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PRE-FINAL COACHING EXAM

MEDICAL SURGICAL NURSING
Prepared By: Prof. Archie Alviz
July 2021 Philippine Nurse Licensure Examination Review
NAME: ZAMORA, MARIA KARINA D.
1. Because of steroid excess, the patient who - buffalo hump: fat pads at your neck or back
has undergone a bilateral adrenalectomy is at an - poor wound healing
increased risk for *inc SALT: moon face
a. malnutrition. *inc SEX: hirsutism - excessive body hair,
b. emboli. - virilization/virilism: nagmumukhang lalaki - hair sa
c. delayed wound healing. chest, beard, mustache sa babae
d. postoperative confusion. *Dx: inc cortisol level, hyperglycemia,
3 steroids: hypernatremia, hypokalemia, hypertension
a) sugar – G – Glucocorticoid *WOF: Fluid overload
b) salt – M – Mineralocorticoid – Aldosterone * Conn's syndrome: hyperaldosteronism > severe
c) sex – A – Androgen HPN
“main branch ng SSS nasa Kamuning > GMA” - give potassium sparring diuretic - "lactone"
*sodium attracts water MGT: LAHAT NG SOBRA BAWASAN, LAHAT NG
*Inc fluid > inc pressure > aldosterone triggers KULANG DAGDAGAN
fluid retention - low sodium diet
*aldosterone is released when there is DHN in the - high K diet
body – compensatory mech to prev further DHN - glucocorticoid antagonist: prev excessive
*inc SSS > inc blood viscosity > delayed wound release of glucocorticoid: Mitotane for life
healing - surgery: Adrenalectomy - surgical removal
of adrenal gland > WOF: Addison's dse kasi
2. Bone resorption is a possible complication of tinanggal yung adrenal glands
Cushing’s disease. Which of the following
interventions should the nurse recommend to help *ADDISONS
the patient prevent this complication? - hyposecretion of SSS
a. Limit dietary vitamin D intake. - bronze skin
b. Maintain a regular program of - dec aldosterone: hyponatremia
weight bearing exercise. – calcium is - PISO: Potassium in, sodium out (inversely
retained ; paglabas ng calcium sa buto > proportional)
inc serum calcium ; hanggang - hyperkalemia
nadedetermine ng bone na need niya ng *Fluid vol def: DHN, hypotension,
calcium, ireretain niya *Dx: dec cortisol, hypogly, hypoNa, hyperK,
c. Increase the amount of potassium in the hypotension
diet. *WOF: Fluid vol def > addisonian crisis -
d. Perform isometric exercises. exacerbated addison's dse > severe s/sx
*Mgt:
- high sodium diet
- low Potassium diet
- glucorticoid agonist for life
3. Cushing‟s disease is manifested by the 4. A 42-year-old female patient reports that
excessive secretion of corticosteroids. The hormones she has gained weight and that her face and body
involved are are “rounder,” while her legs and arms have become
a. glucocorticoids, aldosterone, and thinner. A tentative diagnosis of Cushing‟s disease
androgens. is made. When examining this patient, the nurse
would expect to find
b. adrenocorticotropic hormone.
a. decreased body hair.
c. glucocorticoids and aldosterone.
b. bruised areas on the skin.
d. catecholamines.
c. muscle hypertrophy in the extremities.
*CUSHING'S DISEASE
d. postural hypotension.
- hypersecretion of SSS
*Cushing’s > fluid retention > edematous > inc
*inc SUGAR: truncal obesity / central body / pear-
capillary fragility > extravasation > easily bruised
shaped ; manipis ang arms at manipis ang legs

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5. Which of the following signs and symptoms b. Imbalanced nutrition: less than body
would probably indicate that the patient with requirements.
Addison‟s disease is receiving much glucocorticoids c. Impaired health maintenance.
replacement? d. Disturbed sleep pattern.
a. Rapid weight gain. *Diabetic ketoacidosis:
b. Poor skin turgor. - ketones are by product of fats > they get thinner
c. Anorexia. (DM type 1)
d. Dizziness. - more than 200 mg/dL > coma
6. Which of the following findings would be typical
of Addison‟s disease? *Hypeglycemia hyperosmolar non-ketotic syndrome
a. Decreased BUN level. - hindi na bbreakdown or metabolized ang fat >
b. Hypokalemia. they are commonly fat - Type 2
c. Hypoglycemia. – dec SSS - more than 400-600 mg/dL > coma
d. Hypernatremia.
7. The nurse would expect the patient with both: hemoconcentration d/t hyperglycemia >
Addison‟s disease to exhibit which of the hyperosmosis > reattraction of water from cell >
following signs and symptoms? cell will shrink > polyuria > FVD
a. Lethargy. – abn sleepy ; hypoglycemic
; brain needs 60-75% of glucose > dec *mgt: rehydration therapy: PNSS
LOC normal BS: 70-110 or 80-120 mg/dL
b. Hunger. 11. The best indicator that allows the nurse to judge
c. Weight gain. that the patient has learned how to give an
d. Muscle spasms. insulin self-injection correctly is when the patient
a. Weight gain. can do which of the following?
8. When teaching a patiently newly diagnosed with a. Explain all steps of the procedure
primary Addison‟s disease, the nurse should correctly.
explain that the disease results from b. Perform the procedure safely and
a. oversecretion of the adrenal medulla. correctly. – best way to assess is return
b. idiopathic atrophy of the adrenal demo
gland. – if primary, usually idiopathic or c. Critique the nurse‟s performance of the
unknown cause procedure.
c. dysfunction of the hypothalamic pituitary. d. Correctly answer a post-test about the
d. insufficient secretion of growth hormone procedure.
(GH). 12. A patient with type 1 DM who jogs daily is given
9. Which of the following activities would be a the following education regarding the preferred
major focus of monitoring when planning sites for insulin absorption.
nursing care for a patient who has undergone a. The preferred sites are the arms.
transsphenoidal hypophysectomy? b. Jogging does not cause altered insulin
a. Cardiac arrest. absorption so concern about preferred
b. Cushing‟s syndrome. sites is not important.
c. Fluctuating blood glucose levels. c. The legs are the preferred sites of
d. CSF leak. injection since the patient is a jogger.
*surgical resection of pituitary gland through upper d. The abdomen would provide a
lip / upper gum which includes part of brain consistent and effective absorption
*CSF leak to ears: otorrhea ; nose – rhinorrhea site. – sa fatty area
10. A patient presents to the emergency room with *INSULIN
diabetic ketoacidosis. The nurse would identify - refrigerate
which of the following nursing diagnoses as a - given at room temp - usually after 15 mins ; if
priority problem? cold - erratic absorption
a. Deficient fluid volume. - gently rotated, not shaken

