PNLE ALL IN PRACTICE EXAMS
MEDICAL-SURGICAL NURSING
1. Following surgery, Mario complains of mild incisional pain while
performing deep-breathing and coughing exercises. The nurse's best
response would be:
A. "Pain will become less each day."
B. "This is a normal reaction after surgery."
C. "With a pillow, apply pressure against the incision."
D. "I will give you the pain medication the physician ordered."
Answer: (C) "With a pillow, apply pressure against the incision."
Rationale: Applying pressure against the incision with a pillow will help lessen the
intra-abdominal pressure created by coughing which causes tension on the incision
that leads to pain.
2. The nurse needs to carefully assess the complaint of pain of the elderly
because older people
A. are expected to experience chronic pain
B. have a decreased pain threshold
C. experience reduced sensory perception
D. have altered mental function
Answer: (C) experience reduced sensory perception
Rationale: Degenerative changes occur in the elderly. The response to pain in the
elderly maybe lessened because of reduced acuity of touch, alterations in neural
pathways and diminished processing of sensory data.
3. Mary received AtropineSO4 as a pre-medication 30 minutes ago and is
now complaining of dry mouth and her PR is higher, than before the
medication was administered. The nurse's best
A. The patient is having an allergic reaction to the drug.
B. The patient needs a higher dose of this drug
C. This is normal side-effect of AtSO4
D. The patient is anxious about upcoming surgery
Answer: (C) This is normal side-effect of AtSO4
Rationale: Atropine sulfate is a vagolytic drug that decreases oropharyngeal
secretions and increases the heart rate.
4. Ana's postoperative vital signs are a blood pressure of 80/50 mm Hg, a
pulse of 140, and respirations of 32. Suspecting shock, which of the
,following orders would the nurse question?
A. Put the client in modified Trendelenberg's position.
B. Administer oxygen at 100%
C. Monitor urine output every hour.
D. Administer Demerol 50 mg IM q4h
Answer: (D) Administer Demerol 50 mg IM q4h
Rationale: Administering Demerol, which is a narcotic analgesic, can depress
respiratory and cardiac function and thus not given to a patient in shock. What is
needed is promotion for adequate oxygenation and perfusion. All the other
interventions can be expected to be done by the nurse.
5. Mr. Pablo, diagnosed with Bladder Cancer, is scheduled for a cystectomy
with the creation of an ileal conduit in the morning. He is wringing his hands
and pacing the floor when the nurse enters his room. What is the best
approach?
A. "Good evening, Mr. Pablo. Wasn't it a pleasant day, today?"
B. "Mr. Pablo, you must be so worried, I'll leave you alone with your thoughts.
C. "Mr. Pablo, you'll wear out the hospital floors and yourself at this rate."
D. "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's
surgery?"
Answer: (D) "Mr. Pablo, you appear anxious to me. How are you feeling
about tomorrow's surgery?"
Rationale: The client is showing signs of anxiety reaction to a stressful event.
Recognizing the client's anxiety conveys acceptance of his behavior and will allow for
verbalization of feelings and concerns.
6. After surgery, Gina returns from the Post-anesthesia Care Unit (Recovery
Room) with a nasogastric tube in place following a gall bladder surgery. She
continues to complain of nausea. Which action would the nurse take?
A. Call the physician immediately.
B. Administer the prescribed antiemetic.
C. Check the patency of the nasogastric tube for any obstruction.
D. Change the patient's position.
Answer: (C) Check the patency of the nasogastric tube for any obstruction.
Rationale: Nausea is one of the common complaints of a patient after receiving
general anesthesia. But this complaint could be aggravated by gastric distention
especially in a patient who has undergone abdominal surgery. Insertion of the NGT
helps relieve the problem. Checking on the patency of the NGT for any obstruction will
help the nurse determine the cause of the problem and institute the necessary
intervention.
,7. Mr. Perez is in continuous pain from cancer that has metastasized to the
bone. Pain medication provides little relief and he refuses to move. The
nurse should plan to:
A. Reassure him that the nurses will not hurt him
B. Let him perform his own activities of daily living
C. Handle him gently when assisting with required care
D. Complete A.M. care quickly as possible when necessary
Answer: (C) Handle him gently when assisting with required care
Rationale: Patients with cancer and bone metastasis experience severe pain
especially when moving. Bone tumors weaken the bone to appoint at which normal
activities and even position changes can lead to fracture. During nursing care, the
patient needs to be supported and handled gently.
8. A client returns from the recovery room at 9AM alert and oriented, with
an IV infusing. His pulse is 82, blood pressure is 120/80, respirations are 20,
and all are within normal range. At 10 am and at 11 am, his vital signs are
stable. At noon, however, his pulse rate is 94, blood pressure is 116/74, and
respirations are 24. What nursing action is most appropriate?
A. Notify his physician.
B. Take his vital signs again in 15 minutes.
C. Take his vital signs again in an hour.
D. Place the patient in shock position.
Answer: (B) Take his vital signs again in 15 minutes.
