1) Nurse Lala teaches a client about elastic 4) Nurse Igot is assessing a client with

stockings. Which of the following statements, Cushing’s syndrome. Which observation

if made by the client, indicates to the nurse should the nurse report to the physician
that the teaching was successful? immediately?
A. “I will wear the stockings until the A. Pitting edema of the legs
physician tells me to remove them.” B. An irregular apical pulse
B. “I should wear the stockings even when C. Dry mucous membranes
I am sleep.” D. Frequent urination
C. “Every four hours I should remove the
stockings for a half hour.” Rationale: Cushing’s syndrome can cause
D. “I should put on the stockings before hypokalemia due to potassium loss, so the
getting out of bed in the morning.” nurse should report irregular apical pulse.
Rationale: Promote venous return by Edema is expected, while dehydration signs
applying external pressure on veins. aren’t related.

5) Nurse Jungkook is aware that the disease

2) The client was scheduled to have a
declared through Presidential Proclamation
transsphenoidal hypophysectomy to remove
No. 4 as a target for eradication in the
a pituitary tumor. Preoperatively, the nurse
Philippines is?
should assess for potential complications by
A. Poliomyelitis
doing which of the following?
B. Measles
A. Testing for ketones in the urine
C. Rabies
B. Testing urine specific gravity
D. Neonatal tetanus
C. Checking temperature every 4 hours
Rationale: Presidential Proclamation No. 4 is
D. Performing capillary glucose testing
on the Ligtas Tigdas Program.
every 4 hours

6) Jungsomin is the public health nurse in a

Rationale: The nurse should check capillary
municipality with a total population of about
glucose every 4 hours due to the risk of
20,000. There are 3 rural health midwives
hyperglycemia. Other tests aren’t needed as
among the RHU personnel. How many more
insulin is secreted, fluid balance is stable,
midwife items will the RHU need?
and temperature isn’t a reliable infection
A. 1
indicator.
B. 2
C. 3
3) Diego has beginning stomatitis. To
D. The RHU does not need any more
promote oral hygiene and comfort, the
midwife item.
nurse in-charge should:
Rationale: Each rural health midwife is given
A. Provide frequent mouthwash with normal
a population assignment of about 5,000.
saline.
B. Apply viscous Lidocaine to oral ulcers as
7) When nurse Kaye Abad determines
needed.
whether resources were maximized in
C. Use lemon glycerine swabs every 2 hours.
implementing Ligtas Tigdas, she is
D. Rinse mouth with Hydrogen Peroxide.
evaluating?
A. Effectiveness
Rationale: Apply lidocaine before mouth
B. Efficiency
care to ease stomatitis pain. Once
C. Adequacy
comfortable, saline or diluted hydrogen
D. Appropriateness
peroxide rinses every 2-4 hours for oral
Rationale: Efficiency is determining whether
hygiene.
the goals were attained at the least possible
cost.
8)Hwasa, a 21-year-old is having her placenta delivery. Uterine involution and
menstrual period every 2 weeks that last for mild discomfort are normal postpartum.
1 week. This type of menstrual pattern is
bets defined by: 11) Janella Salvador finds out that some
A. Menorrhagia managers have a benevolent-authoritative
B. Metrorrhagia style of management. Which of the following
C. Dyspareunia behaviors will she exhibit most likely?
D. Amenorrhea
A. Have condescending trust and
Rationale: Menorrhagia is an excessive
confidence in their subordinates.
menstrual period.
B. Gives economic and ego awards.
C. Communicates downward to staffs.
9) A baby boy is born 8 weeks prematurely.
D. Allows decision making among
At birth, he has no spontaneous respirations
subordinates.
but is successfully resuscitated. Within
several hours he develops respiratory Rationale: Benevolent-authoritative
grunting, cyanosis, tachypnea, nasal flaring, managers pretentiously show their trust and
and retractions. He’s diagnosed with confidence to their followers.
respiratory distress syndrome, intubated,
and placed on a ventilator. Which nursing 12) Nurse Liza Hope is in-charge causes an
action should be included in the baby’s plan injury to a female patient and the injury
of care to prevent retinopathy of caused becomes the proof of the negligent
prematurity? act, the presence of the injury is said to
A. Cover his eyes while receiving oxygen. exemplify the principle of:
B. Keep her body temperature low.
C. Monitor partial pressure of oxygen A. Force majeure
(Pao2) levels. B. Respondeat superior
D. Humidify the oxygen. C. Res ipsa loquitor
D. Holdover doctrine
Rationale: Maintain normal PaO2 to prevent
Rationale: Res ipsa loquitor literally means
retinopathy in preemies on oxygen. Eye
the thing speaks for itself. This means in
covering and humidification don’t help. Keep
operational terms that the injury caused is
the infant warm to avoid acidosis and
the proof that there was a negligent act.
respiratory distress.
13) Nurse Kathryn Bernardo is assessing a
10) Maria Regla Cabatingan, a primigravida client’s abdomen. Which finding should the
client, age 19, has just completed a difficult, nurse report as abnormal?
forceps-assisted delivery of twins. Her labor
was unusually long and required oxytocin A. Dullness over the liver.
(Pitocin) augmentation. The nurse who’s B. Bowel sounds occurring every 10
caring for her should stay alert for: seconds.
A. Uterine inversion C. Shifting dullness over the abdomen.
B. Uterine atony D. Vascular sounds can be heard over the
C. Uterine involution renal arteries.
D. Uterine discomfort
Rationale: Shifting dullness over the
Rationale: Multiple fetuses, prolonged abdomen indicates ascites, an abnormal
oxytocin use, and traumatic delivery can finding. The other options are normal
cause uterine atony, leading to postpartum abdominal findings.
hemorrhage. Uterine inversion may result
from excessive cord traction or manual 14) Nurse May is aware that the main
advantage of using a floor stock system is:
 A. The nurse can implement medication 17) Nurse Regla is teaching Jonalyn about
orders quickly. breast self-examination. Which observation
B. The nurse receives input from the should the client be taught to recognize
pharmacist. when doing the examination for detection of
C. The system minimizes transcription breast cancer?
errors.
D. The system reinforces accurate A. tender, movable lump
calculations. B. pain on breast self-examination
C. round, well-defined lump
Rationale: A floor stock system enables the D. dimpling of the breast tissue
nurse to implement medication orders Rationale: The tumor infiltrates nearby
quickly. It doesn’t allow for pharmacist input, tissue, it can cause retraction of the
nor does it minimize transcription errors or overlying skin and create a dimpling
reinforce accurate calculations. appearance.

15) Jonalyn Diego, with tuberculosis, has

18) Which of the following is recognized for
been admitted in the hospital for 2 weeks.
developing the concept of HIGH LEVEL
When a client’s family members come to
WELLNESS?
visit, they would be adhering to respiratory
A. Erikson
isolation precautions when they:
B. Madaw
C. Peplau
A. wash their hands when leaving
D. Dunn
B. put on gowns, gloves and masks
C. avoid contact with the client’s
Rationale: According to Dunn, High level
roommate
wellness is the ability of an individual to
D. keep the client’s room door open
maximize his full potential with the
Rationale: Handwashing is the best method
limitations imposed by his environment.
for reducing cross-contamination. Gowns
and gloves are not always required when
19) Conceptualizes that health is a condition
entering a client’s room.
of actualization or realization of person’s
potential. Avers that the highest aspiration
16) Nurse Lenie Aycardo, is making a
of people is fulfillment and complete
discharge instruction to a client receiving
development actualization.
chemotherapy. The client is at risk for bone
A. Clinical Model
marrow depression. The nurse gives
B. Role performance Model
instructions to the client about how to
C. Adaptive Model
prevent infection at home. Which of the
D. Eudaemonistic Model
following health teachings would be
included?
Rationale: Smith proposed five health
A. “Get a weekly WBC count” models. The Clinical Model defines health as
B. “Do not share a bathroom with the absence of disease symptoms. The Role
children or pregnant woman” Performance Model links health to fulfilling
C. “Avoid contact with others while societal roles. The Adaptive Model sees
receiving chemotherapy” health as effective environmental
D. “Do frequent hand washing and adaptation. The Eudaemonistic Model views
maintain good hygiene” health as self-actualization and optimal
Rationale: Frequent hand washing and good functioning.
hygiene are the best means of preventing
infection. 20) In health belief model, Individual
perception matters. Which of the following
is highly UNLIKELY to influence preventive A. Epidemiology
behavior? B. Ecology
A. Perceived susceptibility to an illness C. Statistics
B. Perceived seriousness of an illness D. Geography
C. Perceived threat of an illness
D. Perceived curability of an illness Rationale: Ecology is the science that deals
Rationale: If a man think he is susceptibe to with the ECOSYSTEM and its effects on living
a certain disease, thinks that the disease is things in the biosphere. It deals with
serious and it is a threat to his life and diseases in relationship with the
functions, he will use preventive behaviors environment. Epidimiology is simply the
to avoid the occurence of this threat. Study of diseases and its occurence and
distribution in man for the purpose of
21) The classification of CANCER according controlling and preventing diseases. This
to its etiology Is best described as: was asked during the previous boards.

1. Nosocomial 24) Stage of GAS wherein, the Level of

2. Idiopathic resistance are decreased
3. Neoplastic
4. Traumatic A. Stage of Alarm
5. Congenital B. Stage of Resistance
6. Degenrative C. Stage of Homeostasis
D. Stage of Exhaustion
A. 5 and 2
B. 2 and 3 Rationale: Resistance are decreased in the
C. 3 and 4 stage of alarm. Resistance is absent in the
D. 3 and 5 stage of exhaustion. Resistance is increased
Rationale: Aside from being NEOPLASTIC, in the stage of resistance.
Cancer is considered as IDIOPATHIC because
the cause is UNKNOWN. 25) Jak Roberto with acute lymphocytic
leukemia suffers from nausea and headache.
22) A type of illness characterized by periods These clinical manifestations may indicate all
of remission and exacerbation of the following except

A. Chronic A. effects of radiation

B. Acute B. chemotherapy side effects
C. Sub acute C. meningeal irritation
D. Sub chronic D. gastric distension
Rationale: A good example is Multiple
sclerosis that is characterized by periods of Rationale: Acute Lymphocytic Leukemia
remissions and exacerbation and it is a (ALL) does not cause gastric distention. It
CHRONIC Disease. Acute and sub acute does invade the central nervous system, and
diseases occurs too short to manifest clients experience headaches and vomiting
remissions. Chronic diseases persists longer from meningeal irritation.
than 6 months that is why remissions and
exacerbation are observable. 26) Aldren Gallardo has been diagnosed with
Disseminated Intravascular Coagulation
23) It is the science of organism as affected (DIC). Which of the following is
by factors in their environment. It deals with contraindicated with the client?
the relationship between disease and
geographical environment. A. Administering Heparin
B. Administering Coumadin
 C. Treating the underlying cause C. “Keep active, use stress reduction
D. Replacing depleted blood products strategies, and avoid fatigue.
D. “You will need to accept the necessity
Rationale: Disseminated Intravascular for a quiet and inactive lifestyle”.
Coagulation (DIC) has not been found to
respond to oral anticoagulants such as Rationale: The nurse's most positive
Coumadin. approach is to encourage the client with
multiple sclerosis to stay active, use stress
27) Which of the following findings is the reduction techniques and avoid fatigue
best indication that fluid replacement for the because it is important to support the
client with hypovolemic shock is adequate? immune system while remaining active.

