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RECALLS 1 EXAMINATION NURSING PRACTICE V CARE OF THE CLIENT WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART C) NOV 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 V” on the box provided Situation: Lea, 75 years, a retired nurse, is a full caregiver for her husband who has Alzheimer disease. She complains and says. “my vision is getting worse. A lot of time, my body aches. I’ve lost interest in eating and I seem to have lost weight. What if I can’t care for my husband anymore? I’m reaching the end of my rope. Yet, when asked by the nurse if she is depressed, her response is an unqualified “NO.” 1. Depression is often overlooked especially adults because of the belief that it is normal for older adults to be less active, less engaged and somatically preoccupied. Which of the following repercussions of this belief warrant the MOST urgency for health care professionals to consider? A. Older persons suffer in silence, remaining either undiagnosed or misdiagnosed B. Greater risk for developing heart disease C. It can mean suicide D. Longer hospital stays and decreased ability to follow health regimens 2. Lea is reluctant to be interviewed by the nurse. In order to assess mental health issues, it is MOST important for the nurse to create an environment of: A. Kind firmness and control B. Respect, compassion and reassurance C. Psychological safety and security D. Privacy and confidence 3. Lea’s verbalizations prompt the nurse to assist her to become aware of the existential aspects of depression such as: A. Denial and cognitive dissonance B. Little or no social support C. Death, isolation and meaninglessness D. Somatic complaints 4. Pharmacotherapy is the mainstay treatment for older adults with moderate to severe depression. Nurses should observe caution in the administration of monoamine oxidase inhibitors because of the risk of: A. Orthostatic hypotension B. Neuromalignant syndrome C. Hypertensive crisis D. Serotonin syndrome 5. Older adults like Lea respond slowly to antidepressants, and clinicians should assess for response at: A. 8-12 weeks B. 2-3 weeks C. 4-6weeks D. 12-16 weeks Situation: Nurses have an important role in establishing an environment that satisfies the biological, psychosocial, and spiritual needs of clients. They are often challenged with issues and problems in creating therapeutic environment for clients. 6. In structuring a therapeutic environment, it is MOST important for the nurse to: A. Safeguard physical safety and psychological security. B. Keep an effective social order that recognizes authority. C. Keep a restrictive environment to prevent patient assaultiveness. D. Maintain a closed-door policy to instill order and disciple. 7. Environment as referred to in ‘milieu therapy’ refers to the: A. Building and grounds where patients interact. B. People with different personalities who relate with one another. C. Physical environment and relationships of people within. D. Immediate physical surroundings that create an ambience for the patients 8. Attitude therapy safeguards the therapeutic application of attitudes toward patients. Rico, seeks attention from the staff by repeatedly deviating and not participating in structured activities. It is BEST for the nurse to: A. Respond: “it is okay for as long as you don't bother anyone” B. Have a patient watcher monitor him closely. C. Ignore the behavior. D. Respond: “we have agreed on a schedule. I expect you to follow.” 9. The nurse is aware that these patients are likely to be exploited in a group setting. These are the patients who are: A. Suspicious B. Sociable C. Withdrawn D. Hostile 10. A therapeutic community aims to: A. Have team leaders to check physical presence and attendance of patients in ward activities. B. Constantly monitor implementation of ward policies and rules. C. Encourage patient interactions, group problem solving and decision making. D. Encourage patients to police themselves and impose sanctions on ward violations. Situation: A nurse researcher in the Psychiatric unit is undertaking a study on the relationship between depressive symptoms and motivation to lose weight among high school overweight teens in selected schools at the National Capital Region. 11. The study design to be used by the researcher is: A. Experimental B. Predictive correlational C. Non-experimental D. Descriptive correlational 12. Which of the following is true about the study design being used by the researchers? A. There is no researcher intervention. B. It is safe to infer causal relationships in this study 1 | Page
design C. It proves causation. D. Effective means of collecting data 13. Which of the following inclusion criteria should be observed by the researcher in selecting the subjects? A. Current diagnosis of major depression. B. High school students with body mass index of 25 or greater. C. Enrolled in high school in NCR. D. High school students with aged limit of 16 – 20 years. 14. The independent variable for this study is: A. Weight loss B. Not applicable C. Depressive symptoms D. Motivation 15. One of the statistical approaches to be used by the researcher in analyzing whether a relationship exists between the number of depressive symptoms and motivation to lose weight is: A. Chi square test B. Analysis of covariance C. Pearson’s coefficient of correlation D. Product moment correlation Situation: Jelly is 12 years old, looks like she is 9 and acts she is 4. She has lightning – quick hands and can grab things off the desk, out of the staff’s pockets and off food trays in the blink of an eye. She is cute and known for getting black eyes and bruises. Wherever she is, there is trouble, but according to her, it is always someone else’s fault. She loves to run away from the Child and Adolescent Unit of the hospital and being chased by young staff members. 