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RECALLS EXAMINATION 2 NURSING PRACTICE III CARE OF CLIENTS WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART A) 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 III” on the box provided Situation: Kiera has felt constipated and bloated for quite a while now. Two days ago, she was complaining of moderate cramping in her abdomen. Upon assessment, she is febrile with two episodes of vomiting before arriving to the emergency department. Nurse Eliza suspects that she has diverticulitis. The following questions apply. 1. Nurse Eliza is aware that, most commonly, the location of diverticulitis is found in which area of the abdomen? A. Right upper quadrant B. Right lower quadrant C. Left upper quadrant D. Left lower quadrant 2. Nurse Eliza differentiates diverticulitis from diverticulosis. She in incorrect when she states which of the following statement to describe the disorders? A. Diverticulosis develops as a result of high intake of fiber and fast colonic transit time B. Diverticulitis develops when one or more diverticula is inflamed C. Diverticulosis forms when the mucosal layers of the colon herniate through the muscular wall D. Diverticulitis occurs as a result of accumulation of bowel contents and obstruction in the diverticulum 3. Which of the following dietary recommendations can Nurse Eliza provide Kiera to manage her condition? A. Fluid intake of 2 liters a day B. Foods low in fiber C. High fat diet D. Regular diet 4. The diagnostic procedure of choice to confirm diverticulitis and reveal any perforation or abscess is done through? A. Abdominal CT scan with contrast B. Abdominal X-ray C. CBC with elevated WBC count D. Presence of frank blood in the stool 5. A few hours later, Kiera reports sudden, severe abdominal pain that radiates to the back and shoulders. Upon assessment, the abdomen appears rigid and board-like with absent bowel sounds. Kiera has a weak, thready pulse and is nauseated. Which of the following priority intervention should Nurse Eliza perform immediately? A. Administer Fleet enema as ordered B. Insert an NG tube C. Notify the physician D. Administer psyllium as ordered Situation: Critically-ill patients with prolonged pressure due to immobility poses great risk for pressure injury. As an ICU nurse, Nurse Ilyana initiates interventions to prevent the occurrence of these injuries. 6. In order to assess for risk for pressure injury, Nurse Ilyana can perform all of the following nursing actions, except? A. Evaluate the level of mobility B. Assess neurovascular status C. Determine presence of incontinence D. Evaluate use of skin care products 7. The most common site or area susceptible to pressure injuries are ______________. A. Scapula and elbows B. Sacrum and heels C. Occiput and ears D. All of the above 8. Nurse Ilyana stages the pressure injury of one of the patients who was admitted to the ICU with existing community-acquired pressure injury. She is aware that partial thickness skin loss with exposed dermis is considered as ____________. A. Stage 1 Pressure Injury B. Stage 2 Pressure Injury C. Stage 3 Pressure Injury D. Stage 4 Pressure Injury 9. To minimize moisture on the skin, the most inappropriate measure for Nurse Ilyana to apply would be? A. Wash soiled skin with mild soap and water B. Lubricate the skin with a bland lotion C. Put absorbent pads in the skin D. Apply drying agents and powders 10. Which nursing intervention is most crucial for the prevention of pressure injuries? A. Frequent position changes B. Elevate head of bed to more than 30 degrees C. Eliminate protein from the diet D. Ignore skin folds when performing hygiene measures Situation: Elmer has been diagnosed with ESRD and is set to undergo hemodialysis while awaiting for availability of functioning kidney transplant. Nurse Mocha assist him during his stay in the hospital. 11. Nurse Mocha knows that the most sensitive indicator of renal function is _________. A. Blood urea nitrogen B. Serum creatinine C. Glomerular filtration rate D. ABG 12. Nurse Mocha interprets the arterial blood gas of the patient. Results show a pH of 7.28, HCO3− of 10 and PaCO2 of 55. She will interpret this as which acid-base imbalance? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis 13. Nephrologists require strict monitoring of intake and output among patients with renal disorders. Nurse Mocha can effectively assess for fluid status by doing all of the following, except? A. Assess skin turgor and presence of edema B. Assess patient’s food preferences C. Weigh the patient daily D. Check for neck distention 1 | Page
