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24791816 Medical Surgical Nursing Test

24791816 Medical Surgical Nursing Test

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Published by Raffy
Medical Surgical Nursing Test
SITUATION : Arthur, A registered nurse, witnessed an old woman hit by a motorcycle while crossing a train railway. The old woman fell at the railway. Arthur rushed at the scene. 1. As a registered nurse, Arthur knew that the first thing that he will do at the scene is A. Stay with the person, Encourage her to remain still and Immobilize the leg while While waiting for the ambulance. B. Leave the person for a few moments to call for help. C. Reduce the fracture manua
Medical Surgical Nursing Test
SITUATION : Arthur, A registered nurse, witnessed an old woman hit by a motorcycle while crossing a train railway. The old woman fell at the railway. Arthur rushed at the scene. 1. As a registered nurse, Arthur knew that the first thing that he will do at the scene is A. Stay with the person, Encourage her to remain still and Immobilize the leg while While waiting for the ambulance. B. Leave the person for a few moments to call for help. C. Reduce the fracture manua

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Published by: Raffy on Jan 18, 2010
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SITUATION : Arthur, A registered nurse, witnessed an old woman hit by amotorcycle while crossing a train railway. The old woman fell at therailway. Arthur rushed at the scene.1. As a registered nurse, Arthur knew that the first thing that he will do atthe scene isA. Stay with the person, Encourage her to remain still and Immobilize theleg whileWhile waiting for the ambulance.B. Leave the person for a few moments to call for help.C. Reduce the fracture manually.D.
Move the person to a safer place.
2. Arthur suspects a hip fracture when he noticed that the old woman’s legisA. Lengthened, Abducted and Internally Rotated.B. Shortened, Abducted and Externally Rotated.C. Shortened, Adducted and Internally Rotated.D.
Shortened, Adducted and Externally Rotated.
3. The old woman complains of pain. John noticed that the knee isreddened, warm to touch and swollen. John interprets that this signs andsymptoms are likely related toA. InfectionB. ThrombophlebitisC.
D. Degenerative disease4. The old woman told John that she has osteoporosis; Arthur knew that allof the following factors would contribute to osteoporosis exceptA.
B. End stage renal diseaseC. Cushing’s DiseaseD. Taking Furosemide and Phenytoin.5. Martha, The old woman was now Immobilized and brought to theemergency room. The X-ray shows a fractured femur and pelvis. The ER  Nurse would carefully monitor Martha for which of the following sign andsymptoms?A.
Tachycardia and Hypotension
B. Fever and BradycardiaC. Bradycardia and HypertensionD. Fever and HypertensionSITUATION: Mr. D. Rojas, An obese 35 year old MS Professor of OLFULagro is admitted due to pain in his weight bearing joint. The diagnosis wasOsteoarthritis.6. As a nurse, you instructed Mr. Rojas how to use a cane. Mr. Rojas has aweakness on his right leg due to self immobilization and guarding. You plan to teach Mr. Rojas to hold the caneA. On his left hand, because his right side is weak.B.
On his left hand, because of reciprocal motion.
C. On his right hand, to support the right leg.D. On his right hand, because only his right leg is weak.7. You also told Mr. Rojas to hold the caneA. 1 Inches in front of the foot.B. 3 Inches at the lateral side of the foot.c.
6 Inches at the lateral side of the foot.
D. 12 Inches at the lateral side of the foot.8. Mr. Rojas was discharged and 6 months later, he came back to theemergency room of the hospital because he suffered a mild stroke. Theright side of the brain was affected. At the rehabilitative phase of your nursing care, you observe Mr. Rojas use a cane and you intervene if you seehimA.
Moves the cane when the right leg is moved.
