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RECALLS EXAMINATION 12 NURSING PRACTICE IV CARE OF CLIENTS WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART B) 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 IV” on the box provided SITUATION: Nurse Anna is developing a teaching plan for clients diagnosed with DIABETES MELLITUS 1. Which information should she include when developing a teaching plan for a client newly diagnosed with type 2 diabetes mellitus. Select all that apply. A. A major risk factor for complications is obesity and central abdominal obesity. B. Supplemental insulin is mandatory for controlling the disease. C. Exercise increases insulin resistance. D. The primary nutritional source requiring monitoring in the diet is carbohydrates. E. Annual eye and foot examinations are recommended by the American Diabetes Association (ADA). 2. One of the clients says, “It would be best to not include carbohydrates in my diet.” Nurse Anna should base the response to this comment on the knowledge that diabetes affects metabolism of which of the following? A. Carbohydrates only. B. Fats and carbohydrates only. C. Protein and carbohydrates only. D. Proteins, fats, and carbohydrates. 3. The nurse should caution the client with diabetes mellitus who is taking a sulfonylurea that alcoholic beverages should be avoided while taking these drugs because they can cause: A. hypokalemia. B. hyperkalemia. C. hypocalcemia. D. disulfiram (Antabuse)–like symptoms. 4. Nurse Anna emphasised that _____ indicates a potential complication of Diabetes Mellitus? A. Inflamed, painful joints B. Blood pressure of 160/100 mm Hg C. Lanky Apperance D. Hemoglobin of 9 g/dL 5. The client with Type 1 Diabetes Mellitus is taught to take isophane insulin suspension NPH (Humulin N) at 5 p.m. each day. The client should be instructed that the greatest risk of A. hypoglycemia will occur at: 11 a.m., shortly before lunch. B. 1 p.m., shortly after lunch. C. 6 p.m., shortly after dinner. D. 1 a.m., while sleeping. 6. To which of the following nursing diagnoses would a nurse give priority when caring for a patient who has syndrome of inappropriate secretion of antidiuretic hormone (SIADH)? A. Decreased cardiac output B. Altered nutrition C. Urinary incontinence D. Fluid volume excess 7. Which of the following measures would a nurse include in the care plan of a patient who has syndrome of inappropriate secretion of antidiuretic hormone (SIADH)? A. Straining all urine B. Encouraging fluid intake C. Monitoring blood glucose D. Increasing sodium intake 8. The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which primary health care provider prescriptions would the nurse anticipate receiving? Select all that apply. A. Initiate an infusion of 3% NaCl. B. Administer intravenous furosemide. C. Restrict fluids to 800 mL over 24 hours. D. Elevate the head of the bed to high-Fowler’s. E. Administer a vasopressin antagonist as prescribed. 9. Which of the following clinical manifestations are commonly associated with SIADH? (Select all that apply) A. Elevated blood pressure B. Hypernatremia C. Confusion and lethargy D. Polyuria E. Nausea and vomiting F. Edema 10. What are appropriate nursing interventions for a patient with SIADH? (Select all that apply) A. Restricting fluid intake as prescribed B. Administering hypertonic saline as ordered C. Encouraging increased fluid intake to dilute serum sodium D. Monitoring neurological status frequently E. Providing a high-sodium diet to increase serum sodium levels F. Monitoring electrolyte levels and adjusting treatments based on results 11. The nurse should expect a patient who has chronic renal failure to be given epoetin alfa (Epogen) to: A. elevate the white blood cell count B. enhances the maturation of thrombocytes. C. increases the production of platelets. D. stimulates the synthesis of red blood cells. 12. A client with acute renal failure has an increase in the serum potassium level. The nurse should monitor the client for: A. Cardiac arrest B. Pulmonary edema C. circulatory collapse D. hemorrhage. 13. A high-carbohydrate, low-protein diet is prescribed for the client with acute renal failure. The intended outcome of this diet is to: A. Act as a diuretic. B. reduce demands on the liver. C. help maintain urine acidity. D. prevent the development of ketosis. 14. A client with the recent diagnosis of myocardial infarction and impaired renal function is recuperating on the step-down cardiac unit. The client’s blood pressure has been borderline low and intravenous (IV) fluids have been infusing at 100 1 | Page
