NURSING PRACTICE 4 - CARE OF CLIENTS WITH PHYSIOLOGICAL AND

PSYCHOSOCIAL ALTERATIONS (PART B)

GENERAL INSTRUCTIONS:
1. This test booklet contains 100 test questions.
2. Detach one answer sheet from the bottom of your examinee ID/Answer Sheet set.
3. Write the subject title “Nursing Practice 4” on the box provided.
4. Shade set box “A” on your answer sheet if your test booklet is SET A: Set box “B” if your test booklet is SET B.
5. This is RN INTERNATIONAL REVIEW CENTER property only.
INSTRUCTION: Select the correct answer for each item 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 ERASURE ALLOWED. Use pencil No. 2 only.

Situation 1: Loreli came to the medical center for parathyroidectomy for hyperparathyroidism. Her chief complaints are fatigue,
and muscle weakness accompanied by pain.
1. While doing admission history and assessment, the client asks the nurse if parathyroid and thyroid glands are the same.
The correct response of the nurse is:
A. The thyroid glands regulate metabolism while the parathyroid glands regulate calcium and phosphates.
B. The thyroid glands secrete iodine while the parathyroid glands secrete calcium and magnesium.
C. Both are located in the dorsal area of the neck responsible for regulating breathing and voice respectively.
D. Both glands are secreting hormones that regulate body processes.
Answer. A. Reference: 1253, Brunner

2. During the history taking, Loreli states that she is taking Furosemide (Lasix). You understand that the indication of the
medication is to:
A. Lower sodium level C. Increase renal clearance of calcium
B. Interfere with calcium resorption D. Lower calcium level
Answer. D. Loop diuretics such as your Lasix, decrease sodium, potassium. The loss of Magnesium and Calcium is
equivalent to that of your sodium. This drug is also used in emergency cases of hypercalcemia. (431, Bennett Clinical
Pharmacology, 10th Ed.)

3. Loreli was put on low calcium diet to decrease the total intake of calcium and prevent renal calculi. You will instruct the
client to avoid which of the following foods?
A. Oats, potatoes, soybean C. Rice, malunggay leaves and carrots
B. Oranges, yogurts, spinach D. Whole grain, leafy vegetables, milk
Answer. D. Though all choices contain foods rich in calcium, letter D, which contains milk and leafy vegetables are
rich sources of calcium thus is chosen as the answer.

4. The doctor orders: “Monitor for signs of renal stones.” What is the most appropriate nursing intervention to accomplish such
doctor’s order?
A. Visually examine urine every after urination C. Use glass container when measuring urine output
B. Observe color of urine every after urination D. Strain all urinary output
5. First day post-parathyroidectomy, the nurse assessed tingling around the mouth, hands and feet. Which of the following
will the nurse do first?
A. Check for most recent serum calcium level C. Perform tests for Chvostek’s and Trousseau’s
B. Check for signs of hypotension and bradycardia sign
D. Auscultate to check for laryngospasm
Answer: C. Nursing assessment first as compared to laboratory assessment.

Situation 2: Nurse Natsu provides instructions in the surgical pediatric ward. She has cleft lip and palate cases waiting for their
surgery schedules.
6. Nurse Natsu provides instructions to mothers of an infant with cleft lip and palate regarding the safe way to feed. Which
statement made by the mother would need reinstruction?
A. “I will gently rub the nipple on the lower lip of my child.”
B. “I will use a small-hole nipple to avoid choking.”
C. “I will allow time for my child to swallow.”
D. Much time is needed for breast feeding to avoid accident of aspiration.

Answer. B. The nipple must be enlarged using the cross-cut procedure to be able to prevent risk for aspiration.
(Lippincott, 1591, 9th Ed.)
7. Nurse Natsu taught the mothers to use the ESSR method of feeding the child with cleft lip. Select the steps below to
illustrate the correct ESSR method.
1. Engorge the nipple 5. Swallow
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2. Enlarge the nipple 6. Reposition the child to the other breast
3. Simulate the sucking reflex 7. Rest to finish swallowing
4. STIMULATE THE SUCKING REFLEX

A. 1,3,5,7 C. 2,3,5,7
B. 2,4,5,6 – TO BE CORRECTED TO 2,4,5,7 D. 1,4,5,6

Answer. B. The ESSR method stands for:

E – enlarge the nipple

S – stimulate the sucking reflex by rubbing nipple on lower lip
S – swallow
R – rest

(http://books.google.com.ph/books?id=2csGAAAAQBAJ&pg=PA147&dq=ESSR+method&hl=en&sa=X&ei=-
MZ1U93jAoWIuATR0ICoDQ&ved=0CDcQ6AEwAg#v=onepage&q=ESSR%20method&f=false PAGE 146)

8. After cheiloplasty, which of the following is Nurse Natsu’s primary nursing intervention during the post-operative care to
prevent crusting?
A. Administer sedation to prevent picking at the incision wound
B. Keep the infant on NPO
C. Restrain all extremities to prevent rubbing of face and lips
D. Clean suture lines

Answer. D. Only the hands are restrained with an elbow immobilizer. Keeping the infant NPO may cause him to cry
putting pressure on the suture site. Administering sedation is not advised since the child is more susceptible to drug
side effects. (1593, Lippincott)

