Tiêu đề RECALLS 7 - NP4 - SC ✅

RECALLS 7 EXAMINATION NURSING PRACTICE IV CARE OF CLIENTS WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART B) NOVEMBER 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 IV” on the box provided Situation: You are caring for clients with thyroid and adrenal disorders. Monitoring for medication complications and hormonal imbalances is critical. 1. A client on propylthiouracil (PTU) reports fever and sore throat. What is the best next action? A. Check TSH level B. Discontinue PTU and get WBC count C. Continue PTU and ice throat D. Teach about agranulocytosis risk 2. A client with Addison’s disease reports nausea, abdominal pain, and profound weakness after missing two doses of hydrocortisone. Which action is priority? A. Provide a high-protein snack B. Obtain serum potassium level C. Prepare to administer IV hydrocortisone D. Monitor intake and output 3. Which teaching point is correct for a client with hyperthyroidism? A. Increase intake of high-iodine foods B. Avoid caffeine and high-stimulant drinks C. Increase caloric intake by 50% D. Restrict fluid intake to 1L/day 4. A client after thyroidectomy reports hoarseness and difficulty speaking. What is the nurse’s best response? A. Reassure the client this is expected and temporary B. Notify the provider immediately of airway obstruction C. Assess for neck swelling and stridor D. Offer lozenges for throat irritation 5. A client with Cushing’s syndrome has a blood glucose of 210 mg/dL and reports muscle weakness. What is the most appropriate nursing action? A. Encourage ambulation and low-protein diet B. Restrict fluid and sodium intake C. Monitor glucose and potassium levels D. Prepare to administer calcium supplements Situation: You are teaching diabetic patients about insulin therapy, glycemic patterns, and self-monitoring of blood glucose. 6. A nurse is teaching a diabetic about the dawn phenomenon. Which statement shows correct understanding? A. “I’ll eat a snack before bed to prevent it.” B. “I’ll measure my blood sugar at 3am.” C. “I’ll increase my insulin in the morning.” D. “I’ll work out before dinner.” 7. Which insulin regimen most closely mimics normal pancreatic function? A. NPH insulin once daily at bedtime B. Short-acting insulin only with meals C. Long-acting insulin once daily with rapid-acting at meals D. Intermediate-acting insulin twice daily only 8. A diabetic client with retinopathy is learning about exercise. Which statement indicates correct understanding? A. “I will avoid heavy weightlifting.” B. “I can exercise vigorously without restriction.” C. “Exercise will reverse my vision loss.” D. “I only need to exercise when my blood sugar is above 250 mg/dL.” 9. A client on an insulin pump has blood glucose of 60 mg/dL and feels shaky. What is the best first action? A. Give 15 g of simple carbohydrate B. Turn off the insulin pump C. Notify the provider immediately D. Administer glucagon IM 10. The nurse is teaching foot care to a client with diabetes. Which statement indicates a need for further teaching? A. “I’ll inspect my feet every day.” B. “I’ll go barefoot at home to strengthen my feet.” C. “I’ll trim toenails straight across.” D. “I’ll wear well-fitting shoes.” Situation: You are caring for patients with acute abdominal emergencies and gastrointestinal disorders. Prompt recognition of complications is essential. 11. Which assessment finding is most concerning in a client with acute pancreatitis? A. Epigastric pain B. Grey-Turner’s sign C. Nausea and vomiting D. Fever 12. Which of the following best indicates resolution of bowel obstruction? A. Distended abdomen B. Absent bowel sounds C. Passage of flatus D. Increased pain 13. A client post-cholecystectomy reports right upper quadrant pain radiating to the shoulder and nausea. What is the nurse’s best initial action? A. Administer ordered opioid analgesic B. Assess for abdominal rigidity and rebound tenderness C. Apply a heating pad to the abdomen D. Encourage deep breathing and coughing 14. A patient with cirrhosis has ascites and dyspnea. Which position best promotes comfort? A. Supine with pillows under the knees B. High Fowler’s with feet dependent C. Prone with head elevated D. Side-lying with knees flexed 15. Which dietary teaching is appropriate for a client with a new ileostomy? A. “Eat high-fiber foods to regulate output.” B. “Limit fluid intake to reduce stool output.” C. “Chew food thoroughly and avoid high-fiber foods initially.” D. “Increase raw fruits and vegetables for bowel health.” 16. A 55-year-old man with a history of alcoholism presents with hematemesis and melena. He is pale, diaphoretic, and 1 | Page
hypotensive (BP 80/50 mmHg, HR 122/min). What is the nurse’s priority intervention? A. Insert a large-bore IV line and prepare for fluid resuscitation B. Prepare the patient for colonoscopy C. Position the patient flat and keep NPO D. Administer an antiemetic 17. A patient with cirrhosis and esophageal varices suddenly begins vomiting bright red blood. The nurse notes confusion and a distended abdomen with ascites. Which intervention is most important? A. Insert a nasogastric tube for gastric lavage B. Place the patient in a high Fowler’s position and give oxygen C. Administer oral vitamin K to reduce bleeding D. Encourage fluids to maintain hydration 18. A 43-year-old woman with peptic ulcer disease complains of sudden, severe abdominal pain radiating to the shoulder, with a rigid abdomen. Her blood pressure is 90/60 mmHg, and pulse is 118/min. What is the nurse’s best immediate action? A. Administer an antacid and reassess pain B. Insert a nasogastric tube and prepare for surgery C. Give oral sucralfate to coat the stomach lining D. Encourage fluids to prevent dehydration 19. A client with hepatic encephalopathy is increasingly drowsy and has asterixis (flapping tremor). The family asks why the client is receiving lactulose. What is the nurse’s best explanation? A. “It helps stop bleeding from the liver.” B. “It reduces fluid buildup in your abdomen.” C. “It decreases ammonia levels that affect brain function.” D. “It stimulates your liver to regenerate.” 