30) Nurse Faith should recognize that fluid

A. Urine output greater than 30ml/hr
shift in an client with burn injury results from
B. Respiratory rate of 21 breaths/minute
increase in the:
C. Diastolic blood pressure greater than
90 mmhg
A. Total volume of circulating whole blood
D. Systolic blood pressure greater than
B. Total volume of intravascular plasma
110 mmhg
C. Permeability of capillary walls
D. Permeability of kidney tubules
Rationale: Urine output provides the most
Rationale: In burn, the capillaries and small
sensitive indication of the client’s response
vessels dilate, and cell damage cause the
to therapy for hypovolemic shock. Urine
release of a histamine-like substance. The
output should be consistently greater than
substance causes the capillary walls to
30 to 35 mL/hr.
become more permeable and significant
quantities of fluid are lost.
28) While performing a physical assessment
of a male client with gout of the great toe,
31) Ace Torres with tuberculosis asks Nurse
Nurse Majo Jubay should assess for
Brian how long the chemotherapy must be
additional tophi (urate deposits) on the:
continued. Nurse Brian’s accurate reply
would be:
A. Buttocks
B. Ears
A. 1 to 3 weeks
C. Face
B. 6 to 12 months
D. Abdomen
C. 3 to 5 months
Rationale: Uric acid has a low solubility, it
D. 3 years and more
tends to precipitate and form deposits at
various sites where blood flow is least active,
Rationale: Tubercle bacillus is a drug
including cartilaginous tissue such as the
resistant organism and takes a long time to
ears.
be eradicated. Usually a combination of
three drugs is used for minimum of 6 months
and at least six months beyond culture
29) Nurse Watermelon is preparing a client
conversion.
with multiple sclerosis for discharge from
32) Halfway through the administration of
the hospital to home. Which of the following
blood, the female client complains of lumbar
instruction is most appropriate?
pain. After stopping the infusion Nurse Lala
Regla should:
A. “Practice using the mechanical aids
that you will need when future
A. Increase the flow of normal saline
disabilities arise”.
B. Assess the pain further
B. “Follow good health habits to change
C. Notify the blood bank
the course of the disease”.
 D. Obtain vital signs. Rationale: Elevation of uremic waste
Rationale: The blood must be stopped at products causes irritation of the nerves,
once, and then normal saline should be resulting in flapping hand tremors.
infused to keep the line patent and maintain
blood volume. 36) Chenny Mangilaya is admitted to the
hospital with benign prostatic hyperplasia,
33) Nurse Chaeunwoo knows that the the nurse most relevant assessment would
positive diagnosis for HIV infection is made be:
based on which of the following:
A. Flank pain radiating in the groin
A. A history of high risk sexual behaviors. B. Distention of the lower abdomen
B. Positive ELISA and western blot tests C. Perineal edema
C. Identification of an associated D. Urethral discharge
opportunistic infection Rationale: This indicates that the bladder is
D. Evidence of extreme weight loss and distended with urine, therefore palpable.
high fever
Rationale: These tests confirm the presence 37) Nurse Mondaya would expect the a
of HIV antibodies that occur in response to client with mitral stenosis would
the presence of the human demonstrate symptoms associated with
immunodeficiency virus (HIV). congestion in the:

34) Nurse Byeonwooseok is aware that a A. Right atrium

client who has been diagnosed with chronic B. Superior vena cava
renal failure recognizes an adequate amount C. Aorta
of high-biologic-value protein when the food D. Pulmonary
the client selected from the menu was:
Rationale: When mitral stenosis is present,
A. Raw carrots the left atrium has difficulty emptying its
B. Apple juice contents into the left ventricle because there
C. Whole wheat bread is no valve to prevent back ward flow into
D. Cottage cheese the pulmonary vein, the pulmonary
circulation is under pressure.
Rationale: One cup of cottage cheese
contains approximately 225 calories, 27 g of 38) Dyan Navarro has been diagnosed with
protein, 9 g of fat, 30 mg cholesterol, and 6 hypertension. The nurse priority nursing
g of carbohydrate. Proteins of high biologic diagnosis would be:
value (HBV) contain optimal levels of amino
acids essential for life. A. Ineffective health maintenance
B. Impaired skin integrity
35) Tingloy who has been diagnosed with C. Deficient fluid volume
uremic syndrome has the potential to D. Pain
develop complications. Which among the Rationale: Managing hypertension is the
following complications should the nurse priority for the client with hypertension.
anticipates: Clients with hypertension frequently do not
experience pain, deficient volume, or
A. Flapping hand tremors impaired skin integrity. It is the
B. An elevated hematocrit level asymptomatic nature of hypertension that
C. Hypotension makes it so difficult to treat.
D. Hypokalemia
39) Nurse Andrea Brillantes teaches the C. Soda
client with angina about common expected D. Regular Coffee
side effects of nitroglycerin including: Rationale: Regular coffee contains caffeine
which acts as psychomotor stimulants and
A. high blood pressure leads to feelings of anxiety and agitation.
B. stomach cramps Serving coffee top the client may add to
C. headache tremors or wakefulness.
D. shortness of breath 43) Espedillon is experiencing alcohol
Rationale: Because of its widespread withdrawal exhibits tremors, diaphoresis
vasodilating effects, nitroglycerin often and hyperactivity. Blood pressure is 190/87
produces side effects such as headache, mmhg and pulse is 92 bpm. Which of the
hypotension and dizziness. medications would the nurse expect to
administer?
40) The following are lipid abnormalities.
Which of the following is a risk factor for the A. Naloxone (Narcan)
development of atherosclerosis and PVD? B. Benzlropine (Cogentin)
C. Lorazepam (Ativan)
A. High levels of low density lipid (LDL) D. Haloperidol (Haldol)
cholesterol Rationale: The nurse would most likely
B. High levels of high density lipid (HDL) administer benzodiazepine, such as
cholesterol lorazepan (ativan) to the client who is
C. Low concentration triglycerides experiencing symptom: The client’s
D. Low levels of LDL cholesterol. experiences symptoms of withdrawal
Rationale: An increased in LDL cholesterol because of the rebound phenomenon when
concentration has been documented at risk the sedation of the CNS from alcohol begins
factor for the development of to decrease.
atherosclerosis. LDL cholesterol is not
broken down into the liver but is deposited 44) Cabatingan a client with antisocial
into the wall of the blood vessels. personality disorder belches loudly. A staff
member asks Joey, “Do you know why
41) Which of the following represents a people find you repulsive?” this statement
significant risk immediately after surgery for most likely would elicit which of the
repair of aortic aneurysm? following client reactions?

A. Potential wound infection A. Defensiveness

B. Potential ineffective coping B. Embarrassment
C. Potential electrolyte balance C. Shame
D. Potential alteration in renal perfusion D. Remorsefulness
Rationale: There is a potential alteration in Rationale: When the staff member asks the
renal perfusion manifested by decreased client if he wonders why others find him
urine output. The altered renal perfusion repulsive, the client is likely to feel defensive
may be related to renal artery embolism, because the question is belittling. The
prolonged hypotension, or prolonged aortic natural tendency is to counterattack the
cross-clamping during the surgery. threat to self-image.

42) Which of the following foods would the

45) Which of the following approaches
nurse Trish eliminate from the diet of a client
would be most appropriate to use with a
in alcohol withdrawal?
client suffering from narcissistic personality
disorder when discrepancies exist between
A. Milk
what the client states and what actually
B. Orange Juice
exists?
 A. Rationalization nurse facilitates communication with the
B. Supportive confrontation client by sitting in silence, asking open-
C. Limit setting ended question and pausing to provide
D. Consistency opportunities for the client to respond.
Rationale: The nurse would specifically use
supportive confrontation with the client to 48) Lola Mary is admitted to the emergency
point out discrepancies between what the room with drug-included anxiety related to
client states and what exists to increase over ingestion of prescribed antipsychotic
responsibility for self. medication. The most important piece of
information the nurse in charge should
46) Roberto Suello is experiencing obtain initially is the:
disordered thinking about food being
poisoned is admitted to the mental health A. Length of time on the med.
unit. The nurse uses which communication B. Name of the ingested medication &
technique to encourage the client to eat the amount ingested
dinner? C. Reason for the suicide attempt
D. Name of the nearest relative & their
A. Focusing on self-disclosure of own food phone number
preference Rationale: In an emergency, lives saving facts
B. Using open ended question and are obtained first. The name and the amount
silence of medication ingested are of outmost
C. Offering opinion about the need to eat important in treating this potentially life
D. Verbalizing reasons that the client may threatening situation.
not choose to eat
Rationale: Open ended questions and 49) .Nurse Jonalyn Marie is caring for a client
silence are strategies used to encourage with depression who has not responded to
clients to discuss their problem in descriptive antidepressant medication. The nurse
manner. anticipates that what treatment procedure
may be prescribed.
47) Nurse Angelina Jolie is assigned to care
for a client diagnosed with Catatonic Stupor. A. Neuroleptic medication
When Nurse Nina enters the client’s room, B. Short term seclusion
the client is found lying on the bed with a C. Psychosurgery
body pulled into a fetal position. Nurse Nina D. Electroconvulsive therapy
should?
Rationale: Electroconvulsive therapy is an
A. Ask the client direct questions to effective treatment for depression that has
encourage talking not responded to medication
B. Rake the client into the dayroom to be
50) When planning the discharge of a client
with other clients
with chronic anxiety, Nurse Gallardo
C. Sit beside the client in silence and
evaluates achievement of the discharge
occasionally ask open-ended question
maintenance goals. Which goal would be
D. Leave the client alone and continue
most appropriately having been included in
with providing care to the other clients
the plan of care requiring evaluation?

A. The client eliminates all anxiety from

Rationale: Clients who are withdrawn may
daily situations
be immobile and mute, and require
B. The client ignores feelings of anxiety
consistent, repeated interventions.
C. The client identifies anxiety producing
Communication with withdrawn clients
situations
requires much patience from the nurse. The
 D. The client maintains contact with a diet isn’t needed unless a nutritional issue
crisis counselor exists.

Rationale: Recognizing situations that 53) Regla Maria, age 19, is highly dependent
produce anxiety allows the client to prepare on her parents and fears leaving home to go
to cope with anxiety or avoid specific away to college. Shortly before the semester
stimulus. starts, she complains that her legs are
paralyzed and is rushed to the emergency
51) Nurse Lani Misalucha notices that a
department. When physical examination
female client with obsessive-compulsive
rules out a physical cause for her paralysis,
disorder washes her hands for long periods
the physician admits her to the psychiatric
each day. How should the nurse respond to
unit where she is diagnosed with conversion
this compulsive behavior?
disorder. Meryl asks the nurse, “Why has this
A. By designating times during which the happened to me?” What is the nurse’s best
client can focus on the behavior. response?
B. By urging the client to reduce the
A. “You’ve developed this paralysis so you
frequency of the behavior as rapidly as
can stay with your parents. You must
possible.
deal with this conflict if you want to
C. By calling attention to or attempting to
walk again.”
prevent the behavior.
B. “It must be awful not to be able to
D. By discouraging the client from
move your legs. You may feel better if
verbalizing anxieties.
you realize the problem is
Rationale: The nurse should set times for
psychological, not physical.”
compulsive behavior, encourage gradual
C. “Your problem is real but there is no
reduction, and avoid prevention to prevent
physical basis for it. We’ll work on
distress. Encouraging verbalizing anxieties
what is going on in your life to find out
helps distract from the behavior.
why it’s happened.”
D. “It isn’t uncommon for someone with
52) After seeking help at an outpatient
your personality to develop a
mental health clinic, Daniel Padilla who was
conversion disorder during times of
raped while walking her dog is diagnosed
stress.”
with posttraumatic stress disorder (PTSD).
Rationale: The nurse should honestly explain
Three months later, Daniel Padilla returns to
that the paralysis has no physical cause while
the clinic, complaining of fear, loss of control,
showing empathy. Psychiatric treatment can
and helpless feelings. Which nursing
help resolve the underlying conflict, leading
intervention is most appropriate for Daniel
to symptom relief.
Padilla?

