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RECALLS 1 EXAMINATION NURSING PRACTICE IV CARE OF THE CLIENT WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART B) 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 IV” on the box provided Situation: You are going to care for Lyrine, a 19 years old college student, who has an order for high doses of chemotherapy to treat leukemia. 1. As Lyrine’s nurse, you have important responsibilities to maximize safe administration of chemotherapy. Which of the following will you do FIRST? A. Review drugs to be administered including dosage site of an administration and potential side effects B. Monitor central or peripheral IV sites by verifying presence of blood return and observing for infiltrations signs C. Conduct client and family teaching on chemotherapy administration procedures, antiemetic schedule, self-care measures for potential side effects D. Administer chemotherapeutic agents following agency policies and safe handling procedures 2. Lyrine is scheduled for chemotherapy at 8:00 a.m. Which of the following is most appropriate for you to do to ensure that she will not experience nausea and vomiting? A. Maintain an intravenous hydration therapy B. Administer antiemetic an hour prior to chemotherapy C. Do not offer food prior to chemotherapy D. Provide oral care with lukewarm water 3. While you are caring for Lyrine, who is receiving a chemotherapy agent intravenously through a peripheral line, she complains of burning at the iv site what will be your PRIORITY action? A. Check for blood serum B. Decrease the infusion flow rate C. Stop the infusion D. Apply cold compress over the IV site 4. On the third therapy Lyrine's mother informs you that she wants to stop the chemotherapy, because of the oral ulcers and pain that Irene has been experiencing since chemotherapy was started what will be your BEST response? A. Do you want to talk with your doctor B. Stop the camo therapy is not the best decision at this time C. Let me check her oral cavity to determine what is best for her D. Let us talk about your concerns 5. To relieve the oral ulceration in pain you can implement the following interventions EXCEPT: A. Avoid irritants like spicy food, tobacco, alcohol carbonated beverages B. Apply topical anesthetics like vicious lidocaine C. Increase fluids and its soft or moist bland food D. Discourage use of saliva substitutes Situation: Rodrigo, 45 years old was admitted to the emergency department because of severe substernal chest pain. The pain radiates to his jaw and left arm. Rodrigo claims pain was not relieved by rest and sublingual Nitroglycerine. 6. The wife of Rodrigo asks you, “what is expected to be detected from the results of the ECG”? Which of the following is your MOST appropriate response? A. “Electrical activity of the heart will be shown on a series of waveforms” B. “Damage to the internal structures of the heart” C. “Blocked coronary arteries” D. “Irregular heart rhythm due to damage of the heart muscle” 7. You recognize that myocardial infarction id described by the damage area of the heart. If the diagnosis of the patient is Lateral Myocardial Infraction, which of the following coronary artery is occluded? A. Left circumflex artery B. Posterior descending artery C. Right coronary artery D. Left anterior descending coronary artery 8. The wife further asks why her husband is experiencing so much pain. The nurse is correct when she says that the cause is/are: A. Macrophages congregating at the site of infarction B. Increased level of serum calcium and potassium C. Circulatory overload D. Inadequate oxygen supply to the cardiac muscle 9. The physician ordered a 12-lead ECG. What ECG result indicates that Patient Rodrigo may have suffered a Myocardial Infarction (MI)? A. ST-segment elevation B. QT-interval narrowing C. Q-wave inversion D. Flat P wave 10. All of these results of enzyme studies may indicate the presence of MI except: A. Increased myoglobin B. Increased CK-MB C. Elevated SGPT (ALT) D. Elevated SGOT (AST) Situation: Patient Gayle is a 54-year-old woman who is scheduled for laparotomy. Nurse July will be the scrub nurse for the said surgical procedure. 11. In regards to being a scrub nurse, which of the following is false? A. The scrub person can simultaneously function in the role of first or second assistant. B. The scrub person is responsible for establishing and maintaining the integrity and safety of the sterile field throughout the surgical procedure. C. Physical stamina is required as a scrub nurse. D. Two scrub persons may join the surgical team if needed. 12. The OR is notified that Patient Gayle will be brought to the OR as scheduled. Nurse July will expect that the patient will be transported: 1 | Page
