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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
has undergone a bilateral adrenalectomy is at an
increased risk for
a. malnutrition.
b. emboli.
c. delayed wound healing.
d. postoperative confusion.
3 steroids:
a) sugar – G – Glucocorticoid
b) salt – M – Mineralocorticoid – Aldosterone
c) sex – A – Androgen
“main branch ng SSS nasa Kamuning > GMA”
*sodium attracts water
*Inc fluid > inc pressure > aldosterone triggers
fluid retention
*aldosterone is released when there is DHN in the
body – compensatory mech to prev further DHN
*inc SSS > inc blood viscosity > delayed wound
healing
2. Bone resorption is a possible complication of
Cushing’s disease. Which of the following
interventions should the nurse recommend to help
the patient prevent this complication?
a. Limit dietary vitamin D intake.
b. Maintain a regular program of
weight bearing exercise. – calcium is
retained ; paglabas ng calcium sa buto >
inc serum calcium ; hanggang
nadedetermine ng bone na need niya ng
calcium, ireretain niya
c. Increase the amount of potassium in the
diet.
d. Perform isometric exercises.
3. Cushing‟s disease is manifested by the
excessive secretion of corticosteroids. The hormones
involved are
a. glucocorticoids, aldosterone, and
androgens.
b. adrenocorticotropic hormone.
c. glucocorticoids and aldosterone.
d. catecholamines.
*CUSHING'S DISEASE
- hypersecretion of SSS
*inc SUGAR: truncal obesity / central body / pear-
shaped ; manipis ang arms at manipis ang legs
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- buffalo hump: fat pads at your neck or back
- poor wound healing
*inc SALT: moon face
*inc SEX: hirsutism - excessive body hair,
- virilization/virilism: nagmumukhang lalaki - hair sa
chest, beard, mustache sa babae
*Dx: inc cortisol level, hyperglycemia,
hypernatremia, hypokalemia, hypertension
*WOF: Fluid overload
* Conn's syndrome: hyperaldosteronism > severe
HPN
- give potassium sparring diuretic - "lactone"
MGT: LAHAT NG SOBRA BAWASAN, LAHAT NG
KULANG DAGDAGAN
- low sodium diet
- high K diet
- glucocorticoid antagonist: prev excessive
release of glucocorticoid: Mitotane for life
- surgery: Adrenalectomy - surgical removal
of adrenal gland > WOF: Addison's dse kasi
tinanggal yung adrenal glands
*ADDISONS
- hyposecretion of SSS
- bronze skin
- dec aldosterone: hyponatremia
- PISO: Potassium in, sodium out (inversely
proportional)
- hyperkalemia
*Fluid vol def: DHN, hypotension,
*Dx: dec cortisol, hypogly, hypoNa, hyperK,
hypotension
*WOF: Fluid vol def > addisonian crisis -
exacerbated addison's dse > severe s/sx
*Mgt:
- high sodium diet
- low Potassium diet
- glucorticoid agonist for life
4. A 42-year-old female patient reports that
she has gained weight and that her face and body
are “rounder,” while her legs and arms have become
thinner. A tentative diagnosis of Cushing‟s disease
is made. When examining this patient, the nurse
would expect to find
a. decreased body hair.
b. bruised areas on the skin.
c. muscle hypertrophy in the extremities.
d. postural hypotension.
*Cushing’s > fluid retention > edematous > inc
capillary fragility > extravasation > easily bruised
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5. Which of the following signs and symptoms
would probably indicate that the patient with
Addison‟s disease is receiving much glucocorticoids
replacement?
a. Rapid weight gain.
b. Poor skin turgor.
c. Anorexia.
d. Dizziness.
6. Which of the following findings would be typical
of Addison‟s disease?
a. Decreased BUN level.
b. Hypokalemia.
c. Hypoglycemia. – dec SSS
d. Hypernatremia.
7. The nurse would expect the patient with
Addison‟s disease to exhibit which of the
following signs and symptoms?
a. Lethargy. – abn sleepy ; hypoglycemic
; brain needs 60-75% of glucose > dec
LOC
b. Hunger.
c. Weight gain.
d. Muscle spasms.
a. Weight gain.
8. When teaching a patiently newly diagnosed with
primary Addison‟s disease, the nurse should
explain that the disease results from
a. oversecretion of the adrenal medulla.
b. idiopathic atrophy of the adrenal
gland. – if primary, usually idiopathic or
unknown cause
c. dysfunction of the hypothalamic pituitary.
d. insufficient secretion of growth hormone
(GH).
9. Which of the following activities would be a
major focus of monitoring when planning
nursing care for a patient who has undergone
transsphenoidal hypophysectomy?
a. Cardiac arrest.
b. Cushing‟s syndrome.
c. Fluctuating blood glucose levels.
d. CSF leak.
*surgical resection of pituitary gland through upper
lip / upper gum which includes part of brain
*CSF leak to ears: otorrhea ; nose – rhinorrhea
10. A patient presents to the emergency room with
diabetic ketoacidosis. The nurse would identify
which of the following nursing diagnoses as a
priority problem?
a. Deficient fluid volume.
