ENHANCEMENT

Prelim Notes
Prof. Jay R Ascanoa, RN

A. NURSES LICENSURE EXAMINATION Distribution of Content (Client Needs):

I. Safe Effective Care Environment
Philippine Nurse Licensure Examination:
1. Comprehensive Licensure Examination for Nurses in the A. Management of Care and Safety - addresses content that
Philippines test the Nurse's knowledge, skills and ability required to
2. Consist of 5 sets of Tests; each has 100 item questions. ensure safe care delivery to protect client, families,
3. Length of time: 2 hours each, 3 subjects in the first day, significate others, visitors and HCP.
the rests for second day, hour break between each exam. Q: A patient was admitted in the ED complaining of shortness
4. Testing Center: According to family name. of breathing. History of chronic airflow limitation (CAL).
Laboratory test are done and the nurse notes that the
patient 02 saturation is 90%. The nurse reviews the
“Knowledge alone is not enough.” physician's orders and contact the AP to verify which order
if noted in the patient's chart?
A. Record the color, amount and consistency of the sputum.
Philippine Nurse Licensure Examination
B. Administer oxygen per nasal cannula at 4LPM.
NP 1: Fundamentals of Nursing C. Administer Albuterol inhalation: 2 inhalations every
4 to 6 hours.
NP 2: Community Health Nursing /Mother & Child D. Place the patient in high fowlers leaning forward
position.

NP 3: Medical-Surgical Nursing (Part 1) Rationale: Administering oxygen at 4 LPM may not be appropriate for a
patient with chronic airflow limitation. Oxygen therapy is typically
started at 2 LPM to prevent the risk of carbon dioxide retention and
NP 4: Medical-Surgical Nursing (Part 2) respiratory depression.

NP 5: Psychiatric Nursing B. Infection control and Safety - addresses content that test
the Nurse's knowledge, skills and ability required to protect
client, families, significate others, visitors and HCP from
Preparation for the exam: health and environmental hazards.
1. Develop your foundation.
Q: A hospitalized patient is diagnosed with MRSA infection.
• Where do you start? Which of the following precautions should the nurse
observe when caring for the patient?
2. Develop a plan for study. A. Keep the patient's room closed at all times
B. Wear mask and gloves when performing nursing
• Self-study? • Place?
procedures to the patient
• Group study? • Schedule? C. Wear gown and gloves when caring for patient
• How many hours? D. Let patient wear mask when transported to another unit.

Rationale: MRSA is spread through direct contact, requiring contact

3. Positive pampering precautions. Options A, B, and D are for airborne precautions.
• Proper exercise
○ Movie ○ Massage
• Declare yourself II. Health Promotion and Maintenance
○ Date ○ Beach
• Diet
○ Sex Addresses principles related to growth & development.
• Time to relax
This also addresses the nurses’ knowledge, skills and ability
required to assist clients, family members & significant others to
Final Preparation prevent health problems, to recognize alterations in health and
✓ Stay focused ✓ Wake up early to develop health practices that promote and support wellness.
✓ Believe in yourself ✓ Good breakfast
✓ Visit the site of the test ✓ Each chocolate Q: A 9-month-old infant was brought by the parents to the Well
✓ Stop studying 2 days ✓ Don't drink liquor baby clinic. Which of the following observations is normal
before the board exam ✓ Smoke for smokers in this infant?
✓ Avoid sex ✓ Pray!!! It really works A. The child walks alone
✓ Good night sleep ✓ Bring something red B. The child falls back when sitting alone
C. The child crawls and creeps
During the exam: D. The child holds onto the furniture to stand and walks
o Don't panic sideways.
o Bring reouirements Rationale: At 9 months, crawling and creeping are normal. Walking alone
o Smoke if you want coffee if you want (Option A) occurs at 13-16 months, falling back (Option B) is expected
at 6 months if unsupported, and moving sideways while holding
o Use test taking strategies
furniture (Option D) happens at 10-12 months.