A. Via a transport stretcher, pushed from the feet end so the patient’s feet go first B. Via a transport stretcher, pushed from the head end so the patient’s head go first C. Via a transport stretcher, pushed from the feet end so the patient’s head go first D. Via a transport stretcher, pushed from the head end so the patient’s feet go first 13. Nurse July knows that as a scrub person, he should drape the unsterile table under the following techniques EXCEPT: A. Unfolding towards the far side first to make sure the whole table will be covered. B. Placing the drape over the unsterile surface nearest himself first and carefully completing the coverage of the far side. C. Unfolding toward self first to protect the gown when working with a folded drape. D. The scrub person stands back from the unsterile table when draping it to avoid leaning over an unsterile area. 14. Before the closure of the incision, the first closing count is performed which consists of three areas. This specific area is done together by the scrub person and the circulating nurse in which they count all items on the Mayo stand and instrument table. The surgeon and assistant may be suturing the wound while this count is in process. A. Field Count B. Table Count C. Floor Count D. Mayo Count 15. Nurse July knows that the ideal position for a client who has had laparotomy is A. Low fowler’s B. Right side lying C. Left side lying D. Flat on bed Situation: Gordon, a 60 year old cook was admitted in the Emergency Department (ED) because of burn wounds sustained when the kitchen where he is working burned down due to a gas tank explosion. 16. The physician diagnosed deep partial thickness on the anterior head and neck, whole anterior truck and anterior upper right and left limbs. If the physician will use the rile of Nine, which of the following is the correct estimate of the surface area burned of the patient’s trunk? A. 18% B. 36%? C. 4.5% D. 9.0% 17. The best describes the characteristics of Gordon’s burn wounds, which of the following will the admitting nurse NOT consider? A. The wound appears pale and waxy with blisters looking like flat dry tissue paper B. The burn wounds may be less painful than the partial thickness burn wound C. Wound will not heal by re-epithelialization D. Skin blanches with pressure 18. Considering the burn wounds on the face, which of the following will the nurse expect to be done immediately on Gordon to maintain alveolar oxygen exchange? A. Oral Suctioning B. Tracheostomy C. Intubation D. Fluid resuscitation 19. Which nursing actions should the nurse do for the client? I. Assess airway patency. II. Administer oxygen, as prescribed. III. Keep the patient warm. IV. Place a cooling blanket. V. Prepare to give oral pain medication, as prescribed. A. I, II, III, V B. I, II, IV C. I, II, III D. I, II, III, IV, V 20. Complete blood count results showed an elevated hematocrit. Then nurse understand that this is the result of ________? A. Increase fluid volume in the interstitial compartment B. Massive destruction of erythrocytes C. Increased microvascular permeability D. Fluids shifts from the intravascular compartment Situation: Diego, 5 years old, was admitted because of persistent low grade fever, pallor, fatigue, petechiae and bleeding from the oral mucous membrane. The attending physician suspects acute Lymphocytic Leukemia. 21. Diego was scheduled for bone marrow aspiration. As his nurse, you are aware that in children the site preferred is the iliac crest because it_______: A. Can easily be penetrated B. Is less painful C. Yields more bone marrow D. Heals faster 22. Diego is for bone marrow aspiration. The physician said he will aspirate bone marrow through the iliac crest posterior. Which of the following position is MOST appropriate? A. Sim’s B. Supine C. Lateral D. Prone 23. To confirm the diagnosis of the physician, which of the following will establish an Acute Lymphocytic Leukemia diagnosis? A. Presence of immature thrombocytes B. Over production of granulocytes C. Presence of more than 25% blast cells D. A WBC count of 50,00 cells/mm 24. During the first hour post bone marrow aspiration, which of the following is a PRIORITY activity? A. Apply pressure dressing B. Monitor body temperature C. Maintain on complete bed rest D. Observe the dressing for bleeding 25. Diego received blood transfusion because of severe anemia, immediately after the strat of transfusion, he cried and complained of headache. Which of the following is your PRIORITY action? A. Refer to the physician B. Take vital signs C. Discontinue the transfusion D. Assess for dyspnea Situation: Gantt, 67 years old business man with symptoms of post-void urinary dribbling, decreased forced of urinary stream, inability to empty the bladder completely, and difficulty in initiating urination. After a series of diagnostic tests, he was diagnosed of benign Prostatic Hypertrophy. 