9. Which would Nurse Natsu consider her priority nursing intervention immediately following cheiloplasty?
A. Position the child in prone position
B. Assess presence of edema of the tongue, lips and mucus membranes
C. Encourage parents to talk and touch the child
D. Restrain the child’s arms with blanket.
Answer. C. Placing the child in prone position increases pressure on the suture line. Restraints are only applied to the
elbows of the client with manufactured device and not with a blanket. Letter C is a psychosocial intervention and is
not a priority as compared to the other interventions. Assessing presence of edema on tongue, lips and mucus
membranes can interfere with the airway of the client thus is a priority. (749, Pilliteri)
10. The most effective restraint that Nurse Natsu would use in this case is:
A. Elbow restraint. C. Blanket restraint for the entire body.
B. Mittens for both hands. D. Blanket restraint for all extremities.
Answer. A. Blanket restraints are applied only for the elbows and not to all extremities or the entire body. As compared
to mittens and elbow restraints, the least restrictive but effective are elbow restraints. (749, Pilliteri)

Situation 3: Specific surgical interventions for lung cancer may be done when it is detected early. You have important
perioperative responsibilities in caring for patients with lung cancer.
11. Herman is scheduled to undergo lobectomy. The purpose of closed chest drainage following a lobectomy is:
A. Prevention of mediastinal shift C. Promotion of wound healing
B. Expansion of the remaining lung D. Facilitation of coughing
12. Following lobectomy, you can best help Herman to reduce pain during deep breathing and coughing exercises by:
A. Administering the prescribed analgesic immediately prior to exercises
B. Placing him on his operative side during exercises
C. Splinting his chest with both hands during the exercises
D. Providing rest for six hours before exercises.

13. Peter underwent pneumonectomy. During the immediate postoperative period, deep tracheal suctioning should be done
with extreme caution because:
A. The bronchial suture line may be traumatized C. The tracheobronchial trees are dry.
B. The remaining normal lung needs minimal stimulation. D. Peter will not be able to tolerate coughing.

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14. On which of the following positions should you place Peter who just underwent pneumonectomy?
A. On his abdomen or on the side opposite the surgery C. Any position is acceptable
B. On his back or on the side of surgery D. Prone position
15. Which of the following observations indicates that the closed chest drainage system is functioning properly?
A. Less than 25mL drainage in the drainage bottle
B. The fluctuating movement of fluid in the long tube of the water seal bottle during inspiration
C. Absence of bubbling in the suction control bottle.
D. Intermittent bubbling through the long tube of the suction control bottle.
Situation 4: The nurses in the intensive care unit are preparing for the end of shift endorsement.
16. Evelyn’s patient is being watched closely for pulmonary embolism and is currently on anticoagulant therapy. Which of the
following endorsement of Evelyn is intended to identify side effects of this therapy?
A. Watch on the cardiac monitor for onset of premature ventricular contractions
B. Turn the patient every 2 hours and with correct body alignment
C. Monitor vital signs every 30 minutes and report sudden increase or decrease STAT
D. Maintain oxygen inhalation at 2 liters per minute and auscultate for abnormal breath sounds
Answer. C. Anticoagulant therapy is associated with bleeding thus the only way that a nurse can identify signs of
bleeding is either through overt bleeding or through changes in vital signs.

17. Herminia closely monitors her patient with traumatic brain injury for increased intracranial pressure. She documented
“positive for Cushing’s response”. Which of the following is the correct interpretation of this documentation?
A. Decreased pulse pressure, bradycardia and increased mean arterial pressure
B. Increased mean arterial pressure, widening pulse pressure and decreased cardiac rate
C. Increased blood pressure, increased pulse pressure and tachycardia
D. Bradycardia, hypotension and narrowing of the pulse pressure.
Answer: B. Cushing’s phenomenon is seen when cerebral blood flow decreases significantly. When ischemic, the
vasomotor center triggers an increase in arterial pressure in an effort to overcome the increased ICP. A sympathetically
mediated response causes an increase in the systolic blood pressure, with a widening of pulse pressure and cardiac
slowing. (1865, Brunner)

18. When Jose endorsed the pulse oximetry reading of his patient to the incoming nurse, which of the following statement of
Jose about SpO2 is correct? Pulse oximetry reading:
A. Provides a complete picture of the patient’s respiratory status
B. Represents how well oxygen is moving across the alveolar-capillary membrane and into the blood
C. Measures oxygen saturation and pulse rate
D. Is an assessment of oxygenation and ventilation

Answer. C. Pulse oximeter reading can appear normal even though the overall oxygen level is low when the hemoglobin
is oversaturated. It only measures oxygenation and not ventilation. (558, Kozier 8th Ed.)

19. Jose further endorsed that to ensure accuracy of the pulse oximetry reading, which of the following is the most appropriate
nursing intervention in case patient shivers or becomes agitated?
A. Keep the patient extremely immobilized.
B. Tape the clip-on sensor on the finger or toe
C. Remove the pulse oximeter temporarily
D. Place the sensor on a different part of the body such as the ear

Answer. D. Earlobe probes are useful when uncontrollable or rhythmic movements are present. (101, Clinical Nursing
Skills and Techniques)

20. The nurse manager observed the performance of her staff nurses. Which of the following behaviors of her staff nurses
indicate personal and professional development?
A. The incoming nurse assured Jose that she will read more about pulse oximetry in context
B. Jose patiently explained the nursing care plan he prepared to the incoming nurse
C. Hermina cautiously disposed the needles and syringes she used for patients
D. Evelyn discussed with the attending physician treatment modalities planned for her patient.

Answer. B. professional behaviors include mentoring other professionals, advocates for patients, demonstrates
understanding of cultures, beliefs and perspectives of others. (81, Kozier 8th Ed)

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Situation 5: In the intensive care unit, effective utilization of management principles is very important because of the critical
needs of the patients.

