Republic of the Philippines

PROFESSIONAL REGULATION COMMISSION

Manila
BOARD OF NURSING

Nurse Licensure Examination

NURSING PRACTICE III – CARE OF CLIENTS WITH PHYSIOLOGIC AND

PSYCHOSOCIAL ALTERATIONS (PART A)
INSTRUCTION: Select the correct answer for each of the following
questions. Mark only one answer for each item by shading the box
corresponding to the letter of your choice on the answer sheet
provided.
STRICTLY NO ERASURES ALLOWED.

Situation: Nurse Uncle Drew is assigned in the telemetry area. He

handles patients suffering from cardiovascular conditions. The
following questions apply.
1. One of Nurse Uncle Drew’s patients, patient Stephen Curry,
suffers from pericardial effusion. Nurse Uncle drew knows that
the normal amount of fluid in the pericardial sac is
approximately:
a. 10 mL
b. 20 mL
c. 30 mL
d. 40mL

2. One of the classic clinical manifestations of pericardial

effusion is pulsus paradoxus. Which of the following describes
this phenomenon?
a. Diastolic blood pressure that is markedly lower during
inhalation
b. Abnormal difference of at least 10mmhg in systolic pressure
between the point of exhalation and inhalation
c. Abnormal difference of at least 10mmhg in diastolic pressure
between the point of exhalation and inhalation
d. False high readings of blood pressure upon inhalation than
exhalation

3. Which of the following tests can be the diagnostic test for

cardiac
tamponade?
a. Doppler Ultrasound
b. BNP test
c. Pericardiocentesis
d. Echocardiogram

4. Which of the following signs indicates that pericardiocentesis

has
been unsuccessful?
a. Increasing central venous pressure
b. Increasing blood pressure
c. Feeling of immediate relief
d. Audible heart sounds

5. One alternative treatment for patient Stephen Curry is

pericardiotomy. Nurse Uncle Drew would explain to the patient
that
this procedure is:
a. A procedure wherein a stoma is created in the anterior part of
the
heart to be connected to the peritoneum for drainage of
pericardial
fluid
b. A portion of the pericardium is excised to permit drainage of
pericardial fluid into the lymphatic system
c. A portion of the heart is directed to the ureters for drainage
of
the excessive pericardial fluid
d. A stoma is created in the pericardium to be connected to a
Jackson
pratt for drainage of excessive fluid

6. Nurse Westbrook is monitoring a 53 year old client who is

undergoing treadmill stress test. Which client finding will
require
the most immediate action?
a. Blood pressure of 152/98 mmhg
b. Heart rate of 134 beats/minute
c. Oxygen saturation of 91%
d. Chest pain level of 2 on a scale of 10

7. Nurse Westbrook is making a home visit to patient James

Harden, a
hypertensive client, who has been taking enalapril (Vasotec).
Which
finding indicates that you need to contact the health care
provider
about the change in drug therapy?
a. Client reports frequent urination
b. Client’s blood pressure is 136/86 mmhg
c. Client coughs often during visit
d. Client says “I get dizzy sometimes”

8. Charge nurse Michael Jordan is assigning patients in the

telemetry.
Which client is best to assign to Nurse Antenkoumpo who has come
for
the day from the general medical surgical unit?
a. Client requiring discharge teaching about coronary artery
stenting
b. Client receiving IV furosemide to treat acute left ventricular
failure
c. Client who just transferred in from the radiology department
after
a coronary angioplasty
d. Client just admitted with unstable angina who has orders of
heparin
infusion and aspirin

9. At 1000H, a hospitalized client receives a new order for

transesophageal echocardiography (TEE) as soon as possible. Which
action will you take first?
a. Put the client on nothing by mouth status
b. Teach the client about the procedure
c. Insert an IV catheter in the client’s forearm
d. Attach the client to a cardiac monitor

10. A resident in a long term care facility who has venous stasis
ulcers is treated with an Unna boot. Which nursing activity
included
in the care is best to delegate to the NA?
a. Teaching family members the signs of infection
b. Monitoring capillary perfusion once every 8 hours
c. Evaluating foot sensation and movement each shift

d. Assisting the client in cleaning around the Unna boot

Situation: Nurse Hannah is helping a patients at the orthopedic

ward
with ambulation.
11. While Nurse Hannah is helping a patient walk without any
walker or
crutches, the patient suddenly has syncope and falls. How will
the
nurse protect the patient from any injuries during the fall?
a. Flexing both legs at the knees and catching by the waist
b. Flexing the patient’s hip and knees, and carrying her back to
her
bed
c. Extending one of the patient’s leg and letting her gently
slide
against that leg down to the floor
d. Widening the base of support of the patient by putting his
feet
apart, catching the patient’s back

