Nursing Assessment and Interventions: NCLEX Practice Exam Questions, Exams of Nursing

Download Nursing Assessment and Interventions: NCLEX Practice Exam Questions and more Exams Nursing in PDF only on Docsity! NLE AND NCLEX PRACTICE EXAM 01 2024 UPDETE Answer the 20 item exam and get your scores below! 1. Which theoretical model is being applied if the nurse views mental illness as a learned behavior? A. Humanistic Model B. Medical Model C. Interpersonal Model D. Behavioral Model 2. The essential foundation that must be established early in the therapeutic relationship is: A. confidence B. insight C. trust D. change 3. The basis for building a strong therapeutic nurse-client relationship begins with the nurse�s: A. sincere desire to help others B. acceptance of others C. self-awareness and understanding D. sound knowledge of Psychiatric Nursing 4. For a beginning nurse practitioner in a psychiatric-mental health setting, which behavior would be least effective in helping to achieve personal and professional growth? A. Completing a task for a client instead of repeatedly prompting him to finish it B. Taking time to adjust to a slower pace C. Avoiding frustration when a client refuses to interact D. Use listening and observation skills 5. You are planning a treatment care for a client who has been on the streets for several years. The client has delusions, and frequently responds to auditory hallucinations. Which of the following client needs would be the priority? A. Self-esteem B. Love and Belongingness C. Self-Actualization D. Physical safety 6. Which contribution of the psychoanalytical model is particularly useful to psychiatric nurses? A. All behavior has meaning B. Behavior that is reinforced will be perpetuated C. The first 6 years of a person�s life determine his personality D. Behavioral deviations result from an incongruence between verbal and nonverbal communication 7. The Psychiatric nurses� role in tertiary prevention is: A. Prevent the spread of disease B. Promote mental health through anticipatory guidance C. Case finding to limit severity of disease D. Prevent the crippling defects of illness through rehabilitation programs 8. A nurse who uses nurturing activities such as bathing or feeding the patient is assuming the role of a: A. Counselor B. Teacher C. Ward Manager D. Parent Surrogate 9. In the application of the nursing process, the nursing diagnoses are prioritized according to: A. the established goals of care B. the nurses� priority of care C. life threatening potential D. focus on resolution of patient�s problems 10. During the assessment process, the nurse: A. establishes a therapeutic contract B. participates in nursing conferences C. collaborates with other nurse D. utilizes a system of data collection 11. Mrs. Dimalanta age 40 was admitted because of bouts of insomnia, nervousness and poor concentration becoming worst in the last 6 months. What is the initial responsibility of the nurse? A. Assess her level of anxiety B. Encourage husband to stay with her C. Orient her to the unit D. Administer medication to allay anxiety 12. During the orientation phase of the N-C-R initiated by the nurse, the appropriate topic would be: A. Effective coping patterns B. Facts about stress and coping C. Mrs. Dimalanta�s perception of her illness D. Feelings about her family 13. All of the following are physical responses to anxiety EXCEPT: A. Perspiration B. Headache C. Increased pulse & respiration D. Forgetfulness 14. In planning the discharge of a client with chronic anxiety, the goal should focus on which of the following? A. Eliminating all anxiety from daily situations B. Ignoring feelings of anxiety C. Identifying anxiety producing situations . Continued contact with crisis counselor 15. Primary gain associated with Somatoform Disorders, is referred to as: A. Financial compensation from disability B. Verbigeration C. Dissociation D. Neologism 11. How will you help a patient anticipate and deal with future recurrence of hallucination? A. Stay with the patient all the time B. Examine the patient�s ways of dealing with hallucinations C. Help patient accept that hallucination is a part of his mental illness D. Assigning permanent staff who knows when the patient hallucinates 12. Your assessment of a patient with a diagnosis of catatonic schizophrenia will most likely reveal the following sets of behavior? A. Aloofness, distrust, suspiciousness, grandiosity B. Regression, giggling, smiling, laughing C. Anxious, bizarre behavior, depression, elation D. Stupor, hallucinations, negativism and automatism 13. Which of the following is an adverse effect associated with the use of Antipsychotic drug? A. Sedation B. Neuroleptic Malignant Syndrome C. Extrapyramidal symptoms D. Anticholinergic effects 14. Anton diagnosed with Schizophrenia Disorganized type was observed sitting alone, looking frightened. How should the nurse approach him? A. Approach