21. The afternoon shift nurse receives endorsement from the morning shift nurse. Which of the following complaints will an
incoming nurse attend to first?
A. Infiltrated intravenous infusion
B. Nasal prong for oxygenation pulled out by patient
C. Pain unrelieved by pain medication given an hour ago.
D. Urine drainage bag not emptied.

22. The ICU unit manager observed increased incidences of absences among staff nurses during the last two weeks schedule.
Which of the following is the most appropriate action of the unit manager to solve the identified problem?
A. Assign those who have been absent on morning shift
B. Talk to the staff nurses concerned individually
C. Implement disciplinary action per hospital policy
D. Identify causes of absences

23. A newly hired staff nurse approached the charge nurse and asked to be taught regarding the pulmonary wedge pressure
reading. She has not done the procedure before. Which of the following is the most appropriate action of the charge nurse?
A. Do the procedure while the staff nurse observes
B. Start the procedure and let the staff nurse finish it.
C. Assist the staff nurse while she performs the procedure
D. Let the staff nurse do the procedure and observe

24. The relative of the patient complained to the charge nurse. She requested that the staff nurse be changed. Which of the
following should the charge nurse do first?
A. Relieve the staff nurse
B. Talk to the patient
C. Have another nurse work with the staff nurse concerned
D. Talk to the staff nurse concerned

25. The staff nurses were called to a meeting by the unit manager because she observed during the past two weeks that nurses’
documentation were incomplete. To ensure improvement process of documentation, which of the following is the most
appropriate purpose of the meeting?
A. Enumerate all types of errors in documentation
B. Identify the nurses who need training for documentation
C. Develop new system to identify non-conformance to documentation
D. Brainstorm on probable causes of non-conformance

Situation 6: Lissa, 33 years old sustained burn injuries on her chest, abdomen and upper extremities when fire broke in the
office where she works.

26. In the emergency department, you are the nurse who admitted Lissa. Which of the following will you do first?
A. Remove clothes C. Assess for inhalation of heated air
B. Start intravenous infusion D. Evaluate total body surface area burned
27. The physician diagnosed deep partial thickness burns. As the nurse of Lissa, which of the following characteristics of burned
skin will you consider as consistent with the physician’s diagnosis?
A. Red to gray with local edema C. Dry, leathery, charred
B. Mottled, non-blanching red D. Fluid-filled blisters, bright pink and waxy

28. Which of the following symptoms is observed during Lissa’s first 24 hours in the hospital would positively indicate paralytic
ileus secondary to burn trauma?
A. Hematemesis C. Negative bowel sounds
B. Nausea and vomiting D. Abdominal discomfort

29. Continuous monitoring of Lissa’s arterial blood gases was done. Results showed pH: 7.40; PaCO2:40mmHg, PaO2:
88mmHg, HCO3: 26mEq/L. Which of the following will you, as the nurse, document in the chart?
A. Respiratory acidosis C. Metabolic alkalosis
B. Hypoxemia D. Within normal limits

30. You prepared a nursing care plan to Lissa. The appropriate nursing diagnosis is: “Abnormal fluid loss secondary to burn
injury.” Which of the following is not a relevant intervention?
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A. Follow IV fluids resuscitation protocol C. Maintain a warm environment
B. Monitor hourly intake and output D. Apply antimicrobial cream to burn wounds

Situation 7: Felicidad, 65 years old, post-coronary artery bypass, sought consultation because of severe shortness of breath,
hemoptysis and anorexia. Patient was admitted to the coronary care unit because of acute heart failure. Chest x-ray shows
cardiomegaly and pulmonary infiltrates.

31. Assessment reveals crackles and diminished breath sounds on both lungs, jugular veins engorged, 3+ pitting edema of
both feet and ankles and abdominal distension. Which of the following is a priority nursing diagnosis for Felicidad related to
impaired cardiac pump?
A. Ineffective breathing pattern C. Ineffective airway clearance
B. Risk for ineffective tissue perfusion D. Excess fluid volume

32. The vital signs of the patient are BP of 90/50mmHg, cardiac monitor reveals atrial fibrillation and a cardiac rate of 120 beats
per minute. Which of the following electrocardiogram characteristics will the nurse specifically note?
A. Two P waves for every QRS
B. Wide and bizarre QRS
C. Irregular and bizarre complexes with no discernible rhythm
D. Absence of identifiable P waves

33. The nurse understands that a fall in cardiac output activates which of the following mechanisms which caused increased
salt and water retention?
A. Renin-angiotensin system C. Cardiac enzymes interaction
B. Parasympathetic mechanisms D. Myocardial contractility

34. To reduce venous return to prevent further congestion, which of the following positions will the nurse recommend for
Felicidad?
A. Fowler’s position with arm rest and legs flexed with pillow under the knee
B. Upright sitting position with the legs dangling
C. High Fowler’s position with the legs hyperextended
D. High Fowler’s position with the legs elevated on two pillows

35. Severe dyspnea and productive cough with pink frothy sputum kept patient awake during the night shift. Morphine sulphate
was administered intravenously. Which of the following is not a purpose of the drug for the patient?
A. Reduce venous return C. Reduce anxiety
B. Relieve pain D. Improve efficacy of breathing

Situation 8: As a nurse, your action during the first crucial hours after a burn injury can increase the client’s chances of survival
and this, ensure fast recovery.