12. A patient who had above-the-knee amputation of the left leg

is
being prescribed with crutches. He claims to have no problems
with
ambulation on the right leg. Which among the following crutch
gaits is
BEST for the patient?
a. Four-point alternate gait
b. Three-point gait
c. Two-point gait
d. Swing-through gait

13. Nurse Hannah is teaching a patient with crutches how to go up

the
stairs. Which among the following is a wrong instruction?
a. Patient should assume the tripod position initially at the
bottom
of the stairs
b. The crutches and the affected leg go up the step together.
c. When moving the affected leg up, the body weight should be on
the
crutches.
d. The unaffected leg goes up the step before the affected leg.

14. Nurse Hannah flexes the arm of a patient with right-sided

hemiparesis. Which among the following will ALLOW flexion of the
arm?
a. Contraction of the triceps brachii
b. Relaxation of the biceps brachii
c. Contraction of the biceps brachii
d. A & B only

15. Nurse Hannah is assisted by another staff nurse in lifting a

patient. Which among the following actions will only cause injury
to
Nurse Hannah?
a. Keeping the feet wide apart and knees extended
b. Positioning herself close to the patient
c. Using the muscles of the arms and legs, not the back, in
lifting
d. Keeping her back, neck, and pelvis aligned

Situation: Nurse Klay Thompson is handling patients in the

medical
surgical unit. The following questions apply to haematological
conditions.
16. A 32 year old patient with sickle cell anemia is admitted to
the
hospital during a sickle cell crisis. Which action prescribed by
the
health care provider will you implement first?
a. Give morphine sulfate 4 to 8mg IV every hours as needed
b. Administer 100% oxygen using a nonrebreather mask
c. Start a 14 gauge IV line and infuse normal saline at 200mL/hr
d. Give Pneumococcal (Pneumovax) and Haemophilus influnzae
(ActHIB)
vaccines

17. As charge nurse, Nurse Steve Kerr is making the daily

assignments
on the medical-surgical unit. Which patient is best assigned to
float
Nurse Kristaps Porzingis who has come from the PACU?
a. 30 year old patient with thalassemia major who has an order
for SQ
infusion of deferoxamine (Desferal)
b. 43 year old patient with multiple myeloma who requires
discharge
teaching
c. 52 year old chronic gastrointestinal bleeding who has returned
to
the unit after a colonoscopy
d. 65 year old patient with pernicious anemia who has just been
admitted to the unit

18. A 67 year old patient Vince Carter who is receiving

chemotherapy
for lung cancer is admitted to the hospital with
thrombocytopenia.
Which statement by the patient when you are obtaining the
admission
history is of most concern?
a. I’ve noticed that I bruise more easily since the chemotherapy
started
b. My bowel movements are soft and dark brown
c. I take one aspirin every morning because of my history of
Angina
d. My appetite has decreased since the chemotherapy has started

19. After a car accident, Ms. Thomas with a medical alert

bracelet
indicating hemophilia A is admitted to the emergency department.
Which
action prescribed by the health care provider will you implement
first?
a. Transport to the radiology department for cervical spine
radiography
b. Transfuse factor VIII concentrate
c. Type and cross match for 4 units of PRBCs
d. Infuse normal saline at 250ml/hr
20. As a home health nurse, you are obtaining an admission
history for
a patient who has deep vein thrombosis and is taking Warfarin
(Coumadin) 2mg daily. Which statement by the patient is the best
indicator that additional teaching about Warfarin may be needed?
a. I have started to eat more healthy food like green salad and
fruit
b. The doctor said it is important to avoid becoming constipated
c. Coumadin makes me feel a little nauseated unless I take it
with
food
d. I will need to have some blood testing done once or twice a
week

21. Manang Betchay, a high school undergraduate, has chronic pain

due
to osteoarthritis but has impaired speech. Which of the following
is
the most appropriate to determine her medication needs for pain?
a. Observe typical pain behavior through facial expressions
b. Medicate the client with analgesics as often as ordered
c. Record frequency of patient’s complaint of pain and administer
medication accordingly.
d. Assess the client’s pain scale through writing in a magic
slate

