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RECALLS EXAMINATION 13 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 1-5. Situation. Mrs. Sotto, a 77 year old widow came in with the chief complaints of difficulty hearing high pitched sounds. Ear examination revealed damage to the middle ear. 1. Which of the following ear assessments is a rough estimate of the ability to hear? A. Weber test B. Whisper test C. Audiometry D. Rinne test 2. When there is damage to the middle ear it will result to: A. Conductive loss B. Nerve deafness C. Mixed loss D. Sensorineural loss 3. Which of the following is a predisposing factor for a sensorineural hearing loss? A. Perforation of the eardrum B. Ototoxic agents C. Otosclerosis D. Serous otitis media 4. Which of the following statements is TRUE in correcting a sensorineural hearing loss? A. Sensorineural hearing loss is irreversible B. Sensorineural hearing loss can be corrected by stapedectomy C. Sensorineural hearing loss can be corrected by ossicular reconstruction D. Sensorineural hearing loss can be corrected by myringotomy 5. What is a high priority risk for the older adult with age-related changes in the vestibular structure of the ear? A. Infection B. Medication errors C. Falls D. Food intolerance 6-10. Situation. You are a staff nurse in the Ear Unit of the hospital. A common condition you encounter is hearing disorder which often results in communication problems. The following questions refer to these statements. 6. The daughter of an older adult patient reports that her father just “stares off into space” more and more in the last several months. However, once she gets his attention her father eagerly smiles and nods. You should assess the patient further for ______. A. Hearing loss B. Anger C. Dementia D. Depression 7. Which of the following should the nurse do FIRST when approaching a deaf patient? A. Get the patient’s attention B. Knock on the patient’s room loudly C. Talk while walking into the room D. Close and open the vertical blinds rapidly 8. You have a patient who is hearing impaired and reads speech. Which of the following strategies should you incorporate when communicating with him? Select all that apply. 1) Avoiding being silhouetted against strong light 2) Not blocking out the person’s view of the speaker’s mouth 3) Facing the patient when talking 4) Having bright light behind so the individual can see 5) Ensuring the patient is familiar with the subject material before discussing 6) Talking to the patient while doing other nursing procedures A. 1, 2, 3, 5 B. 2, 3, 6 C. 2, 3, 5, 6 D. 1, 4, 6 9. The patient with a hearing aid does not seem to hear you whenever you talk to him. What would be your PRIORITY nursing action? A. Irrigate the ear canal B. Contact the patient’s audiologist C. Check the hearing aids placement D. Cleanse the hearing aid earmold with normal saline 10. You have a 75 year old patient who has been taking furosemide (Lasix) regularly for four months now tells you that he is having trouble hearing. What would be your BEST response to this statement? A. Schedule the patient for audiometric testing and a hearing aid B. Tell the patient that because of his age it is inevitable that his hearing should begin to deteriorate C. Having the patient immediately report the hearing loss to his physician D. Tell the patient the hearing loss is only temporary, when his system adjust to the furosemide his hearing will improve 11-15. Situation. As a new RN, you are for one-month orientation in the orthopedic unit of the hospital. 11. Which of the following methods of documentation uses a chronological, story-telling format? A. Computerized documentation B. Narrative charting C. Focus charting D. PIE charting 12. Which of the following is the key issue in malpractice actions brought against nurses in relation to medical records? A. Failure to document the client’s response B. Failure to document medication and treatment given C. Failure to document appropriately D. Failure to use medical terms 13. You have observed the charge nurse charting treatments and medications prior to actual administration and implementation. Which of the following would be your initial action in this situation? A. Document what you have observed regarding the charge nurse’s behavior 1 | Page
