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RECALLS EXAMINATION 11 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. A client with a diagnosis of depression who has attempted suicide says to the nurse, “I should have died. I’ve always been a failure. Nothing ever goes right for me.” Which response by the nurse demonstrates therapeutic communication? A. “You have everything to live for.” B. “Why do you see yourself as a failure?” C. “Feeling like this is all part of being depressed.” D. “You’ve been feeling like a failure for a while? 2. The nurse visits a client at home. The client states, “I haven’t slept at all the last couple of nights.” Which response by the nurse demonstrates therapeutic communication? A. “I see.” B. “Really?” C. “You’re having difficulty sleeping?” D. “Sometimes I have trouble sleeping too.” 3. A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat? A. Using open-ended questions and silence B. Sharing personal preference regarding food choices C. Documenting reasons why the client does not want to eat D. Offering opinions about the necessity of adequate nutrition 4. On review of the client’s record, the nurse notes that the admission was voluntary. Based on this information, the nurse plans care anticipating which client behavior? A. Fearfulness regarding treatment measures B. Anger and aggressiveness directed toward others C. An understanding of the pathology and symptoms of the diagnosis D. A willingness to participate in the planning of the care and treatment plan 5. A client is preparing to attend a Gamblers Anonymous meeting for the first time. The nurse should tell the client that which is the first step in this 12-step program? A. Admitting to having a problem B. Substituting other activities for gambling C. Stating that the gambling will be stopped D. Discontinuing relationships with people who gamble 6. A client is participating in a therapy group and focuses on viewing all team members as equally important in helping the clients meet their goals. The nurse is implementing which therapeutic approach? A. Milieu therapy B. Interpersonal therapy C. Behavior modification D. Support group therapy 7. The nurse is working with a client who, despite making a heroic effort, was unable to rescue a neighbor trapped in a house fire. Which client-focused action should the nurse engage in during the working phase of the nurse– client relationship? A. Exploring the client’s ability to function B. Exploring the client’s potential for self-harm C. Inquiring about the client’s perception or appraisal of why the rescue was unsuccessful D. Inquiring about and examining the client’s feelings for any that may block adaptive coping 8. A client says to the nurse, “The federal guards were sent to kill me.” Which is the best response by the nurse to the client’s concern? A. “I don’t believe this is true.” B. “The guards are not out to kill you.” C. “Do you feel afraid that people are trying to hurt you?” D. “What makes you think the guards were sent to hurt you?” 9. A client is admitted to the mental health unit with a diagnosis of depression. The nurse should develop a plan of care for the client that includes which intervention? A. Encouraging quiet reading and writing for the first few days B. Identification of physical activities that will provide exercise C. No socializing activities until the client asks to participate in milieu D. A structured program of activities in which the client can participate 10. When planning the discharge of a client with chronic anxiety, which is the most appropriate maintenance goal? A. Suppressing feelings of anxiety B. Identifying anxiety-producing situations C. Continuing contact with a crisis counselor D. Eliminating all anxiety from daily situations 11. A client is unwilling to go to his church because his ex-girlfriend goes there and he feels that she will laugh at him if she sees him. Because of this hypersensitivity to a reaction from her, the client remains homebound. The home care nurse develops a plan of care that addresses which personality disorder? A. Avoidant B. Borderline C. Schizotypal D. Obsessive-compulsive 12. The nurse is preparing a client with schizophrenia a history of command hallucinations for discharge by providing instructions on interventions for managing hallucinations and anxiety. Which statement in response to these instructions suggests to the nurse that the client has a need for additional information? A. “My medications will help my anxious feelings.” B. “I’ll go to support group and talk about what I am feeling.” C. “When I have command hallucinations, I’ll call a friend for help.” D. “I need to get enough sleep and eat well to help prevent feeling anxious.” 13. The nurse is caring for a client just admitted to the mental health unit and diagnosed with catatonic stupor. The client is 1 | Page
