PNLE NOV 2021 & MAY 2022

NURSING PRACTICE I: Community Health Nursing

SITUATION 1 - Nurse Nona is a newly hired community health nurse. At the start of her duty she takes into
consideration that she should assume numerous roles and functions that are primarily focused on
promoting a healthy community.

1) In order for nurse Nona to become effective in her caregiver role to the different types of clientele in the
community, she should be equipped with the BASIC knowledge about
A. Statistics C. Nursing process
B. Research D. Nursing theories
2) As planner and programmer in the community setting, Nurse Nona should understand that the
PRIMARY objective of community health nursing is focused on the importance of ____
A. Curative aspect of care
B. Restoration of full function
C. Rehabilitative part of care D. Optimum health and wellness.
3) The BEST community health nursing principle that will guide Nurse Nona in the effective performance
of her various roles and function is focused on the community that_______ A. Has different health needs
and problems
B. Is considered as a primary client.
C. Has various structures and resources
D. Is composed of individuals and families
4) As health monitor, which of the following should be considered by the nurse as health threats in the
community.
(1) Ineffective breastfeeding (2) Fire hazards
(3) Inadequate immunization
(4) Polluted water supply
A. 3, 4 C. 1, 2, 3, 4
B. 2, 3, 4 D. 1, 2
5) Which is the INITIAL task of nurse Nona as a community organizer?
A. Formulates individuals, family groups and community care plans.
B. Motivates and enhances community participation.
C. Prepares and submits required reports on time.
D. Coordinates with individuals, families, groups for health services
SITUATION 2 - Nurse Bella takes charge of handling the mental health promotion program in the midst of
the ongoing health crisis due to the COVID-19 pandemic.
6) Teaching the families on promoting mental health at home in this pandemic time should focus on the
following EXCEPT
A. Seeking community support
B. Observing open communication
C. Engaging in social media the whole day
D. Reaching out to friends
7) During this pandemic time, which of the following roles of nurse Bella should she significantly intensify
to prevent more cases of mental problems in the community?
A. Case finder C. Researcher
B. Case manager D. Surveyor
8) There are individuals who are suffering from mental health challenges due to the pandemic.
The BEST nursing action is ____
A. Refer for admission at the mental health unit
B. Help in setting up debriefing stations
C. Recommend hiking of a community psychiatrist
D. Set up a mental health program
9) Which of the following information about severity of mental illness would be important to the mental
health program in the community setting?
A. Mentally-ill patient are always dangerous
B. Mental illness is hereditary
C. Mental illness is not curable
 D. Mental illness is a global concern
10)After a webinar on the mental health act nurse Bella realized that the community has to change which
of the following perceptions?
A. Mental illness is not hereditary
B. Community resilience is important
C. Mental illness is incurable
D. Psychosocial services should be available

SITUATION 3 - Models and concepts in epidemiology relevant to nursing practice.

11)Her priority in managing community health needs is through knowing in depth the
PREVALENCE of diseases because it indicates the ______
A. Risks to health problem
B. Presence of health problems
C. Priority needs of the people
D. Magnitude of health problems
12) Nurse Rona and her team has been utilizing the, “EPIDEMIOLOGIC TRIAD” model of identifying
causative factors of diseases. Which of the following are not relevant to this model?
A. External agent C. Treatment regimen
B. Susceptible host D. Environment
13) There is an outbreak of measles in some areas of the community where nurse Rona is assigned.
Which of the following steps of an outbreak investigation should nurse Rona and her team begins?
A. Identify and count cases
B. Verify diagnosis
C. Define and identify cases
D. Prepare for field work
14) Nurse Rona is able to know patterns of occurrence and distribution of diseases in the community.
Per record she found out there had been cases of rabies at irregular intervals scattered in particular
places. This occurrence refers to
A. Endemic C. Pandemic
B. Epidemic D. Sporadic
15) As an epidemiology nurse, Nurse Rona’s PRIMARY function and responsibility is to
A. Assist the epidemiologist in making reports
B. Implement public health surveillance
C. Render nursing care to sick residents
D. Follow up cases and contacts
SITUATION 4 - Nurse Danica is assigned to the health education initiative of the health center. 16) Nurse
Danica would like to put more emphasis on healthy lifestyle in her health education classes. Which step of
the teaching-learning process should she FIRST start?
A. Assessing health needs
B. Evaluation of learning takes place
C. Preparing learning takes place
D. Developing health education plan

17) In planning for the health education program about healthy lifestyle nurse Danica targets to work with
parents in the community. Nothing different ethnics backgrounds among them. Which important
consideration should be part of the plan?
A. Economic C. Culture
B. Social D. Educational
18)Based on the theory of adult learning by Knowles, which of the following principles will guide the nurse
to be an effective educator?
A. Educational attainment
B. School where the participants graduated
C. Age and gender of learners
D. Environment and learner’s participation
19)Nurse Danica plans to have the residents of the community conduct brainstorming about their
community problems. Which of the following is the rationale of this teaching format?
A. Encourages problem solving and critical thinking skills
B. Links audience participation to the presenter’s speaking style and content
 C. Allows the participants to generate ideas and discuss them in group setting
D. Offers shared experiences in a familiar setting
20)Successful teaching and learning activities in any health care setting is PRIMARY fosters through.
A. Identifying motivating factors
B. Using clear and concise language
C. Establishing trust and rapport
D. Setting realistic goal and objectives

SITUATION 5 - Nurse Keena is alarmed with the rising number of re-emerging cases of pulmonary
tuberculosis (PTB) in the Philippines.—NOV 2022 LUMABAS LAHAT
21)Case finding for PTB in the community requires that the nurse should identifying persons having ____
sputum characterized as ____ .
A. Rusty, frosty C. Blood stained
B. Yellowish D. Greenish
22)In the care of patients with communicable diseases, nurse Keena should know that feces, urine, blood
and other body fluids are considered as _____
A. Portal of entry
B. Vehicles of transmission
C. Reservoir of agent D. Portal of exit
23)With the onset of the rainy season, the nurse are closely monitoring the increase of dengue cases. The
should focus their health teachings on ways to prevent dengue by ______
A. Destroying breeding places of the vector
B. Using repellent lotion
C. Burning of dried leaves
D. Wearing of protective clothing
24)Outbreak of cases of typhoid fever occurs in the community. Nurse Keena should inform the
Residents that the transmission of the disease is through __
A. A vector
Food and water
B. Blood and body fluids
C. Air
25)There are several cases of rabies in the community. Which of the following preventive measure should
Nurse Keena teach the families?
A. Impound all dogs
B. Impose “No pets allowed” rule
C. Have the dogs vaccinated
D. Report to the authorities households with dogs

SITUATION 6 - As community health nurse it is expected that she is competent in performing core
competency standards on record management.
26)Nurse Anna is aware that the domain of record management entails which of the following, except
A. Write in the kardex what has to be endorsed
B. Keep human resources update at all times
C. Report to MD orally wrong use of drug
D. Ensure entities in patient record is signed
27)Improvement of nursing service as well as patient satisfaction is also a concern of the nurse
manager. Which of the following strategies can be adopted to achieve this goal
A. Hold regular meeting with staff
B. Make chart audit
C. Plan suggestion box
D. Conduct regular rounds of patient
28)A physician in the health facility has forgotten to change antibiotics of the patient and make phone call
order to Nurse Ana. What should be the APPROPRIATE action of the nurse in this situation?
A. Ensure that the order will be signed by the physician as soon as he is back to the facility
B. Have any physician in the facility sign the order
C. Carry all phone orders and bring chart to the doctor for signing
D. Call back MD to give feedback
29)If the CHN written in the treatment record: BP 160/96, Ace inhibitor with thiazide administered, BP
decreased e at 140/88 and urine output 1200 cc for the whole shift. What type of charting is this?
A. PIE C. SOAP
B. AIRA D. DAR

30) Which of the following is the PRIMARY purpose of accurate, updated and reliable documents?
A. Use from the shift report of nurse and doctor
B. Protect nurse from doctors’ reprimand
C. Serve as evidence of legal matters
D. Audit frequency of medication utilization

SITUATION 7 - Nurse Roy assumes various roles and functions as a community health nurse. He considered
collaboration and teamwork as essential in public health.
31) Which of the following is the rationale why team is ESSENTIAL in health care
A. Helping one another
B. Makes work lighter
C. Patient safety
D. Promotes camaraderie
32) What are the MAIN components of collaboration?
A. Shared vision
B. Achievement of goal
C. Working together
D. Partnership
33) Nurse Roy, as a member of the health team, describes himself as a “good team player”. Which of
the following is the BEST characteristic of a good team player?
(1) Sense of humor (3) Inspires other
(2) Good listener (4) Proactive thinking
A. 1, 2, 3, 4 C. 1, 2, 3
B. 1, 2 D. 3, 4
34) Which of the following is an ESSENTIAL element of effective collaboration?
A. Communication
B. Belongs to one team
C. Networking
D. Delegation
35) Nurse Roy in his dealing with his co-workers instill collaborative partnership in doing their task.
Which is the aim of this type of partnership?
A. Make work faster and easier
B. Shared goals
C. Change and influence group behavior
D. Staffs satisfaction

SITUATION 8 - Nurse Nancy is in charge of the geriatric care program of the barangay.
36) To plan out for the activities intended for the elderly population the nurse should begin to _____
A. Do survey of the numbers of the elderly population
B. Get informed consent
C. Ask permission from barangay officials
D. Tap the help of experts
37) In assessing the health condition of the older persons, which is the BEST measure in determining
their functional status?
A. Financial capability of the family
B. Age of the patient
C. Activities of daily living
D. Educational attainment
38) Which information should the nurse provide to the elderly and their families regarding drug
regimen prescribed to patients?
A. Liquid medication is more convenient and safer
 B. Allow them to refuse to take medicines C. Give independence to take medicines
D. They are more vulnerable to adverse drug reactions
39) Caregiving to older persons can be burdensome to others. Members of family who are the
Caregivers. For which during home visit to the family, the nurse should look for symptoms of ____
A. Agitation C. Withdrawal
B. Burnout D. Suicidal tendency
40) For an effective program for the elderly population, which should be the appropriate approach?
A. Assign to the family
B. Supervised by physicians
C. Multidisciplinary
D. Under the care of barangay health workers
SITUATION 9 - Nurse Zoe as a public health nurse together with other members of the health team ensure
there is quality in health and nursing care in their workplace
41) Which of the following is an important tool of assessing quality in the delivery of health services?
A. Research C. Nursing process
B. Standards D. Legislation
42) Choose the key word that BEST describes quality improvement in public health.
A. Status duo
B. Improvement process
C. Very conventional
D. Perfect health facility
43) Choose the description that quality exists at the health center
A. Patient satisfaction
B. Selected delivery of services
C. Controlled by local officials
D. Rapid turnover
44) Nurse Elisa would like to enhance the process standard at the health center. Which should be her
PRIORITY nursing initiative
A. Revise manual for operation
B. Hire more new graduate
C. Upgrade the health equipment
D. Reduce operational expenses
45) Identify to whom nurse Elisa would seek help to improve health resources like medicines in order to
provide quality nursing care at the health center.
A. Head of the church
B. Secretary of health
C. Mayor
D. Governor
SITUATION 10 - Nurse Elisa has been promoted as nurse manager in the health unit. Her functions include
management of resources and environment and budgeting.
46) As nurse manager, which should she consider IMPORTANT when preparing the budget needed for
the operation of the unit.
A. All things and equipment need to be new year
B. Budget is implemented with or without money at hand
C. Cost effectiveness and efficiency are important
D. Budget is not essential for quality assurance
47) In the process of planning, which of the following, Nurse Elisa should use the plan would review the
strengths and weaknesses of the organization.
A. Operational C. Strategic
B. Nursing care D. Program
48) For cost effectiveness measure, which of the following is the BEST nursing action
A. All things should be kept at the supervisors office
B. Identify resources needed to accomplish task
C. Assign the utility worker to keep track
D. Allow everyone to take responsibility
49) Nurse Elisa advocates for a safe staffing pattern at the health center. Which BEST practice he
should instill from the staff.
 A. Delegates task
B. Give all freedom to be honest in their attendance C. Staffing pattern not important in community
setting
D. Requires staff to report on time.
50) Which of the following is a measure of a safe work environment?
(1) Complies with standards
(2) Observe protocols
(3) Adheres to policies
(4) Observe quality
A. 2, 3, 4 C. 3, 4
B. 1, 2 D. 1, 2, 3, 4

SITUATION 11- When prioritizing problems in the community, the problems are categorized as health
status, health resource or health related.
51) Is Nurse Maris correct in identifying which of them is a health resource problem?
A. Feud-between the midwife and head of the barangay sanitation committee
B. High maternal mortality rate
C. Absence of midwife in the community to render health service
D. Increase in number of death from pneumonia
52) There are five criteria in prioritizing community health problems. If nurse Maris is estimating
the proportion of the population affected by the problem, she is using what criterion in Prioritization?
A. Magnitude of the problem
B. Social concern
C. Nature of the problem
D. Modifiability of the problem
53) Select a barrier to goal setting between the nurse and the family.
A. Educational attainment
B. Socio economic status
C. Nature of employment
D. Failure of family to perceive existence of problem
54) Which is the MOST appropriate intervention should the nurse do to help family perform the health
tasks?
A. Refer family to barangay officials for guidance
B. Help family recognized the problem
C. Allow family to decide to use health resources
D. Leave the family what action take on their problem
55) Choose the steps of the nursing process that identifies the family health seeking behavior.
A. Implementation
B. Evaluation
C. Assessment
D. Planning

SITUATION 12 - Nurse Oscar is in charge of the OSTEOPOROSIS Control Program of the Health Center.
56) Nurse Oscar informs the other member of the team about osteoporosis. Which of the following is TRUE
of the disease in the Philippines.
A. There are only few cases in the country
B. The disease is not alarming
C. Filipino are aware of the incidence of osteoporosis
D. Filipino have low awareness about the disease
57) Which is the MOST important risk factor to osteoporosis
A. Menopause
B. Being male
C. With history of previous future
D. Short in height
58) Which of the following is preventive measure to osteoporosis development
A. Iron rich food
B. Calcium rich food and supplement
C. Daily jogging
D. Vigorous exercise
59) Which of the following is TRUE about osteoporosis
A. It is a silent disease
B. It is more common in men
C. It is not that alarming
D. It is only discovered after a fracture
60) The diagnostic examination for osteoporosis is geared towards measuring
A. Bone density
B. Blood volume
C. Weight
D. Height

SITUATION 13 - Nurse Telly is planning to conduct qualitative research about the life experiences of
teenage mothers in the community.
61) Which “APPROPRIATE” research design nurse Telly should use in her planned study?
A. Grounded theory
B. Phenomenology
C. Case study
D. Ethnography
62) After she had decided to conduct the study, which of the following nursing action she what should I
do next?
A. Create conceptual framework
B. Make a research proposal
C. Decide for the data analysis
D. Plan for data collection
63) Which is the APPROPRIATE means to present qualitative data?
A. Themes C. Pie graph
B. Bar graph D. Linear graph
64) Which of the following nursing actions nurse Telly must do in doing data saturation of qualitative
data.
A. Do resurvery
B. Use case study
C. Do interview more than once
D. Seek advice of expert
65) One of the study questions in the proposed study is about needs of teenage mothers. In choosing
framework to make topic more stable, which theory nurse Telly should adopt in her study?
A. Roy C. Orem
B. Maslows D. Kings

SITUATION 14 - Nurse Rina had been working as public health nurse. In working with families she values
the importance of family care plan, and other concept about community health nursing. 66) Nurse Rica is
in charge of the animal bite program of the health center. Which of the following is the causative agent of
rabies.
A. Parasite C. Bacteria
B. Virus D. Fungi
67) Which is the BEST strategy to control incidence of rabies in the community?
A. Impound dogs
B. Kill strays dogs
C. Responsible pet owner
D. Find the owners
68) Which BEST advice the nurse should give in case of dog bite
A. Wash wound with garlic
B. Do not feed the dog
C. Bleed the bitten area
D. Wash thoroughly with running water
69) What advice should be given to the owner of the dog incase of dog bite.
A. Give away the animal
B. Impound the dog
C. Kill the dog
D. Feed well and observe
70) Which IMPORTANT information the nurse should inform the public about rabies.
A. It could be prevented
B. It is an ordinary disease
C. Rabies is not deadly
D. It kills

SITUATION 15 - Nurse Erica is fully aware that being a public health nurse her work is guided by ethico-
moral principles.
71) Which is the MAIN goal of ethical practice of the nursing profession including the community
setting?
A. To protect the nurse and co workers
B. To prevent reprimand from physicians
C. For the patients family satisfaction
D. Centered on the welfare of clients and protect their rights.
72) As public health nurse Erica makes sure all the supplies and medicines needed for the
care of community are available. This is an example of the principle of
A. Justice C. Fair treatment
B. Respect D. Beneficence
73) Select nurses action in keeping with principles of confidentiality
A. Hides identity of patient
B. Shares information from patient chart in public
C. Keeps all matters about the patient as a secret
D. Discusses the case of the patient with others
74) Nurse Erica is always guided by the principle of beneficence in all that she does to all her patients.
Which of the following nursing actions is aligned with the principle of beneficence.
A. Equal and fair allocation of resources to all
B. Getting informed consent
C. Keep records of patients from public viewing
D. Promoting patient safety at all times.
75) Nurse Erica tapped all the newly hired nurses to be members of her new project. She is
observing the ethical principle of A. Justice C. Nonmaleficence
B. Autonomy D. Respect

SITUATION 16 - Nurse Henie uses the family coping index in assessing family health needs to problems
particularly of families who are vulnerable to illness.
76) Which of the following is an evidence of the poor family coping index related to healthcare
attitudes? A. A parent who washes a wound of the child with running water
B. The family who observes the habit of cleaning surroundings
C. A young mother who introduced solid food to her three-months old baby
D. A mother who brings her child to be vaccinated for measles.
77) Which of the following is the BEST evidence of a family whose family coping index on therapeutic
competence is rated as coping well?
A. Shows positive interpersonal relationship
B. Participates in the weekly clean and green program of the community
C. Maintain clean and organized household ambience
D. Visits the clinic frequently well or sick.
78) Which of the following tools used by nurse in the community setting for assessing health needs and
problems of families that is similar to family coping index?
A. Nursing theories
B. Vital statistics
C. Case study
D. Nursing diagnosis
79) In utilizing family coping index nurses should be knowledgeable that the focus of this tool is
identifying the family.
A. Strategies to deal with stressful situation
B. Manner of interaction
C. Ways of managing health needs and challenges
D. Patterns of health habit
80) Nurse Myrna is taking care of a family whose three young children are sick with malnutrition
particularly protein deficiency. Which of the following behaviors is indicative of the family’s positive
coping index.
A. Observing erratic mealtime due to the work schedule of parents.
B. Bringing children to health center for consult only when needed
C. Serving foods that children like but high in carbohydrates
D. Cooking food in a variety that include meat, dairy products and beans.