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b. Imbalanced nutrition: less than body
requirements.
c. Impaired health maintenance.
d. Disturbed sleep pattern.
*Diabetic ketoacidosis:
- ketones are by product of fats > they get thinner
(DM type 1)
- more than 200 mg/dL > coma
*Hypeglycemia hyperosmolar non-ketotic syndrome
- hindi na bbreakdown or metabolized ang fat >
they are commonly fat - Type 2
- more than 400-600 mg/dL > coma
both: hemoconcentration d/t hyperglycemia >
hyperosmosis > reattraction of water from cell >
cell will shrink > polyuria > FVD
*mgt: rehydration therapy: PNSS
normal BS: 70-110 or 80-120 mg/dL
11. The best indicator that allows the nurse to judge
that the patient has learned how to give an
insulin self-injection correctly is when the patient
can do which of the following?
a. Explain all steps of the procedure
correctly.
b. Perform the procedure safely and
correctly. – best way to assess is return
demo
c. Critique the nurse‟s performance of the
procedure.
d. Correctly answer a post-test about the
procedure.
12. A patient with type 1 DM who jogs daily is given
the following education regarding the preferred
sites for insulin absorption.
a. The preferred sites are the arms.
b. Jogging does not cause altered insulin
absorption so concern about preferred
sites is not important.
c. The legs are the preferred sites of
injection since the patient is a jogger.
d. The abdomen would provide a
consistent and effective absorption
site. – sa fatty area
*INSULIN
- refrigerate
- given at room temp - usually after 15 mins ; if
cold - erratic absorption
- gently rotated, not shaken
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- route: SQ
- site of injection: 1/2 inch apart + rotate injection
sites - prev lipodystrophy w/c causes erratic
absorption
- sites: ABDOMEN - most effective and used ;
anterior thigh, arm, upper back, and buttocks
*3 DON'TS IN INSULIN
1. aspirate
2. massage
3. use alcohol (drink) > can't be absorbed - if
alcoholic - need to stop
13. Which of the following indicates a potential
complication of DM?
a. Stooped appearance.
b. Hemoglobin of 9 g/dL.
c. Inflamed, painful joints.
d. BP of 160/100 mm Hg. – inc blood
glucose > viscosity of blood > inc
peripheral resistance > inc BP
14. The patient with DM says, “If I could just avoid
what you call carbohydrates in my diet, I guess
I would be okay.” The nurse should base the
response to this comment on the knowledge
that diabetes affects metabolism of which of the
following?
a. Fats and carbohydrates only.
b. Protein and carbohydrates only.
c. Carbohydrates only.
d. Proteins, fats, and carbohydrates.
15. When teaching the diabetic patient about foot
care, the nurse should instruct the patient to do
which of the following?
a. Avoid going barefoot.
b. Use heating pads for sore feet.
c. Buy shoes a half size larger.
d. Cut toenails at angles.
*DM compli:
1. Diabetic neuropathy – senses
2. D retinopathy – loss of vision, blurred vision
3. D nephropathy – kidney probs
*nasusugatan na sila hindi pa nila alam > poor
wound healing > amputation
*podiatrist – foot doctor
16. Which of the following symptoms might indicate
that a patient was developing tetany after a
subtotal thyroidectomy?
a. Bleeding on the back of the dressing.
b. Tingling in the fingers.
c. Pains in the joints of the hands and feet.
d. Tension on the suture line.
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*removal of thyroid gland > sometimes parathyroid
gland is accidentally removed > hypoparathyroidism
> hypocalcemia > tetany and muscle spasms:
cheek – chvostek’s ; trosseau – inflate +20 mmHG
systolic > inhibited circulation > carpopedal spasm
17. A patient who has undergone a subtotal
thyroidectomy is subject to complications in the first
48 hours after surgery. The nurse should obtain
and keep at the bedside equipment to
a. perform a tracheostomy.
b. begin total parenteral nutrition.
c. start a cutdown infusion.
d. administer tube feedings.
Post op thyroidectomy: BOWTIE
B – Bleeding: nape area
O – Open airway
W – Whisper test: laryngeal damage
T – Trach set @ bedside
I – Cough or sneeze: splinting of Incision
E – Emergency
18. The nurse should teach the patient to
prevent corneal irritation from mild exophthalmos by
a. wearing dark-colored glasses. –
bulging of eyes > photosensitive ;
corneal irritation: cause is
photosensitivity kaya hindi B
b. covering both eyes with moistened
gauze pads.
c. massaging the eyes at regular
intervals.
d. instilling an ophthalmic anesthetic as
ordered.
*EYE CARE:
- eye drops to prev dryness
- dark-colored glasses for photosensitivity
- patch eyes if necessary - absence of eyelid closure
- elevate HOB when sleeping - dec intra ocular
pressure
- restrict dietary sodium - can inc IOP
- assess adequacy of lid closure
- diuretics - dec fluid, dec pressure
- glucocorticoids - methylcellulose drops - prev optic
nerve edema, eye dryness
19. Propylthiouracil (PTU) is prescribed for a
patient with Grave‟s disease to decrease circulating
thyroid hormone. The nurse should teach the patient
to immediately report which of the following signs
and symptoms?
a. Painful, excessive menstruation.