B. Talk to the charge nurse about the legal implications of her action and the violation of standards of practice C. Report the charge nurse’s behavior to the nurse manager D. Tell the charge nurse that you have an obligation to report the behavior to the nurse manager 14. A staff nurse is seen making an entry into an electronic medical record under another nurse’s login. What is the most appropriate thing to do in this situation? A. Tell the staff nurse’s behavior to another nurse B. The staff nurse’s activity should be reported to someone in authority C. Talk to the staff nurse about it D. Just be quiet about the whole thing 15. Which of the following would be your MOST appropriate action when receiving a doctor's order over the phone? A. Have somebody beside you while receiving the doctors order B. Write down the telephone order C. Have the physician sign the telephone order first chance you see him D. Read back or repeat the order the physician gave you 16-20. Situation. As a professional nurse, you meet patients with problems related to sexuality and identity. The following questions relate to this statement. 16. Sex is one topic patients feel uncomfortable discussing with the nurse for which of the following reasons? Patients _______. A. Prefer to discuss sex with health care provider of the same sex B. Assume that sex is something that is not discussed with strangers C. Are mostly knowledgeable about sex and the accompanying problems D. Feel to be embarrassed to introduce the topic of sex 17. A patient tells you that he is transsexual. Knowledge of which of the following is MOST representative as the basis for APPROPRIATE care for this patient? A. Sexual anatomy is not consistent with gender identity B. Sexual attraction is to the individuals with different gender C. Gonadal gender, internal organs, and external genitals are contradictory D. Gender identity is altered by acute psychosis 18. A patient tells you he has a problem related to masturbation. Which of the following is TRUE regarding masturbation? A. Masturbation is a manifestation of psychological imbalance B. Masturbation is a way people learn about their sexual response C. Most people do not masturbate when they become adults D. Teen-age masturbation affects academic achievement 19. A male patient is beginning to take an antidepressant medication. What information should the nurse include in her health teaching as to its side effects? A. Decreased sexual desire B. Better performance in sexual activities C. Premature ejaculation D. Better performance in bed 20. A female patient reports having dyspareunia. The MOST APPROPRIATE for the nurse to ask is ______. A. “Do you have pains in your breast when you have coitus?” B. “Have you had these spasms since you became sexually active?” C. “Do you usually have pains before your period begins?” D. “Have you talked with your partner about this discomfort?” 21-25. Situation. Mr. Wil, a 43 years old writer, was diagnosed with narcolepsy. 21. All of the following are characteristic signs/symptoms of Narcolepsy EXCEPT: A. Excessive daytime sleepiness B. Sleep-onset Rapid Eye Movement (REM) periods C. Disturbed nocturnal sleep D. Cessation of breathing for 10 seconds 22. Patients diagnosed with Narcolepsy are given Methylphenidate (Ritalin). The rationale for giving this drug is to _______. A. Lengthen sleep hours B. Improve alertness C. Improve daytime drowsiness D. Control cataplexy 23. Good sleep hygiene is given emphasis when counseling a narcoleptic patient. Which of the following is NOT considered as such? Encourage the patient to _______. A. Do active exercises B. Ensure a quality sleep environment C. Avoid daytime naps D. Avoid stimulants such as caffeine, nicotine and alcohol near bedtime. 24. Depression and decreased quality of life are frequently reported to be experienced by narcoleptic patients. Which of the following is NOT a major contributory factor to these two conditions? A. A healthy ego B. Disrupted social and occupational roles C. A strong superego D. Low self-esteem 25. Cataplexy is experienced by many narcoleptic patients. Which of the following BEST DESCRIBES this condition? A. Lapse of awareness B. Occurs at sleep onset C. Experienced upon awakening D. Sudden loss of muscle tone 26-30. Situation. Mr. JK, a 35 year old dancer consulted at the Out-Patient Department with the chief complaints of disorientation, abdominal pain, nausea, and excessive perspiration. He claimed to be seeing his mother and heard her calling his name. Upon admission the vital signs were: T = 38.5 degrees centigrade; PR = 110/min; BP = 130/90. Mr. JK is a known alcoholic. 