mL/hr via a central line catheter in the right internal jugular for approximately 24 hours to increase renal output and maintain the blood pressure. Upon entering the client’s room, the nurse notes that the client is breathing rapidly and is coughing. The nurse determines that the client is MOST likely experiencing which complication of IV therapy? A. Hematoma B. Air embolism C. Systemic infection D. Circulatory overload 15. The nurse caring for a patient with renal disease, should be aware that one of the MOST common factors contributing to renal failure is: A. diabetes mellitus B. alcohol abuse C. morbid obesity D. bile stones 16. Heparin has been ordered for a client with pulmonary embolism. Which statement, if made by the graduate nurse, indicates a lack of understanding of the medication? A. “I will administer the medication 1-2 inches away from the umbilicus.” B. “I will administer the medication in the abdomen.” C. “I will check the PTT before administering the medication.” D. “I will need to aspirate when I give Heparin.” 17. The client is admitted with a BP of 210/100. Her doctor orders furosemide (Lasix) 40mg IV stat. How should the nurse administer the prescribed furosemide to this client? A. By giving it over 1–2 minutes B. By hanging it IV piggyback C. With normal saline only D. With a filter 18. The client presents to the clinic with a serum cholesterol of 275mg/dL and is placed on rosuvastatin (Crestor). Which instruction should be given to the client taking rosuvastatin (Crestor)? A. Report muscle weakness to the physician. B. Allow six months for the drug to take effect. C. Take the medication with fruit juice. D. Report difficulty sleeping. 19. A client being treated with sodium warfarin (Coumadin) has a Protime of 120 seconds. Which intervention would be most important to include in the nursing care plan? A. Assess for signs of abnormal bleeding B. Anticipate an increase in the Coumadin dosage C. Instruct the client regarding the drug therapy D. Increase the frequency of neurological assessment 20. The physician has ordered an infusion of Osmitrol (mannitol) for a client with increased intracranial pressure. Which finding indicates the direct effectiveness of the drug? A. Increased pulse rate B. Increased urinary output C. Decreased diastolic blood pressure D. Increased pupil size 21. The nurse is preparing to administer atenolol (Tenormin) to a client. The nurse should check which priority item before administering the medication? A. Temperature B. Blood pressure C. Potassium level D. Blood glucose level 22. A client with hypertension is receiving torsemide (Demadex) 5 mg orally daily. Which finding would indicate to the nurse that the client is experiencing an adverse effect related to the medication? A. A chloride level of 98 mEq/L B. A sodium level of 135 mEq/L C. A potassium level of 3.1 mEq/L D. A blood urea nitrogen (BUN) of 15 mg/dL 23. The nurse is teaching dietary modifications to the client with hypertension. The nurse should instruct the client to eat which snack foods? A. Raw carrots B. Frozen pizza C. Cheese and crackers D. Canned tomato soup 24. The nurse has completed diet teaching for a client on a low-sodium diet for the treatment of hypertension. Which statement by the client should indicate to the nurse that there is a need for further teaching? A. “Frozen foods are usually lowest in sodium.” B. “This diet will help lower my blood pressure.” C. “This diet is not a replacement for my antihypertensive medications.” D. “The reason I need to lower my salt intake is to reduce fluid retention.” 25. A client is taking amiloride (Midamor) 10 mg orally daily for the treatment of hypertension. Which instruction should the nurse give the client regarding its use? A. Take the medication in the morning with breakfast. B. Withhold the medication if the blood pressure is high. C. Eat foods with extra sodium while taking this medication. D. Take the medication 2 hours after lunch on an empty stomach. 26. The nurse is monitoring a client with hypertension who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this medication? A. Report of infrequent insomnia B. Development of expiratory wheezes C. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication D. A baseline resting heart rate of 88 beats per minute followed by a resting heart rate of 72 beats per minute after two doses of the medication 27. A client is taking clonidine (Catapres) for treatment of hypertension. The nurse should teach the client about which of the following common adverse effects of this drug? Select all that apply. A. Dry mouth B. Hyperkalemia C. Impotence D. Pancreatitis E. Sleep disturbance 28. A nurse is educating a patient about lifestyle modifications to manage hypertension. Which of the following recommendations should the nurse include? (Select all that apply) A. Limit sodium intake to 2,300 mg per day or less. B. Engage in regular physical activity, such as 150 minutes of moderate-intensity exercise per week. C. Avoid alcohol completely. D. Increase intake of fruits and vegetables. E. Increase caffeine intake for energy. F. Use the DASH diet (Dietary Approaches to Stop Hypertension). 