36. While the operating room technician was operating under pressure sterilizer, his face was exposed to the steam. Which of
the following is a priority action?
A. Wash face with sterile ice cold water C. Wash face with soap and water
B. Wash face with cool water D. Dry face with sterile towel

37. If clothing is on fire and victim is running, which of the following is the best intervention to do?
A. Stop the victim and remove clothing
B. Roll the victim on the ground and wrap with blanket
C. Wrap with blanket and roll on the ground with victim
D. Stop the victim and tell him to roll on the ground

38. A disabled person on a wheelchair asks the nurse what will she do in case her clothes catch fire. Which of the following is
the correct response of the nurse?
A. “Shout for help.” C. “Drop to the ground and roll.”
B. “Stand and drop to the ground.” D. “Cover yourself with blanket.”

39. In case of electrical burns, the priority action is to:

A. Remove the victim with a dry-nonconductive C. Switch off the electrical source
object D. Wrap the victim with wet blanket.
B. Remove the victim from the electrical source
40. In the pre-hospital period, pain in extensive burn is handled with gentle care and minimal handling. The nurse understands
that the degree of pain is:
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A. Directly proportional to the depth of the burn injury
B. Equal to the depth of burn injury.
C. Inversely proportional to the depth of the burn injury.
D. Increased as the depth of the burn injury increases.
Situation 9: Porsche, the training officer of a tertiary hospital is conducting an orientation of the newly hired nurses who will be
assigned in the special units of the hospital. Legal situations were discussed with the corresponding legal implications.
41. When the nurse reported to the physician that the patient fell out of bed and sustained lacerations in the forehead, the
physician ordered the nurse to state in the nurses’ notes that an incident report has been submitted to proper authorities.
Which of the following is the most appropriate action of the nurse?
A. Refer the physician’s order to the head nurse C. Question the physician’s order
B. For accuracy, attach a copy of the incident report D. Do as ordered.
42. The physician prescribed, Clexane 40mg, subcutaneously, anterior abdominal wall. When the nurse was about to
administer the drug, the patient told the nurse that the previous dose was administered intramuscularly on the deltoid area.
Which of the following is the most appropriate response of the nurse?
A. “Did the nurse tell you why she administered the drug on the deltoid area?”
B. “Is that so? Let me refer to the physician and I will be back.”
C. “The drug has to be administered on the anterior abdominal wall.”
D. “I will re-check the order of the physician.”
43. A patient with possible pulmonary embolism was placed on heparin therapy. Immediately after the blood sample was
obtained by the medical technologist, patient experienced pain on the site. The nurse did not inform the physician until after
4 hours. Patient developed hematoma and nerve damage. The court held the nurse liable along with the medical
technologist for:
A. Failing to recognize and respond to signs of hemorrhage
B. Not informing the medical technologist that the patient is on heparin therapy.
C. Not having implemented precautions on a heparinized patient
D. Reporting the problem to the physician four hours after

44. A patient in diabetic coma with severe pneumonia regained consciousness. She found out that she had burns on her back
from unknown cause. The court decided in favour of the patient under which of the following principles?
A. Res ipsa loquitor C. Expert testimony
B. Paternalism D. Contributory negligence

45. A 65 year old laryngectomy patient had an ongoing intravenous infusion became restless at the start of the night shift. No
relative could stay with the patient. The charge nurse told the nurse assigned to apply restraints. Aware of the possible
liabilities in the application of restraints, which of the following will the nurse do first?
A. Have another nurse watch the patient
B. Question the order of the charge nurse
C. Obtain prescription from the attending physician
D. Call the relative and have a consent for restraints signed.

Situation 10: Arian, 45 years old with a diagnosis of acute myocardial infarction, was prescribed oral Warfarin to be taken once
a day in the evening. The nurse prepared a teaching plan for Arian, specific for the safe administration of the drug at home.

46. To be able to effectively design the teaching plan, the nurse should be guided by which of the following knowledge of the
drug’s action? Warfarin…
A. Dissolves an existing clot
B. Inhibits conversion of fibrinogen to fibrin
C. Prevents hepatic synthesis of Vitamin K dependent clotting factors
D. Prevents conversion of prothrombin to thrombin.

Answer. C. Action of Warfarin is the inhibition of Vitamin K dependent activation of clotting factors II, VII, IX and X
formed in the liver. (899, Nursing 2006 Drug Handbook)

47. To ensure that effective anticoagulation is achieved, which of the following instructions of the nurse is appropriate?
A. Increase fluid intake
B. Report blood in the stools
C. Take warfarin at the same time each day
D. Comply with the prescribed blood testing schedule

48. The physician included in the take home medications that Vitamin K to be taken only as necessary. In the teaching plan,
which of the following is the most appropriate instruction regarding this prescription?
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A. Take as soon as a bruise is observed in the abdomen
B. When weakness is felt and skin is observed to be pale, report to physician and then take the medicine
C. When stools are observed to be black, take the medicine as prescribed
D. To be taken when stomach discomfort is felt

49. The nurse emphasized in the teaching plan that a laboratory test is the basis for the continuation of Warfarin therapy. This
is:
A. Platelet count C. Clotting time
B. Bleeding time D. Prothrombin time

50. During a warfarin therapy, which of the following should the nurse include in the teaching plans on foods to be avoided?
A. Dark meat C. Dark green, leafy vegetables
B. Citrus fruits D. Milk products

Situation 11: Nurse Siri is caring for a client, Katrina, who presents to the emergency department with complains increased
appetite, increased urination and increased thirstiness.

