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Nursing Practice 3 (Dec 2006)

Nursing Practice 3 (Dec 2006)

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Published by ɹǝʍdןnos
Nursing Practice 3 (Dec 2006)
Nursing Practice 3 (Dec 2006)

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Published by: ɹǝʍdןnos on Nov 20, 2009
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05/17/2013

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1
SET A Seat No.____ 
--------------------------------------------------------------------------------------------------------------------------------NURSING PRACTICE 3A:
NURSING CARE OF CLIENT WITH PHYSIOLOGICALAND PSYCHOSOCIAL ALTERATIONS
DIRECTION:
Choose the letter of the BEST answer by shading the corresponding letter of your choice on theanswer sheet provided. STRICTLY NO ERASURE! 
1. A group of nurses are studying the case of a 16-year old nursing student who was accused of frustrated homicide.Benny can determine their understanding of circumstantial evidence if they can identify which of the following in thecase?a. justifying circumstances c. exempting circumstancesb. aggravating circumstances
d. mitigating circumstances
2. E.M. is a 30-year old premenopausal female who is asking the nurse the most appropriate timeof the month to doher self-examination of the breast. The MOST appropriate reply by the nurse would be:a. the 26
th
day of the menstrual cycle
b. 7 to 8 days after conclusion of the menstrual period
c. during her menstruationd. the same day each month3. Copies of certain portions of the chart maybe released at the discretion of the hospital but maybe limited to:a. x-ray result, treatment orders, and surgery techniqueb. laboratory results and abstract only
c. laboratory results, OR reports and patient’s abstract
d. OR reports, laboratory results, nurse’s notes4. Jenny is reading the progress notes of her patient and reads that the physician haddocumented “insensible fluid lossof approximately 800 ml daily.” She understands that this type of fluid loss can occur through:a. urinary output
c. the skin
b. the gastrointestinal part d. wound drainage5. Communication can be verbal and non-verbal. Examples of non-verbal communication inpatient-nurse relationship arethe following EXCEPT:a. signs c. symptomsb. restlessness
d. using an interpreter like a family member
6. The perioperative nurse assumes responsibility and accountability for nursing judgments andactions exemplified by thefollowing, EXCEPT:a. accepting on-call assignmentb. accepting committee assignment
c. selecting a.m. shift only
d. maintaining basic nursing procedure7. What one condition besetting the nursing service prevents the use of team approach?a. fast turn-around of nurses
c. understaffing
b. no administrative support d. politics in the nursing department8. Fe, a nurse at the PACU discovered that Luisa, 50 kilos who is 3 hours post cholecystectomywas in severe pain. Uponchecking the chart, she found out that Luisa had “Demerol 100 mg I.M. prn for pain”. Whatshould Fe do?
a. verify the order from the M.D.
b. inject 100 mg. Demerol I.M. to Luisac. report to the nurse supervisor for opiniond. administer the recommended dose which is 50 mg because Luisa weighs 50 kilos
 