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- route: SQ *removal of thyroid gland > sometimes parathyroid
- site of injection: 1/2 inch apart + rotate injection gland is accidentally removed > hypoparathyroidism
sites - prev lipodystrophy w/c causes erratic > hypocalcemia > tetany and muscle spasms:
absorption cheek – chvostek’s ; trosseau – inflate +20 mmHG
- sites: ABDOMEN - most effective and used ; systolic > inhibited circulation > carpopedal spasm
anterior thigh, arm, upper back, and buttocks 17. A patient who has undergone a subtotal
*3 DON'TS IN INSULIN thyroidectomy is subject to complications in the first
1. aspirate 48 hours after surgery. The nurse should obtain
2. massage and keep at the bedside equipment to
a. perform a tracheostomy.
3. use alcohol (drink) > can't be absorbed - if
alcoholic - need to stop b. begin total parenteral nutrition.
13. Which of the following indicates a potential c. start a cutdown infusion.
complication of DM? d. administer tube feedings.
a. Stooped appearance. Post op thyroidectomy: BOWTIE
b. Hemoglobin of 9 g/dL. B – Bleeding: nape area
c. Inflamed, painful joints. O – Open airway
d. BP of 160/100 mm Hg. – inc blood W – Whisper test: laryngeal damage
glucose > viscosity of blood > inc T – Trach set @ bedside
peripheral resistance > inc BP I – Cough or sneeze: splinting of Incision
14. The patient with DM says, “If I could just avoid E – Emergency
what you call carbohydrates in my diet, I guess 18. The nurse should teach the patient to
I would be okay.” The nurse should base the prevent corneal irritation from mild exophthalmos by
response to this comment on the knowledge a. wearing dark-colored glasses. –
that diabetes affects metabolism of which of the bulging of eyes > photosensitive ;
following? corneal irritation: cause is
a. Fats and carbohydrates only. photosensitivity kaya hindi B
b. Protein and carbohydrates only. b. covering both eyes with moistened
c. Carbohydrates only. gauze pads.
d. Proteins, fats, and carbohydrates. c. massaging the eyes at regular
15. When teaching the diabetic patient about foot intervals.
care, the nurse should instruct the patient to do d. instilling an ophthalmic anesthetic as
which of the following? ordered.
a. Avoid going barefoot. *EYE CARE:
b. Use heating pads for sore feet. - eye drops to prev dryness
c. Buy shoes a half size larger. - dark-colored glasses for photosensitivity
d. Cut toenails at angles. - patch eyes if necessary - absence of eyelid closure
*DM compli: - elevate HOB when sleeping - dec intra ocular
1. Diabetic neuropathy – senses pressure
2. D retinopathy – loss of vision, blurred vision - restrict dietary sodium - can inc IOP
3. D nephropathy – kidney probs - assess adequacy of lid closure
*nasusugatan na sila hindi pa nila alam > poor - diuretics - dec fluid, dec pressure
wound healing > amputation - glucocorticoids - methylcellulose drops - prev optic
*podiatrist – foot doctor nerve edema, eye dryness
16. Which of the following symptoms might indicate 19. Propylthiouracil (PTU) is prescribed for a
that a patient was developing tetany after a patient with Grave‟s disease to decrease circulating
subtotal thyroidectomy? thyroid hormone. The nurse should teach the patient
a. Bleeding on the back of the dressing. to immediately report which of the following signs
b. Tingling in the fingers. and symptoms?
c. Pains in the joints of the hands and feet. a. Painful, excessive menstruation.
d. Tension on the suture line. b. Constipation.
c. Increased urine output.