22. Mrs. Antonia, 65, diabetic, complained of elevated blood

glucose
since she strained her back a week ago despite following her diet
and
drug prescription. Your best explanation would be:
a. Parasympathetic stimulation from the body’s normal response to
pain
b. Physiologic and psychologic stress can elevate blood glucose
level
c. Client is consuming more food as a coping mechanism
d. It is usual occurrence among the elderly who has injuries

23. Individuals aged 50 years old and above are expected to

receive
pneumococcal and influenza vaccine yearly. Their increased
susceptibility to develop pneumonia and influenza is caused by
all of
the following, except:
a. Diminished ciliary & macrophage activity, drier mucus
membranes
b. Decreased cough reflex
c. Increased risk of infection and bronchospasm with airway
obstruction
d. Decreased response to hypoxia and hypercapnia

24. Older male adults have an increased risk for developing

urinary
tract infection. All but one of the following statements provides
correct explanation of this condition:
a. Normal prostate enlargement in males with risk of BPH
b. Increased post void residual and nocturnal urine production
c. Normal occurrence of incontinence
d. Reduced bladder elasticity and muscle tone 25.

25. Which of the following statements is true regarding age-

related
sarcopenia?
a. Physically inactive people can lose as much as 3% to 5% of
their
muscle mass each decade after age 30
b. Age-related sarcopenia starts at the age of 40s
c. Only inactive aging individuals develop sarcopenia
d. Sarcopenia typically happens faster around age 75

26. Patient Dwight Howard is admitted to the intensive care unit

with
disseminated intravascular coagulation associated with gram
negative
infection. Which assessment information has the most immediate
implications for the patient’s care?
a. There is no palpable radial or pedal pulse
b. The patient reports chest pain
c. The patient’s oxygen saturation is 87%
d. There is mottling of the hands and feet

27. Nurse John Wall received a change of shift report about the
following patients. Which one will you assess first?
a. 26 year old with thalassemia who has a hemoglobin level of
8g/L and
orders for a PRBC transfusion
b. 44 year old who has admitted 3 days previously in a sickle
cell
crisis and has orders for a computerized tomographic scan
c. 50 year old with stage IV non-hodgkin lymphoma who is crying
and
saying “I’m not ready to die”
d. 69 year old with chemotherapy induced neutropenia who has an
oral
temperature of 100.1 degrees Fahrenheit

28. Nurse John Wall obtain the following data about a patient
admitted
with multiple myeloma. Which information has the most immediate
implications for the patient’s care?
a. The patient reports chronic bone pain
b. The blood uric acid level is very elevated
c. The 24 hour urine test show Bence Jones protein
d. The patient reports new onset leg numbness

29. Nurse John Wall is transferring a patient with newly

diagnosed
chronic myeloid leukemia to an LTC facility. Which information is
most
important to communicate to the LTC charge nurse before
transferring
the patient?
a. Philadelphia chromosome is present in the patient’s blood
smear
b. Glucose level is elevated as a result of prednisone therapy
c. There has been a 20lb weight loss over the year
d. The patient’s chemotherapy has resulted in neutropenia

30. A patient who has been receiving cyclosporine (Sandimmune)

following an organ transplantation is experiencing the following
symptoms. Which one is of most concern?
a. Bleeding of the gums while brushing the teeth
b. Nontender lump in the right groin
c. Occasional nauseas after taking the medication
d. Numbness and tingling of the feet

Situation: Nurse Hazel is assigned to the medical-surgical unit

where
most of her clients are elderly client, thus, it is essential for
her
to establish basic knowledge on the normal and abnormal
physiological
changes of the ageing population.
31. Changes in an older adult’s sensory perception is one of the
normal changes occurring in ageing. Changes in vision is one of
the
most common occurrence. Which of the following statements about
vision
changes in ageing is not true?
a. 30% of those over age 65 have some level of visual impairment
b. It is normal for adults aged 65 and above to have a visual
acuity
of 20/200
c. Cataracts are the 5th most common chronic condition in adults
over
age 75
d. Macular degeneration is the most common cause of legal
blindness in
the elderly

32. For a client complaining of mild musculoskeletal pain, the

nurse
will anticipate that the treatment for this client’s level of
discomfort will include which of the following?
a. Diazepam
b. Meperidine hydrochloride
c. Acetaminophen
d. Fentanyl – Narcotic

33. Elmma Rosario was to inject Vitamin B intramuscularly to

another
elderly patient. Before injecting, the nurse explained that the
client
may feel some discomfort. This is an example of:
a. anticipatory response
b. reducing pain receptor
c. self-preservation
d. distraction