A. Recommending a high-protein, low-fat 54) Nurse Karina Bautista knows that the
diet. following drugs have been known to be
B. Giving sleep medication, as prescribed, effective in treating obsessive-compulsive
to restore a normal sleepwake cycle. disorder (OCD):
C. Allowing the client time to heal.
A. benztropine (Cogentin) and
D. Exploring the meaning of the
diphenhydramine (Benadryl).
traumatic event with the client.
B. chlordiazepoxide (Librium) and
Rationale: A PTSD client must process the
diazepam (Valium)
trauma to heal and prevent worsening
C. fluvoxamine (Luvox) and
symptoms or self-destruction. Relaxation
clomipramine (Anafranil)
therapy aids anxiety and sleep, while
D. divalproex (Depakote) and lithium
medications are used cautiously. A special
(Lithobid)
Rationale: Fluvoxamine and clomipramine B. Anticholinergics
effectively treat OCD. Librium and Valium C. Antipsychotics
help with anxiety but aren’t primary D. Mood stabilizers
treatments. Other medications aren’t
effective. Rationale: Tricyclics and MAOIs treat panic
attacks, though their mechanism is unclear.
55) Alfredo Encela was newly diagnosed with Anticholinergics ease symptoms but not
anxiety disorder. The physician prescribed anxiety. Antipsychotics and mood stabilizers
buspirone (BuSpar). The nurse is aware that aren’t needed.
the teaching instructions for newly
prescribed buspirone should include which 58) Lovi Poe seeks care because she feels
of the following? depressed and has gained weight. To treat
her atypical depression, the physician
A. A warning about the drugs delayed prescribes tranylcypromine sulfate (Parnate),
therapeutic effect, which is from 14 to 10 mg by mouth twice per day. When this
30 days. drug is used to treat atypical depression,
B. A warning about the incidence of what is its onset of action?
neuroleptic malignant syndrome
(NMS). A. 1 to 2 day
C. A reminder of the need to schedule B. 3 to 5 days
blood work in 1 week to check blood C. 6 to 8 days
levels of the drug. D. 10 to 14 days
D. A warning that immediate sedation can
Rationale: Monoamine oxidase inhibitors,
occur with a resultant drop in pulse.
such as tranylcypromine, have an onset of
Rationale: The drug takes 14–30 days to action of approximately 3 to 5 days. A full
work; the client should take it as directed. clinical response may be delayed for 3 to 4
Blood tests aren’t needed. NMS isn’t weeks. The therapeutic effects may continue
reported, but tachycardia is common. for 1 to 2 weeks after discontinuation.

56) Richard Gutierrez with agoraphobia has 59) Ronualdo, a 65 years old client is in the
been symptom-free for 4 months. Classic first stage of Alzheimer’s disease. Nurse
signs and symptoms of phobias include: Patricia Segovia should plan to focus this
client’s care on:
A. Insomnia and an inability to
concentrate. A. Offering nourishing finger foods to help
B. Severe anxiety and fear. maintain the client’s nutritional status.
C. Depression and weight loss. B. Providing emotional support and
D. Withdrawal and failure to distinguish individual counseling.
reality from fantasy. C. Monitoring the client to prevent minor
illnesses from turning into major
Rationale: Phobias cause extreme anxiety problems.
with sweating, poor motor control, D. Suggesting new activities for the client
tachycardia, and high BP. Depression and family to do together.
involves insomnia, poor focus, and weight
loss, while schizophrenia causes withdrawal Rationale: In early Alzheimer’s, clients feel
and reality distortion. overwhelmed, so care focuses on emotional
support. Later, continuous monitoring and
57) Which medications have been found to finger foods help maintain health and
help reduce or eliminate panic attacks? nutrition.

A. Antidepressants
60) Nurse Rhea is assessing a client who has Rationale: Rh isoimmunization occurs when
just been admitted to the emergency Rh-positive fetal blood cells cross into the
department. Which signs would suggest an maternal circulation and stimulate maternal
overdose of an antianxiety agent? antibody production. In subsequent
pregnancies with Rh-positive fetuses,
A. Combativeness, sweating, and maternal antibodies may cross back into the
confusion fetal circulation and destroy the fetal blood
B. Agitation, hyperactivity, and grandiose cells.
ideation
C. Emotional lability, euphoria, and 63) Yooyonseok then asked you, what is the
impaired memory first process that occurs in the inflammatory
D. Suspiciousness, dilated pupils, and response after injury, You tell her:
increased blood pressure
A. Phagocytosis
Ratioanle: Antianxiety overdose causes B. Emigration
euphoria, mood swings, and memory issues. C. Pavementation
PCP causes aggression, sweating, and D. Chemotaxis
confusion. Amphetamines trigger agitation
and grandiosity. Hallucinogens cause Rationale: The first step in the inflammatory
paranoia, dilated pupils, and high BP. response after injury. It occurs when white
blood cells stick to blood vessel walls,
61) Which of the following is normal preparing for migration to the injury site.
newborn calorie intake?
A. 110 to 130 calories per kg. 64) “Public health services are given free of
B. 30 to 40 calories per lb of body weight. charge”. Is this statement true or false?
C. At least 2 ml per feeding
D. 90 to 100 calories per kg A. The statement is true; it is the
responsibility of government to provide
Rationale: Calories per kg is the accepted haste services
way of determined appropriate nutritional B. The statement is false; people pay
intake for a newborn. The recommended indirectly for public health services
calorie requirement is 110 to 130 calories C. The statement may be true or false;
per kg of newborn body weight. This level depending on the Specific service required
will maintain a consistent blood glucose level D. The statement may be true or false;
and provide enough calories for continued depending onpolicies of the government
growth and development. concerned.
Rationale: Public health services vary by
62) Rh isoimmunization in a pregnant client country and government policy. Some
develops during which of the following nations provide free healthcare, while
conditions? others require payment through taxes,
A. Rh-positive maternal blood crosses into insurance, or fees.
fetal blood, stimulating fetal antibodies.
B. Rh-positive fetal blood crosses into 65) Jak Roberto was involved in a motor
maternal blood, stimulating maternal vehicular accident in which the seat belt was
antibodies. not worn. The client is exhibiting crepitus,
C. Rh-negative fetal blood crosses into decrease breath sounds on the left,
maternal blood, stimulating maternal complains of shortness of breath, and has a
antibodies. respiratory rate of 34 breaths per minute.
D. Rh-negative maternal blood crosses Which of the following assessment findings
into fetal blood, stimulating fetal would concern the nurse most?
antibodies.
 A. Temperature of 102 degrees F and
productive cough 68) The proper way to open an envelop-
B. ABG with PaO2 of 92 and PaCO2 of 40 wrapped sterile package after removing the
mmHg outer package or tape is to open the first
C. Trachea deviating to the right position of the wrapper:
D. Barrel-chested appearance
Rationale: Mediastinal shift suggests tension A. away from the body
pneumothorax, a priority in trauma cases. B. to the left of the body
Other options relate to pneumonia, non- C. to the right of the body
critical values, or COPD. D. toward the body

66) Hannamarie with anemia has a Rationale: When opening an envelop-

hemoglobin of 6.5 g/dL. The client is wrapped sterile package, reaching across the
experiencing symptoms of cerebral tissue package and using the first motion to open
hypoxia. Which of the following nursing the top cover away from the body eliminates
interventions would be most important in the need to later reach across the steri9le
providing care? field while opening the package. To remove
equipment from the package, opening the
A. Providing rest periods throughout the first portion of the package toward, to the
day left, or to the right of the body would require
B. Instituting energy conservation reaching across a sterile field.
techniques
C. Assisting in ambulation to the 69) Assessment of a client with possible
bathroom thrombophlebitis to the left leg and a deep
D. Checking temperature of water prior to vein thrombosis is done by pulling up on the
bathing toes while gently holding down on the knee.
Rationale: Dizziness from cerebral hypoxia The client complains of extreme pain in the
increases injury risk. Safety is the priority, calf. This should be documented as:
while rest and energy conservation help
manage anemia-related fatigue. A. positive tourniquet test
B. positive homan’s sign
67) Barbie Forteza is admitted to the medical C. negative homan’s sign
surgical unit following surgery. Four days D. negative tourniquet test
after surgery, the patient spikes a 38.9 Rationale: Pain in the calf while pulling up on
degrees C oral temperature and exhibits a the toes is abnormal and indicates a positive
wet, productive cough. The nurse assesses test. If the client feels nothing or just feels
the patient with understanding that an like the calf muscle is stretching, it is
infection that is acquired during considered negative. A tourniquet test is
hospitalization is known as: used to measure for varicose veins.

A. a community acquired infection 70) Thomas Elison is a 79 year old man who
B. an iatrogenic infection is admitted with diagnosis of dementia. The
C. a nosocomial infection doctor orders a series of laboratory tests to
D. an opportunistic infection determine whether Mr. Elison’s dementia is
Rationale: Nosocomial infections occur in treatable. The nurse understands that the
hospitals but aren’t the primary reason for most common cause of dementia in this
treatment. Community-acquired infections population is:
originate outside hospitals. Iatrogenic
infections result from medical care, while A. AIDS
opportunistic infections affect weakened B. Alzheimer’s disease
hosts. C. Brain tumors
 D. Vascular disease of death from chronic diseases worldwide in
Rationale: Alzheimer’s disease is the most 2015, surpassing conditions like diabetes,
common cause of dementia in the elderly tuberculosis, and pneumonia.
population. AIDS, brain tumors and vascular
disease are all less common causes of 74) When studying chronic diseases, the
progressive loss of mental function in elderly multifactorial etiology of illness is
patients. considered.What does this imply?