B. Leans on the cane when the right leg swings through.C. keeps the cane 6 Inches out to the side of the right foot.D. Holds the cane on the right side.SITUATION: Alfred, a 40 year old construction worker developed cough,night sweats and fever. He was brought to the nursing unit for diagnosticstudies. He told the nurse he did not receive a BCG vaccine duringchildhood9. The nurse performs a Mantoux Test. The nurse knows that Mantoux Testis also known asA.
B. PDPC. PDDD. DPP10. The nurse would inject the solution in what route?A. IMB. IVC.
D. SC11. The nurse notes that a positive result for Alfred isA. 5 mm whealB. 5 mm IndurationC. 10 mm WhealD.
10 mm Induration
12. The nurse told Alfred to come back after A. a week B.
48 hours
C. 1 dayD. 4 days13. Mang Alfred returns after the Mantoux Test. The test result readPOSITIVE. What should be the nurse’s next action?A.
Call the Physician
B. Notify the radiology dept. for CXR evaluationC. Isolate the patientD. Order for a sputum exam14. Why is Mantoux test not routinely done in the Philippines?A. It requires a highly skilled nurse to perform a Mantoux testB. The sputum culture is the gold standard of PTB Diagnosis and it willdefinitively determine the extent of the cavitary lesionsC. Chest X Ray Can diagnose the specific microorganism responsible for the lesionsD.
 Almost all Filipinos will test positive for Mantoux Test 
15. Mang Alfred is now a new TB patient with an active disease. What ishis category according to the DOH?A.
B. IIC. IIID. IV16. How long is the duration of the maintenance phase of his treatment?A. 2 monthsB. 3 monthsC.
4 months
D. 5 months17. Which of the following drugs is UNLIKELY given to Mang Alfredduring the maintenance phase?A. RifampicinB. IsoniazidC.
D. Pyridoxine18. According to the DOH, the most hazardous period for development of clinical disease is during the firstA.
6-12 months after 
B. 3-6 months after C. 1-2 months after D. 2-4 weeks after 
19. This is the name of the program of the DOH to control TB in thecountryA. DOTSB.
 National Tuberculosis Control Program
C. Short Coursed ChemotherapyD. Expanded Program for Immunization20. Susceptibility for the disease [ TB ] is increased markedly in those withthe following condition exceptA.
23 Year old athlete with diabetes insipidus
B. 23 Year old athlete taking long term Decadron therapy and anabolicsteroidsC. 23 Year old athlete taking illegal drugs and abusing substancesD. Undernourished and Underweight individual who undergonegastrectomy21. Direct sputum examination and Chest X ray of TB symptomatic is inwhat level of prevention?A. PrimaryB.
C. TertiaryD. QuarterlySITUATION: Michiel, A male patient diagnosed with colon cancer wasnewly put in colostomy.22. Michiel shows the BEST adaptation with the new colostomy if heshows which of the following?A. Look at the ostomy siteB.
 Participate with the nurse in his daily ostomy care
C. Ask for leaflets and contact numbers of ostomy support groupsD. Talk about his ostomy openly to the nurse and friends23. The nurse plans to teach Michiel about colostomy irrigation. As thenurse prepares the materials needed, which of the following item indicatesthat the nurse needs further instruction?A.
 Plain NSS / Normal Saline
B. K-Y JellyC. Tap water D. Irrigation sleeve24. The nurse should insert the colostomy tube for irrigation atapproximatelyA. 1-2 inchesB.
3-4 inches
C. 6-8 inchesD. 12-18 inches25. The maximum height of irrigation solution for colostomy isA. 5 inchesB. 12 inchesC.
18 inches
D. 24 inches26. Which of the following behavior of the client indicates the best initialstep in learning to care for his colostomy?A. Ask to defer colostomy care to another individualB. Promises he will begin to listen the next dayC.
 Agrees to look at the colostomy
D. States that colostomy care is the function of the nurse while he is in thehospital27. While irrigating the client’s colostomy, Michiel suddenly complains of severe cramping. Initially, the nurse wouldA.