Anton, touch him on the arm and say: I�m your nurse. B. Sit across him and say: Hi, I�m Rose your nurse. You appear frightened. C. Greet him and say: Come I�ll show you around. D. Allow him to remain alone until he feels more comfortable 15. The goal of rehabilitation of a Schizophrenic is to: A. learn effective coping B. involve the family in client care C. find employment for the client D. facilitate optimal functioning of patient 16. Jenny was admitted to the Psychiatric unit exhibiting elation, incessant chattering and hyperactivity. Which of the following nursing diagnostic categories would hold the highest priority for her? A. Hopelessness B. Potential for injury C. Personal identity disturbance D. Ineffective individual coping 17. Jenny starts saying, �You will be promoted. Just go to Malaca�ang, see my cousin GMA. She is experiencing: A. illusion B. verbigeration C. hallucination D. delusion 18. Sensing that people don�t believe her, she shouted,� I�m really the cousin of GMA. Why don�t you believe me? I own 10 buildings in Makati and the Fort Area. An effective approach of the nurse should be to: A. listen attentively B. leave her to a co-patient C. start presenting reality D. give reasons for not believing her 19. The primary reason for assigning a private room for Jenny is: A. Decrease environmental stimuli B. Prevent the patient�s excessive activity from disturbing others C. Deter the patient from interrupting the nurses D. Provide the patient with a quiet place to thinking about her problems 20. The highest priority nursing intervention for a hyperactive patient like Jenny would be: A. Discourage her from manipulating the staff B. Prevent her assaulting other patients C. Protect her against suicidal attempts D. Provide adequate food and fluid intake NLE PRACTICE EXAM 03 Answer the 20 item exam and get your scores below! 1. Jenny is placed on Lithium therapy. Early signs of toxicity include: A. tinnitus B. vomiting C. ataxia D. stupor 2. The therapeutic blood lithium level is: A. 2.5 MEq/L and above B. 1.5-2.5 MEq/L C. 0.5-1.5 MEq/L D. 1.5-2.0 MEq/L 3. To reduce overt aggression from a manic patient the following are appropriate measures EXCEPT: A. Participation in competitive games B. Encouraging relaxation techniques C. Reduction in environmental stimuli D. Encourage client to discuss angry feelings 4. The biochemical theory of manic behavior may be related to: A. Neurotransmitter deficiency B. Excessive level of Norepinephrine C. Increased cholinergic activity D. Increased noreadrenergic activity 5. Karla was given a diagnosis of Depression with Suicidal tendencies. In planning the nursing care for her, which of the following should be given priority? A. Allow relatives to visit him B. Meet his daily self-care needs C. Keep him safe from self-harm D. Maintain his daily nutritional needs 6. You noticed that Karla combed her hair for the first time while in the hospital. You validate the meaning of her behavior by saying: A. Tell me how you did that B. I sense that you feel good today. Tell me what�s happening C. I like the way you arranged your hair. It�s nice. D. Is that your favorite hairdo? 7. Karla was scheduled for ECT. The most frequent complication of ECT is: A. Loss of consciousness and headache B. Restlessness and confusion C. Fractures of the vertebra & long bones D. Temporary memory loss and apnea 8. The appropriate activity for a depressed withdrawn client should be: A. reading a novel B. playing chess C. taking a walk D. listening to music 9. Suicide precaution should be strictly observed when the client exhibits which of the following manifestations? A. the client feels weak and tired B. the client expresses hostile feelings C. the client has sudden cheerfulness D. the client is agitated 10. Tricyclic Antidepressant was prescribed for Karla. While taking the TCA, she should be observed for: A. diarrhea B. constipation C. muscle rigidity D. polyuria 11. Carlos, age 35 was brought to the rehabilitation center for detoxification. He is a known alcoholic for ten years. Upon assessment, the reason he was asked when was his last intake of alcohol is: A. Specific period when withdrawal symptoms may set in B. How far the dependency has progressed C. To determine the development of delirium tremens D. Severity of withdrawal client may experience 12. Carlos tells the nurse how he hit his wife after an argument they had and asked if he would ever be forgiven. The best response of the nurse is: A. You seem to have bad feelings about hitting your wife. B. You may ask her when she visits you. C. That depends if you�ll be good enough during your confinement. D. Sundown syndrome 8. The family of the client with Alzheimer�s disease asks the nurse about what to expect as the disease progress. The answer of the nurse is based on which fact? A. Improvement depends on the treatment given B. Improvement can occur when underlying medical problems are treated