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 d. Sore throat. Hyperthy: PTU, Lugol's soln / SSKI - Saturated soln
*PTU compli: of potassium iodide
- agranulocytosis > rx for infxn > sore throat, fever PTU via straw - teeth staining ; juice - to make it
- thromobocytopenia > rx for bleeding – never pallatable - para ma-improve lasa at mas malunok
administer with aspirin (ASA) niya ; WOF: agranulocytosis, thrombocytopenia
20. A female patient with thyrotoxicosis would
probably report which changes related to the - exophthalmos
menstrual cycle during initial assessment? - thyroid strom: severe HPN and hyperthermia
a. Dysmenorreah. surgery: thyroidectomy > WOF: hypothy
b. Metrorrhagia.
c. Oligomenorrhea. MEDS:
d. Menorrhagia. Hypothy: Levothyroxine sodium - effect after 2-3
*hyperthy: everything is HIGH, FAST, and WET wks
*hypo: everything is LOW, SLOW, and DRY compli: myxedema coma: severe hypoventilation,
Except: MENSTRUATION for both hypothermia, hypotension, bradycardia
*HYPOVENT: can lead to death
HYPERTHY: 21. Nurse Bagets should expect a client with
1. INC T3 AND T4 hypothyroidism to report which health concerns?
2. "thyrotoxicosis" or Grave's dse a. Increased appetite and weight loss
3. s/sx: heat intolerance - mabilis metabolism - b. Puffiness of the face and hands –
enough na heat nila sa body dec metab
2. diaphoretic c. Nervousness and tremors
3. amenorrhea/oligomenorrhea d. Thyroid gland swelling
4. tachycardia 22. A 62-year-old male client has been
3. HPN complaining of sleeping more, increased urination,
4. diarrhea anorexia, weakness, irritability, depression, and
5. body wasting d/t fast metab bone pain that interferes with her going outdoors.
6. fine hand tremors Based on these assessment findings, nurse Richard
7. goiter - enlarged thyroid would suspect which of the following disorders?
a. Diabetes mellitus
Mgt: b. Diabetes insipidus
1. cool envt c. Hypoparathyroidism
2. high caloric diet d. Hyperparathyroidism –
hypercalcemia > inc serum calcium >
HYPOTHY: nauubusan sa bone > bone weakness,
1. DEC T3 AND T4 bone pain, britle bones, pathologic
fractures
2. cold intolerance
23. Jemma, who weighs 210 lb (95 kg) and
3. dry skin
has been diagnosed with hyperglycemia
4. menorrhagia
tells the nurse that her husband sleeps in
5. bradycardia
another room because her snoring keeps
6. hypotension
him awake. The nurse notices that she has
7. constipation
large hands and a hoarse voice. Which of
8. obesity
the following would the nurse suspect as a
possible cause of the client‟s
Mgt: hyperglycemia?
1. warm envt a. Acromegaly – snoring d/t
2. low caloric diet macroglossia (enlarged tongue) ;
prognanthism – enlarged jaw
MEDS: b. Type 1 diabetes mellitus

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 c. Hypothyroidism nausea, a temperature of 105° F (40.5° C),
d. Deficient growth hormone tachycardia, and extreme restlessness. What is the
24. Which outcome indicates that treatment of most likely cause of these signs?
a male client with diabetes insipidus has been a. Diabetic ketoacidosis
effective? b. Thyroid crisis – remaining thyroid is still
a. Fluid intake is less than 2,500 releasing T3 and T4, surgery was not
ml/day. – konti nalang iniihi kaya effective
hindi na masyado nauuhaw c. Hypoglycemia
b. Urine output measures more than 200 d. Tetany
ml/hour. 27. Nurse Louie is developing a teaching plan for a
c. Blood pressure is 90/50 mm Hg. male client diagnosed with diabetes insipidus.
d. The heart rate is 126 beats/minute. The nurse should include information about
25. A male client is admitted for treatment of the which hormone lacking in clients with diabetes
syndrome of inappropriate antidiuretic hormone insipidus?
(SIADH). Which nursing intervention is appropriate? a. antidiuretic hormone (ADH)
a. Infusing I.V. fluids rapidly as ordered b. thyroid-stimulating hormone (TSH).
b. Encouraging increased oral intake c. follicle-stimulating hormone (FSH).
c. Restricting fluids – FVE d. luteinizing hormone (LH).
d. Administering glucose-containing I.V. 28. Nurse Toy-toy is aware that the most
fluids as ordered appropriate for a client with Addison‟s disease?
*SIADH: a. Risk for infection – inc SSS or dec
- Fluid retention SSS can alter immune system
- s/sx: confusion - d/t cerebral edema b. Excessive fluid volume
- lethargy c. Urinary retention
- irritable d. Hypothermia
*dx: dilutional hyponatremia, inc urine specific 29. Which of these signs suggests that a male client
gravity - concentrated urine, diluted blood > HPN with the syndrome of inappropriate antidiuretic
*WOF: Fluid overload hormone (SIADH) secretion is experiencing
*mgt: fluid restriction (<500 mL/day) complications?
*Diuretics a. Tetanic contractions
*Demeclocycline - dec sensitivity of renal tubules of b. Neck vein distention – FVE > JVD
ADH - walang titigil ng pag-ihi mo ; overdose: can c. Weight loss
lead to diabetes insipidus d. Polyuria

*Diabetes insipidus:
- dec ADH 30. After undergoing a subtotal thyroidectomy, a
- polydipsia female client develops hypothyroidism. Dr.
- dx: dec urine specific gravity - diluited urine, Archie Alviz prescribes levothyroxine
concentrated blood, hypernatremia - nawala lahat (Levothroid), 25 mcg P.O. daily. For which
ng fluid, sodium hindi na-excrete condition is levothyroxine the preferred agent?
- WOF: fluid vol def a. Primary hypothyroidism
1. inc OFI b. Graves‟ disease
2. I & O monitoring c. Thyrotoxicosis
3. Desmopressin acetate - inc water reabsorption d. Euthyroidism – normal
in renal tubules - INTRANASAL - assess for dry B & C – same
mucous membranes, nasal congestion 31. When instructing Brittany diagnosed with
4. ADH = vasopressin hyperparathyroidism about diet, nurse Mercedes
26. Early this morning, a female client had a should stress the importance of which of the
subtotal thyroidectomy. During evening rounds, following?
nurse Tina assesses the client, who now has a. Restricting fluids
b. Restricting sodium