71) Which of the following nursing a. Single organism that causes the disease,
interventions is contraindicated in the care such as cholera, must be studied in
of a client with acute osteomyelitis? moredetail.
b. Focus should be on the factors or
A. Apply heat compress to the affected combinations and levels of factors
area contributing todisease.
B. Immobilize the affected area c. The rise in infectious and communicable
C. Administer narcotic analgesics for pain disease must be the main focus.
D. Administer OTC analgesics for pain d. Genetics and molecular structure of
Rationale: Applying heat to the affected area disease is paramount.
is contraindicated in acute osteomyelitis as it
can increase edema, worsen pain, and Rationale: Chronic diseases result from
promote bacterial spread through multiple interacting factors, including
vasodilation. genetics, lifestyle, environment, and social
determinants. Studying these factors helps
72) Catriona Gray is with congestive heart in prevention, management, and treatment,
failure has digoxin (Lanoxin) ordered rather than focusing on a single cause like
everyday. Prior to giving the medication, the infectious diseases.
nurse checks the digoxin level which is
75) The coccygeus muscle is covered by
therapeutic and ausculates an apical pulse.
______ in the anterior view of the pelvis?
The apical pulse is 63 bpm for 1 full minute.
The nurse should: A. Ancustendireus B. Sacrospinous ligament
C. Spirous pre ligament D. Sacrotuberous
A. Hold the Lanoxin ligament
B. Give the half dose now, wait an hour
and give the other half Rationale: The sacrospinous ligament covers
C. Call the physician the coccygeus muscle in the anterior view of
D. Give the Lanoxin as ordered the pelvis. This ligament extends from the
Rationale: Digoxin is given if the apical pulse sacrum to the ischial spine and lies directly
is ≥60 bpm. Since the client’s pulse is 63 bpm over the coccygeus, contributing to pelvic
and the digoxin level is therapeutic, the floor support and stability.
nurse should administer the medication as
ordered. 76) The mechanism of compression of the
sacroiliac joint to maintain equilibrium
73) The WHO reveals that the NUMBER ONE during extra forces during pregnancy
cause of death from chronic iscalled?
diseasesworldwide, using the 2015 estimate,
is _______ A. Deep anatomical slings B. Contraction C.
.a. Tuberculosis b. Diabetes Mellitus c. Force closure D. Superficial slings
ischemic heart disease d. Pneumonia
Rationale: Force closure refers to the
Rationale: According to WHO estimates, compression mechanism of the sacroiliac
ischemic heart disease was the leading cause joint, where muscles, ligaments, and fascia
work together to stabilize the pelvis against A. causes potassium to be excreted
external forces, such as those experienced B. causes potassium to move into the cell
during pregnancy. This stability helps C. causes potassium to move into the
maintain balance and prevent excessive serum
movement. D. counteracts the effects of insulin
Rationale: 50% dextrose is given to
77) Nursing is the protection, promotion and counteract the effects of insulin. Insulin
optimization of health and abilities, drives the potassium into the cell, thereby
prevention of illness and injury, alleviation of lowering the serum potassium levels.
suffering through the diagnosis and
treatment of human response and advocacy 81) Which of the following findings would
in the care of the individuals, families, strongly indicate the possibility of cirrhosis?
communities and population. This is the
most accepted definition of nursing as A. dry skin
defined by the: B. hepatomegaly
A. PNA B. ANA C. Nightingale D. Henderson C. peripheral edema
D. pruritus
Rationale: The American Nurses Association Rationale: Hepatomegaly is an enlarged liver,
(ANA) defines nursing as the protection, which is correct. The spleen may also be
promotion, and optimization of health, as enlarged.
well as the prevention of illness, alleviation
of suffering, and advocacy in patient care. 82) Madam Cheryl has just been diagnosed
with close-angle (narrow-angle) glaucoma.
78) Nurse Marian Rivera is caring for a client The nurse assesses the client for which of the
with haital hernia, which of the following following common presenting symptoms of
should be included in her teaching plan the disorder?
regarding causes:
A. halo vision
A. To avoid heavy lifting B. dull eye pain
B. A dietary plan based on soft foods C. severe eye and face pain
C. Its prevalence in young adults D. impaired night vision
D. Its prevalence in fair-skinned
Rationale: Acute angle-closure glaucoma is a
individuals
medical emergency causing a rapid rise in
Rationale: Heavy lifting is one factor that
intraocular pressure, leading to severe eye
leads to development of a hiatal hernia.
pain, headache, nausea, and vision changes.
79) Joseph Sabello has been diagnosed with 83) Cultural competence is the process of:
hepatic encephalopathy. The nurse observes
flapping tremors. The nurse understands
A. Learning about vast cultures.
that flapping tremors associated with
B. Acquiring specific knowledge, skills, and
hepatic encephalopathy are also known as:
attitudes.
A. aphasia
C. Influencing treatment and care of clients.
B. ascites
D. Motivation and commitment to caring.
C. astacia
D. asterixis Rationale: Cultural competence involves
Rationale: Flapping tremors associated with gaining knowledge, skills, and attitudes for
hepatic encephalophaty are asterixis. culturally congruent care. It ensures
80) Hyperkalemia can be treated with effective healthcare across languages and
administration of 50% dextrose and insulin. cultures, shaping health practices and illness
The 50% dextrose: perceptions.
84) Ethnocentrism is the root of: Rationale: Coronary artery thrombosis
blocks blood flow, causing myocardial
A. Biases and prejudices. infarction and heart muscle damage or
B. Meanings by which people make sense of death.
their experiences.
C. Cultural beliefs. 88) What supplemental medication is most
D. Individualism and self-reliance in frequently ordered in conjunction with
achieving and maintaining health. furosemide (Lasix)?
Rationale: Because ethnocentrism leads people
to view their own culture as superior, causing A. Chloride
them to judge others unfairly. This fosters B. Digoxin
stereotypes, discrimination, and negative C. Potassium
attitudes toward different cultures. The other Rationale: Potassium is given with
options relate more to cultural interpretation,
furosemide to prevent deficiency since loop
traditions, or individual values rather than the
diuretics cause potassium loss, risking
direct effects of ethnocentrism.
arrhythmias.

85) Mrs. Legazpi, an 82-year-old client, is

89) After myocardial infarction, serum
admitted with the diagnosis of mild chronic
glucose levels and free fatty acids are both
heart failure. The nurse expects to hear
increased. What type of physiologic changes
when listening to client’s lungs indicative of
are these?
chronic heart failure would be:

A. Electrophysiologic
A. Stridor
B. Hematologic
B. Crackles
C. Metabolic
C. Wheezes
Rationale: After myocardial infarction,
Rationale: Crackles indicate fluid buildup in
catecholamine release increases, raising
the lungs due to pulmonary congestion from
glucose and free fatty acid levels while
heart failure.
reducing glucose tolerance.

86) What is the primary reason for

90) Which of the following complications is
administering morphine to a client with
indicated by a third heart sound (S3)?
myocardial infarction?

A. Ventricular dilation
A. To sedate the client
B. Systemic hypertension
B. To decrease the client’s pain
C. Aortic valve malfunction
C. To decrease oxygen demand on the
Rationale: S3 is a low-frequency sound in
client’s heart
early diastole caused by rapid ventricular
Rationale: Morphine reduces myocardial
filling and vasodilation.
oxygen demand and pain, easing autonomic
activation during MI.
91) After an anterior wall myocardial
infarction, which of the following problems
87) Which of the following conditions is most
is indicated by auscultation of crackles in the
commonly responsible for myocardial
lungs?
infarction?

A. Left-sided heart failure

A. Aneurysm
B. Pulmonic valve malfunction
B. Heart failure
C. Right-sided heart failure
C. Coronary artery thrombosis
Rationale: The left ventricle pumps most
cardiac output. Anterior wall MI weakens it,
leading to fluid buildup and crackles in the
lungs. 96) What is the most common complication
of a myocardial infarction?
92) Which of the following diagnostic tools is
most used to determine the location of A. Cardiogenic shock
myocardial damage? B. Heart failure
C. Arrhythmias
A. Cardiac catheterization Rationale: Arrhythmia, caused by oxygen
B. Echocardiogram deprivation to the myocardium, is the most
C. Electrocardiogram common complication of an MI.
Rationale: The ECG is the quickest, most
accurate, and most widely used tool to 97) With which of the following disorders is
determine the location of myocardial jugular vein distention most prominent?
infarction.
A. Abdominal aortic aneurysm
93) What is the first intervention for a client B. Heart failure
experiencing myocardial infarction? C. Myocardial infarction
Rationale: Elevated venous pressure,
A. Administer morphine exhibited as jugular vein distention,
B. Administer oxygen indicates a failure of the heart to pump.
C. Administer sublingual nitroglycerin
Rationale: Supplemental oxygen is the 98) What position should the nurse place the
priority to prevent further myocardial head of the bed in to obtain the most
damage during infarction. accurate reading of jugular vein distention?

94) What is the most appropriate nursing A. High-Fowler’s

response to a myocardial infarction client B. Raised 10 degrees
who is fearful of dying? C. Raised 30 degrees
Rationale: Jugular venous pressure is
A. “Tell me about your feelings right now.” measured using a ruler from the sternal
B. “When the doctor arrives, everything will angle to the highest pulsation at 15–30°
be fine.” incline.
C. “This is a bad situation, but you’ll feel
better soon.” 99) Which of the following parameters
Rationale: Validation of the client’s feelings should be checked before administering
is the most appropriate response. It gives the digoxin?
client a feeling of comfort and safety.
A. Apical pulse
95) Which of the following classes of B. Blood pressure
medications protects the ischemic C. Radial pulse
myocardium by blocking catecholamines Rationale: The apical pulse provides the
and sympathetic nerve stimulation? most accurate heart rate assessment before
giving digoxin.
A. Beta-adrenergic blockers
B. Calcium channel blockers 100) Toxicity from which of the following
C. Narcotics medications may cause a client to see a
Rationale: Beta-blockers reduce heart green halo around lights?
workload and oxygen demand by blocking
catecholamine effects, lowering reinfarction A. Digoxin
risk. B. Furosemide
 C. Metoprolol
Rationale: One of the most common signs of 105) Stimulation of the sympathetic nervous
digoxin toxicity is the visual disturbance system produces which of the following
known as the green halo sign. responses?

101) Which of the following symptoms is A. Bradycardia

most commonly associated with left-sided B. Tachycardia
heart failure? C. Hypotension

A. Crackles Rationale: Sympathetic stimulation releases

B. Arrhythmias norepinephrine, increasing heart rate and
C. Hepatic engorgement contractility.
Rationale: Crackles signal left-sided heart
106) Which of the following conditions is
failure due to fluid buildup in the lungs,
most closely associated with weight gain,
causing breathing difficulty.
nausea, and a decrease in urine output?

102) In which of the following disorders

A. Angina pectoris
would the nurse expect to assess sacral
B. Cardiomyopathy
edema in bedridden client?
C. Right-sided heart failure
Rationale: Right-sided heart failure causes
A. DM
fluid buildup, leading to weight gain, nausea,
B. Pulmonary emboli
and reduced urine output.
C. Right-sided heart failure
Rationale: The most accurate area of the
107) What is the most common cause of an
body to assess dependent edema in a
abdominal aortic aneurysm?
bedridden client is the sacral area. Sacral, or
dependent, edema is secondary to right-
A. Atherosclerosis
sided heart failure.
B. DM
C. HPN
103) Which of the following symptoms might
Rationale: Atherosclerosis weakens the
a client with right-sided heart failure exhibit?
aortic wall, causing 75% of abdominal aortic
aneurysms.
A. Adequate urine output
B. Polyuria
108) In which of the following areas is an
C. Oliguria
abdominal aortic aneurysm most commonly
Rationale: Right-sided heart failure impairs
located?
aldosterone deactivation, causing fluid
retention and late-stage oliguria.
A. Distal to the iliac arteries
B. Distal to the renal arteries
104) Which of the following classes of
C. Adjacent to the aortic branch
medications maximizes cardiac performance
Rationale: The distal aorta is more prone to
in clients with heart failure by increasing
aneurysms due to lack of surrounding stable
ventricular contractility?
structures.

