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REFRESHER PHASE EVALUATIVE EXAMINATION RESPIRATORY & HEMATOLOGY NOVEMBER 2024 Philippine Nurse Licensure Examination Review 1. A nurse is caring for a patient with acute respiratory distress syndrome. To maximize the patient’s respiratory status, the nurse should intervene by: A. cooling all inspired gases. B. weighing the patient every other day. C. monitoring blood glucose levels every 4 hours. D. positioning the patient in high fowlers position. 2. A patient is admitted in sickle cell crisis with symptoms of dyspnea and leg pain. The patient’s significant other asks, I don’t really understand why he is hurting so badly. Which response by the nurse is best? A. The pain is due to a disturbance in cellular metabolism. B. The bone marrow is expanding with the sickled cells and that causes pain. C. Clumping of abnormal red blood cells blocks the flow of blood through the small vessels. D. Bleeding in the joints occurs because red blood cells are being rapidly destroyed by the bone marrow. 3. The nurse is having a health teaching session the community. Which of the following information about emphysema is correct? A. Emphysema is characterized by the presence of over distended and non-functional alveoli. B. Emphysema is characterized by inflammation and increase production of mucus causing narrowing of airway. C. Emphysema is characterized by a productive cough that lasts 3 months in each of 2 consecutive years, in a patient in whom other causes of cough are excluded. D. Emphysema is a form of acute respiratory failure that occurs as a complication of some other condition; it is caused by a diffuse lung injury and leads to extravascular lung fluid. 4. The nurse is having a health education session with a client with tonsillitis. Which of the following rationales is correct about the use of warm saline gargle? A. Warm Saline gargle is used to lessen pain. B. Warm Saline gargle is used to kill microorganisms. C. Warm Saline gargle is used to flush microorganisms. D. Warm Saline gargle is used to decrease inflammation. 5. The physician ordered 1 puff of albuterol and 1 puff of beclomethasone for a client with asthma. Which of the following actions is correct about the doctor’s order? A. Administer albuterol first and wait for 1 minute before giving beclomethasone. B. Administer beclomethasone first and wait for 1 minute before giving albuterol. C. Administer albuterol first and wait for 5 minutes before giving beclomethasone. D. Administer beclomethasone first and wait for 5 minutes before giving albuterol. 6. A homeless client, visiting a health clinic, is noted to have a smooth and reddened tongue and ulcers at the corners of the mouth. The client was tentatively diagnosed with a hematological disorder, and laboratory tests were prescribed. Based on this information, a nurse should expect the client’s laboratory results to reveal: A. low hemoglobin. B. low white blood cells (WBCs). C. elevated red blood cells (RBCs). D. prolonged prothrombin time (PT). 7. The nurse is assisting in the development of a care plan for a patient with anemia. Which nursing diagnosis is most common in a patient with anemia? A. Activity Intolerance related to tissue hypoxia. B. Ineffective Airway Clearance related to dyspnea. C. Chronic Pain related to bone marrow dysfunction. D. Risk for Infection related to reduction in circulating WBCs. 8. Which of the following laboratory test is not related to iron deficiency anemia? A. Ferritin B. Serum iron C. Prothrombin time D. Mean corpuscular volume. 9. Which to the following is the correct administration of IM iron dextran? A. Push the skin prior to injection. B. Inject the needle at 45 degrees. C. Rotate the injection site of iron. D. Use the z-track method when injecting iron. 10. Which of the following is the most common cause of chronic obstructive pulmonary disease? A. Obesity B. Allergens C. Smoking D. Low HDL 11. A nurse is teaching an elderly client about the importance of using a spacer that is attached to the inhaler. The nurse should explain that this item: A. keeps the mouthpiece sterile. B. let the client see the medication as it is delivered. C. allows for a greater amount of medication to be delivered. D. allows for activating the medication canister by simply inhaling. 12. The nurse is doing a health teaching session about the intake of oral liquid iron. Which of the following statements about liquid iron is correct? A. Liquid iron can cause staining of the teeth. B. Liquid iron does not darken the stool. C. Liquid iron should be taken with milk. D. Liquid iron can cause diarrhea. 13. Which of the following medications is indicated to a client with aplastic anemia? A. Insulin B. Heparin C. Penicillin D. Cyclosporine 14. A patient is admitted to the hospital with hypertension and vertigo related to polycythemia vera (PV). For which treatment should the nurse prepare the patient? A. Myelogram B. Splenectomy C. Therapeutic phlebotomy D. Injection of colony-stimulating factors 15.The nurse is taking care of a client with nasal congestion. Which of the following findings would indicate that the client has sinusitis? A. Pain that is worsening when sitting. B. Pain that is worsening when reading. C. Pain that is worsening when lying down. D. Pain that is worsening when drinking large amount of fluids. TOP RANK REVIEW ACADEMY, INC. Page 1 | 3