C. The disorder occurs in a chronic, progressive manner over time D. The disorder typically involves periods of remission and exacerbation 9. Which nursing intervention would be most appropriate for Mang Nano if he is upset and agitated? A. Decrease environmental stimuli while remaining with the client B. Firmly tell the client that the behavior is not acceptable C. Offer medication that will have a calming effect D. Question the client about the cause of the problem 10. A client was admitted with the chief complaint of increasing confusion for about a month. Which assessment question to the family will differentiate delirium from dementia? A. How long have you noticed the confusion in your family member? B. Has there been a history of dementia in the family? C. Do you think something happened that was upsetting to your family member? D. Does your family member live alone or with someone? 11. In the late stages of Alzheimer�s disease, which of the following outcomes would be most realistic for the client? A. The client will verbalize increased feelings of self-worth B. The client will identify life areas that require alterations due to illness C. The client will maintain reality orientation D. The client will remain safe in the least restrictive environment 12. Sui is in his senior year in Nursing. He is an active student leader, an honor student & a part-time tutor. He has little time to rest and often complains of having difficulty in falling asleep, especially at night. He can be suffering from: A. Initial Insomnia B. Intermittent insomnia C. Maintenance insomnia D. Terminal insomnia 13. How can you help Sui overcome his Insomnia? A. Ask him to lessen his food intake B. Limit activities just before bedtime C. Advise him to buy sleep meds D. Ask him to drink warm coffee 14. Mr. TokAn 30y/o experienced sudden wave of overwhelming sleepiness in his job and this problem lasted for more than a month. What can be the appropriate nursing intervention for persons with narcolepsy? A. Ask him to drink at least 4-5 cups of espresso especially during working hours B. Offer a tall glass of warm milk C. Suggest taking scheduled naps D. Tell him to always bring an Ipod or Discman filled with dance tunes 15. Lumen, the mother of an 8 y/o boy remarked, - I�m sick & tired of washing his soiled bed sheets twice a week. This has been going on for 2 months. What can I do to lessen the episode of my son�s bedwetting? The best answer to her query is: A. Transfer him to a sleeping mat B. Punish him for his bedwetting C. Ask him to wear snuggly fit diapers D. Empty his bladder before sleeping 16. BusogBoy, a 20 y/o college student needs help for uncontrolled eating & self-induced vomiting. He has been diagnosed with Bulimia Nervosa. What would be an appropriate nursing intervention for him? A. Observe BusogBoy for the next 24 hrs. for any incidence of purging B. Tell BusogBoy that he�ll be forced to eat soon after purging C. Tell BusogBoy that he�ll be given extra food tray D. BusogBoy must be observed two hours after each meal 17. One of the most common characteristic of persons suffering from Bulimia is binge- eating. This refers to: A. Insatiable appetite B. Eating unusually large amount of food over a short period of time C. Self-induced vomiting D. Use of laxatives, diuretics & enemas to compensate for calories consumed 18. Payatita, 18 y/o was admitted due to rapid weight loss associated with Anorexia Nervosa. The nursing diagnosis identified in her present condition is: A. Altered nutrition: less than body requirements B. Impaired gas exchange C. Alteration in Perception D. Anxiety 19. The most important goal for clients with eating disorders such as anorexia nervosa is: A. Be able to cope with stresses & conflicts B. Develop a more realistic body image C. Be able to identify significant others D. Develop a positive outlook in life 20. Payatita�s refusal to eat serves the primary purpose of allowing her to: A. Gain the sympathy of others B. Gain a sense of control and power C. Remain free from anxiety D. Openly assert her own identity Nurses Licensure Exam NLE NURSING PRACTICE 05 Answer the 20 item exam and get your scores below! 1. When 40 year old Tom was admitted to the hospital, he frequently exposes himself to female staff nurses. He derives pleasure at the sight of shrieking woman. This is behavior is known as: A. Necrophilia B. Sadism C. Voyeurism D. Exhibitionism 2. The nurse responds to this behavior by: A. Ignoring his behavior, realizing that he has low self-esteem B. Informing him that the behavior is unacceptable, limit setting is appropriate C. Holding a ward meeting where unit appropriate behavior is discussed D. Ask the Psychiatrist to confront Tom�s behavior 3. In order to get into areas of sex life of a patient, the nurse must first be: A. Secure about her own sexuality B. Knowledgeable in what is proper and what is improper sexual behavior C. Keen about