Stop the irrigation by clamping the tube
B. Slow down the irrigationC. Tell the client that cramping will subside and is normalD. Notify the physician28. The next day, the nurse will assess Michiel’s stoma. The nurse noticedthat a prolapsed stoma is evident if she sees which of the following?A. A sunken and hidden stomaB. A dusky and bluish stomaC. A narrow and flattened stomaD.
 Protruding stoma with swollen appearance
29. Michiel asked the nurse, what foods will help lessen the odor of hiscolostomy. The nurse best response would beA. Eat eggsB. Eat cucumbersC.
 Eat beet greens and parsley
D. Eat broccoli and spinach30. The nurse will start to teach Michiel about the techniques for colostomyirrigation. Which of the following should be included in the nurse’steaching plan?A. Use 500 ml to 1,000 ml NSSB.
Suspend the irrigant 45 cm above the stoma
C. Insert the cone 4 cm in the stomaD. If cramping occurs, slow the irrigation31. The nurse knew that the normal color of Michiel’s stoma should beA.
 Brick Red 
B. GrayC. BlueD. Pale Pink SITUATION: James, A 27 basketball player sustained inhalation burn thatrequired him to have tracheostomy due to massive upper airway edema.32. Wilma, His sister and a nurse is suctioning the tracheostomy tube of James. Which of the following, if made by Wilma indicates that she iscommitting an error?A. Hyperventilating James with 100% oxygen before and after suctioningB. Instilling 3 to 5 ml normal saline to loosen up secretionC. Applying suction during catheter withdrawalD.
Suction the client every hour 
33. What size of suction catheter would Wilma use for James, who is 6 feet5 inches in height and weighing approximately 145 lbs?A. Fr. 5B. Fr. 10C. Fr. 12D.
 Fr. 18
34. Wilma is using a portable suction unit at home, What is the amount of suction required by James using this unit?A. 2-5 mmHgB. 5-10 mmHgC.
10-15 mmHg 
D. 20-25 mmHg35. If a Wall unit is used, What should be the suctioning pressure required by James?A. 50-95 mmHgB. 95-110 mmHgC.
100-120 mmHg 
D. 155-175 mmHg36. Wilma was shocked to see that the Tracheostomy was dislodged. Boththe inner and outer cannulas was removed and left hanging on James’ neck.What are the 2 equipment’s at james’ bedside that could help Wilma dealwith this situation?A. New set of tracheostomy tubes and Oxygen tank B. Theophylline and EpinephrineC.
Obturator and Kelly clamp
D. Sterile saline dressing37. Which of the following method if used by Wilma will best assure thatthe tracheostomy ties are not too tightly placed?A.
Wilma places 2 fingers between the tie and neck 
B. The tracheotomy can be pulled slightly away from the neck C. James’ neck veins are not engorgedD. Wilma measures the tie from the nose to the tip of the earlobe and to thexiphoid process.38. Wilma knew that James have an adequate respiratory condition if she
notices thatA.
 James’ respiratory rate is 18
B. James’ Oxygen saturation is 91%C. There are frank blood suction from the tubeD. There are moderate amount of tracheobronchial secretions39. Wilma knew that the maximum time when suctioning James isA.
10 seconds
B. 20 secondsC. 30 secondsD. 45 secondsSITUATION : Juan Miguel Lopez Zobel Ayala de Batumbakal wasdiagnosed with Acute Close Angle Glaucoma. He is being seen by NurseJet.40. What specific manifestation would nurse Jet see in Acute close angleglaucoma that she would not see in an open angle glaucoma?A. Loss of peripheral visionB. Irreversible vision lossC. There is an increase in IOPD.
41. Nurse jet knew that Acute close angle glaucoma is caused byA.
Sudden blockage of the anterior angle by the base of the iris
B. Obstruction in trabecular meshwork C. Gradual increase of IOPD. An abrupt rise in IOP from 8 to 15 mmHg42. Nurse jet performed a TONOMETRY test to Mr. Batumbakal. Whatdoes this test measuresA. It measures the peripheral vision remaining on the clientB.
