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REFRESHER PHASE DIAGNOSTIC EXAMINATION NURSING PRACTICE 4 (NP4) NOVEMBER 2025 Philippine Nurse Licensure Examination Review Situation: The nurse provides health education to a group of adolescents about pelvic inflammatory disease. (PID). 1. The nurse explains that prevention of PID in adolescents is important due to which of the following reasons. PID ________: A. can have devastating effects on the reproductive tract of affected adolescents – This condition can result in the fallopian tubes narrowed and scarred, which increases the risk for ectopic pregnancy, infertility, recurrent pelvic pain, tubo-ovarian abscess, and recurrent disease (Brunner &Suddarth, p.1420). B. is easily prevented by compliance to any form of contraception – not by any form of contraception (i.e. pills, injectables); pelvic infection may be caused by IUD insertion or having intercourse without condoms (Brunner &Suddarth, p.1420). C. can cause life-threating defects in infants born to affected adolescents. D. Is easily prevented by proper personal hygiene 2. The nurse explains to the group of adolescents that the most common cause of PID is _______: A. Tuberculosis bacilli B. Gonorrhea – the causative agents of PID are: Chlamydia trachomatis, Clostridium perfringens, and Neisseria gonorrheae (Udan, p.588); Gonorrheal and chlamydial organisms are the most likely causes, while CMV has also been implicated (Brunner &Suddarth, p.1420). C. Staphylococcus D. Streptococcus 3. The nurse further explains that PID presents the following signs and symptoms, which the adolescent should be aware of: A. A hard painless, red and defined lesion on the genital area. B. Small vesicles on the genital area with itching. C. Lower abdominal pain and urinary tract infection. – symptoms of pelvic infection usually begin with vaginal discharge, lower abdominal pelvic pain, and tenderness that occurs after menses (Brunner &Suddarth, p.1420). D. Cervical discharge with redness and edema. 4. Which of the following statements is true when teaching adolescents about gonorrhea? A. Gonorrhea may be contracted through contact with a contaminated toilet seat. – transmission usually is by heterosexual or homosexual intercourse. Autoinoculation of the organism to the conjunctiva is possible. Neonates born to infected mothers can acquire the infection during passage through the birth canal and are in danger of developing gonorrheal conjunctivitis, with resultant blindness, unless treated promptly (Porth, p.1108). B. The infectious agent for gonorrhea is Neisseria gonorrheae. – gonorrhea is a reportable disease caused by the bacterium N. gonorrhoeae(Porth, p.1108). C. Gonorrhea is most often treated by multidose of administration of penicillin. – penicillin-resistant strains of N. gonorrhoeae are prevalent worldwide. The current treatment recommendation is ceftriaxone in a single injection or cefixime, ciprofloxacin, ofloxacin or levofloxacin in a single oral dose (Porth, p.1108). D. Treatment of sexual partners is an essential part of treatment. – not an essential part; all sex partners within 60 days before discovery of the infection should be contacted, tested and treated, but it still depends on the person concerned (Porth, p.1109). 5. The nurse further explains to the adolescents that gonorrhea is highly infectious and it ____: A. Is limited to the external genitalia, - if untreated, gonorrhea spreads from its initial sites upward into the genital tract. In males, it spreads to the prostate and epididymis; in females, it commonly moves to the fallopian tubes (Porth, p.1108). B. Can lead to sterility, - in women, there may be infections of the uterus and development of acute or chronic infection of the fallopian tubes (salpingitis), with ultimate scarring and sterility (Porth, p.1108). C. Is easily treated, - The current treatment recommendation is ceftriaxone in a single injection or cefixime, ciprofloxacin, ofloxacin or levofloxacin in a single oral dose. All are equally effective and should be followed with azithromycin or doxycycline for chlamydiae. Quinolone-resistant straines are now common, hence, the CDC recommends avoiding the use of fluoroquinolones (Porth, p.1108). D. Occurs rarely among adolescents – in 1999, there were 360,076 reported cases of gonorrhea in the US. Of these reported cases, more than 90% involve persons between 15 and 44 years of age, with the heaviest concentration among young adults (15-24 years of age). Genital gonorrhea in young children should raise the possibility of sexual abuse (Porth, p.1108). Situation 3- A 45 year-old female, married with two children, is admitted in the medical department with a diagnosis of osteoarthritis. The nurse assists in the care of this client. 6. Which of the following signs and symptoms should the nurse correlate with a diagnosis of osteoarthritis? A. Erythema and edema over the affected joints B. Joints stiffness that decrease with activity C. Anorexia and weight loss D. Fever and malaise 7. Which of the following factors would MOST likely increase the joints symptoms of osteoarthritis? A. Emotional stress B. Obesity C. History of smoking D. Alcohol abuse Situation – Archie Alviz has been wearing eyeglasses since he was 5 years old. When he turned 18, he wanted to dispose of the eyeglasses and started wearing long-wearing contact lenses. Before his 24th birthday, he was rushed into the emergency department because of severe eye pain. After assessment, he was diagnosed to have corneal ulcer. 8. The nurse attending to Archie is aware that the part of the eye which affects the ability to focus is the: A. Epithelium of the eyeball B. Cornea C. Retina D. Sclera 9. Dr. Mandy Cruz, discusses in simple terms the pathophysiology of Archie's case. He mentions that the cornea is prone to infection and that the body's immune defenses cannot fight off microorganisms because the cornea is: A. 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D. 1, 3, 4 26. In preventing dumping syndrome, which additional instruction should be provided to Dyosa Lande? A. Ambulate following a meal B. Eat high carbohydrate foods C. Limit the fluids taken with meals D. Sit in a high Fowler’s positions during meals Situation: Jugs, a 40 year old teacher just returned to the ward from the PACU. He underwent subtotal thyroidectomy. 