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
d. Deficient growth hormone
24. Which outcome indicates that treatment of
a male client with diabetes insipidus has been
effective?
a. Fluid intake is less than 2,500
ml/day. – konti nalang iniihi kaya
hindi na masyado nauuhaw
b. Urine output measures more than 200
ml/hour.
c. Blood pressure is 90/50 mm Hg.
d. The heart rate is 126 beats/minute.
25. A male client is admitted for treatment of the
syndrome of inappropriate antidiuretic hormone
(SIADH). Which nursing intervention is appropriate?
a. Infusing I.V. fluids rapidly as ordered
b. Encouraging increased oral intake
c. Restricting fluids – FVE
d. Administering glucose-containing I.V.
fluids as ordered
*SIADH:
- Fluid retention
- s/sx: confusion - d/t cerebral edema
- lethargy
- irritable
*dx: dilutional hyponatremia, inc urine specific
gravity - concentrated urine, diluted blood > HPN
*WOF: Fluid overload
*mgt: fluid restriction (<500 mL/day)
*Diuretics
*Demeclocycline - dec sensitivity of renal tubules of
ADH - walang titigil ng pag-ihi mo ; overdose: can
lead to diabetes insipidus
nausea, a temperature of 105° F (40.5° C),
tachycardia, and extreme restlessness. What is the
most likely cause of these signs?
a. Diabetic ketoacidosis
b. Thyroid crisis – remaining thyroid is still
releasing T3 and T4, surgery was not
effective
c. Hypoglycemia
d. Tetany
27. Nurse Louie is developing a teaching plan for a
male client diagnosed with diabetes insipidus.
The nurse should include information about
which hormone lacking in clients with diabetes
insipidus?
a. antidiuretic hormone (ADH)
b. thyroid-stimulating hormone (TSH).
c. follicle-stimulating hormone (FSH).
d. luteinizing hormone (LH).
28. Nurse Toy-toy is aware that the most
appropriate for a client with Addison‟s disease?
a. Risk for infection – inc SSS or dec
SSS can alter immune system
b. Excessive fluid volume
c. Urinary retention
d. Hypothermia
29. Which of these signs suggests that a male client
with the syndrome of inappropriate antidiuretic
hormone (SIADH) secretion is experiencing
complications?
a. Tetanic contractions
b. Neck vein distention – FVE > JVD
c. Weight loss
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
- hypocalcemia > tetany, spasms, seizures > rx for
infection ; prio: SARALI MO AT SAFETY AHAHAHA
- mgt:
- vit D and Ca in diet (if w/o Vit D, 15-35% only is
absorbed but depends on age)
- dec stimuli (dim lights)
- quiet envt
- Calcium containing products: Ca carbonate,
gluconate, regulators > WOF: GERD
32. Capillary glucose monitoring is being performed
every 4 hours for Maria, a female client
diagnosed with diabetic ketoacidosis. Insulin is
administered using a scale of regular insulin
according to glucose results. At 2 p.m., the client
has a capillary glucose level of 250 mg/dl for
which he receives 8 U of regular insulin. Nurse
Percy should expect the dose‟s:
a. Onset to be at 2 p.m. and its peak to
be at 3 p.m.
b. Onset to be at 2:15 p.m. and its peak
to be at 3 p.m.
c. Onset to be at 2:30 p.m. and its
peak to be at 4 p.m.
d. Onset to be at 4 p.m. and its peak to
be at 6 p.m.
33. Nigel has just been diagnosed with type 1
diabetes mellitus. When teaching the client and
family how diet and exercise affect insulin
requirements, Nurse Ebonni should include
which guideline?
a. “You‟ll need more insulin when you
exercise or increase your food intake.”
b. “You‟ll need less insulin when you
exercise or reduce your food
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intake.” – MED: pag nagalaw isa,
kailangan mag-adjust lahat – to prev
hypogly (MED – Medication, Exercise,
Diet)
c. “You‟ll need less insulin when you
increase your food intake.”
d. “You‟ll need more insulin when you
exercise or decrease your food intake.”
*hot and dry: the sugar is high
*cold and clammy: give some candy or orange juice
*unconscious: IV D5050
34. Tyra, a 29-year-old female client who is being
successfully treated for Cushing‟s syndrome, nurse
Lyzette would expect a decline in:
a. Serum glucose level.
b. Hair loss.
c. Bone mineralization.
d. Menstrual flow.
35. Captain America with primary diabetes
insipidus is ready for discharge on desmopressin
(DDAVP). Which instruction should nurse Shey
provide?
a. “Administer desmopressin while the
suspension is cold.”
b. “Your condition isn‟t chronic, so you
won‟t need to wear a medical identification
bracelet.”
c. “You may not be able to use
desmopressin nasally if you have nasal
discharge or blockage.” – intranasal
d. “You won‟t need to monitor your
fluid intake and output after you start taking
desmopressin.”