34. Which of the following shows an incorrect statement about the

peripheral sensation of an ageing individual?
a. Two-point discrimination is decreased with age
b. Vibratory sensation is decreased with age
c. Ability to perceive painful stimuli is not preserved in aging
d. There is a slowed reaction time in pain perception

35. Mr. Andrew, 69 years old, has a history of chronic back pain.
He
thinks that his family perceives him as a “weakling” because he
often
asks for pain medication. Which of the following is the most
therapeutic response of the nurse?
a. “It seems that you are worried. Which matters to you more?
What
people will say or getting relief from your pain?”
b. “Taking pain medication as prescribed will help you become
more
active.”
c. “Chronic back pain is very difficult to manage, use pain
medication
because that is what it is for.”
d. “Don’t you think your family wants you to be comfortable, and
the
only way is to take your medicine?”

SITUATION: A hypothesis in a research study is an intelligent

guest
which provides tentative answer to the problem. It’s vital to a
quantitative study since it establishes basis for statistical
testing,
to determine whether findings are significant or insignificant.
36. Nurse-researcher Marj is currently reviewing related
literature
and studies which she can consider in her study. One of the
published
study hypotheses states that “The consumption of organo coffee
may
improve digestion among people with chronic constipation.” She
correctly identifies the study hypothesis as:
a. Statistical hypothesis
b. Null hypothesis
c. Research hypothesis
d. H0

37. If Marj’s research adviser will ask her to further classify

the
hypothesis she has read, she has a good understanding of what
hypotheses are, if she responds:
a. Alternative
b. Directional
c. Non-directional
d. Complex

38. Marj asks her research adviser on what statistical tools will
she
use to analyze and interpret the hypothesis. Her adviser
recommends to
initially compute for the value of the standard error of the mean
(SEM). If Marj has the following data: mean – 58; median – 56;
mode –
61; range – 32; standard deviation – 45; sample size – 9; the SEM
is:
a. 15
b. 9
c. 12
d. 5

39. What interpretation can Marj draw from the value of the
standard
error of the mean (SEM):
a. The larger the SEM value -- the less variable the sample --
the
more accurate are the means as estimates of the population value

b. The larger the SEM value -- the less variable the sample --
the
less accurate are the means as estimates of the population value
c. The smaller the SEM value -- the less variable the sample –
the
less accurate are the means as estimates of the population value
d. The smaller the SEM value -- the less variable the sample --
the
more accurate are the means as estimates of the population value

40. Suppose nurse-researcher Marj is already done analyzing and

interpreting the hypothesis, if she incorrectly rejects a null
hypothesis when it is true, resulting to a false positive
conclusion,
she has committed:
a. Type I error
b. Type II error
c. Type III error
d. Type IV error

SITUATION: Strategies for enhancing the integrity of qualitative

and
quantitative studies are necessary to produce indispensable
findings
which pave way to research utilization.
41. Lincoln and Guba (1985) suggested criteria for developing the
trustworthiness of a qualitative inquiry. Nurse Arien is aware
that
dependability in qualitative inquiry is analogous to a positivist
criteria known as:
a. Internal validity
b. Reliability
c. Objectivity
d. External validity
42. Moreover, he also knows that transferability in qualitative
inquiry is parallel to this positivist criteria:
a. Internal validity
b. Reliability
c. Objectivity
d. External validity

43. Jomar, another nurse-researcher is undertaking a quantitative

study. If he will have to choose tools for data analysis for
comparing
groups of ordinal data, he will rule out:
a. Mann-Whitney test
b. Kruskal-Wallis H test
c. McNemar’s test
d. Friedman’s test

44. Jomar is appraising the level of evidences in nursing

research.
Considering the designs in the evidence hierarchy, the level
which is
considered as the highest because they are designed to be
unbiased and
have less risk of systematic errors is:
a. Level I
b. Level III
c. Level V
d. Level VII

45. In contrast this level of evidence is regarded as lowest:

a. Level I
b. Level III
c. Level V
d. Level VII

Situation: Nurse Dexter is caring for a 6-y/o patient with

bilateral
impetigo on the lower extremities secondary to S. pyogenes
infection.
Vital signs are: T: 38.0oC, HR 90bpm, RR 17cpm, BP 100/70. He
ensures
containment and prevention of transmission of the infection.
46. Which among the following items used on the patient will need
sterilization after use?
a. Stethoscope
b. Spoon and fork
c. Scalpel
d. A and C

47. Which among the following precautions is best for the

patient?
a. Airborne precaution
b. Contact precaution
c. Droplet precaution
d. Reverse isolation precaution

48. The family is asking the nurse if they can visit the patient.
Nurse Dexter’s best response will be:
a. “I’m afraid the patient cannot entertain visitors because of
his
condition.”
b. “You need to put on masks to prevent transmission of the
bacteria
via airborne droplets.”
c. “Wearing gloves and gowns, especially if you have skin breaks,
is
needed before entering the patient’s room.”
d. “I am not sure if that is allowed. Let me call the doctor to
explain it to you.”