51. Katrina is prescribed with insulin therapy. Nurse Siri plans to teach the client regarding insulin therapy. Which of the following
must she include in her teaching plan regarding the action of insulin in the body?
A. Aids in the process of glycogenesis
B. Stimulates the pancreatic beta cells
C. Decreases the intestinal absorption of glucose
D. Enhances the transport of glucose across cell walls.

52. What will Nurse Siri teach the diabetic client regarding exercise in Katrina’s treatment program?
A. With an increase in activity, the body will utilize more carbohydrates; therefore more insulin will be required.
B. During exercise in the body will use carbohydrates for energy production, which in turn decrease the need
for insulin
C. Exercise will improve pancreatic circulation and stimulate the islets of Langerhans to increase the production of
intrinsic insulin.
D. The increase in activity results in an increase in the utilization of insulin, therefore, the client should decrease his
or her carbohydrate intake.

53. Katrina is scheduled for routine glycosylated haemoglobin (HbA1c) test. What is important for the nurse to tell the client
before the test?
A. Expect to be at the clinic for several hours because of the multiple blood draws
B. Drink only water after midnight and come to the clinic early in the morning
C. Come to the clinic at the earliest convenient time to have the blood drawn
D. Eat a normal breakfast and be at the clinic two hours later

54. Katrina receives a combination of regular insulin and NPH insulin at 0700 hours. Nurse Siri would teach the client to be
alert for signs of hypoglycemia at:
A. 1100 and 1700 hours C. 1000 and 2200 hours
B. 0800 and 1100 hours D. 1200 and 1300 hours

55. It is important for Nurse Siri to teach the client that Metformin (Glucophage):
A. Should be taken at night C. May increase the effects of aspirin
B. May cause nocturia D. Should be taken with meals

Situation 12: Nurse Diane is caring for the following pediatric clients.

56. The parents of a child with cystic fibrosis ask what determines the prognosis of the disease. Nurse Diane know that the
greatest determinant of this prognosis is:
A. The ability to maintain an ideal weight
B. The secretion of lipase by the pancreas
C. The regulation of sodium and chloride secretion
D. The degree of pulmonary involvement

57. The mother of a child with cystic fibrosis tells Diane that her child makes “snoring” sounds when breathing. Nurse Diane is
aware that many children with cystic fibrosis have:
A. Choanal atresia C. Nasal polyps
B. Enlarged adenoids D. Septal deviations
58. Which information obtained from the mother of a child with cerebral palsy correlates to the diagnosis?
A. She was born at 40 weeks gestation C. She has frequent sore throats
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B. She had meningitis when she was 6 months old D. She had physiological jaundice after delivery.
Answer. B.

Antenatal Causes:
 Vascular occlusion
 Cortical migration disorders
 Structural maldevelopment during gestation
 Genetic syndromes
 Congenital infection
Natal causes:
 Hypoxic ischemic injury
Postnatal causes:
 Preterm infants vulnerable to brain damage from periventricular leukomalacia
 Meningitis, encephalitis, encephalopathy, head trauma
 Symptomatic hypoglycemia, hydrocephalus, hyperbilirubinemia (Lippincott, 1543)

59. Hicca, a client receives a beta-adrenergic bronchodilator and supplemental oxygen when entering the Emergency
Department for treatment of asthma, but her condition remains unchanged. The nurse would anticipate that the client:
A. Will be coached immediately in biofeedback technique C. Will undergo STAT pulmonary function tests
B. Will increase the amount of oral fluids D. Will receive intravenous (IV) steroids
60. A client has been receiving cyanocobalamin (B12) injections for the past 6 weeks. Which laboratory findings indicates that
the medication is having the desired effect?
A. Neutrophil count of 60% C. Monocyte count of 2%
B. Reticulocyte count of 1% D. Basophil count of 0.5%
Answer. B. Reticulocytes are immature red blood cells. So a reversal of pernicious anemia is a decrease or a
reticulocyte count within normal limits (1% to 1.5%)

Situation 13: Lea Carlos, who has a history of severe osteoarthritis, has been admitted to the hospital for a right hip replacement.
61. Miss Carlos asks Nurse Noland, “What is the difference between osteoarthritis and rheumatoid arthritis?” The nurse’s
response is correct when she states:
A. Osteoarthritis is a non-inflammatory joint disease. Rheumatoid arthritis is an inflammatory joint disease.
B. Osteoarthritis affects the weight bearing joints while rheumatoid arthritis affects the small joints.
C. Osteoarthritis affects joints on both sides of the body while rheumatoid arthritis are usually unilateral.
D. Osteoarthritis is more common in women, and rheumatoid arthritis is more common to men.
Answer. A. Lippincott RA 1062, OA 1135

62. Pain from osteoarthritis is described as mechanical pain, which means:

A. The pain respond to the medical device used
B. The pain is relieved by rest and worsened by activity
C. The pain is worse at the beginning of the day and improves with activity.
D. Test and activity have no effect on the pain.
63. The nurse understands that the joints most likely to be involved in a client with osteoarthritis are the:
A. Hips and knees C. Fingers and metacarpals
B. Ankles and metacarpals D. Hips and cervical spine and shoulders
Answer. A. OA affects weight bearing joints (hips and knees) as well as joints of the distal interphalangeal and proximal
interphalangeal joints of the fingers.. 1135 Lippincott

64. Post-operative care should include measures to prevent dislocation of Ms. Carlos new hip prosthesis. Which of the following
interventions would achieve this objective?
A. Keeping the affected leg in a position of adduction
B. Placing the leg in abduction
C. Using pressure relief measures, other than turning to prevent pressure ulcers
D. Keeping the hip flexed by placing pillows under the patient’s knees

Answer. B. positioning the leg in abduction which helps prevent dislocation of the prosthesis. (2038. Brunner)

65. As the nurse develops a post-operative nursing care plan for Ms. Carlos, she knows that Ms. Carlos is at risk for developing
complications associated with immobility. Which of the following is the most common post-operative complication of total
hip replacement surgery?
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A. Pneumonia C. Hemorrhage
B. Thromboembolism D. Wound infection

Situation 14: Joy Malabanan, age 75, is admitted to the hospital due to any injury sustained when she slipped on the bathroom
floor. After viewing spinal X-rays, the doctor diagnoses osteoporosis.