36. Nurse Katy Perry is caring for a female client
with type 1 diabetes mellitus who exhibits confusion,
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light-headedness, and aberrant behavior. The client
is still conscious. The nurse should first administer:
a. I.M. or subcutaneous glucagon.
b. I.V. bolus of dextrose 50%.
c. A fast-acting carbohydrate such as
orange juice.
d. 10 U of fast-acting insulin.
37. Which instruction about insulin
administration should nurse Sophie give to a client?
a. “Always follow the same order
when drawing the different insulins
into the syringe.” – GUSTO MAGING RN
> R MUNA BAGO N > CLEAR MUNA BAGO
CLOUDY
b. “Shake the vials before withdrawing
the insulin.”
c. “Store unopened vials of insulin in
the freezer at temperatures well below
freezing.”
d. “Discard the intermediate-acting
insulin if it appears cloudy.” – nakita nung
tropa mo yung NPH na insulin tapos tinapon
niya kasi cloudy awit sayo pre
38. Bugoy with a tentative diagnosis of
hyperosmolar hyperglycemic nonketotic syndrome
(HHNS) has a history of type 2 diabetes that is being
controlled with an oral diabetic agent, tolazamide
(Tolinase). Which of the following is the most
important laboratory test for confirming this
disorder?
a. Serum potassium level
b. Serum sodium level
c. Arterial blood gas (ABG) values
d. Serum osmolarity – DHN
39. An agitated, confused female client arrives
in the emergency department. Her history includes
type 1 diabetes mellitus, hypertension, and angina
pectoris. Assessment reveals pallor, diaphoresis,
headache, and intense hunger. A stat blood glucose
sample measures 42 mg/dl, and the client is treated
for an acute hypoglycemic reaction. After recovery,
nurse Lily teaches the client to treat hypoglycemia
by ingesting:
a. fruit juice
b. cake
c. rice cereal
d. dextrose 50%
40. A patient is admitted with
pheochromocytoma. The nurse assesses the
patient‟s blood pressure frequently. This is based on
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the knowledge that pheochromocytoma of the
adrenal medulla releases excessive amounts of
a. catecholamines.
b. rennin.
c. aldosterone.
d. glucocorticoids.
*tumor in adrenal medulla > hyperstimulation of
PNS
- inc catecholamines
*dx: urinary and plasma cathecholamines are inc
*fight/flight response
*s/sx: HPN, headache, hyperhidrosis - excessive
sweating, hyperglycemia - dahill nasa sympa siya
alam ng body niya na need niya ng glucose, dahil
nasa active form siya, hypermetabolism
*other: agitation, psychoneurosis, dilated pupils
*mgt: alpha adrenergic receptor blockers
DOC: Phentolamine
- smooth muscle relaxant: Sodium nitroprusside -
para hindi ma overwork d/t inc cathecolamines
- Beta andrenergic blocking agents: Propanolol
- cathecolamine synthesis inhibitors: alpha-methyl P
tyrosine
- insulin
41. A 60-year-old man seeks medical attention
because he has been vomiting blood and passing
bloody stools. The tentative diagnosis is cirrhosis of
the liver. Which information in the client's health
history most likely relates to the development of
cirrhosis?
A) He drinks a fifth of whiskey
daily. – Laennec’s: alcohol induced –
main cause ; also pancreatitis
B) He is a Vietnam veteran.
C) He has a history of pancreatitis.
D) He has been taking antihypertensive
medications for the past 15 years.
42.If the client's cirrhosis is advanced, what will the
nurse most likely find during the initial health
assessment?
A) Laboratory results that reveal an
elevated serum cholesterol level.
B) There are spider-like blood
vessels on the skin. – portal HPN >
ascites > distention > blood vessels of
abd will dilate > spider angioma
C) The scrotum is unusually large and
edematous.
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43.Which assessment finding indicates that the
client with cirrhosis is bleeding from somewhere in
his upper gastrointestinal tract?
A) He has mid epigastric pain.
B) His stools are black and sticky. –
melena ; hematochezia – lower GI, fresh
blood/reddish
C) He states that he feels nauseated.
D) His abdomen is distended and shiny.
44.The care plan indicates that the nurse should
monitor the client with cirrhosis each day for signs
and symptoms of ascites. To carry out this nursing
order, which nursing action is most appropriate?
A) The apical and radial pulse rates
are counted.
B) The lying and sitting blood pressure
are taken.
C) The specific gravity of the urine is
checked.
D) The circumference of the
abdomen is measured. – abd girth
45.The physician considers performing a liver biopsy
on the client with cirrhosis. If a liver biopsy is
performed, immediately afterward it is most
important for the nurse to assess the client for
signs of
A) hemorrhage. – after: lie on right side –
apply pressure on punctured site – to prev
bleeding and hemorrhage ; dec clotting; fat
soluble vitamins: vit ADEK
B) infection.
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
side.
D) Elevate the client's legs on two
pillows.
47.Instead of a liver biopsy, a magnetic resonance
imaging (MRI) test is ordered. Before the MRI is
performed, which nursing action is essential?
A) The nurse administers a pretest sedative.
B) The nurse removes the client's dental
bridge. – metals are contraindicated ; combi of
magnet and sound waves > visualization ;
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exemption: aluminum and titanium alloy – capable
of being processed in MRI – not attracted to
magnet: prothesis ; C/I: pacemaker
C) The nurse records the client's body
weight.