Rationale: Monitoring the client's vital signs following surgery gives the nurse a
sound information about the client's condition. Complications can occur during this
period as a result of the surgery or the anesthesia or both. Keeping close track of
changes in the VS and validating them will help the nurse initiate interventions to
prevent complications from occurring.
9. A 56 year old construction worker is brought to the hospital unconscious
after falling from a 2-story building. When assessing the client, the nurse
would be most concerned if the assessment revealed:
A. Reactive pupils
B. A depressed fontanel
C. Bleeding from ears
D. An elevated temperature
Answer: (C) Bleeding from ears
Rationale: The nurse needs to perform a thorough assessment that could indicate
alterations in cerebral function, increased intracranial pressures, fractures and
bleeding. Bleeding from the ears occurs only with basal skull fractures that can easily
contribute to increased intracranial pressure and brain herniation
, 10. Which of the ff. statements by the client to the nurse indicates a risk
factor for CAD?
A. "I exercise every other day."
B. "My father died of Myasthenia Gravis."
C. "My cholesterol is 180."
D. "I smoke 1 1/2 packs of cigarettes per day."
Answer: (D) "I smoke 1 1/2 packs of cigarettes per day."
Rationale: Smoking has been considered as one of the major modifiable risk factors
for coronary artery disease. Exercise and maintaining normal serum cholesterol levels
help in its prevention.
11. Mr. Braga was ordered Digoxin 0.25 mg. OD. Which is poor knowledge
regarding this drug?
A. It has positive inotropic and negative chronotropic effects
B. The positive inotropic effect will decrease urine output
C. Toxicity can occur more easily in the presence of hypokalemia, liver and renal
problems
D. Do not give the drug if the apical rate is less than 60 beats per minute.
Answer: (B) The positive inotropic effect will decrease urine output
Rationale: Inotropic effect of drugs on the heart causes increase force of its
contraction. This increases cardiac output that improves renal perfusion resulting in
an improved urine output.
12. Valsalva maneuver can result in bradycardia. Which of the following
activities will not stimulate Valsalva's maneuver?
A. Use of stool softeners.
B. Enema administration
C. Gagging while toothbrushing.
D. Lifting heavy objects
Answer: (A) Use of stool softeners.
Rationale: Straining or bearing down activities can cause vagal stimulation that leads
to bradycardia. Use of stool softeners promote easy bowel evacuation that prevents
straining or the valsalva maneuver.
13. The nurse is teaching the patient regarding his permanent artificial
pacemaker. Which information given by the nurse shows her knowledge
deficit about the artificial cardiac pacemaker?
A. take the pulse rate once a day, in the morning upon awakening
B. may be allowed to use electrical appliances
C. have regular follow up care
D. may engage in contact sports
MEDICAL-SURGICAL NURSING
1. Following surgery, Mario complains of mild incisional pain while
performing deep-breathing and coughing exercises. The nurse's best
response would be:
A. "Pain will become less each day."
B. "This is a normal reaction after surgery."
C. "With a pillow, apply pressure against the incision."
D. "I will give you the pain medication the physician ordered."
Answer: (C) "With a pillow, apply pressure against the incision."
Rationale: Applying pressure against the incision with a pillow will help lessen the
intra-abdominal pressure created by coughing which causes tension on the incision
that leads to pain.
2. The nurse needs to carefully assess the complaint of pain of the elderly
because older people
A. are expected to experience chronic pain
B. have a decreased pain threshold
C. experience reduced sensory perception
D. have altered mental function
Answer: (C) experience reduced sensory perception
Rationale: Degenerative changes occur in the elderly. The response to pain in the
elderly maybe lessened because of reduced acuity of touch, alterations in neural
pathways and diminished processing of sensory data.
3. Mary received AtropineSO4 as a pre-medication 30 minutes ago and is
now complaining of dry mouth and her PR is higher, than before the
medication was administered. The nurse's best
A. The patient is having an allergic reaction to the drug.
B. The patient needs a higher dose of this drug
C. This is normal side-effect of AtSO4
D. The patient is anxious about upcoming surgery
Answer: (C) This is normal side-effect of AtSO4
Rationale: Atropine sulfate is a vagolytic drug that decreases oropharyngeal
secretions and increases the heart rate.
4. Ana's postoperative vital signs are a blood pressure of 80/50 mm Hg, a
pulse of 140, and respirations of 32. Suspecting shock, which of the
,following orders would the nurse question?
A. Put the client in modified Trendelenberg's position.
B. Administer oxygen at 100%
C. Monitor urine output every hour.
D. Administer Demerol 50 mg IM q4h
Answer: (D) Administer Demerol 50 mg IM q4h
Rationale: Administering Demerol, which is a narcotic analgesic, can depress
respiratory and cardiac function and thus not given to a patient in shock. What is
needed is promotion for adequate oxygenation and perfusion. All the other
interventions can be expected to be done by the nurse.
5. Mr. Pablo, diagnosed with Bladder Cancer, is scheduled for a cystectomy
with the creation of an ileal conduit in the morning. He is wringing his hands
and pacing the floor when the nurse enters his room. What is the best
approach?
