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PAST BOARD EXAMINATION - JUNE 2009

Nursing Practice I - June 2009 Situation: A nurse utilizes the nursing process in managing patient care. Knowledge of this process is essential to deliver high quality care and to focus on the client’s response to their illness. 1. During the planning phase of the nursing process, which of the following is developed? a. Nursing care plan c. Nursing history b. Nursing diagnosis d. Nursing notes The end product of the planning phase of the nursing process is a formal or informal plan of care. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 212 2. Objective data are also known as? a. covert data b. Inferences c. overt data Symptoms d.

Desired/expected outcome statements should usually have the following 4 components: subject (client, or part/attribute thereof), verb (an action client is to perform), conditions or modifiers (may be added to the verb to explain the circumstances by which the verb is performed – when where, how), and criterion of desired performance (standard by which a performance is evaluated). Subject: patient. Verb: identify. Conditions/modifiers: by discharge (when). Criterion: 5 high salt foods from a prepared list. The statements should be written in terms of client responses, not nurse activities. It should follow the SMART criteria, derive from only one nursing diagnosis, use observable and measurable terms, and should be important to the client. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 221-222 8. An expected outcome on a patient’s care plan reads “Patient will state seven warning signs of cancer by discharge.” When the nurses evaluate the client’s progress, the patient is able to state that a change in wart or mole, a sore that doesn’t heal and a change in bowel and bladder habits are warning signs of cancer. Which of the following be an appropriate evaluative statement for the nurse to place on the patient’s nursing care paln? a. Patient understands the warning signs of cancer b. Goal met: Patient cited a change in wart of mole, sore throat that doesn’t heal and a change in bowel or bladder habits as warning signs of cancer. c. Goal not met d. Goal partially met The goal is only partially met since the goal is 7 warning signs but the client was only able to name 3. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 237 9. A quality assurance nurse sends questionnaire to patients after discharge to determine their level of satisfaction with the nurse care they received in the facility. What type of nursing audit is this? a. Concurrent b. Outcome c. Terminal d. Retrospective There are 2 types of nursing audit. Concurrent audit is the evaluation of a client’s health care while the client is still receiving care from the agency. Retrospective audit is the evaluation of a client’s record after discharge from an agency. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 240 10. The nurse makes the following entry in the patient’s record.” Goal not met: patient refuses to attend smoking cessation. Because this goal hasn’t been met, the nurse should: a. Develop a completely new nursing care plan b. Assign the patient to a more experienced nurse c. Critique the steps involve in the development of the goal d. Transfer the patient to another facility When goals have been partially met or unmet, the nurse may either conclude one of 2 things: (1) the care plan needs to be revised, which may involve the phases of assessment, diagnosis, planning, and implementation; or (2) the care plan need not be revised since the client only needs more time to achieve the previously established goals. The first conclusion refers to critiquing of the steps. An entirely new care plan may not be necessary since revision of necessary parts of the plan may just suffice. B and D mean passing the buck. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 237 SITUATION: Health care delivery system affects the health of every Filipino. As a nurse, knowledge of this system is expected to ensure quality of life. 11. When should rehabilitation commence. a. The day before discharge c. Upon admission b. When the patient desires d. 24 hrs after discharge The principles of rehabilitation are basic to the care of all patients, and rehabilitation efforts should begin during the initial contact with a patient. Brunner and Suddarth’s Textbook of Medical Surgical Nursing, p.159 12. What exemplified the preventive and promotive programs in the hospital? a. Hospital as a center to prevent and control infection b. Program for smokers c. Program for alcoholics and drug addicts d. hospital wellness center New trends are showing a shift from inpatient care to outpatient care with a focus on health promotion and wellness. The emergence of hospital-based fitness/wellness centers presents an alternative delivery of healthcare services. RGO REVIEW CENTER... the center that truly cares!!!

Objective data are also known as signs or overt data. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 180 3. Data or information obtained from the assessment of a patient is primarily used by a nurse to: a. Ascertain the patient’s response to health problems b. Assist in constructing the taxonomy of nursing intervention c. Determine the effectiveness of the doctor’s order d. Identify the patient’s disease process Nursing assessments focus on a client’s responses to a health problem. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 179 4. What is an example of the subjective data? a. color of wound drainage b. respirations of 14 bpm c. color of breath d. patient’s statement of “I feel sick to my stomach” Subjective data includes the client’s sensations, feelings, values, beliefs, attitudes, and perception of health status and life situation. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 180 5. Which statement is a difference between comprehensive and focused assessment? a. Comprehensive assessments can’t include any focus assessments. b. Focused assessments are more important than comprehensive assessment c. Focused assessment is usually ongoing and concerning specific problems d. Objective data are included only in comprehensive assessment. Problem-focused assessment is used to determine the status of a specific problem identified in an earlier assessment and also to identify new or overlooked problems. Assessment is a continuous process. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 179-180 6. Two year old Ben’s mother states “Ben vomited 8 ounces of his formula in the morning. This statement is an example of: a. Objective data from a primary source b. objective data from secondary source c. Subjective data from primary source d. subjective data from secondary source Subjective data are apparent only to the person affected and can be described or verified only by that person. Objective data are detectible by an observer or can measured or tested against an accepted standard. Primary source of data is the client. Other sources are secondary. The vomiting and related facts can be detected by an observer. The source is the client’s mother. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 180-181 7. Which expected outcome is correctly written? a. The patient will be less edematous in 24 hrs b. The patient will drink an adequate amount of fluid daily c. The patient will identify 5 high salt foods from prepared list by discharge d. The patient will soon sleep well through the night