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 c. Forcing fluids – inc OFI to prevent
calcium stones by diluting the blood ;
any risk for stones we need to dilute
d. Restricting potassium
*HYPERPARA
- inc Parathormone: bone to blood - bone
resorption
- hypercalcemia
*WOF: osteomalacia, rickets - both are softening
and weakness of bone
*calcium stones: inc OFI, strain all urine
*low calcium diet
*parathyroidectomy > hypopara > dec PTH >
hypocalcemia

*HYPOPARA intake.” – MED: pag nagalaw isa,

- hypocalcemia > tetany, spasms, seizures > rx for kailangan mag-adjust lahat – to prev
infection ; prio: SARALI MO AT SAFETY AHAHAHA hypogly (MED – Medication, Exercise,
- mgt: Diet)
- vit D and Ca in diet (if w/o Vit D, 15-35% only is c. “You‟ll need less insulin when you
absorbed but depends on age) increase your food intake.”
- dec stimuli (dim lights) d. “You‟ll need more insulin when you
- quiet envt exercise or decrease your food intake.”
- Calcium containing products: Ca carbonate, *hot and dry: the sugar is high
gluconate, regulators > WOF: GERD *cold and clammy: give some candy or orange juice
32. Capillary glucose monitoring is being performed *unconscious: IV D5050
every 4 hours for Maria, a female client 34. Tyra, a 29-year-old female client who is being
diagnosed with diabetic ketoacidosis. Insulin is successfully treated for Cushing‟s syndrome, nurse
administered using a scale of regular insulin Lyzette would expect a decline in:
according to glucose results. At 2 p.m., the client a. Serum glucose level.
has a capillary glucose level of 250 mg/dl for b. Hair loss.
which he receives 8 U of regular insulin. Nurse c. Bone mineralization.
Percy should expect the dose‟s: d. Menstrual flow.
a. Onset to be at 2 p.m. and its peak to
be at 3 p.m. 35. Captain America with primary diabetes
b. Onset to be at 2:15 p.m. and its peak insipidus is ready for discharge on desmopressin
to be at 3 p.m. (DDAVP). Which instruction should nurse Shey
c. Onset to be at 2:30 p.m. and its provide?
peak to be at 4 p.m. a. “Administer desmopressin while the
d. Onset to be at 4 p.m. and its peak to suspension is cold.”
be at 6 p.m. b. “Your condition isn‟t chronic, so you
won‟t need to wear a medical identification
33. Nigel has just been diagnosed with type 1 bracelet.”
diabetes mellitus. When teaching the client and c. “You may not be able to use
family how diet and exercise affect insulin desmopressin nasally if you have nasal
requirements, Nurse Ebonni should include discharge or blockage.” – intranasal
which guideline? d. “You won‟t need to monitor your
a. “You‟ll need more insulin when you fluid intake and output after you start taking
exercise or increase your food intake.” desmopressin.”
b. “You‟ll need less insulin when you 36. Nurse Katy Perry is caring for a female client
exercise or reduce your food with type 1 diabetes mellitus who exhibits confusion,

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light-headedness, and aberrant behavior. The client the knowledge that pheochromocytoma of the
is still conscious. The nurse should first administer: adrenal medulla releases excessive amounts of
a. I.M. or subcutaneous glucagon. a. catecholamines.
b. I.V. bolus of dextrose 50%. b. rennin.
c. A fast-acting carbohydrate such as c. aldosterone.
orange juice. d. glucocorticoids.
d. 10 U of fast-acting insulin. *tumor in adrenal medulla > hyperstimulation of
37. Which instruction about insulin PNS
administration should nurse Sophie give to a client? - inc catecholamines
a. “Always follow the same order *dx: urinary and plasma cathecholamines are inc
when drawing the different insulins *fight/flight response
into the syringe.” – GUSTO MAGING RN *s/sx: HPN, headache, hyperhidrosis - excessive
> R MUNA BAGO N > CLEAR MUNA BAGO sweating, hyperglycemia - dahill nasa sympa siya
CLOUDY alam ng body niya na need niya ng glucose, dahil
b. “Shake the vials before withdrawing nasa active form siya, hypermetabolism
the insulin.” *other: agitation, psychoneurosis, dilated pupils
c. “Store unopened vials of insulin in *mgt: alpha adrenergic receptor blockers
the freezer at temperatures well below DOC: Phentolamine
freezing.” - smooth muscle relaxant: Sodium nitroprusside -
d. “Discard the intermediate-acting para hindi ma overwork d/t inc cathecolamines
insulin if it appears cloudy.” – nakita nung - Beta andrenergic blocking agents: Propanolol
tropa mo yung NPH na insulin tapos tinapon - cathecolamine synthesis inhibitors: alpha-methyl P
niya kasi cloudy awit sayo pre tyrosine
38. Bugoy with a tentative diagnosis of - insulin
hyperosmolar hyperglycemic nonketotic syndrome 41. A 60-year-old man seeks medical attention
(HHNS) has a history of type 2 diabetes that is being because he has been vomiting blood and passing
controlled with an oral diabetic agent, tolazamide
bloody stools. The tentative diagnosis is cirrhosis of
(Tolinase). Which of the following is the most
the liver. Which information in the client's health
important laboratory test for confirming this
history most likely relates to the development of
disorder?
cirrhosis?
a. Serum potassium level
A) He drinks a fifth of whiskey
b. Serum sodium level
daily. – Laennec’s: alcohol induced –
c. Arterial blood gas (ABG) values
main cause ; also pancreatitis
d. Serum osmolarity – DHN
B) He is a Vietnam veteran.
39. An agitated, confused female client arrives
C) He has a history of pancreatitis.
in the emergency department. Her history includes
D) He has been taking antihypertensive
type 1 diabetes mellitus, hypertension, and angina
medications for the past 15 years.
pectoris. Assessment reveals pallor, diaphoresis,
headache, and intense hunger. A stat blood glucose 42.If the client's cirrhosis is advanced, what will the
sample measures 42 mg/dl, and the client is treated nurse most likely find during the initial health
for an acute hypoglycemic reaction. After recovery, assessment?
nurse Lily teaches the client to treat hypoglycemia A) Laboratory results that reveal an
by ingesting: elevated serum cholesterol level.
a. fruit juice B) There are spider-like blood
b. cake vessels on the skin. – portal HPN >
c. rice cereal ascites > distention > blood vessels of
d. dextrose 50% abd will dilate > spider angioma
40. A patient is admitted with C) The scrotum is unusually large and
pheochromocytoma. The nurse assesses the edematous.
patient‟s blood pressure frequently. This is based on