49. In disposing the patient’s linen and trash, Nurse Dexter

should
tie the knot at the ____ of the linen and trash bags:
a. Top
b. Posterior surface
c. Upper sides
d. Any part

50. Which among the following will indicate that the patient has
also
developed a parasitic infection?
a. Neutrophil count 75%
b. Lymphocytes 20%
c. Eosinophils 3%
d. Eosinophils 8%

51. Nurse Lebron knows that patients with IBD should be

classified as
Crohn’s or Ulcerative Colitis. Which of the following results in
barium series would be reflective of ulcerative colitis?
a. Diffuse involvement, no narrowing of colon, no mucosal edema,
stenosis are rare, shortening of colon
b. Regional lesions, narrowing of colon, thickening of bowel wall
c. Mucosal edema, stenosis and fistulas are present
d. Friable mucosa with pseudopolyps in descending colon

52. Nurse Lebron knows that IBD is highly idiopathic by nature

and
studies are made to understand the nature of the disorder. Which
of
the following factors are related to the development of IBD?
a. Triggered by pesticides, food additives, radiation
b. Asbestos, silica inhalation
c. Chronic diarrhea
d. poverty

53. Crohn’s diseases, also known as Regional entiritis, is

usually
first diagnosed at what age group?
a. Adolescents
b. 40-50 years old
c. Toddlers
d. Elderly

54. Clinical management for Crohn’s disease include the following

except:
a. NSAIDs
b. Antibiotics
c. Parenteral nutrition
d. Sulfonamides
55. Crohn’s disease usually happens insidiously in affected
patients.
Therefore, critical assessment of patients are needed in order to
diagnose and treat early. Which of the following symptoms, if
seen by
Nurse Lebron, would be indicative of Crohn’s disease?
a. Right lower quadrant abdominal pain with diarrhea unrelieved
by
defecation
b. Left lower quadrant pain with bloody diarrhea
c. Psoas’ sign with right lower quadrant pain
d. Epigastric pain slight left triggered by food intake

56. Which of the following diagnostic studies would be the most

conclusive aid for Crohn’s disease confirmation?
a. Upper GI series showing “string sign”
b. Lower GI series showing malformations
c. Abdominal UTZ
d. Blood tests showing elevated WBC count, decreased Hct and Hgb

57. Nurse Lebron knows that the highest predisposition to

developing
Ulcerative Colitis is from people coming from what race?
a. Jewish heritage
b. African American
c. Asian
d. Japanese
58. Which of the following clinical manifestations, in seen by
Nurse
Lebron, is indicative of Ulcerative Colitis?
a. Intermittent tenesmus, pallor, anemia, fatigue, weight loss
b. Right lower quadrant pain, bloody diarrhea
c. Left lower quadrant pain with fever and cramping
d. Hypercalcemia, anemia, rebound tenderness on left lower
quadrant

59. All of the following are possible complications relating to

Ulcerative Colitis except:
a. Appendicitis
b. Toxic megacolon
c. Vascular engorgement
d. Osteoporotic fractures

60. Pharmacotherapy is used to minimize peristalsis to rest the

inflamed bowel. All but one of the following medications could be
utilized in the management of mild to moderate IBD, except?
a. Aminosalicylates
b. Deltasone
c. Budesonide
d. Methotrexate

Situation: Nurse Nhor is handling patients with dysfunctional

urinary
bladder. The following questions apply.
61. Nurse Nhor knows the oldest and most common of the urinary
diversion procedures in use because of the low number of
complications
and surgeon’s familiarity is the?
a. Ileal conduit
b. Cutaneous ureterostomy
c. Nephrostomy
d. Vesicostomy

62. The patient asked you how often should the ileal bag should
be
changed. The correct response would be:
a. Every 3 to 5 days
b. Every day
c. Every week
d. When necessary