26. While you were taking his history, Gantt asks you what could be the cause of these embarrassing symptoms. Your BEST response would be “the symptoms you are experiencing can be due to_______”. A. Urinary tract infection” B. Stones in your urinary bladder” C. Pressure of your prostate on your bladder and around your urethra: D. Strictures in your ureters and urethra” 27. The physician ordered a number of diagnostic tests for Gantt. Which of the following tests is capable of determining the size of the prostate and differentiate benign prostatic hypertrophy (BHP) from prostate cancer? A. Intravenous pyelography B. Transrectal ultrasound C. Cystouroscopy D. Prostate specific antigen 28. As his nurse, you plan to control urinary retention and incontinence through which of the following strategies? 1. Avoid alcohol 2. Encourage fluid intake 3. Follow a timed voiding schedule 4. Administer antihistamines, as prescribed. 2 | Page
A. 1 and 2 B. 1, 2 and 3 C. 1,2,3 and 4 D. All except 2 29. While reviewing his records, you remember the procedure “transurethral resection of the prostate.” Which of the following is true about TURP? A. Uses scope into the ureter to excise prostatic tissue. B. Bleeding is common following TURP C. A and B D. None of the above 30. You understand that urinary tract infection can occur due to retention of urine in the bladder and subsequent backup or reflux into the ureters and kidneys. Thus, you plan to teach Gantt and his family signs and symptoms of urinary tract infection which include the following EXCEPT. A. Hematuria B. Cloudy urine C. Sweet smelling urine D. Fever Situation: Cyrin, a 50-year-old dressmaker, was diagnosed with myasthenia gravis. For two years, she has been on remission. She takes an anticholinesterase medication which is Pyridostigmine (Mestinon) 60 mg PO every 4 hours. During the past month, Cyrin decreased the dose of her medication without informing her physician because she was feeling so good. An hour ago, Mylene was admitted in the hospital for treatment for exacerbation of myasthenia gravis. Upon admission, she complains of severe weakness with problems in mobility. She is dyspneic, with difficulty to swallow and with ptosis of both eyes. 31. The nurse who admitted the client considers which of the following as a correct description of myasthenia gravis? Myasthenia gravis is_________? A. A degenerative neurologic disease with lower motor neuron involvement B. An autoimmune neuromuscular disorder C. An acute inflammatory demyelinating disorder of the peripheral nervous system D. A viral infection affecting the cranial nerves specifically the oculomotor nerve 32. Which of the following interventions will the nurse not implement for a patient with myasthenia gravis? A. Monitor respiratory status. B. Encourage client to sit up when eating. C. Plan short activities that coincide with times that the patient is awake. D. Administer anticholinesterase medications, as prescribed. 33. Which of the following will the nurse report as a manifestation of cholinergic crisis due to over dosage of Pyridostigmine (Mestinon)? A. Increase heart rate B. Diarrhea C. Decreased sweeting D. Dry mouth 34. Due to impaired swallowing, which of the following interventions will the nurse implemented to promote effectiveness of pyridostigmine (Mestinon)? A. Administer the drug 30 minutes before meals B. Allow patient to take the drug with a glass of fruit juice C. Have patient take the drug after meals D. Dissolve drug in a glass of water 35. Which of the following documentation of the nurse will provide information regarding the effectiveness of pyridostigmine (Mestinon)? A. Vital signs of the client before and after an activity B. Frequency of complaints of pain during movement C. Changes in abilities to comprehend D. Time when fatigue occurs in relation to activities Situation: Alexa, a 30-year-old computer engineer, went to the emergency department with complaints of gnawing pain and burning sensation in the midepigastrium. The physician’s initial diagnosis is peptic ulcer disease. 36. As a nurse, you know that there are few things that differentiate gastric ulcers from duodenal ulcers. Which among the choices correctly differentiates the two? A. Pain in gastric ulcer is aggravated by eating, while pain in duodenal ulcer is relieved by eating. B. Gastric ulcer is known as the executive ulcer. C. Pain in gastric ulcer usually radiates in the right side of the abdomen. D. Melena is more common in gastric ulcers. 