14. Elmer is scheduled for surgical AVF creation of his right forearm. Nurse Mocha will interpret the following as abnormal when it comes to the vascular access for dialysis, except? A. Distal pain of the right extremity B. Poor capillary refill C. Numbness and tingling D. Presence of a thrill and bruit 15. Nurse Mocha understands that all but one are inappropriate interventions when it comes to the patient with an arteriovenous fistula? A. Check the BP in the right and left extremities B. Perform blood culture and sensitivity on two sites C. Insert a large-bore access in the right arm for blood transfusion D. Place an arm precaution sign on the bedside Situation: Patients approaching the end-of-life experience can benefit from palliative care. As a nurse, Nurse Regine is knowledge about palliative and end-of-life principles of care and the ability to recognize the unique response of each patient and family to a given illness. The following questions apply. 16. Nurse Regine’s role in a family meeting for advanced care planning of a terminally-ill patient with pancreatic cancer should be to _________? A. Advocate for patient based on values shared by patient and family B. Share clinical nursing updates C. Act as interpreter when medical jargon is not clearly understood by patient and family D. All of the above 17. Which of the following pertains to a legal document through which the patient appoints and authorizes another person to make medical decisions on their behalf? A. Advance directive B. Living will C. Durable power of attorney D. Physician orders for life-sustaining treatment 18. Hope is a multidimensional construct that provides comfort as a person endures life threats and personal challenges. Nurse Regine will promote the following hope-fostering activities for a terminally-ill patient, except? A. Humor B. Love of family and friends C. Uplifting memories D. Devaluation of personhood 19. The family unconsciously prepares for what might happen when they were informed of the patient’s terminal illness, Nurse Regine will interpret this as _________. A. Anticipatory grief B. Uncomplicated grief C. Complicated grief D. Disenfranchised grief 20. Which illness trajectory is described when a person follows a slow decline after diagnosis, with episodic illnesses, exacerbation and difficulty returning back to functional baseline? A. Sudden death B. Terminal illness C. Organ failure D. Frailty Situation: Marlon, a 63-year old businessman, reported an onset of headache and dizziness while he was driving to work. He has been feeling fatigued for the past few days and he experiences itching and excessive sweating at night. The physician suspects the patient has polycythemia vera upon evaluation of his laboratory results. 21. Laboratory finding for the patient with polycythemia vera will show? A. Elevated erythrocyte and hematocrit count B. Thrombocytosis C. Leukocytosis D. All of the above 22. Patients with polycythemia vera are at great risk for stroke and MI due to which reason? A. Increased risk for thrombosis B. Uric acid elevation C. Increased number of basophils D. Increase in blood cell mass 23. The purpose of phlebotomy as a therapy for the patient is to? A. Prevent vascular thrombosis B. Maintain hematocrit level at less than 45% C. Suppress bone marrow function D. Reduce splenomegaly and pruritus 24. Marlon has developed splenomegaly due to his disorder being unresponsive to initial treatments. The physician prescribed interferon-alfa to counteract this. The nurse helps the patient alleviate its common side effect which are __________. A. Nausea and vomiting B. Myelosuppression C. Pruritus D. Flu-like symptoms 25. Which instruction is appropriate for the nurse to give for a patient with polycythemia vera? A. Advice the patient to wear tight stockings B. Take high-dose aspirin regularly C. Avoid iron supplements D. Allow alcohol intake to no more than 2 bottles a day Situation: Carlos, 48 years of age, reports problems with urinating as evidenced by frequent urination at night and dribbling of urine. He is also anorexic and fatigued as he deals with the discomfort in the pelvic area. Digital rectam exam (DRE) reveals an enlarged, rubbery and nontender prostate gland consistent with the diagnosis of Benign Prostatic Hyperplasia (BPH). 