the varieties of sexual expressions D. Interested, natural and human 4. When the nurse enters the patients room and sees him openly masturbate, what is the best approach to follow? A. Provide privacy and leave the patient B. Warn the patient that masturbation can lead to serious illnesses C. Report the incident to the head nurse and record the observation D. Tell the patient that masturbation is an unacceptable 5. Baffy, 25y/o was sexually abused by a pedicab driver while on her way home from work one evening as a cashier in a 24 hour convenience store. She was brought to the ER with bruises all over her body. She was crying uncontrollably & appears to be very anxious. Nurse Lena therapeutically communicates with her, saying: A. You are very upset, calm yourself first Baffy. I can�t understand you. B. I know something terrible & horrifying happened to you. C. Would you like to relate to me what happened? D. Can you identify your abuser? 6. For victims of sexual abuse like Baffy, nurse Lena can help lower her level of anxiety by: A. Assessing her family history B. Allowing her to express feelings & concern C. Identifying coping mechanisms D. Teaching about human sexuality 7. Emergency care to be given for Rape victims are as follows: 1. If a victim calls the hospital, tell her not to bathe, shower, wash or change clothes, just go the directly to the hospital 2. Provide privacy and be judgemental 3. Stay with the victim, focus on physical safety & emotional security 4. Assist in pelvic examination to collect evidences such as semen, stains A. 1,2,3 B. 2,3,4 C. 1,2,4 D. 1,3,4 8. In providing nursing care for Baffy during her acute stress reaction to rape trauma, Nurse Lena applies which of the following? A. acute bleeding B. pink serous drainage C. purple drainage D. severe pain 4. An adult client�s wound has eviscerated; the nurse assesses his respiratory status because: A. dehiscence elevates the diaphragm B. coughing increases the risk of evisceration C. respiratory arrest commonly accompanies wound dehiscence D. splinting the wound will compromise respiratory status 5. A major advantage of regional anesthesia is that the client: A. retains all reflexes B. remains conscious C. has retroactive amnesia D. is in the OR for a short period of time 6. A client is scheduled for an emergency appendectomy; which of the following preoperative laboratory valued would require intervention prior to surgery? A. hemoglobin 13.5 g/dL B. serum potassium 3.0 mEq/L C. partial thromboplastin time (PTT) 25 sec D. serum sodium 140 mEq/L 7. During preoperative assessment, the nurse finds that the client has an irregular pulses, pedal edema, and cyanotic nail beds. These symptoms indicate an alteration in: A. pulmonary function B. renal function C. cardiovascular function D. liver function 8. During preop interview, which of the following statements made by the client would alert the nurse to an increased risk during surgery? A. I rarely eat red meat, it usually makes me feel bloated B. I do take a large assortment of vitamins daily C. I experience headaches almost daily, but I only need to take a couple of aspirin to get relief D. I am a reformed smoker, I haven not had a cigarette in 10 years 9. Which assessment methodology is likely to provide the most useful information related to a person�s teaching/learning needs preoperatively? A. asking the person what he or she wants to know B. conducting a purposeful interview C. encouraging the person to share aspects of his or her daily routine D. examining old records 10. Which nursing action would best help to prevent thrombophlebitis in a postop client? A. massaging the client�s leg B. assisting the client to sit up in bed after surgery C. maintaining the legs in an elevated position D. reminding the client to exercise her legs and feet 11. A client (high school student) who has a history of seizures reports a recent inability to concentrate and mood swings, which of the following actions is appropriate for the nurse to take? A. explain to the client that this is a normal progression of seizures B. speak to the client�s physician regarding a change in medications C. assess the client for changer in motor or sensory function D. recommend a decrease in the client�s physical activity 12. The nurse observed a client�s gait as short, accelerating steps, shuffling, forward- leaning posture, and difficulty in starting and stopping. The nurse would identify this gait as: A. ataxic B. parkinsonian C. dystrophic D. festinating 13. A patient with CVA is showing slightly dilated pupils. This can be explained by non- conduction of the: A. Cranial nerve II B. Cranial nerve III C. Cranial nerve VII D. Cranial nerve XII 14. Intact, functioning Cranial nerves give information about the: A. cerebellum B. brain stem C. cerebrum D. spinal cord 15. An adult has been in a motor vehicle accident, has 4 inch laceration on forehead that is bleeding