SITUATION 17 - Ms. Sandra is a newly assigned school nurse in the elementary school of the barangay. She
planned to do a physical examination of every school child.
81) In assessing the health condition of school-children, which of the following would be the findings
common to his age group? A. Cancer and other blood disorder
B. Anemia and other blood disorders
C. Lice and parasites
D. Fractures and injuries
82) In the performance of her roles and functions as a school nurse, which guiding principle should she
be considered very IMPORTANT?
A. Health is an integral part of the education process
B. The nurse is in full authority over the children
C. The local health authority supervises the school health.
D. School nursing is more focused on socialization
83) Choose how many times at least the nurse conducts physical assessment to school children.
A. Thrice a year
B. Every semester
C. Every quarter
D. Once a year
84) Who should nurse Sandra consider as a priority for home visitation?
A. Pedro 9 years old whose parents are both working B. Melissa
is 10 years old with stunted growth for her age.
C. Cindy 7 years old who has been absent due to skin lesions
D. Mike 8 years old who often sleeps during class hour
85) Which of the indicators BEST describes an effective outcome of school nursing programs and
initiatives.
A. Zero absenteeism and tardiness of pupils
B. Teachers are observers of school of health initiatives.
C. Limited information in school of health program D. Constant visits and phone calls of parents.
SITUATION 18 - Nurse Cris is about to start her community organizing activities .
86) Together with her core group, their goal is to be successful in community organization through
effective communication. Nurse Cris would like to communicate to the people the health problems they
had identified. In reaching out every household in the community, which is the BEST strategy the nurse
should employ:
A. Call for general assembly
B. Use social media
C. Send memorandum
D. Write a letter to residents
87) Which communication technique should nurse Cris employ in order to successfully capture the details
of the meeting?
A. Summarizing C. Reassuring
B. Restarting D. Validating
88) Nurse Cris received information from some community resident who suspect that a neighbor is
abusing his young child. Which should be the PRIORITY nursing action?
A. Report to police authorities
B. Notify the social worker
C. Ignore the information
D. Validate the information
89) In organizing the community in the midst of a major health crisis, which STRATEGY should nurse
Cris employ to effective communication the importance of health and safety protocol?
A. Send letter compelling everyone to follow
B. Use social media to spread the information
C. Request an elder residents to inform every one
D. Place posters and flyers in dialect in strategic place
90) In order for nurse Cris to facilitate the recognition of the community of the existence of
their health problems, which nursing action would yield BETTER result
A. Ask the barangay head to make the report
B. Set the ground rule that presence of problem is valid
C. Allows people’s participation to confirm the health problems.
D. Acts as an expert to communicate to residents

SITUATION 19 - Nurse Bea engage in both formal and informal learning activities to enhance her
knowledge about nursing theories and other concepts in nursing.
91) Nurse Bea recall the theory of nursing as caring by
A. Orem C. Kings
B. Watson D. Benner
92) Which of the following is the nursing theme of Sr. Calista Roys’ Theory
A. Self-care deficit
B. Adaptation
C. Nursing as caring
D. Transcultural
93) This theory categorizes professionals as Novice to Expert is by__________
A. Benner C. Pender
B. Abdellah D. Kings
94) Nurse Bea reviewed the elements of nursing as a profession. Which of the following is an IMPORTANT
element that characterizes nursing as a profession?
A. Has members
B. Possess body of knowledge
C. Service oriented
D. A calling
95) Nurse Bea wants to pursue higher education in nursing for her career advancement.
Aside from enrolling in graduate school, which of the following could enhance her career?
A. Participates in professional organization
B. Attends seminars
C. Conduct research
D. Attends symposium

SITUATION 20 - Nurse Levy reviews all pertinent laws that affect public health nursing.
96) RA 9173 is otherwise known as the Philippine Nursing Act of 2002. Which is the primary aim of
these laws?
A. To enhance the competence of professional nurses
B. To regulate practice of professional nursing in the country
C. To facilitate mobiling of nurses to other country
D. To promote well-being of health workers
97) The nurse closely monitors the work she delegated to the barangay health workers. She is legally
guided by this principle
A. Respondeat superior
B. The Good Samaritan
C. Res ipsa loquitur
D. Jurisprudence
98) This law promotes the well being and living conditions of health workers especially those from the
government managed facilities
A. Continuing professional development
B. Magna carta for health workers
C. Philippine qualifications framework
D. Local government code
99) It mandates the compulsory immunization of children below 8 years
A. FD 996 C. RA 9173
B. RA 11223 D. RA 10912
100) This law allows every Filipino to avail of affordable medicines.
A. Local government code
B. Primary health care
C. Universal health care
D. Generic drug act

PNLE NOV 2021 & MAY 2022

NURSING PRACTICE II: Care of Healthy/At Risk Mother and Child

SITUATION 1 - Nurse Kathy is caring for a postpartum patient. Routine postpartum care is rendered to the
patient.
1) Which assessment finding would lead the nurse to suspect a postpartum hemorrhage? Blood loss of
______
A. Less than 300 ml/24 hours
B. More than 400 ml/24 hours
C. Less than 200 ml/2 hours
D. More than 500 ml/ 24 hour
2) Which of the following is caused by the markedly distended uterus and intermittent uterine
contraction within 2 to 3 days after birth?
A. Retained placenta B. Uterine atony C. After pains
D. Boggy uterus
3) The nurse prepares a care plan for the patient. Based on Ramona Mercer’s becoming a mother
(BAM) theory, which of the following statements fosters the process of becoming a mother?
A. The woman becomes comfortable with her identity as a married individual
B. It encompasses the dynamic transformation and evolution of a woman’s person
C. A woman learns mothering behavior prior as early as a teenager
D. It accurately reflects the transitional process from being single to a married relationship 4) The
mother asks why she has a gush of blood coming out from the vagina that occurs when she first
arises from bed. The nurse’s CORRECT response should be ___
A. “Blood pools at the top of vagina and forms clots that are passed upon rising or sitting on the
toilet.”
B. “Positioning causes blood to flow out when she stands”
C. “Because of the normal pooling of blood in the vagina when the woman lies down to rest or sleep.
D. “Normal physiologic occurrence that results as the body attempts to eliminate excess fluids.”
5) Some postpartum mothers will experience difficulty voiding because of the edema and trauma of
the perineum. Which PRIORITY nursing measures stimulate the sensation of voiding?
A. Encouraging her to void.
B. Running water in the sink or shower
C. Helping the mother into the shower D. Providing cold tea or fluids of choice.
SITUATION 2 - A postpartum mother newly delivered her baby per vagina. She keeps on asking the nurse
when the basic physiologic changes occur as her body returns to a pre-pregnant state.
6) The nurse explains to the mother that the uterus will return to its pre pregnancy state in ____ weeks
A. Six C. Four
B. Three D. Five
7) In her capacity to teach , the nurse describes the changes of the uterus after childbirth to return to
a non-pregnant state as ________
A. Catabolism
B. Subinvolution
C. Contraction of muscle fibers
D. Involution
8) Which of the following conditions does the nurse explains to the patient the contributory factor that
slows uterine involution?
A. Full bladder during labor
B. Difficult birth
C. Prolonged labor
D. Infection during pregnancy
9) The nurse assesses the uterine fundus of the mother. Which part of the abdomen will the nurse
begin?
A. Symphysis pubis B. Midline
C. Umbilicus
D. Sides of the abdomen
10) The FIRST PRIORITY nursing intervention during the immediate postpartum period is focused on
_____
A. Monitoring urinary output
B. Taking the vital signs every 4 hours
C. Observing postpartum hemorrhage
D. Checking level of responsiveness
SITUATION 3 - Evelyn a multigravida, in her 20th weeks of gestation visited the community clinic with
complaints of dizziness, vertigo, and heartburns. After the physical assessment, Nurse Harper finds the
patient as malnourished.
11) Iron supplementation was prescribed because of her low hemoglobin level. Which statement if
made by Evelyn would indicate an understanding of health instructions?
A. “My body has all the iron it needs and I don't need to take supplements.”
B. “Meat does not provide iron and should be avoided.”
C. “The iron is best absorbed if taken on an empty stomach.”
D. “Iron supplements will give green color to my stool.”
12) Evelyn was given iron as a supplement vitamin to prevent maternal anemia. She asks if it will not
be affected because she is regularly taking vitamin C. Which of the following would be the BEST response
of the nurse?
A. “Take two other vitamins separately.”
B. “Take the iron after a full meal.”
C. “Absorption of iron is enhanced with vit C.”
D. “Drink milk when taking the iron supplement.”
13) Evelyn was also advised to take calcium supplements on the 2nd 3rd trimester of pregnancy. Which
of the following would ENHANCE her intestinal absorption of calcium?
A. Fat-soluble vitamins
B. Proteins
C. Minerals
D. Water soluble vitamins
14) Nurse Harper observes Evelyn has a knowledge deficit regarding fetal nutrition. Nurse Harper has
to explain that the MAIN SOURCE of nutrition for the baby is which of the following?
A. Amniotic fluid C. Placenta
B. Uterus D. Chorionic villi
15) Nurse Harper provides health instruction to the patient experiencing heartburn. Which statement
by the patient indicates a NEED for further instructions? I have to _____
A. Drink milk between meals
B. Eat small frequent meals
 C. Avoid fatty or spicy foods
D. Lie down after eating
SITUATION 4 - The giving of medication to a pediatric patient is a serious responsibility of a nurse. Nurse
Imelda has just been assigned to the pediatric wards.

16) When giving medicines to pediatric patients, dosage varies. Which of the following should nurse
Imelda consider?
A. Height and surface area
B. Size, surface area & age
C. Size, & surface area, age, & height
D. Size, surface area
17) The head nurse checks Nurse Imelda’s knowledge on administering oral medications to pediatric
patients. Which of the following statements below should she chosen as CORRECT?
A. A child’s reaction to a dose ordered by a physician is not less predictable than an adult's reaction.
B. When giving oral medication, the child as young as two years of age cannot be taught to swallow
drugs.
C. The child should be told to place the tablet in the middle of his tongue and drink water to wash
down the tablet.
D. The possibility of error is greater in the giving of medication to children than to adults. 18) In
infants and toddlers, which part should nurse Imelda often use for intramuscular injection to reduce
the risk of vascular and peripheral nerve injuries?
A. Gluteus maximus
B. Dorso-gluteal C. Deltoid muscle D. Vastus lateralis
19)Administering medication intramuscularly can produce a variety of serious adverse affects has been
revealed in comprehensive surveys of research reports. When asked by the head
nurse what is the MOST common complication that may arise , Nurse Imelda should mention___
A. Abscess
B. Nerve palsies and paralysis
C. Hematoma
D. Muscle contracture
20)Prior to administering the drugs ordered by the pediatrician, nurse Imelda needs to know if
she is giving the ordered medication to the right patient. The FIRST step is ________ A. Check
the patient’s hospital bracelet.
B. Ask the parent/ significant other to state name of patient and birth date of patient
C. Verify patient’s allergies with charts and with patients.
D. Compare medication order to identification bracelet
21)Nurse Isabelle is concerned about the patient’s welfare and her ability to comply with the doctor’s
instructions. What should be the APPROPRIATE action?
A. Include a significant other in helping the patient understand the need for rest.
B. Instruct the patient that the baby’s health is more important than her studies at this time.
C. Develop a routine with the patient to balance her studies and her rest needs.
D. Ask her why she is not complying with the prescription for bed rest.
22)Patients Alaia, who seems to be irritated with the nurse, said, “I don’t want to talk to you because
you’re only a nurse. I will wait for my doctor.” Which of the following is an APPROPRIATE response by
the nurse?
A. “I’m angry with the way you dismissed me.”
B. “So then you would prefer to speak with your doctor?”
C. “I understand. I should call your doctor.”
D. “Your doctor prescribed this for us to do nursing care.”
23)Nurse Alaia is now in a dilemma. This occurs when _____
A. There is a conflict between the nurse’s decision and that of his/her superior
B. Choices are unclear
C. There is a conflict of two or more ethical principles
D. A decision had to be made quickly under a stressful situation
24)Which of the ethical principles stipulates that the nurse is responsible for providing all patients with
care, attention and information?
A. Beneficence C. Nonmaleficence
B. Advocacy D. Veracity
25)Which action by the nurse provides a safe environment for a preeclamptic patient? A. Maintain fluid
and sodium restrictions.
B. Take off the room lights and draw the windows shades.
C. Encourage visits from family and friends for psychosocial support
D. Take the patient’s vital signs every 4 hours
SITUATION 6 - Part II of the training is the giving of the hypothetical situation for application of what was
taken during the didactic. A group was given a scenario of a pregnant woman in the OB ward.
26)The scenario states that the nurse is discussing the nursing process with a newly hired nurse.
Which of the following describes the planning phase of the nursing process? A. Identify
the nursing process?
B. Gather information if the patient’s problem has been resolved in the evaluation phase C. Review the
patient’s history during the assessment
D. Prioritize patient problems.
27)Nurse Jezyl one the group leaders reviewed the steps of the nursing process with the group.
Which of the following data should the nurse identify as objective data? Select all that apply I.
Respiratory rate is 22/min
II. Feels pain after a 10-minute walk III. Pain
is rated as 3 on a scale of 10 IV. Skin is pinkish in
color, warm and dry.
A. II and III C. III and IV
B. I and IV D. I and II