A. Beta-adrenergic blockers
109) A pulsating abdominal mass usually
B. Calcium channel blockers
indicates which of the following conditions?
C. Inotropic agents
Rationale: Inotropic agents strengthen heart
A. Abdominal aortic aneurysm
contractions, boosting ventricular
B. Enlarged spleen
contractility and cardiac output.
 C. Gastric distention complaining of abdominal cramps and the
Rationale: A pulsating abdominal mass may nurse observes the client is experiencing
indicate an aortic aneurysm but can be increased perspiration and salivation. The
normal in thin individuals. nurse makes sure the availability of which of
the following?
110) What is the most common symptom in
a client with abdominal aortic aneurysm? A. levodopa
B. methylphenidate hydrochloride (Ritalin)
A. Abdominal pain C. atropine sulfate (Atropine)
B. Diaphoresis Rationale: Keep resuscitation equipment
C. Headache and atropine ready when giving
Rationale: The distal aorta is more prone to edrophonium for cholinergic crisis.
aneurysms due to lack of surrounding
support.
114) Nurse Parker is instructing Lily Cruz
111) Ryan Gosling is with myasthenia gravis regarding carbidopa-levodopa (Sinemet) for
frequently complains of weakness and the treatment of Parkinson’s disease. Nurse
fatigue. The physician plans to identify Parker tells Lily Cruz which of the following
whether the client is responding to an indicates an overdose of the medication?
overdose of the medication or a worsening
of the disease. A tensilon test is performed. A. Difficulty performing a voluntary
Which of the following would indicate that movement.
the client is experiencing an overdose of the B. Increased blood pressure.
medication? C. Decreased appetite.
Rationale: Carbidopa-levodopa overdose
A. Temporarily worsening of the condition. causes dyskinesia, leading to impaired
B. Improvement of weakness and fatigue. voluntary movements.
C. No change in the condition.
Rationale: The Tensilon test distinguishes 115) Hades Riego is giving dietary
cholinergic crisis (worsens symptoms) from instructions to Felicia Riley receiving
myasthenic crisis. levodopa. Which of the following food items
should be avoided by Felicia Riley?
112) Brad Pitt is with juvenile pilocytic
astrocytoma who is receiving A. Goat yogurt
dexamethasone (Decadron) 4mg/IV every 6 B. Whole grain cereal
hours to relieve symptoms of right arm C. Asparagus
weakness and headache. Which of the Rationale: Excess pyridoxine reduces
following assessments will concern the levodopa's effect; avoid foods like bananas,
nurse most? meats, and whole grains.

A. Blood glucose level of 280 mg/dl. 116) Biperiden hydrochloride (Akineton) is

B. Daily weight gain of 0.5 kg. added to a list of antiparkinsonian
C. Client still complains of headaches. medications that Lulu, an elderly client is
Rationale: The inability to recognize family taking. Which of the following instructions
members is a new neurologic deficit for this made by the nurse that needs further
client and indicates a possible increasing learning?
intracranial pressure (ICP).
A. Avoiding alcohol and caffeine.
113) Tom Cruise who is receiving B. Using ice chips, candy or gum for dry
edrophonium chloride suddenly is mouth.
 C. Walking in the morning to have a daily D. SGPT (ALT) level 50 units per liter of
source of direct sunlight. serum.
Rationale: Biperiden treats Parkinson’s Rationale: Carbamazepine treats seizures
symptoms; photophobia side effect requires and nerve pain but may lower platelets,
sunglasses in sunlight. WBCs, and neutrophils.

117) Nurse Batman is giving instructions to a 120) Bianca Umali, female client who has a
client receiving phenytoin (Dilantin). Nurse history of seizures went to a healthcare
Batman concludes that the client has a facility to ask the nurse regarding the use of
sufficient knowledge if the client states that: birth control pills while on phenytoin
therapy. The nurse correctly states to the
A. "Wearing a medical alert tag is not client that:
required".
B. "Alcohol is permitted while taking this A. Taking phenytoin decreases the
medication". effectiveness of birth control pills.
C. "I can take the medicine with milk". B. Pregnancy is not allowed while taking
D. "Have the serum phenytoin level taken phenytoin.
before giving the medication". C. There is no known interaction between
Rationale: Taking the prescribed daily these medicines so there is nothing to worry
dosage to keep the blood level of the drug about.
constant and having a sample drawn for D. To discontinue phenytoin and proceed
serum drug level before taking the morning with the oral contraceptive.
dose. Rationale: Anticonvulsants like
phenobarbitone, phenytoin, and
118) An 18-year-old client is taking carbamazepine reduce oral contraceptive
phenytoin (Dilantin) for the treatment of effectiveness.
seizures. Phenytoin blood level is revealed to
be 25 mcg/ml. Which of the following 121) Phenobarbital (luminal) is given to
symptoms would be expected because of Francis, for a short treatment of anxiety.
the laboratory result? Which of the following results would
indicate a therapeutic serum range of the
A. No symptoms, because the value is within medication?
the normal range.
B. Hyperactivity. A. 5-10 mcg/ml
C. Tremors. B. 15-40 mcg/ml
D. Nystagmus. C. 45-65 mcg/ml
Rationale: Phenytoin levels of 20 to 30 mg/L D. 50-90 mcg/ml
result in nystagmus (Involuntary eye Rationale: Phenobarbital, a CNS depressant,
movement). treats anxiety short-term; its therapeutic
range is 15-40 ng/ml.
119) Gabby Garcia is prescribed with
carbamazepine (Tegretol) for the treatment 122) A child was brought to the emergency
of bipolar disorder. Which of the following room complaining of right upper quadrant
laboratory results indicates that Gabby abdominal pain, nausea, and vomiting. Upon
Garcia is experiencing a side effect of this the interview of Nurse Sheryl to the mother,
medication? the client has been taking a long-term use of
acetaminophen. Overdosage of the
A. Neutrophil count of 1,200/mm3 medication is suspected. Which of the
B. Platelet count of 160,000/mm3. following medications should be readily
C. Uric acid level of 4mg/dl. available?
 A. naltrexone (ReVia) Rationale: Meperidine, an opioid, causes
B. urea (Ureaphil) nausea, hypotension, confusion, respiratory
C. acetylcysteine (Mucomyst) depression, and constipation, not diarrhea.
D. valproic acid (Depakene)
Rationale: Acetaminophen toxicity occurs 126) Codeine sulfate is prescribed to a client
from overdose or prolonged use. Limit with a severe back pain. Which of the
intake to 4,000 mg/day; keep acetylcysteine following side effect is associated with this
ready. medication?

123) Ace Torres is with bell’s palsy tells the A. Hypertension

nurse that acetaminophen (Tylenol) is taken B. Urinary frequency
daily as prescribed by the physician. Which C. Constipation
laboratory value would indicate a toxicity of D. Hyperactivity
the medication? Rationale: Codeine relieves mild to
moderate pain but may cause drowsiness,
A. Blood urea nitrogen of 60 mg/dl dizziness, nausea, and constipation.
B. Total bilirubin of 1.5 mg/dl.
C. Alkaline phosphatase of 120 IU/L. 127) Diego is with tonic-clonic seizure is
D. Direct bilirubin of 0.3 mg/dl. receiving phenobarbital (Luminal) and
Rationale: Acetaminophen is hepatotoxic. valproic acid (Depakene). Nurse Zandro tells
Among the choices, the blood urea nitrogen Diego that:
is elevated. The normal value of BUA is
between 7 to 20 mg/dL (2.5 to 7.1 mmol/L). A. Valproic acid decreases phenobarbital
metabolism.
124) Nurse Sharon is caring for a client with B. Valproic acid increases phenobarbital
a history of overdosage of aspirin. The nurse metabolism.
suspects which of the following can be an C. There is no interaction between the two.
early sign of aspirin toxicity? Rationale: Valproic acid slows phenobarbital
metabolism, increasing its levels; monitor
A. Unsteady gait and adjust dosage accordingly.
B. Drowsiness
C. Confusion 128) Nurse Radleigh is providing instructions
D. Tinnitus to Zareya who is taking doxapram (Dopram).
Rationale: Acute ingestion of less than 150 Which of the following statements made by
mg/kg can result in severe toxicity. The Zareya needs further instructions?
earliest symptoms of acute aspirin poisoning
may include ringing in the ears (tinnitus) and A. "I need to take the medication before
impaired hearing. meals".
B. “I need to take the medication at
125) Meperidine hydrochloride (Demerol) is bedtime”.
given to a Maria Regla who is experiencing C. "I need to avoid drinking coffee".
post-operative pain. Which of the following D. "I will not chew or crush long acting form
are the side effects of the medication, of the medications".
except?
Rationale: Doxapram, a CNS stimulant, may
A. Tremors cause insomnia; take it at least 6 hours
B. Diarrhea before bed.
C. Sweating
129) Diazepam (Valium) is prescribed to
Choti with alcohol withdrawal. Which of the
following statements made by Choti
indicates an understanding of the treatment 132) Nurse Antonious in the newborn
regimen? nursery is monitoring a preterm newborn
infant for respiratory distress syndrome.
A. "This medication causes a blurring of Which assessment signs if noted in the
vision". newborn infant would alert the nurse to the
B. "This medication will cause a decreased possibility of this syndrome?
platelet and white blood cell count in my
blood". A. Hypotension and Bradycardia
C. "I'll have my physician lower my dosage B. Tachypnea and retractions
once I start to feel okay". C. Acrocyanosis and grunting
D. "Drinking grapefruit can decrease the D. The presence of a barrel chest with
side effects with this medication" grunting
Rationale: Diazepam causes drowsiness; Rationale: RDS affects preemies due to
grapefruit slows its metabolism, increasing surfactant deficiency, causing alveolar
effects and side effects. collapse; surfactant forms at 34 weeks
gestation.
130) Nurse Lala in a delivery room is assisting
with the delivery of a newborn infant. After 133) Nurse Patty in a newborn nursery is
the delivery, Nurse Lala prepares to prevent performing an assessment of a newborn
heat loss in the newborn resulting from infant. Nurse Patty is preparing to measure
evaporation by: the head circumference of the infant. Nurse
Patty would most appropriately:
A. Warming the crib pad
B. Turning on the overhead radiant warmer A. Wrap the tape measure around the
C. Closing the doors to the room infant’s head and measure just above the
D. Drying the infant in a warm blanket eyebrows.
Rationale: A newborn's temperature drops B. Place the tape measure under the infant's
after birth due to an immature heat- head at the base of the skull and wrap
regulating system and environmental factors. around to the front just above the eyes
C. Place the tape measure under the
131) Nurse Raia is assessing a newborn infant’s head, wrap around the occiput, and
infant following circumcision and notes that measure just above the eyes
the circumcised area is red with a small D. Place the tape measure at the back of the
amount of bloody drainage. Which of the infant’s head, wrap around across the ears,
following nursing actions would be most and measure across the infant’s mouth.
appropriate? Rationale: Measure head circumference by
wrapping tape around the occiput, just
A. Document the findings above the eyebrows.
B. Contact the physician
C. Circle the amount of bloody drainage on 134) Nurse Regla, a postpartum nurse is
the dressing and reassess in 30 minutes providing instructions to the mother of a
D. Reinforce the dressing newborn infant with hyperbilirubinemia
Rationale: Monitor the circumcision site for who is being breastfed. Nurse Regla provides
complications. Yellow exudate after 24 which most appropriate instructions to the
hours is normal; don’t remove it. Ensure the mother?
infant voids and keep the area clean with
petrolatum until healed. Report excessive A. Switch to bottle-feeding the baby for 2
crying, redness, or tenderness. weeks
B. Stop the breastfeedings and switch to
bottle-feeding permanently
 C. Feed the newborn infant less frequently A. “Your infant needs vitamin K to develop
D. Continue to breast-feed every 2-4 hours immunity.”
Rationale: Hyperbilirubinemia results from B. “Vitamin K will protect your infant from
excess bilirubin, causing yellow skin and having jaundice.”
sclera in newborns. C. “Newborn infants are deficient in
vitamin K, and this injection prevents your
135) Nurse Liliene on the newborn nursery infant from abnormal bleeding.”
floor is caring for a neonate. On assessment D. “Newborn infants have sterile bowels,
the infant is exhibiting signs of cyanosis, and vitamin K promotes the growth of
tachypnea, nasal flaring, and grunting. bacteria in the bowel.”
Respiratory distress syndrome is diagnosed, Rationale: Vitamin K is necessary for the
and the physician prescribes surfactant body to synthesize coagulation factors.
replacement therapy. Nurse Liliene would Vitamin K is administered to the newborn
prepare to administer this therapy by: infant to prevent abnormal bleeding.