1|P a g e Ma. Regina P. Maprangala BSN 4-D

 C. Reduction of Risk Potential - Addressees content that test
III. Psychological Integrity
the nurse's knowledge, skills and ability required to prevent
0
Addresses content that test the nurse’s knowledge, complications or health problems related to the clients
skills and ability required to promote and support the client, condition or any prescribed treatments or procedures.
client's family and significant other's ability to cope, adapt and
problem solve during stressful events. This also addresses the Q: Liver biopsy is prescribed to a patient suspected to have
cancer of the liver. The nurse properly places the patient in
emotional, mental and social well-being of the client family and
which position after the procedure?
significant other, and the knowledge, skills and ability required A. Left Side
care for the client with an acute or chronic mental illness. B. Prone
C. Slight Trendelenburg
Q: An older adult is experiencing grief due to the recent loss of
D. Right Side
her spouse appears restless and unable to organize specific
task. She states, "I feel so helpless and alone." Further Rationale: After a liver biopsy, the patient should be positioned on the right
questioning reveals that she avoids talking to her friends side to apply pressure to the biopsy site and reduce the risk of bleeding
and stop going to her local church meetings. The nurse or hemorrhage, as the liver is highly vascular.
interprets these findings as indication of;
A. Prolonged grieving D. Physiological Adaptation - Addressees content that test
B. Disorganized stage of grief
the nurse's knowledge, skills and ability required to provide
C. Pathologic grief
D. Disequilibrium stage of Grief care to client's with acute, chronic or life-threatening
conditions.
Rationale: The disorganized stage of grief involves helplessness, loneliness,
restlessness, difficulty focusing, and social withdrawal. Prolonged grief
Q: The nurse reviews the ABG (Arterial Blood Gas) result of a
lasts beyond the expected timeframe, pathologic grief causes severe
patient with Diabetic Ketoacidosis. Which of the following
dysfunction, disequilibrium stage includes yearning & protest after loss.
findings validates the condition?
A. pH 7.25; HCO3 18 mEg/L B.
IV. Physiologic Integrity B. PH 7.45; HCO3 29 mEa/L
0 C. pH 7.35; PCO2 40 mmHg
A. Basic Care and Comfort - Addressees content that test the D. pH 7.30; PCO2 54 mmHg
nurse's knowledge, skills and ability required to provide
comfort and assistance to the client in the performance of Rationale: The patient with DKA experiences metabolic acidosis. This is
manifested by Low pH (normal is 7.35-7.45) and low HCO3 (normal is
activities of daily living. 22-26 mEg/L). ABG result of 7.25, HCO3 18 mEg/L indicate metabolic
acidosis. The patient is experiencing and acid-base imbalance, an
Q: The nurse is providing health teachings to a client on the use alteration in body system.
of crutches and observes as the client uses them. Which
observation by the nurse indicates that the client needs
further teaching? E. Integrated Processes - Addresses the Integral Process of
A. The Client places the crutches 2 inches forward and 6 Teaching and Learning.
inches to the side
B. The client bears his weight on the palms of the hands and Q: The patient has been diagnosed to have cancer of the colon.
elbows. She is for colostomy. The patient says, "The doctor told me
C. The client flexes the elbows at 30-degree angle when that there are complications of colostomy." The best initial
holding the crutches action by the nurse is?
D. The client moves the crutches and the stronger leg A. Discuss complication of colostomy.
together, followed by the weaker leg. B. Provide preoperative teachings.
C. Ask the patient, what are the complication of
Rationale: When using crutches, the correct sequence is to move the crutches colostomy
first, followed by the weaker leg, then the stronger leg for support.
D. Instruct the patient to sign the consent form.
Moving the crutches and the stronger leg together is incorrect and
indicates the need for further teaching.
Rationale: The best initial action is to assess the patient's current knowledge
and concerns before providing education. This ensures that the nurse
B. Pharmacological and Parenteral therapies - Addressees addresses misconceptions and tailors teaching to patient's needs.

content that test the nurse's knowledge, skills and ability

required to administer medication and parenteral therapies.

Q: The Nurse is caring for patient with renal failure who is

receiving BUMEX (Bumetanide). Which of the following
health teachings should be given to patient by the nurse?
A. "Let me know if you experience leg cramps
B. “Include fresh fruits in your diet.”
C. "this Medication is best taken at bedtime."
D. “If you experience frequent urination, your need to
increased fluid intake to 10 glasses per day."

Rationale: Bumetanide (Bumex) is a loop diuretic that can cause potassium

loss, leading to hypokalemia, which may present as muscle cramps or
weakness. The nurse should instruct patient to report these symptoms.