37. Which among the following can detect H. pylori infection? 1. Biopsy 2. Stool antigen test 3. Urea breath test 4. Endoscopy A. 1 only B. 1 and 2 C. 1, 2 and 3 D. 1, 2, 3 and 4 38. Which among the following can detect H. pylori infection? 1. Biopsy 2. Stool antigen test 3. Urea breath test 4. Endoscopy A. 1 only B. 1 and 2 C. 1, 2 and 3 D. 1, 2, 3 and 4 39. Alexa tested positive for H. pylori infection. The physician prescribed Metronidazole. What is the most important health teaching that the nurse can provide Alexa? A. Administer with meals. B. Administer before meals. C. Avoid drinking alcohol. D. Drink an adequate amount of fluids to avoid constipation. 40. The most life-threatening complication of PUD is: A. Hemorrhage B. Severe weight loss C. Septic shock D. Heart attack Situation: Nurse Mina is assigned at the TB-DOTS Clinic of Comembo, Makati. A couple of patients went to the clinic one Friday morning. 41. How would Nurse Mina understand Patient Ara's statement "I experience numbness and tingling in my arms and legs" given that she has been taking Isoniazid (INH) for the past two months already? A. Raynaud’s disease B. Hypercalcemia C. Peripheral neuritis D. Impaired peripheral circulation 42. Nurse Mina should educate the patient who will be taking Isoniazid all of the following EXCEPT: A. Avoid taking alcohol. B. Report immediately to the physician any signs of jaundice C. Increase intake of Swiss cheese for good absorption of Isoniazid D. Increase intake of pyridoxine. 43. Nurse Mina should intervene when the student nurse tells the patient taking rifampin (Rifadin) that: A. It can cause orange discoloration of secretions B. Antacids can be taken at least 1 hour before medication, if prescribed. C. The medication can be administered on an empty stomach. D. The patient can double dose if one dose is forgotten. 44. Nurse Mina knows that all of the listed patients below, except for one, have characteristics that increase their risk of noncompliance with the TB medication regimen: A. Patient A, 25-year-old male, who is diagnosed with schizophrenia B. Patient B, 50-year-old female, a government employee C. Patient C, 44-year-old male, wheelchair-bound for three years after having both legs amputated 3 | Page
D. Patient D, a 30-year-old female, who admits to be a PCP user 45. A Nurse Mina is aware that the only antituberculosis medication that is bacteriostatic is: A. INH B. Rifampicin C. Pyrazinamide D. Ethambutol Situation: Lena, reports to the infectious unit of a hospital during the morning shift. Five clients were assigned to her. 46. A 12 year old male was admitted to the unit during the previous shift because of dengue hemorrhagic fever graded 2 by the attending physician. History of epistaxis a few hours prior to admission was noted. When Lena received endorsement form the outgoing nurse, if was specified in the diet to avoid dark colored foods. Lena would relate this prescription to which of the following? A. History of allergies of the client B. Food choices of the client C. Monitoring melena D. Effects of food on the gastric mucosa 47. Lena admits a 24 year old female with manifestation of Hepatitis A. Which of the following data will the nurse obtain from the client to support the physician’s diagnosis? A. History of intake of narcotic drugs B. Incidence of needlestick injury during the past two months C. Contact with contaminated water and food D. Direct contact with friends positive hepatitis A 48. To prevent transmission of virus, the client diagnosed with varicella was isolated in single room. Lena explains to the nurse working with her that the period of communicability of varicella A. Is variable depending upon the age of the client B. Extends up to the time crusts have formed C. Is 14 days from the time lesions appeared D. Is indefinite 49. A client diagnosed with pertussis is closely observed. Which of the following interventions will Lena implement? A. Institute airborne, droplet, and contact precautions. B. Limit fluid intake. C. Administer antiviral therapy, as prescribed. D. Isolate child during the incubation period. 50. Lena admitted an 80 year old male for evaluation and treatment of skin lesions on his right upper arm. Physician confirmed diagnosis of herpes Zoster. Valaciclovir (Valtrex) 500 mg 2 tablets PO TID was prescribed an started. Which of the following is the action of this drug? A. Destruction of bacteria B. Suppression of allergic reaction C. Antifungal D. Prevents replication of the virus Situation: Linda, 65 years old pass total thyroidectomy with modified neck dissection has been scheduled for radioactive iodine therapy a month and a half after her surgery. 