Design Details for Health by C. Leibrock and D. Harris, p. 175

PAST BOARD EXAMINATION - JUNE 2009
Prehospital care includes airway management and arrhythmia treatment per ACLS protocols. In the ER, as for all care, the patient needs immediate evaluation and stabilization of the airway, breathing, and circulation, even without knowledge of the ultimate diagnosis. Treatment of serotonin syndrome is primarily supportive. Toxicity, Selective Serotonin Reuptake Inhibitor by T. Cushing, et. al., Medscape Reference, http://emedicine.medscape.com/article/821737treatment#a1126 19. The nurse is caring for the client admitted to the hospital for subclavian line replacement. Which psychosocial area of assessment should the nurse address with the client? a. Strict restrictions of neck mobility b. Loss of ability to ambulate as tolerated c. Possible body image disturbance d. Continuous pain related to ongoing placement of the subclavian line C is a psychosocial assessment finding. A, B, and D are physiologic. 20. A hospitalized client who has a living will is being fed through a nasogastric tube. During a bolus feeding, the client’s vomits and begins choking. Which of the following actions is most appropriate? a. Clear the clients airway b. make the client comfortable c. start CPR d. stop feeding and remove the NG tube Bolus feedings are given in large volumes (300 to 400 mL every 4 to 6 hours). To prevent aspiration, distention, nausea, vomiting, and diarrhea, continuous feeding (delivery in small amounts over long periods) is preferred. If aspiration is suspected, the feeding is stopped immediately, the pharynx and trachea are suctioned, and the patient is placed on the right side with the head of the bed down. The physician is notified immediately. Brunner and Suddarth’s Textbook of Medical Surgical Nursing, p.995-996 SITUATION. Health promotion is the priority nursing responsibility. The nurse should be able to promote the client’s wellbeing and identify ways on improving the client’s quality of life. 21. The nurse is caring for a 16 year old client who isn’t sexually active. The client asks if she needs a papanicolau test. The nurse should reply: a. Yes, she should have a pap test after the onset of menstruation b. No, because she isn’t sexually active c. Yes, because she’s 16 years old d. No, because is not yet 21 years old The American Cancer Society recommends pap test yearly starting at 18 years old or upon age of sexual activity. Brunner and Suddarth’s Textbook of Medical Surgical Nursing, p.324 22. The nurse is caring for a client who complains of abdominal pain, nausea and diarrhea. When examining the clients abdomen, which sequence should the nurse use? a. Inspection, palpation, percussion, auscultation b. Inspection, auscultation, percussion, palpation c. auscultation , Inspection, percussion ,palpation d. Palpation, auscultation, percussion, Inspection When assessing the abdomen, the nurse performs inspections first, followed by auscultation, percussion, and/or palpation. Auscultation is done before palpation and percussion because palpation and percussion cause movement or stimulation of the bowel, which can increase bowel motility and thus heighten bowel sounds, creating false results. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 631 23. The nurse is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 45. Following the Philippine Cancer Society guidelines, nurse should recommend women; a. Perform breast self examination annually b. Have a mammogram annually c. Have hormonal receptor assay annually d. Have physician conduct a clinical examination every 2 years Yearly mammogram is recommended since the age of 40. BSE is done monthly. Clinical breast examination is done annually. Hormone receptor assay is not among the recommended early detection screening tools for breast cancer. Public Health Nursing in the Philippines by the National League of Government Nurses, p. 207-208 RGO REVIEW CENTER... the center that truly cares!!!

13. Which makes nursing dynamic? a. Every patient is a unique physical, emotional and spiritual being. b. The patient participate in overall care plan c. Nursing practice is expanding in the light of modern development that takes place d. The health status of the patient is constantly changing and the nurse must be cognizant and responsive to these changes This is why the nursing process is dynamic and requires creativity for its application. The steps remain the same, but the application and results will be different in each client situation. The nursing process is designed to be used with clients throughout the life span and in any setting in which a nurse provides care for clients. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 83 14. Prevention is an important responsibility of the nurse in: a. hospitals b. community c. workplace d. all of the above Health promotion and disease prevention programs may be offered to individuals and families, in the home or in the community setting and at schools, hospitals, and worksites. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 277 15. This form of health insurance provides comprehensive prepaid health services to enrollees for a fix period payment. a. Health maintenance Organization b. Medicare c. Philippine health insurance act d. Hospital maintenance org. HMO is a group of health care agency that provides health maintenance and treatment services to voluntary enrollees. A fee is set without regard to the amount or kind of services provided. Available services are at reduced and predetermined cost to the client. They offer comprehensive services but focus on health promotion and disease prevention. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 113 SITUATION: Maslow’s Hierarchy of needs is an integral component of prioritization. As a nurse, you must know the client’s needs that request for an immediate action. 16. The client with history of pulmonary emboli is scheduled for insertion of the inferior vena cava filter. The nurse check on the client 1 hour after the physician has explained the procedure and obtains consent from the client. The client is lying in bed, wringing the hands, and says to the nurse. “I’m not sure about this. What if it doesn’t work and I’m just as bad off as before?” The nurse addresses which primary concern of the client? a. Fear related to the potential risk and outcome of surgery b. Anxiety related to the fear of death c. Ineffective individual coping related to the therapeutic regimen d. Knowledge deficit related to the surgical procedure Fear is an emotion of feeling or apprehension aroused by impending or seeming danger, pain, or another perceived threat. It is one of the most common fears in surgeries and invasive procedures. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 1065 and MedicalSurgical Nursing: Concepts and Clinical Application by J. Udan, p. 33-34 17. A nurse is formulating a plan of care for a client receiving enteral feeding. The nurse identifies which as the highest priority to this client? a. Altered nutrition, less than body requirements b. High risk for aspiration c. High risk for fluid volume deficit d. Diarrhea Enteral tube insertions and feedings constitute a risk for accidental placement of the tube into the lungs. Thus, NGT is not advised for clients without intact cough and gag reflexes. Moreover, checking of tube placement is a must post-insertion and everytime feeding is to be administered Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 1265-1272 18. A home care nurse finds a client in the bedroom, unconscious with pill bottle in hand. The pill bottle contained the SSRI Setralin (Zoloft). The nurse immediately assesses the client’s: a. Blood pressure b. respirations c. Pulse d. urine output

24. The school nurse is planning a program for a group of teenagers on skin cancer prevention. Which will the nurse emphasize in her talk? a. Stay out of the sun between 1 p.m. and 3 p.m. b. Tanning booth are safe alternative for those who wish to tan c. Sun exposure is safe, provided client wears protective clothing d. Examine skin once per month looking for suspicious lesions or changes in moles