A. Subcutaneous injection 138) Nurse Dyan in a newborn nursery

B. Intravenous injection receives a phone call to prepare for the
C. Instillation of the preparation into the admission of a 43-week-gestation newborn
lungs through an endotracheal tube with Apgar scores of 1 and 4. In planning for
D. Intramuscular injection the admission of this infant, Nurse Dyan’s
Rationale: RDS therapy supports the infant highest priority should be to:
until surfactant develops; treatment may
include surfactant replacement via A. Connect the resuscitation bag to the
endotracheal tube. oxygen outlet
B. Turn on the apnea and cardiorespiratory
136) Nurse Snow is assessing a newborn monitors
infant who was born to a mother who is C. Set up the intravenous line with 5%
addicted to drugs. Which of the following dextrose in water
assessment findings would Nurse Snow D. Set the radiant warmer control
expect to note during the assessment of this temperature at 36.5* C (97.6*F)
newborn? Rationale: The highest priority on admission
to the nursery for a newborn with low Apgar
A. Sleepiness scores is airway, which would involve
B. Cuddles when being held preparing respiratory resuscitation
C. Lethargy equipment.
D. Incessant crying
Rationale: A newborn infant born to a 139) Vitamin K is prescribed for a neonate.
woman using drugs is irritable. The infant is Nurse Rio prepares to administer the
overloaded easily by sensory stimulation. medication in which muscle site?
The infant may cry incessantly and posture
rather than cuddle when being held. A. Deltoid
B. Triceps
137) Nurse Kennymarie prepares to C. Vastus lateralis
administer a vitamin K injection to a D. Biceps
newborn infant. The mother asks Nurse Rationale: Vitamin K prevents hemorrhagic
Kennymarie why her newborn infant needs disease and is given IM in the vastus lateralis
the injection. The best response by Nurse muscle.
Kennymarie would be:
140) Sibal, a nursing instructor asks Rhea, a
nursing student to describe the procedure
for administering erythromycin ointment A. Pulse, respirations, temperature
into the eyes of a neonate. Sibal determines B. Temperature, pulse, respirations
that Rhea needs to research this procedure C. Respirations, temperature, pulse
further if Rhea states: D. Respirations, pulse, temperature
Rationale: This sequence is least disturbing.
A. “I will cleanse the neonate’s eyes before Touching with the stethoscope and inserting
instilling ointment.” the thermometer increase anxiety and
B. “I will flush the eyes after instilling the elevate vital signs.
ointment.”
C. “I will instill the eye ointment into each of 144) A comatose client needs a
the neonate’s conjunctival sacs within one nasopharyngeal airway for suctioning. After
hour after birth.” the airway is inserted, he gags and coughs.
D. “Administration of the eye ointment may Which action should the nurse take?
be delayed until an hour or so after birth so
that eye contact and parent-infant A. Remove the airway and insert a shorter
attachment and bonding can occur.” one.
Rationale: Eye prophylaxis prevents B. Reposition the airway.
gonorrhea and chlamydia; do not flush after C. Leave the airway in place until the client
instillation to retain effectiveness. gets used to it.
D. Remove the airway and attempt
141) A baby is born precipitously in the ER. suctioning without it.
The nurse’s initial action should be to: Rationale: If gagging or coughing occurs after
NPA placement, it may be too long; replace
A. Establish an airway for the baby with a shorter one.
B. Ascertain the condition of the fundus
C. Quickly tie and cut the umbilical cord 145) An 79-year-old client requires long-
D. Move mother and baby to the birthing term ventilator therapy. She has a
unit tracheostomy in place and requires frequent
Rationale: The nurse should position the suctioning. Which of the following
baby with head lower than chest and rub the techniques is correct?
infant’s back to stimulate crying to promote
oxygenation. A. Using intermittent suction while
advancing the catheter.
142) The primary critical observation for B. Using continuous suction while
Apgar scoring is the: withdrawing the catheter.
C. Using intermittent suction while
A. Heart rate withdrawing the catheter.
B. Respiratory rate D. Using continuous suction while advancing
C. Presence of meconium the catheter.
D. Evaluation of the Moro reflex Rationale: Apply intermittent suction during
Rationale: The heart rate is vital for life and withdrawal, limit to 10 seconds, and
is the most critical observation in Apgar preoxygenate to prevent hypoxia.
scoring. Respiratory effect rather than rate is
included in the Apgar score; the rate is very 146) Troy’s ABG analysis reveals a pH of 7.18,
erratic. PaCO2 of 72 mm Hg, PaO2 of 77 mm Hg, and
HCO3- of 24 mEq/L. What do these values
143) When performing a newborn indicate?
assessment, the nurse should measure the
vital signs in the following sequence: A. Metabolic acidosis
B. Respiratory alkalosis
 C. Metabolic alkalosis D. Ineffective airway clearance related to
D. Respiratory acidosis retained secretions.
Rationale: Respiratory acidosis occurs from Rationale: Pneumonia causes inflammation
CO₂ buildup, lowering pH; kidneys and excess secretions, leading to ineffective
compensate by excreting acid and airway clearance and difficulty coughing.
reabsorbing bicarbonate.
150) A community health nurse is
147) Cardo Dalisay, a police officer brings in conducting an educational session with
a homeless client to the ER. A chest x-ray community members regarding TB. The
suggests he has TB. The physician orders an nurse tells the group that one of the first
intradermal injection of 5 tuberculin symptoms associated with TB is:
units/0.1 ml of tuberculin purified derivative.
Which needle is appropriate for this A. A bloody, productive cough
injection? B. A cough with the expectoration of
mucoid sputum
A. 5/8” to ½” 25G to 27G needle. C. Chest pain
B. 1” to 3” 20G to 25G needle. D. Dyspnea
C. ½” to 3/8” 26 or 27G needle. Rationale: Early TB symptoms include mild
D. 1” 20G needle. cough with mucoid sputum; later signs
Rationale: Intradermal injections use ≤0.5 ml include hemoptysis, weight loss, fever, and
with a 26G–27G needle inserted 1/8” below night sweats.
the epidermis.
151) Haeinmae is the head of a health care
148) Cabatingan, an 85-year old client is team that consists of one licensed
admitted for elective knee surgery. Physical practical/vocational nurse, one nursing
examination reveals shallow respirations but assistant, a nursing student and yourself. To
no signs of respiratory distress. Which of the whom is it appropriate to assign complete
following is a normal physiologic change care for:
related to aging?
A) Yourself
A. Increased elastic recoil of the lungs. B) The nursing student
B. Increased number of functional C) The licensed vocational nurse
capillaries in the alveoli. D) The nursing assistant
C. Decreased residual volume. Rationale: While the nurse may delegate a
D. Decreased vital capacity. bed bath for a stable client, this care should
Rationale: Aging reduces vital capacity, be performed by an RN for a new admission.
elastic recoil, and alveolar capillaries, while Only tasks that do not require independent
residual volume increases. judgment should be delegated.

149) Gallardo, an 87-year-old client is 152) A mother brings her the clinic,
admitted with pneumonia. Which nursing complaining that the child seems to be The
diagnosis should take priority? nurse expects to find which of the following
on the initial history and physical
A. Acute pain related to lung expansion assessment?
secondary to lung infection.
B. Risk for imbalanced fluid volume related A) Increased temperature and lethargy
to increased insensible fluid losses B) Rash and restlessness
secondary to fever. C) Increased sleeping and listlessness
C. Anxiety related to dyspnea and chest pain. D) Diarrhea and poor skin turgor
Rationale: Rash and restlessness suggest an A) Obtain a history of fluid loss
infectious or allergic reaction, common in B) Report output of less than 30 ml/hr
childhood illnesses. C) Monitor response to IV fluids
D) Check skin turgor every four hours
153) As the nurse takes a history of a 3-year- Rationale: When directing a UAP, the nurse
old Willy, with neuroblastoma, what must communicate clearly about each
comments by the parents require follow-up delegated task with specific instructions on
and are consistent with the diagnosis? what must be reported. Because the RN is
responsible for all care-related
A) "Willy has been listless and has lost decisions,only implementation tasks should
weight." be assigned because they do not require
B) "Willy’s urine is dark yellow and small in independent judgment.
amounts."
C) "Clothes are becoming tighter across 156) Nurse Sarah Lahbati is assessing a 4-
Willy’s abdomen." year-old Shikamaru, for possible rheumatic
D) "We notice muscle weakness and some fever. Which of the following would the
unsteadiness." nurse suspect is related to this diagnosis?
Rationale: One of the most common signs of A) Diagnosis of chickenpox six months ago
neuroblastoma is increasing abdominal girth. B) Exposure to strep throat in daycare last
The parents' report that clothing is tight is month
significant and should be followed by C) Treatment for ear infection two months
additional assessments. ago
D) Episode of fungal skin infection last week
154) A 16-year-old Marvel Stephen presents Rationale: Group A strep infection strongly
to the emergency department. The triage links to rheumatic fever, often following
nurse finds that this teenager is legally strep throat within 2–6 weeks.
married and signed the consent form for
treatment. What would be the appropriate 157) When the nurse becomes aware of
INITIAL action by the nurse? feeling reluctant to interact with a
manipulative client, the BEST action by the
A) Refuse to see the client until a parent or nurse is to:
legal guardian can be contacted
B) Withhold treatment until telephone A) Discuss the feeling of reluctance with an
consent can be obtained from the spouse objective peer or supervisor
C) Refer the client to a community pediatric B) Limit contacts with the client to avoid
hospital emergency room reinforcing the manipulative behavior
D) Assess and treat in the same manner as C) Confront the client regarding the negative
any adult client effects of his/her behavior on others
Rationale: Minors may become known as an D) Develop a behavior modification plan that
"emancipated minor" through marriage, will promote more functional behavior
pregnancy, high school graduation, Rationale: The nurse who is experiencing
independent living or service in the military. stress in the therapeutic relationship can
Therefore, this client, who is married, has gain objectivity through supervision. The
the legal capacity of an adult. nurse must attempt to discover attitudes
and feelings in the self that influence the
155) A newly admitted elderly client is nurseclient relationship.
severely dehydrated. When planning care
for this client, which one of the following is 158) Taylor Swift is being treated for
an appropriate task for an Unlicensed paranoid schizophrenia. When Taylor
Assistive Personnel (UAP)? became loud and boisterous, Nurse Ianne
immediately placed her in seclusion as a discriminate on the basis of a disability.
precautionary measure. Taylor willingly Employers also must make "reasonable
complied. Nurse Ianne’s action? accommodations.
A) May result in charges of unlawful
seclusion and restraint 161) The mother of a school-aged child in a
B) Leaves the nurse vulnerable for charges of long leg cast asks Nurse Rhianne how to
assault and battery relieve itching inside the cast. Which of the
C) Was appropriate in view of the client's following is appropriate for Nurse Rhianne to
history of violence suggest as a remedy?
D) Was necessary to maintain the
therapeutic milieu of the unit A) Scratching the outside of the cast
Rationale: Seclusion should only be used vigorously, applying pressure over the area
when there is an immediate threat of B) Blowing a hair dryer or heat lamp on the
violence or threatening behavior. cast over the area that is itching
C) Using a long, smooth piece of wood to
159) Igot Aldren has been admitted to the gently scratch the affected area
Coronary Care Unit with a Myocardial D) Applying an ice pack over the area of the
Infarction. Which of the following nursing cast that is affected
diagnosis should have PRIORITY? Rationale: Applying ice is a safe method of
relieving the itching.
A) Pain related to ischemia
B) Risk for altered elimination: constipation 162) Which of the following BEST describes
C) Risk for complication: dysrhythmias the application of time management
D) Anxiety strategies in the role of the nurse manager?
Rationale: Pain is related to ischemia, and A) Scheduling staff efficiently to cover client
relief of pain will decrease myocardial needs
oxygen demands, reduce blood pressure and B) Assuming a fair share of the client care as
heart rate and relieve anxiety. Pain also a role model
stimulates the sympathetic nervous system C) Setting daily goals to prioritize work
and increases preload, further increasing D) Delegating tasks to reduce work load
myocardial demands. Rationale: Time management strategies
must include setting priorities and meeting
160) Rhea, a nurse manager who is goals.
responsible for hiring professional nursing
staff is required to comply with the 163) A client is being discharged and needs
Americans with Disabilities Act. The instructions on wound care. When planning
provisions of the law require Nurse Rhea to? to teach the client, the nurse should:

A) Maintain an environment free from a. identifies the client’s learning needs and
hazards learning ability.
B) Provide reasonable accommodations for b. identifies the client’s learning needs and
disabled individuals advises him what to do.
C) Make all necessary accommodations for c. identifies the client’s problems and makes
disabled individuals the appropriate referral.
D) Consider only physical disabilities in d. provides pamphlets or videotapes for
making employment decisions ongoing learning.
Rationale: The law is designed to permit Rationale: To provide the most appropriate
persons with disabilities access to job teaching, the nurse first needs to identify
opportunities. Employers must evaluate an what the client needs to know and
applicant's ability to perform the job and not
determine the client’s educational level and antirheumatic drug (DMARD) before surgery
learning ability. D) Administer an additional dose of
prednisone before surgery
164) Patient Rafaela is with a history of type
2 diabetes is taking metformin to manage Rationale: Stopping prednisone abruptly
blood glucose levels. Rafaela experiences a may cause adrenal insufficiency; it should be
respiratory infection and is prescribed a continued as usual before surgery.
course of antibiotics. What should the nurse
167) Kelsey Meritt, 27 years old, reports hair
advise the patient regarding the timing of
growth on her face and chest. On physical
metformin administration during the
examination, you notice acanthosis nigricans.
antibiotic therapy?
Which endocrine disorder is most likely
responsible for her symptoms?
A. Take metformin immediately before
taking the antibiotic.
B. Take metformin immediately after taking A)Cushing’ssyndrome
the antibiotic. B)Hyperthyroidism
C. Continue taking metformin as usual. C) Polycystic Ovary Syndrome (PCOS)
D. Discontinue metformin until the antibiotic D) Addison’s disease
course is completed.
Rationale: Metformin should be continued Rationale: PCOS causes excess androgens,
unless complications arise, as antibiotics leading to hair growth on the face and chest.
usually don’t interfere. Monitor renal Acanthosis nigricans is linked to insulin
function. resistance, a common feature of PCOS.

168) Ricardo, a 65 year old patient with

165) Zanjo, a 40-year-old presents extreme
pancreatic cancer is receiving chemotherapy.
fatigue, muscle weakness, and unintentional
He complains of persistent nausea and
weight loss. Laboratory results show
vomiting, which is affecting his ability to
elevated levels of serum calcium and low
tolerate food and medications. What is the
levels of parathyroid hormone (PTH). What
most appropriate pharmacological
is the most likely diagnosis?
intervention for managing chemotherapy-
induced nausea and vomiting in this patient?
A)Hyperparathyroidism
A)Antibiotics
B)Hyperthyroidism
B)Loperamide(Imodium)
C)Hypoparathyroidism
C)Painrelievers
D) Diabetes mellitus
D)Prophylacticantibiotics
Rationale: Low PTH despite high calcium E) Antiemetic medications such as
suggests impaired calcium regulation, ondansetron (Zofran)
indicating hypoparathyroidism.
Rationale: Ondansetron prevents
166) Mikha, 45 years old, has a history of chemotherapy-induced nausea and vomiting,
rheumatoid arthritis and is scheduled for improving food and medication tolerance.
elective surgery. She takes prednisone daily
169) Rosemary, a 55-year-old patient with
for disease management. What is the most
ovarian cancer is undergoing chemotherapy.
appropriate action regarding her
She experiences extreme fatigue and a
corticosteroid therapy before surgery?
significant decrease in her hemoglobin levels.
A) Continue prednisone therapy as usual What is the most appropriate intervention
B) Discontinue prednisone 24 hours before for managing chemotherapy-induced
surgery anemia in this patient?
C) Switch to a disease-modifying
A)Increasing fluid intake A.Type1diabetes
B) Administering prophylactic antibiotics B.Type2diabetes
C)Reducing chemotherapy dose C.Gestationaldiabetes
D)Bloodtransfusion D. LADA (Latent Autoimmune Diabetes in
E) Encouraging physical activity Adults)

Rationale: Blood transfusion quickly restores Rationale: Chronic pancreatitis is commonly

hemoglobin levels, relieving anemia-related associated with the development of type 2
fatigue in chemotherapy patients. diabetes due to the progressive loss of
pancreatic function and insulin production
170) Geronimo, a 45-year old patient over time.
presents with severe abdominal pain
radiating to the back, nausea, and vomiting. 173) Loisa Andalio, a 55-year old patient with
Laboratory tests show elevated amylase and diabetes is undergoing surgery. What type of
lipase levels. What is the most common diet should be prescribed for the patient in
cause of acute pancreatitis? the perioperative period?

A.Alcoholconsumption A.Low-proteindiet
B.Gallstones B.Clearliquiddiet
C.Smoking C. NPO (Nothing by mouth) diet
D. High-fat diet D. Regular diabetic diet

Rationale: Gallstones are the most common Rationale: Before surgery, patients are often
cause of acute pancreatitis. They can placed on an NPO (Nothing by mouth) diet to
obstruct the pancreatic duct, leading to prevent complications during anesthesia
inflammation and enzyme release into the and surgery. The patient’s blood glucose
pancreas, causing characteristic symptoms. levels will be closely monitored.

171) Lory Mae, a35-year old patient with 174) A 60-year-old Rosario with a history of
acute pancreatitis has developed diabetes is admitted with symptoms of
pseudocysts. What is the typical hyperglycemia, including excessive thirst
management approach for pseudocysts? and frequent urination. What electrolyte
imbalance is commonly associated with
A.Surgicaldrainage hyperglycemia, and how should it be
B.Antibiotics managed?
C.Conservativemanagement
D. Pancreatic transplantation A. Hyperkalemia; restrict dietary potassium
B. Hyponatremia; administer hypertonic
Rationale: The typical management saline
approach for pseudocysts in acute C. Hypocalcemia; provide calcium
pancreatitis is conservative management, supplements
which involves observation and monitoring D. Hypernatremia; increase fluid intake
for resolution or intervention if necessary.
Surgical drainage is reserved for Rationale: Hyperglycemia is commonly
complications. associated with hyponatremia.
Management involves administering
172) Maria Clara, a 60-year old patient with hypertonic saline to correct sodium levels
chronic pancreatitis is at risk of developing while addressing hyperglycemia.
diabetes mellitus. What type of diabetes is
commonly associated with chronic 175) A 38-year-old Jolina Magdangal with
pancreatitis? type 2 diabetes is struggling with weight gain
despite efforts to control blood sugar levels.
What medication class should be considered
for weight management in this patient with C)Cushing’ssyndrome
diabetes? D) Diabetes mellitus

A.Beta-blockers Rationale: Diabetes mellitus causes high

B.Oralantidiabeticagents blood glucose, leading to excessive thirst,
C.SGLT2inhibitors frequent urination, and weight loss.
D. Statins
178) A 39-year-old male, Eduardo complains
Rationale: Sodium-glucose cotransporter 2 of sudden, severe headaches, palpitations,
(SGLT2) inhibitors are a class of medications excessive sweating, and anxiety. On
that can be considered for weight examination, his blood pressure is
management in patients with type 2 significantly elevated. Which endocrine
diabetes. These medications may lead to disorder is most likely responsible for his
weight loss in addition to their blood sugar- symptoms?
lowering effects. A)Hypoparathyroidism
B)Pheochromocytoma
176) A 45-year-old Cardo Dalisay presents C)Hyperthyroidism
with hypotension, fatigue, and weight loss. D) Diabetes mellitus
Laboratory tests show low cortisol levels and
elevated adrenocorticotropic hormone Rationale: Pheochromocytoma causes
(ACTH). Imaging studies reveal adrenal gland excessive catecholamine release, leading to
atrophy. What is the most likely diagnosis, severe headaches, hypertension, sweating,
and what additional test may be helpful? and palpitations.