28)On the second day, the patient delivered an alive baby girl. She complains of leg pain. The nurse took
hold of the patient’s chart. Ponstan 500 mg every hours PRN for pain was ordered and was given. After
40 minutes, the patient was relieved. What step of the nursing process should the nurse have
conducted?
A. Assessment C. Evaluation
B. Planning D. Intervention
29)According to the nursing process, which of the following actions the nurse takes if the pain does not
satisfactorily relieve?
A. Wait for more time for the pain reliever to take effect.
B. Collect additional data as to why the patient has not been relieved of pain.
C. Teach the patient relaxation breathing techniques.
D. Refer to an attending physician.
30)The nurse trainor discusses the elements of documentation. Which of the following refers to being
comprehensive and timely?
A. Complete and current
B. Accurate and concise
C. Organized
D. Factual
SITUATION 7 - Patient Ellie, a 28-year-old primigravida, is admitted to a birthing center. She has been in
labor with an interval of 5 minutes apart for 10 hours now. Hypotonic contractions are observed by nurse
Nora. She feels more pain in her back than in her abdomen, sonogram shows her fetus is “borderline”
large for gestation and in occipito-posterior position.
31)Nurse Nora observes that the Ellie’s uterine contractions are irregular in frequency and short in
duration. Ellie screams in pain during contractions. Which of the following actions is considered BEST
for the nurse to perform?
A. Try to divert attention from pain
B. Administer pain reliever as ordered
C. Stay with the patient and offer her a back rub
D. Document and report frequency and duration of contractions
32)The physician is considering augmenting her labor with oxytocin. What would make nurse Nora
questions the use of oxytocin for patient Ellise?
A. She had an amniocentesis performed during pregnancy
B. Her fetus is large for gestational age by a sonogram
C. Her membrane ruptured after only 1 hour of labor
D. Her blood pressure is slightly elevated above normal
33)Nurse Nora notices patient's uterine contractions are 70 seconds long and occur every 90 seconds
when assessing the frequency of her contractions after she receives oxytocin. What would be the
nurse’s FIRST action ?
A. Give an emergency bolus of oxytocin to relaxed the uterus
B. Discontinue the administration of the oxytocin infusion
C. Increase the rate of client’s IV infusion
D. Ask client to turn to her left side and breathe deeply
34)Nurse Nora monitors the patient's knowledge that which findings indicate an adequate contraction
pattern?
A. Three to 5 contractions in a 10 minute period, with resultant cervical dilatation
B. Four contractions every 5 minutes, without resultant cervical dilatation
C. Once contraction every 10 minutes, without resultant cervical dilatation
D. One contraction per minute, with resultant cervical dilatation
35)Which of the following nursing measures would the nurse LEAST CONSIDERS to patient Ellie with
oxytocin drip?
A. Know how to recognize potential adverse reactions.
B. Administer oxytocin drug with caution
C. Monitor patient closely when infusing oxytocin D. Inform patients about potential complications.
SITUATION 8 - Miriam at one years of age, is admitted due to pneumonia. She has IV antibiotics,
antipyretic, decongestant and vitamins as medications. She also is under oxygen therapy. 36) Nurse
Messy has been worried about Miriam’s refusal to take oral drugs. How will she handle the situation.
A. Leave the child alone
B. Seek the help of the mother in giving the oral drug.
C. Mix the drug with milk to cover up the unfavorable taste.
D. Get angry with the mother and the child.
37)As a one year child, nurse Messy understands the reason(s) why Miriam continuously refuses to take
her drugs. It is because it is normal for her age to ______
A. Have separation anxiety
B. Internalize the attitudes of others
C. Utilize magical thinking
D. Be negativity in all matters
38)The BEST way to administer oxygen on Miriam is by _______
A. Hood
B. Face mask
C. Incentive spirometer
D. Nasal catheter
39)For the IV antibiotic therapy of Miriam, the MOST common gauge used for IV cannula is gauge
A. 20 C. 22
B. 24 D. 18
40)What IMPORTANT evaluation parameter should nurse Messy observe that would show improvement in
Miriam’s condition?
A. Absence of fever
B. Absence of chest indrawing
C. Respiratory rate of 45 beats per minute
D. Respiratory rate of 55 beats per minute
SITUATION 9 - Ashley a postpartum patient, who has delivered a stillborn wants to leave the hospital
without a physician’s order. The patient is still hooked to an intravenous fluid (IVF) and is on closed post
partum monitoring.
41)To avoid liability, which of the following is an APPROPRIATE action by nurse Valerie?
A. Notify nursing supervisor of the patient's plans to leave
B. Arrange medication prescriptions at the patient’s preferred pharmacy.
C. Notify directly the attending obstetrician
D. Ask the patient about transportation plans from the hospital
42)Nurse Valerie informs Ashley of the need for early ambulation. Which of the nurse’s instructions on
ambulation is INCORRECT?
A. Assist the patient from sitting to standing position
B. Raise the head of the bed slowly to achieve the sitting position of the patient.
C. Allow the patient to rise from the bed to a standing position unassisted.
 D. Assist patients to rise from lying to sitting position.
43)While waiting for a feedback from the nurse supervisor regarding the patient’s desire to go home,
nurse Valerie opted to check on the patient. Upon entering the room, she discovers that the waste
basket is on fire. Sequence the nurse’s actions below.
I. Rescue the patient
II. Activate the fire alarm
III. Close the door to confine the fire.
IV. Put off the fire with fire extinguisher
A. IV, II and I C. I, II, and IV
B. I, II, III, IV D. II, IV and I
44)After the fire was put off, the patient was found to have absconded. What is the ethico-legal
responsibility of the attending nurse?
A. Autonomy C. Beneficence
B. Nonmaleficence D. Justice
45)Absconding is inevitable in any health care facility. who will be informed IMMEDIATELY if the patient
found out absconded?
A. Attending physician
B. Security guard on duty
C. Resident on duty
D. Nursing staff
SITUATION 10 - Catherine, 5 years of age, is admitted to the pediatric ward due to severe otalgia, fever
and irritability. The mother informed nurse Selma that the patient had upper respiratory infection three
weeks prior to admission. The admission diagnosis is Acute Otitis Media (AOM). 46) Nurse Selma conducts
her INITIAL assessment on Catherine. The patient keeps on crying and constantly pulls her right ear. What
is her MOST APPROPRIATE action?
A. Request parent to carry the child
B. Take Catherine’s vital signs C. Refer to the attending physician.
D. Assess the description and frequency of pain
47)Nurse Selma is preparing to administer Ofloxacin ear drop on Catherine per doctor’s order.
She needs to hold the bottle with her hands to warm up the solution to prevent dizziness for ____.
A. 5-6 minutes C. 3-4 minutes
B. 1 to 2 minutes D. 6-7 minutes
48)After washing her hands and gently cleaning any discharge that can be removed easily from the outer
ear, Nurse Selma positions the child . Which of the following steps follows? A. Gently press the tragus of
the ear four times in a pumping motion
B. Gently pull the outer ear
C. Drop the medicine into the ear canal.
D. Keep the ear up for five minutes.
49)Based on her knowledge on otitis media, Nurse Selma recalls that children are predisposed to AOM due
to the following risk factors, EXCEPT _______
A. Absence of breastfeeding
B. Swimming
C. Exposure to cigarette smoke
D. Poor hygiene
50)To promote drainage and reduce pressure from fluid , nurse Selma’s nursing intervention is to
have the child assume any of the following positions, EXCEPT ______ A. Tilt head
to side if sitting up.
B. Lie on the affected area
C. Put the pillows behind the head
D. Lie on the non-affected ear

SITUATION 11 - Nurse Ester is rotated to the Pediatrics Ward. As such, she needs to review the principles
and concept of human growth and development to better appreciate her role as a professional nurse.
51)Being assigned to care for pediatric patients, nurse Ester should remember which of the following
statements?
A. Toddler period ranges from 12 to 36 months
B. An infant’s tongue is smaller than the adult C. Early childhood period ranges from
3 to 7 years.
D. Breast milk provides complete infant nutrition
52) While nurse Easter was taking the temperature of Baby Chooka, the mother asked nurse Ester when
growth and development become more rapid. Her answer should be, during at months of life.
A. Ten C. Twelve
B. Nine D. Eleven
53) It is vital for nurse Ester to give concrete examples of activities to stimulate gross and fine motor
development. Examples are, which of the following
(1)Push/pull
(2)Use of scissors and pencil appropriately
(3)Poking straws into holes
(4)Stand on tiptoes if shown first
A. 1 & 2 C. 3 & 4
B. 2 & 3 D. 1, 2, 3 & 4
54) According to the World Health Organization (WHO), suicide has becomes a global phenomenon.
When taking care of emotionally disturbed adolescent patient’s, Nurse Ester should be alerted with
warning signs which often occur for at least one month before a suicide attempt, EXCEPT
A. Increase in initiative
B. Verbalization of suicidal thoughts
C. Crying
D. Sleep disturbances
55) During one of the nursing rounds, the pediatric ward head nurse asked nurse Ester the inclusive ages
considered as the transition from childhood to adulthood but sometimes
extending until college graduation. Her CORRECT answer should be
A. 15 to 18 C. 11 to 18
B. 12 to 16 D. 12 to 18

SITUATION 12 - In a birthing station, five postpartum mothers delivered 2 hours, 4 hours, and 6 hours
ago,respectively. All of them are multigravida patients. Adalynn, the nurse educator opted to conduct
health education on a postpartum hemorrhage.
56) Nurse Adalynn explains to the mothers that early indication for hypovolemia caused by postpartum
hemorrhage is
A. Increasing pulse and decreasing blood pressure
B. Altered mental status and level of consciousness
C. Dizziness and increasing respiratory rate
D. Cool, clammy skin, and pale mucous membranes
57) The nurse educator Adalynn reviewed the risk factors for postpartum hemorrhage for the Mothers.
Which of the following factors is NOT included?
A. Ruptured uterus
B. Uterine atony
C. Overdistended uterus
D. Retroversion of the uterus
58) During the normal postpartum course, when would the nurse expect to note the fundal assessment
that will be in line with the umbilicus?
A. Immediately after the delivery
B. 4 days after the delivery
C. When the client’s bladder is full
D. The day after the delivery
59) A postpartum patient asks nurse Adalynn when she may safely resume sexual activity. Which of the
following information should the nurse tell the patient on resumption of sexual activity?
A. In 2 to 4 weeks
B. At any time
C. After the 6-weeks physician check-up
D. When her normal menstrual period has resumed
60) Nurse Adalynn discusses the possibilities of future postpartum hemorrhage with the patients. Which of
the following increases the absorption of vitamin k?
A. Proteins C. Mineral
B. Carbohydrates D. Fats
SITUATION 13 - During the nurse’s rounds, the head nurse noticed that the intake & output sheets have
not been filled up.
61) Based on the findings, what should the head nurse do?
A. Ask the staff nurses the reasons for the failure to properly fill up the intake & output flow sheet.
B. Give the staff nurses first warning
C. Conduct a need assessment
D. Review the orientation program
62) The head nurse decided to coach her staff nurses. One of the questions she raised was what fluids
should be excluded in the I & O flow sheet. The CORRECT response should be, which of the following?
A. Intravenous fluids C. Solid foods
B. Gelatin D. Beverages
63) The head nurse emphasized to the staff nurses what NOT to be included under the output list. The
answer should be, which of the following?
A. Drainage from tubes
B. Solid/hard feces
C. Urine
D. Vomitus
64) The BEST time to record the intake & output is
A. During endorsement
B. After endorsement
C. Right before endorsement
D. Anytime before duty
65) A patient’s I & O is vital for patients with chronic heart failure. The MAIN purpose of recording
accurately the I & O of such patient is to
A. Determine if client is improving or not
B. Find out if there is still water retention in the interstitial cells
C. Detect cardiac overload
D. Determine weight gain/loss

SITUATION 14 - The group of nurses assigned in the delivery room is interested in conducting a study on
the experiences of pregnant women in labor. They are thinking of qualitative research. 66) In the
presentation of results of qualitative research, the nurse researcher uses as a reference in the write-up the
person.
A. First C. Fourth
B. Second D. Third
67) Nursing as a human science, deals with the critical and fundamental differences in attitude towards
their respective phenomena. Which of the following is an aim of human science?
A. Construct prediction
B. Seeks causal explanation
C. Set control
D. Makes meaningful interpretation
68) The group was observant as to the activities taking place in the delivery room. One of the activities
involve social processes, which can be better explored. Which of the following qualitative research method
should be used?
A. Grounded theory
B. Historical research
C. Descriptive phenomenology
D. Case study
69) After the data analysis of their study, experiences of pregnant woman in labor, they returned to the
participants to determine the accuracy of the emerged themes. Which criteria of Trustworthiness is the
group doing? A. Confirmability C. Transferability
B. Credibility D. Dependability
70) The group used an audio recorder to capture what transpired during the interview. After the
transcription, which of the following action is APPROPRIATE for the group to do with the audiotape?
A. Keep audiotape in a vault and dispose it a year after.
B. Submit the audiotape to their research adviser
C. Throw it in the trash bin immediately after it was used.
D. Post the recording on their university research website for others to listen.
SITUATION 15 - Marie, OB-GYN head nurse, conducted an in service program on staff development.
71) Head nurse Marie, discussed that the MOST frequently neglected area in management is
A. Managerial knowledge
B. Professional development
C. Clinical skills
D. Successful communication
72) A critical component of the supervisory process is delegation. Which of the following is the MOST
empowering to staff?
A. Effective delegation does not require nurses to know the abilities and weaknesses of staff.
B. Delegation frees the manager to do other tasks while empowering staff C. Delegation fosters
the responsibility of staff while increasing professional growth.
D. Delegations start at top management down to subordinates.
73) Head nurse Marie discussed negotiation. The focus of negotiation is to create a
A. Sooting situation
B. Third-party consultation
C. Trade-off
D. Win-win situation
74) Supervision occurs after delegation. What is the PRIMARY purpose of supervision? A.
Influences the organization’s approach in recruitment, promotion and personnel evaluation.
B. Improves staff compliance with policy and procedure C. Assigns appropriate
work tasks to the best qualified individual.
D. Enhance the delivery of quality nursing care.
75) Delegation involves the transfer of care to an individual. What is the BEST criterion when delegating
staff? A. Responsibility C. Flexibility
B. Adaptability D. Competence

SITUATION 16 - Therapeutic communication promotes understanding between the sender and receiver.
Nurse Gary should be absent with the common effective and achievable. 76) When a patient says, “I
am not sure if I should undergo colonoscopy or not as I am scared.” Which of the following is the MOST
appropriate communication technique that Nurse Gary use?
A. Touch C. Restating
B. Clarifying D. Silence
77) When a patient says, “Whenever I see my husband visit me, I feel depressed.” Nurse Gary says, “Your
husband depresses you?” the therapeutic communication is which of the following
A. Restatement C. Focusing
B. Focusing D. Seeking clarification
78) When a Nurse Gary says to the patient, “Tell me more about your experience when you have the
colonoscopy.” Which of the following therapeutic techniques is Nurse Gary using?
A. Focusing
B. Clarifying
C. Encouraging elaboration
D. Restating
79) When nurse Gary says, “Tell me more about the experience. I wish to hear about.” Which of the
following therapeutic communication techniques is nurse Gary using?
A. Restating
B. Seeking clarification
C. Open-ended questions
D. Summarizing
80) When Nurse Gary tells the patient, “You will be wheeled in to the OR and will be hooked to an IVF
where the anesthesia will be given intravenously.” Which of the following therapeutic communication
techniques is nurse Gary using?
A. Clarification C. Giving information
B. Summarizing D. Reflection

SITUATION 17 - A pediatric patient, 12 years old, is admitted to the private room with a tracheostomy tube.
81) Since the staff nurse assigned to the patient does not have any experience in caring for a patient with
tracheostomy tube, who among the following should NOT do the care?
A. Medical resident
B. Medical intern
C. Charge nurse
D. Mother of child with care of tracheostomy tube experience
82) The otolaryngologist arrives to change the tracheostomy tube. Which of the following should the
nurse collaborate with for the appropriate equipment/supplies needed in changing the tracheostomy
tube. A. Emergency department
B. Central supply unit
C. Anesthesia department
D. Operating room department
83) To assure that nurse Mica will learn the proper way of caring for patients with tracheostomy tube,
the head nurse should collaborate with , who among the following personnel for the training?
A. Asst. chief nurse for clinical
B. Chief of unit
C. Asst. chief nurse for education training
D. Chief of clinics
84) The otolaryngologist ordered a change of the tracheostomy tube ties? Who among the
following should the doctor collaborate with? A. Medical intern C. Nursing aide
B. Medical resident D. Staff nurse
85) The skills of suctioning using a single use catheter for tracheostomy is more safely performed with
which of the number of assistants?
A. Four C. Three
B. Two D. One

SITUATION 18 - Josephine, a multiparous patient is admitted due to labor pains which started an hour ago.
During the vaginal examination, the nurse noted the complete dilatation of the cervix and effacement is
100 percent. The patient is in true labor pains.
86) Which of the following problems with labor and delivery is completed in less than 3 hours? A.
Precipitous C. Induced
B. Preterm D. Prolonged
87) Patient Josephine was referred to the physician, routine blood examinations were taken. After
reviewing the serum electrolyte levels an order of isotonic intravenous (IV) infusion was prescribed. Which
IV solution should the nurse prepare?
A. 5 percent dextrose in water
B. 0.45 percent sodium chloride solution
C. 10 percent dextrose in water
D. 3 percent sodium chloride solution
88) The patient during labor would anticipate some emotional support. Which of the following nursing
interventions should nurse Sarah provide to keep the patient calm?
A. Giving praise for her the sense of satisfaction regarding quick labor
B. Support in maintaining a sense of control.
C. Explanation of the effect of labor on the newborn D. Allowing the patient to express pain and
anxiety.
89) Patient Josephine asks why her labor is much shorter compared to previous deliveries.
Which of the following is the BEST RESPONSE?
A. Onset of contraction was gradual
B. Multigravida patient has shorter labor
C. Cervical lengthening was longer
D. Induction of labor was done
90) Nurse Sarah reads the physician’s prescription to administer methylergonovine maleate
(methergine) intramuscularly after delivery. The rationale for giving this medication is which of the
following?
A. Reduces the amount of lochia drainage.
B. Prevents postpartum hemorrhage.
C. Decreases uterine contractions.
D. Maintains normal blood pressure.

SITUATION 19 - Jose, 10 years old, has bronchitis. He needs oxygenation 4l/min per doctor’s order.
91) The first standard steps in oxygen therapy that the nurse should do is, which of the following?
A. Prepare the patient for the oxygen treatment.
B. Check the chart for ordered flow rate and oxygen delivery method.
C. Gather all the equipment and supplies.
D. Assess the patient's condition.
92) In planning for Jose’s oxygen therapy, the nurse shall consider which of the following, EXCEPT
A. Need for a humidifier
B. Length of tubing
C. Determine the age of Jose
D. Manner of administering oxygen, continuous or intermittent
93) The PRIORITY nursing action of the nurse for Jose due for oxygen therapy is A. Attach
the humidifier and connect tubing to the oxygen delivery device.
B. Connect the flow meter to the pipe in the oxygen outlet.
C. Turn on the oxygen
D. Check the flow
94) What PRIORITY precautionary measure should be done by the nurse during the oxygen therapy?
A. Limit visitors
B. Attach “No Smoking” signage
C. Check humidifier’s water regularly D. Connect belt to oxygen tank
95) One evening, Jose complained of dyspnea despite continuous oxygen therapy. What should be the
nurse’s INITIAL intervention? A. Give PRN medication.
B. Refer patients to the physician.
C. Assess the patency of the tubing.
D. Reassess the patient.