26. Which of the following frameworks does not support the cause of substance abuse? A. Physiologic framework B. Psychological framework C. Biologic framework D. Socio-cultural framework 27. For the nurse to establish a therapeutic relationship with and providing treatment for a client with substance related disorder, he/she must have: A. Knowledge of assessment tools used to determine if substance abuse exist B. Knowledge of existing programs to help people with substance abuse disorder C. Self-awareness about substance use and abuse D. Information on patient’s beliefs about drug and alcohol use 28. Mr. JK’s clinical manifestation were manifestations of: A. Impending brain attack B. Impending heart attack C. Severe alcohol withdrawal D. Severe anxiety 29. For cases like that of Mr. JK’s, the physician will most likely order ______. A. Ativan B. Serax C. Naltrexone D. Diazepam 30. You want to find out the coping skills among young adults with substance abuse disorder. Which research method will you utilize to answer the research question? A. Survey B. Mixed methods C. Quantitative D. Qualitative 31-35. Situation. Inadequate resources in health care and unhealthy conditions in the workplace cause work stress among nurses. The nurse’s work environment plays a vital role in her ability to provide quality patient care. The following questions relate to this situation. 31. Burnout is a phenomenon that is best characterized by ____________. 2 | Page
A. Conflict between personal and professional life B. Emotional exhaustion, depersonalization, and reduced personal accomplishment C. Increased absenteeism and fast turn-over of nurses due to toxic work environment D. Growing dissatisfaction due to changing career expectations 32. Lifestyle modification begins with _______. A. Learning how to read food labels and eating the right kinds of food B. Recognizing the impact of unhealthy habits C. Constructive and positive attitudes in life D. Regular daily exercise 33. Elmo is a young adult nurse who smokes 5 to 10 cigarette sticks a day. He is a well-informed nurse on the “smoking cessation program”. As a next step to his lifestyle change, Elmo needs _______. A. Information B. Motivation C. Skills to implement change D. Commitment 34. A common response to an unhealthy work environment is physical tension which can be overcome by progressive muscle relaxation. Basically, this involves: A. Listening to a relaxation audio program for auto-suggestion B. Releasing muscles from tension C. Active physical exercise to unwind like aerobics exercise D. Focusing to an image to relax 35. Nurses and patients are increasingly getting empowered by learning stress management. All of these are bio-behavioral interventions in stress management EXCEPT: A. Progressive muscle relaxation B. Pharmacotherapy C. Mindful meditation D. Guided imagery 36-40. Situation. Mr. Bang, a 75 year old retired politician has been recently diagnosed as legally blind. His driver’s license has been revoked. You have seen him driving alone to the local grocery store several times. 36. Which of the following nursing actions would be your priority during your initial interaction with Mr. Bang? A. Free the environment obstacles B. Offer to read written information C. Ask Mr. Bang, “How can I help you?” D. Identify yourself as you approach Mr. Bang and before you make a physical contact. 37. Which of the following ethical principles are in conflict with this case? A. Autonomy and nonmaleficence B. Respect for person and nonmaleficence C. Distributive justice and respect for person D. Autonomy and beneficence 38. Mr. Bang’s’ driving without license can result in a violation of which ethical principle? A. Respect for person B. Beneficence C. Autonomy D. Nonmaleficence 39. Mr. Bang had a fall needing hospitalization. All his benefits were given to him just like any senior citizen with the same condition. This ethical principle is upheld in this situation: A. Beneficence B. Respect for person C. Autonomy D. Distributive justice 40. Which principle should have pre-eminence as you proceed to work with Mr. Bang A. Autonomy B. Respect for person C. Nonmaleficence D. Beneficence 41-45. Situation. Mrs. Catherine Fernando, a 78 year old widow, was brought to the clinic by her son with the chief complaint of constant confusion, incontinence, and tendency to wander. Mrs. Fernando has a diagnosis of cognitive impairment disorder. 