lying on the bed in a fetal position. Which is the most appropriate nursing intervention? A. Ask direct questions to encourage talking. B. Leave the client alone so as to minimize external stimuli. C. Sit beside the client in silence with simple open-ended questions. D. Take the client into the dayroom with other clients to provide stimulation. 14. The nurse is caring for a client diagnosed with paranoid personality disorder who is experiencing disturbed thought processes. In formulating a nursing plan of care, which best intervention should the nurse include? A. Increase socialization of the client with peers. B. Avoid using a whisper voice in front of the client. C. Begin to educate the client about social supports in the community. D. Have the client sign a release of information to appropriate parties for assessment purposes 15. The nurse determines that the wife of an alcoholic client is benefiting from attending an Al-Anon group if the nurse hears the wife make which statement? A. “I no longer feel that I deserve the beatings my husband inflicts on me.” B. “My attendance at the meetings has helped me see that I provoke my husband’s violence.” C. “I enjoy attending the meetings because they get me out of the house and away from my husband.” D. “I can tolerate my husband’s destructive behaviors now that I know they are common among alcoholics.” 16. The nurse is caring for a female client who was admitted to the mental health unit recently for anorexia nervosa. The nurse enters the client’s room and notes that the client is engaged in rigorous push-ups. Which nursing action is most appropriate? A. Interrupt the client and weigh her immediately. B. Interrupt the client and offer to take her for a walk. C. Allow the client to complete her exercise program. D. Tell the client that she is not allowed to exercise rigorously. 17. A client with a diagnosis of anorexia nervosa, who is in a state of starvation, is in a 2-bed room. A newly admitted client will be assigned to this client’s room. Which client would be the best choice as a roommate for the client with anorexia nervosa? A. A client with pneumonia B. A client undergoing diagnostic tests C. A client who thrives on managing others D. A client who could benefit from the client’s assistance at mealtime 18. The spouse of a client admitted to the mental health unit for alcohol withdrawal says to the nurse, “I should get out of this bad situation.” Which is the most helpful response by the nurse? A. “Why don’t you tell your spouse about this?” B. “What do you find difficult about this situation?” C. “This is not the best time to make that decision.” D. “I agree with you. You should get out of this situation.” 19. A client with anorexia nervosa is a member of a predischarge support group. The client verbalizes that she would like to buy some new clothes, but her finances are limited. Group members have brought some used clothes to the client to replace the client’s old clothes. The client believes that the new clothes are much too tight and has reduced her calorie intake to 800 calories daily. How should the nurse evaluate this behavior? A. Normal behavior B. Evidence of the client’s disturbed body image C. Regression as the client is moving toward the community D. Indicative of the client’s ambivalence about hospital discharge 20. The nurse observes that a client with a potential for violence is agitated, pacing up and down the hallway, and making aggressive and belligerent gestures at other clients. Which statement would be most appropriate to make to this client? A. “You need to stop that behavior now.” B. “You will need to be placed in seclusion.” C. “You seem restless; tell me what is happening.” D. “You will need to be restrained if you do not change your behavior.” 21. The nurse is reviewing the assessment data of a client admitted to the mental health unit. The nurse notes that the admission nurse documented the client is experiencing anxiety as a result of a situational crisis. The nurse plans care for the client, determining that this type of crisis could be caused by which event? A. Witnessing a murder B. The death of a loved one C. A fire that destroyed the client’s home D. A recent rape episode experienced by the client 22. The nurse is creating a plan of care for a client in a crisis state. When developing the plan, the nurse should consider which factor? A. A crisis state indicates that the client has a mental illness. B. A crisis state indicates that the client has an emotional illness. C. Presenting symptoms in a crisis situation are similar for all clients experiencing a crisis. D. A client’s response to a crisis is individualized and what constitutes a crisis for one client may not constitute a crisis for another client 23. The nurse in the emergency department is caring for a young female victim of sexual assault. The client’s physical assessment is complete, and physical evidence has been collected. The nurse notes that the client is withdrawn, distracted, tremulous, and bewildered at times. How should the nurse interpret these behaviors? A. Signs of depression B. Reactions to a devastating event C. Evidence that the client is a high suicide risk D. Indicative of the need for hospital admission 24. A depressed client on an inpatient unit says to the nurse, “My family would be better off without me.” Which is the nurse’s best response? A. “Have you talked to your family about this?” B. “Everyone feels this way when they are depressed.” C. “You will feel better once your medication begins to work.” D. “You sound very upset. Are you thinking of hurting yourself?” 