D) The nurse inserts a Foley retention
catheter.
48.The MRI confirms the diagnosis of hepatic
cirrhosis and reveals a large amount of fluid in
the peritoneal cavity. A paracentesis is planned.
Which nursing action is most appropriate prior
to assisting with the paracentesis?
A) The nurse asks the client to
void. – prev puncture of bladder
B) The nurse withholds food and
water.
C) The nurse cleanses the client's
abdomen with Betadine.
D) The nurse obtains a suction
machine from the storage room.
49.After the paracentesis has been
performed, which nursing responsibility
is essential?
A) Increasing the client's oral fluid
intake
B) Administering a prescribed
analgesic
C) Recording the volume of
withdrawn fluid
D) Encouraging the client to deep-
breathe
50.When administering an intramuscular
injection to the client with cirrhosis of
the liver, which nursing action is
essential to perform?
A) Cleanse the site with Betadine.
B) Inject no more than 1 mL at any
given site.
C) Obtain a vial of vitamin K and place
at the bedside
D) Apply prolonged pressure to the
injection site. – maliit lang
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 punctured site, sapat na to – SANA
OL ENOUGH :<
51.Which laboratory result, if elevated, is
most indicative that the client may
develop hepatic encephalopathy?
A) Serum creatinine
B) Serum bilirubin
C) Blood ammonia
D) Blood urea nitrogen
*HEP ENCEPH:
- Liver - sa ilalim may 2 kidneys
- Ingest CHON > pass liver > urea > ammonia
- kidney: urea > urine
- ammonia retention - liver damage
- urea/nitrogenous - kidney damage - kasi na-
process ng liver to ammonia
*BUN - not confirmatory because it is dependent
on CHON intake
*hepatic:
isa-isip: hep enceph
isa-puso: hep cardiomyopathy
isa-balat: jaundice
*kidney:
renal enceph
renal cardiomyopathy
uremic frost
52.Which assessment finding best indicates that the
cirrhotic client's condition is worsening?
A) He is difficult to arouse. – excessive
ammonia in the brain is toxic > enceph > LOC
C) He develops pancreatitis.
B) His urine output is 100 mL/h.
D) His blood pressure is 122/60 mm Hg.
53. The seriousness of the client's condition
is explained to his wife. She is prepared for
the possibility of her husband's death. The
client's wife cries as she recalls various
significant events she and her husband
shared together. Which nursing action is
most therapeutic at this time?
A) Offer to call a close family member.
B) Listen to her express her
thoughts.
C) Suggest that she call the clergy at
her church.
D) Ask about her future plans in life.
54.A 48-year-old man comes to the emergency
department because of severe upper abdominal
pain. He reports that the pain came on
suddenly a few hours ago and nothing so far
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has relieved it. The nurse observes that the
client is curled in a fetal position and is rocking
back and forth. Which action would best assist
the nurse in further assessing the client's pain?
A) Determine if the client can stop
moving.
B) Ask the client to rate his pain
from 0 to 10.
C) Observe if the client is breathing
heavily.
D) Give the client a prescribed pain-
relieving drug.
55.Which laboratory test, if elevated, provides the
best indication that the client's pain is caused by
pancreatitis?
A) Serum bilirubin
B) Serum amylase
C) Lactose tolerance
D) Glucose tolerance
*pancreatic enzymes:
Amylase – carbs – 1st to elevate
Lipase – fats
Trypsin – protein ; most damaging
Given w/ food
Never double dosages > autodigestion
56.The physician orders the insertion of a
nasogastric sump tube. To determine the length for
inserting the tube, the nurse most correctly places
the tip of the tube at the client's nose and
measures the distance from there to the
A) jaw and then midway to the sternum.
C) midsternum and then to the umbilicus.
B) mouth and then between the nipples.
D) nose to ear and then to the xiphoid
process. – NEX ; FID Me
Feeding
Irrigation
Decompression
Medication
57.If the client turns blue and coughs as the
nasogastric tube is inserted, which additional sign
indicates that the tube has entered the respiratory
tract?
A) The client cannot speak. – nasa airway ;
withdraw > re-lubricate > re-insert
C) The client begins to sneeze.
B) The client cannot swallow.
D) The client begins to vomit.
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58.After being NPO (nothing by mouth) for several
days, the nasogastric tube is removed and the
client is placed on a bland, low-fat diet. Which food,
if found on the client's breakfast tray, should be
removed?
A) Stewed prunes
B) Skim milk
C) Scrambled eggs – egg yolk – rich in
cholesterol
D) Whole wheat toast
59.Before discharging the client with pancreatitis,
which information is essential for him to receive?
A) He must never donate blood again
B) He must not drink alcohol in any form
C) He must avoid lifting heavy objects
D) He must forgo taking strong laxatives.