SITUATION 20 - Head nurse Wilma has been encountering errors in documentation and records
management based on her review of the nurses’ notes in the patients charts. To solve the issue, she
decided to conduct a lecture on proper nursing documentation and management of records.
96) At the start of her lecture, head nurse Wilma asked the purpose of the nursing process. Which of the
following purposes is the CORRECT answer?
A. Reduce the number of forms of the chart B. List the patients health problems C. Record the patient’s
progress D. Provide confidentiality of the chart
97) One of the staff nurses was asked about the principles to be observed when charting patient’s
progress accurately. Which of the following principles would be the CORRECT answer?
A. Statement are qualified by the use of “seems” and “appears”
B. Assumptions and conclusions are reported
C. Specific and definite words or phrases are used.
D. General statements and measurements are used.
98) Which of the following is NOT a characteristic of charting?
A. Complete C. Objective
B. Subjective D. Accurate
99) During nursing endorsements, the kardex is used. Which of the following statements is NOT correct it
is
A. Kept up to date
B. A quick reference for current information about the client.
C. Consists of folded card for each patient D. Part of the medical record.
100) A sample of an error in charting was shown by head nurse Wilma. Which of the following is the
CORRECT solution to remedy the error?
A. Recopy the sheet and destroy the original sheet
B. Use a single line to cross out the error, the write the date , time and sign the correction
made
C. Use correction fluid to erase the error
D. Use eraser to remove the wrong entry

PNLE NOV 2021 & MAY 2022

NURSING PRACTICE III: Care of Clients with Physiologic and Psychosocial Alterations,
Part A
SITUATION 1 - Nurse G is assigned in the morning shift of the post-anesthesia care unit (PACU) and has a
patient for admission.
1) The “INITIAL” priority assessment performed by the nurse, when admitting a patient in the unit after
abdominal surgery is to check for ______
A. Surgical site for drainage and hemorrhage
B. Skin color and temperature
C. Responsiveness to painful stimuli and noise
D. Respiratory function and airway
2) How should the nurse position the patient who is in a somnolent status and still under the effect of
anesthesia?
A. Supine position with head bed slightly elevated
B. Prone position with a pillow under the abdomen
C. Semi-fowler’s position with a pillow supporting the head
D. Left lateral position with a pillow supporting the head
3) When a patient has bleeding after surgery, the PACU nurse expects which color is coming from the
arterial source?
A. Darkly colored, blood flows fast
B. Bright red and spurts with the heartbeat C. Slow, dark-colored, generally oozing
D. Pinkish colored-slowly flowing.
4) During the immediate post-operative phase, the PRIMARY goal of the healthcare team is to
maintain ventilation. Which of the following situations should be observed as a result of Hypoxemia.
A. Excess carbon dioxide in the blood
B. Increasing ammonia in the blood
C. Decreased oxygen saturation
D. Reduction of blood PH
5) When a patient develops a temperature of 39.8 degree centigrade after an abdominal surgery with
an ongoing blood transfusion, the PACU nurse should notify the surgeon as this may indicate
A. Abdominal tissue injury
B. Ongoing potential infection
C. Post-anesthesia drug reaction
D. Allergic reaction from blood transfusion
SITUATION 2 – Nurse Sandy is a member of the research team in a cardiovascular health facility. One of
the research priority problems in her unit is on the “effect of personalized care management strategies on
stress after an acute myocardial infarction (MI).
6) Nurse Sandy selected a framework which focuses” that humans are in constant relationship with
stressors in the environment and that nursing is keeping the patient’s system adjust to wellness which is
BEST reflected in______
A. Parse’s human becoming theory
B. Neuman’s adaptation model
C. Peplau’s psychodynamic theory
D. Swanson’s theory of caring
7) What type sampling will Nurse Sandy adopt if every third (3 rd) patients with MI are selected after a
random start?
A. Simple random C. Stratified
B. Systematic D. Cluster
8) Nurse Sandy distributed the coded questionnaires to the respondents of the study without their
names on it. What ethical safeguard is being employed in this practice.
A. Confidentiality C. Trustworthiness
B. Truthfulness D. Anonymity
9) When the findings of the study can be applied to all patients with MI under stress patients in the
whole Philippines, it satisfies which of the following criteria in research?
A. Reliability C. Generalizability
B. Validity D. Transferability
10) Nurse Sandy has completed the study and started to make a report to the research department, a
written brief summary is submitted which is known as _______.
A. Narrative C. Critical appraisal
B. Abstract D. Transferability
SITUATION 3 – Communication is a basic competency needed by the nurse in the health care delivery
system as a means of building relationships with patients and significant others. 11) Mrs Lim 52 years
old, has been in the hospital for almost a week. She approached nurse Alma who was doing her rounds
and said “I wish that my children will visit me today” Your BEST response to the patient is______.
A. “Do you have their cell phones, If you want I can call them.”
B. “Just relax, I am sure they will come and visit you today.”
C. “You sound to be lonely, do you want to be with you for a while.”
D. “There is so much traffic, anyway it is not yet time for visiting hours.”
12) Nurse Linda observe that her patient who was just admitted for abdominal pain, looks tense and quite
restless. The patient tells the nurse “I am afraid to undergo the physical examination.”
The best response of nurse Linda is_____
A. “I will inform the physician that you are afraid to undergo the physical examination”

B. “There are several patients waiting for me, the examination has to be done now”
C. “I will call your relative to be with you, while you are being examined”
D. “The examination will not hurt, would you like to sit down first and rest”
13) Ms. Cynthia, a college student is being admitted on and off in the hospital for bronchial asthma
verbalizes to the nurse “Do you think I should stop attending my classes?” What is the BEST response
of the nurse?
A. “Well to me, that is good decision for now especially with your asthma”
B. “You said, you are thinking of stopping from attending your classes?”
C. “Let us consult your physician, which one is better for you.”
D. “Do you feel that is a good decision for and your parents”
14) An elderly patient looks depressed, tells the nurse while her blood pressure is being taken,
“Go away, leave me alone, I don’t want to talk to you anymore.” The Nurse BEST Response is ___
A. “Don’t say that, otherwise I will not come and see you anymore.”
B. “I will be back in an hour, by that time, you might want to talk to me.”
C. “If you need me, just inform your watcher for some help.”
D. “Don’t say that, I will just attend to the other patients in the ward”
15) Patient Alma is receiving insulin injection for her diabetes. She tells the nurse “I don’t want to have that
insulin injection anymore.” The MOST therapeutic response of the nurse is ________ A. You need the
insulin injection, otherwise your diabetes will not be controlled.”

B. Just have your insulin injection now, I will refer you later to your attending physician.”
C. Your physician will get mad, If you will not have your insulin injection.” D. Let us sit
down, I will explain to you why you have to receive the insulin injection.” SITUATION 4 - Nurse
Lina is assigned in the Medical ward and has admitted patient Sonia, a 52year-old accountant, who
was suspected to have Crohn's disease by her family physician.
16) Nurse Lina should assess the patient for the presence of_______
I. Left lower quadrant abdominal pain
II. Diarrhea, relieved by defecation
III. Abdominal tenderness and spasm
IV. Increase in weight
V. Excessive fat in the feces
A. II & III C. II, III & V
B. II, III & IV D. I & II
17) The physician in charge of the patient ordered laboratory and diagnostic studies in order to confirm its
diagnosis. Which of the following examinations is conclusive of the presence of Crohn’s disease?
A. Upper GI series
B. Proctosigmoidoscopy
C. Barium enema
D. Abdominal radiography
18) During Ms. Sonia hospitalization, she had fever, loose bowel movement with foul smelling odor with
abdominal pain. Considering these manifestations, Nurse Lina should monitor the patient on what
specific condition?
A. Hypercalcemia C. Hyperbulemia
B. Thrombocytopenia D. Hypokalemia
19) Ms. Sonia was ordered by her physician to have total parenteral nutrition (TPN) to improve he
hydration, skin turgor and improve the overall well being of the patient. Which of the following nursing
measures should nurse Lina implement to facilitate positive patients outcome?
I. Weighing the patient daily
II. Measure intake and output
III. Provide relief of pain & discomforts
IV. Monitor IV infusion rate daily
A. I, II & III C. I, II, III, IV
B. I & III D. I & II
20) The patient is preparing to go home in a few days. What specific health technique on HOME
PARENTERAL NUTRITION (PN) should be given considering the level of education of the patient.
These include the following EXCEPT________
A. Use of aseptic technique in changing the dressing B. How to store & preparing the solution properly
C. Setting up of the infusion pump safely.
D. Flushing the parenteral nutrition line with antibiotics.
SITUATION 5 - In today's nursing practice role has been expanded to include legal responsibilities and
accountability in the workplace.
21) Nurse Lina is on duty at the ER and has been very busy that morning resulting to the administration of
a penicillin injection which is ordered to another patient. With this error, the nurse can be charged
of______
A. Malpractice C. Assault
B. Negligence D. Battery
22) Transcription of a doctor's order is a nurse’s responsibility to put the order into action. Which of the
following principles of medication safety is NOT considered to belong to transcription error.
A. Illegible handwriting of the physician.
B. Misinterpretation of the directions ordered.
C. Use of unapproved abbreviations in the chart.
D. Wrong route of medication administration.
23) In order for nurse not to encounter legal problems in drug administration which of the following 7 rights
of drug administration should be implemented under the category of “Right Drug” Read the label of the
drug ______ three (3) times.
I. Before removing from the shelf II. Before
measuring actual dose.
III. Before opening a unit dose-container.
A. II & III C. I, II & III
B. I & II D. I, II, III, IV
24)Nurse Edna admits a patient from the ER to the medical unit. The patient is very restless with IV lines
and a urinary catheter. She was put to bed and the nurse applied a body restraint without the doctor’s
order. Nurse Edna’s action can be liable for ______
A. Invasion of privacy C. Battery
B. Assault D. Neglect
25)Ms. Cruz is the supervisor of a hospital on night shift. Several nurses did not report due to jeepney
strike. When the supervisor is executing proper allocation of nurses to the PRIORITY wards to address
this concern she is observing that type of principle?
A. Beneficence C. Justice
B. Non-maleficence D. Fidelity
SITUATION 6 - Mr JC 50-year old is having an episode of bronchial asthma and was examined in the ER by a
physician and ordered to be admitted.
26)Nurse Tita admitted the patient and was observed to be dyspneic. Breath sounds are diminished upon
auscultation. Which INITIAL nursing action should she implement first? A. Position him on bed in semi-
fowler’s position
B. Administer oxygen therapy as ordered.
C. Instruct patient to nebulize self if available
D. Administer bronchodilator as ordered.
27)Based on the health history, the patient is working in a cement factory. This occupational hazard can
bring about asthmatic trigger as an _____
A. Contactant C. Infiltrant
B. Inhalant D. Ingestant
28)The physician ordered theophylline 300 mg. per day to relieve a patient's asthmatic attack.
Which of the following is NOT a mechanism of action of this drug?
A. Regulating the immune system of the body
B. Relaxing the smooth tissue of the bronchial lungs
C. Relaxing inflammation of the airways of the lungs
D. Relaxing the skeletal muscle of the bronchial airways
29)Select from the following potential ADVERSE effects of theophylline, the nurse should observe when he
drug is taken orally ____
A. Dry mucosal membrane
B. Inability to sleep
C. Irregular heart beat
D. Increased blood pressure
30)The patient is preparing to go home with his bronchodilator drugs. He asked the nurse, how will I know
if the drugs are effective? Her APPROPRIATE response is, there will be in initial decreased in ______
A. Allergic reaction C. Body temperature
B. Breath sound D. Wheezing
SITUATION 7 - Noel, a 67 year old, male, anxious and restless with his condition, was admitted by Nurse
Chona is the medical ward due to chronic back pain, general weakness and difficulty of breathing. He was
attended by the physician and was tentatively diagnosed with impending respiratory insufficiency
secondary to hypoxia.

31)It is important that Nurse Chona records accurately the restlessness caused by pain and that of
hypoxia. Which of the following should be recorded as the restlessness caused by pain?
A. Difficulty of breathing
B. Increased respiratory rate and blood pressure
C. Increased heart rate
D. Increased perspiration and change of position
32)Nurse Chona read in one nurse’s notes chart this documentation: “Refused to eat and fell from Bed”
which of the following is lacking in this documentation?
A. Time of complaint, foods missed and reaction on fall incurred
B. Referrals made on fall, medications given and reasons of falling C. Contents of complaints, reasons
of refusing meal and nature of fall
D. Time of eating, medications for back pain and intense pain.
33)Charting are important documents that are used in court proceedings, Nurse Chona should take note
that the following entry recorded would be MOST defensible in court? A. Large bruises on thigh upon
assessment.
B. Patient fell out of bed when reaching out for medication.
C. Burn on the back area observed upon auscultation.
D. Patient drunk when seen in the emergency room.
34)Which of the following charting rules will keep the nurse legally safe?
I. Documenting worries and all concerns as verbalized by the patient. II. Charting
at the end of the shift only
III. Discussing recorded cases and diagnosis of the patient.
IV. Recording all information verbalized by patient and family
A. III, IV B. I, III C. I D. II
35)Nurse Chona saw patient Noel reading his own chart and question the nurse why smoking and liquor
was recorded when he does not smoke and drink alcohol? What is the INITIAL explanation of Nurse
Chona on the record?
A. Get the chart from him and reprimand him from reading the chart.
B. The sign of negative before the words mean he is not drinking alcohol or smoking cigarette
C. Ask patient Noel to apologize for reading the chart.
D. Tell Noel that alcohol and liquor are important factors in diagnosing his ailment. SITUATION 8 -
Ethical dilemma is becoming a common scenario in the health care delivery system brought about
by the advanced technological changes on health care.

36)Which of the following is an example of an ethical dilemma?

A. A nurse providing demonstration of the possible risk if a chest tube drainage of a patient is pulled
out.
 B. Family members having ambivalent feelings whether their father will undergo amputation of a
diabetic leg.
C. A nurse is overheard by the daughter that if her mother will not take her insulin injection she will
not serve her food tray
D. The physician signs the medical directives of a terminally-ill patient admitted in the hospital with
his spouse.
37)A 70-year-old has been rushed to the hospital due to bradycardia and palpitation. The physician
suggested that a pacemaker be inserted to correct the symptoms. The patient voluntarily decides not
to have the pacemaker inserted. This is respected by the family. This is an example of the ethical
principle.
A. Beneficence C. Fidelity
B. Autonomy D. Non-maleficence
38)The ER nurse clarifies the doctor’s prescription on the dose of the pain medication based on the pain
scale assessment and patient's age. Which ethical principle is applied?
A. Fidelity C. Justice
B. Truthfulness D. Non-maleficence
39)Nurse Pat promised to a post-surgical patient, that she would come back to assist in his ambulation
after carrying out the physician’s order. This follows the principle of _____
A. Beneficence C. Autonomy
B. Justice D. Fidelity
40)When a nurse supports the welfare of the patients in relation to health, safety and personal rights, the
ethical principle followed is ____
A. Responsibility C. Confidentiality
B. Accountability D. Advocacy
SITUATION 9 - Nurse Dina is caring for several patients in the medical unit mostly suffering from endocrine
disorders. Evelyn is a 45-year-old government employee who has been diagnosed by their doctor to be
suffering from Grave’s disease. Based on her health history she has been having insomnia, palpitation and
heat intolerance.
41)A classic finding that Nurse Dina would expect to find in addition to the above complaints which is
SPECIFIC to her condition is _____
A. Decreased libido
B. Exophthalmos
C. Infertility
D. Hoarseness of voice
42)Select the two (2) primary laboratory tests findings ordered by his physician that will confirm that
patient Evelyn has grave’s disease.
I. Decreased TSH levels
II. Elevated free thyroxine levels
III. Increased TSH levels
IV. Decreased free thyroxine levels
A. II & IV C. I & II
B. III & IV D. II & II
43)Choose from the listed drug therapy that should be administered to Ms. Evelyn in order to
inhibit the synthesis of thyroid hormones and block the conversion of T3 and T4
A. Adrenergic blocks (Inderal)
B. Radioactive iodine (RAI)
C. Levothyroxine (Synthroid)
D. Propylthiouracil (propylthiouracil)
44)While Ms. Evelyn is being prepared physically and psychologically for possible thyroid surgery
, her nutritional needs was also being met with a diet that is ____
A. High fibrous, low protein, high CHO
B. High caloric, high CHO, low protein
C. High caloric, high CHO, and protein
D. High protein, low Vitamin A&C
45)Ms. Evelyn underwent thyroidectomy , six hours after surgery , she complained of numbness
of the fingers, toe and twitching of the mouth, this is MOST likely caused by
A. Thyrotoxic crisis C. Hypothyroidism
B. Hypoparathyroidism D. Infection
SITUATION 10 - Mr. Santi, a salesman was admitted because of severe abdominal pain. Based on the data
gathered, he smokes and drinks 3-4 bottles of beer every day. He appeared jaundiced, dyspneic with
enlarged abdomen. The physician suspected that he has a liver disorder and beginning esophageal
varices.
46)Which of the following clinical manifestations is not included in client with hepatic disorder?
A. Indigestion B. Diarrhea C. Nausea and vomiting
D. Abdominal bloating
47)Liver function test was ordered. In a damaged liver the following tests will reveal
I. Prothrombin time is prolonged
II. Albumin level is increased
III. Globulin level is decreased
IV. Ammonia level is decreased
A. I and II C. I only
B. I, II and III D. I, II, III and IV
48)Mr. Santos esophageal varices bleed. His doctor ordered Sengstaken-Blakemore tube to stop bleeding
Two hours after the client developed difficulty breathing. What PRIORITY action should the nurse
undertake?
A. Monitor vital signs
B. Asked client to take a deep breath
C. Deflate the esophageal balloon
D. Call the physician at once
49)In clients with esophageal varices, which of the following doctor order do you anticipate?
A. Monitoring progression of anxiety
B. Observing signs of epistaxis
C. Monitoring urine output
D. Preparing client for blood transfusion
50)Which of the following medications is likely be given to quickly stop bleeding from esophageal
varices_____
A. Neperidine C. Aldactone
B. Furosemide D. Vasopressin

SITUATION 11 - Mr. Leo, an insurance agent was ordered by his physician to be admitted to the hospital for
Coronary Artery Bypass Graft (CABG) due to three vessels blockage.
51)As a nurse, you are aware that cardiac surgery is a source of stress to the patient and family. Which of
the following strategies should the nurse implement FIRST to overcome this stress?
A. Identify coping mechanism helpful to the patient and family member
B. Recognize fears and concerns regarding surgery and future health status
C. Explore support system available during the entire hospitalization period
D. Reinforce understanding of the surgical procedure hospitalization and recovery 52) Mr. Leo,
underwent an invasive diagnostic test to determine the location of the
blockage which is needed for his CABG. This procedure is
A. Cardiac CT scan
B. Carotid Doppler
C. Magnetic resonance imaging
D. Cardiac catheterization
53) The nurse is teaching breathing exercises to Mr. Leo at what phase of the perioperative care is this
BEST performed?
A. After surgery when he is inside the recovery room
B. Immediately after he has signed the informed consent
C. During the briefing period prior to the surgical procedure
D. When he is back to his room from the recovery unit
54) Which of the following is a blood thinning drug and temporarily stopped by the physician prior to CABG
due to possible bleeding?
A. Pradaxal C. Aspirin
B. Ibuprofen D. Toradol
55) The nurse formulates a nursing diagnosis “decreased cardiac output R/T blood loss” which of the
following is the HIGHEST priority nursing action?
A. Auscultate for heart sounds and rhythm
B. Assess peripheral pulses, pedal, tibial and radial
C. Monitor EKG pattern for cardiac dysrhythmia
D. Assess arterial blood pressure every 15 min until stable