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43.Which assessment finding indicates that the exemption: aluminum and titanium alloy – capable
client with cirrhosis is bleeding from somewhere in of being processed in MRI – not attracted to
his upper gastrointestinal tract? magnet: prothesis ; C/I: pacemaker
A) He has mid epigastric pain. C) The nurse records the client's body
B) His stools are black and sticky. – weight.
melena ; hematochezia – lower GI, fresh D) The nurse inserts a Foley retention
blood/reddish catheter.
C) He states that he feels nauseated. 48.The MRI confirms the diagnosis of hepatic
D) His abdomen is distended and shiny. cirrhosis and reveals a large amount of fluid in
44.The care plan indicates that the nurse should the peritoneal cavity. A paracentesis is planned.
monitor the client with cirrhosis each day for signs Which nursing action is most appropriate prior
and symptoms of ascites. To carry out this nursing to assisting with the paracentesis?
order, which nursing action is most appropriate? A) The nurse asks the client to
A) The apical and radial pulse rates void. – prev puncture of bladder
are counted. B) The nurse withholds food and
B) The lying and sitting blood pressure water.
are taken. C) The nurse cleanses the client's
C) The specific gravity of the urine is abdomen with Betadine.
checked. D) The nurse obtains a suction
D) The circumference of the machine from the storage room.
abdomen is measured. – abd girth 49.After the paracentesis has been
45.The physician considers performing a liver biopsy performed, which nursing responsibility
on the client with cirrhosis. If a liver biopsy is is essential?
performed, immediately afterward it is most A) Increasing the client's oral fluid
important for the nurse to assess the client for intake
signs of B) Administering a prescribed
A) hemorrhage. – after: lie on right side – analgesic
apply pressure on punctured site – to prev C) Recording the volume of
bleeding and hemorrhage ; dec clotting; fat withdrawn fluid
soluble vitamins: vit ADEK D) Encouraging the client to deep-
B) infection. breathe
C) blood clots.
D) collapsed lung.
46. After a liver biopsy, which nursing order is most
appropriate to add to the plan of care?
A) Ambulate the client twice each shift.
B) Keep the client in high Fowler's
position.
C) Position the client on his right 50.When administering an intramuscular
side. injection to the client with cirrhosis of
D) Elevate the client's legs on two the liver, which nursing action is
pillows. essential to perform?
47.Instead of a liver biopsy, a magnetic resonance A) Cleanse the site with Betadine.
imaging (MRI) test is ordered. Before the MRI is B) Inject no more than 1 mL at any
performed, which nursing action is essential? given site.
A) The nurse administers a pretest sedative. C) Obtain a vial of vitamin K and place
at the bedside
B) The nurse removes the client's dental D) Apply prolonged pressure to the
bridge. – metals are contraindicated ; combi of injection site. – maliit lang
magnet and sound waves > visualization ;

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 punctured site, sapat na to – SANA has relieved it. The nurse observes that the
OL ENOUGH :< client is curled in a fetal position and is rocking
51.Which laboratory result, if elevated, is back and forth. Which action would best assist
most indicative that the client may the nurse in further assessing the client's pain?
develop hepatic encephalopathy? A) Determine if the client can stop
A) Serum creatinine moving.
B) Serum bilirubin B) Ask the client to rate his pain
C) Blood ammonia from 0 to 10.
D) Blood urea nitrogen C) Observe if the client is breathing
*HEP ENCEPH: heavily.
- Liver - sa ilalim may 2 kidneys D) Give the client a prescribed pain-
- Ingest CHON > pass liver > urea > ammonia relieving drug.
- kidney: urea > urine 55.Which laboratory test, if elevated, provides the
- ammonia retention - liver damage best indication that the client's pain is caused by
- urea/nitrogenous - kidney damage - kasi na- pancreatitis?
process ng liver to ammonia A) Serum bilirubin
*BUN - not confirmatory because it is dependent B) Serum amylase
on CHON intake C) Lactose tolerance
*hepatic: D) Glucose tolerance
isa-isip: hep enceph *pancreatic enzymes:
isa-puso: hep cardiomyopathy Amylase – carbs – 1st to elevate
isa-balat: jaundice Lipase – fats
*kidney: Trypsin – protein ; most damaging
renal enceph Given w/ food
renal cardiomyopathy Never double dosages > autodigestion
uremic frost 56.The physician orders the insertion of a
52.Which assessment finding best indicates that the nasogastric sump tube. To determine the length for
cirrhotic client's condition is worsening? inserting the tube, the nurse most correctly places
A) He is difficult to arouse. – excessive the tip of the tube at the client's nose and
ammonia in the brain is toxic > enceph > LOC measures the distance from there to the
C) He develops pancreatitis. A) jaw and then midway to the sternum.
B) His urine output is 100 mL/h. C) midsternum and then to the umbilicus.
D) His blood pressure is 122/60 mm Hg. B) mouth and then between the nipples.
53. The seriousness of the client's condition D) nose to ear and then to the xiphoid
is explained to his wife. She is prepared for process. – NEX ; FID Me
the possibility of her husband's death. The Feeding
client's wife cries as she recalls various Irrigation
significant events she and her husband Decompression
shared together. Which nursing action is Medication
most therapeutic at this time?
A) Offer to call a close family member. 57.If the client turns blue and coughs as the
B) Listen to her express her nasogastric tube is inserted, which additional sign
thoughts. indicates that the tube has entered the respiratory
C) Suggest that she call the clergy at tract?
her church. A) The client cannot speak. – nasa airway ;
D) Ask about her future plans in life. withdraw > re-lubricate > re-insert
54.A 48-year-old man comes to the emergency C) The client begins to sneeze.
department because of severe upper abdominal B) The client cannot swallow.
pain. He reports that the pain came on D) The client begins to vomit.
suddenly a few hours ago and nothing so far