25. The police arrive at the emergency department with a client who has lacerated both wrists. Which is the initial nursing action? A. Administer an antianxiety agent. B. Assess and treat the wound sites. C. Secure and record a detailed history D. Encourage and assist the client to ventilate feelings 26. A moderately depressed client who was hospitalized 2 days ago suddenly begins smiling and reporting that the crisis is over. The client says to the nurse, “I’m finally cured.” Based on the client’s behavior and statement, which intervention should the nurse include in the plan? A. Suggesting a reduction of medication B. Allowing increased “in-room” activities C. Increasing the level of suicide precautions D. Allowing the client off-unit privileges as needed 27. The nurse is planning care for a client being admitted to the nursing unit who attempted suicide. Which priority nursing intervention should the nurse include in the plan of care? A. One-to-one suicide precautions B. Suicide precautions with 30-minute checks C. Checking the whereabouts of the client every 15 minutes D. Asking the client to report suicidal thoughts immediately 28. The emergency department nurse is caring for an adult client who is a victim of family violence. Which priority information should be included in the discharge instructions? A. Information regarding shelters B. Instructions regarding calling the police C. Instructions regarding self-defense classes D. Explaining the importance of leaving the violent situation 29. A female victim of a sexual assault is being seen in the crisis center. The client states that she still feels “as though the 2 | Page
rape just happened yesterday,” even though it has been a few months since the incident. Which is the most appropriate nursing response? A. “You need to try to be realistic. The rape did not just occur.” B. “It will take some time to get over these feelings about your rape.” C. “Tell me more about the incident that causes you to feel like the rape just occurred.” D. “What do you think that you can do to alleviate some of your fears about being raped again?” 30. A client is admitted to the mental health unit after an attempted suicide by hanging. The nurse can best ensure client safety by which action? A. Requesting that a peer remain with the client at all times. B. Removing the client’s clothing and placing the client in a hospital gown. C. Assigning to the client a staff member who will remain with the client at all times. D. Admitting the client to a seclusion room where all potentially dangerous articles are removed 31. A client with schizophrenia has been started on medication therapy with clozapine. The nurse should assess the results of which laboratory study to monitor for adverse effects from this medication? A. Platelet count B. Blood glucose level C. Liver function studies D. White blood cell count 32. A client is scheduled for discharge and will be taking phenobarbital for an extended period. The nurse would place highest priority on teaching the client which point that directly relates to client safety? A. Take the medication only with meals. B. Take the medication at the same time each day. C. Use a dose container to help prevent missed doses. D. Avoid drinking alcohol while taking this medication. 33. The nurse is describing the medication side and adverse effects to a client who is taking amitriptyline. Which information should the nurse incorporate in the discussion? A. Consume a low-fiber diet. B. Increase fluids and bulk in the diet. C. Rest if the heart begins to beat rapidly. D. Walk if you have difficulty urinating because this is a normal side effect. 34. The nurse is administering risperidone to a client with schizophrenia who is scheduled to be discharged. Before discharge, which instruction should the nurse provide to the client? A. Get adequate sunlight. B. Continue driving as usual. C. Avoid foods rich in potassium. D. Get up slowly when changing positions 35. The nurse is teaching a client who is being started on imipramine about the medication. The nurse should inform the client to expect maximum desired effects at which time period following initiation of the medication? A. In 2 months B. In 2 to 3 weeks C. During the first week D. During the sixth week of administration 36. The nurse notes that a client with schizophrenia and receiving an antipsychotic medication is moving her mouth, protruding her tongue, and grimacing as she