63. The ileal conduit insertion is usually accompanied by stents,

usually made of thin pliable tubing, placed in the ureters to
prevent
occlusion. Nurse Nhor knows that if the ureteral stents are not
draining properly, it could be irrigated with:
a. 5 to 10ml of sterile NSS
b. 5 to 10 ml of sterile water
c. 10 to 15ml of sterile NSS
d. 10 to 15 ml of sterile water

64. Because the stoma can cause acid-base imbalances, urine pH is

important assessment for Nurse Nhor. Which of the following is
the
correct procedure in checking the pH of the urine?
a. Testing the urine draining from stoma
b. Testing the urine from the drainage bag
c. Testing the urine from the stent
d. Testing the urine from the urethra of the patient

65. Nurse Nhor knows that the normal output from the ileal
conduit of
the patient is characterized by: a. Blood streaked urine c. Clear
urine b. Mucoid urine d. Brownish urine Situation: Nurse Isaiah
Thomas
is handling patients with respiratory difficulties. The following
questions apply.

66. Nurse Isaiah Thomas is teaching a patient how to use and MDI
without a spacer. Put in correct order the steps that the student
nurse should teach the patient.
i. Remove the inhaler cap and shake the inhaler
ii. Open your mouth and place the mouthpiece 1 to 2 inches away
iii. Breathe out completely
iv. hold your breath for at least 10 seconds
v. press down firmly on the canister and breathe deeply through
your
mouth
vi. wait at least 1 minute between puffs
a. i,iii,ii,iv,v,vi
b. i,iii,ii,v,iv,vi

c. i,iii,ii,iv,vi,v
d. i,ii,iii,v,iv,vi

67. After change of shift, nurse IT is assigned to care for the

following patients. Which patient should you assess first?
a. 68 year old patient on a ventilator for whom a sterile sputum
specimen must be sent to the laboratory
b. 72 year old with pneumonia who needs to be started on IV
antibiotics
c. 57 year old with COPD and a pulse oximetry reading from the
previous shift of 90% saturation
d. 51 year old with asthma who reports shortness of breath after
using
a bronchodilator inhaler

68. You are the charge nurse of nurse IT and you are making
assignments for the next shift. Which patient should be assigned
to
the fairly new nurse, floated from the surgical unit to the
medical
unit?
a. 58 year old on airborne precautions for TB
b. 65 year old who just returned from bronchoscopy and biopsy
c. 72 year old who needs teaching about the use of incentive
spirometry
d. 69 year old with COPD who is ventilator dependent

69. One of nurse IT’s patient is with acute respiratory distress

syndrome is receiving oxygen by nonrebreather mask, but ABG
measurements still show poor oxygenation. As the nurse
responsible for
this patient’s care, you would anticipate a physician order for
what
action?
a. Perform endotracheal intubation and initiate mechanical
ventilation
b. Immediately begin continuous positive airway pressure (CPAP)
via
the patient’s nose and mouth
c. Administer furosemide (Lasix) 100mg IV push STAT
d. Call a code for respiratory arrest

70. Nurse IT has finished assisting the physician with a

thoracentesis
for a patient with recurrent left pleural effusion caused by lung
cancer. The thoracentesis removed 1800mL of fluid. Which patient
assessment information is important to report to the physician?
a. The patient starts crying and says she can’t go on with
treatment
much longer
b. The patient reports sharp, stabbing, chest pain with every
deep
breath
c. The blood pressure is 100/48mmhg and the heart rate is 102
breaths/min
d. The dressing at the thoracentesis site has 1cm of bloody
drainage

Situation: Nurse Arvin is handling patients in the medical

surgical
floor. Majority of his patients suffer from fluid and electrolyte
imbalances. The following questions apply:
71. The client with respiratory failure is receiving mechanical
ventilation and continues to produce arterial blood gas results
indicating respiratory acidosis. Which change in ventilator
settings
should you expect to correct this problem?
a. Increase in ventilator rate from 6 to 10 breaths/min
b. Decrease in ventilator rate from 10 to 6 breaths/min
c. Increase in oxygen concentration from 30% to 40%
d. Decrease in oxygen concentration from 40% to 30%

72. Which action should you delegate to a nursing assistant for

the
client with diabetic ketoacidosis?
i. Checking fingerstick glucose every hour
ii. recording intake and output every hour
iii. measuring vital signs every 15 minutes
iv. assessing for indicators of fluid imbalance
a. i,ii,iii,iv
b. i,ii,iv only
c. i,ii,iii only
d. ii, iii only

73. The client has a NGT connected to intermittent wall suction.

The
student nurse asks why the client’s respiratory rate has
decreased.
What is your best response?
a. It’s common for clients with uncomfortable equipment such as
NGT to
have lower rate of breathing
b. The client may have a metabolic alkalosis due to the NG
suctioning,
and the decreased respiratory rate is a compensatory mechanism
c. Whenever a client develops a respiratory acid-base problem,
decreasing the respiratory rate helps correct the problem
d. The client is hypoventilating because of anxiety, and we will
have
to stay alert for the development of respiratory acidosis.