PAST BOARD EXAMINATION - JUNE 2009
The nurse decides when suctioning is needed by assessing the client for signs of respiratory distress or evidence that the client is unable to cough up or expectorate secretions. The nurse should assess the client’s need for suctioning: inability to effectively clear the airway by coughing and expectoration, or coarse bubbling or gurgling noises with respiration. The signs are assessed in this order: restlessness, gurgling sounds, adventitious breath sounds upon auscultation, change in mental status, skin color, rate and pattern of respirations, pulse rate and rhythm, and decreased oxygen saturation. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 1382 and Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 892 30. A nurse is planning to assist a diabetic client, to perform self monitoring of blood glucose level. The nurse should incorporate which of the following strategies to best help the client obtain an adequate capillary sample? a. Cleanse the hand beforehand using cool water b. Let the arm hang dependently and milk the digit c. Puncture the center of the finger pad d. Puncture the finger as deeply as possible The client holds his or her arm in a dependent position while the nurse is setting up the equipment to promote venous engorgement in the fingertips. A stroking or milking technique toward the fingertip can facilitate obtaining a maximum amount of blood. Warm water must be used since it promotes vasodilation and increases peripheral blood circulation. The side of the fingertips is preferred since it has fewer nerve endings compared with the soft, central part of the fingertips. The puncture must be deep enough to obtain specific specimen but puncturing as deeply as possible is unnecessary and even harmful. Fundamental and Advanced Nursing Skills, 3rd Ed., by G. Altman, p. 119 SITUATION. Mastery of intravenous therapy and all aspects that address the response of the client to complication related to it will help the new nurse in providing quality care. 31. One hour after IV was inserted; Nurse Net found out that the 1 liter of NSS was empty. Patient was in severe respiratory distress with pinkish frothy sputum. Probable complication is: a. Speed Shock c. Renal Failure b. congestive heart failure d. pulmonary edema Fluid overload is one of the adverse effects of the rapid infusion of IV fluids. Overloading the circulatory system with excessive IV fluids causes increased blood pressure and central venous pressure. Signs and symptoms of fluid overload include moist crackles on auscultation of the lungs, edema, weight gain, dyspnea, and respirations that are shallow and have an increased rate. A possible cause, in this case, is rapid infusion of an IV solution. The risk for fluid overload and subsequent pulmonary edema is especially increased in elderly patients with cardiac disease; this is referred to as circulatory overload. In pulmonary edema, the client may manifest increasing respiratory distress, characterized by dyspnea, air hunger, and central cyanosis. The patient is usually very anxious and often agitated. As the fluid leaks into the alveoli and mixes with air, a foam or froth is formed. The patient coughs up or the nurse suctions out these foamy, frothy, and often blood-tinged secretions. Brunner and Suddarth’s Textbook of Medical Surgical Nursing, p. 290, 542 32. When an IV of D5W is not infusing well on patient, it is best to first : a. Pinched the rubber part of the flushed out clog blood b. Coil tube and squeeze hard c. Lower IV to check for return flow d. Restart the IV Recommended actions are: assess puncture site, reposition the venous access device, lower the IV fluid container below the puncture site and observe for a backflow of blood, increase height of IV pole, or replace container on pole. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 1117 33. The doctor ordered venoclysis of dextrose 5 % in water one liter KVO for 24 hrs as a vehicle for IV medications. How many drops per minute should the fluid be regulated? a. 20 drops per minute c. 5 drops per minute b. 10 gtts/min d. 15 gtts/min 1000 cc divided by 24 hours is equal to 41-42 cc/hr. That is equivalent to around 10 drops per minute. 34. The nurse is administering an IV fluid to an Infant. Infants receive I.V therapy is particularly vulnerable to. a. Hypotension c. Cardiac Arrhythmias b. Fluid overload d. Pulmonary emboli RGO REVIEW CENTER... the center that truly cares!!!

Any wart, mole, or freckle that changes color, size, or shape, or that loses its sharp border should be seen by a doctor right away. Any other skin changes should be reported, too. A skin change may be a melanoma which, if found early, can be treated successfully. According to the ACS, the sun’s UV rays are highest from 10am to 4pm. Tanning lamps give out UV rays as well and can cause long-term skin damage and contribute to skin cancer. The protection that clothing provides varies according to different factors like length, color, tightness of weaving, dryness or wetness of fabric, etc. Unnecessary exposure to the sun is not recommended. ‘Signs and Symptoms of Cancer’ and ‘How Do I Protect Myself from UV Rays?’ by the American Cancer Society, http://www.cancer.org/Cancer/CancerBasics/signs-andsymptoms-of-cancer http://www.cancer.org/Cancer/CancerCauses/SunandUV Exposure/SkinCancerPreventionandEarlyDetection/skincancer-prevention-and-early-detection-u-v-protection 25. An employer establishes a physical exercise area in the workplace and encourages all the employees to use it. This is an example of what level of prevention? a. Primary Prevention c. Secondary Prevention b. Tertiary Prevention d. Passive Prevention Primary prevention focuses on health promotion and illness prevention. It addresses areas such as adequate and proper nutrition, weight control and exercise, and stress reduction. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 101 SITUATION. Basic nursing skills are essential for they are vital in many nursing procedures. Such skills are needed to promote health, prevent illness, cure a disease and rehabilitate infirmities. 26. A nurse has just been told by the physician that order has been written to administer an iron injection to a client. The nurse plans to give the medication in the: a. Gluteal muscle using Z tract technique b. Deltoid muscle using an air lock c. Subcutaneous tissue of the abdomen d. Anterolateral thigh using 5/8-inch needle Parenteral iron is given via deep IM method. The ventrogluteal area is the preferred site for IM injections. The z-track technique is recommended for all IM injections. It has been found to be less painful than the traditional injection technique and decreases leakage of irritating and discoloring medications like parenteral iron into the subcutaneous tissue. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 874-875 27. A client has just been told by the physician that a cerebral angiogram will be obtained. The nurse then collects data from the client about which of the following piece of information? a. Claustrophobia c. Excessive weight b. Allergy to eggs d. allergy to iodine and shellfish Cerebral angiography is an x-ray study of the cerebral circulation with a contrast agent injected into a selected artery. The nurse should obtain the patient’s allergy history with emphasis on allergy to iodine, shellfish, and other seafood, because many contrast agents contain iodine. Brunner and Suddarth’s Textbook of Medical Surgical Nursing, p.1265, 1844 28. A client has an order for a wound culture to be performed with the next wound irrigation and dressing change. The nurse would plan to use which of the following solutions for irrigation before this particular procedure? a. Providing iodine (betadine) c. normal saline b. 1/2 strength hydrogen peroxide d. Acetic acid Prior to obtaining cultures, the wound must be cleansed with normal saline until all exudate has been removed. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 915 29. Which is the best indicator in determining the client’s airway need of suctioning? a. O2 saturation measurement c. Breath sounds b. Respiratory rate d. Arterial blood gas results

