Pnle Practice Questions

PNLE PRACTICE QUESTIONS 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." 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. 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 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 0:21 / 0:47 Best Small School Prospects in the 2022 NFL Draft 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 Atropine sulfate is a vagolytic drug that decreases oropharyngeal secretions and increases the heart rate. 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 50mg IM q4h Answer: (D) Administer Demerol 50mg IM q4h 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. 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?" 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. 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. 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. 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 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. 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. 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 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 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." 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. 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. Toxixity 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 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. Mental health is defined as: A. The ability to distinguish what is real from what is not. B. A state of well-being where a person can realize his own abilities can cope with normal stresses of life and work productively. C. Is the promotion of mental health, prevention of mental disorders, nursing care of patients during illness and rehabilitation D. Absence of mental illness Answer: (B) A state of well-being where a person can realize his own abilities can cope with normal stresses of life and work productively. Mental health is a state of emotional and psychosocial well being. A mentally healthy individual is self aware and self directive, has the ability to solve problems, can cope with crisis without assistance beyond the support of family and friends fulfill the capacity to love and work and sets goals and realistic limits. A. This describes the ego function reality testing. C. This is the definition of Mental Health and Psychiatric Nursing. D. Mental health is not just the absence of mental illness. 2. Which of the following describes the role of a technician? A. Administers medications to a schizophrenic patient. B. The nurse feeds and bathes a catatonic client C. Coordinates diverse aspects of care rendered to the patient D. Disseminates information about alcohol and its effects. Answer: (A) Administers medications to a schizophrenic patient. Administration of medications and treatments, assessment, documentation are the activities of the nurse as a technician. B. Activities as a parent surrogate. C. Refers to the ward manager role. D. Role as a teacher. 3. Liza says, "Give me 10 minutes to recall the name of our college professor who failed many students in our anatomy class." She is operating on her: A. Subconscious B. Conscious C. Unconscious D. Ego Answer: (A) Subconscious Subconscious refers to the materials that are partly remembered partly forgotten but these can be recalled spontaneously and voluntarily. B. This functions when one is awake. One is aware of his thoughts, feelings actions and what is going on in the environment. C. The largest potion of the mind that contains the memories of one's past particularly the unpleasant. It is difficult to recall the unconscious content. D. The conscious self that deals and tests reality. 4. The superego is that part of the psyche that: A. Uses defensive function for protection. B. Is impulsive and without morals. C. Determines the circumstances before making decisions. D. The censoring portion of the mind. Answer: (D) The censoring portion of the mind. The critical censoring portion of one's personality; the conscience. A. This refers to the ego function that protects itself from anything that threatens it.. B. The Id is composed of the untamed, primitive drives and impulses. C. This refers to the ego that acts as the moderator of the struggle between the id and the superego. 5. Primary level of prevention is exemplified by: A. Helping the client resume self care. B. Ensuring the safety of a suicidal client in the institution. C. Teaching the client stress management techniques D. Case finding and surveillance in the community Answer: (C) Teaching the client stress management techniques Primary level of prevention refers to the promotion of mental health and prevention of mental illness. This can be achieved by rendering health teachings such as modifying ones responses to stress. A. This is tertiary level of prevention that deals with rehabilitation. B and D. Secondary level of prevention which involves reduction of actual illness through early detection and treatment of illness. 