of a school-age child with ventriculo-peritoneal shunt were given discharge teaching. Which of the following signs of a blocked shunt would the parents be able to identify that the discharge teaching is successful? A. Irritability and increase difficulty with eating B. Elevated temperature and reddened incisional site C. Decreased urine output with stable intake D. Tensed fontanel and increased head circumference 45. After a six-year old child underwent placement of ventriculo-peritoneal shunt, he was put on I.V. medication. The head nurse observed that many of the staff nurses are disconnecting the flush syringe first and then clamping the intermittent infusion device. The staff nurse seem not to understand the benefits of positive pressure techniques. Which of the following strategies would be the MOST EFFECTIVE way to improve the staff nurses technique in giving I.V. medication? A. Post an evidence-based article on the topic in the unit B. Create a poster presentation on the topic with a required post test C. Send a memorandum on the importance of clamping the device first D. Ask each nurse if they are aware that their practice is not current Situation 10- You are a staff nurse in the Stroke Unit of the Medical ward. You have a stroke patient with a tracheostomy. In the unit’s last meeting it was discussed that there has been increasing complaints on the nurse incompetence in caring for a patient with tracheostomy. The following questions related to this situation. 46. In providing tracheostomy care which of the following is the nurse’s PRIORITY nursing action? The nurse _____. A. cut the dressing using sterile scissors B. cleans the incision with iodine-based antiseptic C. secure clean ties before removing soiled ones D. used clean technique 3 | Page
47. which of the following nursing actions should the nurse TEACH the patient’s care giver regarding tracheostomy care? A. Remove the tracheostomy tube if obstruction occurs B. Leave the tracheostomy ties in place until the physician change them C. Remove and clean the inner cannula daily D. Never put a covering over the tracheostomy stoma 48. After a tracheostomy procedure, the nurse documents important observations made during the procedures such as _______. A. response of the patient after the procedure B. vital signs of the patient during the procedure C. amount, color, and consistency of sputum and appearance of the incision D. behavior of the patient during the procedure 49. What is the purpose of a tracheostomy? To _____. A. establish an airway B. establish a pathway for nutrition C. monitor respiratory functions D. maintain the patency of the airway 50. which of the following can be a MAJOR PROBLEM for a patient with tracheostomy? A. Breathing B. Ambulating C. Swallowing D. Singing situation 11- You are staff nurse in the Psychiatric Unit of a private hospital. Lorena, a 20-year old stage actress was admitted with the chief complaints of getting angry easily and inability to tolerate being alone. She claimed that she has also the tendency to manipulate people and feels unhappy most of the time. She was diagnosed to be suffering from Borderline Personality Disorder (BPD). 51. You have observed that Lorena is manifesting “spitting”. This characteristic of BPD is BEST defined as ______. A. viewing people and objects as parts, either good or bad B. having two personalities C. talking about other people behind their back D. literally spitting in other people’s face 52. When assessing a patient with BPD which of the following information would you focus on? A. Ability to get people on his/her side B. Disruption in some aspect of his/her life C. desire for intimate relationship D. Increase acceptance from other people 53. Lorena revealed she has a tendency to manipulate others. What would be the MOST APPROPRIATE short-term goal for her? For Lorena to _____. A. have an intimate relationship B. acknowledge her own behavior C. stop arguing with other people D. express her feelings verbally 54. Patient with BPD manifest transient psychotic symptoms. What is the drug of choice to treat these symptoms? A. Mood stabilizer B. Benzodiazepines C. Lithium D. Antipsychotics 55. Lorena has a history of alcohol abuse so she was started on Antabuse. Which of the following is a COMMON side effect of this drug? A. Hypertension B. Bradycardia C. Depression D. Elation Situation 12- Angela, a 40-year old, single mom of two preschool children, aged two (2) and five (5) years old respectively was admitted to the Psychiatric Unit for attempting to kill her two children. 56. Angela says “My dead mother ordered me to kill my two children before the devil could get them”. What behavior is being manifested by Angela? A. Auditory hallucination B. Visual hallucination C. Tactile stimulation D. Olfactory hallucination 57. You ask Angela to touch a 25-centavo coin and a one-peso coin. You have observed that Angels was having difficulty differentiating one coin from the other. This is manifestation of _____. A. astereognosis B. kinesthetic C. agraphestesia D. cenesthetic 58. You have observed that Angela is manifesting persistent hallucination. What is the MOST EFFECTIVE therapy in treating patient with a condition like that of Angela’s? A. Cognitive-behavior therapy B. Crisis intervention C. Psycho-pharmacologic treatment D. Anti-psychotic drug 59. Which of the following is the GOAL of nursing intervention for a patient who is hallucination. A. To help the patient to have an increased awareness that in symptoms she is experiencing is not real B. To help the patient to identify what triggers her hallucination C. To encourage the patient to verbalized her fear, anxiety, and anger D. To help the patient to go back to her real world 60. What communication technique would be Most effective to achieve the nursing goal for patient with hallucination? A. Listening B. Facilitative communication C. One-on-one discussion D. Social interaction Situation 13- Charting is part of the professional nurse’s responsibility related to record management. The following questions refer to this statement. 61. One of the characteristics of charting is brevity. Which of the following example of charting shows this characteristics? A. Nurse brought the patient to OR via stretcher at 10:15 B. Patient left for surgery via stretcher at 10:15 am C. To surgery via stretcher at 10:15 D. patient brought by the nurse to OR via stretcher at 10:15 accompanied by the “bantay” 62.Which of the following is NOT a requirement for a late entry in charting? A. nurse’s initials above the time B. may be made if something has been forgotten C. circle it and write “late entry” D. reason for the late entry 63. There is a black space after your last entry in your charting. You will ______. A. draw a double line after your last entry B. sign your full name after your last entry C. draw a horizontal line through the center of an empty line D. draw a perpendicular line across the empty space 64. Which of the following should the nurse’s notes focus on? A. Immediate past and the present B. The present only C. The future D. The recent past 65. Which of the following sample charting would show the characteristic of ACCURACY? A. intake from 700-1000 ml: 80 ml of coffee; 240 ml of orange juice; 500ml of water B. Patient on forced fluid but refused to take it most of the time C. Patient on forced fluids observed D. Given fluid at frequent intervals but takes only a few sips Situation 14- During summer season incidence of heat stroke rises. As a community health nurse you should disseminate information on this as part of your role as a health educator. 66. A patient came in with sign of heat stroke. Which of the following are signs/symptoms of profound CNS dysfunction? A. Elevated temperature B. Hot, dry skin C. Tachypnea, hypotension, tachycardia D. Confusion, delirium, bizarre behavior 4 | Page