watches television. The nurse determines that the client is experiencing which medication complication? A. Parkinsonism B. Tardive dyskinesia C. Hypertensive crisis D. Neuroleptic malignant syndrome 37. The nurse is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine. Which information would be important for the nurse to obtain during this client visit regarding the side and adverse effects of the medication? A. Cardiovascular symptoms B. Gastrointestinal dysfunctions C. Problems with mouth dryness D. Problems with excessive sweating 38. A client who has been taking buspirone for 1 month returns to the clinic for a follow-up assessment. The nurse determines that the medication is effective if the absence of which manifestation has occurred? A. Paranoid thought process B. Rapid heartbeat or anxiety C. Alcohol withdrawal symptoms D. Thought broadcasting or delusions 39. A hospitalized client has begun taking bupropion as an antidepressant agent. The nurse determines that which is an adverse effect, indicating that the client is taking an excessive amount of medication? A. Constipation B. Seizure activity C. Increased weight D. Dizziness when getting upright 40. A client receiving tricyclic antidepressants arrives at the mental health clinic. Which observation would indicate that the client is following the medication plan correctly? A. Client reports not going to work for the past week. B. Client complains of not being able to “do anything” anymore. C. Client arrives at the clinic neat and appropriate in appearance. D. Client reports sleeping 12 hours per night and 3 to 4 hours during the day. 41. Your neighbor's husband comes to talk to you. He says his wife has not left the house in 2 weeks, has a flat mood, and has lost interest in her usual activities. You recognize these as the primary symptoms of A. Depression. B. Schizophrenia. C. Suicidal ideation. D. Bipolar manic episodes. 42. Which of the following is an example of cognitive response to a mild level of anxiety? A. Narrowing perception B. Feelings of horror or dread C. Pacing the room D. Increased concentration 43. A client diagnosed with generalized anxiety disorder is placed on clonazepam (Klonopin) and buspirone (BuSpar). Which client statement indicates teaching has been effective? A. The client verbalizes that the clonazepam (Klonopin) is to be used for long-termtherapy in conjunction with buspirone (BuSpar). B. The client verbalizes that buspirone (BuSpar) can cause sedation and should betaken at night. C. The client verbalizes that clonazepam (Klonopin) is to be used short-term until thebuspirone (BuSpar) takes full effect. D. The client verbalizes that tolerance can result with long-term use of buspirone(BuSpar). 44. A client diagnosed with posttraumatic stress disorder is close to discharge. Which client statement would indicate that teaching about the psychosocial cause of posttraumatic stress disorder was effective? A. "I understand that the event I experienced, how I deal with it, and my support system all affect my disease process." B. "I have learned to avoid stressful situations as a way to decrease emotional pain." C. "So, natural opioid release during the trauma caused my body to become 'addicted.'" D. "Because of the trauma, I have a negative perception of the world and feel hopeless 45. A client diagnosed with posttraumatic stress disorder states to the nurse, "All those wonderful people died, and yet I was allowed to live." Which is the client experiencing? A. Denial. B. Social isolation. C. Anger. D. Survivor's guilt. 46. Clients diagnosed with obsessive-compulsive disorder commonly use which mechanism? A. Suppression. B. Repression. C. Undoing. 3 | Page
D. Denial. 47. A newly admitted client is diagnosed with posttraumatic stress disorder. Which behavioral symptom would the nurse expect to assess? A. Recurrent, distressing flashbacks B. Intense fear, helplessness, and horror. C. Diminished participation in significant activities. D. Detachment or estrangement from others. 48. In which situation would the nurse suspect a medical diagnosis of social phobia? A. A client abuses marijuana daily and avoids social situations because of fear of humiliation. B. An 8-year-old child isolates from adults because of fear of embarrassment, but has good peer relationships in school. C. A client diagnosed with Parkinson's disease avoids social situations because of embarrassment regarding tremors and drooling. D. A college student avoids taking classes that include an oral presentation because of fear of being scrutinized by others. 49. A client experiencing a panic attack would display which physical symptom? A. Fear of dying. B. Sweating and palpitations. C. Depersonalization. D. Restlessness and pacing. 