A. "Good evening, Mr. Pablo. Wasn't it a pleasant day, today?"
B. "Mr. Pablo, you must be so worried, I'll leave you alone with your thoughts.
C. "Mr. Pablo, you'll wear out the hospital floors and yourself at this rate."
D. "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's
surgery?"
Answer: (D) "Mr. Pablo, you appear anxious to me. How are you feeling
about tomorrow's surgery?"
Rationale: The client is showing signs of anxiety reaction to a stressful event.
Recognizing the client's anxiety conveys acceptance of his behavior and will allow for
verbalization of feelings and concerns.
6. After surgery, Gina returns from the Post-anesthesia Care Unit (Recovery
Room) with a nasogastric tube in place following a gall bladder surgery. She
continues to complain of nausea. Which action would the nurse take?
A. Call the physician immediately.
B. Administer the prescribed antiemetic.
C. Check the patency of the nasogastric tube for any obstruction.
D. Change the patient's position.
Answer: (C) Check the patency of the nasogastric tube for any obstruction.
Rationale: Nausea is one of the common complaints of a patient after receiving
general anesthesia. But this complaint could be aggravated by gastric distention
especially in a patient who has undergone abdominal surgery. Insertion of the NGT
helps relieve the problem. Checking on the patency of the NGT for any obstruction will
help the nurse determine the cause of the problem and institute the necessary
intervention.
,7. Mr. Perez is in continuous pain from cancer that has metastasized to the
bone. Pain medication provides little relief and he refuses to move. The
nurse should plan to:
A. Reassure him that the nurses will not hurt him
B. Let him perform his own activities of daily living
C. Handle him gently when assisting with required care
D. Complete A.M. care quickly as possible when necessary
Answer: (C) Handle him gently when assisting with required care
Rationale: Patients with cancer and bone metastasis experience severe pain
especially when moving. Bone tumors weaken the bone to appoint at which normal
activities and even position changes can lead to fracture. During nursing care, the
patient needs to be supported and handled gently.
8. A client returns from the recovery room at 9AM alert and oriented, with
an IV infusing. His pulse is 82, blood pressure is 120/80, respirations are 20,
and all are within normal range. At 10 am and at 11 am, his vital signs are
stable. At noon, however, his pulse rate is 94, blood pressure is 116/74, and
respirations are 24. What nursing action is most appropriate?
A. Notify his physician.
B. Take his vital signs again in 15 minutes.
C. Take his vital signs again in an hour.
D. Place the patient in shock position.
Answer: (B) Take his vital signs again in 15 minutes.
Rationale: Monitoring the client's vital signs following surgery gives the nurse a
sound information about the client's condition. Complications can occur during this
period as a result of the surgery or the anesthesia or both. Keeping close track of
changes in the VS and validating them will help the nurse initiate interventions to
prevent complications from occurring.
9. A 56 year old construction worker is brought to the hospital unconscious
after falling from a 2-story building. When assessing the client, the nurse
would be most concerned if the assessment revealed:
A. Reactive pupils
B. A depressed fontanel
C. Bleeding from ears
D. An elevated temperature
Answer: (C) Bleeding from ears
Rationale: The nurse needs to perform a thorough assessment that could indicate
alterations in cerebral function, increased intracranial pressures, fractures and
bleeding. Bleeding from the ears occurs only with basal skull fractures that can easily
contribute to increased intracranial pressure and brain herniation
, 10. Which of the ff. statements by the client to the nurse indicates a risk
factor for CAD?
A. "I exercise every other day."
B. "My father died of Myasthenia Gravis."
C. "My cholesterol is 180."
D. "I smoke 1 1/2 packs of cigarettes per day."
Answer: (D) "I smoke 1 1/2 packs of cigarettes per day."
Rationale: Smoking has been considered as one of the major modifiable risk factors
for coronary artery disease. Exercise and maintaining normal serum cholesterol levels
help in its prevention.
11. Mr. Braga was ordered Digoxin 0.25 mg. OD. Which is poor knowledge
regarding this drug?
A. It has positive inotropic and negative chronotropic effects
B. The positive inotropic effect will decrease urine output
C. Toxicity can occur more easily in the presence of hypokalemia, liver and renal
problems
D. Do not give the drug if the apical rate is less than 60 beats per minute.
Answer: (B) The positive inotropic effect will decrease urine output
Rationale: Inotropic effect of drugs on the heart causes increase force of its
contraction. This increases cardiac output that improves renal perfusion resulting in
an improved urine output.
12. Valsalva maneuver can result in bradycardia. Which of the following
activities will not stimulate Valsalva's maneuver?
A. Use of stool softeners.
B. Enema administration
C. Gagging while toothbrushing.
D. Lifting heavy objects
Answer: (A) Use of stool softeners.
Rationale: Straining or bearing down activities can cause vagal stimulation that leads
to bradycardia. Use of stool softeners promote easy bowel evacuation that prevents
straining or the valsalva maneuver.
13. The nurse is teaching the patient regarding his permanent artificial
pacemaker. Which information given by the nurse shows her knowledge
deficit about the artificial cardiac pacemaker?
A. take the pulse rate once a day, in the morning upon awakening
B. may be allowed to use electrical appliances
C. have regular follow up care
D. may engage in contact sports