16. Which of the following statements, if made by the client about the intake of ferrous sulfate, would indicate a need for further teaching? A. “I will increase my fiber and fluid intake when taking iron supplements.” B. “I will use an antacid together with iron to prevent gastric irritation.” C. “It is better to take iron with vitamin C to increase absorption.” D. “My stool may become dark when taking iron.” 17. A pregnant client presents to a clinic with ongoing nausea, vomiting, and anorexia at 29 weeks gestation. Her medical record reveals a hemoglobin level of 5 g/dL. A blood smear reveals that newly formed red blood cells are macrocytic. The nurse determines that the client is most likely experiencing: A. folic acid deficiency anemia. B. beta thalassemia minor. C. beta thalassemia major D. sickle cell anemia. 18. The nurse is taking care of a client with COPD. Which of the following laboratory findings would correlate to a client with COPD? A. High RBC B. High BUN C. High O2 saturation D. High Platelet count 19. A nurse is caring for multiple 25-year-old female clients. All of the following clients should obtain a referral for genetic counseling and family planning except: A. Client diagnosed with pernicious anemia. B. Client diagnosed with sickle cell disease. C. Client diagnosed with hemophilia A. D. Client diagnosed with hemophilia B. 20. A nurse observes early manifestations of acute respiratory distress syndrome (ARDS) in a client being treated for smoke inhalation. Which signs indicate the possible onset of ARDS in this client? A. Hypertension and elevated PaO2. B. Decrease in both white and red blood cell counts. C. Cough with blood-tinged sputum and respiratory alkalosis. D. Low SaO2 and unresponsive to increased oxygen administration. 21. The nurse is caring for a patient with Polycythemia Vera. Which laboratory study should the nurse monitor to help evaluate the effectiveness of treatment for this patient? A. Hematocrit B. Total protein C. WBC differential D. Blood urea nitrogen (BUN) 22. The parents of an 8-year-old child diagnosed with sickle cell anemia are being taught pain control measures for their child. Which measure is most important to teach the parents to prevent the onset of vaso-occlusive pain? A. Encourage drinking large amounts of fluids daily. B. Use cold water in bathing to prevent hyperthermia. C. Apply ice packs to all joints as soon as the child awakens. D. Increase outdoor exercise and exposure to the fresh air and sunshine. 23. Which of the following acid base imbalance is common among clients with COPD? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis 24. The nurse is caring for a patient in sickle cell crisis. What is the rationale for providing warm compresses and blankets for this patient? A. Heat speeds production of new healthy RBCs. B. Sickle cell crisis causes shivering and discomfort. C. Heat helps prevent the cells from becoming sickled. D. Heat prevents vasoconstriction and impaired circulation. 25. A client with iron deficiency is asking the nurse about foods rich in iron. Which of the following foods will the nurse suggest? A. Beer B. Ice cream C. Red meat D. Carbonated beverages 26.The nurse is instructing the client about the use of inhaled steroids for asthma. Which of the following information should the nurse emphasize? A. The client should increase fluid intake. B. The client should avoid crowded areas. C. The client should be reminded about the importance of oral hygiene. D. The client should be reminded about the importance of avoiding allergens. 27. A nurse is reviewing a plan of care for a postoperative client with a history of sickle cell disease. Which nursing diagnosis, documented on the client’s care plan, should the nurse address first? A. Anxiety B. Impaired skin integrity C. Deficient fluid volume D. Ineffective airway clearance 28. Which of the following clinical manifestations would you expect in a client with iron deficiency anemia? A. Pale tongue B. Ruddy complexion C. Clubbing of the nails D. Weakness and fatigue 29. A client is admitted in an acute care facility with pneumonia is receiving supplemental oxygen, 2 LMP via nasal cannula. The client’s history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these historical findings, the nurse closely monitors the oxygen and the client’s respiratory status. Which complication may arise if the client receives high oxygen concentration? A. Apnea B. Anginal pain C. Metabolic acidosis D. Respiratory alkalosis 30. A nurse teaches a 55-year-old strict vegetarian that, to decrease the risk of developing megaloblastic anemia, the client should: A. undergo a Schilling test. B. increase intake of foods high in iron. C. supplement the diet with vitamin B12. D. have a monthly hemoglobin level drawn. 