27. Jugs was transferred from the stretcher to the bed. The nurse would assist the client to assume which of the following positions? A. Semi-fowlers with head and neck supported with pillow B. High-fowlers with neck supported with rolled towel C. Dorsal recumbent with sandbags on both sides of the neck D. Recumbent with neck supported with pillow 28. The nurse is worrying about possible laryngeal nerve damage. The most appropriate way to assess this is to: A. Observe for any difficulty in swallowing B. Palpate for the laryngeal nerves on both sides of the neck C. Let the client cough three times D. Talk with the client and note change in voice 29. From the laboratory results, the nurse noted the serum calcium to be 5.0 mg/dL. Which of the following will the nurse do first? A. Refer to the physician. B. Take vital signs. C. Note the finding as normal. D. Assess signs of tetany. 30. Jugsstarted complaining of a tightening feeling in his wound dressing. Which of the following is the priority nursing action? A. Assess dressings for drainage. B. Check vital signs. C. Change position of the patient. D. Remove neck support. 31. The watcher asked the nurse, “When can Jugs start to eat? The last time he ate was still last night.” The correct response is: A. “Jugs can start on clear liquids as soon as he is fully conscious.” B. “The doctor will evaluate the client when he is ready to eat.” C. “Jugs is still on IV fluids, and is doing fine.” D. “As soon as bowel sounds are present.” Situation:Knowledge about end-of-life principles of care and patients’ and families’ unique responses to illness are essential to support their unique values and goals. Nurses can have a significant and lasting effect on the way in which clients live until they die, the manner in which death occurs, and the enduring memories of that death for the families. 32. During one of your small group discussions, you were given a sample case of a client who is asking you to help her end her life. You, as the nurse, knows that: A. You should not participate in the wish of the client because it is a violation of the Code of Ethics. B. You should agree with the client’s wish to uphold autonomy. C. You should agree to lessen the suffering of your client. D. You should not agree because it is against your personal belief system. 33. It is a legal document through which the signer appoints and authorizes another individual to make medical decisions on his/her behalf when he/she is no longer able to speak for him/herself. A. Advanced Directive B. Medical Directive C. Living Will D. Durable Power of Attorney for Healthcare 34. While caring for a client who was admitted for Stage 4 Lung Cancer, he suddenly asked you “Am I dying?” How should the nurse best respond or best act? A. Maintain eye contact and remain silent. B. “Do you think you are dying?” C. “I don’t know. It will be best for you to ask your physician.” D. “This must be very difficult for you.” 35. One of the common signs of an approaching death in clients who are terminally ill is losing their interest in eating and drinking. What would be the best nursing intervention for this manifestation? A. Advice the client to take in small, frequent feedings. B. Tell the client to drink warm water at least 15 minutes before eating his meals. C. Enhance the presentation of the foods served to the client. D. Offer food and drinks but do not force the client. 36. Clients who are dying may sometimes give reports of dead family or friends who seem to be calling them to come and join them. What is the nurse’s best action? A. Encourage the patient that may he may leave to join them. B. Stay close and be present for the client. C. Ask the client to discuss what other things do these people tell him to do. D. Remain silent and listen intently to what else the client has to say. Situation: Nurse Sisley is a nurse in Diliman Doctors Hospital caring for clients with problems in the biliary tree. 37. A patient with complaints of indigestion and RUQ pain was diagnosed with cholecystitis and underwent an emergency laparoscopic cholecystectomy. Which of these should Nurse Sisley not include in her post-operative care? A. Instruct the client about splinting during coughing. B. Encourage early ambulation. C. Maintain the client flat on bed. D. Assess the patient’s O2 saturation level frequently. 38. Which of these is the best indicator that peristalsis has resumed after the surgery? A. Active bowel sounds B. Passage of flatus C. Drainage from NG suction D. Tympany upon percussion 39. A T-tube was inserted to maintain patency of the common bile duct. How should Nurse Sisley position the client for better drainage? A. Side-lying position B. Prone position C. Semi-Fowler’s D. Low Fowler’s 40. Rico Y. An is brought to the emergency department because of severe and constant abdominal pain. Nurse Sisley should conduct comprehensive nursing interview: A. Right upon entrance to the emergency department B. After the vital signs have been taken C. After pain is controlled D. During physical examination 41. Rico Y. An was diagnosed to have acute pancreatitis from excessive alcohol intake. Which of these is a characteristic of the abdominal pain in acute pancreatitis? A. Sharp, intermittent pain B. Intense, boring pain C. Relieved when in supine position D. Worsens when a fetal position is assumed SITUATION: Patients with varying diseases always receive medications for them to recuperate. As part of the dependent functions of a nurse, knowledge in pharmacology is one of the most essential competencies that she should possess, to be aware when to verify a doctor’s medication order, and to know the side effects, adverse effects, therapeutic level and nursing consideration for each drug. 42. A nurse in the neuro ward is reviewing the results of a client Rey’s phenytoin (Dilantin) level that was drawn that morning. The nurse determines he had a therapeutic drug level if the result was: A. 3 mcg/mL B. 8 mcg/mL C. 15 mcg/mL D. 24 mcg/mL TOP RANK REVIEW ACADEMY, INC. Page 3 | 6