profusely. Her left ankle is splinted and with BP-100/60, PR-110 RR-16. What is the first action of the nurse? A. start of IV line B. place a foley catheter C. get an ECG D. check her neurologic status 16. An adult is brought in by ambulance after a motor vehicle accident. He is unconscious, on a backboard with his neck immobilized. He is bleeding profusely from a large gash on his right thigh. What is the first action the nurse should take? A. stop the bleeding B. check his airway C. take his vital signs D. find out what happened from the eyewitness 17. While assessing the CVA client, the nurse gently scrapes the sole of his foot with a blunt-pointed object. The nurse notes plantar flexion of the toes and records this response as: A. a present Babinski�s reflex B. a present ankle jerk reflex C. an absent Babinski�s reflex D. an absent patellar reflex 18. The client is comatose following brain surgery, which of the following actions would be contraindicated in his care? A. raising the head of his bed B. pharyngeal suctioning C. nasal suctioning D. tooth brushing 19. A patient in a coma is scheduled for a lumbar puncture. The CSF obtained is cloudy in appearance. This finding most likely indicates: A. infection B. increased ICP C. meningeal irritation D. a normal finding 20. The patient is admitted to the hospital with right sided hemiplegia as a result of a stroke. The nurse should position the client: A. on her right side as much as possible B. on her left side with brief periods on her back and right side C. upright as long as tolerated D. supine with a pillow under her knees NCLEX PRACTICE EXAM 02 Answer the 20 item exam and get your scores below! 1. The nurse notes that the client with head trauma has clear fluid draining from his nose. Which of the following actions by the nurse is most appropriate initially? A. notify the physician immediately B. test the fluid for glucose C. send a specimen of the fluid for culture D. encourage the client to blow his nose often to promote drainage 2. The nurse performing a neurological assessment on a client in a coma. In order to assess motor response, the nurse should ask the client to: A. grasp the nurse�s finger B. cough and deep breathe C. wiggle his toes D. repeat a phrase 3. Following intracranial surgery, the nurse should observe the client for signs of increased ICP which include: A. increased urinary output B. bradycardia C. fever D. change in level of consciousness 4. Henry is a 13 yr old who has been diagnosed as having epilepsy. A positive sign that Henry is taking his Dilantin properly is: A. hair growth on his upper lip B. bradykinesia C. shuffling gait D. depression 19. The nurse is teaching a client the potential complications of osteoporosis. Which of the following conditions are related to this disorder? A. fractures of the hip, wrist, & spine B. fractures of the femur, ankle, and clavicle C. acute MI, CVA, and acute renal failure D. hyperparathyroidism, hypothyroidism, & osteomyelitis 20. The nurse is counseling a client with osteoporosis; which of the following foods should the nurse instruct the client to avoid consuming in large amount: A. carbonated beverages, citrus fruits, and foods high in simple carbohydrates B. foods high in protein, salt, & caffeine C. foods high in fat, sodium, and nitrates D. fatty meats & organ meats NCLEX PRACTICE EXAM 03 Answer the 20 item exam and get your scores below! 1. Which of the following is the most common manifestations of osteoporosis? A. significant weight loss B. fractures C. urinary calculi D. long bone pain 2. The nurse is teaching a class on osteoarthritis. The nurse�s understanding of this disorder is best described as: A. degeneration of articular cartilage in synovial joints B. enzymatic breakdown of tissue in non-weight bearing joints C. joint destruction caused by an autoimmune process D. the overproduction of synovial fluid resulting in joint destruction 3. How does nicotine, a substance in cigarette smoke, increase the prevalence of CAD? A. it decreases the oxygen-carrying capacity of the blood B. it increases the deposits of fat containing substances along the intima of blood vessels C. it causes smooth muscle cell proliferation D. it increases the likelihood of dysrhythmias and elevated heart rate, BP, & oxygen consumption 4. In most cases, which of the following is the cause of sudden cardiac death? A. ventricular fibrillation B. severe congestive heart failure C. myocardial ischemia D. unstable angina 5. Nurses can best help prevent CAD by teaching clients: A. low fat, low-cholesterol diets B. the importance of exercise C. how to maintain normal BP D. how to handle stress 6. The nurse is instructing a client in the proper administration of sublingual Nitroglycerin. Which of the following is correct and should be included in the teaching plan? A. tablets should be stored in the refrigerator B. repeat dosage after 5 minutes if pain is not relieve. Seek