Nursing Practice 3 is a critical component of the Nursing Licensure Examination (NLE) in the Philippines, focusing on the care of clients with physiologic and psychosocial alterations, particularly Alteration in Oxygenation and Fluids and Electrolytes. This course equips nursing students with essential knowledge and skills to assess, intervene, and manage complex alterations in client health.
Alteration in Oxygenation: This component addresses respiratory conditions and oxygenation problems such as asthma, chronic obstructive pulmonary disease (COPD), pneumonia, and acute respiratory distress syndrome (ARDS). Nurses learn to recognize signs of respiratory distress, administer oxygen therapy, and provide respiratory interventions to optimize oxygenation.
Fluids and Electrolytes: Understanding fluid and electrolyte balance is crucial for maintaining homeostasis. Nursing students learn to assess and manage imbalances such as hyponatremia, hyperkalemia, dehydration, and fluid volume excess. Interventions include fluid replacement therapies, electrolyte monitoring, and patient education on dietary modifications.
Nursing Practice 3 integrates theoretical knowledge with practical skills through case studies, simulations, and clinical experiences. By mastering these components, students develop critical thinking, clinical judgment, and holistic care approaches necessary for success in the NLE and future nursing practice.
Prepare for the Nursing Licensure Examination by focusing on these key concepts and competencies. Join us to enhance your understanding of physiologic and psychosocial alterations, ensuring readiness to provide competent and compassionate care to diverse clients in healthcare settings.
Nursing Practice 3 Reviewer
Welcome to our Nursing Practice 3 Practice Examination! In this session, you'll have the opportunity to test your understanding of key concepts in Nursing Practice 3. The quiz consists of multiple-choice questions covering various topics. Pay close attention to each question and select the best answer. After completing the exam, check the video below for the answer key and explanations.
SITUATION:
A 65-year-old male client is admitted to the hospital with a diagnosis of chronic obstructive pulmonary disease (COPD). He presents with increased dyspnea, productive cough with thick sputum, and oxygen saturation of 88% on room air. The client has a history of smoking for over 40 years. Upon assessment, the nurse notes barrel chest, prolonged expiratory phase, and audible wheezes upon auscultation.
1. Which assessment finding is consistent with the client's diagnosis of COPD?
A) Bradypnea
B) Decreased anteroposterior diameter of the chest
C) Decreased respiratory rate upon exertion
D) Increased forced expiratory volume
2. What intervention should the nurse prioritize for this client?
A) Encourage deep breathing and coughing exercises
B) Administer oxygen via nasal cannula at 2 liters per minute
C) Administer bronchodilators and corticosteroids as prescribed
D) Provide intravenous fluids to maintain hydration
3. What precaution should the nurse include in the client's plan of care?
A) Encourage the client to take deep breaths only during periods of dyspnea
B) Monitor oxygen saturation continuously
C) Limit fluid intake to prevent fluid overload
D) Instruct the client to avoid bronchodilators to prevent dependency
4. What teaching should the nurse provide to the client about managing COPD?
A) Encourage the client to engage in aerobic exercise daily
B) Instruct the client to avoid exposure to cigarette smoke and air pollutants
C) Recommend frequent use of over-the-counter cough suppressants
D) Advise the client to limit fluid intake to avoid exacerbations
5. Which nursing diagnosis is most appropriate for this client?
A) Impaired Gas Exchange
B) Excess Fluid Volume
C) Risk for Ineffective Airway Clearance
D) Risk for Imbalanced Nutrition: Less Than Body Requirements
SITUATION:
A 50-year-old female client is admitted to the emergency department with acute respiratory distress. The client presents with severe dyspnea, cyanosis, and a productive cough with pink-tinged sputum. The client has a medical history of congestive heart failure (CHF) and is currently receiving treatment for hypertension. Upon auscultation, crackles are heard bilaterally in the lung bases.