50. A client newly admitted to an in-patient psychiatric unit is diagnosed with obsessive compulsive disorder. Which behavioral symptom would the nurse expect to assess? A. The client uses excessive hand washing to relieve anxiety. B. The client rates anxiety at 8/10. C. The client uses breathing techniques to decrease anxiety. D. The client exhibits diaphoresis 51. A client diagnosed with obsessive-compulsive disorder is newly admitted to an inpatient psychiatric unit. Which cognitive symptom would the nurse expect to assess? A. Compulsive behaviors that occupy more than 4 hours per day. B. Excessive worrying about germs and illness. C. Comorbid abuse of alcohol to decrease anxiety. D. Excessive sweating and an increase in blood pressure and pulse. 52. When a client experiences a panic attack, which outcome takes priority? A. The client will remain safe throughout the duration of the panic attack. B. The client will verbalize an anxiety level less than 2/10. C. The client will use learned coping mechanisms to decrease anxiety. D. The client will verbalize the positive effect 53. A client on an in-patient psychiatric unit is experiencing a flashback. Which intervention takes priority? A. Maintain and reassure the client of his or her safety and security. B. Encourage the client to express feelings. C. Decrease extraneous external stimuli. D. Use a nonjudgmental and matter-of-fact approach. 54. A client diagnosed with panic attacks is being admitted for the fifth time in 1 year because of hopelessness and helplessness. Which precaution would the nurse plan to implement? A. Elopement precautions. B. Suicide precautions. C. Homicide precautions. D. Fall precautions. 55. The nurse on the in-patient psychiatric unit should include which of the following interventions when working with a newly admitted client diagnosed with obsessive compulsive disorder? Select all that apply. A. Assess previously used coping mechanisms and their effects on anxiety. B. Allow time for the client to complete compulsions. C. With the client's input, set limits on ritualistic behaviors. D. Present the reality of the impact the compulsions have on the client's life. 56. A client is experiencing a severe panic attack. Which nursing intervention would meet this client's immediate need? A. Teach deep breathing relaxation exercises B. Place the client in a Trendelenburg position C. Stay with the client and offer reassurance of safety D. Administer the ordered PRN buspirone (BuSpar) 57. A nurse interacts with a newly hospitalized patient. Select the nurse's comment that applies the communication technique of "offering self." A. "I've also had traumatic life experiences. Maybe it would help if I told you about them." B. "Why do you think you had so much difficulty adjusting to this change in your life?" C. "I hope you will feel better after getting accustomed to how this unit operates." D. "I'd like to sit with you for a while to help you get comfortable talking to me." 58. A patient diagnosed with schizophrenia tells the nurse, "The NBI is monitoring us through the fluorescent lights in this room. Be careful what you say." Which response by the nurse would be most therapeutic? A. "Let's talk about something other than the NBI." B. "It sounds like you're concerned about your privacy." C. "The NBI is prohibited from operating in health care facilities." D. "You have lost touch with reality, which is a symptom of your illness 59. Inpatient hospitalization for persons with mental illness is generally reserved for patients who: A. present a clear danger to self or others. B. are noncompliant with medication at home. C. have limited support systems in the community. D. develop new symptoms during the course of an illness. 60. Which expected client outcome should a nurse identify as being correctly formulated? A. Client will feel happier by discharge. B. Client will demonstrate two relaxation techniques. C. Client will verbalize triggers to anger by end of session. D. Client will initiate interaction with one peer during free time within 2 days. 61. This is known as the DRRM Act of 2010 A. RA 10221 B. RA 10121 C. RA 11021 D. RA 11202 62. The following are the 4 thematic areas of NDRRM Plan EXCEPT A. Disaster Prevention and Mitigation B. Disaster Evaluation C. Disaster Preparedness D. Disaster response E. Disaster recovery 63. The chairperson of NRRMC that leads the council in crafting policies and implementing actions A. DILG Secretary B. DND Secretary C. Philippine President D. DSWD Secretary 64. When assessing patients who are victims of a chemical agent attack, the nurse is aware that assessment findings vary based on the type of chemical agent. The chemical sulfur mustard is an example of what type of chemical warfare agent? A. Nerve agent B. Blood agent C. Pulmonary agent D. Vesicant 65. Emergency department (ED) staff members have been trained to follow steps that will decrease the risk of secondary exposure to a chemical. When conducting decontamination, staff members should remove the patients clothing and then perform what action? A. Rinse the patient with water. B. Wash the patient with a dilute bleach solution. C. Wash the patient chlorhexidine. 4 | Page