51. The physician explained to the client that the radioactive iodine therapy is intended the following reason? A. Lessens activity of the thyroid gland B. Enhances the production of thyroid hormone C. Provides scanning of cancer cells in nonthyroid tissues D. Destroys remaining thyroid tissue 52. Linda ask the nurse to explain again how the radioactive iodine therapy will be administered. Which of the following is the correct response of the nurse? “radioactive iodine will be administered __________. A. Via and external radiation equipment” B. Topically on defected site” C. Intravenously incorporated in a normal saline solution” D. Orally in tablet form” 53. Linda, after receiving radioactive iodine, is informed of the following except: A. Avoid sexual contact B. Avoid sharing utensils and cups C. Avoid sleeping in the same bed with other persons D. Avoid drinking water. 54. Low iodine diet has been prescribed to be started two weeks before the radioactive iodine therapy. Since all dairy products are avoided due to their high iodine content, which of the following will be the nurse considered as a PRIORITY in her teaching plan? A. Provision of a list of allowed and not allowed foods B. Preparation of a well balanced diet C. A sample menu plan for the client to follow D. Nutritional strategies to supplement calcium intake 55. While the nurse was teaching the client on foods which are allowed and not allowed, the client asks if she can eat restaurant foods. Which of the following responses of the nurse will ensure that the client will not take foods containing iodine? A. Maybe once, but not twice, because the restaurant may not have a way not to put iodized salt on your food B. You may, provided that you tell them not to put iodized salt on your food C. It is the best that you do not take restaurant foods because there is no way to determine if iodized salt was used D. Just careful that the food you order are not in the list of disallowed foods Situation: During an in-service staff development training the training coordinator considered analysis of legal situations. Group discussion of legal concerns and experience was conducted among the staff nurses with six years experience. 56. Furosemide which was intended for a patient with congestive heart failure was administered intravenously to other patient. Which of the following elements in this incident is not necessary to make claim of malpractice? A. It is the duty of the nurse to administer the right medication to the right patient B. The nurse failed to administer the drug to the patient who is supposed to receive the drugs as prescribed C. The nurse did not identify correctly the patient who is supposed to receive the correct medication D. The patient who received the wrong medication develop diuresis resulting to dehydration 57. A nurse manager administered Lanoxin parenterally to a 3 years old child contrary to the order of administering Lanoxin and orally. The nurse was named a defendant in a malpractice suit filed by the mother of the child because the child died. if you were the nurse manager, as a defendant your action will be compared with: A. Responsibilities expected of the nurse who administers medications per hospital protocol B. A professional nurse who has the same experience as the nurse manager C. Reasonable professional nurse in a similar circumstance D. The expectation of the physician who prescribed the medication 58. A male nurse assigned in the emergency department broke hospital rule when he moved an adult patient alone from the sketcher to the bed. Should this nurse be reprimanded? A. Yes because hospital rules are written to be followed and not violated B. No because hospital rules may not be followed sometimes depending upon the situation C. Yes because working outside of the hospital policy may cause harm to the patient D. No because moving the patient alone does not pose any risk to the patient but to the nurse 59. In the emergency department when a patient with hypersensitivity reactions turned to his side on the stretcher he fell when the side rails were released. He sustained head injuries resulting to paralysis the court held the nurse and the hospital liable under the principle of res ipsa Loquitor because: A. Hospital is the employer of the nurse B. The injuries sustained by the patient speaks for itself C. Head injuries were sustained due to fall D. The plaintiff did not contribute at all to injuries sustained 4 | Page