31. The patient was brought to the ER due to epistaxis. Which of the following prescriptions would the nurse expect to administer? A. I.V. Fluids B. Analgesics C. Oxygen therapy D. Vasoconstrictors 32. Following an unrestrained motor vehicle crash, a client was brought to the emergency department with multiple injuries, including chest trauma. A physician notifies the care team that the client has progressed to acute respiratory distress syndrome (ARDS) and requests that the family be updated on the client’s condition. The nurse should plan to discuss with the family that: A. the condition is always fatal. B. the client can be discharged with home oxygen. C. the condition generally stabilizes with a positive prognosis. D. the condition is highly life-threatening and that end-of-life concerns should be addressed. 33. After tonsillectomy, which of the following findings would alert the nurse to suspect early hemorrhage in the client? A. BP of 110/70 mmHg B. Frequent swallowing C. Pulse rate of 95 bpm. D. drooling of bright green secretions. 34. Which of the following statements, if made by the client about asthma, would indicate a need for further teaching? A. “Asthma is usually worse at night.” B. “Asthma can be caused by allergens.” C. “Asthma is usually worse in the morning.” D. “Asthma is characterized by narrowing of the trachea.” TOP RANK REVIEW ACADEMY, INC. Page 2 | 3
35. A client who is complaining of a sore throat is in the outpatient department. Which of the following microorganisms is the most common cause of tonsillitis? A. Coli B. GABHS C. H. Pylori D. Candida albicans 36. A child having recovered following ingestion of rat poison, develops aplastic anemia. Which assessment finding is not related to aplastic anemia? A. Epistaxis B. Easily fatigued. C. Pale skin color D. Watery, itching eyes 37. Which of the following masks is best for the client with COPD? A. Nasal prong B. Venturi mask C. Simple Face mask D. Non re-breather mask 38. Which of the following medications should be given to a client with asthma for long term use? A. Ipratropium bromide B. Beclomethasone C. Epinephrine D. Albuterol 39. Which of the following should not be avoided by the client after tonsillectomy and adenoidectomy? A. Clearing of the throat. B. Blowing of the nose. C. Dark beverages. D. Cold collar. 40. The client who has sinusitis is admitted to the hospital. Which of the following locations would indicate an inflamed sphenoid sinus? A. Toothache B. Pain at the forehead. C. Pain at the mastoid area. D. Pain between or behind the eyes. 41. Nursing care for a patient who has polycythemia vera would focus in preventing: A. decubitus ulcers B. dysrhythmias C. hypotension D. thrombosis 42. The nurse is planning discharge teaching for a patient with polycythemia. Which nursing intervention should the nurse consider to help prevent complications in this patient? A. Monitor intake and output. B. Avoid use of injections for pain. C. Encourage 3 L of water intake daily. D. Maintain bedrest during treatment. 43. Which of the following positions would the nurse place a client after tonsillectomy? A. Supine B. Recumbent C. Semi-fowler’s D. Trendelenburg 44. Which of the following chemicals in the human body that does not contribute to the pathophysiology of asthma? A. Histamine B. Leukotrienes C. Prostaglandin D. Intrinsic factor 45. The nurse is taking care of a client with sinusitis. Which of the following interventions is inappropriate for the client? A. Increase fluid intake. B. Avoiding hot shower. C. Warm compress over the sinuses. D. Irrigating the sinuses with saline solution. 46. Which of the following lists of foods should be given to a client who has undergone tonsillectomy? A. Clear liquids, ice cream, pudding, crashed ice, and soda. B. Apple juice, ice pops, clear liquids, and cranberry juice. C. Cranberry juice, ice cream, pudding, and apple juice. D. Crashed ice, clear liquids, sorbet, and soft foods. 47. Which of the following is an intrinsic cause of asthma? A. Animal dander B. Spores C. Stress D. Dust 48. Which of the following medications is contraindicated to a client with asthma? A. Ipratropium bromide B. Propranolol C. Albuterol D. Cetirizine 49. The nurse is taking care of a client who is about to undergo a tonsillectomy. Which of the following interventions is inappropriate prior to the surgery? A. Notify the physician if the WBC is 8000/microliter. B. Assess for signs of active infection. C. Assess for any loose teeth. D. Report a prolonged INR. 50. A client was admitted to the hospital 24 hours ago after sustaining blunt chest trauma. Which earliest clinical manifestation of acute respiratory distress syndrome (ARDS) should the nurse monitor for? A. Cyanosis and pallor B. Diffuse crackles and rhonchi on chest auscultation C. Increase in respiratory rate from 18 to 30 breaths per minute. D. Haziness or “white-out” appearance of lungs on chest radiograph TOP RANK REVIEW ACADEMY, INC. Page 3 | 3