20. A post-gastrectomy client develops dizziness, tachycardia, and diaphoresis 20 minutes after eating. What is the nurse’s priority action? A. Encourage fluids during meals to improve digestion B. Place the patient in a recumbent position and monitor C. Give an immediate dose of insulin D. Offer a snack high in simple carbohydrates Situation: You are the charge nurse in a busy medical-surgical unit supervising a mixed team of registered nurses (RNs), licensed practical nurses (LPNs), and nursing assistants (NAs). Your priority is to ensure safe delegation, ethical practice, and proper patient education while handling time-sensitive tasks. 21. A nursing assistant reports a blood pressure of 90/60 mmHg on a post-op client who is pale and diaphoretic. What is the nurse’s first action? A. Reassess the blood pressure manually. B. Document the finding in the chart. C. Ask the NA to recheck it in 15 minutes. D. Notify the provider immediately without reassessing. 22. A nurse delegates feeding a stroke client with dysphagia to an NA. Which instruction is most important? A. “Feed them quickly to reduce fatigue.” B. “Keep them upright at 90 degrees during and after feeding.” C. “Offer thin liquids between each bite.” D. “Use a straw for easier fluid intake.” 23. An LPN asks which tasks they can perform. Which assignment is appropriate? A. Developing a new care plan for a client with sepsis. B. Administering oral antibiotics to a stable client. C. Performing the initial admission assessment. D. Teaching a client about insulin self-administration. 24. During rounds, you find a confused client attempting to pull out their IV line. What is the best immediate nursing action? A. Apply wrist restraints immediately. B. Reorient the client and offer a distraction. C. Document the incident only. D. Assign a staff member to sit with the client. 25. Which situation demonstrates advocacy? A. Supporting a client’s decision to refuse chemotherapy despite family pressure. B. Telling the client that the doctor’s orders cannot be changed. C. Encouraging a client to “just do what the doctor says.” D. Reminding a client that they have no right to refuse life-saving treatment. Situation: You are mentoring a new graduate nurse who struggles with ethical dilemmas, patient teaching, and infection control practices. Your role is to guide safe practice and reinforce core nursing principles. 26. A client says, “I don’t want CPR if I stop breathing.” Which action is most appropriate? A. Document the client’s statement as a DNR order. B. Inform the provider to discuss advance directives. C. Encourage the client to reconsider. D. Tell the family to decide what’s best. 27. Which infection control practice is correct when caring for a client with C. diff.? A. Use alcohol-based sanitizer after removing gloves. B. Wear a mask when within 3 feet of the client. C. Use soap and water handwashing after glove removal. D. Double-glove during all patient care. 28. A nurse educator teaches the principle of fidelity. Which statement shows understanding? A. “I will respect my client’s right to refuse treatment.” B. “I will keep promises and follow through with care I commit to.” C. “I will ensure that resources are distributed fairly.” D. “I will avoid harming my clients.” 29. Which teaching method is best for an older adult with mild hearing loss? A. Providing written instructions in large print. B. Speaking rapidly to finish instructions quickly. C. Turning away from the client while speaking. D. Increasing environmental noise for stimulation. 30. A client refuses a prescribed blood transfusion due to religious beliefs. Which is the nurse’s best response? A. “You must accept this treatment to save your life.” B. “Tell me more about your concerns and beliefs.” C. “I will explain why your family wants you to take it.” D. “You don’t have the right to refuse lifesaving care.” Situation: You are leading an ethics seminar for nurses, highlighting real clinical scenarios to help staff correctly identify ethical principles. 31. A nurse allows a competent client to sign an informed refusal form after explaining all potential consequences. Which principle is primarily upheld? A. Justice B. Autonomy C. Veracity D. Fidelity 32. A nurse documents all assessments truthfully and refrains from altering records, even under pressure. This best reflects: A. Veracity and fidelity B. Beneficence and justice C. Autonomy and non-maleficence D. Privacy and confidentiality 33. While caring for two patients, one wealthy and one homeless, the nurse provides equal attention and resources. Which principle applies? A. Justice B. Beneficence C. Autonomy D. Fidelity 34. After giving the wrong medication, the nurse immediately informs the client and provider, then completes an incident report. Which principle is shown? A. Non-maleficence B. Autonomy C. Veracity a. Privacy 35. A nurse follows through with a promise to return with pain medication within 10 minutes. This reflects: A. Justice B. Fidelity C. Privacy D. 