2|P a g e Ma. Regina P. Maprangala BSN 4-D

 B. TEST TAKING STRATEGIES Practice Test No. 3: False Responses
Q: Cortisol is prescribed for a client with adrenal
Test Taking Strategies insufficiency, and the nurse provides instruction to the
1. Do not delegate. client regarding the medication. Which of the following
ATE, statements if made by the client would indicate a need
o A - assessment
wag mong for further instruction?
o T - teachings i-delegate! A. "I will eat a good breakfast everyday"
o E - evaluation B. "I will avoid people with colds"
C. "I will limit my salt intake"
D. "I will stop the medication when I feel better"
2. Read every word in the question.
o Avoid asking “what if…?” Rationale: Cortisol (a corticosteroid must never be stopped
abruptly, as it can cause adrenal crisis. The dose should be
gradually tapered under medical supervision.
3. Look for the keywords.
Test-Taking Strategy: Eliminate True Statements
o early, late
o A (Eating breakfast) → Correct, as cortisol should be taken
o first, initial, immediate, best with food.
o most or least likely, most appropriate o B (Avoiding people with colds) → Correct, as steroids suppress
immunity.
Practice Test No. 1: o C (Limiting salt intake) → Correct, as steroids can cause fluid
Q: A Nurse is caring for a patient who just returned from retention and hypertension.
recovery room after undergoing abdominal surgery.
The Nurse monitors the client for which early sign of 5. Questions that require Prioritizing
HYPOVOLEMIC SHOCK?
• Look for the keywords
A. Increased Pulse Rate
B. Increased depth of Respiration o Best ○ Initial
C. Lethargy o Primary ○ Next vital, essential
D. Decreased Deep tendon o Immediate highest. priority

Rationale: An increased pulse rate (tachycardia) is an early sign of • Use ABC’s techniques
hypovolemic shock as the body compensates for low blood
A - Airway
volume by increasing HR to maintain cardiac output.
B - Breathing
Test-Taking Strategy: C - Circulation
✓ The keyword "early sign" helps eliminate options related to
late manifestations. • Use Maslow’s
✓ Recognize compensatory mechanisms (tachycardia is the
1. Physiological needs first 4. Self esteem
body's first response to low blood volume).
2. Safety and security 5. Self-actualization
3. Glove and belongingness
4. Use elimination.
o True and False Response questions Practice Test No. 4: Prioritizing
Q: The patient with a diagnosis of cancer is receiving
Practice Test No. 2: True Responses morphine sulfate 10mg subcutaneously every 3 to 4
Q: A Patient suspected of having meningitis is being hours for pain. When preparing the plan of care for
schedule for a diagnostic tests. The nurse anticipates client, the nurse includes which priority action?
that which of the following diagnostic test most likely A. Monitor Stools
be prescribed to confirm the diagnosis? B. Monitor Urine Output
A. Serum Electrolytes C. Encourage patient to cough and deep breathing
B. Electromyography D. Encourage fluid intake
C. WBC Count
Rationale: Morphine can cause respiratory depression, so the
D. Lumbar Puncture
priority is encouraging deep breathing to prevent
Rationale: Lumbar puncture (LP) is the most definitive test for hypoventilation and pneumonia.
diagnosing meningitis, as it allows analysis of cerebrospinal o A (Monitor Stools): Important (opioid-induced constipation)
but not urgent.
fluid (CSF for infection.
o B (Monitor Urine Output): Opioids can cause retention, but
Test-Taking Strategy: Use elimination breathing comes first.
o A (Serum Electrolytes) → Not used to dx meningitis. o D (Encourage Fluids): Helps with constipation but not as
o B (Electromyography) → Evaluates muscle function, unrelated critical as airway management.
to meningitis.
Test-Taking Strategy:
o C (WBC Count) → Can indicate infection but doesn’t confirm
meningitis. o Keyword: "Priority Action" → Use ABCs (Airway, Breathing,
o D (Lumbar Puncture) → Correct, because CSF analysis is the Circulation).
gold standard for diagnosing meningitis. o Respiratory depression is the most serious risk.

3|P a g e Ma. Regina P. Maprangala BSN 4-D

 Practice Test No. 5: Prioritizing Practice Test No. 8: IMPLEMENTATION
Q: The nurse is reviewing the plan of care for pregnant A nurse is caring for a client with angina pectoris who
client with diagnosis of sickle cell anemia. Which begins to experience chest pain. The nurse administers
nursing diagnosis, if stated on the plan of care, would a sublingual nitroglycerin tablet sublingually as
the nurse select the highest priority. prescribed, but the pain is unrelieved. The nurse should
A. Anxiety take which of the following actions first?
B. Ineffective coping A. Contact the physician
C. Disturbed body image B. Call the client's family
D. Deficient fluid volume C. Administer another nitroglycerin tablet
D. Reposition the client.
Rationale: A pregnant client with sickle cell anemia may struggle
with body image due to pregnancy changes, symptoms, and Rationale: For angina pectoris, nitroglycerin should be given
frequent medical care which can impact self-confidence. every 5 minutes (up to 3 doses) before calling the physician
if pain persists.
6. Use the nursing process. o Option A (Contact the physician): Done if pain persists after
3 doses of nitroglycerin.
o Assessment first!
o Option B (Call the client's family): Not a priority in an acute
situation.
Practice Test No. 6: Assessment
o Option D (Reposition the client) : Not the primary action;
Q: The nurse is teaching a client with CAD about dietary
relieving chest pain is the priority.
measures to follow. During the session, the client
expresses frustration in learning the dietary regimen. Test-Taking Strategy:
The nurse would initially: o Keyword: "First Action" → Prioritize immediate
A. Identify the cause of frustration intervention.
B. Continue with the dietary regimen o Use the Nursing Process → Implementation (act to relieve
C. Notify the physician chest pain).
D. Tell the client that diet needs to be followed o Follow Protocol for Angina → Give another nitroglycerin
dose if pain persists after 5 minutes.
Rationale: The nursing process begins with assessment. Before
taking any action, nurse should identify the cause of client's
frustration to address concerns & provide appropriate support.
7. Eliminating similar options
o Option B: Ignoring the client's frustration may increase
resistance to learning. o When answering the question, use the process of
o Option C: Not necessary at this point; the nurse should first elimination and look for similar options. Often, similar
assess the situation. options are incorrect. Usually, one of the opposite options
o Option D: This dismisses the client's feelings and does not help
resolve frustration.
is the correct answer.