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58.After being NPO (nothing by mouth) for several b. Change the client‟s diet to clear liquids
days, the nasogastric tube is removed and the only.
client is placed on a bland, low-fat diet. Which food, d. Administer prochlorperazine (Compazine)
if found on the client's breakfast tray, should be 10 mg IM.
removed? 63. The nurse learns that a client who is being
A) Stewed prunes treated for peptic ulcer disease is still "having
B) Skim milk problems". Which of the following should the nurse
C) Scrambled eggs – egg yolk – rich in instruct this client?
cholesterol a. Smoking cessation techniques. –
D) Whole wheat toast triggers cephalic phase of digestion > inc
59.Before discharging the client with pancreatitis, HCl acid
which information is essential for him to receive? c. Avoid eating breakfast.
A) He must never donate blood again b. Have the largest meal of the day at
B) He must not drink alcohol in any form lunchtime.
C) He must avoid lifting heavy objects d. Make sure the client is eating a bland
D) He must forgo taking strong laxatives. diet.
60. Nurse Bundat is caring for a client who is at risk 64. The nurse monitors a client for early signs
for developing gastritis. Which finding from the of dumping syndrome. Which is not included?
client‟s history leads the nurse to this conclusion? a. Bradycardia
a. The client is lactose-intolerant and cannot b. Vertigo
drink milk. c. Sweating
b. The client recently traveled to Mexico and d. Diarrhea
South America. *common compli of antrectomies
c. The client works at least 60 hours per a. Billorth I - gastroduodenostomy
week in a stressful job. b. Billroth II - gastrojejunostomy
d. The client takes naproxen sodium umikli GI tract nila > rapid gastric emptying time:
(Naprosyn) 500 mg daily for arthritis DIARRHEA, DIZZINESS, DIAPHORESIS,
pain. – NSAID: GI irritants DROWSINESS
61. The nurse is caring for a client with a gastric mgt:
ulcer who suddenly develops sharp mid-epigastric - diet: SFF high CHON, High fat, low CHO - dapat
pain. The nurse notes that the client‟s abdomen is mahirap ma-digest para mas tumagal sa tiyan
hard and very tender to light palpation. Which is - D - dry food is a must - para hindi mabilis
the priority action of the nurse? mabusog
a. Placing the client in a knee-chest position - D - direct to lying down position after eating -left
c. Inserting side lying: ang stomach nasa left
b. Preparing the client for emergency - D - don't take large fluids with meals - para hindi
surgery – peritonitis – possible rupture mabilis mabusog
inside 65. The nurse is caring for a client with colon
d. Administering morphine 2 mg IV as cancer and a new colostomy. The client wishes to
ordered by the physician. talk with someone with a similar experience. Which
is the nurse‟s best response?
62. The nurse is caring for a client with peptic a. I will make a referral to the
ulcer disease. The client vomits a large amount of Philippine
undigested food after breakfast. Which intervention Cancer Society."
will the nurse prepare to do for the client? b. "You can get all the information you need
a. Administer a soap suds cleansing enema. from the enterostomal therapist."
c. Insert a nasogastric (NG) tube to c. "I do not think that we have any other
low intermittent suction. – gastric clients with colostomies on the unit right
elavage / decompression now."