41. The son of Mrs. Fernando informed the nurse that his mother seemed to be inventing stories about certain personal achievements. The nurse identifies this as confabulation and interprets it correctly as ________. A. Indicates a lack of ego-integration B. Results to tendency to lie C. Helps to maintain self-esteem D. Results in poor judgement 42. The nurse asked Mrs. Fernando for her children’s and grandchildren’s names. This is to assess Mrs. Fernando’: Remote Memory Recent Memory Attention Span Orientation Status 43. Which of the following outcome criteria would be the MOST APPROPRIATE for Mrs. Fernando? A. Follow an established schedule for activities for daily living. B. Learn new coping mechanisms to handle anxiety. C. Return to an adequate level of functioning. D. Seek out resources in the community for support. Ratio: A patient with cognitive impairment disorder shall have a routine daily schedule to achieve familiarity in activities. 44. The nurse spent time talking to Mrs. Fernando’s son. She gathered that the son is the primary caregiver. To explore and to prevent burn-out in the son, which of the following nursing actions must the nurse do? A. Assess degree of understanding of family systems and coping mechanisms. B. Explore individual dynamics and personal coping. C. Explore the support system available for Mrs. Meneses’s son. D. Identify the spiritual support system of the family. Ratio: Focus on the primary caregiver since it is what the question is talking about. 45. The nursing diagnosis MOST APPROPRIATE for Mrs. Fernando’s son would be _____. A. Sleep pattern disturbance B. Caregiver role strain C. Social isolation D. Risk violence 46-50. Situation. Your patient, Mrs. Doris, who was diagnosed with Alzheimer’s Disease, is soon to be discharged. You scheduled a family conference to discuss some concerns regarding Mrs. Doris’s condition. 46. You explained to the family members that there will be times Mrs. Doris will feel agitated and fatigued. To MINIMIZE if not totally prevent this situation, you would suggest to _______. A. Make mealtime pleasant B. Provide activities for her C. Avoid noisy activities in the house and schedule rest period for her D. Provide a consistent routine for her 47. A family member asked how they can help minimize Mrs. Doris’ disorientation to time. Your answer would be to: A. Encourage talking with friends on the phone B. Place clocks and calendars at prominent places C. Keep windows wide open D. Provide adequate lighting especially in hallways, stairways and bathrooms 48. A concern regarding physical safety came up during the conference. You would recommend to________. A. Always close the doors and windows B. Provide adequate lighting especially in hallways, stairways and bathrooms C. 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D. Reduce noises and distractions 49. A family member expressed that they may not have the ability to care for Mrs. Doris. Your MOST APPROPRIATE answer would be ________. A. “I will call Mrs. Doris’ doctor to explain to you more about Alzheimer’s Disease”. B. “What information regarding Alzheimer Disease has been given to you by her doctor. C. “Do you want to discuss with me specific concerns that bother you most?” D. “I will refer your case to the social worker” 50. You pointed out to the family that an important aspect of Mrs. Doris’ is the promotion of adequate nutrition. To address this concern, you would suggest to: A. Provide adequate lightning in the dining room B. Reduce noises and distractions during mealtime C. Do some active exercise before mealtime D. Keep mealtime pleasant and serve foods similar to her 51-55. Situation. You are the Quality Assurance Officer of your hospital. The following questions relate to this statement. 51. As the Quality Assurance Officer, you developed a group of nurses to conscientiously use the current evidence in managing patients with rheumatoid arthritis. This is an example of _______. A. Evidence-based practice B. Purposive sampling C. Research utilization D. Random sampling 52. Based on the initial research findings, Sterillium, an alcohol-based hand disinfectant is more effective than the traditional brush-stroke hand scrub method. You recommend its use by the nurses in the OR. This is an example of ______. A. Generalizability of results B. Evidence-based practice C. Dissemination of research findings D. Research utilization 53. One of your programs as a Quality Assurance Officer is to develop the research culture in the Nursing Service Department. What would be the best and easiest thing to do to