29. A nurse is assessing a client with newly diagnosed hypertension. Which of the following findings are common signs or symptoms of hypertension? (Select all that apply) A. Headache B. Nosebleeds C. Bradycardia D. Dizziness E. Shortness of breath F. Chest pain 30. Which of the following complications are associated with long-term uncontrolled hypertension? (Select all that apply) A. Heart failure B. Stroke C. Renal failure D. Vision loss E. Cirrhosis F. Peripheral arterial disease (PAD) 31. A client with active tuberculosis (TB) is to be admitted to a medical-surgical unit. Which action should the nurse take when planning a bed assignment? A. Tell the admitting office to send the client to the intensive care unit. B. Place the client in a private, airborne infection isolation room (AIIR). C. Assign the client to a room with another client because intravenous antibiotics will be administered. 2 | Page
D. Assign the client to a room with another client and place a “strict hand washing” sign outside the door. 32. A client diagnosed with tuberculosis (TB) is scheduled to go to the radiology department for a chest radiograph. The nurse should take which action when preparing to transport the client? A. Apply a mask to the client. B. Apply a mask and gown to the client. C. Apply a mask, gown, and gloves to the client. D. Notify the radiology department so that the personnel can be sure to wear masks when the client arrives. 33. The nurse is caring for a client with active tuberculosis who has started medication therapy that includes rifampin (Rifadin). The nurse instructs the client to expect which side effect of this medication? A. Bilious urine B. Yellow sclera C. Orange secretions D. Clay-coloured stools 34. The nurse sends a sputum specimen to the laboratory for culture from a client with suspected active tuberculosis (TB). The results report that Mycobacterium tuberculosis is cultured. How should the nurse correctly analyze these results? A. The results are positive for active tuberculosis. B. The results indicate a less virulent strain of tuberculosis. C. The results are inconclusive until a repeat sputum specimen is sent. D. The results are unreliable unless the client has also had a positive Mantoux test. 35. The nurse places a hospitalised client with active tuberculosis in a private, well-ventilated isolation room. In addition, which action should the nurse take before entering the client’s room? A. Wash the hands. B. Wash the hands and wear a gown and gloves. C. Wash the hands and place a high-efficiency particulate air (HEPA) respirator over the nose and mouth. D. The nurse needs no special precautions, but the client is instructed to cover his or her mouth and nose when coughing or sneezing. 36. A hospitalised client with active pulmonary tuberculosis has been receiving multidrug therapy for the past month and is being prepared for discharge. Which indicates that respiratory isolation is no longer required and that medication therapy has been effective? A. Stools are clay coloured. B. The Mantoux test is negative. C. Sputum cultures are negative. D. Nausea and vomiting have stopped. 37. A client diagnosed with tuberculosis (TB) is provided instructions concerning home care in preparation for discharge. Which client statement indicates a need for further teaching? A. “I need to place used tissues in a plastic bag when I am home.” B. “I need to eat foods that are high in iron, protein, and vitamin C.” C. “It is not necessary to maintain respiratory isolation when I am at home.” D. “If I miss a dose of medication, I should then resume my regular schedule.” 38. The nurse is planning discharge teaching for a client diagnosed and treated for tuberculosis (TB). Which instruction should be included in order to minimize the spread of TB? Select all that apply. A. All used dishes should be sterilized. B. Close contacts should be tested for TB. C. Soiled tissues should be disposed of properly. D. House isolation is required for at least 8 months. E. The mouth should always be covered when coughing. 