Test-Taking Strategy: Practice Test No. 9: Eliminate Similar Option

o Keyword: "initially" → Always assess first before intervening. Q: A nurse is assigned to care for a group of clients. On
o Follow the nursing process (ADPIE) → Assessment comes first! review of clients medical records, the nurse determines
that which client is at risk for excess fluid intake?
A. The client with ileostomy.
Practice Test No. 7: Assessment The client taking diuretics.
Q: A nurse is reviewing the laboratory results of an infant B. The client who requires gastrointestinal suctioning.
suspected of having hypertrophic pyloric stenosis. C. The client with renal failure.
Which of the following laboratory findings would the
nurse most likely to expect to note in this infant? Rationale: A client with renal failure is at the highest risk for
A. A blood pH of 7.50 fluid overload because the kidneys cannot properly excrete
B. A blood pH of 7.30 excess fluids. Clients with ileostomy, diuretics, or GI
C. A bicarbonate of 22 mEg/L suctioning lose fluids, making excess intake unlikely. Renal
D. A blood bicarbonate of 19 mEg/L failure impairs fluid excretion, leading to fluid overload,
making it the correct answer.
Rationale: Hypertrophic pyloric stenosis causes persistent
vomiting, leading to acid loss and metabolic alkalosis (↑ pH, Test-Taking Strategy:
↑ HCO3, ↓ chloride). o Identify Opposites → Three options involve fluid loss (A, B,
o A (pH 7.50) → Correct (alkalosis from acid loss). C), so eliminate them.
o B (pH 7.30) → Acidosis (incorrect). o Focus on Fluid Retention → Renal failure (D) prevents fluid
o C (HCO3 22) → Normal (not expected). elimination, making excess intake a risk.
o D (HCO3 19) → Low (suggests acidosis, incorrect).

Test-Taking Strategy:
o Keyword: "Most Likely" → Match findings to the condition.
o Vomiting → Acid loss → Metabolic alkalosis (↑ pH, ↑ HCO3).
o Eliminate acidosis-related options.

4|P a g e Ma. Regina P. Maprangala BSN 4-D

8. Eliminate options that contain absolute words
o all ○ always
o never ○ every
o must ○ should
o none ○ only

Practice Test No. 10: Absolute Words

Q. A nurse is providing safety instructions to the mother of
a child with hemophilia and tells the mother to do
which of the following to promote a safe environment
for a child?
A. Remove the toys with sharp edges from child's toy
box.
B. Allow the child to play with toys only if the parents are
present.
C. Place a helmet and elbows pads on the child everyday.
D. Allow the child to play indoors only.

Rationale: Options B, C, and D contain absolute words (only,

every), making them too restrictive. A (Remove sharp-
edged toys) is the best choice, as it promotes safety without
unnecessary limitations.

Test-Taking Strategy:
o Identify Absolute Words → "Only, everyday" (B, C, D) are
too extreme.
o Choose a Balanced Option → A is correct because it
improves safety without overly restricting the child.

General Rule
✓ Use Elimination
✓ Absolutes are mostly wrong.
✓ Qualifiers are often correct.
✓ Use nursing process.
✓ Psychia: Focus on the feelings focused on the patient
safety first.
✓ Safe and triage airway first.
✓ Identify umbrella effect answers.
✓ Don’t delegate A.T.E.
✓ Guess only if needed.
✓ Use pneumonic.
✓ Read and Read and Read!!!

Result be released 10-15 days after pr lockdown/BON

quarantine.

After the examination:

✓ Surrender yourself to God.
✓ Congratulate yourself. You have done your best.

5|P a g e Ma. Regina P. Maprangala BSN 4-D