6. Situation: In a home visit done by the nurse, she suspects that the wife and her child are victims of abuse. Which of the following is the most appropriate for the nurse to ask? A. "Are you being threatened or hurt by your partner? B. "Are you frightened of you partner" C. "Is something bothering you?" D. "What happens when you and your partner argue?" Answer: (A) "Are you being threatened or hurt by your partner? The nurse validates her observation by asking simple, direct question. This also shows empathy. B, C, and D are indirect questions which may not lead to the discussion of abuse. 7. The wife admits that she is a victim of abuse and opens up about her persistent distaste for sex. This sexual disorder is: A. Sexual desire disorder B. Sexual arousal Disorder C. Orgasm Disorder D. Sexual Pain Disorder Answer: (A) Sexual desire disorder Has little or no sexual desire or has distaste for sex. B. Failure to maintain the physiologic requirements for sexual intercourse. C. Persistent and recurrent inability to achieve an orgasm. D. Also called dyspareunia. Individuals with this disorder suffer genital pain before, during and after sexual intercourse. 8. What would be the best approach for a wife who is still living with her abusive husband? A. "Here's the number of a crisis center that you can call for help ." B. "Its best to leave your husband." C. "Did you discuss this with your family?" D. " Why do you allow yourself to be treated this way" Answer: (A) "Here's the number of a crisis center that you can call for help ." Protection is a priority concern in abuse. Help the victim to develop a plan to ensure safety. B. Do not give advice to leave the abuser. Making decisions for the victim further erodes her esteem. However discuss options available. C. The victim tends to isolate from friends and family. D. This is judgmental. Avoid in anyway implying that she is at fault. 9. Which comment about a 3 year old child if made by the parent may indicate child abuse? A. "Once my child is toilet trained, I can still expect her to have some" B. "When I tell my child to do something once, I don't expect to have to tell" C. "My child is expected to try to do things such as, dress and feed." D. "My 3 year old loves to say NO." Answer: (B) "When I tell my child to do something once, I don't expect to have to tell" Abusive parents tend to have unrealistic expectations on the child. A,B and C are realistic expectations on a 3 year old. 10. The primary nursing intervention for a victim of child abuse is: A. Assess the scope of the problem B. Analyze the family dynamics C. Ensure the safety of the victim D. Teach the victim coping skills Answer: (C) Ensure the safety of the victim The priority consideration is the safety of the victim. Attend to the physical injuries to ensure the physiologic safety and integrity of the child. Reporting suspected case of abuse may deter recurrence of abuse. A,B and D may be addressed later. 11. Situation: A 30 year old male employee frequently complains of low back pain that leads to frequent absences from work. Consultation and tests reveal negative results. The client has which somatoform disorder? A. Somatization Disorder B. Hypochondriaisis C. Conversion Disorder D. Somatoform Pain Disorder Answer: (D) Somatoform Pain DisorderThis is characterized by severe and prolonged pain that causes significant distress. A. This is a chronic syndrome of somatic symptoms that cannot be explained medically and is associated with psychosocial distress. B. This is an unrealistic preoccupation with a fear of having a serious illness. C. Characterized by alteration or loss in sensory or motor function resulting from a psychological conflict. 12. Freud explains anxiety as: A. Strives to gratify the needs for satisfaction and security B. Conflict between id and superego C. A hypothalamic-pituitary-adrenal reaction to stress D. A conditioned response to stressors Answer: (B) Conflict between id and superego Freud explains anxiety as due to opposing action drives between the id and the superego. A. Sullivan identified 2 types of needs, satisfaction and security. Failure to gratify these needs may result in anxiety. C. Biomedical perspective of anxiety. D. Explanation of anxiety using the behavioral model 13. The following are appropriate nursing diagnosis for the client EXCEPT: A. Ineffective individual coping B. Alteration in comfort, pain C. Altered role performance D. Impaired social interaction Answer: (D) Impaired social interaction The client may not have difficulty in social exchange. The cues do not support this diagnosis. A. The client maladaptively uses body symptoms to manage anxiety. B. The client will have discomfort due to pain. C. The client may fail to meet environmental expectations due to pain. 14. The following statements describe somatoform disorders: A. Physical symptoms are explained by organic causes B. It is a voluntary expression of psychological conflicts C. Expression of conflicts through bodily symptoms D. Management entails a specific medical treatment Answer: (C) Expression of conflicts through bodily symptoms Bodily symptoms are used to handle conflicts. A. Manifestations do not have an organic basis. B. This occurs unconsciously. D. Medical treatment is not used because the disorder does not have a structural or organic basis. 