39. The nurse is caring for a client who has been diagnosed with tuberculosis. The client is receiving 600 mg of oral rifampin (Rifadin) daily. Which laboratory finding would indicate to the nurse that the client is experiencing an adverse effect? A. total bilirubin level of 0.5 mg/dL B. A sedimentation rate of 15 mm/hour C. Alanine aminotransferase (ALT) of 80 units/L D. A white blood cell count of 6000 cells/ mm 40. The nurse determines that a Mantoux tuberculin skin test is positive. Which diagnostic test should the nurse anticipate to be prescribed to accurately diagnose tuberculosis (TB)? A. Chest x-ray B. Sputum culture C. Complete blood cell count D. Computed tomography scan of the chest 41. The nurse is preparing to initiate an intravenous nitroglycerin drip on a client with acute myocardial infarction. In the absence of an invasive (arterial) monitoring line, the nurse prepares to have which piece of equipment for use at the bedside? A. Defibrillator B. Pulse oximeter C. Central venous pressure (CVP) tray D. Noninvasive blood pressure monitor 42. A client who recently experienced a myocardial infarction is scheduled to have a percutaneous transluminal coronary angioplasty (PTCA). The nurse should plan to teach the client about which aspect of a balloontipped catheter? A. A meshlike device will be inflated that will spring open. B. The catheter will be used to compress the plaque against the coronary blood vessel wall. C. The catheter will cut away the plaque from the coronary vessel wall using a cutting blade. D. The catheter will be positioned in a coronary artery to take pressure measurements in the vessel. 43. A client has just been admitted to the emergency department with chest pain. Serum cardiac enzyme levels are drawn, and the results indicate an elevated serum creatine kinase (CK)-MB isoenzyme, troponin T, and troponin I. The nurse concludes that these results are compatible with what diagnosis? A. Stable angina B. Unstable angina C. Prinzmetal’s angina D. New-onset myocardial infarction (MI) 44. The nurse suspects that a client who had a myocardial infarction is developing cardiogenic shock. The nurse should assess for which peripheral vascular manifestation of this complication? A. Flushed, dry skin with bounding pedal pulses B. Warm, moist skin with irregular pedal pulses C. Cool, clammy skin with weak or thready pedal pulses D. Cool, dry skin with alternating weak and strong pedal pulses 45 The nurse admits a client with myocardial infarction (MI) to the coronary care unit (CCU). What should the nurse plan to do in delivering care to this client? A. Hook to TPN B. Place the client on continuous cardiac monitoring. C. Infuse intravenous (IV) fluid at a rate of 150 mL per hour. D. Administer oxygen at a rate of 6 L per minute by nasal cannula 46. A coronary care unit (CCU) nurse is caring for a client admitted with acute myocardial infarction (MI). The nurse should monitor the client for which most common complication of MI? A. Heart failure B. Cardiogenic shock C. Cardiac dysrhythmias D. Recurrent myocardial infarction 47. A client receiving heparin therapy for acute myocardial infarction has an activated partial thromboplastin time (aPTT) value of 100 seconds. Before reporting the results to the health care provider, the nurse verifies that which medication is available for use if prescribed? A. Methylene blue B. Protamine sulfate C. Phytonadione (vitamin K) D. Cyanocobalamin (vitamin B12) 48. The nurse is providing home care instructions to a client recovering from an acute inferior myocardial infarction (MI) with recurrent angina. What instruction should the nurse provide to this client? A. Avoid sexual intercourse for at least 4 months. 3 | Page
B. Replace sublingual nitroglycerin tablets yearly. C. Participate in an exercise program that includes overhead lifting and reaching. D. Recognize the adverse effects of acetylsalicylic acid (aspirin), which include tinnitus and hearing loss 49. The nurse is planning care for a client who is experiencing anxiety after a myocardial infarction. Which priority nursing intervention should be included in the plan of care? A. Answer questions with factual information. B. Provide detailed explanations of all procedures. C. Limit family involvement during the acute phase. D. Administer an antianxiety medication to promote relaxation. 50. The family of a client with a myocardial infarction complicated by cardiogenic shock is visibly anxious and upset about the client’s condition. What should the nurse plan to do to provide support to the family? A. Offer them coffee and other beverages on a regular basis. B. Insist that they go home to sleep at night to keep up their own strength. C. Ask the hospital chaplain to sit with them until the client’s condition stabilizes. D. Provide flexibility with visiting times according to the client’s condition and family needs. 