74. The client has an order for Microzide 10mg orally every day.
What
should you be sure to include in the teaching plan for this drug?
i. Take this medication in the morning
ii. This medication should be taken in 2 divided doses when you
get up
and when you go to bed
iii. Inform your prescriber if you notice weight gain or
increased
swelling
iv. You should expect your urine output to increase
a. i,ii,ii only
b. i,ii,iv, only
c. i only
d. i, iii, and iv

75. Which blood test result would you sure be to monitory for the
client taking Microzide (HCTZ)?
a. Sodium level
b. Potassium level
c. Chloride level
d. Calcium level

Situation: Nurse Nhor is handling patients with dysfunctional

urinary
bladder. The following questions apply.
76. Nurse Nhor knows the oldest and most common of the urinary
diversion procedures in use because of the low number of
complications
and surgeon’s familiarity is the?
a. Ileal conduit
b. Cutaneous ureterostomy
c. Nephrostomy
d. Vesicostomy

77. The patient asked you how often should the ileal bag should
be
changed. The correct response would be:
a. Every 3 to 5 days
b. Every day
c. Every week
d. When necessary

78. The ileal conduit insertion is usually accompanied by stents,

usually made of thin pliable tubing, placed in the ureters to
prevent
occlusion. Nurse Nhor knows that if the ureteral stents are not
draining properly, it could be irrigated with:
a. 5 to 10ml of sterile NSS
b. 5 to 10 ml of sterile water
c. 10 to 15ml of sterile NSS
d. 10 to 15 ml of sterile water

79. Because the stoma can cause acid-base imbalances, urine pH is

important assessment for Nurse Nhor. Which of the following is
the
correct procedure in checking the pH of the urine?
a. Testing the urine draining from stoma
b. Testing the urine from the drainage bag
c. Testing the urine from the stent
d. Testing the urine from the urethra of the patient

80. Nurse Nhor knows that the normal output from the ileal
conduit of
the patient is characterized by:
a. Blood streaked urine
b. Mucoid urine
c. Clear urine
d. Brownish urine

Situation: Nurse Mary is handling Patient Isaac with de

Quervain’s
disease. The following questions apply.
81. De Quervain’s disease is also known as:
a. Subacute granulomatous thyroiditis
b. Silent thyroiditis
c. Subacute lymphocytic thyroiditis
d. Chronic thyroiditis

82. Patient Isaac asked you what is the demographic affectation

of De
Quervain’s disease. You will explain that the disease mostly
affects:
a. Women, ages 30-50 years old
b. Women, ages 40-50 years old
c. Men, ages 30-50 years old
d. Men, ages 40-50 years old

83. Upon physical examination, which of the following signs are

expected to be manifested by Patient Isaac?
a. Myalgias, pharyngitis, low grade fever, fatigue
b. Anterior neck pain and swelling, fever, dysphonia
c. Irritability, bruit, thrill
d. Hemoptysis, DOB, weight loss

84. Which of the following medications, if prescribed to Patient

Isaac, should be reported to the doctor for reconsideration?
a. NSAIDs

b. Acetylsalicylic acid
c. Beta blockers
d. Corticosteroids

85. Patient Isaac asked why he wasn’t prescribed with anti-

thyroid
agents, which were prescribed to his cousin with hyperthyroidism.
The
correct response is that:
a. De Quervain’s thyroiditis causes hypothyroidism instead of
hyperthyroidism
b. Different patients have different management, for his case the
drug
will cause anaphylaxis
c. These drugs are not effective to the patient since the cause
of
thyroiditis comes from the released stored thyroid hormones
d. These drugs are not indicated for the patient since the
thyroid
gland produces lesser thyroid hormones which causes decreased
synthesis of T3 and T4