Measures the Intra Ocular Pressure
C. Measures the Client’s Visual AcuityD. Determines the Tone of the eye in response to the sudden increase inIOP.43. The Nurse notices that Mr. Batumbakal cannot anymore determineRED from BLUE. The nurse knew that which part of the eye is affected bythis change?A. IRISB. PUPILc. RODS [RETINA]D.
44. Nurse Jet knows that Aqueous Humor is produce where?A. In the sub arachnoid space of the meningesB. In the Lateral ventriclesC. In the ChoroidsD.
 In the Ciliary Body
45. Nurse Jet knows that the normal IOP isA.
8-21 mmHg 
B. 2-7 mmHgc. 31-35 mmHgD. 15-30 mmHg46. Nurse Jet wants to measure Mr. Batumbakal’s CN II Function. Whattest would Nurse Jet implement to measure CN II’s Acuity?A. Slit lampB.
Snellen’s Chart 
C. Wood’s lightD. Gonioscopy47. The Doctor orders pilocarpine. Nurse jet knows that the action of thisdrug is toA.
Contract the Ciliary muscle
B. Relax the Ciliary muscleC. Dilate the pupilsD. Decrease production of Aqueous Humor 48. The doctor orders timolol [timoptic]. Nurse jet knows that the action of this drug isA. Reduce production of CSFB.
 Reduce production of Aquesous Humor 
C. Constrict the pupilD. Relaxes the Ciliary muscle49. When caring for Mr. Batumbakal, Jet teaches the client to avoidA. Watching large screen TVsB.
 Bending at the waist 
C. Reading booksD. Going out in the sun50. Mr. Batumbakal has undergone eye angiography using an Intravenousdye and fluoroscopy. What activity is contraindicated immediately after  procedure?A.
 Reading newsprint 
B. Lying downC. Watching TVD. Listening to the music51. If Mr. Batumbakal is receiving pilocarpine, what drug should always beavailable in any case systemic toxicity occurs?A.
 Atropine Sulfate
B. Pindolol [Visken]C. Naloxone Hydrochloride [Narcan]D. Mesoridazine Besylate [Serentil]SITUATION : Wide knowledge about the human ear, it’s parts and it’sfunctions will help a nurse assess and analyze changes in the adult client’shealth.52. Nurse Anna is doing a caloric testing to his patient, Aida, a 55 year olduniversity professor who recently went into coma after being mauled by her disgruntled 3rd year nursing students whom she gave a failing mark. After instilling a warm water in the ear, Anna noticed a rotary nystagmus towardsthe irrigated ear. What does this means?A. Indicates a CN VIII DysfunctionB. AbnormalC.
D. Inconclusive53. Ear drops are prescribed to an infant, The most appropriate method toadminister the ear drops isA. Pull the pinna up and back and direct the solution towards the eardrumB.
 Pull the pinna down and back and direct the solution onto the wall of thecanal 
C. Pull the pinna down and back and direct the solution towards theeardrumD. Pull the pinna up and back and direct the solution onto the wall of thecanal54. Nurse Jenny is developing a plan of care for a patient with Menieresdisease. What is the priority nursing intervention in the plan of care for this particular patient?A. Air, Breathing, CirculationB. Love and BelongingnessC. Food, Diet and NutritionD.
55. After mastoidectomy, Nurse John should be aware that the cranial nervethat is usually damage after this procedure isA. CN IB. CN IIC.
D. CN VI56. The physician orders the following for the client with Menieres disease.Which of the following should the nurse question?A. Dipenhydramine [Benadryl]B. Atropine sulfateC.
Out of bed activities and ambulation
D. Diazepam [Valium]57. Nurse Anna is giving dietary instruction to a client with Menieres

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