179) A 50-year-old male, Cesario Baka

A) Cushing’s disease; low-dose presents with extreme fatigue, muscle
dexamethasone suppression test weakness, and unintentional weight loss.
B) Hypothyroidism; thyroid function tests Laboratory results show elevated levels of
C) Addison’s disease; 21-hydroxylase serum calcium and low levels of parathyroid
antibody test hormone (PTH). What is the most likely
D) Pheochromocytoma; 24-hour urine diagnosis?
metanephrines A)Hyperparathyroidism
B)Hyperthyroidism
Rationale: The clinical presentation of C)Hypoparathyroidism
hypotension, fatigue, weight loss, low D) Diabetes mellitus
cortisol levels, elevated ACTH, and adrenal
gland atrophy suggests Addison’s disease. Rationale: Hypoparathyroidism causes low
An additional test that may be helpful in PTH, leading to impaired calcium regulation
confirming the diagnosis is the 21- despite elevated serum calcium.
hydroxylase antibody test, which can detect
autoimmune adrenal gland destruction. 180) Crisostomo Ibarra is with type 2
diabetes is prescribed a sulfonylurea
177) A 38-year-old Barbara presents with medication (e.g., glyburide). The nurse
excessive thirst, frequent urination, and should educate Crisostomo Ibarra that one
unexplained weight loss. Her blood glucose of the common side effects of sulfonylureas
levels are consistently elevated. Which is:
endocrine disorder is most likely responsible A.Weightloss
for her symptoms? B.Hypoglycemia
C.Gastrointestinalupset
D. Bradycardia
A)Hypothyroidism
B)Addison’sdisease
Rationale: Sulfonylureas stimulate insulin abdominal pain. On physical examination,
release, increasing the risk of hypoglycemia, Roberto’s skin appears hyperpigmented,
a common side effect. and his blood pressure is significantly lower
than his baseline. Laboratory results show
181) A 30-year-old Profampika, presents hyponatremia, hyperkalemia, and a low
with muscle weakness, hypertension, and a morning cortisol level. Which diagnostic test
buffalo hump on her upper back. Laboratory should be ordered to confirm the diagnosis
tests show elevated cortisol levels, low of Addison’s disease?
potassium levels, and metabolic alkalosis.
What is the most likely diagnosis, and what A) Serum aldosterone level
test should be performed to confirm it? B) Serum thyroid-stimulating hormone (TSH)
A) Addison’s disease; low-dose C) Serum insulin-like growth factor (IGF-1)
dexamethasone suppression test D) Serum parathyroid hormone (PTH)
B) Cushing’s disease; high-dose E) Serum anti-thyroid peroxidase (TPO)
dexamethasone suppression test antibodies
C) Hyperthyroidism; thyroid function tests
D) Conn’s syndrome; 24-hour urine Rationale: To confirm the diagnosis of
aldosterone Addison’s disease, measuring the serum
aldosterone level is crucial, as decreased
Rationale: The clinical presentation of
aldosterone production is a characteristic
muscle weakness, hypertension, a buffalo
feature of this condition.
hump, elevated cortisol levels, low
potassium levels, and metabolic alkalosis is
suggestive of Cushing’s disease. The 184) A 25-year-old Anarose presents with
diagnosis should be confirmed with a high- fatigue, weight loss, and generalized
dose dexamethasone suppression test. weakness. Physical examination reveals
hyperpigmentation of the oral mucosa.
Laboratory tests show hyponatremia,
182) A 32-year-old Garcia presents with hyperkalemia, and a low morning cortisol
chronic fatigue, weight loss, level. Which diagnostic test is the gold
hyperpigmentation, and episodes of standard for confirming the diagnosis of
hypotension. Her laboratory results show Addison’s disease?
hyponatremia and hyperkalemia. A
diagnostic test reveals a low cortisol level. A) Serum aldosterone level
What is the most likely diagnosis for this B) Serum thyroid-stimulating hormone (TSH)
patient? C) 24-hour urinary free cortisol test
D) Serum 25-hydroxyvitamin D level
A) Cushing’s syndrome E) Serum anti-thyroid peroxidase (TPO)
B) Graves’ disease antibodies
C) Addison’s disease Rationale: The 24-hour urinary free cortisol
D) Diabetes insipidus test is the gold standard for confirming the
E) Hypothyroidism diagnosis of Addison’s disease, as it helps to
evaluate cortisol production and its diurnal
Rationale: The patient’s symptoms of
variation.
chronic fatigue, weight loss,
hyperpigmentation, hyponatremia,
185) A 40-year-old Wakin presents with
hyperkalemia, and low cortisol levels are
fatigue, nausea, and abdominal pain.
indicative of Addison’s disease, a condition
Laboratory results reveal hyponatremia,
characterized by adrenal gland insufficiency.
hyperkalemia, and a low morning cortisol
level. The physician suspects Addison’s
183) A 30-year-old Roberto presents with a
disease and orders an ACTH stimulation test.
sudden onset of weakness, dizziness, and
What would be the expected response in a
patient with Addison’s disease? Rationale: The presence of atrophy of the
adrenal cortex on an MRI, along with the
A) A robust increase in cortisol levels patient’s symptoms and laboratory findings,
B) A moderate increase in cortisol levels strongly supports the diagnosis of Addison’s
C) No change in cortisol levels disease, which is characterized by adrenal
D) A decrease in cortisol levels gland insufficiency.
E) An increase in aldosterone levels
188) A 28-year-old Rosalina with a confirmed
Rationale: In a patient with Addison’s diagnosis of Addison’s disease presents with
disease, the ACTH stimulation test typically symptoms of fatigue, weakness, and
results in no significant change in cortisol hyperpigmentation. Her laboratory tests
levels due to adrenal insufficiency. reveal low cortisol levels and elevated ACTH.
What is the initial treatment of choice for
186) A 35-year-old Josephine presents with Rosalina?
fatigue, muscle weakness, and a craving for
salty foods. Laboratory tests show A) Hydrocortisone replacement therapy
hyponatremia, hyperkalemia, and a low B)Levothyroxine
morning cortisol level. The physician orders C)Metformin
an ACTH stimulation test, which results in a D) Insulin therapy
robust increase in cortisol levels. What is the E) Antifungal cream
most likely diagnosis in this case?
Rationale: The initial treatment for
A) Addison’s disease Addison’s disease involves hydrocortisone
B) Cushing’s syndrome replacement therapy to address the cortisol
C) Hypothyroidism deficiency and manage the patient’s
D) Pheochromocytoma symptoms.
E) Hyperparathyroidism
Rationale: In this scenario, a robust increase 189) A 35-year-old Jakson with Addison’s
in cortisol levels following an ACTH disease is experiencing an adrenal crisis,
stimulation test indicates Cushing’s characterized by severe hypotension and
syndrome, a condition characterized by altered mental status. What is the
excessive cortisol production, not Addison’s immediate treatment of choice for this life-
disease. threatening condition?

187) A 28-year-old Marlon presents with A) Intravenous fluids and hydrocortisone

severe fatigue, dizziness, and muscle pain. B) Oral potassium supplements
Laboratory results show hyponatremia, C) High-dose insulin and dextrose
hyperkalemia, and a low morning cortisol D) Nonsteroidal anti-inflammatory drugs
level. The physician suspects Addison’s (NSAIDs)
disease and orders an MRI of the adrenal E) Intramuscular epinephrine
glands, which reveals atrophy of the adrenal Rationale: In an adrenal crisis, the
cortex. What is the likely diagnosis based on immediate treatment of choice involves
these findings? intravenous fluids to address hypotension
and intravenous hydrocortisone to replace
A) Addison’s disease cortisol and manage the crisis.
B) Cushing’s syndrome
C) Diabetes insipidus 190) A 40-year-old Rodora with Addison’s
D) Pheochromocytoma disease is planning to become pregnant.
E) Hypothyroidism Which medication adjustment is necessary
to ensure a healthy pregnancy for Rodora? striae, and hypertension. Laboratory tests
reveal elevated serum cortisol levels. What
A) Increase in hydrocortisone dose is the primary treatment for Cushing’s
B) Discontinue hydrocortisone disease?
C) Switch to oral contraceptive pills A) Surgery to remove the pituitary
D) Start statin therapy adenoma
E) Initiate diuretics B) Radiation therapy
Rationale: During pregnancy, adrenal C) High-dose corticosteroids
hormone requirements increase, and D) Thyroid hormone replacement
patients with Addison’s disease should have E) Angiotensin-converting enzyme (ACE)
an increased hydrocortisone dose to support inhibitors
the pregnancy and prevent complications.
Rationale: The primary treatment for
191) A 45-year-old Eduardo with Addison’s Cushing’s disease, which is often caused by a
disease is scheduled for surgery. What pituitary adenoma, is surgical removal of the
should be emphasized to the surgical team tumor to reduce excess cortisol production.
to ensure a safe perioperative period for
194) A 30-year-old Joseph is diagnosed with
Eduardo?
Cushing’s disease due to an adrenal
A) The need for increased sedation
adenoma. What treatment option is
B) The avoidance of intravenous fluids
commonly recommended when surgical
C) The importance of continuing
intervention is not possible?
hydrocortisone therapy
A) Surgical removal of the adrenal gland
D) The exclusion of any antibiotics
B) Radiation therapy
E) The need for higher-dose anesthesia
C) High-dose corticosteroids
D) Thyroid hormone replacement
Rationale: In patients with Addison’s disease, E) Adrenal enzyme inhibitors
it is crucial to continue hydrocortisone
Rationale: When surgery is not possible or
therapy during surgery to prevent an adrenal
ineffective, the use of adrenal enzyme
crisis and ensure a safe perioperative period.
inhibitors, such as ketoconazole or
192) A 32-year-old Wakin with Addison’s metyrapone, is a common approach to
disease is experiencing recurrent episodes of manage Cushing’s disease caused by an
hypotension and weakness despite being on adrenal adenoma.
hydrocortisone replacement therapy. What
195) A 40-year-old Rosalinda with Cushing’s
additional medication might be prescribed
disease presents with uncontrolled
to improve Wakin’s blood pressure control?
hypertension and a lack of response to
A) Albuterol inhaler
surgery or medical therapy. What alternative
B) Antibiotics
treatment may be considered for Rosalinda?
C) Calcium channel blocker
A) Radioactive iodine (131I) therapy
D) Fludrocortisone
B) Laparoscopic adrenalectomy
E) Insulin therapy
C) Thyroid hormone replacement
Rationale: Fludrocortisone, a D) Electroconvulsive therapy
mineralocorticoid replacement, may be E) Anti-arrhythmic medication
added to the treatment regimen for patients
Rationale: In patients with uncontrolled
with Addison’s disease to help manage
Cushing’s disease or those who do not
blood pressure and electrolyte balance more
respond to other treatments, a laparoscopic
effectively.
adrenalectomy, the surgical removal of one
193) A 45-year-old Angelica presents with or both adrenal glands, may be considered.
weight gain, moon-shaped face, abdominal
196) A 55-year-old Rigor is diagnosed with D) Serum cholesterol levels
Cushing’s disease, and the healthcare E) Serum parathyroid hormone (PTH)
provider decides on medical therapy to
reduce cortisol production. What Rationale: The dexamethasone suppression
medication, often used as a second-line test is the most appropriate diagnostic test
option, may be prescribed in this scenario? for Cushing’s disease. It involves the
A) Levothyroxine administration of dexamethasone and
B) Hydrochlorothiazide subsequent measurement of cortisol levels,
C) High-dose corticosteroids with a lack of suppression indicating the
D) Spironolactone presence of the disease.
E) Statins
199) A 38-year-old Leopoldo presents with
Rationale: Spironolactone, an aldosterone severe fatigue, dizziness, and muscle pain.
receptor antagonist, is sometimes used as a Laboratory results show hyponatremia,
second-line therapy in Cushing’s disease to hyperkalemia, and low cortisol levels. What
reduce the effects of excess cortisol, is the key pathophysiological mechanism
particularly for its mineralocorticoid that accounts for the electrolyte imbalances
receptor blocking properties. of Leopoldo?
A) Increased aldosterone production
197) A 35-year-old Cassy presents with B) Normal adrenal gland function
symptoms of Cushing’s disease, including C) Overactive thyroid gland
weight gain, muscle weakness, and mood D) Decreased renin secretion
changes. Laboratory tests confirm elevated E) Adrenal insufficiency
serum cortisol levels. What initial treatment
approach is recommended to manage Rationale: The key pathophysiological
Cassy’s condition? mechanism accounting for the electrolyte
imbalances (hyponatremia and
hyperkalemia) in this patient is adrenal
A) Antihypertensive medications insufficiency, which results in reduced
B) High-dose corticosteroids aldosterone production and the inability to
C) Radiation therapy regulate electrolyte balance.
D) Thyroid hormone replacement
E) Surgical resection of the pituitary 200) A 25-year-old Manuela presents with
adenoma weakness, nausea, vomiting, and abdominal
pain. Laboratory tests reveal hyponatremia,
Rationale: The initial treatment approach for hyperkalemia, and low cortisol levels. What
Cushing’s disease is surgical resection of the is the key pathophysiological feature
pituitary adenoma, as this aims to correct contributing to Manuela’s symptoms?
the root cause of the condition by reducing A) Elevated cortisol levels
excess cortisol production. B) Increased aldosterone production
C) Decreased ACTH production
198) A 28-year-old Liliene presents with D) Hypothalamic dysfunction
weight gain, round face, and purple E) Impaired thyroid function
abdominal striae. She reports increased
thirst and frequent urination. Laboratory Rationale: The key pathophysiological
tests show elevated serum cortisol levels. feature contributing to her symptoms is the
What is the most appropriate diagnostic test decreased production of ACTH
for confirming Cushing’s disease? (adrenocorticotropic hormone), which
A) Urine dipstick for glucose stimulates the adrenal glands to produce
B) Serum thyroid-stimulating hormone (TSH) cortisol and aldosterone. This results in
C) Dexamethasone suppression test adrenal insufficiency.