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 d. "Most people who have had a colostomy d. Perianal care and restoration of
are reluctant to talk about it." fluids and electrolytes. – diarrhea ;
66. The nurse is caring for a client who just had Inflamm Bowel Dse
colon resection surgery with a new colostomy. *Crohn's dse: 5-6 stools/day
Which teaching objective will the nurse include in *Ulcerative colitis: 20-30 stools/day
the client‟s plan of care? *CROHN'S DSE
a. The client will understand colostomy care - Regional enteritis - malalim sugat pero
and lifestyle implications. magakakahiwalay
b. The client will learn how to change the - small intestine: ileum/ascending colon
appliance. - transmural: all layers are affected
c. The client will demonstrate correct - segmental lesions/skip
changing of the appliance before - 5 to 6 stools/day
discharge. – retdem - fistula formation kasi malalim
d. The client will not be afraid to handle the
a nasogastric tube to low intermittent *ULCERATIVE COLITIS
suctionostomy appliance tomorrow. - malalim sugat pero tuloy tuloy
67. A 23-year-old woman is being evaluated in - rectum/descending colon
the emergency department for acute lower - mucosa and submucosa only
abdominal pain and vomiting. During the nursing - continuous lesions
history, the most helpful question by the nurse to - crypt abscess: pus formation: exudative
obtain information regarding the patient‟s condition - 20 to 30 stools/day
is? - colon CA
a. "What type of foods do you usually eat?"
c. "What is your usual elimination pattern?" *both has rx for peritonitis
b. "Can you tell me about your pain?" *Dx: Crohn's - Barium swallow - "string sign" -
d. "Is it possible that you are pregnant?" lulusot sa malalalim na area
68. A client experiences regurgitation and
dyspepsia. The nurse assists the client to assume *U. colitis: Barium enema - Lower GI - lesions -
an upright position. Which of the following pag dumaan barium, magdedeposit sa mga
statements by the nurse would best describe the sugat
purpose of this measure?
a. "It prevents the flow of gastric *Clostridium difficile: in irratble bowel syndrome
contents into the esophagus." - IBS - in colitis that produces diarrhea
b. "It decreases the inflammatory
changes in the esophagus." *mgt: the same for both
c. "It enhances and strengthens 1. low fiber diet - gastric irritant > stimulate
esophageal peristalsis." peristalsis - hangga't maaari rest muna ang
d. "It increases the lower esophageal colon
pressure." 2. TPN - to rest GIT
69. Because a client has Crohn‟s disease, plans 3. steroids - prev further inflamm
for nursing intervention should include? 4. ostomy - depends on what part
a. Weight reduction measures and low 70. During an acute exacerbation of Crohn‟s
calorie. disease, which of the following nursing diagnoses
b. Frequent application of lubricant should have priority?
location and discouraging scratching. a. Imbalanced nutrition: less than
c. Teaching the importance of body requirements related to anorexia
following-up liver function test after and diarrhea.
discharge. b. Anxiety related to altered self-
concept and health status.
c. Fatigue related to decreased
nutrient intake and anemia.

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 d. Knowledge deficiency related to results of the prostate examination, which should
lack of information about disease process. reveal that the prostate gland is:
71. The client is diagnosed with an acute a. Soft and swollen
episode of ureteral calculi. Which client problem is b. Reddened, swollen, and boggy
priority when caring for this client? c. Tender and edematous with ecchymosis
a. Fluid volume loss. d. Tender, indurated, and warm to the
b. Knowledge deficit. touch
c. Impaired urinary elimination. *not soft, boggy, ecchymosis
d. Pain. – not necessary yung C kasi dalawa 76. Phenazopyridine hydrochloride (Pyridium) is
naman ang ureters mo prescribed for a client for symptomatic relief of
72. Which statement indicates that the client pain resulting from a lower urinary tract
diagnosed with calcium phosphate renal calculi infection. The nurse teaches the client:
understands the discharge teaching for ways to a. To take the medication at bedtime
prevent future calculi formation? b. To take the medication before meals
a. “I should increase my fluid intake, c. To discontinue the medication if a headache
especially in warm weather.” occurs
b. “I should eat foods that contain cocoa and d. That a reddish orange discoloration of
chocolate.” the urine may occur
c. “I will walk about a mile every week and not 77. A 69 – year old male client has been diagnosed
exercise often.” to have benign prostatic hypertrophy. BPH is
d. “I should take one vitamin a day that has primarily associated with which of the following?
extra calcium.” a. Chronic bacterial invasion of the urinary tract
73. The nurse is caring for an elderly client who b. Endocrine imbalances associated with aging
has an indwelling catheter. Which data warrant c. Tumor growth due to excessive smoking
further investigation? d. Local inflammation of the prostate due to
a. The client‟s temperature is 98.0_F. contamination from rectal organisms
b. The client has become confused and
irritable.
78. The client has been diagnosed to have cancer of
c. The client‟s urine is clear and light yellow.
the bladder. The characterisctics manifestation of
d. The client has no discomfort or pain.
the client more likely would be:
*systemic infection > UTI (ascending) – pwede
a. Oliguria – kidney prob
madamay ibang organs ; urethritis > cystitis >
b. Burning or urination – UTI
ureteritis > pyelonephritis > hydronephrosis
c. Painless hematuria
74. The nurse is observing the unlicensed
nursing assistant (NA) provide direct care to a client d. Incontinence
with a Foley catheter. Which data warrant
immediate intervention by the nurse? 79. The client was diagnosed with acute renal
a. The NA secures the tubing to the client‟s leg failure. He has been prescribed low protein, low
with tape. potassium and low sodium diet. A teaching program
b. The NA provides catheter care with the should include:
client‟s bath. a. Encouraging the client to include raw
c. The NA positions the collection bag on carrots , tomatoes and cabbage in the diet
the client‟s bed. – below bladder – drain b. Recommending protein of high
d/t gravity biologic value such as eggs, poultry and lean
d. The NA cares for the catheter after washing meat – easily processed, easily absorbed, easily
the hands. excreted ; ex: CHON shakes: non biologic
75. The client complains of fever, perineal pain, c. Pointing out that raw fruits such as
and urinary urgency, frequency, and dysuria. To bananas, cantaloupe and oranges may be included
assess whether the client's problem is related to in the diet
bacterial prostatitis, the nurse would look at the d. Allowing the client to have cheese, canned
foods, and processed foods.