60. Nurse Bundat is caring for a client who is at risk
for developing gastritis. Which finding from the
client‟s history leads the nurse to this conclusion?
a. The client is lactose-intolerant and cannot
drink milk.
b. The client recently traveled to Mexico and
South America.
c. The client works at least 60 hours per
week in a stressful job.
d. The client takes naproxen sodium
(Naprosyn) 500 mg daily for arthritis
pain. – NSAID: GI irritants
61. The nurse is caring for a client with a gastric
ulcer who suddenly develops sharp mid-epigastric
pain. The nurse notes that the client‟s abdomen is
hard and very tender to light palpation. Which is
the priority action of the nurse?
a. Placing the client in a knee-chest position
c. Inserting
b. Preparing the client for emergency
surgery – peritonitis – possible rupture
inside
d. Administering morphine 2 mg IV as
ordered by the physician.
62. The nurse is caring for a client with peptic
ulcer disease. The client vomits a large amount of
undigested food after breakfast. Which intervention
will the nurse prepare to do for the client?
a. Administer a soap suds cleansing enema.
c. Insert a nasogastric (NG) tube to
low intermittent suction. – gastric
elavage / decompression
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b. Change the client‟s diet to clear liquids
only.
d. Administer prochlorperazine (Compazine)
10 mg IM.
63. The nurse learns that a client who is being
treated for peptic ulcer disease is still "having
problems". Which of the following should the nurse
instruct this client?
a. Smoking cessation techniques. –
triggers cephalic phase of digestion > inc
HCl acid
c. Avoid eating breakfast.
b. Have the largest meal of the day at
lunchtime.
d. Make sure the client is eating a bland
diet.
64. The nurse monitors a client for early signs
of dumping syndrome. Which is not included?
a. Bradycardia
b. Vertigo
c. Sweating
d. Diarrhea
*common compli of antrectomies
a. Billorth I - gastroduodenostomy
b. Billroth II - gastrojejunostomy
umikli GI tract nila > rapid gastric emptying time:
DIARRHEA, DIZZINESS, DIAPHORESIS,
DROWSINESS
mgt:
- diet: SFF high CHON, High fat, low CHO - dapat
mahirap ma-digest para mas tumagal sa tiyan
- D - dry food is a must - para hindi mabilis
mabusog
- D - direct to lying down position after eating -left
side lying: ang stomach nasa left
- D - don't take large fluids with meals - para hindi
mabilis mabusog
65. The nurse is caring for a client with colon
cancer and a new colostomy. The client wishes to
talk with someone with a similar experience. Which
is the nurse‟s best response?
a. I will make a referral to the
Philippine
Cancer Society."
b. "You can get all the information you need
from the enterostomal therapist."
c. "I do not think that we have any other
clients with colostomies on the unit right
now."
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 d. "Most people who have had a colostomy
are reluctant to talk about it."
66. The nurse is caring for a client who just had
colon resection surgery with a new colostomy.
Which teaching objective will the nurse include in
the client‟s plan of care?
a. The client will understand colostomy care
and lifestyle implications.
b. The client will learn how to change the
appliance.
c. The client will demonstrate correct
changing of the appliance before
discharge. – retdem
d. The client will not be afraid to handle the
a nasogastric tube to low intermittent
suctionostomy appliance tomorrow.
67. A 23-year-old woman is being evaluated in
the emergency department for acute lower
abdominal pain and vomiting. During the nursing
history, the most helpful question by the nurse to
obtain information regarding the patient‟s condition
is?
a. "What type of foods do you usually eat?"
c. "What is your usual elimination pattern?"
b. "Can you tell me about your pain?"
d. "Is it possible that you are pregnant?"
68. A client experiences regurgitation and
dyspepsia. The nurse assists the client to assume
an upright position. Which of the following
statements by the nurse would best describe the
purpose of this measure?
a. "It prevents the flow of gastric
contents into the esophagus."
b. "It decreases the inflammatory
changes in the esophagus."
c. "It enhances and strengthens
esophageal peristalsis."
d. "It increases the lower esophageal
pressure."
69. Because a client has Crohn‟s disease, plans
for nursing intervention should include?
a. Weight reduction measures and low
calorie.
b. Frequent application of lubricant
location and discouraging scratching.
c. Teaching the importance of
following-up liver function test after
discharge.
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d. Perianal care and restoration of
fluids and electrolytes. – diarrhea ;
Inflamm Bowel Dse
*Crohn's dse: 5-6 stools/day
*Ulcerative colitis: 20-30 stools/day
*CROHN'S DSE
- Regional enteritis - malalim sugat pero
magakakahiwalay
- small intestine: ileum/ascending colon
- transmural: all layers are affected
- segmental lesions/skip
- 5 to 6 stools/day
- fistula formation kasi malalim
*ULCERATIVE COLITIS
- malalim sugat pero tuloy tuloy
- rectum/descending colon
- mucosa and submucosa only
- continuous lesions
- crypt abscess: pus formation: exudative
- 20 to 30 stools/day
- colon CA
*both has rx for peritonitis
*Dx: Crohn's - Barium swallow - "string sign" -
lulusot sa malalalim na area
*U. colitis: Barium enema - Lower GI - lesions -
pag dumaan barium, magdedeposit sa mga
sugat
*Clostridium difficile: in irratble bowel syndrome
- IBS - in colitis that produces diarrhea
*mgt: the same for both
1. low fiber diet - gastric irritant > stimulate
peristalsis - hangga't maaari rest muna ang
colon
2. TPN - to rest GIT
3. steroids - prev further inflamm
4. ostomy - depends on what part
70. During an acute exacerbation of Crohn‟s
disease, which of the following nursing diagnoses
should have priority?
a. Imbalanced nutrition: less than
body requirements related to anorexia
and diarrhea.