PAST BOARD EXAMINATION - JUNE 2009
Infants and young children are at increased risk for fluid volume overload compared with adults. Essentials of Pediatric Nursing by T. Kyle, p. 365 35. A client with severe inflammatory bowel disease is receiving TPN. When administering TPN, the nurse must take care to maintain the prescribed flow rate because giving TPN too rapidly may cause: a. Hyperglycemia c. Air embolism b. constipation d. Dumping syndrome Rapid TPB administration places the client at increased risk for fluid, electrolye, and glucose imbalances. Because TPN solutions are high in glucose, infusions are usually started gradually to prevent hyperglycemia. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 1277 SITUATION: Teaching and learning is a nursing responsibility. The ability of the nurse to educate and change the client’s behavior through health teaching is one important goal of nursing. 36. A client’s hypertension is recently diagnosed. The nurse would plan to do as which as the first step in teaching the client about the disorder? a. Gather all available resource material b. Plan for the evaluation of the session c. Assess the client’s knowledge and needs d. Decide on the teaching approach The role of nurse as an educator also follows the nursing process. The first step to be taken is a comprehensive assessment of learning needs, characteristics that may influence learning such as readiness, motivation, reading and comprehension levels, development level, etc. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 494 37. A diabetic client who is performing self monitoring of blood glucose at home asks the clinic nurse why a glycosylated hemoglobin level needs to be measured. The nurse would plan to incorporate which into a response. a. The laboratory test is done yearly to predict likelihood of long term complication b. The laboratory test gives an indication of glycemic control over the last 3 months c. It is done as a method of verifying the accuracy of the meter used at home d. It is done to predict risk of hypoglycemia with the current diet and medication regimen Glycosylated hemoglobin (referred to as HgbA1C or A1C) is a blood test that reflects average blood glucose levels over a period of approximately 2 to 3 months. If patients report mostly normal RBS/CBG results but the glycosylated hemoglobin is high, there may be errors in the methods used for glucose monitoring, errors in recording results, or frequent elevations in glucose levels at times during the day when the patient is not usually monitoring the blood. Brunner and Suddarth’s Textbook of Medical Surgical Nursing, p. 1163 38. In teaching the sister of a diabetic client about the proper use of glucometer in determining the blood sugar level of the client. The nurse is focusing min which domain of learning according to bloom? a. cognitive b. affective c. Psychomotor d. Affiliative Bloom (1956) identified 3 domains or areas of learning: cognitive, affective, and psychomotor. The psychomotor domain is the “skill domain” and includes motor skills such as giving injections, etc. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 489 39. Which of the following is the most important consideration for a diabetic client to learn how to control their diet? a. Use of pamphlets and effective teaching devices during health instruction b. Motivation to a symptom free condition c. Ability of the client to understand teaching instruction d. language and appropriateness of the instruction Motivation to learn is the desire to learn. It greatly influences how quickly and how much a person learns. Motivation is generally greatest when a person recognizes a need and believes the need will be met through learning. It is not enough for the need to be indentified and verbalized by the nurse; it must be experienced by the client. Motivation is usually assessed first. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 490, 494

40. When you prepare a teaching plan for a group of hypertensive clients, you first formulate your learning objectives. Which of the following steps in the nursing process corresponds to the writing of learning objectives? a. Planning b. Implementing c. Evaluating d. Assessing The planning phase of teaching involves determining priorities, setting learning outcomes (goals and objectives), choosing content and teaching strategies, and organizing learning experiences. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 500-502 SITUATION: Nursing is a science. It evolves a wide spectrum of theoretical foundation applied in different health care situation. The nurse must use these theories in order to deliver the most needed quality care. 41. The theorist that believes that adaptation and manipulation of stressors are needed to foster change is: a. Betty Neuman c. Martha Rogers b. Dorothea Orem d. Sister Callista Roy Roy defines a person as “an adaptive system…a whole comprised of parts that function as a unity for some purpose”. The person is a biopsychosocial being in constant interaction with a changing internal and external environment. Nursing attempts to alter the environment when the person is not adapting well or has ineffective coping responses. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 35 42. The theorist whose theory can be defined as a development of a science of humankind, incorporating the concepts of energy field, openness, pattern and organization is: a. Dorothea Orem c. Martha Rogers b. Hildegard Peplau d. Myra Levine Martha Rogers, a visionary leader and pioneer in the development of nursing’s unique knowledge base, developed the highly abstract theory of the Science of Unitary Human Beings. According to Rogers, nursing identifies the patterns and organization of the personenvironment unit and aims to repattern the rhythm and organization of these energy fields so that the person’s integrity is heightened. “Maintenance and promotion of health, prevention of disease, nursing diagnosis, intervention, and rehabilitation encompass the scope of nursing’s goals”. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 36-37 43. A theorist whose major theme is the idea of transcultural nursing and caring is. a. Dorothea Orem c. Sister Callista Roy b. Madeleine Leininger d. Virginia Henderson The conceptual framework for understanding cultural diversity and providing culturally competent care is based on Leininger’s transcultural nursing theory. Transcultural nursing, according to Leininger (1978), focuses on the study and analysis of different cultures and subcultures with respect to cultural care, health beliefs and health practices, with the goal of providing health care within the context of the client’s culture. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 296 44. Florence Nightingale was born in. a. Italy, may 12,1840 c. England, May 12, 1840 b. Italy, may 12,1820 d. England, May 12, 1840 Florence Nightingale was born in Florence, Italy, on May 12, 1820. Her family was from England. They were on vacation in Italy when Florence was born. Her parents decided to name her after the Italian city. Florence Nightingale: A Photo-Illustrated Biography by L. Davis, p. 7 45. Smith conceptualizes this health model as a condition of actualization or realization of person’s potential. Avers that the highest aspiration of people is fulfillment and complete developmental actualization. a. clinical model c. adaptive model b. role performance model d. eudemonistic model The eudemonistic model incorporates a comprehensive view of health. Health is seen as a condition of actualization or realization of a person’s potential. Actualization is the apex of the fully developed personality. In this model, the highest aspiration of people is fulfillment and complete development, which is actualization. Illness, in this model, is a condition that prevents self-actualization. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 298 SITUATION. Oxygen is the most important physiologic requirement of the body. Absence of this vital element over 6 minutes leads to irreversible brain damage. RGO REVIEW CENTER... the center that truly cares!!!