26. The pathophysiologic mechanism behind the occurrence of BPH have been implicated by the hormonal changes that play a role in its causation. Which of the following is correct regarding this? A. Prostatic tissue becomes more sensitive to dihydrotestosterone B. Estrogen level is elevated C. Testicular androgens stays normal D. Prostatic lobes atrophies due to elevated DHT 27. In order to reduce the risk of UTI, which dietary regimen is advisable for the patient? A. Eggs, cranberries and tomatoes B. Milk, meat products and poultry C. Plums, legumes and whole grains D. Tomatoes, prunes and milk products 28. Placement of a urinary catheter for the patient was ordered. The main purpose of performing open intermittent bladder irrigation for the patient would be to? A. Free a blockage in a urinary catheter or tubing B. Maintain the patency of urinary catheter and tubing C. Minimize risk of developing urinary tract infection D. To reduce risk of injury to bladder mucosa and risk of bladder spasm 29. The benchmark surgical treatment for BPH which involves the insertion of an endoscope through the urethra to remove the inner portion of the prostate is called as ___________. A. Suprapubic prostatectomy B. Retropubic prostatectomy C. TURP D. Brachytherapy 30. Combination therapy of doxazosin and finasteride has been prescribed to Carlos. As a nurse, finasteride is indicated due to its pharmacologic effects in BPH by? A. Preventing conversion of testosterone to DHT B. Increase in prostatic size C. Relax smooth muscle of the bladder neck and prostate D. Improve urinary flow Situation: Mr. Rez reports hoarseness of voice for more than 2 weeks now. He went to the doctor to have his throat checked and upon examination, a lump in his neck revealed to be a squamous cell carcinoma growth consistent with laryngeal cancer. Nurse Yuri is assigned with his case. The following questions apply. 2 | Page
31. Since the tumor is in its early stages, partial laryngectomy was the mode of surgical treatment considered by the physician. Excision of the vocal cord is termed as? A. Laryngectomy B. Tonsillectomy C. Cordectomy D. Adenoidectomy 32. Nurse Yuri plans for the kong-term communication plan for postoperative communication with Mr. Rez. What type of speech technique is used when a valve is placed in the tracheal stoma to divert into the esophagus and out the mouth where a voice prothesis is fitted over the puncture site to produce sound? A. Electric larynx B. Artificial larynx C. Tracheoesophageal puncture D. Esophageal speech 33. Immediate postoperative instruction in terms of nutrition and hydration was given to Mr. Rez. Nurse Yuri would be incorrect if he states which of the following statements? A. Avoid sweet foods B. Thin liquids will be used first C. Taste sensation will be altered temporarily D. Patient may not be permitted to drink or eat for 7 days 34. To prevent aspiration for Mr. Rez who was placed with a nasogastric tube for temporary feeding, Nurse Yuri will initiate the following interventions, except? A. Keep a suction setup available bedside B. Keep head of bed elevated for 30 minutes after tube feedings C. Instill feedings after aspirating 50% residual volume of previous intake D. Administer antiemetic medications as ordered 35. Following a laryngectomy, what assessment should Nurse Yuri prioritize? A. Swallowing ability B. Airway patency C. Carotid pulse D. Signs of bleeding Situation: Divinagracia came in to the ED due to headache and elevation to more than 200 mmHg of systolic BP. Upon arrival, she appears anxious, weak and profusely sweating. She was noted to have a heart rate of 140 bpm with a spot blood glucose level of 190 mg/dL. The physician performs physical assessment of the abdomen where he suspects pheochromocytoma from a localized growth. Nurse Dori prepares to give prompt interventions to manage the patient. 36. The main origin of the tumor behind pheochromocytoma originates in the ____________. A. Adrenal cortex B. Adrenal medulla C. Renal cortex D. Renal medulla 37. Measurement of catecholamines is used to clinically diagnose pheochromocytoma. When catecholamine test are inconclusive, which drug can alternatively be used to diagnose pheochromocytoma? A. Epinephrine B. Norepinephrine C. Clonidine D. Doxazosin 38. Prior to a 24-hour urine collection sample, these items are restricted for the patient, except? A. Tea B. Chocolate C. Aspirin D. Water 39. What is the priority nursing intervention during the management of the patient with pheochromocytoma? A. Administering IV fluids B. Monitoring BP C. Administering β-adrenergic blockers D. Monitoring intake and output and daily weights 40. During hypertensive crisis, the most optimal instruction for the patient to perform would be to ____________. A. Strict bed rest with head of bed elevation B. Ambulation for 15 minutes C. Consumption of high sodium diet D. Increase in environmental stimuli Situation: Electrolyte imbalances are common in clinical practice. As a nurse, one must be knowledgeable of the different electrolyte imbalances along with their management. The following questions apply. 