51. The recommended technique when performing chest compression in newborn and premature A. Two finger B. two thumb C. one hand D. Two hand 52. A person after a long run under the sun experienced severe cramps, headache and fatigue may be experiencing_____ A. Heat exhaustion B. Heat cramps C. heat stroke D. Near fainting 53. Which of the following is the role of the scribe? A. Record the intervention made by the physician B. Accompany the patient to any radiologic examination C. Transcribe laboratory results D. Record the intervention during the rescucitation 54. You are currently attending a cardiac arrest patient in the emergency department when you were informed that the cardiac defibrillator does not turn on and another machine was about to arrive. Which of the following is the correct response A. Wait for the second defibrillator B. Pause CPR to troubleshoot C. Do chest thump to revive D. Continue CPR 55. It is a heart rhythm problem that occurs when the heart beats with rapid, erratic impulses that causes the heart to quiver A. Ventricular Fibrillation B. Pulseless Ventricular Tachycardia C. Asystole D. Pulseless Electrical Activity 56. A 24 year old patient consulted at the ER due to pounding chest after taking performance enhancing drinks. His BP is 110/70 mmg with a HR of 175 bpm and 02 sat of 99%. On hooking to a cardiac monitor you saw a regular narrow complex tachycardia. What is your next step? A. No intervention necessary B. Attempt vagal maneuvers C. Administer Amiodarone 150mg/IV D. Administer Lidocaine 75mg/IV 57. Important reminders in administering adenosine include? A. Give it through slow IV push (over 10-15 mins) and raise the arm B. Give it rapid IV bolus followed by 10-20 ml saline and raise the arm C. Dilute it in 250mL D5W and administer over 1-2 minute infusion D. Dilute it with normal saline to make 10 ml solution prior to administration 58. What is the recommended dose range (in mcg/kg/min) of Dopamine infusion in patients with symptomatic bradycardia? A. 2-10 B. 10-20 C. 20-30 D. 30-40 59. What is the recommended dose of Epinephrine infusion in patients with symptomatic bradycardia? A. 2-10 mcg per minute B. 2-10 mcg/kg/minute C. 5-15 mcg per minute D. 5-10 mcg/kg/minute 60. Who among the following family members can act as the surrogate of the patient? A. Attending physician B. Patient's widowed mother C. Patient's common law wife D. Aunt who pays for the hospitalization 61. A client who has experienced a stroke has partial hemiplegia of the left leg. The straight-leg cane formerly used by the client is not sufficient to provide support. The nurse determines that the client could benefit from the somewhat greater support, stability, and safety provided by which devices? Select all that apply. 1. Walker 2. Wheelchair 3. Tripod cane 4. Wooden crutch 5. Quadripod cane 6. Lofstrand crutch A. All of the above B. 2 3 4 and 6 C. 1 3 5 D. 1 2 3 4 and 5 62. The home care nurse visits a client who had a stroke with resultant unilateral neglect who was recently discharged from the hospital. Which instruction should the nurse provide to the family regarding care? A. Assist the client from the affected side. B. Place personal items directly in front of the client. C. Discourage the client from scanning the environment. D. Assist the client with grooming the unaffected side first. 63. A client recovering from a stroke has become irritable and angry regarding limitations. Which is the best nursing approach to help the client regain motivation to succeed? A. Ignore the behavior, knowing that the client is grieving. B. Allow longer and more frequent visitation by the spouse. C. Use supportive statements to correct the client’s behavior. D. Tell the client that the nurses are experienced and know how the client feels. 64. The nurse is obtaining a history from a client who was admitted to the hospital with a thrombotic stroke. The nurse assesses the client, knowing that the client most likely experienced which sign/symptom before the stroke occurred? A. No symptoms at all B. Throbbing headaches C. Transient hemiplegia and loss of speech D. Unexplained episodes of loss of consciousness 65. A client with a stroke is prepared for discharge from the hospital. The health care provider has prescribed range-of-motion (ROM) exercises for the client’s right side. Which intervention should the home care nurse’s plan include when planning for the client’s care? A. Implements ROM exercises to the point of pain for the client B. Considers the use of active, passive, or active-assisted exercises in the home C. Encourages the client to be dependent on the home care nurse to complete the exercise program D. Develops a schedule that involves ROM exercises every 2 hours while awake, even if the client is fatigued 66. The home care nurse visits a client with chronic obstructive pulmonary disease (COPD) who is on home oxygen at 2 L per minute. The client’s respiratory rate is 22 breaths per minute, and the client is complaining of increased dyspnea. The nurse should take which initial action? A. Determine the need to increase the oxygen. 4 | Page