Measures that promote oxygenation is integral in successfully managing client’s response to illness. 46. The primary effect of oxygen therapy is to: a. Increase oxygen in the tissues and cells b. Increase oxygen carrying capacity of the blood c. Increase respiratory rate d. Increase oxygen pressure in the alveolar sac Oxygen uptake in the pulmonary capillary beds can be improved by increasing the concentration of oxygen in the alveolar air; this increase in the partial pressure of oxygen in the alveoli (PaO2) increases the driving pressure for gas diffusion across the alveolar-capillary membrane. This is then transported by the blood to the tissues and cells. The primary effect therefore of oxygen therapy is to increase oxygen availability in the alveoli – a necessary perquisite before it diffuses to the blood and is transported to the tissues and cells. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 899 47. A nurse suctions a client who has an endotracheal tube in place. Following the procedure which of the following indicates to the nurse that the client is experiencing an adverse effect of this procedure? a. Hypertension b. A reddish coloration in the clients face c. Cardiac irregularities d. Oxygen saturation level to 95% Suctioning is associated with several complications: hypoemia, trauma to the airway, nosocomial infection, and cardiac dysrhythmia, which is related to the hypoxemia. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 1385 48. The GAUGE size in ET tube determines: a. The external circumference of the tube b. The length of the tube c. The internal diameter of the tube d. The tube’s volumetric capacity Gauge is defined as a diameter of a shaft. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 1544 49. The nurse is correct in performing suctioning when she applies the suction intermittently during: a. Insertion of the suction catheter b. Withdrawing of the suction catheter c. Both insertion and withdrawing suction catheter d. When the suction catheter tip reaches bifurcation of the trachea Apply suction for 5 to 10 seconds while slowly withdrawing the catheter, then remove your finger from the control and remove the catheter. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 1384 50. The purpose of the cuff in tracheostomy tube is to: a. Separate the upper and lower airway b. Separate the larynx from the esophagus c. Separate trachea from the esophagus d. Secure the placement of the tube Cuffed tracheostomy tubes are surrounded by an inflatable cuff that produces an airtight seal between the tube and the trachea. This seal prevents aspiration of oropharyngeal secretions and air leakage between the tube and the trachea. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 1381 SITUATION: To deliver a safe and quality care, knowledge about wound care is necessary. The nurse will have to deal with different types of would during practice. It is of outmost important to apply this knowledge to ensure optimum wound healing. 51. Based on the nurse’s knowledge of surgical wounds, simple surgical incisions heal by: a. Primary intention c. Tertiary intention b. Secondary intention d. Quaternary intention In primary intention healing, the wound is clean and dry and the edges are approximated, as in a surgical wound. Little scar formation occurs, and the wound is usually healed in a week. Brunner and Suddarth’s Textbook of Medical Surgical Nursing, p. 93 52. The nurse document that the wound edges are approximated, this means edges are: a. Brought together by sutures, tapes or staples b. Eythematous and swollen

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c. Gaping and draining d. Necrotic and draining Approximated means tissue surfaces are closed and held together. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 1534 53. Which vitamin is most essential for collagen synthesis? a. Vitamin A b. Vitamin B c. Vitamin D d. Vitamin C Vitamin C is important for capillary formation, tissue synthesis, and wound healing through collagen formation. It is also needed for antibody formation. Brunner and Suddarth’s Textbook of Medical Surgical Nursing, p. 404 54. When assessing the client’s wound for sign of infection, the nurse should look for the presence of the following? a. Granulation tissue c. purulent drainage b. Pink tissue d. Well approximated edges When the skin and mucous membranes are infected, the following may be noted: localized swelling, redness, pain or tenderness, palpable heat at infected area, loss of function of the body part affected, as well as drainage of various colors. All the others are normal findings. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 680 55. The nurse is changing dressing and providing wound care. Which activity should she perform first? a. Assess the drainage in the dressing c. Wash hands thoroughly c. Slowly remove the soiled dressing d. Well approximated edges Right after introducing self and verifying the client’s identity, the nurse should perform hand hygiene. Assessment of drainage in the dressing is done after the dressing has been removed. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 968-969 SITUATION. Physical examination and health assessment are important in rendering care. The nurse must use assessment knowledge in order to determine and prioritize client’s response to his illness. 56. The component that should receive the highest priority before physical examination is the. a. Psychological Preparation of the client b. Preparation of the environment c. Physical preparation of the client d. Preparation of the equipments Before conducting physical assessment, preparation of the client is done first then preparation of the environment afterwards. Before physical preparation such as emptying the bladder, determining contraindicated positions, etc., psychological preparation is done. This consist of explanation of the physical examination. Often client are anxious about what the nurse will find. They can be assured during the examination by explanations at each step. The nurse should explain when and where the examination will take place, why it is important, and what will happen. The client should be assured that all information gathered and documented during the assessment is confidential and only those health care providers who have a legitimate need to know the client’s information will have access to it. S/he should also be informed that the procedure is usually painless. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 566 57. When inspecting the client’s skin, the nurse finds a vesicle on the clients arm. Which description applies to a vesicle? a. A flat, nonpalpable and colored b. Circumscribed, elevated and fill and with serous fluid c. Solid, elevated and circumscribed d. Elevated, pus-filled, and circumscribed A vesicle (bulla) is a circumscribed, round or oval, thin translucent mass filled with serous fluid or blood. Vesicles are less than 0.5 cm. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 577 58. When assessing a client with abdominal pain the nurse should assess: a. Any quadrant first b. Symptomatic quadrant last c. The symptomatic quadrant first d. symptomatic quadrant either second or third During the palpation phase of abdominal assessment, the sensitive or symptomatic area last since this may RGO REVIEW CENTER... the center that truly cares!!!

cause discomfort right away and hamper assessment of other areas. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 636-637

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59. To assess the client’s dorsalis pulse, the nurse should palpate the. a. Medial of the ankle b. ventral aspect of the top of the foot c. Lateral surface of the ankle d. Medial aspect of the dorsum of the foot The dorsalis pedis artery runs over the bones of the foot, on an imaginary line drawn from the middle of the ankle to the space between the big and the second toes. It is on the dorsal part (dorsalis) or the foot (pedis). Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 538 60. Which of the following assessment would be a priority for a 2 years old after bronchoscopy? a. Cardiac rate c. Sputum color b. Respiratory quality d. Pulse pressure changes Prior to bronchoscopy, preoperative medications are administered to suppress the cough and gag reflexes, as well as to sedate the client for the procedure. However, the the preoperative sedation and local anesthesia impairs the protective laryngeal reflex and swallowing for several hours. The nurse also monitors the client’s respiratory status and observes for hypoxia, hypotension, tachycardia, dysrhythmias, hemoptysis, and dyspnea. These are general priorities for all bronchoscopy clients, but especially for 2-year olds. While patients are usually told to spit out and not to swallow secretions until allowed to do so, this may not be possible for 2 year olds; thus, there is greater risk for aspiration. Brunner and Suddarth’s Textbook of Medical Surgical Nursing, p. 486-487 61. The nurse checks the clients gag reflex. The recommended technique for testing the gag reflex is to: a. Touch the back of the client throat with a tongue depressor b. Observe the client for evidence of spontaneous swallowing when the neck is stroked c. Lace a few milliliters of water on the clients tongue and note whether or not he swallows d. Observe the client response to the introduction of the catheter for endotracheal suctioning Touch the posterior one-third of tongue with blade to stimulate the gag reflex. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 590 62. The nurse is evaluating a client’s lung sounds. Which breath sounds indicate adequate ventilation when auscultated over the lung fields? a. Vesicular c. Bronchovesicular b. Bronchial d. adventitious Vesicular breath sounds are auscultated over the entire lung field except over the upper sternum and between the scapulae. Bronchial and bronchovesicular sounds that are audible anywhere except over the main bronchus in the lungs signify pathology, usually indicating consolidation in the lung (e.g. pneumonia, heart failure). This finding requires further evaluation. Brunner and Suddarth’s Textbook of Medical Surgical Nursing, p. 480-481 63. The night nurse informs the primary nurse that a client receiving intermittent gavage feeding is not tolerating them. Primary nurse should first: a. Change the feeding schedule to omit nights b. Request that the type of solution be changed c. Observe the night nurse administering the feeding d. Suggest that the prescribed antiemetic be given first In the primary nursing management system, the professional nurse assumes full responsibility for total client care for a small number of clients. Although care may be delegated to nurse associates for shifts when the primary nurse is not in attendance, the primary nurse maintains responsibility for total client care 24 hours a day. Moreover, following the nursing process, the best step to take first is to assess. The findings will then guide the intervention. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 152