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
lack of information about disease process.
71. The client is diagnosed with an acute
episode of ureteral calculi. Which client problem is
priority when caring for this client?
a. Fluid volume loss.
b. Knowledge deficit.
c. Impaired urinary elimination.
d. Pain. – not necessary yung C kasi dalawa
naman ang ureters mo
72. Which statement indicates that the client
diagnosed with calcium phosphate renal calculi
understands the discharge teaching for ways to
prevent future calculi formation?
a. “I should increase my fluid intake,
especially in warm weather.”
b. “I should eat foods that contain cocoa and
chocolate.”
c. “I will walk about a mile every week and not
exercise often.”
d. “I should take one vitamin a day that has
extra calcium.”
73. The nurse is caring for an elderly client who
has an indwelling catheter. Which data warrant
further investigation?
a. The client‟s temperature is 98.0_F.
b. The client has become confused and
irritable.
c. The client‟s urine is clear and light yellow.
d. The client has no discomfort or pain.
*systemic infection > UTI (ascending) – pwede
madamay ibang organs ; urethritis > cystitis >
ureteritis > pyelonephritis > hydronephrosis
74. The nurse is observing the unlicensed
nursing assistant (NA) provide direct care to a client
with a Foley catheter. Which data warrant
immediate intervention by the nurse?
a. The NA secures the tubing to the client‟s leg
with tape.
b. The NA provides catheter care with the
client‟s bath.
c. The NA positions the collection bag on
the client‟s bed. – below bladder – drain
d/t gravity
d. The NA cares for the catheter after washing
the hands.
75. The client complains of fever, perineal pain,
and urinary urgency, frequency, and dysuria. To
assess whether the client's problem is related to
bacterial prostatitis, the nurse would look at the
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results of the prostate examination, which should
reveal that the prostate gland is:
a. Soft and swollen
b. Reddened, swollen, and boggy
c. Tender and edematous with ecchymosis
d. Tender, indurated, and warm to the
touch
*not soft, boggy, ecchymosis
76. Phenazopyridine hydrochloride (Pyridium) is
prescribed for a client for symptomatic relief of
pain resulting from a lower urinary tract
infection. The nurse teaches the client:
a. To take the medication at bedtime
b. To take the medication before meals
c. To discontinue the medication if a headache
occurs
d. That a reddish orange discoloration of
the urine may occur
77. A 69 – year old male client has been diagnosed
to have benign prostatic hypertrophy. BPH is
primarily associated with which of the following?
a. Chronic bacterial invasion of the urinary tract
b. Endocrine imbalances associated with aging
c. Tumor growth due to excessive smoking
d. Local inflammation of the prostate due to
contamination from rectal organisms
78. The client has been diagnosed to have cancer of
the bladder. The characterisctics manifestation of
the client more likely would be:
a. Oliguria – kidney prob
b. Burning or urination – UTI
c. Painless hematuria
d. Incontinence
79. The client was diagnosed with acute renal
failure. He has been prescribed low protein, low
potassium and low sodium diet. A teaching program
should include:
a. Encouraging the client to include raw
carrots , tomatoes and cabbage in the diet
b. Recommending protein of high
biologic value such as eggs, poultry and lean
meat – easily processed, easily absorbed, easily
excreted ; ex: CHON shakes: non biologic
c. Pointing out that raw fruits such as
bananas, cantaloupe and oranges may be included
in the diet
d. Allowing the client to have cheese, canned
foods, and processed foods.
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80. Patients with urolithiasis need to ne encourage
to:
a. Decrease fluid intake
b. Strain all urine
c. Supplement diet with calcium
d. Void every 6 – 8 hours
81. You‟re assessing a 24-year-old woman who
might have a urinary tract infection (UTI). Which
statement by the client suggests that UTI is likely?
A. “I urinate large amounts.”
B. “It burns when I urinate.” – dysuria
C. “I go for hours without the urge to urinate.”
D. “My urine has sweet smell.”
82. You must send a patient for a magnetic
resonance imaging (MRI) study of his kidneys.
Identify two primary nursing considerations in
preparation for the MRI.