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 D. Urea nitrogen cannot be used to
80. Patients with urolithiasis need to ne encourage synthesize amino acids in the body, so the
to: nitrogen for amino acid synthesis must
a. Decrease fluid intake come from the dietary protein
b. Strain all urine 85. To obtain an accurate urine output for a
c. Supplement diet with calcium client with a continuous bladder irrigation (CBI), the
d. Void every 6 – 8 hours nurse should:
A. Measure the contents of the bedside
81. You‟re assessing a 24-year-old woman who drainage bag
might have a urinary tract infection (UTI). Which B. Stop irrigation until the urine output is
statement by the client suggests that UTI is likely? determined
A. “I urinate large amounts.” C. Subtract the volume of the irrigant
B. “It burns when I urinate.” – dysuria from the total drainage – baseline data
C. “I go for hours without the urge to urinate.” D. Ensure that urine and irrigant drain into two
D. “My urine has sweet smell.” separate bags
82. You must send a patient for a magnetic 86. Which data would support the client‟s
resonance imaging (MRI) study of his kidneys. diagnosis of acute bacterial prostatitis?
Identify two primary nursing considerations in a. Terminal dribbling.
preparation for the MRI. b. Urinary frequency.
A. Coordinating the MRI with other patient care c. Stress incontinence.
activities and informing the patient about the d. Sudden fever and chills.
test 87. The client is admitted to a nursing unit from
B. Giving all scheduled medications and a long-term care facility with a hematocrit of 56%
completing the bath before the test and a serum sodium level of 152 mEq/L. Which
C. Report metal screening findings to the condition would be a cause for these findings?
MRI department and sedate for a. Overhydration.
claustrophobia before sending him or b. Anemia.
her to the MRI department c. Dehydration. – hemoconcentration
D. Make sure the patient is NPO and hold all d. Renal failure.
medications until the test is completed 88. A patient with Chronic Renal Failure is being
83. The main indication for hemodialysis for a client maintained on Peritoneal Dialysis. Which of the
who has chronic kidney failure is: following is NOT an indication that the patient is
A. Ascites developing possible Peritonitis?
B. Acidosis a. Slightly blood tinged drainage after the
C. Hypertension first exchange – normal
D. Hyperkalemia – cardiac arrest b. Rigid abdomen with abdominal pain
84. A client with acute kidney failure is to c. Decreased rate of fluid return
receive a very low-protein diet. This diet is based d. Nausea and vomiting
on the principles that: 89. The client diagnosed with ARF is admitted
A. A high-protein intake ensures an adequate to the intensive care department and placed on a
daily supply of all amino acids to therapeutic diet. Which diet would be most
compensate for loses appropriate for the client?
B. Essential and nonessential amino acids are a. A high-potassium and low-calcium diet.
necessary in the diet to supply materials for b. A low-fat and low-cholesterol diet.
tissue protein synthesis c. A high-carbohydrate and restricted-
C. This supplies only essential amino acids protein diet. – prev azotemia:
reducing the amount of metabolic waste nitrogenous waste deposition in the
products, thus decreasing stress on the body
kidneys d. A regular diet with six (6) small feedings a
day.

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ESRD: End-stage renal dse 95. If the client‟s serum potassium continues to
ARF: Acute renal failure rise in ARF, the nurse should be prepared for which
CRF: Chronic renal failure of the following emergencies?
90. Edward needs to be taught how to detect A. Cardiac arrest
signs of the most serious and most common B. Pulmonary edema
complication of CAPD – Continuous Ambulatory C. Circulatory collapse
Peritoneal Dialysis, which is: D. Hemorrhage
A. an abdominal hernia 96. The client‟s blood urea nitrogen (BUN)
B. anorexia concentration is elevated in renal failure. This is
C. edema likely due to:
D. peritonitis A. Fluid retention
91. Edward needs to be aware that toxic B. Hemolysis
wastes are exchanged during the equilibration or C. Below normal metabolic rate
dwell time, which usually lasts for: D. Reduced renal blood flow
A. 10 to 15 minutes – about 20 mins din 97. The client undergoes a transurethral
talaga resection of the prostrate (TURP) and is brought
B. 30 minutes back to his room with continuous bladder irrigation
C. 1 hour (CBI). Which of the following statements best
D. 2 to 3 hours explains for the CBI?
*Inflow time: pagpasok ng dialysate - 10 mins A. to decrease bladder atony
*Equilibration/dwell time - pag stay - 20 mins B. to remove blood clots form the
*Drainage - 30 mins - mas matagal - labas bladder
dialysate, excess fluid and wastes C. to maintain gateway of the urethral
92. Health information for a female patient catheter
diagnosed as having cystitis includes all of the D. to dilute the concentrated urine
following except: 98. The physician examines the prostrate gland of
A. cleanse around the perineum and urethral the client. What will the nurse prepare?
meatus (from front to back) after each A. a foley catheter
bowel movement. B. lubricant and gloves – KY jelly, pag wala
B. drink liberal amounts of fluid – laway hAHAHAHAHAHAHAHAHAH
C. shower rather than bathe in a tub. C. urethral dilators
D. void no more frequently than every 6 D. a rectal tube
hours to allow urine to dilute the bacteria 99. The client appears distressed and asks the
in the bladder. – dapat q hour umiihi ; urinary nurse how she got the infection. The nurse explains
stasis > can cause cytitis > aaaa nag lag that in most cases, cystitis is caused by
93. A clinical diagnosis of nephrotic syndrome is A. an ascending infection from the
consistent with an exceedingly high level of: urethra
A. albumin B. an infection elsewhere in the body
B. low-density lipoproteins C. congenital structure of the urethra
C. protein in the urine – “nephrotein” D. urine stasis in the urinary bladder
D. serum cholesterol 100. When scheduling the administration of Lasix
94. In the oliguric phase of ARF, the nurse (furosemide) it would be in the patient‟s best
should anticipate the development of which of the interest to schedule the medication to be given at:
following complications? A. 9:00 am – can disrupt sleep pag
A. Pulmonary edema – fluid retention gabi
B. Metabolic alkalosis B. 12:00 noon
C. Hypotension C. 2100
D. Hypokalemia D. 12:00 midnight

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