64. A client has a chest tubes attached to a pleural drainage system. When caring for the client, the nurse should: a. palpate for surrounding area for Crepitus b. Clamp the test tubes when suctioning the client c. Change the dressing daily using aseptic technique d. Empty drainage chamber at the end of the shift Crepitus may indicated subcutaneous emphysema, a condition where there is accumulation of air in the subcutaneous areas. This may result from a poor seal at the chest tube insertion site. In severe cases, it may threaten airway patency and may require tracheostomy. This should be observed for and immediately reported by the nurse. Avoid clamping the chest tube, especially for an extended amount of time, as this increases the risk of tension pneumothorax. The dressing should be checked every 4 hours for excessive bleeding and abnormal discharge, and are changed as necessary. The drainage is measured at regularly scheduled times depending on agency policy. The unit is not replaced until almost full. Brunner and Suddarth’s Textbook of Medical Surgical Nursing, p. 563, 631 and Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 1394 65. The nurse aware of the 25 year history of excessive alcohol use, would expect that physical assessment would reveal: a. Liver infection b. Low blood ammonia c. small liver with a rough surface d. High fever with generalized rash Although several factors have been implicated in the etiology of cirrhosis, alcohol consumption is considered the major causative factor. Early in the course of cirrhosis, the liver tends to be large and its cells loaded with fat. The liver is firm and has a sharp edge noticeable on palpation. Later in the disease, the liver decreases in size as scar tissue contracts the liver tissue. The liver edge, if palpable, is nodular. Brunner and Suddarth’s Textbook of Medical Surgical Nursing, p. 1101-1102 SITUATION: Nursing is a profession. Miss Linda is a newly appointed nurse in a hospital in Manila. Born May 1985’her knowledge of nursing professional development is required in order to project the profession in a way that it lifts the standards of nursing. 66. Mrs. Linda defined nursing as one of the following except: a. Assisting individual, family, community in attaining health b. Assisting basic health needs c. Establishing nursing diagnosis & implementing nursing care d. Diagnosing, prescribing medication and doing minor surgery D is not included in the scope of nursing stipulated in RA 9173. Doing so may constitute malpractice. Article VI, Section 28, Philippine Nursing Act of 2002 (RA 9173) 67. PNA was established in: a. 1922 b. With Mrs. Francisco Delgado as first President c. 1926 d. With Mrs Anastacia Tupas as first president The Filipino Nurses Association (later called Philippine Nurses Association) was founded in October 22, 1922 upon the initiation of Mrs. Anastacia Giron Tupas with Mrs. Rosario Delgado as first president. Professional Nursing in the Philippines by L. Venzon, p. 156 68. As national nurses association, it is characterized as follows except: a. Both professional body and a labor union b. Affiliated with international Council of Nurses c. Advocating for improved work and life condition for nurses d. Accrediting body for continuing education program A is false. In contrast with the American Nurses Association (ANA) which participates in collective bargaining on behalf of nurses through its economic and general welfare programs, the PNA does not function as a labor union. Nothing about functioning as a labor union has been stated in the PNA by-laws. B, C, and D are true. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 20 and Professional Nursing in The Philippines by L. Venzon, p. 221-245 69. CPE Units per year is needed for license renewal. The number of CPE units per year should be. a. 20 units b. 30 units c. 60 units d. 100 units The number of required CPE units is 60 units every 3 years, or 20 units per year. RGO REVIEW CENTER... the center that truly cares!!!

Annex A, Article I, Section 16, PRC Resolution No. 2008466 70. As a nurse R.A. 1080 exempts her from: a. Paying her professional tax b. Qualifying for the CGFNS c. Examination for civil service eligibility d. Paying business permit Successfully passing the licensure exam for nurses automatically qualifies the registered nurse for civil service eligibility. Taking the Civil Service Examination is therefore unnecessary. An Act Declaring the Bar and Board Examinations as Civil Service Examinations (RA 1080) 71. In resigning for her job as a staff nurse, she must give advance notice of: a. 15 days b. 30 days c. 45 days d. 60 days Give advance notice before resigning. A month is usually enough for those holding staff nurse positions. For those in teaching or administrative positions, six months is recommended. Give the employer enough time to get a reliever. Professional Nursing in the Philippines by L. Venzon, p. 69 72. Why is there an ethical dilemma? a. Because the law do not clearly state the right and wrong b. Because the morality is subjective and it differs from each individual c. Because the patients right doesn’t coincide with the nurse’s responsibility d. Because the nurse lack ethical knowledge to determine what action is correct and what action is unethical An ethical dilemma occurs when there is a conflict between two or more ethical principles. Ethical dilemmas are situations of conflicting requirements in that there is no right or wrong option. The most beneficial decision depends on the circumstances. When an ethical dilemma occurs, the nurse must make a choice between two alternatives that are equally unsatisfactory. Ethical analysis is not an exact science. The patient’s rights and nurse’s responsibility are 2 ethical considerations that may possibly cause a dilemma. Morals are not the same with ethics since morality is personal while ethics is a judgment of a group on what is right and wrong. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 482 73. Who among the following can work practicing nurse in the Philippines without taking the licensure examination? a. Internationally well known expert which services are for a fee b. Those that are hired by local hospital in the country c. Expert nurse clinician hired by prestigious hospitals d. Those involve in medical mission whose services are for a fee