15. What would be the best response to the client's repeated complaints of pain: A. "I know the feeling is real tests revealed negative results." B. . "I think you're exaggerating things a little bit." C. "Try to forget this feeling and have activities to take it off your mind D. "So tell me more about the pain" Answer: (A) "I know the feeling is real tests revealed negative results." Shows empathy and offers information. B. This is a demeaning statement. C. This belittles the client's feelings. D. Giving undue attention to the physical symptom reinforces the complaint. 16. Situation: A nurse may encounter children with mental disorders. Her knowledge of these various disorders is vital. When planning school interventions for a child with a diagnosis of attention deficit hyperactivity disorder, a guide to remember is to: A. provide as much structure as possible for the child B. ignore the child's overactivity. C. encourage the child to engage in any play activity to dissipate energy D. remove the child from the classroom when disruptive behavior occurs Answer: (A) provide as much structure as possible for the child Decrease stimuli for behavior control thru an environment that is free of distractions, a calm non - confrontational approach and setting limit to time allotted for activities. B. The child will not benefit from a lenient approach. C. Dissipate energy through safe activities. D. This indicates that the classroom environment lacks structure. 17. The child with conduct disorder will likely demonstrate: A. Easy distractibility to external stimuli. B. Ritualistic behaviors C. Preference for inanimate objects. D. Serious violations of age related norms. Answer: (D) Serious violations of age related norms. This is a disruptive disorder among children characterized by more serious violations of social standards such as aggression, vandalism, stealing, lying and truancy. A. This is characteristic of attention deficit disorder. B and C. These are noted among children with autistic disorder. 18. Ritalin is the drug of choice for chidren with ADHD. The side effects of the following may be noted: A. increased attention span and concentration B. increase in appetite C. sleepiness and lethargy D. bradycardia and diarrhea Answer: (A) increased attention span and concentration The medication has a paradoxic effect that decrease hyperactivity and impulsivity among children with ADHD. B, C, D. Side effects of Ritalin include anorexia, insomnia, diarrhea and irritability. 19. School phobia is usually treated by: A. Returning the child to the school immediately with family support. B. Calmly explaining why attendance in school is necessary C. Allowing the child to enter the school before the other children D. Allowing the parent to accompany the child in the classroom Answer: (A) Returning the child to the school immediately with family support. Exposure to the feared situation can help in overcoming anxiety. A. This will not help in relieving the anxiety due separation from a significant other. C. and C. Anxiety in school phobia is not due to being in school but due to separation from parents/caregivers so these interventions are not applicable. D. This will not help the child overcome the fear 20. A 10 year old child has very limited vocabulary and interaction skills. She has an I.Q. of 45. She is diagnosed to have Mental retardation of this classification: A. Profound B. Mild C. Moderate D. Severe Answer: (C) Moderate The child with moderate mental retardation has an I.Q. of 35-50 Profound Mental retardation has an I.Q. of below 20; Mild mental retardation 50-70 and Severe mental retardation has an I.Q. of 20-35. 21. The nurse teaches the parents of a mentally retarded child regarding her care. The following guidelines may be taught except: A. overprotection of the child B. patience, routine and repetition C. assisting the parents set realistic goals D. giving reasonable compliments Answer: (A) overprotection of the child The child with mental retardation should not be overprotected but need protection from injury and the teasing of other children. B,C, and D Children with mental retardation have learning difficulty. They should be taught with patience and repetition, start from simple to complex, use visuals and compliment them for motivation. Realistic expectations should be set and optimize their capability 22. The parents express apprehensions on their ability to care for their maladaptive child. The nurse identifies what nursing diagnosis: A. hopelessness B. altered parenting role C. altered family process D. ineffective coping Answer: (B) altered parenting role Altered parenting role refers to the inability to create an environment that promotes optimum growth and development of the child. This is reflected in the parent's inability to care for the child. A. This refers to lack of choices or inability to mobilize one's resources. C. Refers to change in family relationship and function. D. Ineffective coping is the inability to form valid appraisal of the stressor or inability to use available resources 23. A 5 year old boy is diagnosed to have autistic disorder. Which of the following manifestations may be noted in a client with autistic