16. From the behavior of Justine, the nurse infers that a fundamental issue is Jelly’s: A. Difficulty developing stable relationships B. Inability to learn from past experiences C. Withdrawn attention D. Suspiciousness and mistrustful of others 17. With other children in the unit, Jelly smiles with glee watching adult staff struggle to take time to fix the place and put things in order every time she and other children create chaos. This pattern of behavior is: A. Assaultive B. Demanding C. Hostile D. Manipulative 18. The psychodynamics of Jelly’s behavior most likely would point to: A. Lack of social support for growing children from the local government. B. Lack of parenting, stressful and stormy family life. C. Failure of the school system to provide early education. D. Excessive media that portray sex and violence in TV programs. 19. In creating a therapeutic environment of Jelly and kids of the same situation, it is foremost to: A. Develop a positive self-image. B. Give high calorie rich nutritional intake. C. Provide safety and security. D. Provide remedial education. 20. In the unit, it is not common to hear loud bangs and thuds with yelling, screaming, and cursing of these children with the company of Jelly. A therapeutic activity that the staff can provide is: A. Leisurely and active gardening. B. Active ball games that are not competitive. C. Sports that foster cooperation and teamwork. D. Organizing book clubs for interaction. Situation: Nurses who are helping professionals and first responders in psychiatric emergencies and catastrophic situations often experience trauma and intense stress. Continuing education offered to nurses in this field aim to equip nurses’ knowledge and skills related to the important role in recognizing and responding to peers and colleagues struggling with maladaptive responses to trauma and stress. 21. Awareness of the varied responses of trauma and stress is a primary consideration in recognizing problems of helping professionals. Which of the following stress responses are cognitive in nature? A. Intrusive thoughts and reliving the incident, reduced ability to concentrate or mental confusion. B. Substance use, withdrawal from others, or acting out behaviors. C. Unfounded or unusual anger, depressive feelings, or anxiety reactions D. Fatigue, recurring headaches, or inability to sleep or eat. 22. Characteristic features of posttraumatic stress disorder include hyperarousal, i.e., exaggerated startle response, numbing effects and re-experiencing physiological and psychological reactions. The nurse notes that the duration of these symptoms MUST persist for at least: A. 2 days B. 1 month C. 2 weeks D. 3 days 23. Effects of compassion fatigue can be observed among emergency mental health professionals. This easily leads to: A. Somatic reactions B. Burnout C. Psychoses D. Neuroses 24. The idea of self – medication to cope with stress and trauma is common in helping professionals and first responders. This practice if it becomes pervasive has potential for: A. Substance use and abuse B. Behavioral changes and abuse C. Malpractice D. Avoidance behavior 25. A group strategy that allows processing of emotional effects of traumatic exposure is: A. Alcoholic anonymous B. Milieu therapy C. Psychodrama D. Avoidance behavior Situation: Kia, an adolescent, participating in a behavior therapy group cried while relating her experience of “cutting” on her skin, “the pain is so bad, this is the only way to get it out”. Kia is a survivor of sexual abuse perpetuated by her own father. She has history of repeated admission at Psychiatric Emergency Unit with repeated history of self – mutilation. She was diagnosed as Borderline Personality Disorder. 26. Kia verbalized the intensity of her emotional pain and anger, desperation and anxiety that escalate to a feeling of mounting tension. With this overwhelming anxiety, she may resort to dissociation which is characterized by: A. Feelings of emptiness and numbness and experience of depersonalization B. Retreat to an earlier developmental stage C. Use of excessive reasoning rather that reacting or changing D. Blame of others for one’s own feelings and thoughts 27. Nurses may perceive clients like Kia with strong countertransference reactions and feelings of frustration, betrayal, anger, and disgust. To work therapeutic with clients who self -mutilate, it is MOST important for nurses to: A. Do - self disclosure and solicit understanding from clients B. Acknowledge and overcome strong emotions C. Suppress reactions to maintain professionalism D. Engage in constructive activities to dissipate strong emotions. 28. Kia has a pattern of “cutting ” as a self – mutilating act. All of the following are therapeutic interventions EXCEPT: A. Offer sympathy, and additional attention to the behavior while cleaning the wound B. Care for the wounds in a matter-of-fact manner C. Allow the client to express angry feelings D. Problem-solve the situation with the client 29. Which of the following is a necessary initial step in determining interventions for Kia? 2 | Page