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B. Demonstrating mood improvement in one week C. Verbalizing no plan for self-harm D. Participating in recreational activities 58. Which medication is most likely prescribed for acute alcohol withdrawal? A. Disulfiram B. Lorazepam C. Haloperidol D. Lithium 59. A nurse notes a client smiling while reporting sadness and hopelessness. This is known as: A. Flat affect B. Incongruent affect C. Restricted affect D. Blunted affect 60. A nurse teaching a group about stress explains that the fight-or-flight response initially causes: A. Bradycardia and pupil constriction B. Increased HR, BP, and dilated pupils C. Increased digestion and urine output D. Decreased blood glucose and muscle tension Situation: You are caring for clients with schizophrenia and psychotic disorders. Your role includes recognizing priority symptoms, preventing harm, and reinforcing medication adherence. 61. Which is the best response to a client experiencing auditory hallucinations? A. “I hear the voices too.” B. “That’s not real, ignore them.” C. “I know the voices seem real to you; what are they saying?” D. “You need to focus on reality now.” 62. Which assessment finding indicates benzodiazepine toxicity? A. Hyperreflexia and hypertension B. Respiratory depression and confusion C. Tinnitus and blurry vision D. Abdominal cramps and diarrhea 63. A client with dementia suddenly becomes more confused at night. This is called: A. Echolalia B. Perseveration C. Sundowning D. Confabulation 64. A nurse is reinforcing teaching about buspirone. Which statement indicates understanding? A. “I can take it as needed for anxiety attacks.” B. “It will start working in 1–2 days.” C. “I might feel dizzy but it’s not addictive.” D. “I need to avoid grapefruit juice.” 65. Which finding indicates serotonin syndrome? A. Hypothermia and depression B. Muscle rigidity, high fever, and confusion C. Bradycardia and excessive sleepiness D. Enlarged pupils and orthostatic hypotension Situation: You are addressing cognitive disorders and side effects of psychotropic medications, focusing on early complication detection and therapeutic approaches. 66. A nurse notices a client with dementia fabricating stories. This is known as: A. Perseveration B. Confabulation C. Flight of ideas D. Circumstantiality 67. Which therapeutic approach is best for a paranoid client refusing food? A. Offer food in sealed containers B. Force-feed for nutrition\ C. Ignore food concerns and focus on medication D. Restrict interaction until trust is gained 68. A nurse suspects neuroleptic malignant syndrome (NMS). Which symptom supports this? A. Sudden severe hypertension and headache B. High fever, muscle rigidity, altered consciousness C. Pinpoint pupils and respiratory depression D. Flushed skin and diarrhea 69. Which intervention is most appropriate for a client with moderate anxiety? A. Use a calm voice and explore feelings B. Avoid discussion until anxiety subsides C. Provide written instructions only D. Confront all irrational thoughts immediately 70. Which sign is associated with alcohol withdrawal rather than intoxication? A. Slurred speech and unsteady gait B. Bradycardia and hypotension C. Tremors and hypertension D. Pinpoint pupils and drowsiness Situation: You are assigned to clients with mood disorders, substance abuse issues, and risk for harm to self or others. Early identification and safety measures are essential. 71. A client in lithium therapy develops diarrhea, tremors, and confusion. What is the priority action? A. Document and continue monitoring B. Give an anti-diarrheal and fluids C. Hold the lithium and notify the provider D. Encourage a salty snack 72. Which behavior is expected in borderline personality disorder? A. Rigid perfectionism B. Intense, unstable relationships and fear of abandonment C. Lack of remorse for wrongdoing D. Detachment and restricted emotions 73. Which client statement reflects improved coping after depression treatment? A. “I still don’t feel like doing anything.” B. “I called a friend to go for a walk.” C. “Nothing will ever change for me.” D. “I can’t make any decisions.” 74. Which lab must be monitored for clients on valproic acid? A. Liver function tests B. Renal function C. Electrolytes D. Thyroid function tests 75. A client taking clozapine develops fever and sore throat. What is the priority action? A. Administer acetaminophen and fluids B. Hold the medication and get a CBC C. Reassure and continue treatment D. Schedule an outpatient follow-up Situation: You are working in an ICU responding to multiple cardiac arrests. Your role includes medication preparation, safe administration, and understanding their effects during code situations. 76. During a cardiac arrest, the first-line medication for asystole is: A. Epinephrine B. Amiodarone C. Atropine D. Dopamine 77. Which statement best explains the action of epinephrine during cardiac arrest? A. Increases vagal tone and decreases HR B. Enhances myocardial contractility and peripheral vasoconstriction C. Slows conduction through the AV node D. Decreases myocardial oxygen demand 78. The recommended route for epinephrine during code if IV/IO access is unavailable is: A. Oral B. Endotracheal (ET) tube C. Intramuscular deltoid D. Subcutaneous 79. What is the primary indication for atropine during a code? A. Ventricular fibrillation B. Pulseless electrical activity C. Symptomatic bradycardia D. Supraventricular tachycardia 80. Amiodarone is used during ACLS primarily for: A. Refractory VF/pulseless VT 4 | Page