SITUATION 12 - Venus, 32 year old, a government employee has been having abdominal pain which was
on and off for almost 6 months. She has been having flatulence, and recently lost weight because of
vomiting. She consulted their office physician and she was suspected to be suffering from chronic
pancreatitis. She was advised to be hospitalized for further work-up. 56) You were the admitting
Nurse when Ms. Venus arrived in the hospital. When doing a
comprehensive pain assessment, you should conduct the procedure during the
A. Evaluation of nursing pain management
B. Initial contact with the patient
C. Course of pain management
D. The time the physician instructed you to do
57) When a patient is having pain due to pancreatitis, you expect that the pain is located in the
A. Hypogastrium right upper quadrant of the abdomen radiating to the left lumbar area
B. Epigastrium , right upper quadrant of the abdomen radiating to the left lumbar area C.
Hypogastrium, left upper quadrant of the of the abdomen radiating to the left lumbar area
D. Epigastrium, left upper quadrant of the abdomen radiating to the left lumbar area 58) You
are aware of several manifestations when a patient is in pain. Which of the following is behavioral
response to pain? A. Changes is skin color
B. Increase in blood pressure
C. Depth in respiration
D. Moaning and grimacing
59) When a patient is ordered corticosteroids, which of the following drugs will produce therapeutic effects
of reducing pain?
A. Spironolactone C. Atropine so4
B. Diazepam D. Prednisone
60) When severe vomiting occurs in this patient, it results to what particular condition?
A. Hyperkalemia C. Alkalosis
B. Hypocalcemia D. Acidosis

SITUATION 13- Collaboration and teamwork are critical to the success of health care operations. 61)
Which of the following statements is INCORRECT of collaboration in a health care setting?
A. Trust and respect are core values of a collaborative organization.
B. A shared vision is essential for collaboration in any health care operations.
C. Successful conflict resolution can help collaborative teams overcome differences D. Inter
professional collaboration & multidisciplinary collaboration can be used interchangeably
62) Nurse Lyn received on order from the attending physician of patient Pilar who was having a severe
abdominal pain of almost a double dose of morphine SO4. The nurse consulted her unit manager and the
pharmacist regarding the order which was also questioned. The nurse called the attention of the physician
regarding the dose of the drug and changed the order to at an acceptable level, what relevant principle of
collaboration is applied in this case?
I. Shared vision III. Communication
II . Respect and trust IV. Interpersonal relationship
A. I, II, III and IV C. I and II
B. III and IV D. I, II and III
63) In a tertiary hospital where Gie works as unit manager, an interdisciplinary team model is adapted
on collaboration of care. With this type of model, how is DECISION making made? A. Shared
responsibility of the group for the problem solving final decision.
B. One person makes the final decision for the treatment.
C. Partnership with the patient & team for the final decision D. All members work
together for both alternative & final decision.
64) Nurse Ime, is a member of the Quality Assurance team of the hospital and has been always rated
as very assertive. Which of the following is NOT a characteristic of an assertive person?
A. Intervene with the situation calmly and confidently
B. She stands up with what she believes & pushes control on others.
C. Articulate clearly the importance of nursing perspective.
D. Use “I” when stating thoughts and feelings & “YOU” when persuading others.
65) A patient is going for a coronary arterial bypass graft (CABG) due to a 4 blocked arterial blood
vessels. A surgical team has been formed with the cardiac surgeon as the head. Who is the member of
the health team that prepares the pre-operative orders for the patient?
A. Cardiologist C. Surgeon
B. Anesthesiologist D. Medical internist

SITUATION 14 - Roy, 65 years old, came to the outpatient clinic due to dyspnea fever and on and off
productive cough. He has smoked one pack of cigarettes per day for the last 30 years. The doctor ordered
a sputum examination, chest xray and blood culture.
66) In collecting sputum specimen, the nurse should instruct Roy to A. Breathe
slowly, cough and expectorate into the specimen container.
B. Breathe deeply and cough, expectorate into the sputum container.
C. Cough and expectorate saliva into the specimen container
D. Cough and expectorate into the specimen container
67) Which of the following are the four chronic diseases identified by WHO:
(1) Cardiovascular diseases
(2) Cancer
(3) Dementia
(4) Arthritis
(5) Diabetes mellitus
(6) Chronic Obstructive Lung disease
A. 1, 2, 3, 4 C. 2, 3, 4, 5
B. 1, 2, 5, 6 D. 2, 4, 5, 6
68) The WHO reveals that the NUMBER ONE cause of death from chronic disease worldwide, using the
2015 estimate is: A. Tuberculosis
B. Diabetes mellitus
C. Ischemic heart disease
D. Pneumonia
69) When a patient is diagnosed to have pneumonia, the breath sounds detected by the nurse on
auscultation of the affected area would be
A. Wheezing sounds
B. Stridor
C. Fine crackles
D. Deep and low-pitched breath sound
70) When there respiratory depression resulting from drug overdose, the nurse have to watch for which
of the following? A. Hyperventilation
B. Tachypnea
C. Biot’s respiration D. Bradypnea SITUATION 15 - Ms. Bel 66 year
old consulted the OPD due changes in energy level, fatigue and
not able to tolerate performance of activities of daily living. The
physician suspected that she has hypothyroid disorder and
advised admission for further work-up.
71) When the patient is with hypothyroidism, the assessment findings of the nurse that is NOT present is
A. Brittle nails
B. Hair loss
C. Dry skin
D. Fine tremors of hands
72) In assessing the thyroid gland for size, shape, symmetry, consistency and presence of tenderness,
the MOST appropriate examination modality is
A. Auscultation C. Palpation
B. Percussion D. Inspection
73) After several thyroid diagnostic tests, Ms Bel was ordered to take thyroids hormone (levothyroxine).
Which of the following nursing actions is not ADVISABLE in administering this drug? The nurse should give
A. A single dose daily before breakfast
B. A single dose daily after breakfast
C. It with a full glass of water
D. It without mixing with fruit juices
74) In monitoring the effectiveness of the drug therapy, which of the following is NOT
expected as a POSITIVE patient’s outcome? A. Regular bowel function
B. Excessive sweating at night time C. Participates in
self-care activities.
D. Metabolism returns to normal
75) The nurse is developing a nursing care plan for Ms. Bel. If the Nursing diagnosis is “Activity
intolerance R/T fatigue and depressed cognitive process”. Which of the following is an APPROPRIATE
intervention?
A. Increase mobility through early ambulation
B. Allow self-care activities with active exercises
C. Space nursing activities to promote rest and sleep D. Avoid stimulating interesting conversation.

SITUATION 16 - Resources in the healthcare delivery system are one of the challenging concerns in the
country today. Nurse Gayle is a unit manager in a tertiary hospital and conducts meetings regularly every
two weeks to her staff to address PRIORITY affecting their services.
76) Which of the following statement indicate an effective communication technique used by the unit
manager to her staff?
A. “We need to improved our nursing services , otherwise top management will take over,” B. “Let
us limit requesting supplies and equipment, our budget for our promotion might be affected."
C. “There are a lot of redundant positions in our unit, there is a need to retrench some staff." D.
“We need to discuss strategic approaches to facilitate delivery of nursing services with less expense on
our consumers."
77) For the past 6 months, several nurses have been resigning. Some have verbalized in the exit
interview that they are not happy anymore. Which of the following descriptions manifest
BEST, a nurse who has job satisfaction
A. Competitive, self-centered, euphoric
B. Empowered, enthusiastic, ethical
C. Loner, egoistic, reactive
D. Outgoing, sensitive, competitive
78) Delegation is a critical component of leadership and governance. Which of the following
empowering activities should the unit manager apply in delegation?
A. In delegation, facilitating professional growth and development of a staff is necessary B. When
delegating a responsibility to a nursing staff, modification of standards of care is permitted.
C. Delegation of responsibility in patient care has to start from top management to the staff-nurse
level
D. Delegation requires responsibility with corresponding accountability of a staff-nurse
79) Nurse Gyle is guided that the initial step of delegation is
A. Demonstrate the task and let the staff continue the next activities
B. Assess the capability of staff , change him if not performing
C. Determine the competency level of staff for the task being given
D. Explain the task to be done with the accompanying job description
80) The unit manager is planning to take her regular official business leave for the year. She has written a
letter of recommendation to her immediate supervisor for her assistant manager to
assume her position while she is on leave. This is an example of delegation by
A. Rank C. Succession
B. Authority D. Authority

SITUATION 17 - Nurse Adela is on duty in the medical unit and has two patients for discharge. Eliza, 38
years old diagnosed with diabetes mellitus and on insulin therapy for the first time and Eileen, 42 years old
who had myocardial infarction (MI).
81) When preparing a teaching plan for patient Eliza, the following are the instructions provided to
patients with diabetes mellitus. Which ONE of the teaching plan is considered NOT a
PRIORITY concern when discussing the list with the patient
A. Diet and genetic counseling
B. Exercise in extreme heat and cold.
C. Regular exercise, diet and medications.
D. Monitoring of blood sugar and urine ketones.
82) Eliza was taught by nurse Adela on how to administer self- injection insulin and rotation sites with
the use of the chart every day till her discharge. The following is the procedure for the self injection of
insulin. Which of the following are the CORRECT Sequence in self administration of the drug.
I. Inject the insulin, push the plunger all the way in
II. With one hand stabilize the skin by spreading a large area
III. Pull the needle straight out of the skin & press cotton ball over injection site
IV. Pick- up syringe with the other hand, hold and insert needle to the skin V. Dispose syringe in a hard
plastic container.
A. I, IV, III, II, V C. III, II, I, V, IV
B. II, IV, I, III, V D. IV, III, I, V, II
83) The doctor ordered a low- saturated fat, low-cholesterol diet to patient Eileen who was also going
home. From the following list of foods, which meals has to be included in the instructional plan of Nurse
Adela to her patient?
A. Pork steak, mixed vegetables with butter and cheese
B. Hamburger, macaroni salad and milk shake
C. Fried chicken, green beans, and skin milk
D. Baked fish, green beans, coffee
84) Considering that patient Eilen is a post MI patient, she was taught by the nurse on home exercises
on leg movements while resting on bed. The expected goal of his intervention is to. A. Facilitate better
digestion of food
B. Prevent stasis of urine and stone formation
C. Facilitate circulation for skin integrity
D. Prevent venous stasis in the lower extremities
85) The resumption of sexual activity is an important activity that has to be included in the home
instructions to be given to patient Eileen together with her husband. Which of the following is the SAFE
period for an uncomplicated MI to resume sexual activity?
A. One month after MI C. Two months after MI
B. 12 to 14 days after MI D. 7 to 10 days after MI

SITUATION 18 - Mo, a 22 years old nurse graduate, passed the November 2018 Philippine Nurse Licensure
examination before her birthday which is November 16. The scheduled oath-taking ceremony was set on
January 6, 2019.
86) To obtain her license to practice, she must do the following, EXCEPT:
A. Must take the oath to any government official
B. Must register in the registration division of the PRC
C. Must take the oath of professionals before any member of the PRBON
D. Must be issued a certificate of registration (COR) and profession identification card (PIN)
87) Nurse Marle has to renew her license on or before
A. January 6, 2021
B. November 16, 2022
C. November 16, 2021
D. January 6, 2022
88) For Merle to continually practice nursing, she must satisfy the requirements set by the PRC and
comply with how many units of CPD upon renewal?
A. 45 units C. 25 units
B. 10 units D. 15 units
89) After 3 years being assigned in the operating Room, Merle is interested to join the activity.
Which appropriate professional organization? A. ORNAP C. ADPCN
B. NLGN D. APO
90) What would Merle do to keep abreast with the latest trends in perioperative nursing?
A. Attend training and seminars
B. Perform researches
C. All of these
D. Pursue graduate studies

SITUATION 19 - A computer analyst of a company, was rushed to the emergency room due to abdominal
pain, nausea and vomiting, ascites and shallow breathing due to enlarged abdomen. The physician
suspected that the patient was suffering from peritonitis and was advised to be admitted for further
workout.
91) In assessing a patient suffering from peritonitis, which of the following manifestations is
NOT likely to be present? A. Rebound tenderness
B. Abdominal gas
C. Abdominal guarding
D. Abdominal rigidity
92) The overall goals set by the members of the health team once the patient is admitted includes
which of the following? I. Relief of the abdominal pain
II. Resolution of inflammation
III. Provision of normal nutritional status
IV. Prevention from complications
A. I, II, III C. II, III
B. I, II D. I, II, III, & IV
93) Diagnostic tests were ordered to the patient which included: complete blood count (CBC) and
abdominal CT scan. The primary purpose for ordering CT scan is to determine PRESENCE of
A. Amylase content C. Fluid shifts
B. Bacteria D. Abscess
94) Which of the following drugs do you expect to be ordered by the physician for severe acute pain?
A. Acetaminophen (Tylenol)
B. Levorphanol (Levo-Dromoran)
C. Percodan (aspirin)
D. Codeine (ambenyl)
95) The physician ordered the patient for paracentesis. Which of the following pre-procedure nursing
actions should the nurse perform EXCEPT _ A. Place him in upright position on the edge of the bed
B. Place him in low- lying position with knees straight
C. Check for the signed consent form
D. Instruct patient to urinate or empty bladder

SITUATION 20 - Jen is an active member of the quality Assurance (QA) team in a health facility where the
major role is setting quality standards.
96) Which of the following statements is TRUE of Quality improvement? A. Focuses
on the organizational structure rather than patient care.
B. Continually improves every process in the organization.
C. Centered on people rather than processes.
D. An approach that is externally driven by the stakeholders.
97) As a QA nurse, which of the following can Nurse adopt as a concurrent evaluation of a patient's
outcome in the unit?
I. Direct observation of patient’s condition
II. Patient’s interview in the unit
III. Face to face interview with nursing staff.
IV. Nursing audit from the patient’s chart
A. III & IV C. I, II, III & IV B. I, II &
III D. I, II
98) Nurse Jen, distributed the patient satisfaction form to the admitted patients in the hospital, this tool
is in compliance to the quality standards
A. Human resource
B. Organizational structure
C. Patient care
D. Legal-ethical
99) The QA team was alerted by the administration, that they have to anticipate for a possible
earthquake in the forthcoming days. As part of safe practice environment (SPE) standards, which of the
following are to be given PRIORITY attention by the team?
I. Electrical wires
II. Combustible materials of the building
III. Entry, exit of the building
IV. Infected waste materials
A. I, II, III, IV C. I & II
B. B. II & II D. I, II & III
100) The QA team has been bombarded by complaints of patients on their long waiting period in the OPD
before the health care professionals are examining them. In response to this concern, which type of
quality assessment should the team implement?
A. Outcome evaluation C. Ongoing evaluation B. Process evaluation D. Structure evaluation

PNLE NOV 2021 & MAY 2022

NURSING PRACTICE IV: Care of Clients with Physiologic and Psychosocial Alterations, Part B