medical help if pain is not relieved after 3 sublingual nitroglycerin tablets C. assess BP for reactive hypertension after each dose D. headache is a rare side effect and should be reported to the physician 7. When administering Nifedipine (Procardia) to a client with a history of angina, the nurse should: A. observe for signs of respiratory depression B. monitor the client�s BP C. observe for manifestation of GI bleeding D. force fluids 8. When caring for a client immediately after an MI, the nurse�s first priority is: A. relief of pain B. monitoring for presence of dysrhythmias C. prevention of embolism D. relieving client�s apprehension 9. Which of the following nursing orders would be found on the care plan for a client for the first 24 hours after an MI? A. utilize bedside commode for bowel movements B. 200 calorie, soft diet C. feed the patient D. administer promethazine regularly 10. Which of the following would be included in the discharge teaching plan for a client after MI? A. don�t begin sexual intercourse until after 3 months B. begin walking frequently C. take one aspirin every 8 hours as ordered D. continue previous lifestyle when ready 11. When auscultating the respirations of a client in left ventricular heart failure, the nurse will most likely detect: A. wheezing B. loud expiratory sounds C. loud inspiratory sounds D. crackling sounds 12. In which position should the nurse place the client who is experiencing acute congestive heart failure (CHF)? A. Sim�s position B. supine C. Trendelenburg D. high Fowler�s with feet dependent 13. The most important action of Digitalis derivatives on the heart of a client in CHF is to: A. re-establish normal heart rhythm B. increase ventricular contractility C. decrease dysrhythmias D. decrease AV node refractory period 14. What is the long term effect of rheumatic fever? A. Cardiomegaly B. cardiac tamponade C. sudden cardiac death syndrome D. pericarditis 15. The client admitted for the treatment of rheumatic fever and has fever of 101 degrees F should have which activity order? A. activity ad lib B. bed rest C. out of bed in a chair D. exercise until the point of fatigue 16. The nurse is conducting a ward class for a group of client who are to undergo cardiac surgery. What information should the nurse include when discussing the use of the ventilation in the ICU immediately after surgery? A. no visitors will be allowed while the client is intubated B. refraining from coughing is especially important while using the ventilator C. while being ventilated the client must remain on bed rest D. the client will be unable to talk while being ventilated 17. A client is admitted to the hospital with chronic venous disease. Physical assessment of the client�s legs would most likely reveal: A. erythema B. reduced muscle mass C. overgrowth of hair D. decreased pulses 18. Which of the following manifestations would the nurse expect when assessing a client with arterial insufficiency? A. warm, erythematous legs B. thin fragile toenails C. muscular atrophy D. bounding arterial pulses 19. Which of the following is the most common cause of secondary hypertension? A. chronic renal disease B. primary hyperaldosteronism C. pregnancy induced hypertension D. oral contraceptive use 20. A client is admitted to the ICU with malignant hypertension. Assessment of the client would most likely reveal symptoms of: A. fluid overload B. livery dysfunction C. Suggest taking scheduled naps D. Tell him to always bring an Ipod or Discman filled with dance tunes 15. Lumen, the mother of an 8 y/o boy remarked, - I�m sick & tired of washing his soiled bed sheets twice a week. This has been going on for 2 months. What can I do to lessen the episode of my son�s bedwetting? The best answer to her query is: A. Transfer him to a sleeping mat B. Punish him for his bedwetting C. Ask him to wear snuggly fit diapers D. Empty his bladder before sleeping 16. BusogBoy, a 20 y/o college student needs help for uncontrolled eating & self-induced vomiting. He has been diagnosed with Bulimia Nervosa. What would be an appropriate nursing intervention for him? A. Observe BusogBoy for the next 24 hrs. for any incidence of purging B. Tell BusogBoy that he�ll be forced to eat soon after purging C. Tell BusogBoy that he�ll be given extra food tray D. BusogBoy must be observed two hours after each meal 17. One of the most common characteristic of persons suffering from Bulimia is binge- eating. This refers to: A. Insatiable appetite B. Eating unusually large amount of food over a short period of time C. Self-induced vomiting D. Use of laxatives, diuretics & enemas to compensate for calories consumed 18. Payatita, 18 y/o was admitted due to rapid weight loss associated with Anorexia Nervosa. The nursing diagnosis identified in her present condition is: A. Altered nutrition: less than body requirements B. Impaired gas exchange C. Alteration in Perception D. Anxiety 19. The most important goal for clients with eating disorders such as anorexia nervosa is: A. Be able to cope with stresses & conflicts B. Develop a more realistic body image C. Be able to identify significant others D. Develop a positive outlook in life 20. Payatita�s refusal to eat serves the primary purpose of allowing her to: A. Gain the sympathy of others B. Gain a sense of control and power C. Remain free from anxiety D. Openly assert her own identity Nurses Licensure Exam NLE NURSING PRACTICE 05 Answer the 20 item exam and get your scores below! 