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76. Which the following persons cannot have a free access to a patients record? a. The patients c. The pharmacist b. The physical therapist d. The lawyer Nurses are bound by ethical codes and laws to treat all client information in a confidential and professional manner; this includes the client’s record. The written documentation contained in the client’s chart is a legal record of care, and it should be available only to members of that client’s health care team. The client’s significant others, insurance companies, or other parties not directly involved in the care provided by the health care team may not have access to clients’ records; it is the nurse’s responsibility to protect the privacy and confidentiality of client interactions, assessments, and care. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 512 77. Ms. Linda license will expire in 2007.She must renew her license when? a. January 2007 c. May 2007 b. December 2007 d. May 2008 The professional license is valid for 3 years and is renewed on the holder’s birth month. 78. The practice of nursing in the Philippines is registered by: a. RA 9163 c. RA 7164 b. RA 9173 d. RA 7146 RA 9173, the Philippine Nursing Act of 2002 is the current law regulating the practice of nursing in the Philippines. Review Guide for Leadership, Management, Research, Bioethics, Nursing Law, Jurisprudence, and Professional Adjustment by R. Enolva, p. 77 79. The quality is being demonstrated by a nurse who raised the side rails of a confused and disoriented patient? a. Autonomy c. Prudence b. Responsibility d. Resourcefulness Prudence is defined as competence based on skilled application of relevant knowledge of moral and practical principles to specific situations, enabling choice of the best means to a good end. It is the characteristic of having sound judgment in practical affairs and exercising due care. Nursing Ethics by I. Thompson, et. al., p. 82

80. Nurse Joel and Ana is helping a 16 year old nursing student in case filed against the student. The case was frustrated homicide. Nurse Joel and Ana are aware of the different circumstances of crimes. They are correct in identifying which of the following circumstances that will be best applied in this case? a. Justifying b. Aggravating c. Mitigating d. Exempting Mitigating circumstances are those that have the effect of reducing the penalty due to lesser perversity of the offender. In this case, the offender, being below 18 years of age, qualifies to be in one of the mitigating circumstances Review Guide for Leadership, Management, Research, Bioethics, Nursing Law, Jurisprudence, and Professional Adjustment by R. Enolva, p. 54 . SITUATION: This is the first day of Mark, RN. to report as a staff nurse in the tertiary hospital. As morning duty nurse, he is about to chart his nursing care. 81. Which of the following is not accepted medical abbreviation a. NPO b. PRN c. Ca d. Non Non is not an acceptable abbreviation for use in the client’s records. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 259-260 82. Communication is best undertaken if barriers are first removed. Considering this statement, which of the following is not considered as deterrent factor in communication? a. Not universally accepted abbreviations c. Poor penmanship b. Wrong grammar d. Old age of the client The legal issues of documentation require: legible and neat writing; proper use of spelling and grammar; use of authorized abbreviations; and factual and timesequenced descriptive notations. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 507 RGO REVIEW CENTER... the center that truly cares!!!

A special/temporary permit may be issued by the Board to the following persons subject to the approval of the Commission and upon payment of the prescribed fees: licensed nurses from foreign countries/states whose service are either for a fee or free if they are internationally well-known specialists or outstanding experts in any branch or specialty of nursing; licensed nurses from foreign countries/states on medical mission whose services shall be free in a particular hospital, center or clinic; and licensed nurses from foreign countries/states employed by schools/colleges of nursing as exchange professors in a branch or specialty of nursing. D would’ve been correct if it was for free. Article IV, Section 21, Philippine Nursing Act of 2002 (RA 9173) a. Personal property b. A Right c. Can be revoked by the board of nursing d. Can be revoked by the PNA A license is a legal document given by the government that permits a person to offer to the public his or her skills and knowledge in a particular jurisdiction, where such practice would otherwise be unlawful without a license. It is a privilege, not a right, and moreover not a personal property. The BON is granted by the Philippine Nursing Act of 2002 the power to revocation and/or suspend the certificate of registration/professional license and cancellation of special/temporary permit. Article IV, Section 23, Philippine Nursing Act of 2002 (RA 9173) 75. A license renewed every: a. 1 Year b. 2 Years d. 4 Years c. 3 Years

A professional license card is valid for 3 years.

83. Which of the following chart entries are not acceptable? a. Patient complained of chest pain b. Patient ambulated to bathroom c. Vital signs 130/70: 84:20 d. Pain relived by nitroglycerine gr 1/150 sublingually

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under specific circumstances, on the individual’s behalf. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 469 89. Which behavior of Mang Carlos least indicate readiness to learn? a. Talking with the nurse in charge and doctor about diabetes b. Reading brochures and pamphlets about diabetes c. Inquiring about date of discharge d. Asking question about diabetes mellitus The nursing diagnosis for the given stem is ‘readiness for enhanced knowledge’. The subjective characteristics of this diagnosis are the following: expresses an interest in learning, explains knowledge of the topic, and describes previous experiences pertaining to the topic. The objective indicators are behaviors congruent with expressed knowledge. Inquiring about date of discharge is immaterial to readiness to learn. Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales by M. Doenges, et. al., p. 338-339 90. Which of the following behaviors best contribute to the learning of Mang Carlos regarding his disease condition? a. Drawing him in discussion about diabetes b. Frequent use of technical term c. Loosely structured teaching session d. Detailed lengthy explanation When dealing with elders, the nurse should increase the time for teaching and allow for rest periods as processing of information is slower. A, B, and D are exhausting and not helpful to the elderly. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 495 SITUATION: Mrs. Purificacion is now the Chief nurse of a hospital in Manila. She is carefully reviewing different management styles and theories that will best help her in running the nursing services in the hospital. 91. Which leadership style best empower the staff towards excellence? A. Autocratic B. Situational C. Democratic D. Laissez Faire The democratic leadership style (also called participative leadership) is based on the belief that every group member should have input into development of goals and problem solving. The democratic leader acts primarily as a facilitator and resource person. Concern for each member of the group as a unique individual is demonstrated by the leader. It stimulates increased productivity, creativity, autonomy, cooperation, communication and teamwork. It also promotes empowerment of team members and provides opportunities for personal growth. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 450-451 92. As a Nurse Manager, DSJ enjoys his staff of talented and self motivated individuals. He knew that the leadership style to suit the needs of this kind of people is called: A. Autocratic B. Participative C. Democratic D. Laissez Faire In the laissez-faire leadership style, the leader assumes a passive, nondirective, and inactive approach. Leadership responsibilities are assumed by the group. This is best when leading expert level nurses that require little, if any, direction and guidance. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 450-451 93. A fire has broken in the unit of DSJ R.N. The best leadership style suited in cases of emergencies like this is: A. Autocratic B. Participative C. Democratic D. Laissez Faire The autocratic style of leadership facilitates a quick response and is often applied in crisis situations. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 451 94. Mrs. Purificacion is thinking of introducing the Primary Nursing Model Approach. You understand that this nursing model is: A. The nurse manager assigns tasks to the staff members B. Critical paths are used in providng nursing care C. A single registered nurse is responsible for planning and providing individualized nursing care D. Nursing staff are led by an RN leader in providing care to a group of clients In the primary nursing management system, the professional nurse assumes full responsibility for total client care for a small number of clients. Although care RGO REVIEW CENTER... the center that truly cares!!!