SITUATION 1 - Research is vital endeavor nurses must engage into in order to contribute to nursing science
1) When the nurse researcher collects data at more than one point over an extended period, which
design is applied?
A. Cross-sectional C. Time sequenced
B. Time-related D. Longitudinal
2) If a research study involves an intervention and “blinding” which research design is being referred to?
A. Non-descriptive
B. Phenomenological C. Experimental
D. Descriptive
3) Which of the following statements is LEAST descriptive of a qualitative research design?
A. Researchers become involved
B. Gather data from one collection strategy
C. It is flexible and elastic
D. Strives for an understanding of the whole strategy
4) Qualitative researchers should choose their participants who can best meet the objectives of the study.
Who of the following BEST qualifies?
A. Cooperative persons in the community
B. Those readily available are thus convenient for the researcher.
C. Able to articulate and reflect on the phenomenon that they experienced
D. Persons referred by friends
5) A “full understanding” in research should be understood by the nurse researcher as _____
A. Ensuring that participants are not placed at risk
B. Explaining the study including risks and benefits
C. The right to decide voluntarily
D. Not exploiting information shared by participants
SITUATION 2 - Management of records is very vital in any health care facility. The nurse must ensure there
is due diligence in the task.
6) Nurse Gay is assigned in the medical unit. She is guided that in documentation, she should use
abbreviation that is __
A. Used automatically to save precious time.
B. Reduced to the minimum in all units
C. Approved standards list by the hospital
D. Not used at all because it can be misinterpreted
7) One error in record-keeping is illegible handwriting. What is the APPROPRIATE action by the nurse in this
situation?
A. Request the senior nurse to read the order for you B. Let the resident-on-duty in the nurses station
interpret it.
C. Call the physician who made the order.
D. Report the laps to the quality Assurance Committee.
8) When a nurse commits an error in the progress notes the BEST action she should do is to_____
A. Cross the error many times to ensure it could no longer be read and sign
B. Delete the erroneous phrase or sentence using correction fluid and sign
C. Put a line across the sentence, make the correction over it and sign.
D. Erase whatever is in error using a rubber eraser and sign 9) Which is NOT a correct statement
regarding record-keeping?
A. Failure to do it could be evidence of professional misconduct
B. It is an optional task to be done when circumstances allow.
C. It is a tool in professional practice that helps provide quality care.
D. It is part of the professional duty of the nurse.
10) The QA nurse conducts a regular audit of the medical records. The PRIMARY purpose of conducting
audit in a health facility is to_____
A. Identify errors made by health personnel B. Identify areas for improvement
C. Ensure that standards are met.
D. Promote risk management
SITUATION 3 - Health education to Bong and his family is set up prior to surgery. A program of weight gain
aims for a high protein and high calorie diet. The nurse prepares the health education plan.
11) The nurse ensure, which of the following should be present and be cooperative in the educational
program?
A. Patient, student nurses and interns
B. Patient, family and significant others
C. Head nurse and family
D. New staff nurses and nursing aides of the unit.
12) The nurse must include in the education plan, which of the following components? (Select all that
apply)
I. Objectives
II. Content and time allotment
III. Teaching and learning resources
IV. Evaluation parameters
A. II, III, and IV C. I, II, III, IV
B. I, III, and IV D. I, II and III
13) To have a simplified and more understandable implementation of the plan the nurse presents it with
use of ___
A. Printed content in cartolina
B. A lecturer
C. A co-worker
D. Colored pictures
14) Before the education plan of the staff nurse can be finalized and implemented, it is BEST that it is
reviewed by ___.
A. Nurse supervisor
 B. Medical Director C. Head nurse
D. Chief nurse
15) During the implementation process, the nurse should ensure a _______ for a better assimilation of the
teachings
A. Serious lecturer
B. Lecture to start at 11:00 am
C. Conducive time and place
D. Neophyte as sharer
SITUATION 4 - Nursing student Myra decides to do a qualitative phenomenological study on how the stigma
of AIDS affects the patients. She has previously identified 6 participants: 3 teenage girls.
16) What is the BEST way for Myra to collect data from these participants?
A. Focus group discussion
B. Survey, questionnaire
C. Individual interview
D. Observation
17) What kind of sampling method should she apply?
A. Network C. Stratified
B. Random D. Purposive
18) The statements of the findings of the study that will be formulated by Myra should be by___
A. Summarizing the sharings of the participants of both sexes
B. Identifying the answers of the males and the females
C. Describing answers of the males and females by percentages
D. Extracting meanings and themes from significant statements
19) Informed consent in this study will be obtained by Myra from the ____
A. Six participants only
B. Parents only
C. Six participants and available relative
D. Six participants and their parents
20) What is NOT important for Myra to do when listening to tape recordings? A. Do the listening as soon as
possible after the interview
B. Note for the voice tone and voice inflection.
C. Listen when she feels the motivation for a more productive time.
D. Take notice of the pauses of the participants.
SITUATION 5 - Communication is very important in a nurse-patient interaction relationship.
21) It is not enough for the nurse to listen, but she also has to validate what she heard.
The importance of validation are the following, EXCEPT
A. Perceptions influence the interpretation of a message
B. Most patients are cognitively impaired
C. Eye contact does not necessarily send the same message
D. Assist clarifying thoughts
22) To be more responsible, a nurse needs to understand the elements of the communication process.
When she initiates interpersonal communication, the element involved is_____
A. Referent C. Message
B. Sender D. Channel
23) Should the nurse encounter patients who are stressed due to their health condition, the BEST way to
communicate is through one of the following.
A. Sympathizing C. Sharing
B. Empathizing D. Listening
24) The reasons for the nurse wishing to enhance his/ her communication skills is to be able to establish
rapport, EXCEPT_____
A. Brings about change to promote well-being of patients
B. Decreased incidents of legal problems
C. Gets better evaluation rating of care and delivery
 D. Generates threat between the nurse and the patient
25) When the nurse interacts with patients face to face such as in getting information during the
assessment phase of the nursing process, the level of communication is which of the following?
A. Intrapersonal
B. Interpersonal
C. Public communication
D. Verbal
SITUATION 6 - It is necessary that records are well-recorded and properly kept if they are to serve the
organization and the requesting public well.
26) Incident reports (IRs) shall be collected for the day and due investigations
scheduled by the Quality department. Upon completion of the investigation, the Irs ____
A. Must be completed and stored on the open cabinet
B. Can be stored on the table top for easy retrieval
C. Must be summarized monthly and stored in a secured cabinet
D. Classified by date so they can be easily accessibility
27) The patient records (charts) are collected every three nights from the various departments. The night
nurse is EXPECTED to the following EXCEPT _______
A. Ensure the correct order of the chart
B. See to the completeness of the chart pages
C. Bind the charts as they are
D. Tape or repair torn pages
28) When patient record reach the medical records, the assigned staff will ________
A. Store the charts in their respective shelves
B. Separate the medico-legal charts
C. Check the completeness of the charting of the doctors and nurses
D. Bind the chart immediately
29) The charts are stored in the medical records or storage room for at least ______ years.
A. 3-5 years C. 5-10 years
B. 1-5 years D. 1-3 years
30) How many years are medico-legal charts stored?
A. 8 years
B. 10 years after the case is closed
C. 5 years
D. 10 years
SITUATION 7 - Health education on HIV-AIDS has been massive in the years prior, yet patients and their
relatives still have a number of queries and misconceptions about it.
Lerma, a young mother of 34, has been recently diagnosed with the disease. 31) Lerma is aware that
there is mother to child transmission of HIV-1. She becomes concerned and asks the nurse when it
specifically happens. The nurse answer that it can occur in the following circumstances, EXCEPT____
A. During breastfeeding
B. During casual contact
C. At the time of delivery
D. In utero
32) Lerma would like to know how she could limit further exposure to more HIV virus by using
preventive measures. The nurse informs her that the use of a highly effective male
condom that can decrease the transmission of HIV is_____
A. Non-latex C. Polyurethane
B. Latex D. Lambskin
33) Patient Lerma has a CD4 lymphocyte count which is below 200 cells/cumm. She then asks what it
means The nurse answers that ____
A. The result still falls within normal limits
B. She is in stage 3 HIV-AIDS
C. It is slightly below normal but there is nothing to worry
 D. It is a worrisome result but immediate attention in not necessary
34) The nurse counsels Lerma that the prevention of HIV infection that is usually NOT REALISTIC is
which one of the following?
A. HIV testing
B. Behavioral intervention to reduce risks
C. Total abstinence
D. Linkage to treatment center
35) Nurses are at risk for HIV exposure. Post exposure prophylaxis (PEP) DOES NOT include one of the
following?
A. Take 2-3 anti-retroviral drugs, as prescribed
B. Drugs must be taken for 28 days
C. Drugs must be taken for at least a week
D. Take the medicines within 72 hours of exposure
SITUATION 8 - The Quality Department has received numerous complaints, some of them on patient falls.
36) Nonah who is an 86-year old patient is admitted for fever and falls from the bed despite the
presence of a watcher. The head nurse was concerned since a fall protocol has been formulated for some
time now. To avoid a similar incident, which of the following is MOST effective?
A. Interview the patient
B. Interview the nurse-on-duty
C. Investigate everyone
D. Do a root cause analysis
37) The nurse informed the head nurse that the lock in the side rails does not work properly at times
and might have gotten loose in the night thus the incident of fall.
What is the APPROPRIATE thing for the head nurse to do in this regard?
A. Penalize all the nurse for not having reported such defect
B. Make a memo to the maintenance department to check involved bed and the rest of the beds
C. Punish the nurse-on-duty for not reporting such observation before the incident
D. Warn everyone this is not going to be tolerated in the future
38) The quality improvement officer-in-charge of the unit plans to conduct a meeting with the staff. The
MOST important thing to tackle is to _______
A. Inform them of their punishment
B. Review the protocol
C. Inform them of their lapses
D. Scold those involved
39) What is the INITIAL action that the nurse should do immediately after the fall mitigate the situation?
A. Document the incident right away
B. Phone the Head nurse to report the incident
C. Wait for the head nurse’s advice
D. Have a doctor assess the patient immediately 40) What lesson will the nurse learn from this
incident?
A. Tell the others to cover her up
B. Safety first report even trivial but relevant observation
C. Deny any error or omission
D. Never get caught in her omissions.
SITUATION 9 - Nilda 58 years of age was brought to the ER because of numbness on her left face and arm
and a confused mental state The ER doctor made an initial impression of ischemic stroke.
41) Nilda wonders how she developed the manifestation of ischemic stroke. The nurse explains that there
is _______
A. Extravasation of blood into the brain
B. Possible presence of a cerebral aneurysm
C. Vascular occlusion to the brain
D. An increase in cerebral blood flow
42) The nurse knows that visual-perceptual disturbances can occur in stroke when
patient Nilda manifests hemianopsia, She has _______
A. Inability to perform everyday movement and gestures
B. Blindness in half of the visual field
C. Difficulty speaking
D. Inability to understand spoken language
43) The nurse knows that initial diagnostic test that is ordered for stroke is ______
A. Carotid ultrasound
B. 120 lead ECG
C. Magnetic resonance imaging (MRI)
D. CT scan
44) The ER nurse anticipates that a thrombolytic agent would be ordered to treat ischemic attacks.
Knowing the action of thrombolytics, the nurse must particularly be alert for which adverse reaction?
A. Formation of blood clots
B. Bleeding
C. Early onset of infection
D. Allergies
45) Patient Nilda complains of shoulder pain The nurse is aware that she is prone to
have adduction of the shoulder A nursing intervention for this is to ___
A. Position distal Joint higher that proximal joint
B. Place a pillow under the arm to keep the arm close to the chest
C. Position the finger so that they are barely flexed
D. Place one pillow in the axilla to keep the arm away from the chest

SITUATION 10 - Emmy 22 years of age is a midwife in the OB ward is now complaining of contact dermatitis
from gloves.
46) Patient like Emmy who have experienced delayed hypersensitivity to latex
FREQUENTLY complains of ____
A. Flushing, Bronchospasm
B. Urticaria, laryngeal edema
C. Rhinitis , Conjunctivitis, blisters
D. Papules, vesicles, pruritus
47) The nurse knows that the diagnosis of contact latex allergy is based on history and _____
A. Latex specific igE
B. Finding IgE in serum
C. Skin patch test
D. ELISA
48) Latex allergy can be a type I IgE-mediated immediate hypersensitivity to plant
proteins from the latex of rubber. It can manifest in its MOST severe form as ____
A. Pruritus, erythema and swelling
B. Asthma
C. Anaphylaxis
D. Blisters and other skin lesion
49) Type I IgE-mediated immediate hypersensitivity reaction is promptly managed with ________
A. Theophylline B. Epinephrine C. Corticosteroid
D. Diphenhydramine
50) The best prevention management of contact latex allergy is ____
A. Applying lotion before gloving
B. Avoidance of latex product
C. Avoiding rubberized goods
D. Resigning from the job
50) The best prevention management of contact latex allergy is
A. Applying lotion before gloving
B. Avoidance of latex product
C. Avoiding rubberized goods
D. Resigning from the job

SITUATION 11 - Sins of Omission and Commission may be committed by the nurse in the course of her
duty. She must therefore be extra careful.
51) The patient for breast biopsy is very anxious and seemed not to understand her ordered surgery,
radical mastectomy. What is the APPROPRIATE action by the nurse? A. Call the supervisor to explain the
procedure.
B. Have the available resident explain the surgery further.
C. Request the doctor to give the patient more information.
D. Supply the information missed to be explained by the doctor.
52) The patient refused his intramuscular injection but the nurse proceeded to administer it anyway.
What can the nurse be accused of?
A. Moral distress
B. Trespass to person
C. Assault
D. Battery
53) The staff nurse was doing prescribed modified steam inhalation to a pediatric patient which
resulted in burns. What is NOT a RELEVANT statement to establish negligence? A. There is a duty to care
B. There is a breach in the standard C. The breach caused the harm
D. It was a verbal order by the physician
54) Staff nurse A told her co-workers that staff B is suffering from gonorrhea. What can staff A be sued
for?
A. Defamation C. Discrimination
B. Slander D. Libel
55) The surgical patient, a Jehovah's witness, reiterated non-acceptance to a blood transfusion. The
nurse defied it and the patient was transfused intraoperatively. What case can be filed by the patient?
A. Moral distress C. Trespass to person
B. Battery D. Assault

SITUATION 12 - Nurses must closely adhere to the ethical principles and rules, and not only to the laws.
56) When the nurse ensures that patients have consented to all treatments and procedures, is she is
TRUE to which ethical principle?
A. Fidelity C. Veracity
B. Beneficence D. Autonomy
57) If the nurse will refuse to perform duties for which she is not qualified, she is practicing
A. Veracity
B. Beneficence
C. Respect
D. Non-maleficence
58) The code ethics stipulates that human life is inviolable. Which statement CORRECTLY translates the
principle to the situation of the Filipino nurse as a professional?
A. It is okay to participate in euthanasia provided there is a doctor’s order.
B. Participation is permissible when the patient, family, and doctor have a written agreement on it.
C. After the patient, doctor and hospital administrators have agreed, nurses may choose to
participate.
D. Nurses shall not participate in euthanasia
59) When the physician insists that his cancer patient undergoes radiation, in addition to chemotherapy
which is CONTRARY to the patient’s and family's wishes, the physician is exercising A. Veracity C. Fidelity
B. Autonomy D. Paternalism
60) An Iranian was admitted to the hospital for kidney transplantation. He claims his donor is a Filipino
relative as required by the law. However, it was discovered later that his claim was not true. Should the
doctor fail to act accordingly to the wrong information, the nurse is obligated to refer the case to, which of
the following?
A. Medical Director C. Chief Executive Officer
B. Administrator D. Ethics Committee

SITUATION 13 - The nurse conducts health education on common types of allergy with the parents of
allergic children and adults with hypersensitivity issues.
61) During the conduct of the health education class, which communication skill involves active
listening that is being used by nurses to gain an understanding of the patient’s message?
A. Clarifying C. Attending
B. Responding D. Confronting
62) The nurse must be alert about BARRIERS to communication during the health education class so
that she can A. Use them when communicating
B. Communicate much better
C. Use them to enhance interaction
D. Rationalize wrong styles of communication
63) The mother of the atopic dermatitis patient is very concerned about scarring
that will result from the child’s frequent scratching. How will the nurse BEST communicate her
reassurance?
A. Asking the mother what she prefers: for the child to have scars or he be unable to sleep
B. Telling the mother matter of fact that scars will lighten as the child grows older anyway.
C. Tapping the hand of the mother while explaining that scarring occurs only when lesions get
infected.
D. Reminding the mother that beauty is only secondary to comfort derived from scratching
64) Because of the presence of skin lesions, atopic dermatitis affects the patient’s self-esteem and his
willingness to interact with others. The nurse communicates her nursing intervention by
A. Instructing the patient to go back to the primary physician
B. Giving instructions and counseling on preventive measures and treatments
C. Referring the patient to the dermatologist
D. Referring the patient to the psychologist
65) The adult patient who was receiving diphenhydramine (Benadryl) verbalized he was always sleepy
and fears he would sleep on the job and will get fired. The nurse will BEST calm the patient by assuring
him that his physician can readily change his medicine to A. Chlorpheniramine (Actifed)
B. Brompheniramine (Dimetapp)
C. Loratadine (Allerta)
D. Dimenhydrinate (Dramamine) (how to effect a good communication)

SITUATION 14 - Susie, 5 years old, is diagnosed with nephrotic syndrome and is manifesting
massive proteinuria resulting to decreased albumin in the blood. 66) The nurse understands
that the passage of protein in the urine is the result of_______
A. Inherited kidney disorder
B. Increased glomerular permeability
C. Rise in the production of albumin D. Intrinsic kidney disease
67) Upon clinic assessment, the nurse observes that the OUTSTANDING manifestation of the patient is
A. Weight gain C. Emaciation
B. Obesity D. Edema
68) The physical appearance of the urine of the patient with nephrotic syndrome is
COMMONLY
A. Cloudy C. Whitish
B. Clear D. Frothy
69) The patient with nephrotic syndrome is ordered corticosteroids. Who of the following are
NOT ALLOWED in the patients. A. Parents with diabetes.
B. Relatives with upper respiratory tract infection.
C. Visitors with mild asthma.
D. Personnel with allergy
70) Corticosteroids are one of the main therapy for nephrotic syndrome. Which of the following
COMMON side effects should the nurse watch for?
A. Loss of appetite
B. Increase in body hair
C. Loss of weight
D. Lowering of blood pressure

SITUATION 15 - Patient Reno, 53 years of age is pale and complains of easy fatigability. He has undergone
Complete Blood Count (CBC) where abnormal cells were found. He was diagnosed with Acute Lymphocytic
Leukemia (ALL).
71) The nurse ensures that the isolation procedure APPROPRIATE for Reno is______________
A. Standard
B. Airborne precaution
C. Strict
D. Protective
72) Which of the following diagnostic procedures will definitely establish the diagnosis for patient
Reno? A. White blood cell count
B. Complete blood count
C. Bone marrow biopsy
D. Hemoglobin and hematocrit counts
73) When the thrombocyte count falls below 20,000/cu mm, the nurse will expect that the physician will
order
A. Complete bed rest
B. Strict aseptic technique
C. Platelets transfusion
D. “Limit visitors”
74) On the basis of his leukocyte count, the nurse instructs the patient NOT to do, which one of the
following?
A. Limit number of staff entering the room
B. Be in private room with the door closed always C. Receive immunization
with a live attenuated virus.
D. Use antimicrobial soap when bathing.
75) During the period of exacerbation, the patient’s hemoglobin is markedly decreased. What
instruction by the nurse is APPROPRIATE?
A. Allow exercise as long as tolerated
B. Let patient be dependent on self-care
C. Perform only activities of daily living D. Serve pork and liver barbeque.