66. Joy Malabanan asks the nurse, “I never knew that I had this condition, I thought it would have overt changes.” The nurse
should respond with the knowledge that a patient may have osteoporosis unknowingly because:
A. Most women die before it becomes a problem
B. Fractures resulting from osteoporosis are rare
C. There is no way to determine the mineral content of the bone
D. There are no clear warning signs and symptoms.

67. Which of the following could have helped prevent osteoporosis in Ms. Malabanan?
A. Post-menopausal hormone replacement therapy
B. Increasing her daily calcium intake to 500mg
C. Low-cholesterol diet
D. Participating in sports such as swimming, cycling and golfing

Answer. A. The calcium must be increased to 1.5g daily, weight-bearing exercises are done. Estrogen show benefit in
preserving the bone density. (189, Lippincott)

68. The risk of osteoporosis is increased when a client:

A. Receives long-term steroid therapy C. Engage in strenuous physical activity
B. Has a history of hypoparathyroidism D. Consumes excessive amount of estrogen

Answer. Risks are: age, inactivity, chronic illness, and medications such as corticosteroids, excessive thyroid
replacement, cyclosporine, calcium and vitamin D deficiency. Family history, smoking and alcohol use, diet (caffeine),
race (whites and asians), small frame or short stature and low body fat. (189, Lippincott)

69. Ms. Malabanan is vulnerable to:

A. Fatigue fractures C. Greenstick fractures
B. Pathologic fractures D. Compound fractures

70. The nurse should encourage the client with osteoporosis to increase the intake of:
A. Red meat C. Turnips
B. Soft drinks D. White meat

Situation 15: A nurse is caring for Lao Ai, a client undergoing chemotherapy with radiation therapy.

71. Lao Ai has a problem of nausea and vomiting, the nurse can independently intervene by doing which of the following?
A. Administer Dolasetron, an antiemetic drug
B. Giving the drug 30 minutes before administering the chemotherapy.
C. Removing the emesis basin from the room.
D. Refer the client to a nutritionist to help the client prepare a low fat meal.

Answer. C. Independently intervene. A and B require doctors order – dependent nursing function, referring to a
nutritioninst is a collaborative function.

72. The nurse is studying on antiemetic drugs, which of the following is the drug of choice when it comes to nausea and vomiting
associated with chemotherapy and radiation therapy?
A. Serotonin antagonists C. Anticholinergics
B. Neurokinin 1 receptor antagonist D. Phenothiazines

Answer. A.
(http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/nauseaandvomiting/nauseaandvomiting/nause
a-and-vomiting-drugs)

73. Palonosteron, a serotonin antagonist or 5HT3 receptor blocker, was chosen by the physician for management of nausea
and vomiting for the client, this drug is administered:
A. 30 minutes after chemotherapy
B. Once before the start of a 3-day chemotherapy
C. Before chemotherapy and is continued for a few days afterwards
D. At any time convenient for the client
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 NURSING PRACTICE 4 - CARE OF CLIENTS WITH PHYSIOLOGICAL AND
PSYCHOSOCIAL ALTERATIONS (PART B)

74. A client is caring for a client undergoing Cisplatin therapy, an alkylating agent. The nurse knows that this drugs acts by:
A. Causing crosslinking of DNA strands
B. Displacing or substituting metabolites being incorporated into RNA or DNA strands
C. Disrupting DNA replication and RNA transcription
D. Binding to specific protein in tumor cells that promotes chromosomal migration

Answer. A.

Antimetabolites, a group of somewhat diverse drugs, are phase specific, working best in the S phase and having little
effect in G0. They interfere with nucleic acid synthesis by either displacing normal metabolites at the regulatory site of
a key enzyme or by substituting for a metabolite that is incorporated into DNA or RNA molecules.（Letter B）

Antitumor Antibiotics. They are not phase specific and act in several ways: They disrupt DNA replication and RNA
transcription; create free radicals, which generate breaks in DNA and other forms of damage; and interfere with
DNA repair. In addition, these drugs bind to cells and kill them, probably by damaging the cell membrane. Their
main toxic effect is damage to the cardiac muscle. (Letter C)

Mitotic inhibitors are drugs that act to prevent cell division during the M phase. Mitotic inhibitors include the plant
alkaloids and taxoids. Plant alkaloids consist of medications extracted from plant sources: Vinca alkaloids (e.g.,
vincristine and vinblastine) and etoposide (also called VP-16). The Vinca alkaloids are phase specific, acting during
mitosis. They bind to a specific protein in tumor cells that promotes chromosome migration during mitosis and serves
as a conduit for neurotransmitter transport along axons. (Letter D)

Alkylating agents are not phase specific and basically act on preformed nucleic acids by creating defects in tumor
DNA. They cause crosslinking of DNA strands, which can permanently interfere with replication and transcription.
Alkylating agents work with both proliferating and nonproliferating cells (those in G 0 phase).