1. When 40 year old Tom was admitted to the hospital, he frequently exposes himself to female staff nurses. He derives pleasure at the sight of shrieking woman. This is behavior is known as: A. Necrophilia B. Sadism C. Voyeurism D. Exhibitionism 2. The nurse responds to this behavior by: A. Ignoring his behavior, realizing that he has low self-esteem B. Informing him that the behavior is unacceptable, limit setting is appropriate C. Holding a ward meeting where unit appropriate behavior is discussed D. Ask the Psychiatrist to confront Tom�s behavior 3. In order to get into areas of sex life of a patient, the nurse must first be: A. Secure about her own sexuality B. Knowledgeable in what is proper and what is improper sexual behavior C. Keen about the varieties of sexual expressions D. Interested, natural and human 4. When the nurse enters the patients room and sees him openly masturbate, what is the best approach to follow? A. Provide privacy and leave the patient B. Warn the patient that masturbation can lead to serious illnesses C. Report the incident to the head nurse and record the observation D. Tell the patient that masturbation is an unacceptable 5. Baffy, 25y/o was sexually abused by a pedicab driver while on her way home from work one evening as a cashier in a 24 hour convenience store. She was brought to the ER with bruises all over her body. She was crying uncontrollably & appears to be very anxious. Nurse Lena therapeutically communicates with her, saying: A. You are very upset, calm yourself first Baffy. I can�t understand you. B. I know something terrible & horrifying happened to you. C. Would you like to relate to me what happened? D. Can you identify your abuser? 6. For victims of sexual abuse like Baffy, nurse Lena can help lower her level of anxiety by: A. Assessing her family history B. Allowing her to express feelings & concern C. Identifying coping mechanisms D. Teaching about human sexuality 7. Emergency care to be given for Rape victims are as follows: 1. If a victim calls the hospital, tell her not to bathe, shower, wash or change clothes, just go the directly to the hospital 2. Provide privacy and be judgemental 3. Stay with the victim, focus on physical safety & emotional security 4. Assist in pelvic examination to collect evidences such as semen, stains A. 1,2,3 B. 2,3,4 C. 1,2,4 D. 1,3,4 8. In providing nursing care for Baffy during her acute stress reaction to rape trauma, Nurse Lena applies which of the following? A. Collaboration with community agencies B. Crisis intervention techniques C. Physical assessment D. Teaching & Learning principles 9. To become a patient advocate to rape victims, nurse Lena should note the following responsibilities: A. Since this is a legal case, call the press B. Isolate the patient first to provide privacy while attending to other patients C. Postpone the physical examination, until the patient is calm D. Perform thorough physical assessment & document objectively all evidences of rape 10. Sheila, 5 years old, was diagnosed as autistic since she was 1 year old. This disorder is characterized by: A. Anxiety induced involuntary stereotype motor movements B. Inappropriate behavior, poor attention span with impulsivity C. Negativistic, hostile and defiant behavior D. Failure to develop interpersonal skills 11. At her age, Sheila is at what stage of psychosocial development? A. Industry vs. Inferiority B. Initiative vs. guilt C. Trust vs. Mistrust D. Autonomy vs. Shame and Doubt 12. The best strategy that the nurse can use to provide a trusting relationship with an autistic child like Sheila is to: A. Reinforce positive behavior through praise and rewards B. Explain to the child activities and routines C. Provide a structured environment D. Convey warmth through touch 13. A distinguishing factor that separates conduct disorder from oppositional defiant disorder in children include the following: A. Obvious symptoms at birth B. Violation of rights of others C. Opposition to authority D. Angry outburst 14. A normal response to hospitalization for a young child is: A. being emotionally upset B. withdrawal from the family C. regressive behavior D. free-floating anxiety 15. Prevention of mental retardation begins: A. As soon as pregnancy is suspected B. With family planning C. During the first trimester of pregnancy D. During the second trimester of pregnancy