A. Coordinating the MRI with other patient care
activities and informing the patient about the
test
B. Giving all scheduled medications and
completing the bath before the test
C. Report metal screening findings to the
MRI department and sedate for
claustrophobia before sending him or
her to the MRI department
D. Make sure the patient is NPO and hold all
medications until the test is completed
83. The main indication for hemodialysis for a client
who has chronic kidney failure is:
A. Ascites
B. Acidosis
C. Hypertension
D. Hyperkalemia – cardiac arrest
84. A client with acute kidney failure is to
receive a very low-protein diet. This diet is based
on the principles that:
A. A high-protein intake ensures an adequate
daily supply of all amino acids to
compensate for loses
B. Essential and nonessential amino acids are
necessary in the diet to supply materials for
tissue protein synthesis
C. This supplies only essential amino acids
reducing the amount of metabolic waste
products, thus decreasing stress on the
kidneys
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D. Urea nitrogen cannot be used to
synthesize amino acids in the body, so the
nitrogen for amino acid synthesis must
come from the dietary protein
85. To obtain an accurate urine output for a
client with a continuous bladder irrigation (CBI), the
nurse should:
A. Measure the contents of the bedside
drainage bag
B. Stop irrigation until the urine output is
determined
C. Subtract the volume of the irrigant
from the total drainage – baseline data
D. Ensure that urine and irrigant drain into two
separate bags
86. Which data would support the client‟s
diagnosis of acute bacterial prostatitis?
a. Terminal dribbling.
b. Urinary frequency.
c. Stress incontinence.
d. Sudden fever and chills.
87. The client is admitted to a nursing unit from
a long-term care facility with a hematocrit of 56%
and a serum sodium level of 152 mEq/L. Which
condition would be a cause for these findings?
a. Overhydration.
b. Anemia.
c. Dehydration. – hemoconcentration
d. Renal failure.
88. A patient with Chronic Renal Failure is being
maintained on Peritoneal Dialysis. Which of the
following is NOT an indication that the patient is
developing possible Peritonitis?
a. Slightly blood tinged drainage after the
first exchange – normal
b. Rigid abdomen with abdominal pain
c. Decreased rate of fluid return
d. Nausea and vomiting
89. The client diagnosed with ARF is admitted
to the intensive care department and placed on a
therapeutic diet. Which diet would be most
appropriate for the client?
a. A high-potassium and low-calcium diet.
b. A low-fat and low-cholesterol diet.
c. A high-carbohydrate and restricted-
protein diet. – prev azotemia:
nitrogenous waste deposition in the
body
d. A regular diet with six (6) small feedings a
day.
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ESRD: End-stage renal dse
ARF: Acute renal failure
CRF: Chronic renal failure
90. Edward needs to be taught how to detect
signs of the most serious and most common
complication of CAPD – Continuous Ambulatory
Peritoneal Dialysis, which is:
A. an abdominal hernia
B. anorexia
C. edema
D. peritonitis
91. Edward needs to be aware that toxic
wastes are exchanged during the equilibration or
dwell time, which usually lasts for:
A. 10 to 15 minutes – about 20 mins din
talaga
B. 30 minutes
C. 1 hour
D. 2 to 3 hours
*Inflow time: pagpasok ng dialysate - 10 mins
*Equilibration/dwell time - pag stay - 20 mins
*Drainage - 30 mins - mas matagal - labas
dialysate, excess fluid and wastes
92. Health information for a female patient
diagnosed as having cystitis includes all of the
following except:
A. cleanse around the perineum and urethral
meatus (from front to back) after each
bowel movement.
B. drink liberal amounts of fluid
C. shower rather than bathe in a tub.
D. void no more frequently than every 6
hours to allow urine to dilute the bacteria
in the bladder. – dapat q hour umiihi ; urinary
stasis > can cause cytitis > aaaa nag lag
93. A clinical diagnosis of nephrotic syndrome is
consistent with an exceedingly high level of:
A. albumin
B. low-density lipoproteins
C. protein in the urine – “nephrotein”
D. serum cholesterol
94. In the oliguric phase of ARF, the nurse
should anticipate the development of which of the
following complications?
A. Pulmonary edema – fluid retention
B. Metabolic alkalosis
C. Hypotension
D. Hypokalemia
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95. If the client‟s serum potassium continues to
rise in ARF, the nurse should be prepared for which
of the following emergencies?
A. Cardiac arrest
B. Pulmonary edema
C. Circulatory collapse
D. Hemorrhage
96. The client‟s blood urea nitrogen (BUN)
concentration is elevated in renal failure. This is
likely due to:
A. Fluid retention
B. Hemolysis
C. Below normal metabolic rate
D. Reduced renal blood flow
97. The client undergoes a transurethral
resection of the prostrate (TURP) and is brought
back to his room with continuous bladder irrigation
(CBI). Which of the following statements best
explains for the CBI?
A. to decrease bladder atony
B. to remove blood clots form the
bladder
C. to maintain gateway of the urethral
catheter
D. to dilute the concentrated urine
98. The physician examines the prostrate gland of
the client. What will the nurse prepare?
A. a foley catheter
B. lubricant and gloves – KY jelly, pag wala
– laway hAHAHAHAHAHAHAHAHAH
C. urethral dilators
D. a rectal tube
99. The client appears distressed and asks the
nurse how she got the infection. The nurse explains
that in most cases, cystitis is caused by
A. an ascending infection from the
urethra
B. an infection elsewhere in the body
C. congenital structure of the urethra
D. urine stasis in the urinary bladder
100. When scheduling the administration of Lasix
(furosemide) it would be in the patient‟s best
interest to schedule the medication to be given at:
A. 9:00 am – can disrupt sleep pag
gabi
B. 12:00 noon
C. 2100
D. 12:00 midnight
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