9. Postoperatively, the nurse teaches the patient with a modified radical mastectomy to preventlymphedema by:
a. avoiding unnecessary trauma (e.g. Venipuncture, BP) to the arm on the operativeside
2
b. using a sling to keep arm flexed at the sidec. exposing the arm to sunlight to increase circulationd. wrapping the arm with elastic bandages during the night10. Ms. De Leon is suffering from Bell’s palsy as indicated by a feeling of stiffness and a drawingsensation of the face. Inteaching her about the disease, what would be important to tell her?a. There may be increased sensitivity to soundb. There is a heightened awareness of taste, so that foods must be bland
c. The eye is susceptible to injury if the eyelid does not close
d. Drooling from an increase of saliva on the affected side may occur11. The patient is scheduled for adrenalectomy. In the preoperative period, the priority nursingaction would be tomonitor:a. urine for glucose and acetone
b. vital signs
c. intake and outputd. blood urea nitrogen results12. Virtue ethics gives us a special prospective in the parent’s role to decide for their childrenincluding decision of:
a. professional choice of children
b. spouse choice for childrenc. life and death prior to conception and birthd. gender choice for children13. One of the reasons why behavior in the OR is so tightly controlled is:a. it is hard to move around in a OR gownb. the door of OR suite are closedc. everybody is busy doing their operation
d. to prevent the cross-contamination of infection between OR staff and patient
14. One of the hidden dangers in the OR is missing instruments. What is the appropriateapproach to this happening?a. correct labeling
b. “a place for everything and everything in its place”
c. install a flush sterilizer in the ORd. increase instrument inventory15. Ms. W.O. is found on the floor of her room. She fell while crawling over the side rails of herbed. She is unconsciousand has a large laceration to the head that is bleeding profusely. The nurse’s priority actionwould be:a. apply direct pressure to the laceration to her head
b. ensure the patient has an open airway
c. notify the physiciand. check the patient’s vital signs16. During admission of a patient with a severe head injury to the emergency department, thenurse places the highestpriority on assessment for:a. presence of a neck injuryb. neurological status with the Glasgow Coma Scalec. cerebrospinal fluid leakage from ears or nose
d. patency of airway
17. In the hospital, the best indicator of quality is:a. patients recover but spend more on supplies
b. patients come back with referral like their family and friends
c. patients demand more use of technology
 
d. patients come back of their doctor’s advice18. A most critical strategy in nursing communication is:a. non-verbal communication
3
b. giving stereotyped commentsc. verbal communication
d. active listening
19. Mr. T.O. has undergone surgery for lyses of adhesions. He is transferred from Post AnesthesiaCare Unit (PACU) tothe Surgical floor, the nurse should obtain blood pressure, pulse and respiration every:a. 3 minutes c. 15 minutes
b. 30 minutes
d. 20 minutes20. Mr. K, age 13, is diagnosed with chronic bronchitis. He is very dyspneic and must sit up tobreath. An abnormalcondition in which there is discomfort in breathing in any bed or sitting position is:a. Cheyne-stokes c. eupnea
b. orthopnea
d. dyspnea21. The nurse recognizes that the MOST common causative organism in pyelonephritis is:
a. E.Coli
c. Candida Albicansb. Klebsiella d. Pseudomonas22. There is a global concern on AIDS. There are legal and ethical concerns specially:a. duty siblings and spouseb. need for universal testing
c. confidentiality
d. public support and understanding23. Mr. WT is cleaning the garage and splashes a chemical to his eyes. The initial priority carefollowing the chemical burnis to:a. irrigate with normal saline for 1 to 15 minutesb. transport to a physician immediately
c. irrigate with water for 15 minutes or longer
d. cover the eyes with a sterile gauze24. Licensed nurses from foreign countries can practice nursing in the Philippines in the followingcondition:a. employed in state colleges and universitiesb. special projects with hospitals with a fixed feec. employees by private hospitals
d. medical mission whose services are free
25. A patient diagnosed with breast cancer has been offered the treatment choices of breastconservation surgery withradiation or a modified radical mastectomy. When questioned by the patient about these options,the nurse informs thepatient that the lumpectomy with radiation:a. reduces the fear and anxiety that accompany the diagnosis and treatment of cancerb. has about the same 10-year survival rate as the modified radical mastectomyc. provides a shorter treatment period with a fewer long term complications
d. preserves the normal appearance and sensitivity of the breast.
26. Following a fracture of the forearm or tibia, complaints of sharp, deep, unrelenting pain in thehand or foot unrelievedby analgesics or elevation of the extremity indicate which complication?a. cast syndrome b.
compartment syndrome c.
gangrene d. fat embolism27. Another worthy study is the compliance to the principles of aseptic technique among thesterile OR team. Who doesNOT belong to the sterile OR team?a. scrub nurse
c. x-ray technician
b. assistant surgeon d. surgeon28. Circulation must be restored within 4 minutes of cardiopulmonary arrest because:a. the lungs fill with fluid

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