C does not specify which specific vital sign each value belongs to. Notations on records must be accurate and correct. Information that is recorded needs to be complete and helpful to the client and health care professionals. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 260-261 84. Which of the following indicates narrative charting? a. Written descriptive nurse’s notes b. Use of checklist c. Date recorded on nurse activity sheets d. Use of flow sheets Narrative charting is a traditional part of the sourceoriented record. It consists of written notes that include routine care, normal findings, and client problems. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 247 85. Being a new staff nurse, Mark remember that information needed for daily nursing care of clients are readily available in which of the following? a. Kardex c. Admission notes b. Order sheet d. Nurses notes A Kardex (client profile and client summary sheets) is a summary worksheet reference of basic client care information that traditionally is not part of the medical record. The Kardex, a concise client data source, is used as a reference throughout the shift and during change-of- shift reports. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 517 SITUATION: Mr. Orlando is assigned to Mang Carlos a 60 years old man, newly diagnosed diabetes patient. He is beginning to write objective for his teaching plan. 86. Which of the following written in behavioral term? a. Mang Carlos will know about diabetes related foot care and the techniques and equipment necessary to carry it out. b. Mang Carlos sister will be able to determine his insulin requirement based on blood glucose levels obtain from glucometer in two days. c. Mang Carlos daughter most learn about diabetes mellitus within the week d. Mang Carlos wife needs to understand the side effect of insulin There are 3 main learning theories: behaviorism, cognitivism, and humanism. Behaviorism focuses on observable actual responses to stimuli e.g. health teachings. Learning is deemed to have occurred when there is behavioral change. B is an example. Cognitivism focuses on learning as largely a mental or intellectual activity. A and C are examples. Humanism focuses on the feelings and attitudes of learners, on the importance of the individual in identifying learning needs and in taking responsibility from them, and on the self-motivation of the learners to work toward selfreliance and independence. D is an example. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 489-490 87. Which of the following is the best rationale for written objectives? a. Document the quality of care b. Facilitate evaluation of the performance of the nurses c. Ensure learning on the part of the nurse d. Ensure communication among staff members The most obvious reason for formal, written plans of care (including goals and objectives) is that is provides for continuity of care and continuity of care is contingent upon communication amongst the health team. When goals and objectives are clearly written, their establishment provides direction for the nursing plan of care and for determination of effectiveness in the evaluation of nursing interventions. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 212 and Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 135 88. Mang Carlos has been terminally ill for 5 years. He asked his wife to decide for him when he is no longer capable to do. As a nurse you know that this is called: a. Last will and testament c. Living will b. DNR d. Durable power of attorney Durable power of attorney (health care proxy) is an authorization that enables any competent individual to name someone to exercise decision-making authority,

may be delegated to nurse associates for shifts when the primary nurse is not in attendance, the primary nurse maintains responsibility for total client care 24 hours a day. The primary nurse sets health care goals with the client and plans care to meet those goals. The principal advantage of this approach is the continuity of care inherent in the system. Primary nursing is most effective with a total staff of registered nurses, which makes this system expensive to maintain. Fundamentals of Nursing Standards and Practice by S. DeLaune & P. Ladner, 2nd Ed., p. 152

PAST BOARD EXAMINATION - JUNE 2009

An extraneous variable is a variable that confounds the relationship between the independent and dependent variables and that needs to be controlled either in the research design or statistical procedures. It could threaten internal validity. Nursing Research: Principles and Methods, 7th Ed., by D. Polit and C. Beck, p. 718

95. Structure, Process and Outcome are components of which step of the management process? A. Planning B. Organizing C. Directing D. Controlling The controlling phase of the management process consists of evaluation. Such evaluation may be done using the quality assurance program. QA makes use of the structure, process, and outcome criteria. Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8th Ed., p. 239 and Guide to Nursing Management and Leadership, 7th Ed., by A. Tomey, p. 217 SITUATION. Nursing research is the term used to describe the evidence used to support nursing practice. Nursing as evidence area base of practice, has been developing since the time of Florence Nightingale to the present day, where nurse now work as researchers base on Universities as well as in Health Care Settings. 96. Mr. DSJ plans to undertake a research on community 1 and 2 on how they manage their health using Primary Health care after organization and training seminars. This type of research is. a. Experimental b. Historical c. Descriptive d. Basic In experimental research, researchers actively introduce and intervention or treatment. Experimental studies are explicitly designed to test causal relationships and offer greater possibility of control over extraneous variables. Nursing Research: Principles and Methods, 7th Ed., by D. Polit and C. Beck, p. 46 97. The independent Variable is: a. Primary health care c. Organization and training seminars b. Community 1 and 2 d. Management of their health The independent variable is presumed cause that creates an effect on the dependent variable. The IV is the one which is manipulated by the researcher in experimental studies. Nursing Research: Principles and Methods, 7th Ed., by D. Polit and C. Beck, p. 30 98. In this design, the variable that is being manipulated is 1. Independent 2. Organization and Training Seminars 3. Dependent 4. Management of Primary Health Care a. 1,2 b. 1,4 c. 2,3 d. 3,4 The independent variable is presumed cause that creates an effect on the dependent variable. The IV is the one which is manipulated by the researcher in experimental studies. In this case, ‘organization and training seminars’ is the independent variable. Nursing Research: Principles and Methods, 7th Ed., by D. Polit and C. Beck, p. 30 99. In general, the research process follows the general ordered sequence. 1. Determination of design 2. Statement of the problem 3. Definition of variables 4. Collection and analysis of data 5. Review of related Literature a. 2,5,3,1,4 c. 2,5,3,4,1 b. 3,5,4,1,2 d. 2,5,1,3,4 The general steps in conducting a research are: (1) developing the research question, (2) using a hypothesis, (3) searching and evaluating the literature, (4) choice of methodology and research design, (5) preparing a research proposal, (6) gaining access to the data, (7) sampling, (8) pilot study, (9) data collection, (10) data analysis, (11) dissemination of the results, (12) implementation of the results, (13) ensuring validity and reliability, (14) conclusions, (15) references. The Research Process in Nursing, 6th Ed., by K. Gerrish and A. Lacey p. 13-26 100. Studies done in natural setting such as this one, possess difficulty of controlling which variable? a. Independent c. Extraneous b. Dependent d. Organismic RGO REVIEW CENTER... the center that truly cares!!!