Tiêu đề DIAGNOSTIC EXAMINATION - NP4 - STUDENT COPY ✅

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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B. A vascular tissue C. An avascular tissue D. Filled with aqueous humor 10. He emphasized that the predisposing factor for Archie's condition is: A. Bacterial infection B. Prolonged use of contact lenses C. Fungal infection D. Low socioeconomic status 11. Dr. Mandy Cruz further discussed that corneal ulcers are considered medical emergencies. He mentions that in cases of corneal ulcers, the priority intervention is to: A. Remove the contact lens B. Refer to opthalmologist immediately C. Administer eyedrops D. Apply pressure dressing to both eyes SITUATION : Venice, is an autistic child who loves to bang her head. One day, while head banging, she unintentionally hit the wall and briefly loses consciousness. 12. Venice is brought into the emergency department of Malan-dee Medical Center after suffering a head injury. The first action by the nurse is to determine the Venice’s: A. Level of consciousness B. Pulse and blood pressure C. Respiratory rate and depth D. Ability to move extremities 13. The nurse anticipates to detect the occurrence of what common complication of head injury? A. Intracranial haemorrhage B. Diabetes insipidus C. Diabetes mellitus D. Basilar skull fracture 14. The nurse is aware that she should monitor Venice’s? A. Pulse rate B. Temperature C. Urine output D. Oxygen saturation 15. Venice is ordered to receive desmopressin (DDAVP) for management her condition. The nurse should check which of the following measurements to determine the effectiveness of this medication? A. Daily weight B. Temperature C. Apical heart rate D. Pupillary response 16. The nurse knows that which of the following conditions may alter the effectiveness of DDAVP (Noctiva)? A. Increased oral secretions B. Arterial obstruction C. Nasal congestion D. Obesity SITUATION:A 30-year old client named Gardo Versosa is admitted to Philippine Lung Center due to sudden onset of chest pain and dyspnea. He has no history of respiratory disease but had complete femur fracture 3 days ago. The following questions apply. 17. He is diagnosed with pulmonary embolism. The nurse immediately implements which expected prescription for this client? A. Semi-Fowler’s position, oxygen, and morphine sulfate (IV) B. Supine position, oxygen, and meperidine hydrochloride (Demerol) [IM] C. High Fowler’s position, oxygen, and meperidine hydrochloride (Demerol) [IV] D. High Fowler’s position, oxygen, and two tablets of acetaminophen with codeine (Tylenol #3) 18. The doctor ordered ABG analysis for Gardo Versosa. The nurse is now sending the ABG specimen to the laboratory for analysis. Which of the following pieces of information should the nurse write on the laboratory requisition? 1.Ventilator settings 2 A list of client allergies 3 The client’s temperature 4 The date and time the specimen was drawn 5 Any supplemental oxygen the client is receiving 6 Extremity from which the specimen was obtained A. 1, 3, 5, 6 B. 1, 2, 4, 5 C. 1, 2, 3, 4 D. 1, 3, 4, 5 19. Arterial blood gas (ABG) results indicate: pH 7.29, PCO2 49 mm Hg, PO2 58 mm Hg, HCO3 18 mEq/L. Gardo Versosa is at risk for respiratory failure. He is receiving oxygen via nasal cannula at 6 L per minute. The nurse anticipates that the physician will prescribe which of the following for respiratory support? A. Intubation and mechanical ventilation B. Adding a partial rebreather mask to the current prescription C. Keeping the oxygen at 6 L per minute via nasal cannula D. Lowering the oxygen to 4 L per minute via nasal cannula 20. The nurse is now inserting an oropharyngeal airway to Gardo Versosa. The nurse plans to use which correct insertion procedure? A. Flex the client’s neck B. Leave any dentures in place C. Suction the client’s mouth once per shift D. Insert the airway with the tip pointed upward 21. Gardo Versosa is now intubated and receiving mechanical ventilation. The physician has added 7 cm of positive end expiratory pressure (PEEP) to the ventilator settings of the client. The nurse assesses for which of the following expected but adverse effects of PEEP? A. Decreased peak pressure on the ventilator B. Increased temperature from 98OF to 100OF rectally C. Decreased heart rate from 78 to 64 beats per minute D. Systolic blood pressure decrease from 122 to 98 mm Hg SITUATION: Dyosa Lande is a 50-year old obese patient. She admits that her self-esteem has been progressively becoming low as her body size increases. She also claimed that her performance in her work has already been impaired. She electively subjects herself to a bariatric surgery. 22. Rapid emptying of gastric contents into the small intestine may occur postoperatively due to gastric resection. Dyosa Lande is at risk for developing dumping syndrome. The nurse monitors her for: A. Dizziness B. Bradycardia C. Constipation D. Extreme thirst 23. The nurse places Dyosa Lande in which best position to prevent occurrence of dumping syndrome? A. Prone B. Supine C. Trendelenburg D. Fowler’s 24. The nurse performed an abdominal assessment on Dyosa Lande 36 hours postop. The nurse documents that her bowel sounds are normal. Which of the following descriptions best describes this assessment finding? A. Waves of loud gurgles auscultated in all four quadrants B. Soft gurgling or clicking sounds auscultated in all four quadrants C. Low-pitched swishing sounds auscultated in one or two quadrants D. Very high-pitched loud rushes auscultated, especially in one or two quadrants 25. Dyosa Lande is now ready to resume diet since she now has normal bowel sounds. To minimize complications from eating, the nurse teaches her to do which of the following? 1 Lying down after eating 2 Eating a diet high in protein 3 Eating a diet low in protein 4 Eating six small meals per day 5 Eating concentrated sweets between meals A. 1, 3, 5 B. 1, 2, 5 C. 1, 2, 4 TOP RANK REVIEW ACADEMY, INC. Page 2 | 6