disorder? A. argumentativeness, disobedience, angry outburst B. intolerance to change, disturbed relatedness, stereotypes C. distractibility, impulsiveness and overactivity D. aggression, truancy, stealing, lying Answer: (B) intolerance to change, disturbed relatedness, stereotypes These are manifestations of autistic disorder. A. These manifestations are noted in Oppositional Defiant Disorder, a disruptive disorder among children. C. These are manifestations of Attention Deficit Disorder D. These are the manifestations of Conduct Disorder 24. The therapeutic approach in the care of an autistic child include the following EXCEPT: A. Engage in diversionary activities when acting -out B. Provide an atmosphere of acceptance C. Provide safety measures D. Rearrange the environment to activate the child Answer: (D) Rearrange the environment to activate the child The child with autistic disorder does not want change. Maintaining a consistent environment is therapeutic. A. Angry outburst can be rechannelled through safe activities. B. Acceptance enhances a trusting relationship. C. Ensure safety from self-destructive behaviors like head banging and hair pulling. 25. According to Piaget a 5 year old is in what stage of development: A. Sensory motor stage B. Concrete operations C. Pre-operational D. Formal operation Answer: (C) Pre-operational Pre-operational stage (2-7 years) is the stage when the use of language, the use of symbols and the concept of time occur. A. Sensory-motor stage (0-2 years) is the stage when the child uses the senses in learning about the self and the environment through exploration. B. Concrete operations (7-12 years) when inductive reasoning develops. D. Formal operations (2 till adulthood) is when abstract thinking and deductive reasoning develop. 26. Situation : The nurse assigned in the detoxification unit attends to various patients with substance-related disorders. A 45 years old male revealed that he experienced a marked increase in his intake of alcohol to achieve the desired effect This indicates: A. withdrawal B. tolerance C. intoxication D. psychological dependence Answer: (B) tolerance tolerance refers to the increase in the amount of the substance to achieve the same effects. A. Withdrawal refers to the physical signs and symptoms that occur when the addictive substance is reduced or withheld. B. Intoxication refers to the behavioral changes that occur upon recent ingestion of a substance. D. Psychological dependence refers to the intake of the substance to prevent the onset of withdrawal symptoms. 27. The client admitted for alcohol detoxification develops increased tremors, irritability, hypertension and fever. The nurse should be alert for impending: A. delirium tremens B. Korsakoff's syndrome C. esophageal varices D. Wernicke's syndrome Answer: (A) delirium tremens Delirium Tremens is the most extreme central nervous system irritability due to withdrawal from alcohol B. This refers to an amnestic syndrome associated with chronic alcoholism due to a deficiency in Vit. B C. This is a complication of liver cirrhosis which may be secondary to alcoholism . D. This is a complication of alcoholism characterized by irregularities of eye movements and lack of coordination. 28. The care for the client places priority to which of the following: A. Monitoring his vital signs every hour B. Providing a quiet, dim room C. Encouraging adequate fluids and nutritious foods D. Administering Librium as ordered Answer: (A) Monitoring his vital signs every hour Pulse and blood pressure are usually elevated during withdrawal, Elevation may indicate impending delirium tremens B. Client needs quiet, well lighted, consistent and secure environment. Excessive stimulation can aggravate anxiety and cause illusions and hallucinations. C. Adequate nutrition with sulpplement of Vit. B should be ensured. D. Sedatives are used to relieve anxiety. 29. Another client is brought to the emergency room by friends who state that he took something an hour ago. He is actively hallucinating, agitated, with irritated nasal septum. A. Heroin B. cocaine C. LSD D. marijuana Answer: (B) cocaine The manifestations indicate intoxication with cocaine, a CNS stimulant. A. Intoxication with heroine is manifested by euphoria then impairment in judgment, attention and the presence of papillary constriction. C. Intoxication with hallucinogen like LSD is manifested by grandiosity, hallucinations, synesthesia and increase in vital signs D. Intoxication with Marijuana, a cannabinoid is manifested by sensation of slowed time, conjunctival redness, social withdrawal, impaired judgment and hallucinations. 30. A client is admitted with needle tracts on his arm, stuporous and with pin point pupil will likely be managed with: A. Naltrexone (Revia) B. Narcan (Naloxone) C. Disulfiram (Antabuse) D. Methadone (Dolophine) Answer: (B) Narcan (Naloxone) Narcan is a narcotic antagonist used to manage the CNS depression due to overdose with heroin. A. This is an opiate receptor blocker used to relieve the craving for heroine C. Disulfiram is used as a deterrent in the use of alcohol. D. Methadone is used as a substitute in the withdrawal from heroine