1. Based on the client's presentation, which condition is most likely causing the acute respiratory distress?
A) Pneumonia
B) Pulmonary embolism
C) Acute exacerbation of chronic obstructive pulmonary disease (COPD)
D) Acute pulmonary edema
2. What is the primary pathophysiological mechanism of acute pulmonary edema in this client?
A) Increased capillary permeability
B) Pulmonary artery vasoconstriction
C) Left ventricular failure with fluid back-up into the lungs
D) Viral infection causing alveolar damage
3. Which assessment finding is consistent with acute pulmonary edema?
A) Bradypnea
B) Decreased heart rate
C) Crackles on lung auscultation
D) Hyperoxygenation with oxygen therapy
4. What is the priority nursing intervention for this client?
A) Administering bronchodilators to improve airway patency
B) Elevating the client's legs to promote venous return
C) Providing supplemental oxygen to improve oxygenation
D) Restricting fluid intake to prevent further fluid overload
5. Which nursing diagnosis takes priority for this client?
A) Ineffective Breathing Pattern
B) Impaired Gas Exchange
C) Fluid Volume Excess
D) Risk for Decreased Cardiac Output
SITUATION:
A 60-year-old female client with a history of chronic kidney disease (CKD) is admitted to the medical-surgical unit. The client presents with lethargy, confusion, and muscle weakness. Initial assessment reveals dry mucous membranes, decreased skin turgor, and a low blood pressure of 90/60 mmHg. Laboratory results indicate elevated serum potassium levels (hyperkalemia) and decreased serum sodium levels (hyponatremia).
1. What is the primary cause of the client's altered fluid and electrolyte balance?
A) Excessive fluid intake
B) Decreased kidney function
C) High sodium diet
D) Overactive adrenal glands
2. Which electrolyte imbalance poses the greatest immediate risk to the client's health?
A) Hyperkalemia
B) Hyponatremia
C) Hypocalcemia
D) Hypomagnesemia
3. What intervention is crucial for managing hyperkalemia in this client?
A) Administering intravenous potassium supplements
B) Initiating a low-potassium diet
C) Administering calcium gluconate to stabilize cardiac membranes
D) Providing insulin and glucose to promote cellular uptake of potassium
4. How should the nurse approach the management of hyponatremia in this client?
A) Encourage increased sodium intake with foods rich in potassium
B) Implement fluid restriction to prevent further sodium loss
C) Administer diuretics to increase sodium excretion
D) Provide isotonic saline solution to restore serum sodium levels
5. What nursing diagnosis is most appropriate for this client's condition?
A) Risk for Imbalanced Nutrition: Less Than Body Requirements
B) Risk for Falls related to muscle weakness
C) Ineffective Tissue Perfusion related to altered electrolyte balance
D) Impaired Skin Integrity related to dry skin and decreased skin turgor
SITUATION:
A 45-year-old male client is admitted to the emergency department with complaints of severe diarrhea and vomiting for the past 24 hours. The client appears weak and dehydrated, with sunken eyes and dry mucous membranes. Vital signs reveal tachycardia, hypotension, and increased respiratory rate. Laboratory results show decreased serum sodium levels (hyponatremia) and increased serum potassium levels (hyperkalemia).
1. What is the primary cause of the client's fluid and electrolyte imbalances?
A) Excessive intake of sodium-rich foods
B) Gastrointestinal fluid losses
C) Overconsumption of potassium supplements
D) Adrenal gland dysfunction
2. Which electrolyte imbalance poses the most immediate threat to the client's cardiac function?
A) Hyponatremia
B) Hyperkalemia
C) Hypocalcemia
D) Hypomagnesemia
3. What is the priority nursing intervention for managing hyperkalemia in this client?
A) Administering calcium gluconate to stabilize cardiac membranes
B) Initiating oral potassium supplements
C) Providing intravenous insulin and glucose
D) Encouraging increased potassium intake in the diet
4. How should the nurse manage hyponatremia in this client?
A) Administering diuretics to increase sodium excretion
B) Providing isotonic saline solution to restore serum sodium levels
C) Encouraging increased fluid intake to dilute serum sodium levels
D) Restricting fluid intake to prevent further electrolyte imbalances
5. What nursing diagnosis is most appropriate for this client's condition?
A) Risk for Impaired Skin Integrity related to dehydration
B) Risk for Falls related to weakness and hypotension
C) Deficient Fluid Volume related to gastrointestinal fluid losses
D) Ineffective Breathing Pattern related to electrolyte imbalances
WATCH THE VIDEO FOR THE ANSWER KEY AND EXPLANATION