41. All of the following are ECG findings consistent with hyperkalemia except? A. Tall T waves B. Prominent U waves C. Absent P waves D. Prolonged QRS duration 42. Which of the following medications can be administered for a patient with elevated serum potassium level? A. Calcium gluconate B. Sodium polysterene sulfonate C. Regular insulin and hypertonic dextrose solution D. All of the above 43. Which clinical sign associated with hypocalcemia consists of twitching of the facial muscles in response to light tap over the facial nerve in front of the ear? A. Chvostek sign B. Trosseau sign C. Levine’s sign D. Murphy’s sign 44. For a patient taking lithium, which electrolyte imbalance predisposes the patient to lithium toxicity? A. Hypokalemia B. Hypocalcemia C. Hyponatremia D. Hypophosphatemia 45. The normal serum phosphorus level in adults is ___________. A. 3.5 to 5 mg/dL (3.5 to 5 mmol/L) B. 135 to 145 mg/dL (135 to 145 mmol/L) C. 2.7 to 4.5 mg/dL (0.87 to 1.45 mmol/L) D. 1.8 to 2.6 mg/dL (0.74 to 1.07 mmol/L) Situation: Delegation is an important aspect of care to direct the performance of a specific activity whilst retaining accountability. Nurse Casey is guided by the principle of delegating in an effective and efficient manner. 46. All but one are included in the rights of delegation. Nurse Casey is correct when she selects which of the following? A. Right direction/communication B. Right task C. Right circumstance D. Right principle of care 47. Which of the following tasks can be safely delegated to a nursing attendant? A. Administration of IV medications B. Turning and positioning of patient C. Suctioning D. Nursing handover 48. With delegation, accountability is _________. A. Transferred B. Shared C. Neglected D. Irrelevant 49. Which delegation error occurs when a leader is reluctant to give ownership of a tough task ahead and lack of trust towards subordinate? A. Underdelegating B. Overdelegating C. Improper delegating D. Collaboration 50. When working with staff coming from a culturally diverse background, the cultural phenomenon that pertains to the person’s distance and intimacy techniques to allow delegation to succeed is classified as __________. A. Time B. Space C. Environmental control D. Biological variation Situation: Nurse Shayne, a newly registered nurse, is ordered 3 | Page
to perform several nursing procedures. Understanding different considerations for diagnostics and procedures is a necessary part of quality patient care. 51. A patient was scheduled for an emergency MRI due to recent head trauma. The patient was noted to be wearing a nicotine patch, but the nurse forgot to remove it before the MRI scan, and the patient was already in the machine. What might be the potential consequences for the patient? A. The effect of the patch will be increased B. The patient will become hypotensive C. The patient will become hypertensive D. The patient will have skin burn 52. What is the standard needle gauge used for blood transfusions? A. 17G – 19G B. 19G – 21G C. 15G – 17G D. 21G – 23G 53. Sarah, a cancer patient, is undergoing IV Hydroxyurea treatment in the oncology unit. During her infusion, Nurse Shayne notices that the IV cannula is leaking fluids around the insertion site. What is the specific complication associated with this therapy? A. Phlebitis B. Thromboembolism C. Extravasation D. Infiltration 54. Nurse Shayne prepares to administer a blood transfusion to a patient admitted to the medical-surgical unit. Before initiating the transfusion, she conducts a comprehensive assessment and educates the patient about the procedure. What laboratories should be addressed before proceeding with your blood transfusion? EXCEPT: A. Blood Type B. Cross-Matching C. Neutrophils D. Rh Compatibility 55. What will be your priority action after initially starting the transfusion? A. Run the blood slowly for the first 15 minutes B. Monitor the patient for 30 minutes C. Check the vital signs every 30 minutes D. Stay with patient for 15 minutes to note for any possible reactions and fast drip the blood after. Situation: Nurse Paula is assigned to care for patients admitted to the endocrinology unit for management of thyroid disorders. Throughout her shift, Nurse Paula provides comprehensive nursing care tailored to the needs and the complexities of thyroid disorders. 