46. Patient Sandro is being treated for his bipolar disorder. He is prescribed with Eskalith. As a nurse, which of the following should you exclude from your health teachings? A. Medication can be administered with food. B. He is allowed to drink coffee every morning. C. Notify the physician if fever occurs. D. He can take the missed dose within 2 hours of the scheduled time. 47. While reviewing about Eskalith, you know that severe lithium toxicity is manifested by: A. Anuria B. Severe diarrhea C. Apathy D. Muscle twitching 48. Patient Cielo’s chart states that dystonia is noted on her while taking antipsychotic medications. Which manifestations do you expect to see? A. Dysphagia, facial grimacing B. Oculogyric crisis, increased heart rate, drooling C. Twisting of the torso D. Drowsiness, restlessness 49. Fluoxetine is prescribed to Patient John Mark. How should it be administered? A. On full stomach B. On an empty stomach C. At the same time each morning D. At the same time each evening 50. A mother of a child with ADHD asked you the most effective medication in controlling the disorder. Your answer would be: A. CNS stimulants B. CNS depressants C. Donepezil D. Rivastigmine Situation: A client is brought to the Emergency Department complaining of generalized weakness of all extremities and facial muscles and drooping of the eyelids since a week ago His condition fluctuates from day to day. The examining physician tested the client with an acetylcholinesterase inhibitor test to diagnose myasthenia gravis. 51. Nurse Liza is assigned to care for the client. Which of the following medications prescribed by the physician should nurse Liza prepare to diagnose myasthenia gravis? A. Atropjne sulfate B. Tensilon C. Mestinon D. lsuprel 52. Thirty minutes after injection, nurse Liza noted an immediate Improvement in the muscle strength. This can be interpreted as a: A. Autoimmune disorder B. Positive test confirming the diagnosis C. Negative failure D. Negative for myasthenia gravis 53. The client asked if he will take Tensilon for MG treatment. Nurse Liza answered “NO” because: A. It is toxic to the body B. It is only short-acting C. It causes adverse effects D. It crosses the blood-brain barrier 54. Nurse Liza noticed the client suddenly developed cramps and sweating. In a situation like this, which of the following drugs must be made available to control the side effects of he tested drug? A. Prednisone B. Mestinon C. Atropine sulfate D. Potassium supplement 55. Nurse Liza is administering pyridostigmine (Mestinon) orally to the client. Which of the following nursing intervention indicates safety measure before administering the medication? A. Instructing the client to be in bed when taking the medication B. Determining client’s ability to swallow C. Positioning the client to lie down on his left side D. Requiring the client to lei still in bed Situation: A 67 year old female client is diagnosed with Senile Nuclear Cataract OU (both eyes) H25.1; Dry Eye Syndrome. 56. The nurse is conducting nursing assessment and preparing a nursing history. Which of the following clinical manifestations of the client gathered by the nurse is characteristic of cataracts? A. Narrow anterior chamber B. Optic nerve damage C. Painless blurry vision D. Age factor 57. Based from the information gathered the nursing diagnosis is: A. Self-care deficit related to impaired vision B. Disturbed sensory perception related to visual impairment C. Acute pain related to eye dysfunction D. Anxiety related to possible vision loss 58. The physician scheduled the client for Phacoemulsification with intraocular lens implantation surgery. The physician informed the client of the nature of the procedure and what to expect after surgery. The client verbalized to the nurse,” I have never had surgery before”. Given this situation, the nurse appropriate expected outcome for the client to: A. Maintain asepsis aids in protecting the surgical site form infection and complications B. Know sign and symptoms of complications that are to be reported to physician immediately C. Verbalize preoperative routine activities and postoperative procedures and expectations D. Understand handwashing and aseptic technique for postoperative eyes care 59. The admitting order include: Phacoemulsification with intraocular lens implantation surgery right eye local anesthesia 7:00AM OPD. Start Sanmyd – P Ophthalmic Solution 1 drop every 5 minutes to right eye once the client is admitted. The client demonstrates understanding of the pre – operative medication when she states that the administration to eye drops: A. Reduce intraocular pressure B. Minimize swelling C. Dilate the pupils D. Relieve pain 60. The client is given post – cataract surgery instructions consisting of instillation of eye meds, Tobrex, 1 drop every 3 hours (waking hours), Pred Fortre – 1 drop every 3 hours (waking hours): oral meds for pain including health teaching and other instructions. Client education guide should include the following EXCEPT: A. Not rubbing the right eye nor lifting objects B. Placing plastic eye shield when sleeping. Using eyeglasses while awake C. Having regular baths and washing of face but no swimming D. Taking aspirin or drugs containing aspirin Situation: Romina, age 19, was admitted with acute pyelonephritis and has elevated temperature. The nurse on duty reported that she refused acetaminophen and has had only sips of fluid to supplement her IV therapy. The patient appears sad and has remained in bed with the covers over her head most of the day. Her history includes a psychiatric hospitalization two years ago for major depressive disorder. She was started on antidepressant medication. 61. Depressed mood or loss of interest in pleasure and activities in depressive disorder is with duration of at least: A. month B. Two weeks C. 2-3 days D. one week 62. Romina has been withdrawn and appears sad. Which of the following approaches validate your initial impression? A. “I noticed that you've been withdrawn. Describe your mood for me” B. “what happened that brought your sadness?” C. “in a scale of 1 - 10, 10 being the highest, what level is your feeling sad?” 4 | Page

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