SITUATION 16 - Nurses must continually grow as a person and as a professional. 76) As a newly
licensed nurse employed in a tertiary hospital, you are required to attend a continuing professional
development (CPD) program. When the training program is for the enhancement of the competencies
of nurses employed in the hospital, it is called A. Self-directed
B. In-service training program
C. Informal training program
D. Formal education program
77) The professional career development of a nurse can be achieved through various ways, such as
A. Participating in political rallies
B. Attending culinary courses
C. Attendance in socio-civic activities
D. Engaging in CPD programs
78) When nurses are projected in a television advertisement as sex symbols, what APPROPRIATE action is
expected from concerned nurse?
A. Go to the street to manifest displeasure of the nurses portrayal
B. Report to the concerned agency
C. Condemn the issue in the radio program
D. Keep your silence, it is the television station’s prerogative.
79) To enhance the personality of the graduate nurse, she / he may attend. Which of the following
programs?
A. Gymnastic
B. Marathon training
C. Social graces and physical fitness
D. Scuba diving
80) The nurse application to Canada has finally been approved and she was advised to depart in three
months. She is currently enrolled in graduate school. Moreover, her mother has just been discharged from
the hospital. which of the following actions is BEST
A. Inform family that the money spent in graduate school can be easily earned in Canada.
B. Inform the agency that she could go anytime as they wish.
C. Share with friends that this is her escape from her sad life with her family.
D. Request the recruiter to give her more time to settle her personal concerns.

SITUATION 17 - Patient Narding is diagnosed with stroke and suffers from a number of deficits as a result of
injury to his brain. His rehabilitation may be long, depending on the extent of brain injury.
81) Narding has been urinating on and off in bed which is possibly related to a flaccid bladder and
difficulty in communication. The nurse becomes concerned because he is showing signs and symptoms of
pressure sores due to his immobility and the frequently wet beddings. The nurse decides to refer the
patient to the
A. Resident on duty
B. Attending physician
C. Infectious doctor specialist
D. Supervisor-in-charge
82) Narding became unduly silent and kept to himself after his stroke left him with left-sided weakness.
The nurse observes that the patient seems really sad and shares the information to the physician who
refers the patient to a
A. Psychiatrist C. Psychologist
B. Neurologist D. Physiotherapist
83) The patient shared his concern about being able to father a child after the stroke especially that he
has only one child a girl. He would like to have two boys but he doubts his present sexual capacity. Who
can BEST help him along this area?
A. Primary consultant C. Supervisor in charge B. Nurse D. Urologist
84) The patient should be assisted back to normal mobility after his stroke partially incapacitated him.
The referral that will be done by the attending physician must be to which professional?
A. Occupational therapist
B. Resident physician
C. Physical therapist
D. Primary consultant
85) Narding seems forgetful, inattentive, and not answering appropriately to some question posed.
The nurse anticipates that the consultant will need to ask the professional help of the for cognitive
improvement
A. Psychologist C. Family doctor
B. Psychiatrist D. Neurologist

SITUATION 18 - You are a nurse manager of a tertiary hospital. One of your responsibilities is to keep a
record of all patients admitted in the hospital. 86) You are aware of the importance of keeping
hospital records. Which of the following statements is NOT true about hospital records? Hospital
records. A. Provide data on health information system.
B. Are a key source of data for medical research or statistical reports.
C. Provide personal information about the physicians and nurses assigned to care for the patients.
D. Provide evidence of a hospital’s accountability.
87) You are oriented on the hospital policy that when a patient is readmitted, the patient’s file maybe
retrieved from the hospital records department. From which file may a readmitted patient’s record be
retrieved?
A. Physician's ledger
B. Master patient index file
C. Civil service file
D. Hospital library records
88) You orient your staff on the common system used in recording nursing interventions. The system
used is a nursing card index or Kardex. What information is NOT included in the Kardex? A. Drug regimen
of the patient. B. Allergies if any of the patient.
C. Progress notes of the physician.
D. Dietary requirements of the patient.
89) A patient’s record contains information of the medications and treatments administered, and
observations of the patient’s condition. Which of the following data MUST be filled up in the patient’s chart
when he/she is discharged from the hospital?
A. Religion C. Final medical diagnosis
B. Nursing diagnosis D. Educational attainment
90) You are familiar with the ethical aspects of patients and hospital records. Which of the following
statements is NOT true? A. Health records are the property of the locality where the patient is treated.
B. Hospital records maybe released without the patient’s consent when required in investigation for
serious criminal offense.
C. Confidential records must be protected against loss, damage, unauthorized access, modification
and disclosure.
D. Patients have the right to confidential treatment of information they provide to health
professionals.

SITUATION 19 - Ms. Gina is a staff nurse in a medical unit of X hospital. She collaborates with other
members of the health team to provide safe and quality patient care. 91) Which of the following
statements BEST explains the role of the nurse in collaborating with others to plan for the patient’s care?
The nurse.
A. Collaborates with colleagues and the patient’s family to provide combined expertise in planning
care.
B. Works independently to plan and deliver care and does not depend on other staff for assistance.
C. Consults the physician for direction in establishing goals for clients.
D. Depends on the latest literature to complete an excellent plan for care. 92) Nurse Gina is aware
that collaborative interventions are therapies that require the following: Which of the collaborative
interventions is the MOST therapeutic?
A. Nurse and patient intervention
B. Multiple health care professionals
C. Physician and nurse intervention
D. Patient and physician intervention
93) To initiate an intervention in collaboration with the health team, Nurse Gina must be competent in
which of the following areas?
A. Leadership, autonomy, and skills
B. Experience, advanced education, and skills
C. Knowledge, function, and specific skills
D. Leadership, finances, and skills
94) Nurse Gina is aware that there are nursing activities that maybe delegated to other health care
team members. Which principle should guide the nurse in delegating tasks?
A. Delegation occurs only upon a physician’s order.
B. The delegated personnel is accountable for the care.
C. Delegation may reduce the patient’s cost of care.
D. The nurse has the primary responsibility for the quality of patient care.
95) Nurse Gina is a potential team leader of the health team. Which of the following skills should she
develop?
A. Collaborative skills
B. Management
C. Supervisory skills
D. Patient advocacy

SITUATION 20 - Quality improvement must be embraced by every health institution if it aims for safe and
quality care. The medical director of Camiguin Medical Center made random rounds for five consecutive
days to all areas of the hospital to assess its services.
96) Which of the following is NOT a characteristic of quality improvement that the medical director is
interested in
A. The leader is the empower
B. Problem-solving is by everyone
C. The employees are treated as customer
D. Reacts to correct or bad situation
97) A risk is any event that causes problems or benefits on the healthcare institution. The medical
director knows that potential risks must be identified across the hospital in order to prevent the following
EXCEPT A. Financial loss C. Accident
B. Incident reports D. Injuries
98) Based on patient survey a number of complaints have been tracked. Which of the following is NOT
a preventive activity in the practice of the medical director risk management?
A. Fostering good administration-personnel relation B. Providing safe environment every time
C. Tracking patient complaints at irregular intervals D. Satisfying patient needs and desires chief nurse
and other officers of the hospital believe that patient relation is important in risk management because a
dissatisfied customer is likely to sue. Which is NOT the way to handle complaints?
A. Let the patient express himself
B. Be sure to rebut the patient point by point
C. Staff should not be defensive
D. Listen to the patients cue carefully
100) Nurses usually complain they have no personal life because of rotating shifts. The following are
three major ways to create personal time EXCEPT A. Delegate work to other
B. Fill every moment with task or chores
C. Eliminate task that add no value
D. Hire someone else to do the work
PNLE NOV 2021 & MAY 2022
NURSING PRACTICE V: Care of Clients with Physiologic and Psychosocial Alterations, Part C

SITUATION 1 - Nurses inform patients taking antipsychotic medications about the types of side effects that may
occur. She encourages patients to report instead of discontinuing the medications. Following are related to
patient teachings.
1) When taken antianxiety drugs like benzodiazepines, which APPROPRIATE health teaching should the nurse
emphasize?
A. Antianxiety drugs can treat the underlying problem.
B. Patient should not drink alcohol because it potentiates its effect.
C. Patients can discontinue the drug abruptly even without orders.
D. Patient can still drive his car because of delayed response time
2) When taking anticonvulsant drugs like lithium, which APPROPRIATE HEALTH TEACHING should the nurse
emphasize?
A. Time of last dose must be accurate so that blood level monitoring is accurate.
B. Patients can take drugs even without food intake.
C. Patients will not experience polyuria and polydipsia.
D. Patient will have constipation, thus he has to increase fluid intake
3) Which of the following does NOT signify extrapyramidal symptoms (EPS) haldol? A. Acute
dystonia
B. Akathisia
C. Pseudo parkinsonism
D. Increased libido
4) The patient often appears restless, anxious, agitated with rigid posture and lack of spontaneous gestures.
Which of the following describes this patient with intense need to move about? A. Withdrawal
C. Dystonia
B. Dyskinesia D. Akathisia
5) When taking SSRI (Selective Serotonin Reuptake Inhibitors), which APPROPRIATE health teaching should the
nurse emphasize?
A. Aged cheese may be allowed
B. Patient should take the drug first thing in the morning
C. Peanuts are allowed
D. Tyramine free diet can lower blood pressure sITUATION 2 - Remedios, a 65-years-old housewife has been
diagnosed with rheumatoid arthritis both hands and knees.
6) On a visit to the clinic, a patient reports the onset of early symptoms of rheumatoid arthritis. What will be the
nurse focused assessment during patient interview?
A. Enlarged nodules
B. Early morning stiffness of the lower extremities
C. Limited motion of joints of upper extremities
D. Deformed joints of the hands
7) Patient Remedios complains she could not be household chores and her knees hurt whenever she walks.
Which nursing diagnosis would be MOST APPROPRIATE?
A. Self- care deficit related to increasing joint pain B. Activity
intolerance related to fatigue and joint pain.
C. Disturbed body image related to fatigue and joint pain
D. Ineffective coping related to increased joint pain
8) For a patient in the acute phase of rheumatoid arthritis, which of following should the nurse identify as the
LOWEST priority in the plan of care?
A. Preserving joint function
B. Preventing joint deformity
C. Relieving pain
D. Maintaining usual task
9) A patient with osteoarthritis develops coagulopathy secondary to long-term nonsteroidal anti-
inflammatory drug (NSAID) use. The coagulopathy is most likely the result of ________
A. Decreased platelet adhesiveness
B. Blocked prothrombin conversion
C. Impaired vitamin K synthesis D. Factor VIII destruction
10) A nurse is teaching a patient with osteoarthritis about lifestyle changes. The nurse knows the
patient understands the teaching when she states that she will ____
A. Abstain from alcohol
B. Avoid exercise
C. Loss weight
D. Restrict caffeine
SITUATION 3 - Eighteen years old Chimeya and her father came to the clinic for possible depression. She has a
number of fears of getting sick and dying from COVID 19. She eats less and sleeps restlessly. She has not taken
a bath for a week, always talking about her missing mother who died due to COVID 19 infection.
11) Working with a depressed Chimeya, the nurse should understand that depression is MOST directly related to
a person’s ________
A. Remembering her childhood
B. Stage in life
C. Having experienced a sense of loss
D. Experiencing poor interpersonal relationships with others
12) Early identification and treatment are essential to prevent long term depression. Preventive Measures DO
NOT INCLUDE _____.
A. Medication as a treatment alone.
B. Providing a stable home life.
C. Practicing open and honest communication.
D. Facilitating a strong sense of self trust, resilience and self-esteem
13) Chimeya was admitted to the hospital for treatment of her depression. Which antidepressant drugs are
COMMONLY used?
A. Norframin
C. Prozac
B. Elavil
D. Tofranil
14) To prevent the recurrence of depression, how long should the patient take the antidepressant
drugs? A. Six months to two years
B. Two months to one year
C. One year to three years
D. One to three months
15) Three days after the admission of Chimeya, the nurse observes she has taken a bath, worn a clean dress,
and combed her hair. What is the APPROPRIATE reaction of the nurse to the behavioral change in Chimeya?
A. “Something is different about you today. What is it?”
B. “Oh, I’m so pleased that you finally put on a clean dress”
C. “I see that you have worn a clean dress and have combed your hair”
D. “That's good. You have on a clean dress and have combed your hair.”
SITUATION 4 - Nurses provide their patients information they need to give informed consent, only
if it is within their scope of nursing practice and nursing knowledge. Consent is the patient's acknowledgement
and acceptance of medical treatment
16) In emergency situation when a patient is unable to give consent for life saving treatment, what type of
consent allows us to assume APPROPRIATE medical treatment?
A. Implied consent
B. Informed consent
C. Express consent
D. Involuntary consent
17) Which of the following are essential components of informed consent?
I. Explanation of the procedure and alternatives to the procedure
II. Discussion of potential risk and benefits of the procedure
III. Confirmation that patient understands the risk, benefits and any alterations
A. I, III
B. I, 7
C. II, 7
D. I, II,18) Treatment of a patient without consent can constitute ______, which is defined as intentional and
unwanting touching. Error! Bookmark not defined.

A. Battery
C. Negligence
B. Slander
D. Tort
19) Whose responsibility is it to obtain informed consent?
A. Nurse manager
B. Anesthesiologist
C. Physician
D. Midwife
20) Bioethical issue should be describe as_______
A. The withholding of food and treatment at the request of the patient in a written advance directive given
before a patient acquired permanent brain damage from an accident B. The physician’s making all
decisions of client management without getting input from the patient
C. After the patient gives permission, the physician’s disclosing all information to the family for this support
in the management of the patient
D. A research project that included treating all regular employed personnel not treating all casual employed
to compare the outcome of specific drug therapy
SITUATION 5 - Rosie, a new staff nurse, was assigned to the psychiatric unit. A depressed patient assigned to her
fell from her bed. Her head nurse asked her to submit an incident report (IR).
21) The purpose why the head nurse asked Nurse Rosie to submit an IR is to __
A. Note patterns of incidences in the same unit
B. Place it in nurse Rosie’s 201 file
C. Document immediately the incident
D. Evaluate nurse Rosie’s performance
22) In writing the IR, which of the following is NOT included? A. Who was/
were involved?
B. What daily medications are given to the patient
C. What happened?
D. Who witnessed the incident?
23) What guideline is IMPORTANT in relation to incident report (IR)? it is __ A. Not made
part of the patient's chart
B. Placed in the nurse’s 201 file
C. Filed in the nurses station
D. Filed in the Records section of the hospital
24) Which of the following would prove that nursing action carried out met the standards of care on falls?
A. Utilizing the nursing process in providing safe, quality nursing care
B. Documenting the procedures done
C. Carrying out the doctor’s order
D. Performing physical assessment
25) Should the investigation of the fall go further, which of the following is the best source of factual
information?
A. Incident report
B. Nurse’s notes in the chart
C. Anecdotal record D. Process recording
SITUATION 6 - Mrs. Del, 70-years old retired teacher is diagnosed of dementia. She lives with her 24- year-old
granddaughter. Nurse Maxie attends to her when she goes for her OPD check-ups. 26) Mrs. Del must be aware
that the MOST common chronic incidence that brings about injury among elderly persons is
A. Rheumatic fever
B. Hip fracture
C. Gallbladder
D. Urinary tract infection
27) Nurse Maxie should recognize that the MOST common psychogenic disorder among elderly persons is _____.
A. Depression
B. Sleep disturbances
C. Decreased appetite
D. Inability to concentrate
28) Which of the following is the MOST common cause of dementia among elderly persons? A. Parkinson’s
disease
B.Alzheimer’s disease
C. Amyotrophic lateral sclerosis D. Multiple sclerosis
29) Which of the following symptoms is COMMON to both the pre-senile and senile dementias associated with
Alzheimer's disease?
A. Increased appetite
B. Loss of short-term memory
C. Inappropriate behavior
D. Inability to provide self-care
30) Patient with dementia suffers from “sundown syndrome”. Which nursing action should be included in this
patient’s care plan?
A. Maintain consistent schedule and sequence of daily activities B. Integrate
patient’s culture preferences into the care provided.
C. Serve warm beverages and snacks in the early evening.
D. Provide opportunities for patients to learn and practice new skills.
SITUATION 7 - Nurse Annie is assigned to Sherry, a junior high school student, who is treated for her Bulimia.
31) Bulimia is best defined as a/an _____
A. Disorder of the unknown origin associated with starving oneself
B. Pathological disorder of binging and vomiting
C. Phobic disorder of fear of obesity
D. Eating disorder associated with vomiting
32) What condition is NOT likely to develop in Sherry?
A. Hyperkalemia
B. Tooth decay
C. Gastric ulcer
D. Rectal bleeding
33) Which of the following conditions may lead to death in a bulimic patient like sherry?
A. Hypokalemia and cardiac arrhythmias and arrest
B. Metabolic acidosis and renal failure
C. Hyponatremia and circulatory collapse
D. Hypernatremia and congestive heart failure
34) Endocrine changes often result in a bulimic patient. Which of the following would be an expected change in
sherry?
A. Delayed thyroid stimulating hormone response to hormone replacement therapy
B. Increased production of follicle stimulating hormone
C. Hypopituitarism
D. Decreased adrenocorticotropic hormone in response to cortisone
35) Amitriptyline, an antidepressant, is the drug of choice in treating bulimia. What is COMMON side effects of
this drug? A. Anticholinergic effects
B. Cholinergic effects
C. Urinary frequency
D. Diarrhea
SITUATION 8 - Mr. Rollan is diagnosed to have chronic schizophrenia.
36) To prevent relapses of schizophrenia with Mr. Rollan, which of the following Nurse Anna should NOT
encouraged Mr. Rollan and his family?
A. Keep any troubling side effects of medications with nurses.
B. Practice stress reduction techniques
C. To follow the medication regimen accurately
D. Participate regularly in any other forms of treatment 37) Choose one nursing strategy nurse Anna should NOT
use. A. Speak in a low, calm tone of voice.
B. Let him interact with you while he is hallucinating.
C. Maintain a non-threatening stance, keep a physical distance.
D. Maintaining safety for herself and Mr. Rollan.
38) Choose one LAST Anna’s nursing action while communicating with Mr. Rollan
A. “Please let me know if I can be helpful.”
B. “Check his use of ordered PRN medication.”
C. “I’ll let you sit here quietly and I will be at the nurse station.”
D. “I’m just checking in with you to see if there is anything you need right now.”
39) Which of the following strategies would the nurse instruct the patient to do as a measure to prevent relapse?
A. Report changes in sleeping, eating and mood.
B. Block hallucinations during daily activities.
C. Take additional medications on days when Mr. Rollan is “feeling bad”.
D. Take a stress management class.
40) Which of the following identified ability of Mr. Rollan that he can now effectively participate in
Rehabilitation?
A. Ability to concentrate
B. Ability to think
C. Ability to talk
D. Ability to do listen
SITUATION 9 - Mrs. Labrador, 75 years old, is in the clinic for the treatment of acute closed-angle glaucoma.
41) The physician would like to measure the intraocular pressure with non-contact (air puff) tonometer. While
preparing patient for her examination, the nurse informs the patient that ____
A. After the examination, a slight pain will be experienced
B. Before the examination, a medication will be given
C. It is painless procedure that has no side effects
D. During the ocular fundoscopy, atropine eye drop will be instilled.
42) Which symptoms are ASSOCIATED with acute-closed angle glaucoma?
A. Diplopia and photophobia
B. Blurred vision and colored rings around lights
C. Episodic blindness and no pain
D. Sensation of curtain drawn across the visual field
43) The physician has prescribed pilocarpine one percent eye drops every six hours. The expected
OUTCOME for this medication is to ______ A. Dilate the pupil by paralyzing the ciliary muscle
B. Prevent dryness of the cornea and conjunctiva
C. Promote drainage of aqueous humor from anterior chamber
D. Reduce inflammation of the iris and choroid
44) The physician recommends peripheral iridectomy to relieve intraocular pressure. He prescribed meperidine
hydrochloride (Demerol) 50mg and atropine sulfate 0.mg IM as the preoperative medications. The nurse should
____
A. Recognize that atropine sulfate is given preoperatively to dilate the pupil
B. Recognize this as a usual preoperative medication and administer it.
C. Realize that the atropine sulfate is being given to dry up secretion
D. Notify the physician and question the order
45) Which of these nursing diagnoses should the nurse give PRIORITY for an elderly patient who has impaired
vision due to glaucoma?
A. High risk for injury
B. Impaired physical mobility
C. Grooming self-care deficit
D. Feeding self-care deficit
SITUATION 10 - Rizal, a 50- year old house painter, came in with chief complaints of slurred speech blurring
of vision, and hallucinations. Upon evaluation of his case, it revealed volatile substance intoxication.
46) The predisposing factor in Rizal’s case is his_____
A. Age
B. Occupation
C. Home environment
D. Community
47) Volatile substance abuse is considered the most dangerous among the abused
psychoactive substances because of the RISK of _____
A. Violence
B. Developing schizophrenia
C. Irreversible damage to the bone marrow, brain, liver, kidney
D. Malnutrition
48) The nurse heard Rizal saying, “My mother visited me last night and reminded me to take care of myself”.
This is a manifestation of ________
A. Auditory hallucination
B. Visual hallucination
C. Delusion
D. Reaction formation
49) Substance abuse affects not only the nurse but also the other members of the family. Which of the following
is the MOST APPROPRIATE nursing diagnosis in the care of Rizal.
A. Impaired social interactions
B. Impaired parenting
C. Dysfunctional family process
D. Ineffective coping