56. While taking care of a patient with thyroid disorder, one of the doctors asked Nurse Paula about the signs and symptoms of thyroid problems. Which of the following is a manifestation of hypothyroidism? A. Diarrhea B. Obesity C. 20% BMR D. Fine and oily hair 57. Another doctor asked Nurse Paula about the manifestations of hyperthyroidism. The doctor is satisfied when the nurse answered? A. Anergia B. Listlessness C. Fatigue D. Diaphoresis 58. Nurse Paula discusses the treatment plan with the patient who has hyperthyroidism and explains the importance of medication adherence in effectively managing his condition. All of these medications will be possibly prescribed to the patient with hyperthyroidism, except? A. Liothyronine B. Propylthiouracil C. Tapazole D. Lugol’s Solution 59. What is the appropriate diet for patients with hyperthyroidism? A. High fat diet B. High fiber diet C. Low sodium diet D. Low residue diet 60. Nurse Paula is giving instructions regarding the best time to take the drug of choice for hypothyroidism. The patient understood the instructions given by Nurse Paula when the patient verbalizes: A. “I will take my medication in the morning with meals” B. “I will take my medication in the afternoon with empty stomach” C. “I will take my medication in the morning without meals” D. “I will take my medication after breakfast” Situation: Nurse Shobe is responsible for providing care to several patients with diabetes in the medical-surgical unit. Each patient has unique needs and challenges related to their diabetes management. 61. Nurse Shobe is conducting rounds with the doctor when suddenly the doctor asks her about the other term for type 2 diabetes. She is correct when she answers: A. Syndrome X B. Juvenile Diabetes C. Congenital Diabetes D. Syndrome Z 62. During rounds, a relative of the patient, who is also a healthcare professional, asked Nurse Shobe about the difference between type 1 and type 2 diabetes regarding the onset of the disease. The nurse is correct when she verbalizes: A. The onset of type 1 diabetes (DM1) starts early in life, while type 2 diabetes (DM2) develops later in life. B. Type 1 diabetes (DM1) typically starts in childhood or adolescence, while type 2 diabetes (DM2) may develop rapidly after birth. C. Both type 1 diabetes (DM1) and type 2 diabetes (DM2) develop during adulthood; however, DM1 manifests earlier. D. Type 1 diabetes (DM1) typically starts early in life, while type 2 diabetes (DM2) may onset during toddler years. 63. What is the best management for patient with type 1 diabetes? A. Oral hypoglycemic agents B. Diet C. Exercise D. Insulin 64. A patient with type 2 diabetes mellitus (DM2) arrived at the hospital with a blood glucose level of 600 mg/dL. The patient was observed to have an altered level of consciousness and was diagnosed with hyperglycemic hyperosmolar nonketotic syndrome. The patient was administered IV normal saline solution (NSS) for hydration. What laboratory parameters would be the best indicators to monitor patient's recovery? A. Hematocrit B. Potassium level C. Serum osmolality D. Urine glucose 65. Nurse Shobe is reviewing medication orders for an elderly diabetic patient admitted to the medical-surgical unit. The patient is currently taking metformin to manage her diabetes. The nurse is aware of the potential interactions between metformin and certain drugs and takes proactive steps to ensure patient safety. The nurse is correct when she recommends to the doctor to avoid, except: A. Procedure involving contrast dye B. Alcohol intake C. Cimetidine usage to treat ulcers and gastroesophageal reflux disease D. Undergoing CT scan and MRI Situation: Nurse Dianne is responsible for managing insulin therapy for patients in the endocrinology clinic. Today, she is preparing insulin for several newly diagnosed diabetic patient who requires insulin injections to manage their blood sugar levels. 66. As a knowledgeable nurse, Nurse Dianne knows which one is not rapid acting insulin? 4 | Page