75. To manage the complication of hemorrhagic cystitis associated with Ciplastin therapy, the nurse should include which of
the following in the client’s education?
A. Increasing fluid intake to 3L daily
B. Taking the medication on an empty stomach
C. Wearing long sleeves when going outside
D. Insertion of a catheter for continuous bladder irrigation

Answer. A. To prevent hemorrhagic cystitis, a client must be well hydrated prior to administration of medication as
well as encouraging increased intake of 2 to 3 liters of water daily. (Lemone 394)

Situation 16: Dorothy is a newly hired staff nurse. The training coordinator emphasized during orientation that nurses must be
guided by ethico-moral principles during the execution of their functions.

76. The Training coordinator differentiated laws and ethics. Which of the following BEST describes the difference between laws
and ethics?
A. Ethics looks at the goodness of an individual while law concerns the “why” of an individual’s actions.
B. Source of law is external while ethics is internal.
C. Ethics focuses on what the person did while law is concerned with motives.
D. Law protects individuals within society while ethics is interested with society as a whole.

77. The Code of Ethics provides that the nurse maintains competency in the execution of her functions. Who among the
following nurses practice this provision?
A. Eloisa borrows journal from the library.
B. Zeny attends regularly the in-service education program of the hospital.
C. Helen readily accepts responsibilities.
D. Ursula’s performance evaluation is improving.

78. During Lenten Season, patient census is low and during this time hospital employees may either take a vacation or float to
another unit. Which of the following decisions of the nurse manager reflect application of the principle of veracity?
A. Inform the staff of all the options and then, allow then to decide.
B. Guide the staff on what options to take.
C. Allow those with good performance to take a vacation.
D. Abide by whatever is the agreement made with the staff.

79. A group discussion regarding an ethical problem was initiated. Julio, a member of the group decided to use the Act
Utilitarianism theory to justify his opinion. Which of the following reflects this theory?
A. Given circumstances, most humanistic action is considered.
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 NURSING PRACTICE 4 - CARE OF CLIENTS WITH PHYSIOLOGICAL AND
PSYCHOSOCIAL ALTERATIONS (PART B)
B. Decision is based on what brings greatest happiness.
C. Determine the good and the bad consequences of the action.
D. An existing obligation prevails.

80. During another group discussion, Dora presented her ethical opinion regarding the behavior of a nurse in the given situation
based on the theory of Deontology. Dora says behavior of the nurse is acceptable because:
A. It benefits the majority. C. It primarily is based on respect of person.
B. It is in accordance with a given rule. D. Its consequences are good.

Answer. B. Deontology came from the Greek word meaning duty. The basic rightness or wrongness of the
act depends on the intrinsic nature rather than upon the situation or its consequences. (97, Professional
Nursing in the Philippines) Letter A describes utilitarianism. Letter C describes Virtue Ethics Approach. Letter
D describes Teleological approach.

Situation 17: To ensure community preparedness during emergency and disaster, your community has organized a Disaster
Brigade Team. You are part of that team.

81. While you are visiting the community pool, a small child who is unconscious and cyanotic is pulled out. What is your
PRIORITY action?
A. Give two rescue breaths C. Assess airway patency
B. Perform jaw thrust D. Quickly move child from the pool area

82. You are called by a mother whose child had a bee sting. He is in pain and with swollen lips. What is your PRIORITY action?
A. Administer the child’s EpiPen.
B. Remove the stinger with tweezers and encourage rest
C. Administer Tylenol (Acetaminophen) and applies ice
D. Apply ice to the site and notify parents

83. You are at the scene of a lightning strike during a thunderstorm and there are casualties. Which is your PRIORITY action?
A. Move victims to the sheltered area
B. Start cardiopulmonary resuscitation (CPR) on anyone who is not breathing
C. Assess for burned areas
D. Make sure that the construction workers are not electrically charged after the lightning strike

84. You are teaching a community health class about water safety. Which statement by your student indicates that additional
teaching is needed?
A. “I cannot leave my toddler alone in the bathtub for even a minute or two.”
B. “I can go swimming all by myself because I am certified lifeguard.”
C. “I will appoint one adult to supervise the pool at all times, even though there will be lots of people there.”
D. “I will make sure that there is a phone near my pool in case of emergency.”
85. You are caring for a client who had a near-drowning incident in a lake. Which assessment will you perform to monitor for
possible complications?
A. Check the client’s blood glucose before meals
B. Assess the client’s bowel sounds three times daily
C. Check the client’s skin for petechiae daily
D. Assess the client’s temperature every 8 hours

Answer. D. The most important priority in resuscitation is to manage the hypoxia, acidosis and hypothermia.
(2171, Brunner)

Situation 18: Nessy, a staff nurse on probation is assigned in the pediatric oncology unit.

86. As Nessy was about to administer an antiemetic drug to one of her patients, the mother stopped her. She tells Nessy that
nausea and vomiting are proof that chemotherapy is working. Which of the following will Nessy do?
A. Listen and proceed with the administration of the drug
B. Explain to the mother the effects of the drug and proceed with the administration
C. Ask mother where the information was obtained
D. Do not administer the drug and refer to the physician immediately.

87. One of the patients of Nessy is for chemotherapy at 8am. Which of the following is MOST appropriate for Nessy to do to
ensure nausea and vomiting are prevented?