Situation: Nurse Ana conducts health teaching on PCOS in Barangay

Niregla. The following questions apply.
86. One of the major topics to be discussed is the nature of
PCOS.
Nurse Ana should be accurate in discussing that PCOS is:
a. Is a common condition which presents irregular periods,
unwanted
hair growth, absence of acne vulgaris, and weight problems
b. This disorder affects the hypothalamic pituitary and ovarian
network or axis
c. This disorder results to chronic over ovulation and clinical
androgen excess
d. This disorder affects 5-10% of women of non-child bearing age

87. Nurse Ana screens the women residents of Barangay Niregla to

determine possible cases of PCOS. Which of the following features
would be signs of PCOS?
a. Overweight, normal menstruation patterns, 40-50 years old
b. Hirsutism, 60-70 years of age, underweight
c. Insulin resistance, dyslipidemia, sleep apnea, infertility

d. Irregular menstrual patterns, normal weight, androgen deficit

88. Nurse Ana knows that all but one are the management for PCOS:
a. Metformin
b. Weight management
c. surgical removal of large cysts
d. avoid Clomid (clomiphene) medication

89. Nurse Ana should be careful in prescribing oral

contraceptives in
patients with PCOS because:
a. Most of the patients affected are of child-bearing age
b. Oral contraceptives can destroy the normal menstrual patterns
c. Oral contraceptives are not allowed by the church
d. Oral contraceptives are found to be the major cause of PCOS

90. Which of the following conditions is the greatest

complication
that may arise from PCOS?
a. Infertility
b. Metabolic syndrome
c. Hypoinsulinemia
d. Suicidal tendencies

Situation: Nurse Joe is handling patients with respiratory

disorders.
One of his patient loads is Patient Mark who suffers from
Pneumoconiosis.
91. Nurse Joe knows that Pneumoconiosis is one of the leading
causes
of Occupational disorders. All but one are examples of
Pneumoconiosis:
a. Silicosis
b. Asbestosis
c. Coal worker’s disease
d. Hairdresser’s disease

92. Nurse Joe would know that patient Mark’s condition progressed
from
acute silicosis to chronic silicosis if which of the following
signs
are seen?
a. Dyspnea, fever, cough, weight loss
b. Progressive symptoms indicative of hypoxemia, severe airflow
obstruction, right sided heart failure
c. Progressive dyspnea, persistent dry cough, mild to moderate
chest
pain, anorexia, weight loss, malaise, clubbing of fingers
d. Chronic cough, dyspnea, expectoration of black or gray sputum

93. Nurse Joe knows that all but one of the following occupations
can
be a risk factor in developing Silicosis:
a. Shipbuilding
b. Glass manufacturing
c. Foundry work
d. Stone cutting

94. The patient asked Nurse Joe regarding the goal of medical
management of his condition. Nurse Joe knows that Pneumoconiosis
is:
a. Treatable by nature and that goal of the medical management is
return of optimal lung functioning
b. Not preventable due to the exposure to several different types
of
agents such as toxic fumes, biologic dusts that are present in
the
atmosphere
c. Irreversible once they develop; thus goal of treatment is of
supportive therapy and aimed at preventing infections and further
complication
d. Related only to the nature of the occupation of the patient

95. Given the nature of the disorder, occupational health nurses

play
an important role in the workplace. All but one are the roles of
the
nurses in preventing the disease except,
a. Patient advocate
b. Nurse anaesthesiologist
c. Ostomy Nurse

d. Diabetic

Nurse Situation: A patient complaining of changes in vision of

the
right eye accompanied with headache is being admitted. Nurse Jun
performs fundoscopy.
96. Which among the following should Nurse Jun use to assess the
affected eye with the ophthalmoscope?
a. Hold in right hand; use left eye
b. Hold in left hand; use right eye
c. Hold in right hand; use right eye
d. Hold in left hand; use left eye
97. Which among the following should Nurse Jun assess for to
assess
clarity of the lens and cornea?
a. Red reflex
b. Blue reflex
c. Yellow reflex
d. Green reflex

98. Which among the following funduscopic findings is suggestive

of an
increased intracranial pressure?
a. Absent physiologic cup
b. Papilledema
c. Engorged retinal veins
d. Irregular retinal patches

99. Which among the following refers to the spasm of the pupil
caused
by the excessive brightness of the light beam of the
ophthalmoscope?
a. Yellow Reflex
b. Strabismus
c. Nystagmus
d. Hippus

100. Nurse Jun knows that the structure immediately surrounding

the
fovea in fundoscopy is called the:
a. Lens
b. Pupil
c. Retina
d. Macula