encourage the nursing personnel to participate in research? A. Teaching them statistical procedures commonly applied in research B. Letting them do a critical analysis of a research topic C. Doing a review of related literature and studies D. Asking them to participate in gathering data 54. You were asked to present the most frequently occurring causes of sentinel events for the last six months as the basis for the patient safety program. What measure of central tendency are you going to use in this situation? A. Mode B. Median C. Mean D. Analysis of variance 55. You want to determine the difference in the coping skills among adolescents diagnosed with drug abuse as a basis of a gender specific program on coping skills. What will be your sampling technique to answer the research problem? A. Stratified sampling B. Purposive sampling C. Convenience sampling D. Random sampling 56-60. Situation. In interdisciplinary care of a psychiatric patient: Each number of the health item has his/her roles and functions. The following questions relate to this statement. 56. Which of the following is NOT an ingredient of the collaboration process? A. Negotiations between each member of the health team to conceptualize new ways of solving problems B. Communication techniques used by each health team member C. Receptively and respect for each health team member’s contribution D. Active and assertive contribution from each member of the health team 57. The MOST important steps in interdisciplinary team building is _________. A. Define disciplinary and individual roles and responsibilities B. Use disciplinary treatment plan C. Specify conflict resolution procedures D. Communicate regularly, openly and clearly 58. Which of the following is NOT a BARRIER to interdisciplinary collaboration? A. Personal qualities of the individual health care team member that promote shared problem solving B. Inequality of power and status C. Inappropriate education and training of mental health team members D. Role conflict 59. The element of collaboration essential in developing further psychiatric nursing is ________. A. Link between nursing theory and clinical practice through research B. Use of informatics C. Collaborative practice D. Utilization of evidence-based nursing interventions 60. The mental health team member is responsible for helping patients to receive the needed services is the __________. A. Case worker B. Psychologist C. Social worker D. Psychiatric nurse 61-65. Situation. You are a staff nurse in the Neurologic Unit of the Hospital. You are taking care of patients with different neurological conditions. The following questions refer to this statement. 61. Dan, a 24 year old stuntman, was admitted to your unit unconscious, after falling from a horse. Tentative diagnosis of Spinal Cord Injury was the cause of? A. Motor Vehicle Crashes B. Sports C. Violence D. Falls 62. The final diagnosis for Dan is Spinal Cord Injury, Anterior Cord Syndrome. Which of the following is NOT a characteristic of this condition? A. Loss of motor power B. Loss of pain and temperature sensations C. Pronounced sensory loss in the upper extremities D. Preserved position, vibration and touch sense 63. Patients suffering from Spinal Cord Injury are at risk for hypotension. This risk is attributable to ______. A. Volume depletion B. Pulmonary overload C. Loss of reflexes D. Fluid depletion 64. Patients with Spinal Cord Injury benefit from rehabilitation. Which of the following is NOT a goal of rehabilitation? A. To promote independence B. To prevent infection C. To reduce morbidity D. To maximize function recovery 65. Which of the following can be used as a guide when establishing the functional ability of a patient with Spinal Cord Injury? A. Degree of Residual Muscle Function B. Absence of Hypotension C. Degree of Independence D. Absence of Complications 66-70. Situation. You are a staff nurse assigned at the Musculo-Skeletual unit of the Pediatrics Department. 66. You do the initial assessment of a child diagnosed to have OSTEOMYELITIS, LEFT TIBIA. Which of the following would you expect to find when assessing the area over the tibia? A. Diffused tenderness B. Decreased pain C. Localized edema D. Increased warmth 67. Which of the following should you include in the care plan to meet the development needs of an 8 year old child confined at home with osteomyelitis? A. Talking to the child about his interests twice daily B. Allowing siblings to visit throughout the day 4 | Page