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 NURSING PRACTICE 4 - CARE OF CLIENTS WITH PHYSIOLOGICAL AND
PSYCHOSOCIAL ALTERATIONS (PART B)
A. Administer antiemetic an hour before therapy
B. Do not offer food
C. Provide oral care with lukewarm water
D. Maintain an intravenous hydration therapy
88. Nessy is preparing a discharge plan for patient who is being sent home on a chemotherapy protocol. Nessy was informed
by the mother that there are incidences of chickenpox in their neighborhood and patient has not been immunized against
chickenpox. Which of the following interventions would be BEST to ensure that the patient will not be infected with
chickenpox?
A. Recommend antibiotic prior to discharge
B. Instruct mother on the correct technique of isolation at home
C. Recommend that patient be passively immunized before discharge
D. Delay discharge for another week to ensure patient is strong enough to resist infection
89. Mother of Nessy’s patient who is being sent home on chemotherapy was instructed regarding potential problems on
infection specifically chickenpox. Which of the following statements of the mother would require re-instruction?
A. “Once exposed to chickenpox, I will bring my son to the hospital.”
B. “I am very sure the chemotherapy will be enough to protect him.”
C. “I will be very vigilant regarding the incidences of chickenpox.”
D. “My son will die if he becomes infected with chickenpox.”
90. Nessy always includes in her instruction to mothers not to give vitamins when on chemotherapy. Which of the following
chemotherapeutic agents’ effects will be interfered by vitamins with Folic acid?
A. Vincristine C. 6-Mercapturine
B. Prednisone D. Methotrexate
Situation 19: You are assigned to Christian, 40 years old who was brought to the Emergency Department because of bruises
and lacerations sustained from a vehicular accident. After having obtained medical history, you noted that Christian is currently
undergoing treatment for Chronic Hepatitis B.
91. You know that Chronic Hepatitis B can be transmitted by Christian to the Health team through which of the following?
A. Airborne C. Sexual contact
B. Contaminated needle D. Urine contact
Answer. B. Mode of transmission is transmitted primarily through blood (percutaneous and permucosal route.) (720,
Lippincott)

92. During the interview, Christian’s wife informed you that he was treated with Interferon Alpha. You understand that this drug
was prescribed for which of the following purposes?
A. Kill the virus C. Interferes with viral replication
B. Provide short term immunity D. Reduce liver inflammation
93. As a protective measure, which of the following will you do FIRST before you proceed with dressing the wounds of Christian?
A. Wear a gown C. Wash hands
B. Put on a surgical mask D. Wear gloves
94. While you were obtaining intravenous access to start fluids, you accidentally pricked yourself with the needle you were
about to use. Which of the following is the BEST action to do?
A. Dispose the needle, change gloves and restart the procedure
B. Discontinue the procedure and report to the Head nurse
C. Dispose the needle, ask to be excused and secure treatment for the needle prick
D. Ignore the needle prick, replace the needle and proceed with the IV insertion
95. While you were dressing the wound, Christian vomited. Vomitus was coffee ground in color. You suspect internal bleeding.
Which of the following will you do FIRST?
A. Prepare patient for NGT insertion C. Have a kidney basin available
B. Check vital signs D. Place patient in Fowler’s position
Situation 20: You are caring for Arsenio, 50 years old who was admitted because of severe body weakness, ascites, peripheral
edema and jaundice. Laboratory results reveal anemia, low white blood cell and platelet count. Medical history reveals Chronic
Hepatitis B. Admitting diagnosis is Post-hepatic Cirrhosis.
96. You inspected Arsenio’s abdomen, and observed dilated veins around the umbilicus. Which of the following will you consider
as the underlying pathophysiology of your assessment?
A. Decreased clotting factor synthesis C. Collateral vessel development
B. Impaired ammonia metabolism D. Portal hypertension

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 NURSING PRACTICE 4 - CARE OF CLIENTS WITH PHYSIOLOGICAL AND
PSYCHOSOCIAL ALTERATIONS (PART B)
97. To determine shifting dullness, you performed percussion. If Arsenio is positive for ascites, which of the following is
expected?
A. The level of dullness decrease an Arsenio assumes dorsal recumbent position
B. The borders between tympany and dullness remain relatively constant despite position changes
C. With Arsenio on a left side lying position, the level of dullness increase as you percuss from the right lower quadrant
to the left lower quadrant
D. With Arsenio on a supine position, the percussion tone on the left lower quadrant is decreased as compared to
the right upper quadrant

98. The wife of Arsenio tells you that her husband’s hands tremble and he is unable to maintain his upper extremities on a fixed
position. You will validate this through a test for which of the following signs?
A. Chvostek C. Asterexis
B. Trousseau D. Brudzinski

99. A low protein diet was prescribed. You understand that this prescription is intended to prevent which of the following?
A. Blood cell destruction C. Altered bile synthesis
B. Hypoalbuminemia D. Impaired ammonia metabolism

100. After an episode of gastrointestinal bleeding, nursing order in the Kardex states, “Closely monitor for signs of hepatic
encephalopathy”. Which of the following is the MOST appropriate reason of the nursing order?
A. Bleeding caused severe blood loss leading to cerebral hypoxia
B. Loss of blood volume cause orthostatic hypotension with resultant cerebral hypoxemia
C. Digestion of blood in the gastrointestinal tract may result to increased serum creatinine
D. Blood in the gastrointestinal tract is digested as protein, thereby increasing serum ammonia level

* * * * * * END * * * * * *

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