50) Severe intoxication to volatile substances may lead to unconsciousness or even death. The
PRIORITY nursing intervention in caring for such patient is monitoring the ______
A. Mental status
B. Neurological functions
C. Nutritional status
D. Vital signs

SITUATION 11 - Darwin, 35 years old engineer met a vehicular accident while going to work. He suffered
headinjury, was responsive and admitted at the intensive care unit for close monitoring and management.
51) During nursing assessment, Darwin speaks in a rambling manner and is unable to repeat words spoken
to him. Which area of the brain MOST LIKELY is affected? A. Wernicke’s area
B. Broca’s area
C. Foramen magnum
D. Brodmann's area
52) The physician orders a computerized transverse axial tomogram (CAT) scan. Nursing preparation of the
patient for this procedure includes:
A. Explaining that the vital signs were monitored for 2 hours after the examination.
B. Reassuring that CAT scanning is a noninvasive procedure.
C. Explaining that a spinal tap will be done so that a radioactive isotope can be injected
D. Telling patients that a radiopaque dye is injected into an artery in the arm.
53) The physician order to observe for EARLY signs of increased intracranial pressure which includes A.
Restlessness and change in level of consciousness
B. Elevated temperature and decerebrate posturing
C. Rising blood pressure and bradycardia
D. Widening pulse pressure and dilated pupils
54) All of the following signs indicate increased intracranial pressure EXCEPT?
A. Decreased level of consciousness
B. Tachycardia
C. Papilledema
D. Vomiting
55) The nurse noticed the dressing was wet. Which action by the nurse can be safely used to determine if
the drainage contains cerebrospinal fluid (CSF)? What is the attending nurse should do?
A. Blot the drainage with sterile gauze pad and look for a clear wet ring around the spot of blood
B. Swab the orifice of the ear with a sterile applicator and send the specimen to the laboratory
C. Obtain a negative reading for sugar after testing the CSF with test-tape
D. Gently suction the ear and send the specimen to the laboratory

SITUATION 12 - Nurse manager participates in quality improvement projects to increase awareness and achieve
better performance of the nursing team.
56) A professional practice system that manages clinical care of patients across a
continuum using managed care concept and tools is called
A. Modular nursing
B. Differentiated practice
C. Case management
D. Primary nursing
57) What is the outcome of having a sound clinical care management by professional healthcare team?
A. It decreased patients length of stay
B. It diminishes collegiality between health care providers
C. It increases cost of hospitalization
D. It contributes to duplication of services
58) During a staff meeting the nurse manager presents his own analysis of problems and proposal for
actions to the staff, inviting critique and comments. Which answer indicates the manager’s leadership
style?
A. Laissez-faire
B. Autocratic
C. Participative leadership
D. Democratic
59) Which of the following is often associated with the concept of decentralized decision making in
management?
A. Team nursing
B. Interdisciplinary practice model C. Shared governance
D. Primary nursing
60) Some decisions are best made by a group rather that by the nurse alone. What is an advantage of group
decision making? A. Promotes collective contributions of ideas B. Different ideas and opinions
C. Individual opinions are influenced by others
D. Dependency is fostered

SITUATION 13 - Glory, a 23 years old evening cashier of seven eleven 24 hours convenience store, was sexually
abused by a jeepney driver while on her way home from work one evening. She was brought to the ER with
bruises all over her body. She was crying uncontrollably and appeared to be anxious.
61) Which of the following therapeutic communication should Nurse Ann say for Glory? A. “If you are upset, calm
yourself first. I can't understand you.”
B. “Can you identify your abuser?”
C. “I know something terrible and horrifying happened to you.”
D. “Would you like to tell me what happened?”
62) In providing nursing care for Glory during her acute stress reaction to rape trauma, Nurse Ann may apply
which of the following?
A. Physical assessment
B. Collaborate with community agencies
C. Crisis intervention techniques
D. Teaching and learning principles
63) Glory’s physical assessment is complete and physical evidence has been collected. After three days,
Nurse Ann noted Glory to be withdrawn, confused and at times physically immobile. How should nurses interpret
these behaviors?
A. Evidence that that the client’s is a high suicide risk B. Sign of depression
C. Indicative of the need for longer hospital admission D. Normal reactions to a devastating event
64) Emergency care to be a given for rape victims are as follows:
I . If victim calls the hospital, tell her to take a bath, wash or change clothes, just go directly to the
hospital
II . Provide privacy and be-judgmental
III .Stay with the victim, focus on physical safety and emotional security
IV .Assist on pelvic examination to collect evidence as semen stains
A. I, III, IV B. I, II, III C. II, III, IV D. I, II, IV
65) Nurse Ann wanted to become a patient advocate to rape victims. Which of the following
RESPONSIBILITIES should she note?
A. Isolate the patient first to provide privacy while attending to other patients
B. Call the press since this is a legal case
C. Perform thorough physical assessment and document objectively all evidences of rape.
D. Postpone the physical examination until the patient is calm.

SITUATION 14 - Head Nurse Alona ensures teamwork and collaboration in her unit to achieve efficient shared
decision- making and open communication to provide safe patient care. 66) A nurse returns from
vacation and friends a new model of I.V. pump attached to her patient’s I.V. How should the nurse proceed?
A. Read the I.V pump manual before caring for the patient
B. Refuse to care for the patient
C. Inform the charge nurse and ask her to provide an teaching about how to use the pump
D. Use the pump because it is somewhat like the old pumps on the unit
67) A nurse is caring for a 72-years-old male patient who requires insertion of a central venous catheter.
Who is responsible for obtaining informed consent?
A. Physician who will insert the catheter
B. Charge nurse
C. Attending physician
D. The nurse assisting with the procedure
68) A nurse reports that a patient coughs frequently after taking anything by mouth. The dietitian recommends
a swallow evaluation for the patient, in which the physician participating
in the team rounds write the order. This is an example of collaboration of client care
A. With the ancillary care providers
B. Between the physician and the dietary department C. With the risk management team because of risk
for aspiration
D. Among members of the multidisciplinary group
69) Before delegating to a new nurse the task of giving a shower to a paraplegic elderly, the charge nurse
should first ensure that the new nurse
A. Has demonstrated competency for the task
B. Has received the assignment during endorsement time
C. Is supervised at all times
D. Provides companion to the patient
70) Which of the following task would be APPROPRIATE for the nurse to delegate to nursing aide?
A. Assist a new postoperative patient to the bathroom.
B. Teach a patient how to administer discharge medications.
C. Change a central line dressing.
D. Assist the patient during meal time.

SITUATION 15 - Mr. Ferrer, 42 years old, is admitted to the hospital in a semi-conscious state diagnosed with a
cerebrovascular accident.
71) The nurse obtains a history of the patient's present illness from his family. What significant information can
the nurse gather from the patient’s family?
A. Consistent hypertension and dizziness
B. Palpitations and hypotension
C. Family history about illness
D. Emotional response to past illness
72) The PRIORITY nursing care for Mr. Ferrer during the acute phase is to A. Provide sensory stimulation
B. Maintain respiratory and cardiac function
C. Prevent contracture and deformities
D. Maintain optimal nutrition
73) Part of the nursing care plan is to observe Mr. Ferrer for signs of increased intracranial pressure.
Which of the following clinical manifestations would INDICATE this condition? A. Tachycardia and drop in
blood pressure B. Bradycardia and rising blood pressure C. Bradycardia and drop in blood pressure D.
Tachycardia and raising blood pressure 74) Which of the following positions will be MOST APPROPRIATE to
Mr. Ferrer's care? A. Head of bed elevated in a lateral
position
B. Head of bed elevated in a supine position
C. Right lateral position
D. Left lateral position
75) Mr. Ferrer’s wife is very upset and asks if there is any hope to recover from his condition?
Which of the following is the MOST APPROPRIATE reply by the nurse?
A. “You must be patient, let's hope for the best outcome.”
B. “You should never lose hope.”
C. “It is too soon to tell what the outcome will be.” D. “Actually, manifestations may even get worse.”

SITUATION 16 - Leila, 5 years old, was diagnosed as autistic since she was 1 year old.
76) What behavior will Nurse Raffy observe as characterized by Leila?
A. Inappropriate behavior, poor attention span with impulsivity
B. Negativistic hostile and defiant behavior
C. Failure to develop interpersonal skills
D. Anxiety induced involuntary stereotyped motor movements 77) At her age, what is the stage of social
development?
A. Initiative vs Guilt
B. Trust vs. Mistrust
C. Industry vs Inferiority
D. Autonomy vs Shame and Doubt
78) Nurse Raffy recognizes which of the following as a COMMON behavioral sign of autism?
A. Clinging behavior towards parent
B. Early language development
C. Indifference to being hugged or hold
D. Creative imaginative play with peers
79) The BEST nursing intervention that nurse Raffy can use to provide trusting relationship with an autistic
Leila's is to
A. Convey warmth through touch
B. Reinforce positive behavior through praise and rewards
C. Explain to the child activities and routines D. Provides a structured environment 80) Which
pharmacological treatment is APPROPRIATE for Leila’s temper tantrum, aggressiveness, self injury and
stereotyped behavior?
A. Clonidine (Catapres)
B. Naltrexone (Re Via)
C. Clomipramine (Anafranil)
D. Haloperidol (Haldol)

SITUATION 17 - Patient safety remains a global health care challenge. There are basic principles of infection
control. These include standard precautions and transmission based precautions. The following are transmission
based precaution questions.
81) Which of the following is considered the MOST important intervention infection control?
A. Personal protective clothing
B. Prevention of infection associated with catheter
C. Safe use and disposal of sharps
D. Hand hygiene of health care staff
82) Which mode of infection transmission is due to splashes of blood body fluids into the mucosa or
contamination of non-intact skin with infected blood and body fluids?
A. Ingestion C. Inoculation
B. Airborne D. Direct/ Indirect contact
83) Which mode of infection transmission is due to microorganism being transferred to other patients from
contaminated equipment via the transferred to other patients from contaminated equipment and via the hand of
nurses?
A. Ingestion C. Inoculation
B. Airborne D. Direct/ Indirect contact
84) What mode of transmission is due to contaminated food and water being consumed?
A. Inoculation
B. Direct/ Indirect contact
C. Ingestion
D. Airborne
85) Which of the following is NOT a standard precautions?
A. Respiratory hygiene
B. Injection safety
C. Personal protective equipment
D. Hand hygiene

SITUATION 18 - The nurse abides with ethico moral principles.

86) When the nurse placed the patient in restraints before using other methods of intervention, she/he
violated the patient’s rights to
A. Receive confidential and respectful care B. Provide informed consent
C. Receive treatment in the least restrictive environment
D. Refuse treatment
87) Which of the following actions is a violation of psychiatric patient’s rights?
A. Paranoid patient with delusions about his family is told that if he makes a will, it might not be valid.
B. The nurse confiscated the cellphone from the patient's room and told him it was locked in the vault.
C. Staff members confiscated written letters done by patients addressed to local newspaper.
D. Patients are paid minimum wage for helping in the hospital kitchen.
88) Which of the following is NOT covered in the patient's bill of rights?
A. Refusal to treatment
B. Informed consent
C. Right to treatment
D. Civil commitment
89) A patient has been advised by the psychiatrist that he needs inpatient hospitalization. The patient
agrees, signs the admission forms, and agrees to receive treatment. What type of admission is this?
A. Formal C. Informal
B. Voluntary D. Involuntary
90) Disclosure of client information beyond the interdisciplinary team without consent of the client is a breach of
A. Confidentiality C. Duty
B. Beneficence D. Veracity

SITUATION 19 - Nursing research is conducted to answer a question or resolve problems on the relevance of the
nursing profession.
91) The nurse develop the following hypothesis: elderly women receive less aggressive treatment for
terminally-ill spine patients than younger women. Which variable would be considered to be the
independent variable.
A. Degree of treatment received
B. Age of the patient
C. Use of inpatient treatment
D. Type of complications being treated
92) The following are considered qualitative research processes EXCEPT?
A. Sample
B. Literature review
C. Hypothesis
D. Data collection
93) Which of the following is an example of a PRIMARY source in a research study?
A. A textbook of medical surgical nursing
B. A doctoral dissertation that critiques all research in the area of attention deficit disorder
C. A published commentary on the findings of another study
D. A journal article about a study that used large, previously unpublished databases generated
94) What is the BEST source to use when conducting a level one (1) systematic metaanalysis of literature?
A. An electronic database and doctoral dissertations
B. An electronic database
C. Doctoral dissertations
D. The cochrane statistical methods
95) Which type of research allows researchers to be neutral observers?
A. Quantitative research
B. Ethnographic research
C. Case studies
D. Qualitative research

SITUATION 20 - Mrs. Gomez, 63 years old admitted for cataract extraction. Nurse Lucy is assigned to prepare the
patient for surgery.
96) Mrs. Gomez tells the nurse that she does not want to know about her surgery. What would be the BEST
response of the nurse?
A. “I must go over certain information with you.” B. “You are right; do not worry yourself tonight.”
C. “You really sound quite concerned about this instead.”
D. “Well, I could talk to your son about this instead.”
97) What should the nurse do before giving preoperative teaching to the patient? A. Determine Mrs.
Gomez anxieties, level of understanding and expectations.
B. Research to surgical procedure so as to give step-to-step explanation.
C. Schedule teaching to begin 2-3 hours before surgery
D. Give Mrs. Gomez general information because specifics might be threatening.
98) While doing health teaching to Mrs. Gomez, the attending nurse can BEST recognize that her patient is
learning by
A. Demonstrating a positive change in her behavior
B. Constant verbal reaffirmations that she understands
C. Her ability to repeat what was discussed
D. Nonverbal acknowledgement that she understands, such as nodding
99) The nurse prepares Mrs. Gomez for discharge. What would be the nurse MOST important post cataract
surgery instruction to her patient?
A. Avoid the use of laxatives
B. Use an eye shield at night
C. Avoid to touch the eye dressing
D. Curtail most heavy activities
100) After discharge, Mrs. Gomez attends the eye clinic for follow-up visit. When she received her Cataract
glasses, it is important that the nurse advice her that
A. Magnification by the lens is only about 10 percent
B. Daily eye drops are required with eyeglasses C. Her peripheral vision will be increased D. Objects will
appear closer than they really are